Thoracic disc herniation diagnosis [Neurosurgery Wiki]

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====== Thoracic disc herniation diagnosis ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1-ONS2P_EKbcHyxt8f_b5NB-QrD5-xVNWm7szJQQjfenYMWMD-/?limit=15&utm_campaign=pubmed-2&fc=20240111184111}}
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[[Thoracic disc herniation]]s are rare and difficult to diagnose.

The first step in diagnosing a [[Thoracic disc herniation]] always includes a good patient [[medical history]] and [[physical examination]]. 

Location of the pain

Severity of the pain

Type of pain (numbness, weakness, burning, etc.).

The physician will often follow up by learning if any injuries occurred prior to the thoracic back pain or if any other problems (weight loss, fevers, illnesses, difficulty urinating) were recently present before the upper back pain. The physician will then perform a physical examination.

[[Myelopathy]] is a potential consequence that can lead to irreversible neurological impairment if not treated appropriately. It is incumbent on all clinicians who see patients with low back pain (LBP) to be aware of such pathologies.


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If a thoracic herniated disc is suspected as the underlying cause of the pain, there are several diagnostic tests that can confirm the diagnosis and provide additional information, including:


X-rays – While plain x-rays will not show a thoracic herniated disc, they may be used to help localize injuries in cases of trauma as well as aid in identifying spinal instability.

===== Magnetic resonance imaging =====

[[Thoracic disc herniation magnetic resonance imaging]].

===== Computerized tomography =====

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Noncontrast thoracic [[Computerized tomography]] should be routinely obtained to determine if it is a “[[soft
disc]]” (noncalcified) or a “[[hard disc]]” (calcified) which can have a profound effect on the choice of approach and the removal technique. CT also delineates the bony detail which is helpful if instrumentation is needed.

{{::thoracicdischerniationhardct.jpg?257|}}
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A [[systematic review]] illustrates that lumbar provocation [[discography]] performed according to the [[International Association for the Study of Pain]] (IASP) criteria may be a useful tool for evaluating chronic lumbar discogenic pain. The evidence is weaker for cervical and nonexistent for thoracic discography
((Manchikanti L, Soin A, Benyamin RM, Singh V, Falco FJ, Calodney AK, Grami V,
Hirsch JA. An Update of the Systematic Appraisal of the Accuracy and Utility of
Discography in Chronic Spinal Pain. Pain Physician. 2018 Mar;21(2):91-110. PubMed
PMID: 29565943.
)).