Imaging in Thoracic Disc Prolapse – A Study of 25 Patients and Review of the Literature
Volume 1 | Issue 1 | October 2020-March 2021 | page: 23-27 | Devanand Degulmadi, Bharat R Dave, Ajay Krishnan, Shivanand Mayi, Ravi Ranjan Rai
Authors: Devanand Degulmadi , Bharat R Dave , Ajay Krishnan , Shivanand Mayi , Ravi Ranjan Rai 
 Stavya Spine Hospital and Research Institute, Near Nagari Eye Hospital, Mithakhali, Ellisbrige, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Devanand Degulmadi,
Stavya Spine Hospital and Research Institute, Mithakali, Ellisbrige, Ahmedabad, Gujarat, India.
Purpose: Unlike cervical and lumbar disc, thoracic disc prolapse (TDP) has limited literature. Many studies have focused on surgical technique of TDP. The aim of this study is to highlight the radiological features of TDP that would help surgeons in understanding the peculiar features of such uncommon entity and also planning the surgery.
Materials and Methods: All the patients surgically treated for TDP between May 2010 and June 2018 were included in the study. A retrospective collection of all the radiographs, CT and MR images were done.
Results: A total of 25 subjects, two patients had double level disc prolapse; hence, a total of 27 discs were analyzed. On radiographs, end-plate was concave (n = 9), straight (n = 12), cupid bow shaped (n = 6), calcification in disc space (n = 5), and calcification within the canal (n = 14). EP junction failures were type IA (n = 10), type IB (n = 6), type ID (n = 2), and type II (n = 9). On MRI, central disc prolapse (n = 10), right paracentral (n = 12), and left paracentral (n = 5). According to Pfirmann grading, three discs were Grade 2; five discs as Grade 3; 14 as Grade 4; and five as Grade 5. Fourteen discs had >40% canal occupancy. Schmorl nodes were noted (n = 17).
Conclusion: Lower thoracic spine has a higher incidence of TDP. Calcification is commonly seen in cases of TDP, either in the disc space or within the canal. Most of the cases present with >40% of canal occupancy. End plate defect, a variant of schmorl node, may be a possible contributor to disc prolapse.
Keywords: Thoracic disc prolapse, radiology, calcification.
1. Arce CA, Dohrmann GJ. Herniated thoracic disks. Neurol Clin 1985;3:383-92.
2. Ridenour TR, Haddad SF, Hitchon PW, Piper J, Traynelis VC, VanGilder JC. Herniated thoracic disks: Treatment and outcome. J Spinal Disord 1993;6:218-24.
3. Patterson RH Jr., Arbit E. A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 1978;48:768-72.
4. Pfirrmann CW, Resnick D. Schmorl nodes of the thoracic and lumbar spine: Radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1, 650 spinal levels in 100 cadavers. Radiology 2001;219:368-74.
5. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26:1873-8.
6. Rajasekaran S, Nipun B, Vijay T, Rishi MK, Shetty AP. ISSLS prize winner: The anatomy of failure in lumbar disc herniation: An in vivo, multimodal, prospective study of 181 subjects. Spine (Phila Pa 1976) 2013;38:1491-500.
7. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: Assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193-9.
8. Mcallister VL, Sage MR. The radiology of thoracic disc protrusion. Clin Radiol 1976;27:291-9.
9. Key CA. On paraplegia: Depending upon disease of the ligaments of the spine. Guys Hosp Rep 1838;3:17-34.
10. Middleton GS, Teacher JH. Injury of the spinal cord due to rupture of an intervertebral disc during muscular effort. Glasgow Med J 1911;76:1-6.
11. Stetkarova I, Chrobok J, Ehler E, Kofler M. Segmental abdominal wall paresis caused by lateral low thoracic disc herniation. Spine (Phila Pa 1976) 2007;32:E635-9.
12. Khoo LT, Smith ZA, Asgarzadie F, Barlas Y, Armin SS, Tashjian V, et al. Minimally invasive extracavitary approach for thoracic discectomy and interbody fusion: 1-year clinical and radiographic outcomes in 13 patients compared with a cohort of traditional anterior transthoracic approaches. J Neurosurg Spine 2011;14:250-60.
13. Gille O, Soderlund C, Razafimahandri HJ, Mangione P, Vital JM. Analysis of hard thoracic herniated discs: Review of 18 cases operated by thoracoscopy. Eur Spine J 2006;15:537-42.
14. Caron JP, Djindjtan R, Julian H, Lebrigand R, Comoy J. Les hernies discales dorsales. Ann Med Interne 1971;6-7:657-88.
15. Dreyfus P, Six B, Dorfmann I, Desezi H. La hernie discale dorsale. Sem Hop Paris 1972;l48:3045-52.
16. Stillerman CB, Chen TC, Day JD, Couldwell WT, Weiss MH. The transfacet pedicle-sparing approach for thoracic disc removal: Cadaveric morphometric analysis and preliminary clinical experience. J Neurosurg 1995;83:971-6.
17. Brown CW, Deffer PA Jr., Akmakjian J, Donaldson DH, Brugman JL. The natural history of thoracic disc herniation. Spine (Phila Pa 1976) 1992;17:S97-102.
18. Lowe TG. Current concepts review: Scheuermann disease. J Bone Joint Surg Am 1990;72:940-5.
19. Heithoff KB, Gundry CR, Burton CV, Winter RB. Juvenile discogenic disease. Spine (Phila Pa 1976) 1994;19:335-40.
20. Sorensen KH. Scheuermann’s Juvenile Kyphosis: Clinical Appearances, Radiography, Aetiology, and Prognosis. Copenhagen, Denmark: Ejnar Munksgaard Forlag; 1964.
21. Liu N, Chen Z, Qi Q, Shi Z. The relationship of symptomatic thoracolumbar disc herniation and scheuermann’s disease. Eur Spine J 2014;23:1059-66.
22. Videman T, Battie MC, Gill K, Manninen H, Gibbons LE, Fisher LD. Magnetic resonance imaging findings and their relationships in the thoracic and lumbar spine. Insights into the etiopathogenesis of spinal degeneration. Spine (Phila Pa 1976) 1976;20:928-35.
23. Barbanera A, Serchi E, Fiorenza V, Nina P, Andreoli A. Giant calcified thoracic herniated disc: Considerations aiming a proper surgical strategy. J Neurosurg Sci 2009;53:19-25.
24. Hott JS, Feiz-Erfan I, Kenny K, Dickman CA. Surgical management of giant herniated thoracic discs: Analysis of 20 cases. J Neurosurg Spine 2005;3:191-7.
25. Paolini S, Tola S, Missori P, Esposito V, Cantore G. Endoscope-assisted resection of calcified thoracic disc herniations. Eur Spine J 2016;25:200-6.
26. Braithwaite I, White J, Saifuddin A, Renton P, Taylor BA. Vertebral end-plate (Modic) changes on lumbar spine MRI: Correlation with pain reproduction at lumbar discography. Eur Spine J 1998;7:363-8.
27. Wood KB, Blair JM, Aepple DM, Schendel MJ, Garvey TA, Gundry CR, et al. The natural history of asymptomatic thoracic disc herniations. Spine (Phila Pa 1976) 1997;22:525-9.
|How to Cite this Article: Degulmadi D, Dave BR, Krishnan A, Mayi S, Rai RR Imaging | in Thoracic Disc Prolapse: A Study of 25 Patients and Review of Literature| Back Bone: The Spine Journal | October 2020-March
2021; 1(1): 23-27.
(Abstract) (Full Text HTML) (Download PDF)