Definition
Herniation of a thoracic intervertebral disc into the canal or foramen. Uncommon, and most frequent in the lower thoracic spine.
Clinical Features
- Axial or band like radicular chest wall pain
- Myelopathy with spastic gait, hyperreflexia and a sensory level
- Bladder and bowel disturbance when the cord is compressed
- Often an incidental MRI finding without symptoms
Investigations
- MRI to show cord compression and signal change
- CT to show disc calcification, which is common in large herniations
- CT myelogram when MRI is not possible
Management
- Nonoperative care. Analgesia and physiotherapy for pain without myelopathy
- Surgery. Progressive myelopathy or intractable radicular pain
Surgical Approaches
- Posterior laminectomy. Associated with neurological worsening and no longer recommended
- Transpedicular or transfacet. Lateral and soft herniations
- Costotransversectomy and lateral extracavitary. Posterolateral access to central disc
- Transthoracic. Anterior approach for central, calcified or giant herniations
- Thoracoscopic. Minimally invasive anterior access
Complications
- Cord injury and spinal cord ischaemia
- Cerebrospinal fluid leak, more likely with calcified intradural herniation
- Pleural effusion and pneumothorax after anterior approaches
Related
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 21 October 2026.