Degenerative Thoracic Spine Conditions

I. General considerations

1. Incidence is ~15%.

2. Frequently presents in the fourth to sixth decade of life

3. Clinical presentation

a. May be either radicular or myelopathic

(1) Thoracic canal is relatively small.

(2) Subtle myelopathic symptoms are significant.

(3) Radiculopathy involves radiating pain around the associated rib.

B. Diagnosis

1. Thoracic disk herniation is frequently seen on magnetic resonance imaging (MRI).

a. MRI is most useful because of the wide field of view.

(1) Provides information regarding the status of disk degeneration and spinal canal impingement (Fig. 12–1)

(2) High false-positive rate

(3) Also useful in ruling out infections and tumors

b. Myelogram/computed tomography (CT) scan

(1) More accurate assessment of spinal cord impingement (Fig. 12–2)

2. Thoracic stenosis

a. Ossification of posterior longitudinal ligament

(1) Common in Asian populations

b. Ossification of ligamentum flavum

(1) Posterior spinal cord compression

(2) Treated with posterior thoracic decompression

c. Spondylosis

**Table 12–1** Differential Diagnosis of Thoracic Pain
Category	Etiologies
Cardiovascular	Angina pectoris Myocardial infarction Mitral valve prolapse Pericarditis Aortic aneurysm
Pulmonary	Pneumonia Carcinoma Pneumothorax Pulmonary embolus Pulmonary effusion
Mediastinal	Esophagitis Tumors
Intra-abdominal	Hepatitis Abscess Cholecystitis
Gastrointestinal	Peptic ulcer disease Hiatal hernia Pancreatitis
Retroperitoneal	Pyelonephritis Ureteral stone Aneurysm
Neurological	Intraspinal cyst/tumor Demyelinating disease Transverse myelitis
Infectious	Osteomyelitis Discitis Epidural abscess Tuberculosis
Traumatic	Compression fractures Rib fractures
Neoplastic	Metastatic disease Multiple myeloma Intradural tumors
Metabolic	Osteoporosis Osteomalacia Paget’s disease
Miscellaneous	Herpes zoster Inflammatory disease Polymyalgia rheumatica