Thoracic Disc Herniation Treatment: Options & Recovery

Thoracic disc herniation is less common than cervical/lumbar but can compress spinal cord (myelopathy) or nerve roots (radiculopathy).

Treatment Algorithm

1. Diagnosis: MRI (gold standard); CT myelogram if MRI contraindicated.
2. Conservative (First-line for radiculopathy without myelopathy):
   • Activity modification, NSAIDs, neuropathic pain agents (gabapentin).
   • Physical therapy: Core stabilization, thoracic mobility, posture.
   • Epidural steroid injections (transforaminal/interlaminar).
3. Surgical Indications: Progressive myelopathy, intractable pain, failed conservative care.
4. Surgical Options:
   • Thoracoscopic microdiscectomy (minimally invasive).
   • Open costotransversectomy or transthoracic approach.
   • Fusion if instability or extensive decompression.
5. Rehabilitation: Gradual return to activity; avoid heavy lifting/twisting initially.

Multidisciplinary team (spine surgeon, physiatrist, PT) optimizes outcomes.