Lumbar and thoracic disk herniations

Lumbar disk herniation most commonly occurs in younger patients in the fourth to sixth decades of life. Nonsurgical therapies frequently result in a resolution of symptoms. Pain is produced by mechanical and chemical factors and tends to dissipate with anti-inflammatory medications and physical therapy. The minority of patients who have persistent symptoms despite more than 6 weeks of nonsurgical care or who present with progressive neurologic deficits or cauda equina syndrome should be treated surgically. Surgical techniques can vary. Open and minimally invasive options that focus on a limited diskectomy without aggressive curettage of the disk space can be appropriate. The short-term to midterm results for surgically treated patients are superior to those of patients treated nonsurgically. Thoracic disk herniations can present as a diagnostic challenge for clinicians. Symptoms can be nonspecific and vague and often result in a delayed diagnosis. MRI is the optimum modality for diagnosis, but clinical correlation is critical because of a high prevalence of disk abnormalities in asymptomatic adults. Nonsurgical treatment yields favorable outcomes for most patients with thoracic disk herniation. Patients with signs of myelopathy, progressive neurologic deficits, or intractable pain can be treated surgically with good reported outcomes.