Atypical Presentation of Thoracic Disc Herniation: Case Series and Review of the Literature

Abstract

Modern imaging has revealed that thoracic disc herniation (TDH) has a prevalence of 11–37% in asymptomatic patients. Pain, sensory disturbances, myelopathy, and lower extremity weakness are the most common presenting symptoms, but other atypical extraspinal complaints, such as gastrointestinal or cardiopulmonary discomfort, may be reported. Our objective is to make providers familiar with TDH's atypical symptoms to help avoid potential serious consequences created by a delay in diagnosis. We report the cases of two patients who each presented with atypical extraspinal symptoms secondary to a TDH. One patient presented with a chronic history of nausea, emesis, and chest tightness and MRI showed a large right paramedian disc herniation at T7-8. A second patient reported chronic constipation, buttock and leg burning pain, gait instability, and urinary frequency; an MRI of his thoracic spine demonstrated a central disc herniation at T10-11. TDH can present with vague extraspinal symptoms and unfamiliarity with these symptoms can lead to misdiagnosis with progression of the disease and unnecessary diagnostic tests and medical procedures. Therefore, TDH should be included in the differential diagnosis of patients with negative gastrointestinal, genitourinary, and cardiopulmonary system basic studies.

Skin, fascias, and scars: symptoms and systemic connections

“…We can hypothesize the presence of a vertebral dysfunction at the metameric level, which results in a painful symptomatology, because of an abnormal increase in the muscular tone and in loads incorrectly distributed, with consequent postural alteration. Again, this dysfunction is attributable to a sympathetic return efferent, influenced by electrical and biochemical afferents 64,65. In addition, we can assume a malfunction of the respiratory diaphragm because of the stiffening of the lumbodorsal spine, to which the primary muscle of respiration is closely connected 40.…”

Decompression of the anterior thoracic spinal canal using a novel full‐endoscopic uniportal transthoracic retropleural technique—an anatomical feasibility study in human cadavers

“…(Quint et al, ; Roelz et al, ). Atypical symptoms (e.g., gastrointestinal, cardiopulmonary, abdominal) have also been reported (Rohde and Kang, ; Shirzadi et al, ).…”

“…(Quint et al, 2012;Roelz et al, 2016). Atypical symptoms (e.g., gastrointestinal, cardiopulmonary, abdominal) have also been reported (Rohde and Kang, 2004;Shirzadi et al, 2013). Conservative treatment, in this case with injections, is also possible, especially for radiculopathies due to lateral disc herniation (Benyamin et al, 2012;Manchikanti et al, 2010).…”

Thoracic Facet Arthropathy Presenting with Pain Abdomen: An Unusual Presentation

“…It can lead to unnecessary invasive, and expensive diagnostic tests and extensive medical and surgical workup. 7,8 Though thoracic spine problems are a rare cause of pain abdomen but the clinician should be aware of it while forming a diagnosis. 9…”