In recent years the increased knowledge of thoracic disk protrusions and refinements in neurosurgical technics, which together have improved the surgical results, have encouraged neurologists, neurosurgeons, and neuroradiologists to suspect and seek such lesions in a large number of patients with unusual pain problems. The opinion of Cyriax (5), that the degree of patient disablement seldom warranted surgical intervention and that roentgen studies seldom afforded any help in the diagnosis, is no longer prevalent. Most authors (1–4, 6–15) now agree that early diagnosis and treatment of ruptured thoracic disk are desirable because the natural course of the disorder is one of progression and the results of treatment are more salutary if it is undertaken before the appearance of a severe neurologic deficit. Most would also agree that roentgenologic studies, especially myelography, are the most helpful and rewarding in arriving at the diagnosis. As in many other uncommon disorders, however, the condition must first be considered if the proper studies are to be performed. This communication is a report of the roentgen features in 43 cases of protruded thoracic intervertebral disk in which the diagnosis was surgically verified at the Mayo Clinic (Rochester, Minn.). Clinical Signs and Symptoms Some knowledge of the clinical features of protruded thoracic disk is necessary before one can intelligently conduct radiologic examinations to detect it. Love and Schorn (12) have recently reviewed these features in 61 cases seen at our institution. They found that protrusion of a thoracic intervertebral disk may occur at any level, but that one of the lower four dorsal interspaces was involved in two-thirds of their cases. Multiple (two) protrusions were found in only one case; in the remainder, a single disk was involved. The most common symptoms were pain, either radicular or of a dull, nagging type; paresthesias or numbness; motor weakness, usually involving the lower extremities; and visceral disturbances, affecting the urinary bladder or the bowel. Neurologic examination often revealed sensory loss, spastic paraparesis, hyper-reflexia, and positive Babinski signs, all of which indicate involvement of the spinal cord. The authors were unable, however, to formulate any clear-cut syndrome of thoracic intervertebral disk protrusion. Laboratory examination of the cerebrospinal fluid was of little help. In half the cases the results were normal, and in the remainder the changes noted were not specific or diagnostic. It is important to remember that a protruded thoracic disk may mimic other neurologic conditions in its symptoms and signs. Such conditions include demyelinizing diseases, intramedullary and extramedullary tumors of the spinal cord, protruded cervical or lumbar disks, herpes zoster, intercostal neuralgia, parasagittal brain tumors, cerebrovascular accidents, diseases of the various thoracic and abdominal viscera, and psychoneurosis. The correct diagnosis may be suspected only after extensive medical and surgical examinations.
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