[Anterolateral approach for thoracic disc disease. Report of six cases].
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Adult↗
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Endovascular stent-graft treatment of thoracic aortic disease.
Aneurysmal diseases of the thoracic aorta are life-threatening conditions. In such cases, stent-graft treatment has been proposed as an alternative to surgery. The morbidity and mortality associated with endovascular repair are significantly lower than those associated with open surgery. In the largest surgical series, the mortality ranged from 5% to 20%. In studies of endovascular repair, the 30-day mortality was 0%-20% and the periprocedural stroke rate was 0%-7%. Often, open surgery is prohibited in patients with these high-risk lesions; thus, in many cases endovascular treatment is the only alternative. Thoracic aortic diseases that can be treated with endovascular stent-graft placement include aneurysms, dissection, traumatic rupture, traumatic pseudoaneurysms, intramural hematoma, penetrating atherosclerotic ulcers, and aortic rupture. Thorough preprocedure imaging is essential for selecting patients, choosing the stent-graft devices, and planning the intervention. Prerequisites for endovascular stent-graft placement are an adequate neck for graft attachment and adequate vascular access. When the ascending aorta or aortic arch is involved, surgical and endovascular procedures can be combined and performed simultaneously, allowing treatment of a wider range of cases. An experienced interdisciplinary team is needed to manage such cases.
Aortic Dissection↗
Changing trends in management of thoracic aortic disease: where do we stand with thoracic endovascular stent grafts?
BACKGROUND: Descending thoracic aortic surgery is linked to a high morbidity and mortality. Thoracic endovascular stent grafts were designed to decrease perioperative risks, especially in patients with severe comorbidities. However, procedure-related complications and clinical outcomes remain ill-defined. PATIENTS AND METHODS: The authors' experience in 24 patients (mean age 63.3+/-25.4 years) from May 2001 to February 2004 is reported. The diagnosis was thoracic aneurysm in 10 patients, complicated penetrating aortic ulcer in six patients, blunt traumatic aortic rupture in four patients, complicated type B dissection in two patients, and aortoesophageal fistula and postoperative pseudoaneurysm in one patient each, respectively. Symptoms were present in 15 of 24 patients (62.5%). The decision to implant a thoracic endovascular stent graft was based on significant coinjuries in three patients, severe comorbidities in 16 patients and patient decision in five patients. RESULTS: The mean operative time was 2.3+/-1.7 h and the mean number of stents per patient was 1.8+/-0.7. Six patients required coverage of the left subclavian artery without complications. A carotid-carotid bypass was required in two patients. In one patient, a thoracic endovascular stent graft was introduced through a 10 mm graft anastomosed to the distal descending aorta accessed through a video-assisted minithoracotomy. Perioperative complications were an arterial access problem in one patient and pneumonia in four patients. The primary success rate was 100%. An 82-year-old patient with a ruptured thoracoabdominal aneurysm died of multi-organ failure (4.1% hospital mortality). All 23 surviving patients were alive at 13.4+/-3.5 months. One patient required an additional procedure for recurrent hematemesis. CONCLUSIONS: Thoracic endovascular stent grafts show excellent early results in well-selected cases. Extra-anatomical bypass or novel vascular access procedures increase the applicability of thoracic endovascular stent grafts. Meticulous follow-up is essential to identify and treat stent graft-related complications. Data on long-term outcomes are required before applying thoracic endovascular stent grafts to patients with a lower operative risk.
Aged↗
Transferring diagnosis versus actual diagnosis at a center for thoracic aortic disease.
BACKGROUND: Lack of physician awareness of thoracic aortic disease has received increased media attention. As a referral center for thoracic aortic disease our institutional experience confirms discrepancies between the transferring diagnosis and the actual pathologic diagnosis. A retrospective review was undertaken to identify the incidence and sources for disparate diagnoses. METHODS: Medical records from 100 consecutive patients transferred to The University of Florida--Shands Hospital between April 2002 and October 2003 were reviewed. To identify sources for error, the charts of 24 patients with diagnostic discrepancies were examined in detail with attention to outside radiologic reports, level of physician experience, and additional diagnostic testing required. RESULTS: The transferring diagnosis of 24 patients was different from the final aortic pathologic disease. The most common discrepancies were misclassifications of dissections and aneurysms. Seven patients had either no leak or no dissection. Two patients had misleading "pulsation artifacts" on their computed tomographic scans. In half of the patients diagnostic differences were secondary to initial misinterpretation by the referring radiologist. Seventeen of 24 patients underwent additional diagnostic testing. Misdiagnoses were more common when the referring physician was not a surgeon (15 of 24). The diagnosis of 5 patients was confirmed only in the operating room. CONCLUSIONS: A significant incidence of disparate diagnosis was identified between transferring facilities and our referral center. Discrepancies were secondary to initial radiographic misinterpretation and the complexity of thoracic aortic pathologic disease. Medical schools and continuing medical education programs should place increased emphasis on thoracic aortic disease in their curricula.
Adolescent↗
Endovascular treatment of thoracic aortic diseases: combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries.
PURPOSE: The objective of this study was to assess the initial and 1-year outcome of endovascular treatment of thoracic aortic aneurysms and dissections collated in the European Collaborators on Stent Graft Techniques for Thoracic Aortic Aneurysm and Dissection Repair (EUROSTAR) and the United Kingdom Thoracic Endograft registries. METHODS: Four hundred forty-three patients underwent endovascular repair of thoracic aortic disease between September 1997 and August 2003 (EUROSTAR, 340 patients; UK, 103 patients). Patients represented 4 major disease groups: degenerative aneurysm (n = 249), aortic dissection (n = 131), false anastomotic aneurysm (n = 13), and traumatic aortic injury (n = 50). RESULTS: Mean age in the entire study group was 63 years. Fifty-two percent of patients were deemed at high risk for open surgery because of major comorbidity. Sixty percent of patients underwent an elective procedure, and 35% required emergency treatment. Conventional indications for treatment of aortic dissection, including aortic expansion, continuous pain, rupture, or symptoms of branch occlusion constituted the basis for endograft placement in 57% of patients, whereas in 43% of patients aortic dissections were asymptomatic. Primary technical success was obtained in 87% of patients with degenerative aneurysm and in 89% with aortic dissection. Paraplegia was a postoperative complication in 4.0% of patients with degenerative aneurysm and 0.8% of patients with aortic dissection (not significant). Thirty-day mortality in the entire study group was 9.3%, with mortality rates after elective procedures of 5.3% for degenerative aneurysms and 6.5% for aortic dissection. Mortality for degenerative aneurysm after emergency repair was higher (28%; P <.0001) then after elective procedures. For aortic dissection the emergency repair rate was 12% (not significant compared with elective repair of aortic dissection, and P = .025 compared with emergency repair of degenerative aneurysm). One-year follow-up was complete in 195 patients. The outcome at 1 year was more favorable for aortic dissection than for degenerative aneurysm with regard to aortic expansion (0% vs 15%; P = .001) and late survival (90% vs 80%; P = .048). In the groups with false anastomotic aneurysm and traumatic aortic injury, 30-day mortality rates were 8% and 6%, respectively. CONCLUSION: This multicenter experience demonstrates acceptable rates for operative mortality and paraplegia after endovascular repair of thoracic aortic disease. Outcome after 30 days and 1 year was more favorable for aortic dissection than for degenerative aneurysm. However, the durability of this technique is currently unknown, and continued use of registries should provide data from long-term follow-up.
Adolescent↗
Underlying aortic pathology and clinical health status determine success of endovascular stent-grafting for descending thoracic aortic disease.
Despite advances in medical and surgical treatment, acute as well as chronic diseases of the thoracic aorta are still associated with a high mortality. For the descending thoracic aorta, endovascular stent-graft placement competes with surgical therapy for clinical outcome. From July 1999 till December 2004, a total of 84 patients (64 +/- 14 years) with aortic disease of the descending thoracic aorta were treated. Nine patients had acute (AAD) and 35 chronic aortic dissection (AD), 16 had thoracic aortic aneurysms (TAA), 21 had penetrating aortic ulcer (PAU), and 3 patients had traumatic dissection (trans). Initial clinical status was assessed using the American Society of Anesthesiologists (ASA) classification. Fifty-three patients were in class 2, 16 in class 3, 8 in class 4, and 7 in class 5. Stent-graft placement was performed in the cardiac catheterization laboratory with the patient under general anesthesia. Technical success was obtained in 81/84 patients (96%). Within 30 days, seven patients (8%) died, four of them due to aortic rupture. In 14 patients, additional stent-grafts had to be implanted due to type I endovascular leakage (n = 5) or additional entry site adding up to a total of 107 implanted stent-grafts. During a follow-up period of 21 +/- 18 months, 17 additional patients died (22%). In 10 patients, death was disease- or procedure-related (13%). This long-term mortality depended on the underlying disease and was highest in the group with TAA (45%) followed by AAD (38%) and AD (18%). Patients in ASA class 4 and 5 had a significantly worse outcome. No aortic-related death occurred among patients with PAU or traumatic transsections. Overall, there was only one transient neurological deficit. Endovascular stent-graft placement has acceptable results in the treatment of patients with disease of the descending thoracic aorta. The outcome strongly depends on the underlying aortic pathology and the clinical health status of the patients. Randomized trials are necessary in order to establish the exact value of this new therapeutic option.
Adult↗
Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease.
We report two cases of proximal endograft collapse with an almost complete aortic occlusion after endovascular tube-graft treatment of thoracic aortic disease (thoracic aneurysm after a type B dissection, traumatic blunt aortic rupture) using the TAG Gore system. Oversizing of endografts is known to cause this complication. In our two cases, however, the oversizing was between 12% and 21.7%, which is less than the allowed oversizing of 25% that is recommended by the manufacturer. This endograft-related complication might be due to a poor alignment of the currently available endografts in highly angulated and tight aortic arches. In the first case, a combined endovascular and open emergent repair procedure achieved a reopening of the proximal endograft by proximal extension (TAG Gore). In the second case, proximal extension was not considered owing to a precise positioning of the endograft distal to the left carotid artery. A balloon-expanding Palmaz stent was therefore placed interventionally in the proximal part of the TAG graft to expand the endograft and to avoid another collapse of the device. This proximal endograft collapse has to be acknowledged as a potentially hazardous complication. We therefore recommend that the proximal part of thoracic endografts in the aortic arch should be closely monitored and we offer two possible endovascular solutions for resolving the problem of proximal endograft collapse.
Adult↗
[Importance of medical history in diagnosis of respiratory insufficiency in patients suffering from neuromuscular diseases and thoracic deformities].
Patients suffering from neuromuscular diseases and thoracic deformities may develop global respiratory failure during their illness. We wanted to judge clinical parameters and information from the patients' medical history to reliably, quickly and noninvasively diagnose a ventilatory failure. Therefore we evaluated 105 situations with and without mechanical ventilation from 29 patients with indication for noninvasive nocturnal mask ventilation. 6 clinical parameters (e.g. heart rate, oxygen saturation, relative vital capacity), 2 test results (pH and partial pressure of carbon dioxide (pCO2)) and 6 parameters from the patients' medical history (e.g. nycturia, frontal headache in the morning, breathlessness) were investigated. After statistical evaluation we could show a relation between heart rate and pCO2 (Spearman's correlation: r = 0.331, p = 0.001, n = 105; one-tailed significance: r = 0.335, p = 0.038, n = 29). Significant differences between the groups of nycturia incidence indicate a tight relation between the incidence of nycturia and the height of hypercapnia levels (ANOVA--analysis of variance: p = 0.001). Using logistic regression we could show that information regarding medical history, especially nycturia, frontal headache and indrawings, gives important indications for global respiratory failure (sensitivity 97.62-100%, specificity 57.14-76.19%). Pathogenesis needs to be elaborated further.
Diagnosis, Differential↗
Endovascular treatment of thoracic aortic disease: four years of experience.
BACKGROUND: The aim of this retrospective study is to investigate efficacy and middle-term results of the stent graft treatment for diseases of descending thoracic aorta. METHODS AND RESULTS: From March 1999 to October 2003, 132 patients (113 male and 19 female, mean age 62+/-14 years) were enrolled. They were divided into 4 groups: aneurysms (43, group A), post-traumatic lesions (24, group B), and complicated type B dissections (43, group C). Twenty-two further patients, with chronic type B dissection and not suitable for endovascular or surgical or hybrid techniques because of multiple entry tears without difference between the true and false lumen and poor clinical conditions, were obliged to receive medical management only (group D). All patients underwent computed tomography (CT) scan and angiography as preoperative assessment. An optimal deployment with exclusion of the aneurysm and/or closure of the entry tear in dissection was achieved in 96.4% (106/110) of the patients that were discharged in good conditions within 6 days. No spinal cord injuries were observed. The follow-up (average 20.82+/-10.01 months, range 1 to 55 months), performed with serial chest CT scans, was 100% complete. No stent graft-related complications were detected, although only in 1 case, an asymptomatic rupture of the Excluder connecting bar was found with a perforation of the fabric and an intra-aortic exposition of the bar itself. In 2 patients with chronic dissection an asymptomatic type II endoleak was detected. A total of 4 hospital deaths resulted in an overall operative mortality of 3.9%. Seven patients (6.3%) died during the follow-up 5 of them for other diseases (4.5%). However, a 40.9% mortality was observed within the obliged medical treatment group. CONCLUSIONS: Endovascular treatment of thoracic aortic diseases, even in the acute phase, may represent a valid option with a low mortality rate. Moreover, the efficacy is proved in the middle-term whereas the long-term follow-up is still pending.
Aged↗
[Evaluation of the efficacy of pariet in patients with gastroesophageal reflux disease with thoracic pain not connected with cardiac disease].
The research was aimed at evaluating the efficiency of the inhibitor of the Rabeprazole (Pariet) proton pump in the therapy of the gastroesophageal reflux disease (GERD) with extra esophagus manifestations, and the presence of pains in the chest not caused by cardiac diseases. 37 patients suffering from GERD underwent monotherapy with inhibitors of the proton pump: 17 patients were taking Omeprazole 40 mg a day, and 20 patients--Rabeprazole 20 mg a day. The treatment with Rabeprazole supplied authentic data concerning faster pain reduction in the heart area and heartburn starting from the first day of treatment. According to the daily pH monitoring, administration of Pariet is accompanied by a reliably much more manifested reduction of the total time with pH less than 4 in the esophagus as compared to Omeprazole. The data received demonstrate the advantages of using Pariet in the treatment of GERD with atypical symptoms.
2-Pyridinylmethylsulfinylbenzimidazoles↗
Noninvasive evaluation of suspected thoracic aortic disease by contrast-enhanced computed tomography.
Traditionally, suspected thoracic aortic disease has been evaluated by aortography, which has associated risks because it is invasive. With the introduction of computed tomography (CT), a noninvasive alternative has become available. In the present retrospective study, the potential clinical value of CT in providing correct diagnoses and pertinent information required for current therapies is evaluated. For this purpose, results of CT in 200 patients examined for suspected thoracic aortic disease were compared with "hard" (surgical and autopsy findings) or "soft" (follow-up clinical information) evidence of the true diagnoses. Aortographic results, available in 51 patients (26%), were also compared with available clinical evidence. Excluding inadequate examinations, the diagnostic accuracy of the independently and blindly interpreted results of CT and aortography were similar (86% and 87%, respectively) in patients with true diagnoses confirmed by hard evidence. When patients evaluated for aortic damage from acute blunt chest trauma were also excluded, the accuracy was 90% for CT and 86% for aortography. Specifically, CT was 83% and 67% accurate in proved (i.e., confirmed by hard evidence) type A and type B dissections, respectively (75% for both type A and B by aortography). In the 183 patients suspected of having thoracic aortic disease not attributable to acute blunt chest trauma and with follow-up information, 91% would have been managed appropriately based on their CT evaluation alone. In the subset of patients who underwent aortographic evaluation as well, 91% would have been managed appropriately based on aortography alone. The accuracy for combined CT and aortography was 94%.(ABSTRACT TRUNCATED AT 250 WORDS)
Aortic Dissection↗
[Change of paradigms in the surgical treatment of complex thoracic aortic disease].
One of the main issues in complex thoracic aortic disease, requiring the replacement of the ascending aorta, the entire aortic arch and the descending aorta, is the vast amount of surgery necessary to cure the patient. Though one-stage repair is feasible by a clamshell thoracotomy, the associated surgical trauma and perioperative morbidity limit this approach to younger patients only. Classic surgical repair consist of a two-stage strategy, whereby, in the first step, the ascending aorta and the aortic arch are replaced via a midline sternotomy. In the second step, via a lateral thoracotomy, the descending aorta is replaced. The two stages may sum up to a mortality of 20%; furthermore, the waiting period between the stages is associated with a mortality rate of 10% of its own. Additionally, the two-stage strategy has an inherent limitation, due to the comorbidity and advanced age of the majority of patients. Therefore, the second stage cannot be offered to up to 30% of patients. New developments and improvements in aortic surgery were introduced to overcome these shortcomings and to simplify the surgical repair. The "elephant trunk" principle, introduced by Borst et al. in 1983, was an important step to facilitate surgical repair, but still required the second step. With the introduction of endovascular repair of thoracic aortic disease with stent grafts implanted retrograde via the femoral artery, new therapeutic concepts emerged. In the late 1990s, two Japanese groups reported first trials to stabilize the free-floating "elephant trunk" prosthesis by implantation of nitinol stent grafts into the vascular graft. The applied devices were purely custom-made and nonstandardized. The availability of industrially made and CE-marked stent-graft devices raised the possibility to apply them in open aortic arch surgery. The experience with stent-graft devices implanted antegrade into the descending aorta (Medtronic Talent) was reported first by the Essen and the Vienna group. The experience gained with these devices revealed the limitations of the devices designed for pure retrograde aortic delivery. This required a complete redesign and new construction of the stent graft itself as well as the introducer system. In a preliminary series of 14 patients the required stent-graft properties were presented in detail and resulted in the first industrially manufactured standardized and CE-marked Hybrid stent graft (Essen 1 prosthesis, E-vita Open, Jotec), especially made for antegrade open stent grafting of the descending aorta. This device consists of a stent graft with an integrated Dacron vascular prosthesis, enabling for direct and continuous aortic arch replacement after stent grafting of the descending aorta. From 01/2005 to 03/2006, this hybrid prosthesis was implanted in 16 patients (one aneurysm and 15 aortic dissections). In all cases, the underlying pathology within the thoracic aspect of the aorta could be excluded in a one-stage approach. In case of aortic dissection, thrombosis of the false lumen was detectable by transesophageal echocardiography already at the end of surgery. Though long-term results using this new method are not yet available, the initial promising results postoperatively are encouraging toward true one-stage repair by combining classic aortic surgery with open antegrade stent grafting utilizing the newly designed hybrid prosthesis. While surgical trauma is markedly reduced, this treatment option can be offered to elderly patients as well.
Adult↗
Magnetic resonance imaging of thoracic vascular disease.
Magnetic resonance imaging (MRI) appears to provide at least as much diagnostic information as angiography in the evaluation of acquired and congenital forms of disease of the great arteries. Since it can also be used to assess the tissues adjacent to the great arteries, MRI often provides a distinct diagnostic advantage over angiography. In addition, the recently introduced dynamic MRI techniques may provide valuable information regarding hemodynamic abnormalities associated with diseases of the thoracic aorta and the pulmonary arterial system.
Humans↗
[Recurrent sarcoidosis in skin scars disclosing repeated thoracic sarcoidosis].
Recurrence of thoracic sarcoidosis after spontaneous regression is extremely rare. Its existence is proven by two new cases associating sarcoidosis with L ofgren 's syndrome and sarcoid in skin scars, the latter facilitating the recognition of the presence of thoracic disease. Surveillance of the behaviour of scars forms part of routine examinations in the sarcoid patient. Even when there has been total spontaneous regression, subsequent clinical and radiological follow-up every two years must be continued.
Adult↗
Thoracic disc disease: diagnosis and surgical treatment.
Symptomatic thoracic disc disease is uncommon. Unlike cervical or lumbar disc disease, this disorder frequently is not associated with pain. Often, diagnosis is delayed until signs of myelopathy develop. Surgical intervention is the treatment of choice. Because of the unique characteristics of the thoracic spinal canal, the vascular supply to the spinal cord, and the fact that many of these disc extrusions are anterior to the cord, different surgical techniques are needed. Few patients experience intraoperative complications; however, some approaches predispose patients to the risks of both thoracotomy and exploration of the spinal canal. Postoperative complications are similar to those associated with thoracotomy. Most patients have an improvement in neurologic function after therapy.
Female↗
Long-term results from a 12-year experience with endovascular therapy for thoracic aortic disease.
BACKGROUND: Endovascular approaches promise to revolutionize therapy for thoracic aortic disease. This study describes a long-term analysis of endovascular thoracic aortic repair. METHODS: Seventy-three patients (mean age, 67.4 years) underwent endovascular thoracic aortic repair from 1993 to 2005. Indications for intervention included aneurysm (38%), dissection (23%), or penetrating ulcer or pseudoaneurysm (34%). Rupture was present in 16 patients (22%). Seventy-one percent were considered high risk for open surgery for reasons of age or comorbid conditions. Treated segments included ascending aorta (n = 1), distal arch (n = 24), and proximal (n = 50) or distal (n = 55) descending aorta. The total descending thoracic aorta was covered in 31 patients. Procedural success was achieved in 96%. Devices were delivered by femoral (79%), retroperitoneal iliac (18%), or carotid (2.7%) exposure. Devices used included Excluder (n = 30), Talent (n = 23), Zenith (n = 3), AneuRx (n = 5), and custom-fabricated (n = 14). Follow-up was 100% complete. RESULTS: Thirty-day mortality was 5.5%. Significant morbidity included stroke (8.2%) and need for dialysis (4.1%). Although 3 patients had transient spinal cord ischemia (4.1%), none had permanent sequelae. Intervention for fusiform aneurysm was independently associated with a composite end point of 30-day mortality, need for dialysis, and stroke (p = 0.015). Eight patients (11%) had new or persistent endoleaks, and aortic reintervention was performed in 7 patients (9.6%). Mean survival for the entire cohort was 46.8 +/- 5.1 months. Intervention for penetrating ulcer or pseudoaneurysm (p = 0.045) was independently associated with long-term all-cause mortality. CONCLUSIONS: An endovascular approach produces acceptable results for a broad range of thoracic aortic disease. However, the potential for endoleak or need for reintervention mandates continued close follow-up to achieve satisfactory long-term results.
Aged↗
Thoracic aortic endografting is the treatment of choice for elderly patients with thoracic aortic disease.
OBJECTIVE: To assess the effect of age on outcomes following thoracic aortic endografting. SUMMARY BACKGROUND DATA: Endograft therapy for thoracic aortic disease is rapidly evolving. This therapy is less invasive, and elderly patients with significant medical comorbidities are more frequently referred for endografting. We hypothesized that elderly patients over the age of 75 have worse outcomes after thoracic endografting than patients under the age of 75. METHODS: We retrospectively reviewed the charts of the first 42 patients who underwent endografting for thoracic aortic pathology. Charts were reviewed for demographics, comorbid conditions, perioperative complications and death, endoleaks, and results at 3, 6, and 12 months. Preexisting medical conditions were also evaluated to determine if any patient characteristics were associated with adverse outcomes. Perioperative morbidity included cardiac, pulmonary, renal, hemorrhagic, and neurologic (stroke and spinal cord injury) complications. RESULTS: Twenty-four patients were under the age of 75, and 18 patients were 75 or older. Baseline demographics and comorbidities were similar between the 2 groups. There were no differences in operative time, length of stay, perioperative mortality, or the incidence of significant complications between the 2 age groups. Gender, however, was associated with a statistically significant difference between the occurrence of complications, with more women experiencing complications than men (P = 0.026, relative risk = 2.36). One patient (age >75 years) in the entire cohort of 42 (2.4%) suffered a spinal cord injury. At 3 months, endoleaks were more common in the older age group (P = 0.059). CONCLUSION: Endograft therapy for thoracic aortic disease can be performed safely in elderly patients with no significant increase in perioperative morbidity or mortality compared with younger patients. Female gender is associated with a higher likelihood of perioperative complications, regardless of age. The overall incidence of spinal cord injury is very low. Endograft therapy, when anatomically possible, is the treatment of choice for thoracic aortic disease in elderly patients.
Adult↗
'Benign thoracic pain' syndrome: role of magnetic resonance imaging in the detection and localization of thoracic disc disease.
The syndrome of 'benign thoracic pain' is seen in young women who have pain and tenderness in the mid-thoracic spine radiating around the chest and aggravated by spinal movement. Ten consecutive patients with this syndrome and 15 controls were evaluated with magnetic resonance imaging (MRI). This showed thoracic intervertebral disc dehydration with no associated prolapse in 90% of the patients and 13% of the controls. We postulate that the clinical features are due to impaired shock absorption of these degenerate discs rather than direct compression of surrounding structures. MRI is non-invasive and does not use ionizing radiation; it allows direct visualization of the entire thoracic spine and cord, and accurate detection of early disc degeneration. Thus, it is the imaging modality of choice for defining the subtle intervertebral disc abnormalities that characterize the 'benign thoracic pain' syndrome.
Adult↗