Thoracic intervertebral disk herniation: a commonly missed diagnosis.

In the emergency department and the physician's office, it is often difficult to distinguish benign causes of back pain from more serious ones. The diagnosis of thoracic intervertebral disk herniation is often missed because of its complex and variable presentation. In order to further investigate this condition, 78 patient charts were reviewed in the largest single study of thoracic disk herniation in the world's literature. Injury was associated with disk herniation in approximately half of patients, much higher than reported in previous studies. Back pain was the most common presenting symptom (73% of cases) and weakness was the most common physical finding (42% of cases). Eighty-five percent of patients had either historical or physical findings consistent with neuropathy; 26% of patients had multiple thoracic disk herniations. These findings will aid physicians in the diagnosis of this potentially serious condition.