Clinical Significance of Thoracic Disc Findings in a 13-Year-Old
These MRI findings—mild disc desiccation and small annular fissures at T7-8 and T8-9—are likely incidental and clinically insignificant in this 13-year-old boy, as thoracic disc abnormalities are extremely common in asymptomatic individuals and do not predict symptoms or require intervention in the absence of neurological deficits. 1
Why These Findings Are Typically Benign
High Prevalence in Asymptomatic Populations
Thoracic disc abnormalities including herniations, bulges, annular fissures, and cord contour deformity are common in asymptomatic patients, making isolated imaging findings poor predictors of clinical significance 1
In a general pediatric population study, signs of disc degeneration were noted in approximately one-third of 13-year-old children, with many showing no associated symptoms 2
Thoracic annular fissures occur in 31.4% of patients undergoing MRI, are positively correlated with older age and male gender, and rarely resolve over time—remaining hyperintense on T2-weighted imaging 3
Modern imaging reveals thoracic disc herniation has a prevalence of 11-37% in asymptomatic patients 4
Location-Specific Considerations
The T7-8 and T8-9 levels fall within the most common distribution for thoracic disc abnormalities, which predominate in lower segments from T6 to T10 5
Symptomatic thoracic disc disease, when it does occur, most frequently affects levels below T7—but the mere presence of abnormalities at these levels does not indicate pathology 1
What Actually Determines Clinical Significance
Red Flags That Would Make These Findings Concerning
Focus on clinical correlation rather than imaging measurements alone. 6 The following features would elevate concern:
Myelopathy signs: Progressive weakness, gait instability, hyperreflexia, positive Babinski sign, or bowel/bladder dysfunction 1, 4
Radiculopathy: Dermatomal sensory changes, radiating pain in specific nerve root distributions, or motor weakness corresponding to the T7-9 levels 1
Progressive neurological deficits: Any worsening of neurological examination findings over time 1
Atypical extraspinal symptoms: Though rare, thoracic disc pathology can present with gastrointestinal complaints, chest tightness, or genitourinary symptoms 4
Clinical Context in Pediatric Patients
In the pediatric spine trauma literature, MRI is valuable for detecting injuries requiring surgical intervention, particularly in children with abnormal neurological examinations 1
However, in non-trauma settings without neurological deficits, disc abnormalities in children—even when associated with some back pain—are often managed conservatively 2
Disc degeneration in the upper lumbar spine showed associations with low back pain in 13-year-old boys (OR 2.5-3.6), but thoracic findings were not specifically implicated in symptomatic disease 2
Management Algorithm for This Patient
If Neurologically Normal (Most Likely Scenario)
No intervention required: Imaging abnormalities do not equal pathology, and correlation with clinical symptoms is essential 6
Reassurance: Educate the patient and family that these findings are common incidental discoveries that do not predict future problems 6, 7
Activity as tolerated: No activity restrictions are warranted based on imaging alone 7
Clinical follow-up only if symptoms develop: Monitor for development of red flag symptoms listed above 1, 6
If Symptomatic Back Pain Present (Without Neurological Deficits)
Conservative management first: Activity modification while remaining active (bed rest is contraindicated), patient education about favorable natural history 7
Physical therapy: Exercises with individual tailoring, supervision, stretching, and strengthening 7
Pharmacotherapy if needed: NSAIDs and acetaminophen as first-line agents 7
Avoid interventional procedures: Epidural steroid injections are not indicated for non-radicular thoracic pain without signs of radiculopathy 7
If Red Flags Present
Urgent neurosurgical consultation: Progressive myelopathy, cauda equina syndrome, or rapidly progressive neurological deficits require immediate specialist evaluation 6, 7
Consider additional imaging: MRI with contrast may be indicated if infection, malignancy, or vascular pathology is suspected 1
Critical Pitfalls to Avoid
Do not use disc abnormality size or presence as a decision-making criterion: There is no specific millimeter threshold that defines a "concerning" finding, as asymptomatic individuals commonly have disc abnormalities 6
Avoid overtreatment of incidental findings: Imaging patients without clinical symptoms leads to unnecessary interventions without improving outcomes 6, 7
Do not order interventional procedures based solely on MRI findings: Without radicular symptoms or myelopathy, procedures like epidural injections are not indicated and represent non-adherence to guidelines 7
Remember that annular fissures persist over time: These findings remain hyperintense on T2-weighted imaging and rarely resolve, but this persistence does not indicate progressive disease or need for intervention 3
Recognize the natural history: Disc degeneration can be rapidly evolving but tends to remain unchanged after occurrence, and most thoracic disc abnormalities remain stable over months to years 5