Many patients who come to me have already seen one or several neurosurgeons who could not help them because of limited experience with the pathology or with a safe surgical approach towards the disc herniation(s). Often, their clinical presentation and neuroimaging findings were simply deemed aspecific. Consequently, surgery was advised against or occasionally offered with many reservations and with a significant risk for neurological deterioration. As a result, patients suffering mild myelopathy and/or refractory pain (i.e. pain not responding to medical and invasive pain treatments as well as physiotherapy) were usually left untreated, confused, searching a physician who recognized and understood their complaints and was able to relate these complaints to the neuroimaging findings (often incomplete, as the entire cervico-thoracic (and lumbar) spine has to be scanned not to miss anything). Their problem thus became a chronic problem, usually getting worse over the course of several years, severly impacting their personal and professional life and quality of life. Not surprisingly, it means a lot to these patients to be heard and for their symptoms to be acknowledged and explained, or in some cases to be clearly advised against surgery if a relation with neuroimaging findings cannot be established. At least, they are no longer in doubt.
My first step is to take enough time to listen to the patient's individual story and try to establish whether there is a consistent correlation with the neuroimaging findings. Subsequently, I take substantial time to explain that thoracic disc herniations are quite different from their cervical and lumbar counterparts, regarding their clinical and radiological presentation, pathophysiology, conservative and surgical treatment options. Finally, if every potential conservative option has failed, and surgery seems a viable option, I clearly explain the procedure, the expected perioperative course, as well as the surgical risk (and every possible precaution, including intraoperative neuromonitoring) in my hands.