This chapter describes an extradural oblique technique for efficiently and safely accessing the thoracic disc. As with lumbar discography, the final needle tip target is the geometric center of the disc’s nucleus pulposus.

A single-needle technique is preferred for thoracic disc access. However, a double-needle technique can be used with either a combination of 18 G introducer and 22 G intradiscal needles or 20 G introducer and 25 G intradiscal needles. The thoracic discs are generally narrower than the lumbar discs, so a thinner diameter needle may enable easier access. The needle tip can be slightly bent as described in Chapter 2 to optimize needle navigation. However, we do not suggest using a bent needle when navigating into narrow disc spaces.

The trajectory view used for this technique is similar to that used for the lumbar technique ( Chapter 17 ) (i.e., inserting from lateral to superior articular process (SAP) between the vertebral end plates); however, the thoracic spine has an additional limitation that the needle must enter medial to the rib margins. The trajectory view used for thoracic discography is similar to that used for thoracic infraneural transforaminal injections ( Chapter 21 ). There is a difference in the anatomy between lower, middle, and upper thoracic levels. The more cephalic lamina is wider, making it more challenging to access the disc’s geometric center above T5-T6. We recommend a needle entry contralateral to the more painful side unless there are prohibiting issues. Multiplanar imaging should be used to advance the needle into its final position.

Thoracic provocation discography is a developing procedure with many similarities to lumbar provocation discography. As with the lumbar spine, imaging techniques alone cannot sufficiently identify the thoracic disc that causes pain in a patient. Data collection includes pain provocation (i.e., none, discordant, or concordant) correlated with the patient’s clinical scenario. It also includes contrast volumes and disc architecture (nucleogram and postdiscography computed tomography [CT]).