About Thoracic Disc Herniation
A thoracic disc herniation is a displacement of the disc between the vertebral bones in your thoracic spine, the middle part of the spine associated with your rib cage. The displaced disc may be off to the side, compressing an individual nerve. This can create pain or numbness that travels around your trunk, from your spine along your ribs to your belly. If the disc is displaced in the middle, the spinal cord can be compressed, resulting in symptoms of leg numbness and unsteadiness.
Thoracic disc herniation is usually caused by either degenerative disc disease or trauma to the upper back. These disc herniations occur at any age, but can be seen in younger patients that would not have experienced degenerative disc changes yet. In older patients, the herniation may calcify and harden like a bone, making management more difficult.
The surgical treatment of thoracic disc herniations is highly variable, depending on the location of the herniation and the degree of calcification within the disc. Some, but not all, can be addressed with minimally invasive spine surgery.
Common Symptoms of Thoracic Disc Herniation
A common symptom of a thoracic herniated disc is pain. The pain may only occur in the upper back or radiate to the chest or the stomach. Sometimes, coughing or sneezing will make the pain worse. If the disc herniation compresses, the spinal cord symptoms may include leg weakness and numbness, loss of balance, walking difficulty, and bowel/bladder dysfunction.
There are other spine conditions that may produce similar symptoms as a thoracic herniated discs, which makes a correct diagnosis essential.
Other symptoms depend on the size and location of the disc herniation. Symptoms for each include:
- Central disc protrusion
- upper back pain and/or myelopathy
- paralysis from the waist down (serious cases)
- Lateral disc herniation
- radiating chest wall pain
- radiating abdominal pain
- Centro-lateral disc herniation
- upper back pain
- radiating pain
Diagnosis of Thoracic Disc Herniation
A complete patient medical history and physical exam are the first steps of diagnosing a thoracic disc herniation. Defining the symptoms is essential, including the location of the pain, severity of the pain, and type of pain. If a thoracic herniated disc is suspected any of the following imaging tests can be ordered.
- X-rays – will not show a thoracic herniated disc, but may help localize injuries in cases of trauma as well as aid in identifying spinal instability.
- Magnetic Resonance Imaging (MRI) – produces images of the spine and is the most useful imaging tool to identify disc pathology.
- Computer Tomography (CT) – produces three-dimensional image of the spine after processing data from an X-ray beam rotated around the spine and provides the best detail regarding the bony anatomy.
- Myelogram – involves the injection of a special dye into the spinal column to examine any pressure on the spine and any problems with the discs or vertebrae.
Treatment Options for Thoracic Disc Herniation
There are a variety of nonsurgical options that either solely or in combination will help those suffering from a thoracic disc herniation. Some of these options include:
- Activity modification
- Gentle exercise
- Medication to treat pain
- Manual manipulation
- Strengthening exercises
- Anti-inflammatory agents
- Ice packs
- Epidural steroid injections
Symptoms typically improve between 6-12 weeks after starting nonoperative treatment. Surgery is only recommended if the thoracic herniated disc causes myelopathy, progressive neurological deficiencies, or intolerable pain.
Typically, one of the following surgical approaches will be used:
- Open thoracotomy- involves approaching the spine through the chest cavity (instead of through the back)
- Costotransversectomy- involves removal of rib and transverse process to allow access to the disc space