Disc pain – thoracic herniated
What is a thoracic herniated disc?
A thoracic herniated disc is a disc in the middle of the back (thoracic spine) that has flattened and expanded under the pressure from the surrounding vertebrae.
What causes a thoracic herniated disc?
A herniated disc occurs when the intervertebral disc’s annulus (the outer fibers) is damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal. There is very little extra space around the spinal cord in the thoracic area, so when a herniated disc occurs in the mid-back,it can be extremely serious.
The first symptom of a thoracic disc herniation is usually pain. The pain is most often felt in the back, directly over the sore disc. Pain may also radiate around to the front of the chest.
Pressure or irritation on the nerves in the thoracic area can also cause symptoms. Depending on which nerves are affected, a thoracic disc herniation can include pain that feels like it is coming from the heart, abdomen, or kidneys. Herniated thoracic discs sometimes press against the spinal cord. When this happens, symptoms may include:
- Muscle weakness, numbness, or tingling in one or both legs
- Increased reflexes in one or both legs that can cause spasticity
- Changes in bladder or bowel function
- Paralysis from the waist down
Diagnosis of a thoracic herniated disc may include history and physical exam, diagnostic tests, an X-ray to eliminate other causes of pain, such as a fracture; a CT or MRI scan to produce images of the intervertebral discs and possibly nerve root compression.
- Physical Therapy: If your condition is causing only mild symptoms and does not appear to be getting worse, your doctor may have you work with a physical therapist.
- Laminotomy and Discectomy: The traditional way of surgically treating a herniated thoracic disc used to be to perform laminotomy and discectomy. The term laminotomy means "make an opening in the lamina", and the term discectomy means "remove the disc." The purpose of taking out a herniated thoracic disc was to decompress the spinal cord or spinal nerves. But nerve problems that occurred with this traditional method of decompression have led many doctors to discontinue this form of surgery for disc herniations in the thoracic spine.
- Transthoracic Decompression: A new way to decompress the spinal cord or spinal nerves is a technique called transthoracic decompression. Operating from the patient's side, the doctor makes a small opening through the ribs and works on the spine through the chest cavity. A minimal amount of the vertebral body and problem disc are removed, taking pressure off the spinal cord. Fusion surgery is sometimes needed right afterward if a larger section of the vertebra has to be taken out.
- Fusion surgery: Fusion surgery joins two or more bones into one solid bone. The medical term for this procedure is arthrodesis. If surgery on the herniated thoracic disc requires removal of a large section of bone and disc material, the section of spine may become loose or unstable. When this happens it may be necessary to fuse the bones right above and below the unstable section. Bone graft material is used to get the unstable bones to grow together. Rods, plates, and screws are commonly used to hold the bones in place so the bone graft heals.
Depending on the severity of your pain, medications can be used to help control it. Over-the-counter pain relievers, such as ibuprofen, Tylenol, and some of the newer anti-inflammatory medications, may be helpful.