Bulging Disc In Thoracic Spine

A bulging disc in the thoracic spine is a serious medical condition in which the strong sidewall of the disc is weakened causing the disc to bulge outward.  This can result in pressure on exiting nerves and or the spinal cord leading to symptoms such as pain, numbness, and weakness in the affected area.  

What Manifests During A Bulging Thoracic Disc?

The disc has two principal components: a soft gelatinous center that functions as a shock absorber and a thick supportive outer layer. The center is called the nucleus whereas the outer fibers are the annulus fibrosus.  The annulus fibrosus surrounds the gelatinous center and provides support preventing the disc from bulging out or rupturing. 

Weakening or tears in the strong annulus fibrosus can occur allowing the nucleus to push outward resulting in a thoracic disc bulge.

Where In The Back Does It Hurt? 

The thoracic spine is that portion of the spine that resides below the neck and above the low back.  It is commonly referred to as the mid-back.  A bulging disc in the thoracic spine can occur at any level. 

The location and severity of the mid-back pain will depend upon the location of the disc protrusion, its size, and whether or not it is compressing or irritating exiting nerves or the spinal cord. Common symptoms of thoracic disc protrusions (1) include:

1. Pain in the mid-back
2. Chest pain
3. Radiating pain 
4. Numbness and tingling in upper or lower extremities.

How Does A Bulging Disc Cause Pain? 

A bulging disc in the thoracic spine can cause pain in a number of different ways. 

• First the outer annulus of the thoracic disc contains nerve fibers which when stretched or distended can cause pain (2).
• Second, a bulging disc in the thoracic spine can compress or irritate nearby nerves leading to pain and other symptoms.
• Third, a bulging thoracic disc can cause inflammation in the surrounding tissue which can cause pain.
• Finally, a bulging thoracic disc by irritating or compressing exiting nerve roots can alter the normal mechanics of the thoracic spine leading to muscle tension, spasms, and pain.

Causes Of Bulging Discs In The Thoracic

Thoracic disc protrusions are relatively uncommon compared to the lumbar and cervical spine.  There are several different causes of bulging discs in the thoracic spine.  The most common include degeneration and trauma. Understanding the underlying cause of the condition is essential to determine the most effective treatment plan.  The two most common causes are: 

Degeneration

Degeneration is a common cause of disc protrusions in the thoracic spine. As we age the spine loses its water content, making them less flexible and prone to damage. Other causes of degeneration include genetic predisposition, infections, repetitive motions and metabolic abnormalities.  The majority of the thoracic bulging discs occur in the lower thoracic spine between T8 and T12 (3). 

Physical Trauma

Trauma is another cause of bulging discs in the thoracic spine.  Sudden force or impact such as a car accident or fall can cause a disc to bulge or even rupture (herniation). Chronic overload from lifting heavy objects as seen in athletics and construction workers can lead to thoracic disc protrusions.

Symptoms Of A Bulging Thoracic Disc

The symptoms of a bulging thoracic disc vary depending on the location and severity of the protrusion.  Common symptoms include:

Radiculopathy

Radiculopathy is a medical term used to describe a condition that occurs when there is a compression or irritation of the spinal nerve.  This can occur in the cervical, thoracic, and lumbar spine.  It can be caused by a disc bulge, disc herniation, facet overgrowth, ligament overgrowth, bone spurs, and other conditions that narrow the spinal canal and neuroforamen. 

The irritated or compressed nerve can cause pain both locally as well as along the path of the nerve.  Patients with thoracic radiculopathy often complain of burning, sharp pain that radiates across the chest wall and into the abdomen. 

Myelopathy

Myelopathy is a medical condition in which there is irritation, compression, or damage of the spinal cord. It can be caused by those conditions that narrow the spinal canal (stenosis). Examples include tumors, infections, disc bulges, disc herniations, and trauma.  Common symptoms include weakness in the upper and lower extremities, loss of bowel and bladder function, difficulty walking and loss of balance and coordination. 

Abdominal Pain

The pain may be worsened by movement or certain positions, and may also be accompanied by other symptoms such as difficulty breathing or digestive problems.

Pain In The Back

The pain associated with a thoracic disc bulge can vary in intensity and location depending upon the severity and the location of the disc bulge.  Pain may be localized in the mid-back (thoracic spine) or can radiate across the chest wall and into the abdomen (4). 

Back Pain in Ribs

Back pain in the ribs can be a common and often debilitating condition, causing discomfort and limiting mobility for many individuals. The pain can range from mild to severe and may be caused by various underlying conditions. Understanding the many causes of rib and back pain is important and can assist in securing an accurate diagnosis. Treatment options vary depending on the underlying cause and severity of symptoms. Persistent pain in the ribs that does not respond to conservative therapy can be an indication that there are problems within the musculoskeletal system. Consider it a warning sign that warrants further attention…

Read More About Back Pain in Ribs

Gastrointestinal (GI) Problems

Gastrointestinal (GI) problems can be debilitating comprising one’s wellbeing and ability to confidently engage in life. Symptoms vary and can include nausea, bloating, constipation, diarrhea, delayed motility, abdominal pain, irritable bowel-like symptoms, heartburn, and reflux. GI problems can be due to structural and functional problems within the gut itself. Examples include hiatal hernia and bacterial overgrowth. Less appreciated is the fact that many patients with Craniocervical instability (CCI) can also have significant GI problems. Regrettably, many of these patients undergo extensive, costly GI evaluations only are told that their examinations and studies are normal. This can be extremely frustrating. For these patients…

Read More About Gastrointestinal (GI) Problems

Lower Back Pain When Sitting

After a long day on your feet sitting down is supposed to be way to relaxing. Unfortunately for some sitting for any length of time can be painful. Most people experience low back pain at some point in their life. The lifetime prevalence of low back pain is 85% (1). Let’s take a deeper look at the different types of pain and causes of low back pain when sitting. Pain can present in many different ways. It can be intermitent or constant. The quality of the low back pain can also vary depending upon the actual source of injury. Common examples include: Sharp and Stabbing, Dull and Aching, Throbbing/ Pulsating, Pins and Needles, Burning, Electrical

Read More About Lower Back Pain When Sitting

Lower Back Pain When Standing

When you’re seated, the facet joints in your lower back are in an open and slightly flexed position. When you stand up, these joints compress. If they are painful or have arthritis, you’ll have pain as you stand up because this puts pressure on the painful joints. In addition, if there is any type of movement of one vertebra forward on another (called spondylolisthesis), then this shift will have occurred as you sit. This is called degenerative spondylolisthesis. When you get back up, the vertebrae will come back into position after a few seconds, leading to that awkward “walk it out period” that starts out painful and ends up more normal.

Read More About Lower Back Pain When Standing

Upper Back Pain Between The Shoulder Blades

Upper back pain between the shoulder blades is also known as interscapular pain. Fifteen percent of the population suffers from chronic upper back pain. Finding the source of interscapular pain can be tricky because the upper back houses many important structures like the heart, the upper lobes of the lung, the cervical spine, the scapulas, and a dozen or so of muscles and nerves.

Read More About Upper Back Pain Between The Shoulder Blades

What Happens When A Bulging Disc Is Left Untreated? 

When a thoracic bulging disc is left untreated, it can lead to a variety of symptoms and complications.  A bulging thoracic disc can put pressure on the spinal cord or exit spinal nerves potentially causing pain, weakness, and numbness in the back, chest, abdomen, and upper and lower extremities.

If left untreated a thoracic bulging disc can progress to a disc herniation where the gelatinous soft material on the inside of the disc is pushed out into the spinal canal.  A disc herniation can potentially cause more severe symptoms than a disc bulge including lower extremity weakness or paralysis.

Treatments For Bulging Thoracic Disc

Bulging in the thoracic disc can be a painful and debilitating condition.  Fortunately, there are a number of different treatment options.  The treatment plan will depend upon many factors which include the size and location of the disc bulge, a patient’s symptoms, their medical history, and current medications. 

Common treatments include:

Home Treatments

• Stretches
• Ice packs
• Rest
• Heat

Non-Surgical Options

• Medication

Common medications include NSAIDs which can decrease inflammation and potentially increase range of motion. Muscle relaxants can help with muscle spasms.

• Epidural injections

When conservative treatments fail, many patients are referred for epidural steroid injections.  This is a medical procedure where a steroid is injected into the space surrounding the spinal cord and exiting nerves.  A steroid is a powerful anti-inflammatory agent that is used to reduce swelling and pain.  Unfortunately, there are a large number of side effects associated with steroid epidurals and therefore they should be avoided.

Thoracic epidurals are technically challenging and require extensive training and years of experience.  Why?  The steep angle that is required to perform an epidural which is unlike that of the lumbar and cervical spine.  In addition, a misguided needle can potentially collapse a lung resulting in changes in blood pressure and need for a chest tube.

• Physical therapy
• Dry needling
• Acupuncture

Surgical Options

When conservative care, medications, and steroid injections fail to provide benefits some patients are referred to a surgeon. The specific surgical option will depend upon many factors that include the size and location of the thoracic disc bulge, current health, and medications.  The most common surgical options include:

• Discectomy
• Laminectomy
• Spinal fusion

Regenerative Options

At the Centeno-Schultz Clinic, we are experts in the evaluation and treatment of thoracic disc bulges.  A board-certified, fellowship-trained physician will evaluate your current thoracic complaint along with imaging, past medical and surgical history, and medications. 

All treatments are performed under X-ray or ultrasound guidance.  Treatment options include: 

Platelet-Rich Plasma

The Centeno-Schultz Clinic has a state-of-the-art laboratory that is able to customize the PRP for your need.  PRP is rich in growth factors that can increase blood flow, decrease inflammation, and aid in healing.

Bone Marrow Concentrate

Another treatment option is the use of bone marrow concentrate which can be injected under x-ray or ultrasound guidance into the area of injury. It can activate other helper and healing cells throughout the body to aid in the healing process.

What To Avoid To Promote Healing

If you are dealing with a thoracic dis bulge, it is important to take steps to promote healing and alleviate symptoms.  To ensure a successful recovery, it is important to avoid certain activities that can exacerbate the condition and or compromise the healing process.  These include:

• Too much bed rest: muscles become deconditioned
• Poor posture: places additional pressure on the thoracic disc bulge
• Sleeping without neutralizing the spine
• Bending, twisting, lifting, or straining the back
• Use of NSAIDs such as Ibuprofen and Motrin

Perc-FSU – Trusted Alternative to Spinal Fusion

The Perc-FSU Procedure is an injection-based treatment that utilizes the patients’ own blood platelets to bring stability to the spine without the need for the rods, nuts, bolts, and hardware of fusion surgery. “Perc” stands for percutaneous, and “FSU” stands for “Functional Spinal Unit,” which means that the spine is treated as one functioning unit. Up and down the spine, the discs, facet joints, ligaments, and muscles that assist in stabilizing the spine are treated with image-guided injections of PRP and Platelet Lysate to help bring stability to the spine as a whole. It is the trusted alternative to spinal fusion.

Read More About Perc-FSU – Trusted Alternative to Spinal Fusion

Platelet-Rich Plasma (PRP) Injections

PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…

Read More About Platelet-Rich Plasma (PRP) Injections

Thoracic Herniated Disc Surgery

Disc herniation is a painful medical condition in which the central portion of the disc is pushed outside of the disc and into the spinal canal.  This occurs due to a weakness or injury to the outer sidewall of the disc.  Pain, muscle spasm, muscle weakness, and numbness can occur.  It can occur in the neck, low back, and thoracic spine. When conservative treatments fail, patients are often referred for thoracic herniated disc surgery. The goal of thoracic herniated disc surgery is to remove that portion of the herniated disc that is responsible for the ongoing pain and compression of the nerves. 

Read More About Thoracic Herniated Disc Surgery

Thoracic Spine Surgery

Thoracic spine surgery is a major surgery aimed at treating injuries in the thoracic spine. Because of the complex anatomy and close proximity to the heart and lungs, there are significant surgical risks and complications. Surgery on the thoracic spine can take hours and may require deflating the lung in order to gain access to the thoracic injury. Recovery can be lengthy depending upon the specific thoracic spine surgery performed. There are several different types of thoracic spine surgery.  The specific thoracic spine performed depends upon the underlying thoracic injury and a symptoms of the patient.  For example, a thoracic disc herniation…

Read More About Thoracic Spine Surgery

Take Care Of Bulging Disc Pain Before It’s Too Late

A bulging disc in the thoracic spine is a serious medical condition in which the strong sidewall of the disc is weakened causing the disc to bulge outward. It can inflame, irritate or compress spinal nerves or the spinal cord resulting in pain in the mid back, abdomen and chest wall.  If severe patients may experience a diminished feeling in the lower extremities and or loss of bowel and bladder function. 

A bulging disc in the thoracic spine is a warning signal that you have a problem that warrants evaluation. If left untreated a thoracic disc protrusion can progress to a disc herniation with aggravation of symptoms.

At the Centeno-Schultz Clinic, we are experts in the evaluation and treatment of thoracic disc bulges and other thoracic injuries.  Prevent complications and aggravation of symptoms by scheduling an appointment with us today.  Learn about your candidacy for regenerative treatment options.

Doctors At Centeno-Schultz Clinic

Thoracic Spine Physician and Expert

John Schultz, MD

John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate and PRP for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI).

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Read more about John Schultz, MD

More Resources for Those Suffering From Spine Pain

The Spine Owner’s Manual: How to Avoid Back Pain & Life-Altering Surgery

This e-book from Dr. Chris Centeno focuses on the spine and how it functions within the human musculoskeletal system and the body as a whole. Everything in our bodies works together like a well-tuned symphony to support our well-being, and a strong spine (including all of its component parts, such as spinal nerves, ligaments, muscles, etc.) is critical to complete health.

Using the Regenexx SANS approach, The Spine Owner’s Manual provides a series of tests and clearly defined exercises that you can do on your own to measure and monitor your own spinal health. These musculoskeletal tests will allow you to monitor where your own body might be struggling to maintain proper stability, articulation, symmetry, and neuromuscular function.

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1. Cho, S. K. (2019). Thoracic disc herniation. Journal of spinal disorders & techniques, 32(8), 555-561. doi: 10.1097/BSD.0000000000000828.

2. Raj PP. Intervertebral disc: anatomy-physiology-pathophysiology-treatment. Pain Practice. 2008;8(1):18-44. doi: 10.1111/j.1533-2500.2007.00168.x.

3.Kim, M. J., Lee, S. H., Kim, H. S., Moon, S. H., & Kim, T. H. (2013). The prevalence and radiological findings in thoracic outlet syndrome caused by cervical ribs. Journal of Korean Neurosurgical Society, 54(6), 487–491. doi: 10.3340/jkns.2013.54.6.487.

4.Telfeian, A. E. (2010). Thoracic disc herniation: update. Neurosurgical focus, 28(2), E6. doi: 10.3171/2009.12.FOCUS09263