Lesions on Thoracic Spine

What Are Thoracic Spine Lesions?

A thoracic spine lesion is an abnormality in the spine itself, adjacent tissue or spinal cord. The abnormality may occur in any of the following structures: 

•  Vertebral Bodies: The boney building blocks that stack one upon the other to make the thoracic spine. There are 12 thoracic vertebral bodies.   
• Disc: A critical shock absorber that is sandwiched between each boney building block. It is composed of a thick outer layer and soft, gelatinous center. The outer fiber is called the annulus fibrous whereas the center is the nucleus pulposus. Both structures are susceptible to injury. 
• Facet Joints: Paired cartilage lined joint that restricts motion and provides stability. 
• Costotransverse Joints: Cartilage lined joint created by the union of the rib and transverse process. 
• Spinal Canal: Boney canal on the backside of the spine that contains and protects the spinal cord and cerebral spinal fluid (CSF). 
• Neuroforamen: The boney doorway through which the exiting nerve roots travel en route to their final destination.

In the following video, I go over all of this in detail:

What Are The Thoracic Spine Lesion Symptoms?

Thoracic lesions can cause a number of different symptoms depending on their location, size, and adjacent structures. A lesion in the bone of one of the thoracic vertebral bodies will cause symptoms that are different from a lesion in the spinal cord.  The most common symptoms include: 

• Pain: Can be mild, moderate, or severe.  Onset can be gradual or abrupt. May be on left or right side of the thoracic spine or both. 

• Numbness: Compression of exiting nerves or the spinal cord can give cause numbness and tingling. 

• Weakness: Compression of the motor nerve can lead to lower extremity weakness.  Patients may complain of difficulty walking or balance problems. 
• Movement Limitations: Lesions in the thoracic spine can limit movement due to pain and swelling. 

What Causes Thoracic Spine Lesions?

A spine lesion is an abnormality in the spine, adjacent tissue, or spinal cord. There are many different causes of thoracic spine lesions.  They can be broken down into the following categories.

Trauma

Acute trauma can lead to injury and subsequent change in the tissue of the thoracic spine, adjacent tissue, or spinal cord.  Common examples include motor vehicle accidents and contact sports. For example, a rear-end MVA can injure the facet joint, costotransverse joint, vertebral bodies or disc thereby creating a lesion in the thoracic spine.

Degenerative Conditions

Generalized wear and tear or post-traumatic arthritis can affect the vertebrae, discs, facet joints, costotransverse joints, spinal canal, and spinal cord leading to a thoracic spine “lesion”. 

Tumors And Cysts

Benign or malignant tumors do occur in the thoracic spine. The most common malignant tumors in the spine are spinal gliomas, ependymomas, and Astrocytic tumors of the spinal cord. (1). Vertebral hemangiomas are the most common benign.  Metastases from other primary cancers can also occur creating a lesion in the thoracic spine.

Inflammatory Conditions

Congenital Abnormalities

Common thoracic abnormalities include kyphosis, lordosis, scoliosis, and spina bifida. The two most common chest wall deformities in the thoracic spine include pectus excavatum and pectus carinatum.

Postural Issues

Poor posture, rounding of the shoulders, head forward posture, and extensive screen time can all lead to injury of the thoracic discs, facet joints, costotransverse joint, and musculature potentially leading to ‘lesion in the thoracic spine”.

Diagnostic Methods For Thoracic Spine Lesions

• Radiographic Studies: Radiographic tests are essential and may include:
  • X-ray: Low-cost and readily available, X-rays provide an image of the bones and can reveal fractures, dislocation, osteoporosis, and deformities like scoliosis and kyphosis.  It is often the first-line diagnostic tool used to evaluate spinal conditions. Low amount of radiation exposure.  
  • MRI:  The best option for the diagnosis of a lesion in the thoracic spine is an MRI which provides a 3d image of the bones and soft tissues that include muscle, tendons, blood vessels, nerves, discs, and thoracic joints. MRI uses a combination of magnetic fields and radio waves to create dynamic 3d images that do not use any radiation.  

What Are The Common Treatments For Thoracic Spine Lesions?

Treatment depends upon the specific type of lesion and its severity. When appropriate, conservative care should be the first-line treatment. Common treatments include: 

• Medications: NSAID, muscle relaxants, oral steroids, and oral narcotics. 
• Physical Therapy: PT can provide a significant role in the treatment of lesions in the thoracic spine by addressing pain, improving mobility, and restoring function.  
• Surgical Treatments: When conservative care and injections have failed to provide significant and sustained relief, patients may be referred for a surgical consultation. The specific surgery is dependent upon the type of thoracic spine lesion and its severity. 

The Centeno-Schultz Clinic Approach

Regenerative treatment options aim to facilitate the healing and repair of damaged or injured tissue by using a patient’s own cells.  This is a viable treatment alternative to both traditional pain injections and surgery in many cases. Traditional pain injections use different techniques that only address the symptoms and not the underlying injuries.  

For example, traditional pain clinics use high-dose steroid injections to reduce the inflammation which has many side effects and may aggravate the underlying condition. Radiofrequency ablation cauterizes the nerve that transmits the pain signal from an injured thoracic facet joint to the brain thereby reducing the pain but not addressing the underlying facet injury.  

Regenerative treatment options involve a functional spine approach (FSU) which is comprehensive in nature acknowledging that all the different parts of the spine work together in a highly synchronized fashion. 

Injections are performed under X-ray or ultrasound guidance to ensure the injected cells are precisely placed into the targeted structures and not into potentially life-threatening areas such as the lungs or heart. 

Bone Marrow Concentrate Containing Your Body’s Own Stem Cells

Bone marrow concentrate is extracted from the iliac crest and processed at the Centeno-Schultz Clinic to provide a customized treatment plan. Bone marrow concentrate is rich in many different cells including stem cells which can accelerate healing thereby reducing pain and increasing function.

Platelet-Rich Plasma (PRP)

Platelets are cells within our blood that are powerhouses of healing.  They play a critical role in clot formation. They also have a large number of growth factors that can decrease inflammation and improve blood flow.  

PRP injections super concentrate a patient’s platelets which can then be injected into a lesion in the thoracic spine to promote healing. PRP injections are a viable alternative to traditional pain injections. They can address and treat the underlying injury as opposed to masking the symptoms.  

Embrace Optimal Spine Health

A thoracic spine lesion is an abnormality in the spine, adjacent tissue, or spinal cord.  It may occur in the thoracic vertebral body, disc, facet joint, costotransverse joint, spinal canal, neuroforamen, or spinal cord. 

Symptoms include pain, weakness, restriction in range of motion or numbness. Common causes of lesions of the thoracic spine include trauma, degenerative conditions, tumors, cysts, inflammatory conditions, congenital abnormalities, and postural issues. 

Diagnosis includes medical history, detailed physical examination, and radiographic imaging. Treatment options depend upon the location of the lesion and its severity. When appropriate conservative treatment should always be the first line treatment of choice.  

PRP and bone marrow concentrate in many cases are viable treatment alternatives to potentially addicting medications or life-changing thoracic surgery. 

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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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References

1. Kumar N, Tan WLB, Wei W, Vellayappan BA. An overview of the tumors affecting the spine-inside to out. Neurooncol Pract. 2020 Nov 18;7(Suppl 1):i10-i17. doi: 10.1093/nop/npaa049. PMID: 33299569; PMCID: PMC7705529.