Thoracic Degenerative Disc Disease

What Is Degenerative Disc Disease In The Thoracic Spine?

Degenerative disc disease is a clinical condition that refers to the gradual deterioration of the discs located in the thoracic spine and the associated symptoms.  Pain, weakness, muscle spasms, and restriction in range of motion are common. Degenerative disc disease can occur at each level of the spine:  cervical, thoracic, and lumbar.  Studies have demonstrated that degenerative disc disease in the thoracic spine most commonly occurs in the third to fourth decades (1) and occurs most frequently in the lower thoracic segments from T7-T12 (2).  

Stages Of Thoracic Disc Degeneration In The Thoracic Spine

Thoracic degenerative disc disease has four main stages that start with mild symptoms and progress in severity 

Stage 1: Dysfunction

In stage 1 the affected thoracic disease fails to properly function as a shock absorber.  Signs and symptoms include loss of spinal curve and intermittent mild thoracic pain. 

Stage 2: Instability

In stage 2 there is continued loss of disc function. The affected discs lose some of the height and signal on MRI as the water content within the disc decreases. As the height of the disc decreases the thoracic ligaments which support the spine become lax creating instability.  This makes the discs and facet joints more susceptible to injury.  Pain and dysfunction typically increase. 

Stage 3: Restabilization 

In stage 3 disc degeneration, facet overload, and ligament laxity continues. This results in significant thoracic spine instability.  The body responds to this instability by forming bone spurs.  The bone spurs are the body’s attempt to create stability. Pain and dysfunction increase.

Stage 4:  Collapse

Stage 4 is the final stage of thoracic degenerative disc disease.  It is characterized by advanced disc injury leaving little shock absorber between the boney building blocks of the spine (vertebral bodies).  The vertebral bodies may begin to fuse.  Pain and dysfunction continue to increase. 

How Thoracic Disc Degeneration Causes Pain

Thoracic disc degeneration refers to the gradual deterioration of the discs located in the thoracic region of the spine.  The discs act as cushions between the vertebrae and help to absorb shock, distribute weight and facilitate movement. When the discs degenerate they can lead to various symptoms including pain.

The pain associated with thoracic disc degeneration can arise from many different sources that include:

Discs

The thoracic disc is rich in nerve fibers that can cause pain.  A disc herniation or annular tear can release highly inflammatory chemicals into the spinal canal creating pain and dysfunction. 

Thoracic Facet

A pair joint occurs at each level of the thoracic spine.  As the discs degenerate and fail, the facet joint becomes overloaded and is susceptible to injury, degeneration, and a source of significant thoracic pain. 

Ligament Instability

As the thoracic discs become smaller the supporting ligaments become loose.  This instability can lead to thoracic pain. 

Nerve Root Irritation or Compression

A thoracic disc protrusion or herniation can irritate or compress an existing nerve leading to significant pain. 

Spinal Cord

A thoracic disc protrusion or herniation may also extend into the spinal canal.  If it narrows the spinal canal in many cases there is irritation or compression of the spinal cord with resultant pain and lower extremity weakness. 

Common Symptoms Of Thoracic DDD

Thoracic degenerative disc disease is a progressive condition characterized by the gradual deterioration of the discs in the thoracic spine. As the discs degenerate there are a number of symptoms that include. 

Chronic Pain Radiating Toward The Ribs Or Chest Wall

Disc degeneration can lead to disc protrusions or herniations.  If the disc injury causes irritation or compression of one or more of the intercostal nerves a patient may have chronic pain radiating toward the rib or chest wall.  It can be an unrelenting burning type of pain that does not respond to NSAIDs or opioids.  To learn more about thoracic spine pain click here. 

Severe Episodes Of Pain Lasting For Weeks Or Months

The pain associated with thoracic degenerative disc disease can start out as mild and infrequent and progress in severity and duration ultimately becoming chronic. 

Pain That Worsens When Sitting, Lifting, Bending, Or Twisting

Thoracic degenerative disc disease can lead to a variety of different symptoms including pain that worsens when sitting, lifting, bending, or twisting. 

Sporadic Tingling Or Weakness

Thoracic disc degeneration may cause irritation or compression of exiting nerves which can cause numbness, tingling, or weakness.  These symptoms may remain stable or can progress requiring urgent medical attention. 

Muscle Spasms

Muscle spasms are common in thoracic degenerative disc disease and are due to disc irritation, leakage of inflammatory agents from the disc, facet arthritis, or irritation of exiting nerves

Spinal Stenosis (in severe cases)

Spinal stenosis is a medical condition in which the spaces within the spinal canal narrow putting pressure on the spinal cord and nerve roots.  To learn more about spinal stenosis please click here.  

Common Causes Of DDD In The Thoracic

Thoracic degenerative disc disease is a progressive condition characterized by the gradual deterioration of the discs in the thoracic spine.  The thoracic disc is composed of the gelatinous center called the nucleus pulpous and the strong outer side wall call the annuls fibrous (3).  Because the thoracic disc has a very poor blood supply it can be affected by many factors.

The degenerative process involves the structural damage of the disc itself along with changes in the cells.  The gelatinous center of the disc becomes stiffer and less able to absorb the daily forces of living.  The outer sidewall ( annulus) weakens and becomes more susceptible to bulges or herniation.  The most common causes of degenerative disc disease in the thoracic spine are (4):

• Aging
• Lifestyle Factors
• Autoimmune Factors
• Heavy And Strenuous Activity
• Injury And Trauma
• Disc Herniation

How Is It Diagnosed?

Thoracic degenerative disc disease is typically mild in the early stages and difficult to diagnose.  There are a large number of vital structures within the thoracic space that include the heart, lungs, liver, and kidneys.  These structures are susceptible to injury and disease and can cause thoracic pain.  The diagnosis of thoracic degenerative disc disease involves the combination of findings and studies that include:

Medical History: Medical history is essential and will involve a detailed discussion of a patient’s symptoms such as pain, numbness, and weakness, as well as any medical conditions or previous injuries that may be relevant.

Physical Exams: The physical examination may include tests of sensation, muscle strength, reflexes, and range of motion, as well as palpation of the spine to identify areas of tenderness.

• X-rays
• MRIs

• CT scans  For those patients unable to undergo MRI imaging, CT scans are an alternative.  Unfortunately, they are associated with radiation exposure and may not be readily available in all communities.
• EMGs:  When nerve compression is suspected electromyography (EMG)  and nerve conduction (NCS) studies may be ordered.
• Myelogram: A myelogram is an advanced radiographic study.  It involves placing a needle into the low back followed by the injection of contrast ( dye).  The patient then undergoes a CT scan with an evaluation spinal canal and thoracic spine.  The risks for a myelogram include bleeding, infection, allergic reaction to the contrast, radiculopathy, and spinal headache( 5).

Common Treatments For Thoracic DDD

Treatments for thoracic degenerative disc disease will vary depending upon the severity of the symptoms and the presence or absence of neurologic conditions such as lower extremity numbness or weakness. The most common treatments include:

Natural Treatments For Mild Degeneration

• Rest
• Ice
• Moist Heat
• Exercise
• Supports

Non-Surgical Interventions For Moderate To Severe Degeneration

Steroids are a common treatment for thoracic degenerative disc disease when conservative treatment fails.  Steroids can be administered orally or injected.  Oral steroids are commonly referred to as dose pack and include 21 tablets that are tapered over several days. Steroids can also be injected into the muscle where after being absorbed into the bloodstream they provide a widespread reduction in inflammation.  Common examples include Solumedrol, Betamethasone, and Decadron. 

When conservative therapy fails to provide significant or sustained benefit patients may be referred for thoracic epidural steroid injections.  This is a medical procedure in which powerful anti-inflammatory agents are injected through a needle into the area of tissue injury or damage. The procedures are typically performed in an ambulatory surgery center or pain clinic.  Thoracic spine steroid injections are complex procedures that your local orthopedic doctor or PCP can not perform.  There are risks which include bleeding, infection, failure, and injury to the lung.  To learn more about steroid injections please click here.

NSAIDs

The other day I was evaluating a patient and reviewing the treatment options for their spine condition.  After discussing prior treatments, we got to the topic of medications taken for pain relief. She explained that she mainly utilized anti-inflammatory (NSAID) medications and then she told me to hold much she takes and has been for many years…..she takes close to 2 grams (2000 milligrams) on a daily basis which equated to about 9-10 capsules of medication per day.  I was shocked, considering she was pre-diabetic and with high blood pressure plus the kicker of it is that her PCP (primary care physician) is ok with this…

Read More About NSAIDs

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

Disc Replacement Surgery

The surgeon first accesses the spinal column (for example, in the cervical spine, the surgeon would access the spine through an incision in the front of the neck). From here the surgery is quite aggressive as the disc is scraped and chiseled out of the disc space. Pins are screwed into the vertebrae above and below the disc space that will anchor the space in place as the surgeon works. A tool is inserted into the disc space and used to further separate the upper and lower vertebrae, enlarging the space. The vertebrae surfaces within the disc space are prepared…

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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

Are There Alternative Treatment Options For Thoracic DDD?

Orthobiologics are an exciting treatment option for thoracic degenerative disc disease.  It involves the use of your own body’s resources to aid in tissue repair and reduction in inflammation.  The two most common and effective treatments include PRP and bone marrow concentrate.  Both treatments are not associated with the significant side effects of steroid injections and surgery. 

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

Prolotherapy Injections

It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…

Read More About Prolotherapy Injections

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

Prolotherapy For Thoracic Pain

Prolotherapy is an injection based regenerative therapy used in the treatment of ligament, tendon, muscle and spine injuries. It is minimally invasive and involves the injection of an irritant such as dextrose into the damaged or painful area. The injected irritant stimulates a delayed or frozen healing cycle thereby increasing blood flow and tissue healing. The thoracic spine is that section of the spine that is below the neck and above the low back. It is also referred to as the mid back. It has multiple components that include: Vertebral Bodies: Boney building blocks that stack one upon another…

Read More About Prolotherapy For Thoracic Pain

Get The Best Treatment For Thoracic DDD

Thoracic degenerative disc disease is a clinical condition that refers to the gradual deterioration of the discs in the thoracic spine. Pain, weakness, and limited movement are common.  There are 4 stages of thoracic disc degeneration. Pain associated with thoracic degenerative disc disease can arise from many different structures including the disc, thoracic facet, lax ligaments, nerve root irritation, and irritation or compression of the spinal cord. There a number of causes of degenerative disc disease in the thoracic spine that include injury to the disc, aging, lifestyle factors, autoimmune, injury, trauma, and disc herniation. 

If you or a loved one are experiencing symptoms of thoracic degenerative disc disease, it’s important to take action now. This condition is progressive in nature and can cause debilitating pain and limit your ability to perform everyday tasks. Don’t let it control your life any longer.  The Centeno-Schultz Clinic are experts in the evaluation and treatment of thoracic spine conditions.  A board-certified, fellowship-trained physician can review your past medical history, current symptoms, and radiographic studies in the office or digitally.  PRP and bone marrow concentrate are treatment options that are injected under x-ray or ultrasound guidance. 

Securing an accurate diagnosis is key as it allows for the proper treatment plan created.  With the proper treatment plan, patients can realize their best clinical outcomes while avoiding the side effects of steroids and the significant risks of thoracic surgery.   To schedule please contact Jen at 720-287-7196 or [email protected] or Vanessa at [email protected].

Our Doctors

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

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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