Understanding Thoracic Spondylosis

Spondylosis is a medical term that refers to a degenerative condition affecting the spine. It is a common condition that occurs because of wear and tear in the spine, typically due to aging or injury. Spondylosis can affect any part of the spine.

What is Thoracic Spondylosis?

The thoracic spine, also known as the mid back, is that portion of the spine that is below the cervical spine (neck) and above the lumbar spine (low back). Thoracic spondylosis is a degenerative condition of the thoracic spine.

The thoracic spine, also known as the mid back, is composed of many important different structures that work together to provide stability and movement.

The major components include:

Vertebrae: 12 boney building blocks that stack one upon another.
Thoracic Disc: 12 fibrocartilaginous cushions sandwiched between the vertebrae that act as shock absorbers.
Thoracic Joints: 3 important joints: thoracic facets, thoracic costotransverse and costovertebral
Thoracic Muscles: three principal layers: superficial, intermediate and deep muscles.
Thoracic Ligaments: multiple dense bands of connective tissue that hold bones together. Think of them as duct tape for the body.
Thoracic Nerves: Multiple nerves that are responsible for sending and receiving signals from the muscles, skin, and organs in the chest and upper abdomen.

Causes And Risk Factors Of Thoracic Spondylosis

Thoracic spondylosis is a degenerative condition affecting the middle region of the spine, known as the thoracic spine. The major causes include:

Aging

With age, there is a generalized wear and tear on the thoracic spine. The discs lose their water content and become less flexible. They also tend to become smaller in size which can lead to the development of bone spurs, nerve root irritation, facet joint arthritis, and ligament laxity (1).

Genetics

Some people may be more prone to developing thoracic spondylosis due to genetic factors.

Poor Posture

Poor posture for extended periods can cause excessive stress on the thoracic vertebrae, discs, facet joints, and ligaments and can lead to the development of thoracic spondylosis.

Repetitive Strain

Activities that involve repetitive movement or heavy lifting can cause wear and tear on the spine, leading to spondylosis.

Trauma

Trauma to the spine, such as a fall or car accident, can cause damage to the thoracic disc, facet joints, and ligaments and this can lead to spondylosis (2).

Symptoms Of Spondylosis Of The Thoracic

Thoracic spondylosis is a degenerative condition that affects the thoracic spine. Symptoms can be mild, moderate, or severe depending upon the location and severity of degenerative changes. The most common symptoms associated with thoracic spondylosis include:

Back Pain

One of the major symptoms of spondylosis of the thoracic spine is mid back pain. The pain can be intermittent or constant. It can be isolated to one side or may involve both sides of the spine.

The severity of the pain is dependent upon many factors that include the location and severity of the degenerative changes. The back pain can be dull and throbbing or electrical and stabbing. It may be localized along the spine or can radiate across the chest wall or into the abdomen.

Stiffness

Stiffness is common in patients with thoracic spondylosis as the disc’s lose their water content and ability to act as shock absorbers. The forces of daily living are then transferred to the vertebrae bodies, posterior facet joints, and supporting ligaments. The resulting pressure and inflammation can cause symptoms like pain, stiffness, and restricted range of motion.

Tingling or numbness

Tingling and numbness are common symptoms associated with thoracic spondylosis. The thoracic discs can become injured with a loss in disc height or disc protrusions. Disc injuries in turn can cause compression of the nerves in the thoracic spine, leading to a sensation of tingling and numbness in the affected area.

As the condition progresses, the numbness may spread to other parts of the body, such as the arms, legs, and hands. In severe cases, thoracic spondylosis can also lead to muscle weakness, loss of balance, and difficulty walking.

Diagnosis Of Thoracic Spondylosis

The diagnosis of thoracic spondylosis usually involves a combination of medical history, physical examination, and radiographic imaging tests.

Important questions during the medical history include onset of symptoms, triggering events, location of pain, numbness and tingling, aggravating factors and alleviating factors. Other important questions include past medical and surgical history and current medications.

During physical examination the doctor will evaluate a patient’s range of motion, muscle strength, reflexes, and sensation to light touch and pin prick.

Imaging tests are most often used to confirm the diagnosis for thoracic spondylosis. Thoracic x-rays are beneficial as they are widely available, low cost, with little radiation exposure. X-rays provide detailed images of the bony structures of the spine and can identify bone spurs, fractures, and injury to the disc.

Unfortunately, they do not provide detailed information on the discs, facet joint, ligaments, tendons, nerves, or the spinal cord.

MRI is the gold standard in the diagnosis of thoracic spondylosis (3). MRI uses a powerful magnetic field and radio waves to produce detailed images of the body. Thoracic MRI clearly details the spinal cord, spinal nerves, discs, ligaments, and tendons and can detect both large and small abnormalities.

Common Treatment Options

Thoracic spondylosis is a degenerative condition that affects the thoracic spine. It can cause pain, stiffness, restricted range of motion, and numbness and tingling in the extremities. Treatment options include conservative therapy, medications, injections and in severe cases possibly surgery. When appropriate, the first line of treatment should be conservative care.

The best treatment option depends on many factors which include the severity of the spondylosis, a patient’s symptoms, past medical condition, current medications and access to treatment. The most common treatment options include:

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…

Cervical Epidural Steroid Injection

The neck pain started out as a dull ache but steadily progressed. It becomes constant and oftentimes keeps you up at night. Turning your head can send an electrical current down your arm. Rest, medications and physical therapy failed to provide much relief. Your doctor referred you to a pain clinic for a Cervical Epidural steroid injection. The injection was performed at an ambulatory surgical center. Unfortunately, the pain is now worse. What is a Cervical Epidural injection? Are there different types of Cervical Epidural injections? What are…

Graston Technique

The Graston Technique® (GT) is a manual therapy used to diagnose and treat soft tissue injuries and pain. It involves using handheld instruments that allow clinicians to detect and treat scar tissue and adhesions in muscles, tendons, and ligaments. It is usually performed to increase the range of motion of the soft tissues, especially after a soft tissue injury. It can be used to treat a variety of conditions, including tendinitis, plantar fasciitis, carpal tunnel syndrome, and rotator cuff injuries. Short-term studies have shown that it successfully improves the range of motion with around six treatments for the ankle and elbow (1)…

Surgery

Patients that fail to get significant or sustained benefit from conservative care, medications, and steroid injections are often referred for surgical consultation. Surgery should be the last option given the significant complications and complex anatomy. The exception are those patients with progressive neurologic deficits such as weakness, numbness, or tingling in the arms or legs.

Surgery may also be considered in cases of spinal instability that are threatening an individual’s quality of life. The most common surgeries include thoracic laminectomy, thoracic discectomy, and fusion. All are major surgeries with significant and potentially permanent complications which have been discussed in a previous blog.

Regenerative Options For Thoracic Spondylosis

At the Centeno-Schultz Clinic, regenerative treatment options are available for the treatment of thoracic spine injuries including thoracic spondylosis. Regenerative treatment options utilize the healing potential of your body’s own cells.

Treatment options include bone marrow concentrate, prolotherapy and PRP. All injections are customized and performed under ultrasound or x-ray guidance. Regenerative treatment options allow patients to forgo the toxicity of steroids, the potential dependence of medications, and complications of surgery.

Bone Marrow Aspirate Concentrate

Bone marrow aspirate also known as Regenexx SD is a procedure in which bone marrow is harvested from a patient, processed in the state of art cell laboratory, and injected in the area of tissue damage. Bone marrow concentrate contains stem cells.

These repair cells live inside all of us and are poised to leap into action to repair damage as it occurs. The bone marrow concentrate is customized for each patient in the lab as opposed to using the “one size fits all” approach commonly used by many stem cell clinics.

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…

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…

Experience The Centeno-Schultz Difference

Thoracic spondylosis is a degenerative condition of the thoracic spine. It can affect the thoracic vertebrae, discs, thoracic joints, muscles, ligaments, nerves, and spinal cord.

Major causes include aging, genetics, poor posture, repetitive sprain, and trauma. Symptoms include pain, stiffness, restriction in range of motion, tingling, and numbness.

Diagnosis involves medical history, physical examination, and radiographic imaging tests. MRI is the gold standard as it allows for clear visualization of the discs, facet joints, ligaments, tendons, spinal cord, and nerves.

Conservative care when appropriate should always be first line treatment. Other options include medications and steroid injections. Thoracic spine surgery is major surgery and associated with significant risks. It may be indicated in patients with progressive neurologic symptoms or instability.

Regenerative treatments include bone marrow concentrate, prolotherapy, and PRP which allows patients to use their own healing cells and avoid the risks of steroids, medications, and potentially surgery.

At the Centeno-Schultz Clinic we are experts in the evaluation and treatment of thoracic spine injuries. Board certified, fellowship trained physicians can evaluate your candidacy for regenerative, non-surgical treatment options.

Thoracic pain is poorly understood and oftentimes mismanaged. Come to the experts and learn which regenerative treatments are best for you or a loved one.

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.Lauerman, W. C., & Stetkarova, I. (2018). Age-related changes in the spine: a review of spinal pathology through the human life span. The American Journal of Orthopedics, 47(12).

2.Furlan, J. C., Catharine Craven, B., Fehlings, M. G., & Shannon, P. (2006). Spondylotic myelopathy: a clinical and radiological evaluation of the consequences of traumatic injury. Journal of Neurology, Neurosurgery & Psychiatry, 77(7), 944-947.

3.Ahn SH, Ahn MW, Byun WM. Effectiveness of magnetic resonance imaging in diagnosing thoracic myelopathy caused by thoracic spondylosis. Int Orthop. 2003;27(3):152-154. doi:10.1007/s00264-002-0402-9