Your mid back pain has been unrelenting since the accident. Rest, medications, and physical therapy have failed to provide significant or sustained benefits. Your doctor thinks you have a thoracic disc herniation and thinks you have a thoracic herniated disc. What are the symptoms? And what can you do? Let’s dig in.
What Is A Thoracic Herniated Disc?
A thoracic herniated disc is a serious medical condition in which the soft gelatinous center of the thoracic disc is forcibly pushed out into the spinal canal. The extruded disc can irritate or compress the spinal cord or thoracic spinal nerves causing pain, restriction in range of motion, and potentially serious neurologic symptoms such as lower extremity weakness and loss of bowel and bladder control. A disc herniation can occur at all levels of the spine: cervical (neck), thoracic, and lumbar (low back).
What Are The Symptoms Of the Condition?
The symptoms associated with a thoracic herniated disc can vary depending on the size and location of the herniated disc. Pain is the most common symptom however if there is irritation or compression of the spinal cord or spinal nerves other symptoms can occur as discussed below.
Here’s a video all about the symptoms of thoracic disc herniation:
The most common symptoms include:
Pain In The Thoracic Region
The pain associated with a thoracic disc herniation can vary in intensity and location depending upon the severity and the location of the disc herniation. Pain may be localized in the mid-back (thoracic spine) or can radiate across the chest wall and into the abdomen (1). 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.
Radiating Pain In The Arms Or Legs
A thoracic herniated disc can put pressure on the spinal cord causing potentially significant neurologic symptoms. These include radiating pain in the arms or legs (2).
Numbness And Tingling
A thoracic herniated disc can put pressure on the spinal cord or thoracic spinal nerves. Patients often complain of numbness and tingling in their arms or legs. Similar to the feeling when your extremity falls asleep after prolonged sitting or awkward positions.
Muscle Weakness
Pressure on the spinal cord or thoracic spinal nerves can result in muscle weakness. Depending upon the size and location of the thoracic disc herniation the muscle weakness may be gradual or abrupt in onset.
Loss Of Bladder Or Bowel Control
A thoracic disc herniation can cause loss of bowel and bladder control when the herniated disc presses on the spinal cord or nerves that control these functions. This can disrupt the normal communication between the brain and the bowel/bladder muscles, leading to problems with controlling bowel or bladder movements (3). In severe cases, this can result in complete loss of bowel and bladder control, which requires immediate medical attention.
Calf Muscle Twitching
A thoracic disc herniation can cause calf muscle twitching when the herniated disc compresses the spinal cord or nerves that control the muscles in the calf. This can result in abnormal signals being sent to the calf muscles, causing them to twitch involuntarily. The twitching may be accompanied by other symptoms such as pain, numbness, or weakness in the legs.
What Causes A Thoracic Disc Herniation?
Thoracic disc herniations account for less than 1% of all disc injuries (4). The majority of disc herniations occur below the T8 level (5). The two major causes of thoracic disc herniation are:
Degenerative Disc Disease
Degenerative disc disease is a medical condition in which the spinal discs gradually break down and lose their ability to cushion the vertebrae leading to pain and dysfunction. As the thoracic discs degenerate, they also become more prone to herniation. Repetitive motions or heavy lifting can accelerate the degenerative changes leading to disc herniation.
Injury or Trauma
Injury and trauma can cause thoracic disc herniation by placing sudden and excessive force on the spine. These forces can cause the disc in the thoracic spine to bulge or herniate. Examples of injuries and trauma that can cause thoracic disc herniation to include falls, car accidents, and sports injuries.
Factors That Contribute To A Herniated Thoracic Disc
A herniated thoracic disc can be caused by a variety of factors, including degenerative disc, trauma, or injury to the spine. Other factors that may increase the risk of developing a thoracic herniated disc include repetitive motions, heavy lifting, genetics, and increased BMI. The major factors that contribute to a herniated thoracic disc include:
- Age: frequency varies directly with age (6). This is due to age-related degenerative disc changes characterized by loss of water content and diminished disc flexibility.
- Genetics: current studies demonstrate that genetic factors are important contributors to the onset and progression of disc degeneration (7)
- Obesity: there is limited research on the correlation between obesity and thoracic disc herniation, but some studies suggest that there may be a link. A 2015 study demonstrated that obesity was significantly associated with thoracic disc herniation (8). Obesity can put extra pressure on the spine and discs making them susceptible to injury.
- Lifestyle: smoking, heavy physical workloads, and sedentary lifestyles have all been associated with an increased risk of a herniated thoracic disc (9).
How Is A Thoracic Disc Herniation Diagnosed?
The diagnosis of thoracic disc herniation typically involves a combination of patient history, physical examination, imaging tests such as MRI or CT scans, and neurological tests. The aim of diagnosis is to accurately identify the location and severity of the herniation to determine the most appropriate treatment plan.
Imaging Tests (CT Scan, X Rays).
X-rays may help identify the loss of height of one or more discs in the thoracic spine but are of limited value in diagnosing a thoracic disc herniation.
MRI is generally considered the best imaging test for diagnosing a thoracic disc herniation. This is because MRI provides detailed images of the soft tissues, including the spinal cord and the discs, which can help identify the location and severity of the herniation. The thoracic disc herniation may be located centrally or off to the side. It may be barely touching or compressing the spinal cord and thoracic spinal nerves. This information is essential in determining the best treatment plan.
Myelography
Myelography is a diagnostic imaging procedure that involves injecting a contrast dye into the spinal canal to visualize the spinal cord and nerve roots. It is typically performed along with a CT scan. Myelography can help diagnose a thoracic disc herniation by visualizing the spinal cord and nerve roots, which may be compressed by the herniated disc. The dye may demonstrate areas of blockage or narrowing caused by the thoracic herniated disc. Myelography is associated with radiation exposure.
Physical Examination
A physical examination can provide important information in diagnosing thoracic disc herniation, however, it is typically not sufficient to confirm that diagnosis. The examination includes assessing a patient’s reflexes, sensations, strength, and range of motion. Findings can vary depending on the location and severity of the herniation. Common findings on physical examination can include:
- Decreased feeling in the chest, abdomen, and legs
- Weakness in the legs or arms
- Changes in deep tendon reflexes
- Pain
EMG/NCS
Electromyography (EMG) and nerve conduction studies (NCS) may be helpful in the diagnosis of thoracic disc herniation, especially if the herniation is compressing a nerve root or affecting nerve function. It can help determine the location and extent of nerve damage or compression, which can aid in the diagnosis of thoracic disc herniation
Can a Thoracic Herniated Disc Heal By Itself?
In some cases, a thoracic herniated disc may heal by itself, depending upon the severity and the location of the herniation. Thoracic disc herniations are not as common as lumbar herniated discs and some are asymptomatic. Conservative care including rest, physical therapy, chiropractic care, and safe NSAIDs may be effective in managing the symptoms.
However, more severe cases of thoracic disc herniation associated with pain, restriction in motion, lower extremity weakness, and numbness typically require more aggressive treatment.
Common Surgical Procedure For Thoracic Disc Herniation
When conservative care and pain medications have failed to provide significant or sustained relief, many patients are referred for a surgical consultation. There are many different types of surgeries for thoracic disc herniations with different approaches depending upon the severity and location of the herniation along with patient symptoms. The most common surgical procedures for thoracic disc herniation include:
Thoracic Fusion
A thoracic fusion is a major surgery in which one or more of the thoracic discs are removed and replaced with bone or a spacer. The spine is then stabilized with rods, screws, and plates. The end result is two or more thoracic vertebrae permanently connected (fused). The thoracic spine is complex due to the presence of 12 ribs and its close proximity to vital organs including the lungs and heart.
Complications are significant and include failed fusion, infection, bleeding, nerve damage, spinal cord injury, blood clots, hardware fracture or migration, and adjacent segment disease.
Thoracic Discectomy
A thoracic discectomy is a major surgery that involves the removal of a portion or all of the damaged thoracic disc. The procedure is typically performed to relieve pressure on the spinal cord or spinal thoracic nerves caused by the herniated disc. It may also be performed to remove that portion of the disc thought to be causing the pain. Complications are significant and similar to those associated with thoracic fusion.
Alternative Treatment Options To Manage The Condition
When conservative treatment fails to provide significant relief there are other options to consider before surgery. Thoracic surgery is major surgery associated with significant and potentially life-changing and permanent complications. The goal of these treatments is to decrease pain, increase function and restore normal neurologic function. The most common treatment options include:
Epidural Steroid Injections
An epidural steroid injection is a medical procedure that involves the injection of a steroid into the epidural space in the spine. Steroids are powerful anti-inflammatory agents that reduce inflammation and swelling which may alleviate pain and improve mobility. Unfortunately, steroids have significant side effects that have been discussed in prior posts. Side effects include toxicity to cartilage and ligaments and compromised bone repair, endocrine system, and blood sugar.
An alternative to steroids is the use of PRP. The Centeno-Schultz Clinic are expert in the evaluation and treatment of thoracic spine injuries including thoracic disc herniations. All physicians are board certified, fellowship-trained with an extensive background in the use of PRP and bone marrow concentrate.
Thoracic epidural injections require extensive training and expertise and can not be performed by your PCP or local orthopedic surgeon. They require expertise in the anatomy of thoracic use and the use of x-ray imaging. Complications can occur and are typically associated with inexperience and lack of high-level training.
Prolotherapy
Ligaments are strong pieces of connective tissue that connect bone to bone. They provide stability for the spine. Unfortunately, ligaments can become loose due to trauma, repetitive wear, and tear, or underlying genetics. Thoracic instability can cause injury to the thoracic facets, disc, and costotransverse joint with resultant pain and dysfunction.
Prolotherapy is a treatment option for ligament laxity. It involves the injection of an irritant typically glucose along with local anesthetic into the damaged ligaments. The goal is to kick-start a delayed or frozen healing cycle. Inflammation is the first step in healing. Prolotherapy in the thoracic spine is a highly skilled procedure always performed with x-ray or ultrasound guidance.
Early Detection And Treatment Is Key
Securing an accurate diagnosis is critical to a patient’s long-term success. Treatment of symptoms is important but understanding and identifying the underlying cause is paramount. An accurate diagnosis allows for the creation of the best treatment plan. The goal is to treat the underlying problem so that you can get back to living life without restrictions.
Conclusion:
Thoracic disc herniation is a serious condition that requires prompt medical attention to manage symptoms and prevent further complications. While surgical intervention may be necessary in severe cases, the Centeno-Schultz Clinic offers a range of nonsurgical treatment options that use image guidance to place the patient’s own bone marrow concentrate and/or blood platelets to stimulate healing.
These treatments are minimally invasive and have shown promising results in reducing pain, inflammation, and promoting healing. At the Centeno-Schultz Clinic, our goal is to provide our patients with the highest quality care and individualized treatment plans to help them get back to their daily lives. If you are experiencing symptoms of thoracic disc herniation, contact us today to schedule a consultation with one of our expert physicians.
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