Thoracic Disc Herniations are especially difficult because there aren’t as many treatments available as there are for disc herniations in other areas of the spine. To understand Thoracic Disc Herniations, though, we first need to cover thoracic spine anatomy and function.
Thoracic Spine Anatomy and Function
Your thoracic spine is the section of the spine that connects your neck (cervical spine) to your low back (lumbar spine). It is made up of bones called vertebrae that are stacked on top of each other with a disc (cushion) sandwiched between the bones. Your discs act as shock absorbers and allow the spine to be flexible (1). You have one disc between each vertebra in your spine. There are 12 thoracic vertebrae with 11 thoracic discs between each vertebra.
The thoracic spine has 2 major functions: 1, to protect your spinal cord and 2, to anchor your rib cage to your spine (1). Thoracic discs are made up of 2 types of tissue: 1, the Nucleus Pulposus (NP) and 2, the Annulus Fibrosus (AF) (2). The annulus fibrosus consists of several layers of fibrocartilage made up of both type I and type II collagen. This gives the disc its strength. Nucleus pulposus is the inner core of the vertebral disc. The core is composed of a jelly-like material that consists of mainly water, as well as a loose network of collagen fibers (3). As seen below, you can think of a disc anatomy like a jelly doughnut where the dough on the outside is the AF and the jelly in the middle is the NP.
What Causes Thoracic Disc Herniations?
Discs can be damaged in many ways (4):
- Traumatic – which is the most common cause of thoracic disc injuries (such as car accident or contact sports) (7)
- Genetic issues (example) – Ehlers Danlos syndrome, a genetic defect that makes weakened collagen fibers in the disc. This makes them weaker and easily injured) (5)
- Age related changes – (with time disc becomes weaker over time and can become damaged) (6)
- Posture related – (scoliosis or increased curve called “kyphosis” aka slouching. Places increased stress on the disc resulting in repetitive trauma and eventual damage (8)
What Are the Symptoms of Thoracic Disc Herniations?
While not all thoracic disc herniations are symptomatic, when they are, they can create a number of different symptoms ranging from upper back pain, mid back pain, arm pain and even groin pain!
Pain can be generated 2 different ways:
- Directly from the disc called “discogenic pain”
- Irritation of the surrounding nerve tissue called “radicular pain“
Many times thoracic disc herniations go undiagnosed for years because the pain mimics many different conditions such as heart attacks, gall bladder problems, stomach or other abdominal problems. (9, 10). It might not be diagnosed until you see a specialty physician who takes the time to listen to your history about what makes it worse or better, and, is able to do a good physical exam. Then getting an MRI of the thoracic spine can be confirmatory. Here is a previous patient for whom the pain was so severe that they considered suicide! https://regenexx.com/blog/upper-back-stomach-pain/
How Do You Treat a Thoracic Herniated Disc?
With any orthopedic condition it’s important to begin with conservative treatment. Things like physical therapy, acupuncture, medications and other conservative care can be very helpful. The problem comes when all these conservative treatment options fail to resolve your pain. The next option offered would usually be corticosteroid epidurals, but looking at the research, no high levels studies exist for long term improvement using steroid epidurals (11). Here is a quick video outlining why corticosteroids actually have negative long-term detrimental side effects.
Should epidural corticosteroids fail to give relief surgery is generally offered as the only other option. While surgery is an option, it should only be used if all else fails. The biggest problem with surgery, is the complication rate is as high as 35%! This is not surprising given the high value real estate near in the thoracic spine: lungs, many large blood vessels, spinal cord, rib cage and other vital structures. Complications from surgery can be life threatening. These complications include things like, infections, re-herniation of disc, persistent pain, further degeneration of the disc and spinal cord or nerve injury. Some complications do not show up until after surgery. Some show up quickly and some may take months to become evident (12).
Is There a Better Option?
We have been utilizing regenerative medicine for the treatment of spine disease since 2005 and have been able to help patients’ symptoms and avoid the need for surgery! We use platelet base procedures such as platelet lysate epidurals as a regenerative medicine replacement of high dose corticosteroid epidurals. What is platelet lysate and how can this help? Dr Centeno has explained this in a blog previously. If this helps but you are still having issues, using a precise image guided stem cell containing injection can possibly help the disc to heal without the need for more invasive surgery!
1. Newell N, Little JP, Christou A, Adams MA, Adam CJ, Masouros SD. Biomechanics of the human intervertebral disc: A review of testing techniques and results. J Mech Behav Biomed Mater. 2017;69:420-34. https://www.ncbi.nlm.nih.gov/pubmed/28262607
2. González Martínez E, García-Cosamalón J, Cosamalón-Gan I, Esteban Blanco M, García-Suarez O, Vega JA. [Biology and mechanobiology of the intervertebral disc]. Neurocirugia (Astur). 2017;28(3):135-40. https://www.ncbi.nlm.nih.gov/pubmed/28130014
3. Iatridis JC, MacLean JJ, Roughley PJ, Alini M. Effects of mechanical loading on intervertebral disc metabolism in vivo. J Bone Joint Surg Am. 2006;88 Suppl 2:41-6. https://www.ncbi.nlm.nih.gov/pubmed/16595442
4. Bowles RD, Setton LA. Biomaterials for intervertebral disc regeneration and repair. Biomaterials. 2017;129:54-67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5627607/
5. Tinkle B, Castori M, Berglund B, et al. Hypermobile Ehlers-Danlos syndrome (a.k.a. Ehlers-Danlos syndrome Type III and Ehlers-Danlos syndrome hypermobility type): Clinical description and natural history. Am J Med Genet C Semin Med Genet. 2017;175(1):48-69.
6. Vergroesen PP, Kingma I, Emanuel KS, et al. Mechanics and biology in intervertebral disc degeneration: a vicious circle. Osteoarthr Cartil. 2015;23(7):1057-70. https://www.ncbi.nlm.nih.gov/pubmed/25827971
7. Ahmet Ö, Orkun K, Onur Y, Mesut Y, Sedat D. Traumatic Sequestrated Thoracic Disc Herniation; A Case Report. Turk Neurosurg. 10.5137/1019-5149.JTN.23504-18.3 https://www.ncbi.nlm.nih.gov/pubmed/30649791
8. Meir A, McNally DS, Fairbank JC, Jones D, Urban JP. The internal pressure and stress environment of the scoliotic intervertebral disc–a review. Proc Inst Mech Eng H. 2008;222(2):209-19. https://www.ncbi.nlm.nih.gov/pubmed/18441756
9. Singh V, Manchikanti L, Onyewu O, et al. An update of the appraisal of the accuracy of thoracic discography as a diagnostic test for chronic spinal pain. Pain Physician. 2012;15(6):E757-75. https://www.ncbi.nlm.nih.gov/pubmed/23159975
10. O’Connor RC, Andary MT, Russo RB, DeLano M. Thoracic radiculopathy. Phys Med Rehabil Clin N Am. 2002;13(3):623-44, viii. https://www.ncbi.nlm.nih.gov/pubmed/12380552
11. Benyamin RM, Wang VC, Vallejo R, Singh V, Helm Ii S. A systematic evaluation of thoracic interlaminar epidural injections. Pain Physician. 2012;15(4):E497-514. https://www.ncbi.nlm.nih.gov/pubmed/22828696
12. McCormick WE, Will SF, Benzel EC. Surgery for thoracic disc disease. Complication avoidance: overview and management. Neurosurg Focus. 2000;9(4):e13. https://www.ncbi.nlm.nih.gov/pubmed/29225115