What Is Thoracic Disc Herniations
The thorax is the region between your neck and your abdomen. Your thoracic spine is composed of twelve bones, labeled T1-T12. This is between your cervical (upper) and lumbar (lower) spine. In between these twelve bones, there is a cushion or a disc material that serves as the “shock absorber” for the bones. When a portion of this disc material herniates, or bulges out from its usual spot, it can leak into the spinal canal and compress the spinal cord and/or nerves.
What causes thoracic disc herniation?
Thoracic disc herniation can be caused by degenerative disc disease, which occurs as people age and their discs become less flexible. Wear and tear over the years causes the spine to degenerate and break down. It may also be related to smoking, obesity, and/or caused by an injury.
What are the symptoms of a thoracic disc herniation?
The most common symptom of thoracic disc herniation is axial back or chest pain. Sometimes the pain spreads around the chest in a “band like fashion.” You may also have:
- Numbness or sensory changes
- Weakness in your arms or legs
- Problems with your bowel or bladder
- Problems with sex
- Problems with your walking
How is a thoracic disc herniation diagnosed?
A thoracic disc herniation is usually diagnosed with an MRI, which will show the disc material pressing on your spinal cord and/or nerves. Your history and physical exam will also help Dr. Webb make the diagnosis.
How is it treated?
Most thoracic disc herniations can be treated with conservative treatment including activity modifications, physical therapy, injections and/or pain medications.
Most thoracic disc herniations are able to heal on their own without surgery. This is because the disc can be resorbed and shrinks, but this process may take weeks or even months.
If the disc herniation results in bladder or bowel issues, numbness around the genital area, weakness in your arms or legs, problems with your balance and/or gait then surgery may be warranted.
Level I – Non-operative/Conservative treatment
- Pain medications
- Oral steroid medications
- Physical therapy, chiropractic therapy
- Activity modification
Level II – Spinal Injections
- Epidural steroid injections
- Outpatient procedures
- Done with x-ray guidance
- 1-3 injections may be needed
Level III: Surgery
- Transthoracic discectomy: For central or centro-lateral thoracic disc herniations, a minimally invasive approach using cameras and mini-incisions are able to remove the portion of the disc which is compressing the spinal cord. Cameras are able to view the inside of the thoracic spine, and with the aid of small scopes, the herniation may be removed. This procedure is less commonly performed these days.
- Costotransversectomy: fancy word meaning if the disc herniation is lateral (located near the outside of the spine), this may sometimes be approached from a posterolateral angle, which involves removal of a rib and transverse process to allow access to the disc space and herniation.