What is thoracic myelopathy?
The thorax is the medical term for the space between your neck and abdomen. The thorax is the place where your chest and ribs are located.
Myelin is the substance that forms a whitish sheath around nerve fibers of your spine.
“-pathy” is a latin suffix for “disorder”
Putting them together, thoracic myelopathy, refers to a disorder where the middle area of the spinal cord (thorax) is compressed.
What causes thoracic myelopathy?
Thoracic myelopathy is caused by compression of the spinal cord in the thoracic region. The most common causes are bulging or herniated intervertebral discs, bone spurs, or spinal trauma. It may also be caused when there is spinal stenosis, or narrowing of the bony passageways of the spine where nerves travel. In rare cases, it may be caused by cancer or autoimmune diseases such as rheumatoid arthritis.
What symptoms can it cause?
Symptoms of thoracic spinal stenosis include
- neck pain
- neck stiffness
- numbness in the shoulders, arms, or hands
- an electric shock pain shooting down your legs
- feeling as though your foot is dropping or slapping on the ground
- difficulty with normal standing or walking in a straight line
- urinary or stool incontinence
How is it Diagnosed?
Thoracic myelopathy may be diagnosed with:
- X rays: This allows Dr. Webb to determine if there are any structural reasons that may be the cause of your myelopathy such as fractures or tumors.
- Magnetic resonance imaging (MRI): this allows Dr. Webb to see detailed images of your spinal cord and its associated nerves.
- Electrical tests: These are exams such as electromyogram or somatosensory evoked potentials which check to see how well your nerves are functioning.
How may it be treated?
There are three levels of treatment Dr. Webb uses to treat patients with thoracic myelopathy. Some patients may only need conservative management, while others, due to their emergent nature, may require the urgent surgery.
Most patients are able to be managed with conservative treatment only, namely pain medications and/or injections. If this fails to alleviate the pain or if you have progressive muscle weakness, problems with your gait, bowel, or bladder then surgery may be recommended.
Note: Conservative treatment and injections do not treat or cure the underlying cause of your compression. They ONLY help manage the symptoms, which is what allows you to live your normal life. Only surgery is able to definitively treat the cause of the problem.
Level I – Non-operative/Conservative treatment
- Oral Pain medications
- Oral Steroid medications
- Physical therapy
- Chiropractic therapy
- Activity modification
Level II – Injections
- Epidural steroid injections
- Outpatient procedures
- Done with x-ray guidance
- 1-3 injections may be needed
Level III: Surgery
- Spinal decompression – in this procedure, Dr. Webb will remove the cause of your thoracic myelopathy and source of the compression. This procedure sometimes also requires a fusion.