THORACIC CORD COMPRESSION: 

Questions and Answers

Symptoms of Thoracic Cord Compression

Thoracic cord compression occurs when the spinal cord in the thoracic region of the spine is compressed or damaged, leading to a variety of neurological symptoms. The severity of symptoms can vary depending on the underlying cause, the extent of compression, and individual patient factors. Recognizing the symptoms of thoracic cord compression is crucial for timely diagnosis and intervention. Here are the key symptoms associated with this condition:

Back Pain:

• Dull, aching pain in the mid-back region is a common symptom of thoracic cord compression.
• The pain may remain locally in the affected area or radiate along the ribs or abdomen.

Radicular Pain:

• Patients may experience shooting or burning pain that radiates along the path of the affected nerves.
• Radicular pain often extends from the thoracic spine to the chest, abdomen, or upper extremities.

Numbness and Tingling:

• Sensory disturbances such as numbness, tingling, or “pins and needles” sensations may occur in the chest, abdomen, or upper back.
• Patients may also experience altered sensation or hypersensitivity to touch in the affected areas.

Muscle Weakness:

• Weakness in the muscles of the trunk, abdomen, or lower extremities may develop as a result of impaired nerve function.
• Patients may have difficulty with activities such as walking, standing, or lifting objects.

Loss of Coordination:

• Patients may see coordination and balance problems due to disruption of signals between the brain and the muscles.
• Patients may experience clumsiness, difficulty with fine motor tasks, or a sensation of “heaviness” in the legs.

Bowel or Bladder Dysfunction:

• Compression of the thoracic spinal cord can lead to dysfunction of the bowel or bladder.
• Patients may experience urinary retention, urinary urgency, incontinence, or constipation.

Motor Impairment:

• Progressive weakness or paralysis may develop in severe cases of thoracic cord compression.
• Patients may exhibit muscle wasting, reduced muscle tone, or loss of voluntary movement.

Sensory Loss:

• Loss of sensation or decreased sensitivity to touch, temperature, or pain may occur in the affected areas.
• Patients may have difficulty discerning hot or cold temperatures and may not know of any injuries.

Spasticity:

• Increased muscle tone and spasticity may arise due to abnormal nerve signaling.
• Patients may experience muscle stiffness, involuntary muscle contractions, or difficulty with movement.

Gait Disturbances:

• Abnormalities in walking patterns, such as dragging the feet, stumbling, or difficulty with balance, may occur.
• Changes in gait may result from muscle weakness, sensory deficits, or impaired coordination.

In conclusion, thoracic cord compression can manifest with a range of symptoms affecting sensory, motor, and autonomic functions. Early recognition of these symptoms is essential for prompt diagnosis and initiation of appropriate treatment to prevent neurological complications and optimize patient outcomes. Patients experiencing any of the symptoms mentioned above should seek medical evaluation for further assessment and management.

Methods of Diagnosing Thoracic Cord Compression

Diagnosing thoracic cord compression involves a combination of clinical evaluation, imaging studies, and diagnostic tests to assess spinal cord function and identify the underlying cause of compression. Timely and accurate diagnosis is crucial for implementing appropriate treatment strategies and preventing neurological complications. Here are the key methods used in diagnosing thoracic cord compression:

Medical History and Physical Examination:

• A thorough medical history helps identify risk factors, previous injuries, and symptoms suggestive of thoracic cord compression.
• During a physical examination, the healthcare provider assesses muscle strength, reflexes, sensation, and coordination to detect neurological deficits indicative of spinal cord dysfunction.

Imaging Studies:

• MRI (Magnetic Resonance Imaging): MRI is the primary imaging modality used to visualize the spinal cord, nerve roots, and surrounding structures with high resolution.
• MRI can identify the location, extent, and severity of spinal cord compression, as well as detect abnormalities such as herniated discs, tumors, or spinal stenosis.
• CT (Computed Tomography) Scan: Doctors may authorize CT scans to provide detailed images of the bony structures of the spine and assess for fractures, bone spurs, or other abnormalities that may contribute to cord compression.
• X-rays: Doctors may authorize X-rays to evaluate the alignment of the spine and identify fractures, dislocations, or degenerative changes.

Electrodiagnostic Testing:

• Electromyography (EMG) and Nerve Conduction Studies (NCS): EMG and NCS are used to assess the electrical activity of muscles and nerves, respectively.
• These tests can help determine the extent of nerve damage, identify the location of nerve compression or injury, and differentiate between nerve root and spinal cord involvement.

CSF Analysis:

• In some cases, doctors will perform a lumbar puncture (spinal tap) to collect cerebrospinal fluid (CSF) for analysis.
• CSF analysis may help identify inflammatory or infectious causes of spinal cord compression, such as meningitis or spinal cord tumors.

Neurological Evaluation:

• Neurological assessments, including sensory testing, reflex testing, and assessment of muscle strength and coordination, help evaluate the severity and progression of spinal cord dysfunction.
• Basically, doctors will perform neurological examinations periodically to monitor changes in neurological status and response to treatment.

Specialized Tests:

• Depending on the suspected cause of thoracic cord compression, doctors may request additional specialized tests.
• These may include genetic testing for hereditary conditions, angiography for vascular abnormalities, or biopsy for suspected tumors or inflammatory disorders.

In conclusion, the diagnosis of thoracic cord compression relies on a comprehensive approach involving clinical evaluation, imaging studies, and specialized tests. Collaboration between healthcare providers, neurologists, and radiologists is essential to accurately diagnose the condition and develop an individualized treatment plan for optimal patient outcomes. Early diagnosis and intervention are critical to prevent neurological deficits and improve long-term prognosis for patients with thoracic cord compression.

Nonsurgical Treatment

Nonsurgical treatment options for thoracic cord compression may include medications to manage pain and inflammation, physical therapy to improve strength and mobility, and lifestyle modifications to reduce strain on the spine. In some cases, bracing or orthotic devices may be recommended to provide additional support to the spine.

Surgical Treatment

Surgical treatment options for thoracic cord compression are typically considered when conservative measures fail to alleviate symptoms or when there is evidence of progressive neurological deficits. The specific surgical approach depends on factors such as the underlying cause of compression, the extent of spinal cord involvement, and the patient’s overall health. Here are the surgical options commonly used for thoracic cord compression:

Decompressive Surgery:

• Decompressive surgery aims to alleviate pressure on the spinal cord by removing or reshaping the structures causing compression, such as herniated discs, bone spurs, or tumors.
• Procedures may include laminectomy, laminoplasty, or discectomy, depending on the location and nature of the compression.
• Laminectomy involves removing a portion of the vertebral bone (lamina) to create more space for the spinal cord.
• Laminoplasty is a technique used to expand the spinal canal by reshaping the lamina without removing it entirely.
• Discectomy involves removing part or all of a herniated disc that is compressing the spinal cord.

Spinal Fusion:

• Spinal fusion may be performed in conjunction with decompressive surgery to stabilize the spine and prevent future instability or deformity.
• During spinal fusion, bone grafts, metal implants, or bone substitutes are used to fuse adjacent vertebrae, limiting movement at the affected segment.
• Fusion may be performed anteriorly (from the front), posteriorly (from the back), or both, depending on the surgical approach and the extent of spinal instability.

Tumor Resection:

• In cases where spinal tumors cause thoracic cord compression, surgical resection of the tumor may be necessary.
• The goal of tumor resection is to remove as much of the tumor as possible while preserving neurological function.
• Depending on the tumor’s location and characteristics, surgery may be performed using minimally invasive spine surgery or open surgical approaches.

Spinal Cord Detethering:

• Tethered spinal cord syndrome occurs when the spinal cord is abnormally attached to surrounding tissues, causing tension and compression.
• Surgical detethering involves releasing the adhesions and restoring the spinal cord’s normal mobility and function.
• This procedure may be indicated for patients with conditions such as tethered cord syndrome or spinal dysraphism.

Vertebroplasty or Kyphoplasty:

• Vertebroplasty and kyphoplasty are minimally invasive procedures used to treat vertebral compression fractures caused by osteoporosis or trauma.
• During vertebroplasty, bone cement is injected into the fractured vertebra to stabilize it and relieve pain.
• Kyphoplasty involves inserting a balloon-like device into the fractured vertebra to restore height before injecting bone cement.

Dynamic Stabilization:

• Dynamic stabilization techniques involve implanting devices such as pedicle screws, rods, or interspinous spacers to provide stability while preserving some degree of spinal mobility.
• These procedures may be considered in select cases to address thoracic cord compression while allowing for physiological movement of the spine.

Each surgical option for thoracic cord compression carries its risks, benefits, and considerations. The choice of procedure depends on factors such as the underlying cause of compression, the patient’s overall health, and the surgeon’s expertise and preferences. Patients need to discuss the potential risks and benefits of each surgical option with their healthcare provider to make informed decisions about their treatment.

Benefits of Surgical Treatment

The benefits of surgical treatment for thoracic cord compression include the relief of neurological symptoms.  In addition, the benefits will preserve and restore neurological functions, and prevention of further spinal cord damage. Surgery can also improve the overall quality of life and functional outcomes for patients with this condition.

Recovery Period and Rehabilitation

The recovery period following surgery for thoracic cord compression can vary depending on the extent of the procedure and individual factors such as overall health and fitness level. Rehabilitation may include physical therapy, occupational therapy, and other modalities to promote recovery, improve strength and mobility, and prevent complications.

Reasons to Choose The Southwest Scoliosis and Spine Institute:

Finally, patients with syringomyelia can benefit from the expertise of the renowned spine surgeons at The Southwest Scoliosis and Spine Institute. Led by Doctors Richard A. Hostin, Devish Ramnath, and Ishaq Syed, the institute offers state-of-the-art diagnostic and treatment options for complex spinal conditions. With offices in Dallas, Plano, and Frisco, Texas, the institute provides personalized care and comprehensive support to help patients achieve optimal outcomes and improve their quality of life.

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ScienceDirect.com: Thoracic Cord Compression