THORACIC HERNIATED DISC

How Common Is A Herniated Disc In The Thoracic Region Of The Spine?

A herniated disc in the thoracic (upper) region of the spine is quite uncommon. Most disc herniations typically occur in the lower back or the cervical (neck) area. When a herniation does take place in the thoracic region, it often leads to upper back pain, which can sometimes extend to the chest or abdomen.

The thoracic spine is uniquely protected compared to other parts of the spine. Each thoracic vertebra is joined to a rib on either side, creating a sturdy rib cage that provides additional support and stability. This extra support means the thoracic region experiences less wear and tear, making it less likely to develop herniated discs or other degenerative conditions. In fact, thoracic herniated discs account for less than 1 percent of all herniated discs, making them quite rare. The thoracic spine also has the highest number of vertebrae, but is the least mobile region, further reducing its susceptibility to disc herniation.

In rare cases, a thoracic herniated disc may press against the spinal cord, leading to serious conditions like myelopathy, a type of spinal cord dysfunction. This situation is a herniated disc emergency symptom and requires prompt attention. Overall, while herniated discs appear in other parts of the spine, they rarely occur in the thoracic region.

What is the Prognosis for Someone with a Herniated Thoracic Disc?

The outlook for people with a herniated thoracic disc looks good. Early detection and proper management boost success. Most individuals respond well to conservative treatments. Rest, medication, and physical therapy bring significant pain relief. These nonsurgical methods often meet all needs.

Sometimes, severe symptoms or poor response to therapies require surgery. Doctors recommend surgery for ongoing pain or advancing neurological changes. Many patients see big improvements after surgery. They gain pain relief and sometimes recover lost function.

You should know that many thoracic disc herniations show up by chance. Imaging for unrelated issues reveals them. These cases often cause no pain or symptoms. Doctors suggest observation instead of instant treatment. They act only if new symptoms emerge.

Severe complications like paralysis stay rare. Symptoms develop slowly, giving time for medical care. Most people get treatment before serious nerve damage occurs. Surgery often reverses gradual symptoms. Some issues may still linger.

Always consult a healthcare provider for new or worsening symptoms. Early intervention makes a big difference in recovery.

Anatomy of the Mid-Back

To understand your symptoms and treatment choices, patients should understand the anatomy of the mid-back. As such, patients should become familiar with the various parts that constitute the thoracic spine and how they work together.

The spine is made up of 33 vertebrae, divided into five distinct segments running from the base of your skull down to your pelvis:

• Cervical: the neck region
• Thoracic: the middle back (mid-back)
• Lumbar: lower back
• Sacrum: connects the spine to the hips
• Coccyx: the tailbone

The thoracic spine comprises 12 vertebrae, extending from the base of your neck to the bottom of your rib cage. What sets the thoracic vertebrae apart from those in other regions is their direct connection to the ribs. Each thoracic vertebra has joints that attach to a rib on either side, providing additional support and stability. This rib cage support means the thoracic spine experiences less wear and tear compared to the cervical and lumbar segments, making conditions like thoracic herniated discs less common in this region.

Learn more about the anatomy of the thoracic spine.

The intervertebral discs refer to the shock-absorbing cushions between each vertebra of your spine. For instance, only one disc exists between each vertebra. Meanwhile, each disc has a strong outer ring of fibers, called the annulus, and a soft, jelly-like center, called the nucleus pulposus. The annulus refers to the disc’s outer layer and the strongest area of the disc. Also, the annulus helps connect each vertebra. The nucleus in the center of the disc serves as the main shock absorber.

A herniated disc occurs when the intervertebral disc’s outer fibers (the annulus) become damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal.

Causes of a Thoracic Herniated Disc

Herniated discs can occur in children, although rarely. However, a true herniated nucleus pulposus usually happens in young and middle-aged adults and generally occurs in the lower back. Additionally, disc herniations in the thoracic spine mostly affect people between the ages of 40 and 60. In older folks, the degenerative disc changes that occur in the spine with aging make it less likely for them to suffer a true herniated disc.  Thoracic herniated discs typically arise from degenerative changes in the spine, which often link to the aging process. However, several other factors can also contribute to the development of this condition.

• Trauma and Injuries: A sudden injury or acute trauma to the spine, such as from an accident, can cause a disc in the thoracic region to herniate. Improper lifting techniques or handling heavy objects can also strain the spine, leading to herniation.
• Repetitive Strain: Occupations or activities involving repetitive movements can put continuous stress on the spine, increasing the likelihood of disc herniation. Over time, this constant strain weakens the spinal discs.
• Genetic Factors: Herniated discs can sometimes run in families. Genetic predisposition may play a role, making some individuals more susceptible to this condition.
• Lifestyle Choices: Certain lifestyle factors can elevate the risk of disc herniation. Smoking, for instance, has been linked to accelerated disc degeneration, while excess body weight puts additional pressure on the spinal discs, making herniation more likely.

Additional Causes

• Other Contributing Factors: Age-related spinal degeneration is a primary cause, but it’s crucial to note that having any of these risk factors does not guarantee the development of a thoracic herniated disc.
• Disc Degeneration: One of the primary culprits is disc degeneration. As we age, the spinal discs lose their moisture content and elasticity. This natural wear and tear makes the discs more prone to herniating, particularly in the thoracic region.
• Obesity: Carrying excess weight puts additional pressure on the spine. This added strain can accelerate disc degeneration and heighten the risk of herniation.
• Poor Posture: Lastly, poor posture, especially from sitting for extended periods, can misalign the spine and place uneven stress on the thoracic discs. By being aware of these causes, you can take proactive steps to mitigate the risk and seek treatment if needed. If you’re experiencing persistent upper back pain, consult a healthcare professional to explore the best course of action.
• Discs: The ruptured material can enter the spinal canal from the nucleus pulposus and can cause pressure on the nerves in the spinal canal. Also, there is some evidence that the nucleus pulposus material causes a chemical irritation of the nerve roots. Both the pressure on the nerve root and the chemical irritation can lead to problems with how the nerve root functions. Thus, the combination of the two can cause pain, weakness, and numbness in the area of the body to which the nerve supplies sensation.

Understanding these causes can help in taking preventive measures to protect your spine from unnecessary strain and injury.

Understanding Radiculopathy and Its Connection to Thoracic Herniated Discs

Radiculopathy refers to a condition where a spinal nerve becomes compressed, leading to a variety of symptoms such as pain, numbness, and tingling sensations that extend from the spine along the affected nerve pathway. This condition can significantly impact your daily life, depending on the severity and location of the nerve compression.

In the context of a thoracic herniated disc, radiculopathy occurs when the herniation exerts pressure on a spinal nerve within the thoracic region of the spine. This type of herniation happens when the soft inner gel of a spinal disc protrudes through its tougher exterior. Here’s how it affects you:

• Pain and Discomfort: You may experience sharp or radiating pain that wraps around your rib cage or upper abdomen, following the path of the affected nerve.
• Numbness and Tingling: These sensations often accompany the pain, adding to the discomfort and potentially affecting your ability to carry out routine tasks.
• Localized Symptoms: While thoracic herniated discs are less common than cervical or lumbar herniations, the symptoms can be particularly disruptive due to the central location in the spine.

Recognizing these symptoms early and seeking appropriate medical advice can help manage the condition and reduce its impact on your quality of life.

Thoracic Herniated Disc Symptoms

Whether your symptoms stem from a herniated thoracic disc or another spinal condition, it’s important to seek professional evaluation. Your primary care doctor can help rule out other possible causes of your pain and, if appropriate, refer you to a specialist for further assessment. A consultation with a spine surgeon or spinal neurosurgeon can clarify whether surgery or a conservative treatment approach would best address your unique situation.

Taking that first step toward expert care ensures you receive a thorough diagnosis and a treatment plan tailored to your needs—so you can get back to living life with less pain and more confidence.

Identifying symptoms of a thoracic herniated disc is crucial for timely diagnosis and treatment. These symptoms vary based on the location and severity of the herniation. Here’s what you need to look out for:

Central Disc Protrusion

• Upper Back Pain: This is a typical symptom when the disc herniates centrally. The pain may intensify based on the size of the herniation and the pressure it exerts on the spinal cord.
• Myelopathy: A more severe symptom, characterized by spinal cord dysfunction, which can manifest as difficulty walking, loss of coordination, or even incontinence.
• Paralysis: In critical cases, significant pressure on the spinal cord can lead to paralysis below the waist.

Lateral Disc Herniation

• Radiating Pain: When the disc herniates to the side, it can press on the nerve root exiting the spine, causing pain that may radiate to the chest wall or abdomen.
• Localized Discomfort: Pain may occur around the area of the herniation, depending on which nerves are affected.

Centro-Lateral Disc Herniation

• Combination of Symptoms: This type of herniation can present a mix of the above symptoms, such as upper back pain, radiating pain, or myelopathy. The specific symptoms depend on the extent and direction of the protrusion.

When it comes to herniated discs, the thoracic vertebrae most commonly impacted are T11 and T12. In fact, the majority of these cases—around 75%—occur below the T8 vertebra. This proximity to the more flexible lumbar spine might contribute to their susceptibility. Understanding these symptoms can aid in recognizing a potential thoracic herniated disc early on, thereby enabling more effective management and care.

 

How Do Doctors Diagnose a Thoracic Herniated Disc?

Diagnosing a middle-back herniated disc begins with a comprehensive medical history and a physical examination. During this evaluation, the doctor will check for symptoms indicating spinal cord compression, such as muscle weakness, altered sensation, and unusual reflexes.

To confirm the preliminary diagnosis, doctors will order one or more of the following imaging tests:

• MRI: This test generates detailed images of the spine, providing a clear view of the herniated disc’s location and size.
• CT Scan: Often used to get a more intricate look at the spine’s bony structures and check for any compression on the spinal cord or nerves.
• Myelogram: In certain scenarios, the doctor will order a myelogram. This involves injecting a dye into the spinal canal to enhance the visibility of the spinal cord and nerve roots during imaging.

Following the confirmation through these imaging techniques, the doctor can develop an appropriate treatment plan tailored to the specifics of the thoracic herniated disc.

When diagnosing symptoms of a thoracic herniated disc, it’s vital to consider a range of other conditions that might present similar signs. Potential issues include complications with the heart, lungs, kidneys, and gastrointestinal system. These must be evaluated to rule out other serious problems.

Sometimes, additional tests may be necessary because pain and symptoms from a herniated thoracic disc can closely mimic those of heart, lung, or stomach conditions. For instance, chest pain or upper abdominal discomfort could easily be mistaken for cardiac or gastrointestinal issues, so physicians take care to exclude these potentially life-threatening causes first.

Additionally, within the spine, doctors will look into other disorders. Conditions such as spine fractures, often due to osteoporosis, infections, tumors, and various metabolic disorders, can manifest with similar upper back pain and radiating discomfort. Effective diagnosis requires a comprehensive assessment of these possible factors to accurately pinpoint the cause of the symptoms.

A thorough evaluation helps ensure that the true source of pain is identified, paving the way for targeted and effective treatment.

Non-Surgical Treatments for a Thoracic Herniated Disc

Managing a herniated disc doesn’t always lead to surgery. Several non-invasive treatment options can effectively manage symptoms and improve comfort. Here’s what you should know about conservative treatments available for handling a herniated disc:

Initial Observation

• Often, immediate intervention isn’t necessary if the disc’s herniation is causing tolerable pain without aggravating symptoms like weakness or numbness. Physicians might recommend an initial period of observation to closely monitor if symptoms naturally subside.

Activity Modification and Rest

• Taking a short break from strenuous activities can alleviate symptoms. Reducing daily activities and incorporating rest periods helps minimize further spinal stress and strain. This is usually followed by a gradual reintroduction of movement through controlled, gentle exercises such as walking, which promotes healing and flexibility.

You should know that herniated thoracic discs rarely heal on their own. Sometimes doctors find them by chance, and they never cause pain or symptoms. In these cases, careful monitoring over time works best instead of instant action. If symptoms start, modifying activity and resting become key first steps. This manages discomfort and prevents further aggravation. Thoracic disc herniations occur rarely, so data on self-resolution lack strength. For symptom-free cases, ongoing observation and gentle activity often suffice.

Pain Management through Medications

• Pain relief is paramount in managing a herniated disc. Over-the-counter pain medications such as ibuprofen or acetaminophen can reduce swelling and pain. In cases where pain appears more intense and persistent, your doctor may prescribe a stronger medication. Doctors may prescribe higher potency meds, both narcotic and non-narcotic, depending on the pain’s severity. However, these are generally recommended for short-term use due to potential side effects, including the risk of addiction to narcotics.

These conservative management strategies are usually recommended as a first approach, aiming to alleviate symptoms without surgery. Each patient’s treatment plan may vary depending on their specific symptoms and medical history; thus, regular consultations with a healthcare provider are essential to adjust the treatment as needed effectively.

Spinal Injections

When dealing with back pain, many patients explore different treatments to alleviate discomfort. Among these options, spinal injections stand out due to their effectiveness in targeted pain relief. Here’s a breakdown of the most commonly used types:

• Epidural Steroid Injections: These are perhaps the most well-known and are used to reduce inflammation around the spinal nerves. They help reduce pain radiating from the lower back down to the legs.
• Nerve Blocks: If your doctor needs to pinpoint specific nerves causing pain, a nerve block injection will achieve this purpose. These help by temporarily numbing the nerves and providing relief from persistent back pain.
• Facet Joint Injections: These are administered directly into the facet joints, which are small stabilizing joints located between and behind adjacent vertebrae. Facet joint injections can help determine whether the facet joints are a source of pain.
• Sacroiliac Joint Injections: Focused on the sacroiliac joint that links the lower spine to the pelvis, these injections help in both diagnosing and treating pain sourced from this area.

Doctors use Epidural Steroid Injection (ESI) for treating pain associated with a herniated disc when the pain is severe. It is typically recommended when other less invasive treatments have failed and surgery is becoming a likely option. An ESI aims to alleviate discomfort, although this method is reported to be only effective in about 50% of such cases.

Epidural steroid injections (ESI) have a varied success rate when it comes to alleviating pain from a herniated disc. Clinical evidence suggests that ESIs are effective in about 50% of cases. This means that for half of the patients receiving these injections, there is a significant reduction in pain associated with herniated discs.

Physical Therapy

If your condition is causing only mild symptoms and does not get worse, your doctor may recommend a physical therapist. A well-rounded rehab program assists in calming pain and swelling.  This will improve your movement and strength, and help you do your daily activities with greater ease and ability.

In very mild cases, physical therapy offers ways to control symptoms and enable you to improve without surgery. For this condition, treatments focus on improving movement and posture. Based on the patient, doctors may recommend therapy sessions two to three times each week for up to six weeks.

The goal of physical therapy is to help you

• learn correct posture and body movements to reduce back strain
• learn ways to manage your condition and control the symptoms
• Identify symptoms of the thoracic herniation that require medical attention
• learn ways to manage your condition

Learn more about spinal rehabilitation

Herniated Disc Surgery: Potential Risks

Understanding the causes of herniated disc symptoms matters before surgery. A disc herniating into the spinal cord or cauda equina area triggers spinal cord dysfunction, or myelopathy. This condition forms a medical emergency. Symptoms like numbness, balance loss, weak legs, and bladder control issues signal a severe impact. These signs demand immediate and precise treatment approaches. Identifying causes helps pick the right surgical strategy. It also predicts complications and boosts surgical outcomes.

Surgery to remove a herniated disc risks affecting spinal nerves. All back operations carry complications. Surgeons work near the spinal cord, making these procedures delicate and risky. Patients should discuss thoracic spine surgery risks with their doctor. Ensure you feel good about the risks and benefits of your planned treatment.

Complications

There are also possible complications specifically related to a thoracic disc herniation. If these nerves are damaged:

• Permanent Damage: The nerves can suffer lasting harm that may not recover fully.
• Symptoms: Affected patients might experience persistent numbness, ongoing weakness, or chronic pain along the nerve’s path in the leg.

The surgery might also inadvertently harm the dura mater, a crucial tissue enveloping the spinal cord and nerves. By understanding the specific symptoms and their causes, surgeons can better navigate the complexities of spinal surgery, aiming to minimize these risks and enhance recovery prospects.

• Immediate Detection and Repair: If noticed during surgery, a dural tear is typically sutured immediately, leading to a smooth recovery.
• Post-Surgical Complications: Unidentified during operation, a tear can result in continued leakage of spinal fluid, posing several risks:
• Spinal Headaches: Result from the leakage of spinal fluid.
• Increased Infection Risk: The persistent leak can heighten the likelihood of spinal meningitis, a severe infection.
• Additional Surgery: If the tear doesn’t heal naturally and quickly, another surgery might occur to mend the dura mater.

Understanding these risks helps in making informed decisions and discussing preventive measures with your healthcare provider when considering surgery for a herniated disc.

When Do Doctors Recommend Surgery for a Thoracic Herniated Disc?

Thoracic herniated disc surgery is generally reserved for severe cases, particularly those involving:

• Myelopathy: Spinal cord dysfunction due to compression.
• Progressive lower extremity weakness: Worsening weakness in the legs.
• Intolerable radicular pain: Extreme nerve pain that does not improve with non-surgical treatments.

By carefully choosing and executing the appropriate surgical approach, healthcare providers can effectively manage the complexities associated with thoracic disc herniation, providing significant relief for patients.

Surgical Treatment for a Thoracic Herniated Disc

The traditional way of surgically treating a herniated disc is to perform a laminotomy and discectomy. The term laminotomy means “make an opening in the lamina”, and the term discectomy means “remove the disc.” Therefore, the purpose of taking out a herniated disc was to decompress the spinal cord or spinal nerves. However, nerve problems that occurred with this traditional method of decompression have led many doctors to discontinue this form of surgery for disc herniations in the thoracic spine.

Transthoracic Decompression

A new way to decompress the spinal cord or spinal nerves is a technique called transthoracic decompression. Operating from the patient’s side, the doctor makes a small opening through the ribs and works on the spine through the chest cavity. With this procedure, a minimal amount of the vertebral body and the problem disc is removed, taking pressure off the spinal cord. Thus, fusion surgery is sometimes needed right afterward if a larger section of the vertebra needs removal.

Surgical Interventions for Relief

When these herniations cause significant pressure on the spinal cord, doctors will recommend surgery. One effective procedure is the costotransversectomy. In this surgery, the surgeon makes an incision through the back of the spine and removes the ends of one or more ribs where they join the spine, as well as a section of the transverse process. This allows the surgeon to access the herniated disc and decompress the spinal cord by removing the ruptured disc material from the spinal canal.

Fusion Surgery

Another surgical option is fusion, or arthrodesis, which is often considered when a large section of bone and disc material needs removal, potentially destabilizing the section of the spine. This procedure involves joining two or more bones into one solid structure to stabilize the spine. The bones above and below the unstable section are fused using bone graft material, which encourages bone growth. To facilitate healing, rods, plates, and screws are commonly employed to hold everything in place securely.

By understanding the types of thoracic herniated discs and their symptoms, medical professionals can better diagnose and choose the appropriate treatment method, including surgical options like costotransversectomy and fusion, to alleviate pain and restore function.

Managing Large (“Giant”) Thoracic Herniated Discs

Size plays a key role in thoracic disc herniations, especially with “giant” discs. Doctors define these as discs blocking over half the spinal canal’s diameter. Even without pain or symptoms, these herniations threaten spinal cord health. The severe narrowing creates a significant risk.

Surgeons almost always recommend surgery for giant thoracic discs. Imaging reveals the issue, whether symptoms exist or not. The reason is clear: large herniations can compress the spinal cord quickly. This raises the chance of permanent nerve damage or paralysis. Early surgery acts as a preventive step. It decompresses the spinal cord before irreversible harm strikes.

Surgeons monitor smaller herniations or mild symptoms closely. They reserve surgery for worsening cases. Pain, numbness, weakness, or spinal cord signs like myelopathy or severe radiculopathy trigger action. Conservative treatments fail to help in these instances.

This proactive approach to giant discs maximizes mobility, sensory function, and quality of life.

Benefits of Minimally Invasive Thoracic Discectomy

Minimally invasive thoracic discectomy represents a significant advancement over traditional open spine procedures. Rather than requiring large incisions from the front or back of the body, this technique accesses the thoracic spine through a small opening at the side. As a result, the impact on surrounding tissues is reduced, and recovery times tend to be much shorter.

Some of the key advantages of minimally invasive discectomy include:

• Quicker Recovery: Patients typically experience a shorter hospital stay and can return to normal activities sooner.
• Less Post-Operative Discomfort: Because the approach is less disruptive to muscles and other tissues, there is generally less pain after surgery.
• Reduced Time in Surgery: Smaller incisions and focused access mean surgeries are often completed more efficiently.
• Lower Risk of Complications: There tends to be less blood loss and a decreased likelihood of needing measures such as chest tubes.
• Cosmetic Benefits: Smaller incisions result in smaller scars, which most patients appreciate.

Collectively, these benefits make minimally invasive thoracic discectomy an appealing option when surgical intervention is necessary for herniated thoracic discs.

Research Findings on Thoracic Herniated Disc Surgery Outcomes

Research on thoracic herniated disc surgery has provided insightful outcomes. Two researchers evaluated 19 patients who underwent either costotransversectomy or trans-thoracic decompression. Here’s what they found:

• Good or Excellent Outcomes: 16 patients
• Fair or Poor Results: 3 patients, with 2 of these poor outcomes from the costotransversectomy group

The results suggest that the trans-thoracic approach generally yielded better outcomes, leading the researchers to recommend it as the preferred method. In a separate study, involving 29 patients who underwent Video Assisted Thoracic Surgery, a minimally invasive trans-thoracic procedure, 76% reported satisfactory results. This further supports the benefits of the trans-thoracic approach over other surgical methods.

In summary, current research indicates that the trans-thoracic approach, particularly when minimally invasive techniques like Video Assisted Thoracic Surgery are used, leads to more favorable outcomes in patients with thoracic herniated discs.

Results of Different Surgical Approaches for Thoracic Herniated Disc Surgery

When it comes to thoracic herniated disc surgery, a study evaluated 19 patients who underwent either costotransversectomy or transthoracic decompression. The outcomes revealed that 16 patients experienced good or excellent results, while 3 patients had fair or poor results. Notably, 2 of the poor outcomes were associated with the costotransversectomy procedure, leading researchers to recommend the transthoracic approach as the preferred method.

Moreover, another study focusing on the minimally invasive Video Assisted Thoracic Surgery (VATS) approach reported that 76% of 29 treated patients achieved satisfactory results. This technique involves a trans-thoracic access to the disc space and has shown promising outcomes in terms of patient satisfaction and recovery.

In conclusion, the trans-thoracic methods, particularly the minimally invasive VATS procedure, appear to offer better overall results compared to costotransversectomy for thoracic herniated disc surgery.