THORACIC HERNIATED DISC

Upon reviewing disc herniations in the thoracic spine, we see people between the age of 40 and 60. A disc can rupture from a small amount of force and can happen as we age. Particularly, these ruptures can happen to a weakened disc due to the effects of aging on the spine.

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Thoracic Herniated Disc

Slipped disc, artworkA thoracic herniated disc occurs when the intervertebral disc’s annulus (the outer fibers) becomes 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. Unfortunately, The spinal cord in the Thoracic area does not provide extra space.

So, when a herniated disc occurs in the mid-back, doctors often consider it extremely serious. In severe cases, the pressure on the spinal cord can lead to paralysis below the waist. Fortunately, herniated discs are not nearly as common in the thoracic spine as in the lumbar spine.

Learn about herniated thoracic discs including:

  • What causes a herniated thoracic disc
  • The Complications
  • What constitutes a diagnosis
  • What treatment options are available

Questions and Answers

What is a Thoracic Herniated Disc?

A thoracic herniated disc refers to a condition where the gel-like inner material of a disc in the thoracic (mid-back) region of the spine protrudes or leaks through a tear or weakness in the outer disc wall. This can cause compression of nearby nerves, leading to various symptoms.

What are the symptoms of a Thoracic Herniated Disc

The symptoms of a thoracic herniated disc can vary depending on the location and severity of the herniation. Common symptoms include localized back pain in the mid-back region, radiating pain along the ribs or chest wall, numbness or tingling in the chest, abdomen, or lower extremities, and muscle weakness. In some cases, individuals may experience difficulty with bowel or bladder control, but this is relatively rare.

How is a Thoracic Herniated Disc Treated?

The treatment for a thoracic herniated disc typically starts with conservative measures. This may include rest, physical therapy exercises to strengthen the supporting muscles, pain medication, and the use of braces or supports to stabilize the spine. In cases where conservative treatments fail to provide relief, or if there is severe nerve compression or worsening neurological symptoms, surgical intervention may be considered. Surgical options can include discectomy (removal of the herniated portion of the disc) or spinal fusion to stabilize the spine.

Anatomy of the Mid-Back

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

Learn more about the anatomy of the thoracic spine.

The intervertebral discs are 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 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.

Discs can rupture suddenly because of too much pressure all at once. For example, falling from a ladder and landing in a sitting position can cause a great amount of force through the spine. If the force gets strong enough, either a vertebra can break or a disc can rupture. So, bending places high forces on the discs between each vertebra. If you bend and try to lift a heavy object, the force can cause a disc to rupture.

In the thoracic spine, the pressure can also affect the spinal cord. For instance, this is because there is little extra space within the spinal canal of the thoracic spine. Although, too much pressure on the spinal cord can lead to paralysis from the waist down.

Discs

Discs can also rupture from a small amount of force, usually due to the weakening of the annulus from repeated injuries that add up over time. As the annulus becomes weaker, at some point lifting or bending causes too much pressure across the disc. Then, the weakened disc ruptures while doing something that five years earlier would not have caused a problem. Furthermore, the effects of aging comprise the most common reason for disc herniation in the thoracic spine.

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.

Thoracic Herniated Disc Symptoms

The first symptom of a thoracic disc herniation usually appears as pain. which often comes from the back — directly over the sore disc. Pain may also radiate around to the front of the chest. In addition, depending on which nerves are affected, a thoracic disc herniation can include pain that feels like it emanates from the heart, abdomen, or kidneys.

Herniated thoracic discs sometimes press against the spinal cord. When this happens, symptoms may include:

  • Muscle weakness, numbness, or tingling in one or both legs
  • Increased reflexes in one or both legs can cause spasticity
  • Changes in bladder or bowel function
  • Paralysis from the waist down

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Surgical Treatment for a Thoracic Herniated Disc

Laminotomy and Discectomy

The traditional way of surgically treating a herniated thoracic disc was 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 thoracic 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.

Costotransversectomy

Pressure on the spinal cord from a herniated thoracic disc can effectively treat a surgical procedure called costotransversectomy. In this procedure, the surgeon makes an incision through the back of the spine. Also, the ends of one or more nearby ribs are removed where they join the spine. A section of the transverse process (the small bone on the side of the vertebra) is taken off. Therefore, this forms an opening for the doctor to see the injured disc. Finally, the surgeon can then decompress the spinal cord by locating and removing the disc material that has ruptured into the spinal canal.

Fusion

A fusion surgery joins two or more bones into one solid bone and doctors refer to this procedure as arthrodesis. If surgery on the herniated thoracic disc requires the removal of a large section of bone and disc material, the section of the spine may become loose or unstable. When this happens the doctor may fuse the bones right above and below the unstable section.

The bone graft material provides a methodology to get the unstable bones to grow together. Consequently, rods, plates, and screws are commonly used to hold the bones in place so the bone graft heals. 

Physical Therapy

If your condition is causing only mild symptoms and does not get worse, your doctor may have you work with a physical therapist. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.Physical Therapy

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 mobility and posture. Based on the patient, doctors may recommend therapy sessions two to three times each week for up to six weeks.

The goals of physical therapy are 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

Surgery Complications for a Thoracic Herniated Disc

Like all surgical procedures, operations on the back may have complications. Because the surgeon operates around the spinal cord, back operations are always considered extremely delicate and potentially dangerous. So, patents should review the risks associated with thoracic spine surgery with their doctor. Make sure you are comfortable with both the risks and the benefits of the procedure planned for your treatment. There are also possible complications specifically related to a thoracic disc herniation.

The Southwest Scoliosis and Spine Institute

One of the best ways to avoid complications is to ensure you are in the hands of experts. At the Southwest Scoliosis and Spine Institute, patients can expect the expertise and dedication of highly skilled surgeons who prioritize patient well-being and strive to achieve the best possible outcomes. The institute boasts a team of expert surgeons who specialize in spine-related conditions, including scoliosis, spinal deformities, and various spine disorders. These surgeons have undergone extensive training and possess years of experience in their field, allowing them to handle complex cases with precision and care.

When it comes to patient care, the surgeons at the Southwest Scoliosis and Spine Institute prioritize safety and take every precaution to minimize the risk of complications during surgical procedures. They adhere to established protocols and guidelines, ensuring a meticulous approach to surgical techniques and patient management. By following stringent safety measures, the surgeons aim to provide optimal results while prioritizing patient comfort and well-being throughout the treatment process.

Stopping the Pain

The ultimate goal of the expert surgeons at the Southwest Scoliosis and Spine Institute is to alleviate pain, address the underlying problem, and restore the patient’s quality of life. By utilizing advanced surgical techniques and staying up-to-date with the latest advancements in spinal care, these surgeons work diligently to deliver successful outcomes. They work closely with each patient, taking into consideration their unique circumstances, medical history, and treatment preferences to develop personalized treatment plans.

Patients at the Southwest Scoliosis and Spine Institute can trust that their surgical procedures will prioritize patient safety and strive for successful outcomes. With the expertise and commitment of the institute’s surgeons, patients can look forward to improved spinal health, reduced pain, and the opportunity to enjoy a normal, active life.

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Footnote:

Health Central: Thoracic Herniated Disc

 

If you or a loved one suffers from spinal pain, you owe it to yourself to call Southwest Scoliosis and Spine Institute at 214-556-0555 to make an appointment.