THORACIC HERNIATED DISC

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.

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.

Non Surgical Treatments

Managing a herniated disc doesn’t always lead to surgery. There are several non-invasive treatment options that 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 monitored over time to see 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.

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 prescription. 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 injections 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 in determining 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 where the pain is severe. It is typically recommended when other less invasive treatments have failed and surgery is becoming a likely option. The aim of an ESI is to alleviate discomfort, although this method is reported to 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 the cases. This means that for half of the patients receiving these injections, there is a significant reduction in pain associated with herniated discs.

Herniated Disc Surgery Potential Risks

Understanding the underlying causes of herniated disc symptoms is crucial before considering surgical interventions. If a disc herniates into the spinal cord or cauda equina area, it can lead to spinal cord dysfunction, or myelopathy, which is a medical emergency. Symptoms such as numbness, loss of balance, lower extremity weakness, and loss of bladder control indicate a severe impact that requires immediate and accurately targeted treatment approaches. Identifying these underlying causes not only helps in choosing the right surgical strategy but also in anticipating potential complications and improving surgical outcomes.

During the surgical removal of a herniated disc, there’s a risk of affecting the spinal nerves. 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. Patients 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.

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 which 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?

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

Laminotomy and Discectomy

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.

Costotransversectomy

Understanding Thoracic Herniated Discs: Types and Symptoms

Thoracic herniated discs can manifest in various forms, each with distinct symptoms depending on the location and severity of the herniation. These herniations are generally categorized into three types:

• Central disc protrusion: Typically causes upper back pain and/or myelopathy. The limited space around the spinal cord in the thoracic spine means that any protrusion can put significant pressure on the spinal cord, potentially affecting nerve function. In severe cases, this type of herniation can lead to paralysis from the waist down.
• Lateral disc herniation: Occurs when the disc protrudes to the side, likely impinging on the exiting nerve root at that level of the spine. This can cause radiating pain across the chest wall or abdominal area, often leading to significant discomfort.
• Centro-lateral disc herniation: Presents a combination of symptoms from central and lateral herniations, including upper back pain, radiating pain, and potential myelopathy.

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.

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 preferable 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.

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 helping 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

How Can a Thoracic Herniated Disc Affect the Body When Coughing or Sneezing?

A thoracic herniated disc can significantly impact your body, especially during actions like coughing or sneezing. This condition occurs when the disc in the upper spine becomes damaged, leading to pain from the upper back.

When you cough or sneeze, this pain might intensify. Why? Because these actions increase the internal pressure on the spine. This added pressure can further irritate the affected nerve root, causing pain that may radiate along the nerve’s path.

Key Points to Consider:

• Localized Pain: Pain eminate from the upper back.
• Radiating Pain: Pain may spread in a specific nerve pattern.
• Increased Pain: Actions like coughing or sneezing can exacerbate the discomfort.

Understanding these effects is crucial for managing symptoms and seeking appropriate treatment.

The Southwest Scoliosis and Spine Institute

One of the best ways to avoid complications is to ensure you seek doctors who are the very best in what they do. 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. Significantly, 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 careful approach to surgical techniques and patient management. By following safety measures, the surgeons 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. Therefore, they work closely with each patient, taking into consideration their unique circumstances, medical history, and treatment preferences. However, each case is different and the doctors will develop personalized treatment plans for each patient.

Patients at the Southwest Scoliosis and Spine Institute can trust that their surgical procedures will prioritize patient safety and strive for successful outcomes. Finally, 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