THORACIC HERNIATED DISC

Anatomy

In order 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, there is one disc 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 is actually a strong ligament that helps connect each vertebra together. 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) are 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 low back. Additionally, disc herniations in the thoracic spine mostly affect people between the ages 40 and 60. In older folks, the degenerative 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 due to the fact that 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 is usually 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

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. But 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. 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. 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.

Video-Assisted Thoracoscopy Surgery (VATS)

VATS is a new way to perform thoracic surgery. Only small incisions are required. The thoracoscope is a small TV camera that is passed through the chest cavity. Watching on a TV screen, the surgeon can see and treat the herniated disc. Because the incisions are small, most patients have an easier time recovering from the procedure.

Fusion

A fusion surgery joins two or more bones into one solid bone. 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 is used to get the unstable bones to grow together. Rods, plates, and screws are commonly used to hold the bones in place so the bone graft heals. Learn more about spinal fusion.

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.

In very mild cases, physical therapy offers ways to control symptoms and enable you to improve without surgery. Treatments focus on improving mobility and posture. Doctors may recommend scheduling 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. Take time to review the risks associated with thoracic spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the procedure planned for your treatment. Learn more about possible complications of spine surgery.

There are also possible complications specifically related to a thoracic disc herniation.