THORACIC SPINE MYELOPATHY

Thoracic Spine Myelopathy

Thoracic Spine Myelopathy is a disorder that results from severe spinal cord compression, especially in the thoracic region. The spinal cord in this area usually gets compressed due to bulging or herniated discs, bone spurs, and spinal trauma, and thus causes severe pain and discomfort. If you are wondering what could be one of the most effective ways to treat this condition, it is thoracic decompression surgery.

Understanding Myelopathy

Myelopathy is a broader term used to describe the compression of the spinal cord, leading to nerve dysfunction. This condition can affect various parts of the spine, but it most commonly impacts the cervical spine (neck) and lumbar spine (lower back). However, when it strikes the thoracic spine, it is specifically referred to as thoracic spine myelopathy.

Causes and Progression

In individuals aged 50 and older, myelopathy often develops gradually, progressing over months or even years due to degenerative changes typically caused by osteoarthritis. However, it can also emerge quickly, especially when an underlying condition progresses to cause compression and produces acute symptoms. Besides degenerative changes, thoracic spine myelopathy can arise from:

• Fractures
• Herniated discs
• Bone spurs (osteoarthritis)
• Cancer metastases
• Trauma

Symptoms and Treatment

The symptoms can range from mild discomfort to severe pain and significant functional impairment. A common and effective treatment for thoracic spine myelopathy is thoracic decompression surgery, which aims to relieve the pressure on the spinal cord and alleviate the symptoms.

Understanding the causes and treatment options for thoracic spine myelopathy can help manage the condition effectively and improve quality of life.

Causes and Progression

In individuals aged 50 and older, myelopathy often develops gradually, progressing over months or even years due to degenerative changes typically caused by osteoarthritis. However, it can also emerge quickly, especially when an underlying condition progresses to cause compression and produces acute symptoms. Besides degenerative changes, thoracic spine myelopathy can arise from:

• Fractures
• Herniated discs
• Bone spurs (osteoarthritis)
• Cancer metastases
• Trauma

Understanding the causes and treatment options for thoracic spine myelopathy can help manage the condition effectively and improve quality of life.

Thoracic Spine Anatomy

The thoracic spine is the core part of the spine. The spine comprises 33 vertebral bones. And these are stacked one on top of the other with cushioning discs between each vertebra. It consists of 7 cervical vertebrae (neck), 12 thoracic vertebrae (mid back), five lumbar vertebrae (lower back), five sacral bones, and four coccyx bones.

The sacral and coccyx bones are joined together. And they do not help with any movement in the spine. The spine plays a crucial role in smooth movement, maintaining the stability and protection of the delicate spinal cord. Also, this gives symmetry and support to the body.

Myelopathy typically occurs in specific regions of the spine, primarily affecting the neck and lower back areas. The cervical spine, located in the neck, is a prevalent site where myelopathy develops. Similarly, the lumbar spine, found in the lower back, is another common region prone to this condition. Although less frequently affected, the thoracic spine, which runs through the middle of the back, can also experience myelopathy.

Causes of Thoracic Spine Myelopathy

Thoracic myelopathy typically develops because of gradual degeneration of the spine. Also, there is compression of the nerve roots and spinal cord that result from the following conditions:

• Spinal stenosis
• Autoimmune disorders: rheumatoid arthritis of the spine
• Hernias, Hematomas, cysts, and spinal tumors, including bone cancer
• Spinal infection, neurological disorders, spinal trauma, inflammatory disease, radiation therapy
• Central disc herniations
• Congenital disorders

With increasing age, arthritic illness, inflammation, bone spurs, and flattened spinal discs between the vertebrae can compress the spinal cord and the nerve roots. Thus, Myelopathy usually develops slowly due to the gradual degeneration of the spine (spondylosis). However, it can also take a severe form or can occur from spine deformity present at birth.

• The common reasons behind myelopathy are degenerative spinal conditions such as spinal stenosis. In this condition, the bony passageways of the spine through which nerve roots and the spinal cord travel narrow.
• Central disc herniations can also compress the spinal cord leading to myelopathy.
• Also, autoimmune disorders such as rheumatoid arthritis in the spine can result in degenerative changes in the vertebrae leading to spinal cord compression and myelopathy.
• Diseases like hematomas, Hernias, cysts, and spinal tumors, for example, bone cancer, may also create compression on the spinal cord leading to myelopathy.
• Severe myelopathy can form quickly from a spinal injury, radiation therapy, neurological disorders, spinal infection, inflammatory disease, etc.

How Do Herniated Discs and Bone Spurs Affect the Spine?

Herniated discs and bone spurs can significantly impact spinal health, often leading to discomfort and limited movement. Understanding their effects can help in seeking prompt medical attention and choosing the right treatment options.

Herniated Discs

When a herniated disc occurs, the disc’s outer layer is compromised, allowing the gel-like center to protrude. This bulging often presses on nearby nerves or even into the spinal canal itself. The pressure on these nerve roots can cause pain, numbness, and weakness in the body areas served by those affected nerves. In many cases, it can lead to conditions such as sciatica, where the pain radiates down the buttocks and legs.

Bone Spurs

Bone spurs, or osteophytes, develop as a natural response to joint wear and tear. As discs dry and lose height, the vertebrae may rub together. This friction prompts the body to produce extra bone mass, forming spurs around the vertebrae. These spurs can further narrow the spinal canal, leading to spinal stenosis, a condition that can result in back pain and difficulty walking or remaining active.

Both conditions, individually or together, can lead to a range of symptoms that may influence daily activities and overall quality of life. Effective diagnosis and a tailored treatment plan are crucial in managing these spine-related issues.

Symptoms 

Typically, spinal cord trauma or compression leads to loss of sensation and function and pain or discomfort around the area. Thoracic myelopathy symptoms are:

• Tingling, numbness, or weakness
• Neck, arm, lower back, or leg pain
• Difficulty walking
• Problems with balance and coordination
• Losing control of bowel or urination
• Abnormal or increased reflexes in the extremities
• Problems with fine motor skills

In severe cases of myelopathy, patients may experience an array of additional symptoms that significantly impact daily life. These can encompass challenges with mobility, marked by difficulty in walking. Sufferers might also notice increased muscle weakness, which can lead to muscle wasting over time.
Reflexes might diminish or disappear altogether, complicating normal bodily responses. Furthermore, there can be a loss of control over bladder and bowel functions, as well as disturbances in sexual function, adding a layer of complexity to the condition.

Diagnosis of Thoracic Spine Myelopathy

Accurate diagnosis is necessary for the effective management of thoracic myelopathy. To get a proper diagnosis, you need to have a detailed review of your medical history and a thorough physical and neurological examination as well. Neurological examination plays a significant role in identifying any signs of neurological injury.

Also, it entails proper assessment of reflexes and muscle weakness. Our spine doctors may also recommend different tests to get a detailed view of the spine and spinal canal. It will help evaluate any abnormalities and confirm the diagnosis of thoracic myelopathy accordingly. The recommended tests are:

• Myelography
• Treatment for Thoracic Myelopathy
• X-rays – These will help point out other problems as well.
• MRI scan – It delivers a detailed image of the spine and spinal canal. This procedure can show stenosis areas.
• Electrical tests, such as somatosensory evoked potentials or electromyogram – These tests will show how effectively your nerves are functioning to deliver sensation and the ability to move your arms and legs. These tests help measure how the stimulation of nerves in different limbs connects through the spinal cord to the brain.

The doctor will discuss the diagnosis with you in different ways. Sometimes, myelopathy adds to other conditions that indicate the association of the spinal cord. For example, an individual may have cervical stenosis with myelopathy or thoracic disc disorder with myelopathy.

On the other hand, if the condition does not involve the spinal cord, your diagnosis will say without myelopathy, for example, displaced lumbar intervertebral disc without myelopathy. In case myelopathy is a complication related to another disease, the doctor may refer to it with regard to that disease. For example, diabetic myelopathy means the spinal cord is damaged because of diabetes. Carcinomatous myelopathy means that the spinal cord is damaged due to carcinoma.

Thoracic Spine Myelopathy Treatment

Doctors usually determine the treatment depending on the reasons for thoracic myelopathy. The treatment includes both non-surgical and surgical methods.

Non-Surgical Treatment

Non-surgical procedures help treat mild thoracic myelopathy types. And surgeons use it to relieve pain and discomfort with the help of bracing, physiotherapy, and medication. These treatments can be helpful in treating mild myelopathy, reducing pain, etc. Thus, you can return to your daily activities fast.

However, the non-surgical approach does not help treat compression. Your symptoms may progress gradually, and sometimes acutely. If you notice a steady progression of your symptoms, consult your doctor asap. Remember that some of the damage can be irreversible even with proper treatment. That is why it’s crucial to stop any progression when figured out in the mild stages.

Surgical Treatment of Thoracic Spine Myelopathy

Thoracic spine decompression surgery is the common surgical treatment used to treat spinal cord compression. Decompression surgery helps take the pressure off the nerve root or spinal cord, thus relieving pain and discomfort. Decompression surgery, often referred to as a laminectomy, may be performed minimally invasively or with open surgery. This surgery has been proven to be safe and effective, offering improvements in function and quality of life.

Thoracic herniated disc surgery also plays a crucial role in eliminating herniated discs or bone spurs that often press against the spinal cord. Your physician may recommend surgery (laminoplasty) to treat advanced thoracic myelopathy that occurs due to stenosis (narrowing of the spinal canal). Laminoplasty is a motion-sparing procedure that provides more space for the spinal cord and nerve roots, allowing them to relieve abnormal pressure while retaining flexibility in the compressed area of the spine.

Some patients may not be candidates for laminoplasty. In such cases, decompression and spinal fusion are suitable alternatives. During spinal fusion, surgeons fuse two or more vertebrae together, allowing them to heal into a single, solid bone. This procedure helps improve painful motion and restores stability to the spine.

Minimally invasive spine surgery can also be an excellent option as it involves lower risks and complications. This approach guarantees a faster recovery due to minimal surgical incisions and reduced trauma to the body, unlike traditional open surgery. While performing this type of surgery, specialists generally use tiny instruments and an endoscope that visually guides the surgery.

In summary, decompression surgery, whether through laminectomy, laminoplasty, or minimally invasive techniques, offers effective solutions for relieving spinal pressure and improving quality of life. Each method provides unique benefits and may be tailored to the patient’s specific needs.

Decompression Surgery

This is also called a laminectomy which surgeons perform minimally invasively or with the help of open surgery. Laminectomy is considered safe and highly effective in improving function and quality of life.

Apart from surgeries, exercises, and medications too can help improve the condition.

Thoracic Spine Myelopathy Bottomline 

If your child is suffering from Thoracic Spine Myelopathy and if you are wondering where to get the best treatment for this, look no further than us. From the initial consultation and diagnosis to treatment and care – we will take care of everything.

The Southwest Scoliosis and Spine Institute Specialists have offices in  Dallas, Plano, and Frisco, Texas.  Furthermore, the practice is led by a team of highly qualified, experienced orthopedic and spine surgeons.  These surgeons are recognized as the very best by their fellow doctors and surgeons. The doctors are also recognized as leaders in diagnosing and treating the most sophisticated and complex spine conditions.

The orthopedic and spine surgeons at The Southwest Scoliosis and Spine Institute are board-certified, having completed great training at the finest medical institutions in the country.

Each patient’s treatment program is tailored to the patient’s specific needs. Also, we continue to monitor patients with ongoing re-evaluations and adjustments as the recovery progresses. Chiefly, the team offers the most advanced treatment, which combines the latest in cutting-edge technology.  The surgeons prioritize minimally invasive techniques.  However, when necessary the surgeons will use surgery to treat patients and get them back to normal.  The practice welcomes new patients and encourages patients with neck pain to call and make an appointment.

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Bon Securs: Thoracic Spine Myelopathy