Thoracic Disc Herniation
The thorax is the region between your neck and your abdomen. Your thoracic spine is composed of twelve bones, labeled T1-T12. This is between your cervical (upper) and lumbar (lower) spine. In between these twelve bones, there is a cushion or a disc material that serves as the “shock absorber” for the bones. When a portion of this disc material herniates, or bulges out from its usual spot, it can leak into the spinal canal and compress the spinal cord and/or nerves.
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Thoracic disc herniation can be caused by degenerative disc disease, which occurs as people age and their discs become less flexible. Wear and tear over the years causes the spine to degenerate and break down. It may also be related to smoking, obesity, and/or caused by an injury.
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The most common symptom of thoracic disc herniation is axial back or chest pain. Sometimes the pain spreads around the chest in a “band like fashion.” You may also have:
Numbness or sensory changes
Weakness in your arms or legs
Problems with your bowel or bladder
Problems with sex
Problems with your walking
How is a thoracic disc herniation diagnosed?
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Most thoracic disc herniations can be treated with conservative treatment including activity modifications, physical therapy, injections and/or pain medications.
Most thoracic disc herniations are able to heal on their own without surgery. This is because the disc can be resorbed and shrinks, but this process may take weeks or even months.
If the disc herniation results in bladder or bowel issues, numbness around the genital area, weakness in your arms or legs, problems with your balance and/or gait then surgery may be warranted.
Thoracic Stenosis
The thorax is the area between your neck and abdomen. Stenosis means narrowing of the area that houses your spinal cord and nerves. Thoracic stenosis is a rare spinal condition in which the middle area of your back, the thorax, is narrowed and has less room for the spinal cord.
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Thoracic stenosis can be caused by disc herniations, arthritis, fractures, bone spurs or tumors. Some people are born with congenital forms of thoracic stenosis, which causes the area that houses the spinal cord to be narrowed from birth. Most other people develop it over time from normal ‘wear and tear’ of the spine and aging.
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The most common symptoms are:
Numbness in the shoulders, arms, hands, feet or legs
Stiffness in your neck
Unsteady balance or abnormal walking
Pain in the thoracic region of the back or around the ribs
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Treatment is done in a graduated manner, starting first with conservative measures and ultimately leading to surgery if the symptoms are not managed appropriately. Most patients can be treated with either level 1 or 2 treatment plans. One should understand that conservative treatments may not address the underlying cause of the thoracic stenosis. These treatments are to simply treat the pain and allow you to function better. Treatment of the underlying cause is usually only able to be addressed with surgery.
Thoracic Myelopathy
The thorax is the medical term for the space between your neck and abdomen. The thorax is the place where your chest and ribs are located. Myelin is the substance that forms a whitish sheath around nerve fibers of your spine, “-pathy” is a latin suffix for “disorder.” Putting them together, thoracic myelopathy, refers to a disorder where the middle area of the spinal cord (thorax) is compressed.
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Thoracic myelopathy is caused by compression of the spinal cord in the thoracic region. The most common causes are bulging or herniated intervertebral discs, bone spurs, or spinal trauma. It may also be caused when there is spinal stenosis, or narrowing of the bony passageways of the spine where nerves travel. In rare cases, it may be caused by cancer or autoimmune diseases such as rheumatoid arthritis.
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neck pain
neck stiffness
numbness in the shoulders, arms, or hands
an electric shock pain shooting down your legs
feeling as though your foot is dropping or slapping on the ground
difficulty with normal standing or walking in a straight line
urinary or stool incontinence
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There are three levels of treatment Dr. Wilson uses to treat patients with thoracic myelopathy. Some patients may only need conservative management, while others, due to their emergent nature, may require the urgent surgery.
Most patients are able to be managed with conservative treatment only, namely pain medications and/or injections. If this fails to alleviate the pain or if you have progressive muscle weakness, problems with your gait, bowel, or bladder then surgery may be recommended.