Herniated Thoracic Disc (2024)

A Patient's Guide to Herniated Thoracic Disc

Introduction

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 outof its normal space. If the annulus tears near the spinal canal, the nucleuspulposus material can push into the spinal canal. In the thoracic area, thereis very little extra space around the spinal cord. When a herniated disc occursin the thoracic spine it can be extremely serious. In some cases, the firstsign of the herniated disc is paralysis below the waist. Luckily, herniateddiscs in the thoracic area are not nearly as common as in the lumbar spine.

The purpose of this information is to help you understand:

The causes of a herniated thoracic disc
How a diagnosis is made
Treatment for a herniated thoracic disc
Possible complications or problems from a herniated thoracic disc

Anatomy

The intervertebral discs are the cushions that act as shock absorbers betweeneach of the vertebra in your spine. There is one disc between each vertebra.Each disc has a strong outer ring of fibers called the annulus, and a soft,jelly-like center called the nucleus pulposus.

The annulus is the disc's outer layer and the strongest area of the disc. Theannulus is actually a strong ligament that connects each vertebra together.The mushy nucleus of the disc serves as the main shock absorber.

In order to understand your symptoms and treatment choices, you should startwith some understanding of the general anatomy of your spine. This includesbecoming familiar with the various parts that make up the spine and how theywork together.

Please review the document, entitled:

Anatomy and Function of the Spine

Causes

Herniated discs can occur in children, although this is rare. Usually a trueherniated nucleus pulposus is most common in young and middle-aged adults. Inolder folks, the degenerative changes that occur in the spine with aging actuallymake it less likely they will suffer a true herniated disc.

Discs can rupture suddenly because of too much pressure all at once on a disc.For example, falling from a ladder and landing in a sitting position can causea great amount of force across the spine. If the force is strong enough, eithera vertebra can fracture or break, or a disc can rupture. Bending over placesa great amount of force on the discs between each vertebra. If you bend andtry to lift something that is too heavy, the force can cause a disc to rupture.

Discs can also rupture from a small amount of force - usually due to weakeningof the annulus fibers of the disc by repeated injuries that add up over time.As the annulus becomes weaker, at some point you lift something or bend in sucha way that you cause too much pressure across the disc. The weakened disc ruptureswhile you are doing something that five years earlier would not have causeda problem. Such is the aging process of the spine.

A herniated disc causes problems in two ways. First, the material that hasruptured into the spinal canal from the nucleus pulposus can cause pressureon the nerves in the spinal canal. There is also some evidence that the nucleuspulposus material causes a chemical irritation of the nerve roots. Both thepressure on the nerve root and the chemical irritation can lead to problemswith how the nerve root functions. The combination of the two can cause pain,weakness, and/or numbness in the area of the body that the nerve usually goes.

Symptoms

The symptoms of a true herniated disc may not include back pain at all! Thesymptoms of a herniated disc come from pressure on, and irritation of, the nerves.In the thoracic spine area, this can include total paralysis of the legs. The symptoms of a herniated disc in the thoracic area usually include:

Pain that travels around the body and into one or both legs
Numbness or tingling in areas of one or both legs
Muscle weakness in certain muscles of one or both legs
Increased reflexes in one or both legs that can cause spasticity in the legs

Where these symptoms occur depends on which nerve(s) has been affected in thethoracic spine and whether the disc has ruptured enough to put pressure on thespinal cord itself. Where the symptoms occur helps your doctor with the diagnosis- to determine which disc has probably ruptured.

Diagnosis

Making the diagnosis of a herniated nucleus pulposus begins with a completehistory of the problem and a physical examination. The main questions your doctorwill be interested in are:

Did you have an injury?
Where is the pain?
Do you have any numbness? Where?
Do you have any weakness? Where?
Have you had this problem or something like it before?
Have you had any weight loss, fevers, or illnesses recently?

Finally, your doctor will be interested in making sure that you do not haveproblems with knowing when you have to have a bowel movement or urinate. Thisis important to make sure that you do not have pressure from the herniated discon the nerves that go to the bowels and bladder. If this situation is occurring,this may be an emergency and require immediate surgery.

Your doctor may suggest taking X-rays of your middle back. Regular X-rays willnot show a herniated disc, but they will give your doctor an idea of how muchwear and tear is present in the spine and may show other causes of your problem.

The most common test done today to diagnose a herniated disc is the MRI scan.This test is painless and very accurate. As far as we know, there are no sideeffects. It has almost completely replaced the other tests such as the myelogramand CAT scan as the first test to do (after X-rays) if a herniated disc is suspected.

Sometimes, the MRI does not tell the whole story. Therefore, other tests maybe suggested. A myelogram, usually combined with a CAT scan, may be necessaryto give as much information as possible. Still, if it has not been confirmedthat the pain is coming from a herniated disc, additional, more specializedtests may be conducted. Electrical tests (such as the EMG and SSP) can confirmthat the pain in your leg is actually coming from a damaged nerve. These testsmay be required before a decision is made to proceed with surgery.

Treatment

Just because a disc has herniated does not necessarily mean that you will needto undergo surgery. The treatment of a herniated disc depends on the symptoms.It also depends on whether the symptoms are getting steadily worse - or whetherthey are getting better. If the symptoms are getting steadily worse, your doctormay be more likely to suggest surgery. If the symptoms are getting better, hemay suggest watching and waiting to see if the symptoms go away. Many people,who initially have problems due to a herniated disc, find that they completelyresolve over several weeks or months.

Conservative Treatment

Observation

You may not need any treatment other than watching to make sure that the problemdoes not progress. If the pain is bearable and there is no progression of weaknessor numbness, your doctor may just suggest watching and waiting.

Rest

If the pain is more severe, you may need to take a few days off from workand decrease your activity for a while. After several days, you should beginto mobilize yourself. Begin a gentle walking program and increase the distanceyou walk each day.

Pain medications

Depending on the severity of your pain, several different approaches can beused to help control your pain with medications. Over the counter pain relievers,such as ibuprofen, Tylenol and some of the newer anti-inflammatory medicationsmay help reduce your pain. Make sure you follow the directions and do not taketoo many. If these types of medications do not control your pain, your doctormay prescribe some stronger pain pills - narcotic or non-narcotic pain medications.Narcotic pain medications are very strong but also very addictive. Non-narcoticpain medications are less addictive, but are somewhat less effective than thenarcotics. Most physicians do not like to prescribe narcotics for more thana few days or weeks!

For more information on the pain medications commonly used to treat back pain,you may wish to refer to the document entitled:

Medications for Back Pain

Epidural Steroid Injection (ESI)

The ESI is usually reserved for more severe pain due to a herniated disc. Itis not usually suggested unless surgery is fast becoming an option to try toreduce you pain. The ESI is probably only successful in reducing the pain froma herniated disc in about half the cases that it is used.

For more information on the types of injections commonly used to treat backpain, you may wish to refer to the document, entitled:

Spinal Injections

Surgical Treatment

Laminotomy and Discectomy

The traditional way of treating the herniated disc with surgery is to performa laminotomy and discectomy. The term laminotomy means "make an opening in thelamina", and the term discectomy means "remove the disc".

This procedure is performed through an incision down the center of the backover the area of the herniated disc. Once the incision is made through the skin,the muscles are moved to the side so that the surgeon can see the back of thevertebrae. X-rays during surgery may be required to make sure that the correctvertebra is chosen. A small opening is made between the two vertebrae wherethe disc is ruptured. This allows the surgeon to see into the spinal canal.The term laminotomy (make an opening in the lamina) comes from the fact thatusually a small amount of the bone of the lamina must be removed. This is tomake room to see into the spinal canal and to allow room to work.

Once this is done, the surgeon moves the nerve roots out of the way to seethe intervertebral disc. The surgeon locates the disc material that has rupturedinto the spinal canal and removes it. This removes any pressure and irritationon the nerves of the spine. Using small instruments that fit inside the discitself, he also removes as much of the nucleus pulposus material still insidethe disc as possible. This is done to prevent any remaining disc material toherniate again after the operation.

After the procedure is complete, the muscles of the back are returned to theirnormal position around the spine. The skin incision is repaired with suturesor metal staples.

Microdiscectomy

Recently, improvements have been made in the tools available to the spinalsurgeon for performing a laminotomy and discectomy. The procedure is essentiallythe same as the traditional way of removing a ruptured disc; however, it requiresa much smaller incision. The advantage of this procedure over the traditionalapproach is that there is less damage to the normal parts of the spine duringthe operation. You may also recover faster.

To be able to see through the smaller incision, the surgeon uses an operatingmicroscope. A small incision (as small as two inches) is made in the back justabove the area where the disc is herniated. Once the muscles are moved asideand the vertebra can be seen, a microscope is used to finish the operation.The rest of the operation is performed exactly like the more traditional approachdescribed above.

Complications

With any surgery, there is a risk of complications. When surgery is done nearthe spine and spinal cord these complications (if they occur) can be very serious.Complications could involve subsequent pain and impairment and the need foradditional surgery. You should discuss the complications associated with surgerywith your doctor before surgery. The list of complications provided here isnot intended to be a complete list of complications and is not a substitutefor discussing the risks of surgery with your doctor. Only your doctor can evaluateyour condition and inform you of the risks of any medical treatment he or shemay recommend.

Please review the document, entitled:

Complications of Spine Surgery

Before surgery:

There can be complications from a herniated disc even before surgery.The most serious complication from a thoracic herniated disc is the developmentof complete paralysis below the waist. This results when a fragment of discmaterial is ruptured into the spinal canal. Pressure on the spinal cord causespermanent damage to the nerves traveling to the lower body and legs. If thisoccurs, you may lose the ability to control your bowels and bladder. This isa serious problem. Fortunately, it is also rare. If your doctor suspects thisis occurring, he will probably recommend surgery immediately to try and removethe pressure from the spinal cord.

During surgery:

Many complications can occur during surgery. There is always the risk of acomplication due to the anesthesia used during any type of surgery. Complicationsthat are possible during the removal of a herniated disc include:

Nerve Injury

Removing a herniated disc requires working around the nerves of the spine.During the operation, these nerves may be injured. If this occurs, you may havepermanent damage to the nerves involved. This may cause permanent numbness,weakness or pain in the area that the nerve travels in the leg.

Dural Tear

A watertight sack of tissue called the dura mater covers the spinal cord andthe spinal nerves. A tear in this covering can occur during surgery. It is notuncommon to have a dural tear during any type of spine surgery. If this is noticedduring the surgery, it is simply repaired and usually heals uneventfully. Ifit is not recognized, the tear may not heal and may continue to leak spinalfluid. This can cause problems later. A spinal headache can result from thespinal fluid leak and it can increase the risk of infection of the spinal fluid(spinal meningitis). If the dural leak does not seal itself off fairly quicklyon its own, you may need a second operation to repair the tear in the dura.

After surgery:

Some complications do not show up until after surgery. Some show up fairlyquickly and some may take months to become evident. These include:

Infection

Any surgical operation has a small risk of infection, and operations on thespine are no different. Infection can occur in the skin incision, inside thedisc, or in the spinal canal around the nerves. If an infection occurs thatinvolves the skin incision, you may only need antibiotics. If the infectioninvolves the spinal canal or the disc area, you may require a second operationto drain the infection. You will also require antibiotics after the second operationto treat the infection.

Re-herniation

There is always the chance that the same disc may herniate again. It is mostlikely to occur in the first six weeks after surgery, but it can occur anytime.In this case, you might need a second operation.

Persistent Pain

Sometimes these operations simply do not work. You may continue to experiencepain for many reasons. Sometimes, the nerves are actually damaged by the pressurefrom the disc herniation and may not recover completely. You may also developscar tissue around the nerves weeks after the operation that causes pain similarto what you had before the operation. Your pain may also be from other problemsin the back that have not been helped by removing the herniated disc.

Degenerative Disc Disease

Any injury to a disc can lead to degeneration of the spinal segment that isinvolved. A disc that has been operated on - and a portion removed - has definitelybeen injured. The development of additional problems in the area where a dischas been removed is not for certain, but there is an increased chance. Thissituation may require a second operation if the pain from the degenerative processbecomes severe. This usually takes several years to develop.

Rehabilitation

Physical Therapy

After surgery, your doctor will probably suggest that you see a physical therapistbefore you start an exercise routine. Exercise is vital to recovery and to maintaininga healthy spine. Consider it part of long-term health management and risk reduction.Regular exercise is the most basic way to combat back problems. You need tomake sure the exercises you choose are effective and safe for your particularcase.

Why exercise? Scientific studies have shown that people who exercise regularlyhave far fewer problems with their back. It helps strengthen the muscles inyour back that correspond with your spine. It can reduce your risk of fallsand injuries. It can strengthen your abdomen (your belly), arms, and legs, whichreduces back strain. Stretching reduces risk of muscle spasms. In addition,weight bearing exercises help prevent loss of bone mass caused by osteoporosis,reducing your risk of compression fractures. Aerobic exercise, the type thatgets your heart pumping and the pulse rate up has been shown to be a good painreliever as well. The natural chemicals of the body that combat pain - calledendorphins - are released during exercise and actually reduce your pain.

For more information about spinal rehabilitation review the following document,entitled:

Understanding Spinal Rehabilitation

« Back to Patient Guides