Radiculopathy
Radiculopathy is the technical term for pain or other symptoms caused by pinching of a nerve root that enters the spinal cord.
People often describe radiculopathy as feeling like a strap is being tightened around their chest. The location of this “strap” corresponds to the level of the spine where the herniated thoracic disc is located. It also corresponds to the parts of the body supplied by the nerve that is being pinched.
About 52% of people with a symptomatic herniated thoracic disc experience radiculopathy.
Many people assume that radiculopathy involves a sensation of pain, but that is not always the case. In addition to pain in or around the spine, radiculopathy can also describe numbness, weakness, a feeling of pressure, or generalized discomfort. Many people diagnosed with thoracic herniated disc experience no spine pain at all.
Myelopathy
Myelopathy describes the symptoms caused when pressure from the herniated disc puts pressure on the spinal cord. This can cause dysfunction in areas of the body below the level of the herniated thoracic disc, including the leg weakness and numbness mentioned above.
Myelopathy also can cause pain in the area where the spinal cord is compressed or pain in the extremities, although some people with myelopathy experience no pain at all.
Symptoms vary depending on the quantity of thoracic disc material that has escaped and which structures the escaped material is putting pressure on. In some instances, a thoracic herniated disc may not produce pain or any other symptoms.
It is common for doctors to suspect and investigate other, more common conditions because thoracic herniated discs are rare. Often times, people may be tested for heart problems, gastrointestinal problems, angina, lung issues, and shingles in this process.
About 70% of people with symptomatic thoracic disc herniation experience myelopathy.
Pain and other symptoms consistent with radiculopathy and myelopathy can be caused by other medical conditions. Only a medical professional can confirm or rule out a diagnosis of herniated thoracic disc.
Classification of Herniated Thoracic Discs
Spinal neurosurgeons at Barrow recently led the creation of a classification system for herniated thoracic discs based on their size, location, and whether or not they are calcified.1
Type 0 herniated thoracic discs are small, taking up 40% of the spinal canal or less, and do not put large amounts of pressure on the spinal cord or spinal nerves. Most surgeons recommend observation for these lesions.
Type 1 herniations are also small, but located to the side of the spinal canal, where they are more likely put pressure on the nerve roots that exit the spine and spinal cord or the side of the spinal cord itself. Most surgeons favor approaching these discs from the back (posterior approach).
Type 2 herniations are small but located in the middle of the spinal canal and are more likely to involve the spinal cord and not the spinal nerve roots. Spine surgeons may elect to approach these from the side or the back.
Type 3 herniations are very large and located to the side of the spinal canal.
Type 4 thoracic disc herniations are giant and located in the center of the spinal canal. Most surgeons prefer to approach type three and four herniations from the side.
Most cases of thoracic disc herniation can be treated with a nonsurgical approach, which usually consists of rest, anti-inflammatory medication, and physical therapy. However, you may be a candidate for surgery if you have severe back pain and/or neurological symptoms that are not responding to conservative treatment.
Herniated Thoracic Disc Surgery Explained
Thoracic Discectomy
In this procedure, the neurosurgeon removes the protruding fragment of the disc that is compressing the spinal cord or spinal nerves and causing thoracic pain or other symptoms.
Traditionally, thoracic discectomy has been performed through an anterior (front) approach or a posterior (back) approach. At Barrow Neurological Institute, our spine surgeons are leaders in minimally invasive techniques, including minimally invasive lateral thoracic discectomy. The benefits of this approach, in which the spine surgeon accesses the spine through the side of the body using a less disruptive approach, include:
- A shorter hospital stay
- Less post-operative pain
- Less time in surgery
- Reduced blood loss
- Usually no need for chest tubes
Thoracic Fusion
In some cases, a degenerated disc may need to be removed entirely and the adjacent vertebrae fused together to stabilize the spine.
In this process, the neurosurgeon first removes the damaged thoracic disc. Then, the disc is replaced with a bone graft. This graft can be taken from the patient’s rib or hip (autograft) or from a cadaver donor (allograft).
After the bone graft has been placed, the neurosurgeon will usually place rods ands screws in the vertebrae above and below the disc that has been removed. This hardware stabilizes and supports the spine while the bone graft fuses with the surrounding vertebrae.
Spinal fusion can also be performed using minimally invasive techniques. Many people report that their pain and other symptoms are reduced or eliminated after surgery.
