Conditions We Treat
Thoracic Disc Herniation
What Is It?
Thoracic disc herniation occurs when the gel-like center (nucleus pulposus) of an intervertebral disc in the thoracic spine protrudes through the outer layer (annulus fibrosus).
This herniation can compress nearby nerve roots or, more concerningly, the spinal cord. Although less common than cervical or lumbar disc herniations, thoracic disc herniations can cause significant pain and neurologic symptoms due to the narrow spinal canal in this region.
Common causes include:
- Degenerative disc changes over time
- Trauma such as falls or lifting injuries
- Repetitive spinal strain
- Congenital or structural spinal abnormalities
Symptoms
- Mid-back pain that may be sharp or aching
- Band-like pain radiating around the chest or ribcage in a dermatomal pattern
- Numbness, tingling, or weakness in the trunk or lower extremities if nerves are involved
- Balance problems or gait disturbance when spinal cord compression is present
- Rare bowel or bladder dysfunction, which may represent a surgical emergency
- Symptoms may worsen with coughing, sneezing, or straining
Diagnosis
- Detailed clinical history and neurologic examination
- MRI of the thoracic spine as the preferred imaging modality
- CT scan or myelogram if MRI is contraindicated
- X-rays to evaluate alignment and exclude other causes of mid-back pain
Treatment
Conservative Treatment:
- Activity modification to avoid symptom-provoking movements
- Medications including NSAIDs, acetaminophen, or short courses of oral steroids
- Physical therapy focused on thoracic stabilization, posture, and pain control
- Epidural steroid injections in select cases to reduce nerve inflammation
Surgical Treatment:
- Considered for progressive neurologic deficits, spinal cord compression, or severe persistent pain
- Surgical options may include:
- Discectomy
- Laminectomy or laminotomy
- Spinal fusion when instability is present
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