A herniated disc at the upper back, also known as a thoracic herniated disc, can lead to a range of symptoms, including pain, numbness and weakness. Sharp, axial back pain that gets worse with activity is the most common. However, there are other symptoms and signs.
- A burning sensation or electric-like pain that radiates around the chest and abdomen.
- Similar pains can radiate to the legs as shock-like.
- At the same or lower level as the herniated disc, sensory disturbances such as tingling and numbness may occur.
- Motor deficits, such as gait instability and leg weakness, can also be detected.
- Paralysis of the legs, bowel or bladder dysfunction may occur in the most severe cases.
When the inner gelatinous material from an intervertebral disc leaks out, a herniated disc can develop in the upper back. Upper back pain can be caused by a herniated disc in the thoracic.
The symptoms of a herniated disc in the thoracic spine are often different depending on where it herniates. Because the herniated disc material can be found in the upper back, the impact on an existing nerve root and/or the spinal cord can cause severe pain.
Thoracic Degenerative Disc Disease
The concept of thoracic disc disease is similar to disc problems in the cervical or lumbar spines, but the incidence of symptomatic lesion (anatomical problems related to the symptoms) is much lower.
Thoracic disc disorders are most commonly found at the thoracolumbar junction (T8-12) in the middle-back. It is not known how many thoracic disc diseases cause symptoms or thoracic back pain. They also make up a small percentage of all herniated disc treatment procedures.
One study involved 90 patients who were asymptomatic and had no pain or other symptoms. They were then evaluated using thoracic MRI scans. These were the results:
73% of patients had disc abnormalities in their upper backs, such as a herniated disc or degenerative disc disease.
37% of those surveyed had a thoracic herniated disc.
29% of patients had radiographic evidence that spinal cord impingement was identified on an MRI.
The 26-month-long follow up of these patients revealed that none of them experienced thoracic back discomfort due to their thoracic disc conditions.
A herniated disc in the thoracic region can cause pain
The thoracic spine has 12 intervertebral discs that support and cushion the vertebrae.1 When the outer layer of the disc (annulus fibrosus) is torn, the inner jelly-like core (nucleus pissosus), bulges or becomes exposed, a herniated disc can occur.
A herniated disc in the thoracic region can cause pain of many kinds, including:
Discogenic pain. Back pain may be caused by a ruptured or torn annulus fibrosus. This pain could be mistaken for abdominal, pulmonary, or cardiac pain.
Muscle spasm. The surrounding muscles can respond to local injuries to the intervertebral disc and supporting ligaments. Large muscles in the back may tighten, eventually leading to spasms. Muscle spasms can cause pain in a large area of the back, affecting multiple levels and limiting motion.
Radicular pain. Radicular pain may be caused by a herniated thoracic disc with a lateral component. This could compress or irritate nerves that innervate the chest wall, ribs, and abdomen. The pain is usually unilateral and can be described as electric shock-like or burning. However, it can also feel mild or achy. This pain may feel like a band around your abdomen or chest in some cases.
Treatments
The surgeon might recommend the following non-operative treatments before discussing the possibility of surgery:
- Modification of activity
- Education of patients on body mechanics to help reduce the risk of disc damage or worsening.
- Physical therapy can include massage, ultrasound, conditioning and exercise programs.
- Weight control
- Medication (to control inflammation, reduce pain, and/or relax the muscles)
- The following are the guidelines for surgical treatment of a herniated disc:
The history, severity, duration, and cause of the pain
- Consider whether or not disc disorders have been treated previously and how successful those treatments were.
- It is important to determine if there are any signs of neurologic damage, such as sensory loss, weakness or impaired coordination.
- Patients with disc problems of the spine are usually advised to have surgery if they don’t find relief from non-operative treatment within 6-12 weeks. Patients with a neurologic deficit (numbness or weakness due to pressure on the spinal cord or nerves) may also need surgery. To maximize your chances of neurologic recovery, it is important to intervene as soon as possible.
These are some of the procedures that your surgeon might perform:
- Microdiscectomy: This procedure uses a microscope to view the disc and microsurgical tools. It relieves the pressure from a herniated disc. Microdiscectomy is often performed to treat herniated discs in cervical, thoracic and lumbosacral. The procedure is done under general anesthesia by making a small incision on the skin. To expose a small section of the spine, the muscles are gently lifted or stretched apart. To allow safe access to the spinal canal, a small portion of the back of the spine is removed called the lamina or facet joint. Our neurosurgeons use microsurgical techniques to identify and remove the herniated disc, while also protecting the compressed nerve. Patients may be able to return home the same day or next morning.
- For large, calcified disc herniations causing spinal cord compression, it may be necessary to perform anterior (from the front) and lateral (from both the sides) surgery.
- Anterior Cervical Discectomy and Fusion (ACDF): This procedure involves the removal of the herniated cervical disc through the front part of the neck. To stabilize the spine after discectomy, spinal fusion surgery may be necessary.
