Prof. Dr. Roth Vargas

NEROUCIRURGIÃO

Campinas SP

Brazil

Tel. (55) X 19 9 3789 5577

www.cmcnet.com.br


THORACIC DISC HERNIATION

Thoracic Disc Herniation Symptoms



Pain is the most common symptom of a thoracic herniated disc and may be isolated to the upper back or radiate in a dermatomal (single nerve root) pattern. Thoracic back pain may be exacerbated when coughing or sneezing. Radiating pain may be perceived to be in the chest or belly, and this leads to a quite different diagnosis that will need to include an assessment of heart, lung, kidney and gastrointestinal disorders as well as other non-spine musculoskeletal causes.

Within the spine itself there are also many other disorders that can have similar presenting symptoms of upper back pain and/or radiating pain, such as a spine fracture (e.g. from osteoporosis), infection, tumor, and certain metabolic disorders.
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If the disc herniates into the spinal cord area, the thoracic herniated disk may also present with myelopathy (spinal cord dysfunction). This may be evident by sensory disturbances (such as numbness) below the level of compression, difficulty with balance and walking, lower extremity weakness, or bowel or bladder dysfunction.
Common Thoracic Herniated Disc Symptoms

Presenting symptoms of a thoracic herniated disc often correlate with the size and location of the disc herniation. The herniated material may protrude in a central, lateral (sideways), or centro-lateral direction with the majority having a central component. Typical symptoms for each include:
Central disc protrusion.


This type of herniation usually causes upper back pain and/or myelopathy, depending on the size of the herniated disc and the amount of pressure on the spinal cord. There is limited room around the spinal cord in the thoracic spine, so a thoracic herniated disc can put pressure on the cord and affect the related nerve function. In serious cases, a thoracic herniated disc can lead to paralysis from the waist down.

Lateral disc herniation.
When herniating laterally, or to the side, the thoracic herniated disc is more likely to impinge on the exiting nerve root at that level of the spine and cause radiating chest wall or abdominal pain.

Centro-lateral disc herniation
This type of thoracic herniated disk may present with any combination of symptoms of upper back pain, radiating pain, or myelopathy.

Upper Back Pain from a Thoracic Herniated Disc

A herniated disc in the upper back can occur when the inner gelatinous material of an intervertebral disc leaks out of the inside of the disc. A thoracic herniated disc can cause upper back pain and other symptoms, such as radiating pain or numbness.
Specific symptoms of a thoracic herniated disc are usually different depending on where the disc herniates, as the herniated disc material in the upper back can either impinge on an exiting nerve root or on the spinal cord itself.

Thoracic Degenerative Disc Disease
Thoracic disc disease is conceptually similar to disc disorders in the cervical and lumbar spine, but symptomatic lesions (anatomical problems related to the symptoms) are far less common.
The most common location for thoracic disc disorders is at the thoracolumbar (the thoracic and lumbar parts of the spinal column) junction (T8-T12) in the mid back. The true incidence is unknown because many thoracic disc disorders do not cause thoracic back pain or other symptoms, and they comprise only a very small percent of all herniated disc treatment surgeries.
In one study, 90 asymptomatic patients (with no pain or other symptoms) were evaluated with thoracic MRI scans. These were the findings:


• 73% of patients were found to have disc abnormalities in the upper back, such as a thoracic herniated disc or thoracic degenerative disc disease
• 37% specifically had a thoracic herniated disc
• 29% had radiographic evidence of spinal cord impingement identified on the MRI.
These patients were followed for 26 months and none of them developed thoracic back pain from their thoracic disc disorders.

Thoracic Herniated Disc Diagnosis

The first step in diagnosing a thoracic herniated disc always includes a good patient medical history and physical examination. The spine physician will begin by getting a better understanding of the patient’s symptoms, including the:
• Location of the pain
• Severity of the pain
• Type of pain (numbness, weakness, burning, etc.).
The physician will often follow up by learning if any injuries occurred prior to the thoracic back pain or if any other problems (weight loss, fevers, illnesses, difficulty urinating) were recently present before the upper back pain. The physician will then perform a physical examination.
This combination of the patient’s description of how the pain feels, where it occurs, when it occurs, etc., as well as the spine physician’s physical examination, should yield clues to help localize the lesion to the thoracic spine.

Thoracic Herniated Disc Diagnostic Tests

If a thoracic herniated disc is suspected as the underlying cause of the pain, there are several diagnostic tests that can confirm the diagnosis and provide additional information, including:
• X-rays – While plain x-rays will not show a thoracic herniated disc, they may be used to help localize injuries in cases of trauma as well as aid in identifying spinal instability.
• Magnetic Resonance Imaging (MRI) – An MRI utilizes a powerful magnet attached to a computer to produce images of the spine. A painless and often accurate test, an MRI scan is the most useful imaging tool to identify disc pathology.

Thoracic Herniated Disc Causes

When the inner core of any disc between the 12 vertebrae of the thoracic spine extrudes through the outer core and irritates a nearby spinal nerve root, a herniated disc occurs.
Determining causation of the thoracic herniated disc is essential before treatment of upper back pain and any related symptoms can take place. Doctors typically classify thoracic herniated discs as being caused by either one of two sources:
• Degenerative disc disease. Many thoracic herniated discs occur from gradual wear and tear on the disc, which leads to settling of the vertebral bodies and calcification about the disc space.
• Trauma to the upper back. Traumatic herniated discs are defined as those associated with a significant traumatic event that caused the abrupt onset of symptoms.
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Thoracic Herniated Discs from Degenerative Disc Disease

When symptomatic of degenerative disc disease, the symptoms of a thoracic herniated disk most commonly occur between the 4th and 6th decades of life and usually develop very gradually.
With degenerative disc disease, the patient’s thoracic back pain and other symptoms are often present for a longer period of time prior to consultation with a physician.
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