A herniated disc occurs when the intervertebral disc\'s annulus (the outer fibers) is damaged and the soft inner material of the nucleus pulposus ruptures out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal. There is very little extra space around the spinal cord in the thoracic area. So when a herniated disc occurs in the mid back it can be extremely serious. In severe cases, the pressure on the spinal cord can lead to paralysis below the waist. Fortunately, herniated discs are not nearly as common in the thoracic spine as in the lumbar spine.
The annulus is the disc\'s outer layer and the strongest area of the disc. The annulus is actually a strong ligament that helps connect each vertebra together. The nucleus in the center of the disc serves as the main shock absorber.
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 out of its normal space. If the annulus tears near the spinal canal, the nucleus pulposus material can push into the spinal canal.
Herniated discs can occur in children, although it is rare. A true herniated nucleus pulposus is most common in young and middle-aged adults and generally occurs in the low back. Disc herniations in the thoracic spine mostly affect people between age 40 and 60. In older folks, the degenerative changes that occur in the spine with aging make it less likely for them to suffer a true herniated disc.
Discs can rupture suddenly because of too much pressure all at once. For example, falling from a ladder and landing in a sitting position can cause a great amount of force through the spine. If the force is strong enough, either a vertebra can break or a disc can rupture. Bending places high forces on the discs between each vertebra. If you bend and try 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 weakening of the annulus from repeated injuries that add up over time. As the annulus becomes weaker, at some point lifting or bending causes too much pressure across the disc. The weakened disc ruptures while doing something that five years earlier would not have caused a problem. This is due to the effects of aging on the spine-the most common reason for a disc herniation in the thoracic spine.
The material that has ruptured into the spinal canal from the nucleus pulposus can cause pressure on the nerves in the spinal canal. There is also some evidence that the nucleus pulposus material causes a chemical irritation of the nerve roots. Both the pressure on the nerve root and the chemical irritation can lead to problems with how the nerve root functions. The combination of the two can cause pain, weakness, and numbness in the area of the body to which the nerve supplies sensation.
In the thoracic spine, the pressure can also affect the spinal cord. This is due to the fact that there is little extra space within the spinal canal of the thoracic spine. Too much pressure on the spinal cord can lead to paralysis from the waist down.
The first symptom of a thoracic disc herniation is usually pain. The pain is most often felt in the back, directly over the sore disc. Pain may also radiate around to the front of the chest. Pressure or irritation on the nerves in the thoracic area can also cause symptoms. Depending on which nerves are affected, a thoracic disc herniation can include pain that feels like it is coming from the heart, abdomen, or kidneys.
Herniated thoracic discs sometimes press against the spinal cord. When this happens, symptoms may include
- muscle weakness, numbness, or tingling in one or both legs
- increased reflexes in one or both legs that can cause spasticity
- changes in bladder or bowel function
- paralysis from the waist down
Diagnosing a herniated nucleus pulposus begins with a complete history of the problem and a physical exam. Your doctor will want to make sure that you are aware when you have to urinate or have a bowel movement. If there is a problem, it could indicate that a herniated disc in the thoracic spine is pushing against the spinal cord.
Common Diagnostic Tests:
- CT Scan
- EMG and SSEP
The treatment of a herniated disc depends on the symptoms. If the symptoms are getting better, your doctor may suggest watching and waiting to see if they go away. If they are getting steadily worse, your doctor may be more likely to suggest surgery. Many people, who initially have problems due to a herniated disc, find their symptoms completely resolve over several weeks or months.
You may not need any treatment other than watching to make sure that the problem does not progress. If the pain is bearable and symptoms from nerve or spinal cord pressure are not getting worse, your doctor may just want to watch and wait.
Depending on the severity of your pain, medications can be used to help control it. Over-the-counter pain relievers, such as ibuprofen, Tylenol(tm), and some of the newer anti-inflammatory medications, may be helpful. Make sure to follow the directions and not take too many.
If these types of medications do not control the pain, your doctor may prescribe stronger pain pills-narcotic or non-narcotic pain medications. Narcotic pain medications are very strong but also very addictive. Non-narcotic pain medications are less addictive, but are somewhat less effective than narcotics. Most physicians do not like to prescribe narcotics for more than a few days or weeks.
Learn more about medications used to treat back pain.
If the pain is more severe, it may be necessary to take a few days off from work and decrease your activities. Your doctor may also prescribe a back brace to help limit movement around the injured disc. After two days, you should begin to get moving. Start with a gentle walking program and increase the distance you walk each day.
Patients with a herniated disc are commonly prescribed physical therapy. A well-rounded rehabilitation program assists in calming pain and inflammation, improving your mobility and strength, and helping you do your daily activities with greater ease and ability.
Therapy visits are designed to help control symptoms, enabling you to resume normal activities. Exercises focus on improving strength and coordination of the low back and abdominal muscles. The emphasis of therapy is to help you learn to take care of your back through safe exercise and self-care when symptoms flare up. Therapy sessions may be scheduled two to three times each week for up to six weeks.
The goals of physical therapy are to help you
- learn ways to manage your condition and control symptoms
- resume appropriate activity levels
- learn correct posture and body movements to reduce back strain
- maximize your flexibility and strength
Learn more about spinal rehabilitation.
Epidural Steroid Injection (ESI)
The ESI is usually reserved for more severe pain from nerve root irritation due to a herniated disc. It is not usually suggested unless surgery is fast becoming an option. An ESI is only successful in reducing the pain from a herniated disc in about half the cases.
Learn more about spinal injections.
Surgical treatment for a herniated disc depends on several factors such as your specific problem and your surgeon\'s experience.
Like all surgical procedures, operations on the back may have complications. Because the surgeon is operating around the spinal cord, back operations are always considered extremely delicate and potentially dangerous. Take time to review the risks associated with lumbar spine surgery with your doctor. Make sure you are comfortable with both the risks and the benefits of the procedure planned for your treatment.
Learn more about possible complications of spine surgery.