What it is
Thoracic disc herniations are far less common than cervical or lumbar ones, partly because the rib cage limits movement in the mid-back. Many are found incidentally. The ones that matter are those pressing on the spinal cord, because the thoracic canal is tight and the consequences of cord compression are significant.
Symptoms
- Mid-back pain, sometimes band-like around the chest or abdomen
- Pain or numbness following a rib line
- Where the cord is involved: leg weakness, stiffness, balance problems, bladder change
Symptoms can be misleading and are sometimes investigated for cardiac or abdominal causes first.
How it is diagnosed
MRI of the thoracic spine. A CT is often added because many thoracic herniations calcify, which changes the surgical approach considerably. Dr. Long will assess whether the cord is merely touched or genuinely compressed, and whether there is any signal change within it.
Non-surgical treatment
For herniations without cord compression: physical therapy, anti-inflammatory medication, activity modification and occasionally targeted injections. Observation with repeat examination is entirely reasonable where the examination is normal.
When surgery is considered
Cord compression with neurological signs, or intractable pain from a confirmed herniation that has not responded to non-operative care. The approach depends on where the fragment sits and whether it is calcified. This is an operation worth planning carefully and getting a second opinion on, and Dr. Long is happy to be either the first or the second.