From the Guidelines
Thoracic disk disease symptoms include mid-back pain, numbness, tingling, weakness in the legs, and in severe cases, difficulty walking or bowel/bladder dysfunction, with treatment options ranging from conservative approaches like pain medications and physical therapy to surgical interventions for severe or persistent cases. The symptoms of thoracic disk disease can vary widely, but common presentations include thoracic midback pain, motor/sensory deficit, spasticity/hyperreflexia, positive Babinski sign, or bladder dysfunction, as noted in patients with symptomatic thoracic disc herniations 1.
Symptoms
- Mid-back pain that may radiate around the chest or abdomen
- Numbness or tingling sensations
- Weakness in the legs
- Difficulty walking
- Bowel or bladder dysfunction in severe cases
Treatment Options
Treatment for thoracic disk disease typically begins with conservative approaches, including:
- Pain medications such as acetaminophen or NSAIDs like ibuprofen
- Physical therapy focusing on core strengthening and posture correction
- Activity modification to avoid exacerbating the condition Epidural steroid injections may be considered for temporary relief of inflammation. For cases with progressive neurological deficits or intractable pain, surgical options such as discectomy, laminectomy, or fusion procedures may be necessary, with the choice depending on the disk location and patient factors 1.
Considerations
The decision for surgery is usually based on the presence of severe, intractable pain, or progressive/severe myelopathy, highlighting the importance of prompt evaluation and treatment to prevent complications, especially given the thoracic spine's anatomy and the potential for spinal cord compression 1. Recovery times can vary significantly between conservative and surgical treatments, ranging from 6-12 weeks for conservative approaches to 3-6 months for surgical recovery.
From the Research
Symptoms of Thoracic Disk Disease
- Atypical pain patterns, including severe back pain and stubborn intercostal neuralgia 2, 3
- Myelopathy, which can manifest as weakness, numbness, or tingling in the lower extremities 2, 3
- Chronic abdominal pain, which can be mistaken for other conditions such as chronic pancreatitis 4
- Neurological deficits, including weakness, numbness, or tingling in the lower extremities 2, 3
Treatment Options for Thoracic Disk Disease
- Nonoperative management, which can include physical therapy, pain management, and lifestyle modifications 3
- Surgical intervention, which can include:
- Transthoracic approach, which is often used for mid-line calcified hernias 2
- Posterolateral approach, which is often used for lateralized soft hernias 2, 5
- Thoracoscopic approach, which is a less invasive option but has a lengthy learning curve 2
- Retropleural mini-thoracotomy, which is a potential compromise solution 2
- Fusion, which is recommended in cases of multilevel herniation, herniation in the context of Scheuermann's disease, or when more than 50% of the vertebral body is resected 2
Complications of Surgical Treatment
- Neurological worsening, including worsening of myelopathy or neurological deficits 2, 6
- Dural breach and subarachnoid-pleural fistulas, which can occur during surgical intervention 2, 6
- Vertebral column instability, which can occur after surgical intervention 6
- Intercostal neuralgia, which can occur after surgical intervention 6