Effects of a T5/6 Bulging Spinal Disc
A T5/6 bulging spinal disc can cause local thoracic back pain, possible radicular symptoms, and in severe cases may lead to spinal cord compression with neurological deficits, though many cases remain asymptomatic and can be managed conservatively.
Clinical Presentation
Pain Patterns
- Localized thoracic back pain at the T5/T6 level
- Possible radiation of pain around the chest wall following the dermatome pattern
- Pain may worsen with certain movements, weight-bearing activities, or prolonged positions
- Unlike lumbar disc disease, thoracic disc herniations are less common due to:
- Limited mobility in the thoracic spine
- Additional support from the rib cage
- Relatively smaller disc size compared to cervical or lumbar regions 1
Neurological Symptoms
- Radicular symptoms may include:
- Pain radiating in a band-like distribution around the chest
- Sensory changes (numbness, tingling) in the affected dermatome
- In severe cases, weakness in the corresponding myotome
- Myelopathy (spinal cord compression) may present with:
- Lower extremity weakness or sensory changes
- Gait disturbances
- Bowel/bladder dysfunction in severe cases
Diagnostic Considerations
Imaging Findings
- MRI is the gold standard for evaluating thoracic disc bulges 2
- Shows the relationship between the disc and neural elements
- Can identify cord compression or signal changes
- Can differentiate disc bulge from other pathologies
- CT may be used when MRI is contraindicated 2
- Provides good definition of bony elements
- Less sensitive for neural compression
Important Distinctions
- Asymptomatic disc bulges are common in the thoracic spine 1
- Thoracic disc abnormalities such as herniations, bulges, and annular fissures are frequently found in patients without mid-back pain 1
- Morphologic imaging changes do not always correlate with pain 1
Pathophysiology
Mechanisms of Pain Generation
- Mechanical stimulation of nociceptors in the outer annulus fibrosus 3
- Inflammatory mediators (tumor necrosis factor, interleukins) released from degenerating disc tissue 3
- Possible ingrowth of vessels and nerve fibers into deeper layers of the annulus fibrosus 3
- Altered biomechanics affecting surrounding structures (facet joints, ligaments, muscles) 3
Progression
- Disc bulging is the earliest stage of disc herniation 4
- May progress to more severe forms (protrusion, extrusion, sequestration) 4
- Risk of neurological deficits increases with more advanced stages of disc herniation 4
Management Approach
Conservative Management
- First-line approach for most patients with thoracic disc bulges 2
- Approximately 80% of patients experience symptom resolution with conservative treatment 2
- Components include:
- Activity modification
- Physical therapy with focus on core strengthening
- Pain management with NSAIDs or other appropriate medications
- Structured rehabilitation program
When to Consider Advanced Imaging
- Imaging should be considered after a trial of conservative therapy fails 2
- Immediate imaging is warranted with:
- Progressive neurological deficits
- Signs of myelopathy
- Severe or disabling pain unresponsive to initial management
Surgical Considerations
- Surgery is typically reserved for cases with:
- Significant or progressive neurological deficits
- Spinal cord compression with myelopathy
- Disabling pain unresponsive to conservative management for at least 6 weeks 2
Prognosis and Complications
Long-term Issues
- Chronic pain may develop in some patients
- Fatigue and psychological distress can accompany chronic pain conditions
- Risk of progression to more severe disc herniation exists but is not inevitable
Potential Complications of Severe Cases
- Myelopathy with permanent neurological deficits
- In rare cases, delayed surgical intervention in severe stenosis can lead to irreversible neurological damage 2
Remember that many thoracic disc bulges remain asymptomatic, and treatment decisions should be based on clinical presentation rather than imaging findings alone.