From the Guidelines
A degenerative change with posterior disc bulge in the mid-thoracic spine typically requires a combination of conservative treatments, starting with over-the-counter pain relievers and physical therapy, as surgery is usually reserved for severe, intractable pain, or progressive/severe myelopathy. The goal of treatment is to alleviate pain, improve mobility, and prevent further degeneration. According to the American College of Radiology Appropriateness Criteria 1, MRI of the thoracic spine is the initial imaging modality of choice for patients with thoracic back pain and myelopathy or radiculopathy.
Key considerations for treatment include:
- Over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) for pain and inflammation
- Physical therapy focusing on thoracic spine mobility and core strengthening exercises 2-3 times weekly for 6-8 weeks
- Heat therapy for 15-20 minutes several times daily to relax muscles and improve blood flow
- Maintaining proper posture throughout the day, especially when sitting for long periods, and considering using a supportive chair with lumbar support
- Using a medium-firm mattress and avoiding stomach sleeping
If pain persists after 4-6 weeks of conservative treatment, consultation with a spine specialist for further evaluation is recommended, which might include prescription muscle relaxants like cyclobenzaprine (5-10mg at bedtime) or consideration of epidural steroid injections 1. It's essential to note that symptomatic thoracic disc herniations requiring surgery are rare, accounting for 1% to 2% of all discectomies, and indication for surgery is usually severe, intractable pain, or progressive/severe myelopathy 1.
From the Research
Degenerative Change Posterior Disc Bulge in the Mid Thoracic
- The provided studies primarily focus on lumbar disc degeneration, with no direct mention of the mid thoracic region 2, 3, 4, 5.
- However, the general principles of disc degeneration and bulging may still be applicable to other regions of the spine.
- Disc degeneration is often characterized by an imbalance between catabolic and anabolic processes, leading to extracellular matrix degradation, neoinnervation, and neovascularization 2.
- This degenerative process can result in disc bulging, loss of nucleus pulposus and water content, and subsequent loss of disc height 2.
- The behavior of degenerative intervertebral discs under physiologic loads has been studied using kinematic magnetic resonance imaging (kMRI), which has shown that disc bulging increases with the severity of disc degeneration 3.
- In the lumbar region, extension has been found to result in significant posterior disc bulging, while flexion does not demonstrate obvious anterior derangement 3.
- The pathomechanism and biomechanics of degenerative disc disease involve the disruption of homeostasis maintained by the structures of the intervertebral disc, with genetic and environmental factors contributing to disease progression 4.
- MRI findings of disc degeneration, including disc bulge, are more prevalent in adults with low back pain than in asymptomatic controls 5.