Your spine consists of twenty-four individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebra. A disc is made up of two basic parts. The inner disc, called the “nucleus” is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus,” which is wrapped around the inner nucleus, much like a ribbon wrapping around your finger. The term “thoracic disc lesion” means that one or more of the 12 discs in the center section of your spine has been damaged.
Disc problems start when the outer fibers of the disc become strained or frayed. If enough fibers become frayed, the disc weakens and when compressed, may “bulge” like a weak spot on an inner tube. If more fibers are damaged, the nucleus of the disc may “herniate” out of the disc.
Surprisingly, thoracic disc bulges are present without any symptoms in almost half of the adult population. Disc bulges that cause pain commonly occur in the neck or lower back but are relatively infrequent in the thoracic spine – accounting for less than 1% of all symptomatic disc problems. The condition is most common between the ages of 40 and 60. Certain occupations or activities place you at greater risk, especially physically demanding activities that involve repetitive twisting, awkward postures.
Pain can range from dull, localized discomfort to sharp, radiating pain. Your symptoms may change unpredictably. If the disc bulge is bad enough to compress your nerve, you could experience sharp, burning, or shooting pain in a band-like distribution around your rib cage. Thoracic disc herniations commonly mimic other conditions like heart or lung problems. Be sure to let our office know if you notice chest pressure; shortness of breath; pain radiating into your arm, face, or jaw; pain with deep breathing; clumsiness; loss of bowel or bladder control; unexplained weight loss; night sweats; pain that awakens you at night; fever; indigestion; nausea; flu-like symptoms or if you notice a rash following the margin of one of your ribs.
You should avoid excessive bed rest while recovering. Researchers have shown that disc bulges may be successfully managed with exercise and conservative care, like the type we will provide at Cole Pain Therapy Group.
Thoracic disc lesion refers to a disruption of annular fibers and subsequent displacement of nuclear material. Like cervical and lumbar lesions, thoracic disruptions may be sub-classified as a circumferential bulge, protrusion, extrusion, or sequestration. Ensuing symptoms vary from nothing to possible referred or radicular pain, paresthesia, or numbness in the distribution of the affected nerve root(s).
Thoracic disc lesions develop from multiple factors, in a similar fashion to their cervical and lumbar counterparts. (1-4) Repetitive mechanical stressors, like compression, vibration, and shear or torsional stress can weaken annular fibers, eventually leading to disruption. (5) The majority of thoracic disc lesions, however, result from the loss of normal viscoelastic properties over time (i.e. degeneration). (5) Discs dehydrate as we age, leading to impaired ability to dissipate loads. Repetitive microtraumas spawn small circumferential annular tears, which weaken the annular fibers and allow for diffuse circumferential bulging. Tears that coalesce create “channels,” allowing herniation of disc material. Continued microtrauma is associated with separation of the annulus from the vertebral end plate, thereby further compromising disc imbibition and hydration.
While asymptomatic thoracic disc lesions may be present in up to half of the population, these problems account for less than 1% of all symptomatic spinal disc lesions. (6-9) The relative rarity of symptomatic thoracic disc lesion makes it an often overlooked diagnosis. (10) Of those patients experiencing thoracic disc herniation, almost ¼ demonstrate herniations at multiple (often non-contiguous) levels. (11) Over 75% of thoracic disc herniations occur below T8, with the T11/12 segment being affected most often. (6,12) Lower thoracic hypermobility and posterior longitudinal ligament weakness are thought to predispose this region to problems. (6)
Symptomatic herniations occur most frequently in the fourth or fifth decade and affect females more often. (12) Risk factors for the development of thoracic disc lesion includes trauma, repetitive twisting, awkward postures, and physically demanding occupations or activities (i.e. golf). (5,13)