Degenerative disc disease in the thoracic spine is a relatively rare condition compared to other parts of the spine. This is because the rib cage stabilizes the thoracic vertebrae, limiting movement and resultant trauma from constant flexing and bending as occurs in the rest of the spine. If thoracic degenerative disc disease does occur, it usually is brought about by trauma. It can be diagnosed by MRI, X-ray, discogram, CT scan and myelogram.
Physiology of the Disease
Degenerative disc disease at any spinal level is part of the normal aging process. In the thoracic spine, it more commonly occurs between T9 and T12, according to MDGuidelines. As described by SpineUniverse, the intervertebral disc has a fibrous outer membrane surrounding a more gelatinous internal core. Combined, they form a cushion between vertebrae. With degenerative disc disease, defects begin to form in the outer membrane, and with pressure from the vertebrae, the inner core can herniate through. When the disc material herniates, it can compress neural tissues and result in pain and other neurological symptoms.
Up to one-third of people who have degenerative disc disease and herniation, as shown by MRI, have no symptoms, according to MDGuidelines. Why one individual may have no back pain while another may experience debilitating back pain with the same degree of degeneration is unknown. When thoracic pain is present in younger people, usually there is a history of trauma. Also, those with chronic compression of the spinal cord or nerve roots have prolonged symptoms.
Types of Symptoms
When the thoracic disc herniates or becomes displaced, symptoms of disc degeneration begin to occur. The result is usually pain in the thoracic region of the upper back. Pain also can follow along a rib when a nerve root is compressed. If the spinal cord is compressed, there can be lower extremity weakness and loss of coordination. Bladder and bowel control also may be affected.
The most important risk factor for developing degenerative disc disease is aging, according to MDGuidelines. Normal aging changes the integrity of the disc and starts a cascade of events leading to herniation. People most at risk are those who perform repetitive or traumatic twisting movements of the thorax. Also, people with spine deformities such as kyphosis and scoliosis also are at risk for developing thoracic degenerative disc disease. If the patient is elderly, chronic diseases like osteoporosis and osteoarthritis increase risk. The frequency of the disease is equal in men and women.
Conservative or non-surgical treatment is normally sought first to treat a herniated thoracic disc, according to the Mayfield Clinic. Therapy may include rest, massage treatments, physical therapy, chiropractic manipulation, exercise and pain management. Non-steroidal anti-inflammatory and other medicines can be used to control pain and inflammation.
When conservative therapy fails, surgery is used to remove the disc or the bulged area pressing on neural tissues. This is called discectomy. If removal of the disc creates instability between vertebrae, the bones may be fused. This requires bone grafting into the intervertebral space and may require metal hardware to hold the bones together.