Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Out-of-state? Free MRI review + telehealth consult before you travel4.9 ★ · 619 Google reviewsBoard-certified — American Board of Orthopaedic SurgeryMinimally invasive, same-day spine surgery in Beverly HillsCall (424) 217-7463
Thoracic Myelopathy, Cord Compression, and Disc Herniation
Thoracic myelopathy is compression of the spinal cord in the thoracic spine, the mid-back region between the neck and the lower back. Because the spinal cord itself is being squeezed — not just a single exiting nerve root — the symptoms can affect the legs, balance, and coordination, and they can progress if the pressure is not relieved.
The thoracic spine is a less common place for cord compression than the neck, which is one reason the diagnosis is sometimes missed. Symptoms can be subtle at first: a change in walking, stiffness or heaviness in the legs, or numbness that wraps around the trunk. This is a condition Dr. Melamed treats as time-sensitive, because the spinal cord tolerates prolonged pressure poorly and earlier decompression generally protects function better than waiting.
Thoracic myelopathy, thoracic cord compression, and thoracic disc herniation are potentially serious spinal conditions affecting the thoracic spine, or mid-back.
Given the spinal cord’s critical role in transmitting signals between the brain and the rest of the body, any compression can lead to a variety of symptoms, particularly neurological ones.
Many patients are misdiagnosed, with some undergoing surgery in the incorrect part of the body, overlooking the thoracic spine. Consequently, numerous patients consult multiple physicians before receiving the correct diagnosis.
Symptoms of Thoracic Myelopathy, Cord Compression, and Disc Herniation
✓Difficulty walking, unsteadiness, or a change in gait
✓Heaviness, stiffness, or weakness in the legs
✓Numbness or a band-like tightness around the chest or trunk
✓Loss of coordination or balance, especially in the dark
✓Increased reflexes or leg spasticity
✓In advanced cases, changes in bladder or bowel control
Patients experiencing pressure or irritation of the thoracic spinal cord might also report:
Pain in the thoracic region (mid-back)
Weakness or numbness in the legs
Sensation of the buttocks being overly heavy or as if they’re falling off
Burning sensation in the legs or feet
Abdominal pain, even when gastrointestinal workups are negative
Pain radiating from the side to the front of the abdomen
Pain resembling that of kidney stones
Pain radiating into the groin
Causes of Thoracic Myelopathy, Cord Compression, and Disc Herniation
Thoracic disc herniation pressing on the spinal cord
Bone spurs and arthritis narrowing the canal (spondylosis)
Thickening or calcification of the ligaments behind the cord
Ossification of the posterior longitudinal ligament (OPLL)
Less often, tumors, cysts, or deformity affecting the cord
These conditions can stem from various factors, primarily related to spinal health and trauma. Other causes include:
Degenerative Disc Disease: Deterioration of the discs in the thoracic spine.
Spinal Tumors or Infections: Abnormal growths compressing the spinal cord.
Trauma: Incidents causing fractures or dislocations in the thoracic spine.
Kyphosis: Particularly when combined with a calcified or soft disc herniation compressing the spinal cord.
Spinal Deformities: Including congenital kyphosis, congenital scoliosis, severe scoliosis, kyphoscoliosis, Neurofibromatosis, Scheuermann kyphosis, tuberculosis, and other deformities.
Risk Factors
Certain elements can increase the risk of developing these conditions:
Age: Older individuals face higher risks due to natural spinal degeneration.
Kyphosis: When the mid-back spine curves more forward than usual.
Previous spinal injuries
Genetic predisposition to spinal issues
Elevated inflammation levels in the body
Activities or jobs that strain the mid-back excessively
Diagnostic Process
Dr. Melamed looks for the signs that point to the spinal cord rather than a single nerve — changes in walking, balance, reflexes, and coordination. An MRI of the thoracic spine is the key study, showing exactly where and how severely the cord is compressed and by what. Because thoracic myelopathy can be mistaken for a lower-back or neurologic problem, getting the imaging and the level right is essential before any treatment is planned.
Diagnosing thoracic myelopathy/cord compression/disc herniation typically involves:
Clinical Examination: A very thorough, detailed history, physical and neurological examination to assess symptoms and spinal health is an absolute must.
Imaging Tests: X-rays, MRI and CT scans are a must to visualize the thoracic spine and identify any compression and look at the entire bony and soft tissue anatomy.
Treatment Options
Unlike many spine conditions, established myelopathy from cord compression usually does not improve with therapy or injections alone, because the problem is mechanical pressure on the cord. When the compression is mild and symptoms are minimal, careful monitoring may be reasonable. But progressive or significant myelopathy is generally treated surgically to take pressure off the cord and stop further decline.
Dr. Melamed plans the decompression around the specific anatomy, using the least-invasive approach that safely relieves the cord — often muscle-sparing techniques that avoid the larger open exposures of the past. The goals are to halt progression, protect walking and coordination, and give the cord the best chance to recover, all with an opioid-sparing recovery plan. He is direct about the fact that outcomes are best when compression is relieved before deficits become severe or long-standing.
Treatment for thoracic myelopathy depends on the severity and cause of the condition.
Initial treatments often include physical therapy, acupuncture, inversion tables, chiropractic care, and non-narcotic medications for pain and inflammation. If these modalities prove ineffective, epidural injections might be considered. However, in some cases, surgery might be recommended as the first line of treatment to prevent potential irreversible neurological damage.
Surgical Treatments
Surgical options encompass decompression or a combination of decompression, fusion, and instrumentation to relieve pressure on the spinal cord and possibly stabilize the spine. It’s vital to emphasize that most patients only require decompression and do not need fusion or additional hardware like rods, screws, and plates.
Decompression
There are two primary methods:
Posterior Decompression: For compression originating from the back. This can be addressed with minimally invasive outpatient procedures, such as micro laminotomy, medial facetectomy, and microforaminotomy, avoiding large incisions. No rods or screws are needed. Dr. Melamed specializes in this approach.
Anterior Decompression: For compression originating from the front, which is more common. Dr. Melamed has developed a unique non-narcotic, minimally invasive anterolateral approach to decompress the spinal cord using a high-powered microscope and live CT-guided navigation.
Why Choose Dr. Melamed
Many surgeons lack familiarity with the anterior approach, leading to potential complications. Dr. Melamed at The Spine Pro offers a unique approach, combining a high-powered microscope with live intra-operative CT scans, allowing for a precise, safe, and microscopic method to decompress the spinal cord while preserving as much anatomy as possible. This technique facilitates a quicker recovery for patients.
Like any medical treatment or procedure, surgery carries inherent risks. It’s crucial to understand these risks and weigh them against the potential benefits of the operation. Risks associated with the surgery include, but are not limited to, infection, bleeding, pain, full or partial paralysis, numbness, bowel/bladder dysfunction, death, heart attack, stroke, implant failure, blindness, blood clots, dural tear that may require a lumbar drain, loss or decreased range of motion, and deformity, among others. It’s essential to consult with your spine surgeon about these risks before the surgery. Dr. Melamed at The Spine Pro ensures that all patients are given informed consent and are made active participants in the surgical decision-making process. A comprehensive consent form detailing all risks is provided.
It’s important to emphasize that if a patient has any neurologic deficit, the primary goal of the surgery is to prevent the neurologic deficit from worsening. There’s no guarantee of improvement. The longer the delay in undergoing surgery, the higher the likelihood of permanent neurologic deficit and nerve damage.
The Importance of a Second Opinion
The thoracic spine is a particularly high-risk area. Given the intricacies of this region and the potential risks associated with surgery, obtaining a second opinion is of paramount importance, especially for conditions as significant as thoracic myelopathy, thoracic cord compression, and thoracic disc herniation. Dr. Hooman Melamed specializes in providing second opinions.
Most spine surgeons are unfamiliar with the specific type of surgery required for these conditions and may not feel comfortable performing it. As a result, they might advise patients to seek pain management instead. It’s imperative to get a second opinion from a spine surgeon with expertise in this area.
As previously mentioned, the majority of patients do not require fusion or implants. If you’ve been recommended fusion with screws, rods, or plates, or if you’ve been advised to undergo a posterior approach to decompress your spinal cord, it’s essential to seek a second opinion. The wrong surgical approach can lead to severe complications, including paralysis.
It is a condition to take seriously and evaluate promptly rather than a routine backache. Because the spinal cord is involved, symptoms can progress, and function is best protected when compression is relieved before deficits become severe. New or rapidly worsening leg weakness, balance loss, or any change in bladder or bowel control should be assessed urgently.
Why can't this be treated with physical therapy or injections?
Once the spinal cord is being compressed, the core problem is mechanical pressure, which therapy and injections cannot remove. Those measures may help related symptoms, but relieving the compression itself generally requires surgery. Mild, stable cases can sometimes be monitored, and Dr. Melamed will tell you honestly where your case falls.
Will I recover fully after surgery?
Decompression is aimed first at stopping further decline and protecting the function you have; many patients also regain ground over time. How much recovery is possible depends on how severe and how long-standing the compression was, which is why earlier treatment tends to yield better results.
How is this different from a pinched nerve in my back?
A pinched nerve root usually causes pain, numbness, or weakness along one nerve's path. Myelopathy involves the spinal cord itself, so it tends to affect walking, balance, and coordination across both legs. The distinction changes both the urgency and the treatment, which is why accurate imaging matters.
