Thoracic myelopathy, thoracic cord compression, and thoracic disc herniation are potentially serious spinal conditions affecting the thoracic spine, or mid-back. These conditions result from the compression of the spinal cord within the thoracic region.
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
Patients experiencing pressure or irritation of the thoracic spinal cord might report:
- Pain in the thoracic region (mid-back)
- Weakness or numbness in the legs
- Difficulty walking or maintaining balance
- Challenges with gait, balance, and leg coordination
- Heaviness in the legs
- Sensation of the buttocks being overly heavy or as if they’re falling off
- Stiffness or tightness in the legs
- Bowel or bladder dysfunction in severe cases
- 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
These conditions can stem from various factors, primarily related to spinal health and trauma:
- Degenerative Disc Disease: Deterioration of the discs in the thoracic spine.
- Spinal Stenosis: Constriction of the spinal canal.
- Herniated Disc: A disc bulging and pressing on the spinal cord.
- 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.
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
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 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 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.
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 and total laminectomies. 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. Over 90-95% of spine surgeons are not comfortable with the anterior method. 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, with most returning to driving and work within days and starting physical therapy in two weeks.
Potential Risks of the Surgery
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, ensuring that patients receive an accurate diagnosis and the most effective treatment recommendations.
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
Book a Consultation
Thoracic myelopathy, cord compression or disc herniation are conditions that demand prompt attention and expert care. At The Spine Pro, Dr. Hooman Melamed brings his unique, minimally invasive, non-narcotic experience and expertise to diagnose, treat, and offer second opinions for patients with these conditions. Your spinal health is paramount, and we’re here to ensure you receive the best care possible.
For more information or to schedule a consultation, click here or call (424) 21-SPINE.