How Do I Treat a Thoracic Herniated Disc?

Thoracic disc herniation is more common in adults between the ages of 40 and 50. There are more males than females, but there is no significant racial difference. The common location is T8-L1, with T11-T12 and T12-L1 most common. Because of its varied clinical manifestations, its diagnosis is also difficult. In recent years, due to the application of some advanced diagnostic methods, such as CT, MRI, especially MRI, this disease can be diagnosed early.

Basic Information

English name: thoracic disc hemiat
Visiting department: orthopedics
Multiple groups: Adults around 40-50 years old

Common locations: thoracic
Common causes: Degeneration, crash, traffic accident, etc.
Common symptoms: Chest and back pain, sensory disorders, dysfunction of the stool

Causes of thoracic disc herniation

Because thoracic disc herniation is more common in the thoracolumbar region, and thoracic degeneration is the most obvious, most scholars believe that degeneration is the main cause of thoracic disc herniation. The role of trauma in thoracic disc herniation is still controversial, and trauma It is true that thoracic disc herniation is caused in traffic accidents and fall injuries, but whether chronic and mild injuries are the cause of thoracic disc herniation remains uncertain. Chronic spinal strain injury and incorrect posture can also cause this disease.

Clinical manifestations of thoracic disc herniation

The performance of thoracic disc herniation varies, and its symptoms and signs are determined by the disc herniation, including the disc herniation segment, size, direction, time of compression, the degree of vascular damage and the size of the spinal canal. In symptomatic patients, the lesions often progress progressively.

Patients often experience chest and back pain first, followed by sensory disturbances, weakness and dysfunction. The spine may have mild scoliosis and localized vertebral pain, tenderness, and tenderness.

Thoracic disc herniation

Imaging examination

(1) X-ray examination of conventional thoracic vertebrae in normal orthopedic and lateral X-rays can show changes in disc degeneration: lip-like hyperplasia at the edge of the vertebral body, sclerosis, narrowing of the intervertebral space, calcification of the disc, and hyperplasia of facet joints Sclerosis is a common manifestation, the most important of which is calcification of the disc, especially the calcification protruding into the spinal canal.

(2) Myelography: Large-dose water-soluble contrast agents are used for myelography and CT scanning at the same time, which is a more accurate and excellent diagnostic method.

(3) CT examination CT can show prominent discs, and CT can also show spinal cord compression after myelography.

(4) MRI examinations and patients with this disease should be performed as soon as possible. MRI is the most effective measure for early diagnosis of this disease.

2. Other inspections

Including EMG and somatosensory evoked potentials can also be helpful in the diagnosis of thoracic disc herniation.

Diagnosis of thoracic disc herniation

Clinically, the diagnosis of this disease is based on the following three points:

1. Weakness of lower limbs, numbness, back pain, dysfunction of bowel movements, feeling of cotton on the soles of the feet, radiation pain in the lower limbs (no significant relationship with walking).

2. Compression syndrome in the lower thoracic spinal cord or motor neuron damage in the lower limbs.

3. Imaging examination showed that there were corresponding levels of spinal cord compression and thoracic disc herniation.

Treatment of thoracic disc herniation

Non-surgical therapy

It is mainly used for light cases, and its main measures include the following:

(1) Rest Depending on the severity of the illness, absolute bed rest, general rest, or limited activity can be selected. The former is mainly used in patients with acute stage, or those whose condition suddenly worsens.

(2) The degree of movement of the thoracic brake thoracic spine itself is very small, but for the sake of safety, it can be supplemented with a chest-back brace to fix the active cases. This has a positive significance for reversing the disease or preventing deterioration.

(3) Symptomatic treatment includes oral sedatives, topical analgesic and anti-inflammatory ointment, physical therapy, blood circulation, and other effective treatment measures, etc., which can be selected as appropriate. Try glucosamine sulfate and chondroitin sulfate for supportive care. Glucosamine sulfate and chondroitin sulfate are used clinically to treat osteoarthritis in various parts of the body. These chondroprotective agents have a certain degree of anti-inflammatory and anti-chondrogenic effect. Basic research has shown that glucosamine can inhibit the production of inflammatory factors by spinal cord nucleus pulposus cells and promote the synthesis of glycosaminoglycans, the components of the disc cartilage matrix. Clinical studies have found that injecting glucosamine into the disc can significantly reduce lower back pain caused by degenerative disc disease and improve spinal function. Case reports suggest that oral glucosamine sulfate and chondroitin sulfate can reverse the degenerative changes of the disc to a certain extent.

2. Surgery

There are three main types of surgical techniques for thoracic discectomy and fusion:

(1) Anterior approach is to reach the front of the thoracic vertebra through the thorax or thoracoabdominal incision to remove the protruding nucleus pulposus and perform internal fixation (fusion) at the same time.

(2) This traditional surgical procedure has been used for many years. Most orthopaedic or neurosurgeons are familiar with this surgical approach, and it is easier to operate. However, it is difficult to remove the nucleus pulposus in front of the thoracic spinal canal, especially in central cases.

(3) Lateral and posterior operation of thoracolumbar spinal canal subtotal decompression approach: This surgical approach is easier to remove the pressure in front of the spinal canal and has less damage, which basically does not affect the stability of the vertebral segment.