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Thoracic Disc Prolapses

Prolapse of a thoracic disc is uncommon and may be under-diagnosed due to the fact that examination findings and symptoms are difficult to pin down and not diagnostic of this kind of problem. Conservative treatment is the commonest way of managing these condition and surgery is uncommon. A large number of people have thoracic disc herniations when magnetic resonance imaging has been examined but no symptoms are reported typically so these prolapses can be normal findings.

Symptomatic thoracic disc prolapses are very uncommon and neurological abnormalities on examination from such prolapses are even less common. Lumbar and cervical discectomies are much more common than thoracic discectomies. Disc prolapse may be more effective in causing problems due to the fact that the spinal canal is relatively more narrow in this region and the spinal cord takes up 40 percent of the canal compared to 25 percent in the neck region.

The location of the herniation of the thoracic disc determines what the effects will be on the patient. Protrusions which bulge centrally can impact the spinal cord and give the symptoms of central cord compression such as increased tone in the muscles of the legs, increased reflexes, gait abnormality and incontinence of the bowel or bladder. If the prolapse is to the side of the centre then the results are weakness of one side with possible pain on the other side. Protrusions which point far to the side result in compression of the nerve root which can give severe pain to one side of the same nature as sciatica. As the outer layers of the disc have a nerve supply a tear in the annulus of the disc can add to the pain problems a person with thoracic disc changes can suffer.

Onset of this kind of pain is often slow although in some cases the person will have performed a physically stressful movement in sport or other energetic activity. A dull local pain in the thoracic area may be the main symptom, although the areas of pain can be referred to the front of the body or up towards the neck and lumbar regions. Nerve root pain will be typically described as severe and often surging or shooting, typically confined to a narrow band around the trunk. Physiotherapy aims to reduce pressure within the disc by improved posture, short periods of rest, moving on to thoracic extension exercises, spinal stabilisation and overall strengthening.

 

Author: Jonathan Blood-Smyth

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