Thoracic Herniated Disc: Diagnosis, Symptoms, Causes, & Treatment

Got unexplained pain in your upper back? A thoracic herniated disc might be the reason. In this article we will go over what that means, the symptoms, causes, diagnosis, and treatment options to help you fix it.

What is a thoracic herniated disc?

Let's break it down word by word.

"Thoracic" is the middle section of your spine, in the middle and upper back. It is made up of 12 vertebrae (bones), which are labelled T1 through T12.

"Herniated" is related to the word "hernia," which is the protrusion of an organ through a defect in the structure which holds it in place. The most common type of hernia occurs in the belly or groin, when a gap in the muscular wall of the abdomen allows a section of the intestine to push through.

A "disc" is a cushion-like pad that sits between two vertebrae. Each disc is made up of a tough outer layer (the annulus fibrosus), and a gel-like center (the nucleus).

When a hernia occurs with a disc, part of the fibrous outer layer of the disc has become weak. This allows the gel-like inside of the disc to push outwards. You can imagine each disc in your spine as a jelly-filled doughnut. The dough is the outer layer of the disc, and the jelly is the center. Now imagine some of the jelly oozing out. This is what happens in a herniated disc.

Herniated discs are most common in the lower back (the lumbar spine), but can also occur in the mid and upper back (the thoracic spine) and the neck (the cervical spine). When they do happen in the upper back, it’s more likely to be in the lower end of the thoracic spine, which is the most flexible part of this region.

A herniated disc often produces no symptoms at all, and host hernias heal themselves and do not need surgery. However, in some cases the disc can put pressure on the nerves of the spinal cord and the nucleus can irritate the nerves if they come into contact. If this happens in the upper back, pain or other symptoms can spread to the chest, shoulders, neck, abdomen, and even the lower limbs.

How rare is a thoracic disc herniation?

Thoracic disc herniations make up less than 1% of all herniated discs. Because they are rare and symptoms can present in other parts of the torso, they are sometimes misdiagnosed as cardiovascular or gastrointestinal issues.

What causes a thoracic herniated disc?

There are several reasons why you might have a herniated disc. These include age-related changes, sudden injuries that jar the spine, or a genetic predisposition that gives you a natural tendency toward this condition.

Symptoms of thoracic herniated disc

Symptoms of a thoracic herniated disc can include:

• pain that comes in sharp or burning waves and radiates outward from the area
• discomfort that mimics heart or gastrointestinal problems
• pain that wraps around the chest wall or goes down the limbs
• pain that goes to the upper abdomen, arms, or groin.

These symptoms can vary depending on where along the spine the herniation occurs.

How do I know if I have a thoracic herniated disc? A diagnosis

Most disc herniations heal of their own accord – without specific medical intervention or the need for scans or imaging. For this reason, not everyone will seek a diagnosis.

However, if you and your doctor decide it's best for you, getting a diagnosis is likely to include a physical examination – such as examining different aspects of your pain, including its location, intensity, and character – to assess your symptoms, and a discussion of your medical history – including past injuries, any illnesses, weight changes, and urinary habits.

Imaging tests, such as MRI and CT scans, can provide a clear and precise view of the spinal anatomy, helping to pinpoint the exact location and severity of the herniation.

Differential diagnosis

Symptoms of thoracic herniated discs are notorious for mimicking other conditions. For example, chest pain from a thoracic herniated disc can be mistaken for heart disease.

If you have symptoms that match more than one possible explanation, your physician will create what's called a differential diagnosis, which is a list of possible conditions that they can then work through. After ruling out potential, but incorrect causes, they will come to your official diagnosis. This process makes sure that you get the correct diagnosis, and whether your symptoms are truly a herniated disc or are actually caused by another medical condition.

What does a thoracic herniated disc feel like?

Having a thoracic herniated disc can feel like a sudden onset of sharp or burning pain in your back, which may radiate to an arm or leg and be exacerbated by coughing or sneezing. The pain often wraps around the chest and lower ribs, creating a sensation akin to being squeezed by an invisible vice, making deep breaths a challenge. This pain can also be similar to costochondritis. You might also experience muscle weakness, which can turn simple tasks like lifting a grocery bag into a daunting endeavor.

In severe cases, the discomfort can extend to your upper abdomen, making it feel like your whole torso is under siege. This relentless pain and sensory disturbance can disrupt your daily life, turning routine activities into painful chores and impacting your overall quality of life.

Does a thoracic disc herniation occur in the upper back?

As mentioned earlier, the thoracic spine is the middle section of your spine. It goes through the upper and mid back, starting immediately below the base of the neck, and ending at your lowest ribs.

A thoracic disc herniation is not a common back problem. Although this condition can cause pain in that area, it doesn’t act alone. Other factors like referred pain and central sensitization might be the culprit of your pain, that’s why exact diagnosis is important.

Central sensitization

Central sensitization is a condition where the central nervous system becomes hyper sensitive to stimuli that wouldn’t normally cause pain. This increased sensitivity results in a stronger response to stimuli that cause pain, or even pain without any injury or external cause. In essence, the nervous system is in a state of hyperreactivity, making the body more prone to pain.

Research shows that back pain is influenced by the central nervous system, how we process pain, and involves our immune system¹. That means pain is not just due to physical issues like a herniated disc; it is also greatly affected by how the brain and spinal cord respond to stimuli, making the pain feel more intense and widespread.

Treatment for upper back pain

In managing the pain from thoracic herniated discs, we need to take a multi-disciplinary treatment approach. This would focus on non-surgical methods, unless surgery is deemed absolutely necessary, and is likely to include:

• physical therapy and exercise to desensitize the nervous system and strengthen the body
• cognitive-behavioral therapy to address psychological factors that might contribute to your pain
• medications to manage symptoms and provide pain relief
• minimally invasive procedures, such as nerve blocks or epidural steroid injections (spinal injections)
• surgical measures like discectomy or spinal fusion if needed.

The treatment plan is tailored to each patient’s case of thoracic herniated discs.

Conservative treatment

The first step in the healing process is conservative treatment which starts with:

• rest and taking short breaks
• gentle movement and a gradual getting return to your activities
• anti-inflammatory medications
• gentle manual therapy to guide the body back to recovery.

Surgical intervention

When conservative measures do not alleviate severe pain, thoracic disc surgery may be necessary.

Through decompression techniques, surgeons can relieve pressure on the nerve roots, which will hopefully calm down an irritated spinal cord. The approach is chosen based on where the thoracic herniated disc is located in the spinal canal and depends on the surgeon’s skill set.

Despite all the planning, there are risks involved with these complex procedures. Large calcified thoracic disc herniations that take up a lot of space in the spinal canal are big challenges and have uncertain outcomes post-operation. Since these surgeries are done near critical anatomy like the diaphragm and aorta, it requires extreme precision and expertise from experienced surgeons to ensure patient safety during spine surgery and good outcome after disc herniation intervention.

Do I need surgery for thoracic herniated discs?

Thoracic herniated discs usually do not need surgery. Rest, anti-inflammatory meds, and physical therapy can be conservative treatment.

If these conservative measures fail or there’s significant compression on the spinal cord or nerve root, then surgery may be necessary. The decision to proceed with surgery should be based on the severity of symptoms and the overall impact on the patient's quality of life².

Spinal surgeries often have limited success. For example, for spinal fusions, about 41% of people require further surgeries within three years and 80-90% of people still need to take strong medications for pain.

If your doctor suggests a surgery to you, always ask about the success rate, complications, and why having this procedure will be better for you than not having it done. If your doctor can’t answer you to your satisfaction, or you feel at all unsure, seek a second opinion from a different healthcare professional.

What is the rehabilitation process?

Finishing a surgery is a big achievement but it’s followed by a crucial phase of recovery. Rehabilitation takes over as it combines rest, meds, and targeted exercises to get you back to your daily activities with more energy and flexibility.

Retrain your pain

Learning to retrain your pain response is like learning a new language, it requires gentleness and consistency. Cognitive-behavioral techniques are the guides in transforming the experience of pain into a story of endurance and management. Exercise – the poetic expression of healing – releases endorphins, our natural painkillers. Focused stretches and exercises strengthen the support network of the spine, takes away stress from the herniated disc.

For those with thoracic herniated discs, you can work through a sequence of exercises that build up on each other. You're likely to start with calming movements like Cat-Cow stretches, before progressing to strength building exercises such as pelvic tilts. With time and gentle execution, more complex exercises can be added to this rehabilitation program to improve movement and flexibility in the thoracic area.

Exercise

Contrary to the common myth that you should stop or modify your exercise when you have back pain, exercise when done gradually is safe and good for your spine.

Exercise is the foundation of rehabilitation, it creates a framework that guides the recovery process. Start with gentle movement, such as walking, swimming, or cycling. These low-impact exercises can strengthen the muscles that support your spine, reduce stiffness, and increase flexibility.

Gradually work up to your normal activities. As the spine starts to get its rhythm back, add in exercises that focus on mobility and strength in the thoracic area. Pilates offers beautiful movements and complex rotations under professional guidance which gives resilience and flexibility to the thoracic spine – qualities needed to withstand daily stresses³.

Sleep

Sleeping is tough when you have back pain but it’s important for healing. Here are some tips to improve your sleep and overall health:

• Stick to a sleeping schedule. Aim for 8 hours of sleep and be consistent with your bedtime and wake up time.
• Keep naps short so they won’t interfere with your nighttime sleep.
• Stay active during the day to help you sleep better at night.
• Develop a bedtime routine that doesn’t involve screens. This helps your mind wind down before sleep.
• Make your bedroom a sleep haven. Keep it dark and quiet.
• Watch your caffeine intake, especially in the afternoon and evening. Caffeine can stay in your system and make it hard to sleep.
• Avoid heavy meals and alcohol before bedtime. They can disrupt your sleep.
• Find time for relaxation outside of sleep. This can help you manage your symptoms and sleep better.

Finding the right sleeping position is like tuning an instrument. It aligns your spine and takes pressure off the herniated disc and allows for restful sleep. Whether you lie flat with a pillow under your knees or in the fetal position, each position plays its part in the nightly dance that helps recovery.

Medication as an enabler

Medications are necessary to reduce discomfort and swelling so you can actively participate in healing. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are used to relieve pain and inflammation. If the pain is very severe, your doctor may prescribe stronger medications like muscle relaxants and even narcotic pain medications which can give more relief.

While these medications can help with pain, they are only part of the overall treatment plan and not a long-term solution. Long-term use of any medication can affect the body’s central nervous system and can cause tolerance. This means you may need higher doses to get the same pain blocking effect, that’s why a comprehensive approach is important.

More Information

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