Thoracic Spinal Stenosis
Not as common as cervical or lumbar stenosis, thoracic spinal stenosis is a rare degenerative condition in which the spinal canal in the upper/middle back is narrowed. This can cause pain, weakness, bowel and bladder dysfunction or sexual dysfunction.
Some people are born with a congenital form of stenosis, but most develop spinal stenosis as part of aging and degeneration. Some people do not feel any effects of the narrowing, but most people who are affected will eventually notice mid-back or scapular pain that radiates around to the chest and abdomen, weakness, and/or numbness secondary to the compression of the nerves or spinal cord. This can often be confused with chest pain or abdominal pain from other problems because of the level of the nerves in the spine. A thorough workup must be performed before a diagnosis is made.
Thoracic Disc Herniation/Radiculopathy
Few people with a thoracic disc herniation feel any symptoms or have any problems as a result of this condition. In rare cases when symptoms do arise, the main concern is whether the herniated disc is affecting the spinal cord.
A herniated disc happens when the material in the center of the disc has squeezed out of the normal space. In the thoracic spine, this condition mostly affects people between 40 and 60 years old.
The upper half of the thoracic spine is much less mobile than the lower section, making disc herniations in the upper thoracic spine rare.
Symptoms of thoracic disc herniation vary widely. Symptoms depend on where, and how big the disc herniation is, where it is pressing, and whether the spinal cord has been damaged. If it is pressing on one side or the other, the symptoms are pain, numbness or weakness on that side and often around the back and into the chest area. This is called Thoracic Radiculopathy. If it herniates straight back into the spinal cord, paralysis of the lower extremities, weakness or bowel and bladder changes are noted. This is called Myelopathy.
If symptoms are spinal cord related, a surgical consult is recommended. Otherwise most thoracic herniations gradually get better with conservative care.
Spinal Compression Fracture
Back aches and pains can be a normal sign of aging or a sign that small fractures are happening in your spine. Compression fractures are often caused by bone-thinning called osteoporosis and is most common in post- menopausal women. When bones are brittle, everyday activities can trigger minor spinal compression fractures. When you bend to lift an object, trip on a rock, or slip on a carpet, you can put your spinal bones at risk of fracture. After a number of small compression fractures, your body begins to show the effects. These small fractures can lead to the vertebra collapsing and a Spinal Compression Fracture.
These tiny fractures can permanently alter the strength and shape of the spine. You lose height because your spine is shorter. Most compression fractures occur in the front of the vertebra, which causes the front part of the bone to collapse creating a wedge-shaped vertebra. The back of the bone is unchanged because it’s made of harder bone. This creates a stooped look called Kyphosis.
The biggest treatment for this is to treat the underlying cause which is Osteoporosis. There are many different treatments available and most Rheumatologists would try several to see what is best tolerated.
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