Thoracic disc bulge

The thoracic spine is located between the cervical spine (neck) and the lumbar spine (low back). It consists of 12 separate vertebrae which are named from the top to the bottom as T1 to T12. The mobility in this region is restricted because of the presence of the rigid rib cage which houses and protects our internal organs such as the heart and lungs.

The intervertebral discs are located between each of the vertebrae bodies (bones) of the thoracic spine. Commonly described as the "cushions" or "shock absorbers" of the spine, these circular pads of cartilage are composed of tough, fibrous tissue on the outside (annulus fibrosis) and a watery, gelatinous material on the inside (nucleus pulposus).

In the low back and neck, the discs are much more susceptible to injury than the mid back whereby the limited mobiity in the thoracic spine reduces stress through the discs making injury to these structures much rarer.

 An Intervertebral Disc

Symptoms of a thoracic disc bulge

Symptoms arising from a thoracic disc injury are very varied with regards to location of pain and severity. The symptoms maybe localised or radiate out across the mid back just on one side or both. If the disc bulge is causing irritation or compression of one of the nerves that exists the thoracic spine, there will also be alterations in sensation along the course of this nerve with resultant numbness or pins and needles. In the thoracic spine, nerve irritation commonly follows the course of the ribs across the back and around into the chest in what is termed a dermatomal distribution (see below)

 The symptoms described by patients often relate to aggravating positions which increase the pressure in the discal material as well as manoeuvres which increase the traction on the nerve roots i.e. sitting, slouching and looking down.

treatment for a thoracic disc bulge

Typically, this will involve a combination of the following interventions:
 
Medication: Where appropriate painkillers such as paracetamol and anti-inflammatories may be advised.  

POSTURAL ADVICE (SITTING, STANDING AND LAYING): This not only helps reduce symptoms but allows the healing process to begin.  

Functional advice: Patients are encouraged to stay as active as possible. We therefore take time to advise patients on how best to maintain a normal lifestyle as possible without aggravating the complaint. This may range from how to pick a newborn baby out of a cot to modifying gym/training programmes.  

Cryotherapy: Cold packs are often advised for acute patients. This can help reduce pain and inflammation.  

Muscle relaxation techniques: The mid back muscles can often become very tense in an attempt to splint the thoracic spine. This can sometimes distort posture causing a lateral lean of the body. Our chiropractors are trained and experienced in deep tissue massage and trigger point therapy. They may also use very specific stretches to relax and lengthen short tight muscles.  

Joint manipulation/mobilisation: Chiropractors receive very specific training on mobilising and manipulating restricted (stiff) joints. This may relieve pressure on the spinal segment with the disc derangement.   

 
Nerve mobilisation: Nerves are dynamic structures and lengthen and shorten depending on our position and movement. Specific techniques are utilised to allow the nerve to move more freely in order to reduce irritation and ease symptoms.  

Further treatment options

Surgical procedures: This is rarely required and with the exception of emergency cases is only considered when a patient has failed to respond to more conservative care measures i.e. rest, medication, physical therapy (chiropractic) etc.

The advent of MRI scans has allowed for the greater use of less invasive surgical interventions with keyhole surgery becoming more common. Dependent on the location and size of the herniation, either the whole disc (complete discectomy) or part of the disc which has herniated (partial discectomy) may be removed.  If the disc is completely removed then the vertebrae body above and below will need to be secured which may be done by taking a bone graft from elsewhere (often the pelvis) and fusing the vertebrae together or alternatively,  a metal spacer may be placed between the vertebrae with oblique screws being positioned into the adjacent segments. There is much research being conducted to produce an artificial disc replacement but given the complexity of the structure it is proving very difficult.  

   
Epidural injections: Occasionally injections of corticosteroids and anaesthetics may be used to reduce inflammation and pain

If you are concerned about your back pain and would like some advice please do not hesitate to contact one of our chiropractors at the clinic