Upper Back Pain from a Thoracic Herniated Disc

Thoracic Disc Herniation

A herniated disc in the upper back can occur when the inner gelatinous material of an intervertebral disc leaks out of the inside of the disc. A thoracic herniated disc can cause upper back pain and other symptoms, such as radiating pain or numbness. The specific symptoms are usually different depending on where the disc herniates, as the herniated disc material in the upper back can either impinge on an exiting nerve root or on the spinal cord itself.

Thoracic disc disease is conceptually similar to disc disorders in the cervical and lumbar spine, but symptomatic lesions are far less common. The most common location for thoracic disc disorders is at the thoracolumbar junction (T8-T12) in the mid back. The true incidence is unknown because many thoracic disc disorders are asymptomatic and they comprise only a very small percent of all disc operations.

In one study, 90 asymptomatic patients (with no pain or other symptoms) were evaluated with thoracic MRI scans and these were the findings:

• 73% of patients were found to have disc abnormalities in the upper back
• 37% had thoracic disc herniations
• 29% had radiographic evidence of spinal cord compression.

These patients were followed for 26 months and none of them developed upper back pain from their thoracic disc disorders¹. The fact that so many people had thoracic disc herniations but no pain or symptoms is important to mention, as it shows that people may have both upper back pain and a thoracic herniated disc, but that the disc disorder may not be the cause of the upper back pain – it may just be an incidental finding. In fact, there are many causes of upper back pain that are much more common than a herniated disc, and a correct diagnosis of the cause of the patient’s pain is more important than whether or not an MRI scan shows a thoracic disc herniation.

The etiology (cause) of thoracic disc herniations is generally classified as having either a degenerative or traumatic cause.

• Degenerative causes of thoracic herniated discs. Many thoracic disc herniations are due to gradual wear and tear on the disc, which leads to settling of the vertebral bodies and calcification about the disc space. When symptomatic, the symptoms of a degenerated thoracic disc most commonly occur between the 4th and 6th decades of life and usually develop very gradually. Often, the patient’s upper back pain and other symptoms and are present for a longer period of time prior to consultation with a physician.
• Traumatic causes of a thoracic herniated disc. Traumatic disc herniations are defined as those associated with a significant traumatic event that caused the abrupt onset of symptoms. Any injury that causes a high degree of sudden force on the discs in the upper spine could lead to a thoracic herniated disc. Examples include a fall or sports injury that places sudden force on the upper back. Herniated discs in the upper back tend to occur in younger patients prior to significant degenerative disc changes. While in most cases some history of mild trauma has led to an exacerbation of the patient’s symptoms, a mild trauma (such as reaching up while twisting) will usually just worsen symptoms from a degenerated disc.

Regardless of the cause of the upper back pain, getting a correct diagnosis is critical because it will guide the treatment decisions.

• Article written By:
• David DeWitt, MD

October 17, 2006

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