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Thoracic Disc Protrusion T7/8, Seeking Guidance

ItsNotFibroIItsNotFibro Posts: 9
edited 09/09/2015 - 1:37 PM in Upper Back Pain, Thoracic
I hope I'm posting to the right place. New here, but I found the site via google because their appears to be a lot of smart people here!

I recently discovered I have a disc protrusion at t7/8 and could use some guidance in understanding it and understanding who in the medical field can help me. Chronic pain sufferer, but wondering how much this plays a part.

I've been diagnosed with Fibromyalgia because of pain and fatigue over the past 4 years. Some of the worst pain now is in a band along my rib cage, and my pain management doctor send me to the local hospitals pain management be evaluated for a nerve block for the intercostal nerves. They did the MRI to rule out any possible spine issues. Which they assured me was routine and I should not expect them to find something.

Low and behold, they did. They found a "small right paracental protrusion indenting the thecal sac". I spoke to the Physican's Assistant who ordered the test, and she said yes, that will cause the band of pain I'm feeling. She said that she would expect it on the right side, but it isn't impossible its causing the whole thing.

So I did some interneting, and found some information that both surprised and astonished me. Namely the number of symptoms that can be associated with thoracic disc injuries, and how similar they are to my problems for the last 4 years. Here is the trouble I'm running into - They all seem to be referencing herniations. Even the band of pain I am feeling talks about that, not protrusions. But the Physician's Assistant assured me that it was probably the cause, and that the doctor recommended an epidural for relief.

I'm so very confused. In part, because I don't know who to talk to about this. I haven't even seen or spoke the doctor I was referred to, just the PA. My pain management doc didn't have much to say about it other than the epidural is a good place to start, and if it doesn't work, they can still do the nerve block (echoed by the PA). A friend with her own spine issues who is also a nurse told me that the amount of pain doesn't necessarily correlate with the amount of damage. I have seen that echoed elsewhere, but don't know what to think. It's seems excessive, I mean this pain is just so bad and so there every day.

I'm also wondering if there is any connection to the other conditions - the Fibromyalgia I was diagnosed with. I was diagnosied with Fibromyalgia as a "diagnosis of exclusion" because they couldn't find anything else wrong. Most of the pain is leg (feeling like it's radiating down from my buttocks/hips), hip, pain in the buttocks. I had a cervical and lumbar MRI to rule out issues there back when I first started having trouble. It started with pain in the legs and arms and I always just felt so weak, especially my legs. They were like lifting logs. The pain has increased with time and moved upwards and more to my core, if you will. I have other symptoms that seem consistent with thoracic injuries listed here
Counting Reference: Craniocervical junction.

Vertebral bodies are normal height. There is mild disc space narrowing and endplate degenerative changes at t7-8. Alignment is anatomical. The cord is normal in size and signal. The conus medullaris has a normal appearance and terminates at approximately L1

T7-8 there is a small right paracentral disc protrusion/herniation indenting the thecal sac. There is no cord compression or canal stenosis. Forma are patent.

The remander of the thoracic intervertebral dis spaces are unremarkable. Prevertebral/paraspinal soft tissues are unremarkable.


1. At T7-8, there is a small right paracentral disc protrusion indenting the thecal sac

2. Intrinsic cord signal is normal

Welcome to Spine-Health

One of the most important things that members can do is to provide the rest of the community with as much information about themselves as possible. It is so very difficult for anyone to respond when we do not have enough information to go on. This is not meant to indicate that you are doing anything wrong or violated any rule, we are just trying to be pro-active and get the information upfront so that people can start responding and your thread is more effective.

So many times we read about members who have different tests and they all come back negative. The more clues and information you provide, the better chances in finding out what is wrong, The fact that your test results are negative does not mean that you are fine and without any concerns. Many times it takes several diagnostic tests and procedures to isolate a specific condition.

Here are some questions that you should answer:

  • - When did this first start?

    . Year, Your age, etc
- Was it the result of an accident or trauma?
- Are there others in your family with similar medication conditions?
- What doctors have you seen? (Orthopedic, Neurosurgeon, Spine Specialist, etc)

  • . Which doctor did you start with? Ie Primary Care Physician
    . Who are you currently seeing?
- What Conservative treatments have you had? Which ones?

  • . Physical Therapy
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- What diagnostic tests have you had? And their results (MRI, CTScan, XRay, EMG, etc)

  • . Summarize the results, please do not post all details, we cannot analyze them
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- What medications are you currently using? (details, dosage, frequency, etc)

  • . Name of Medication
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Providing answers to questions like this will give the member community here a better understanding
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You should also consult your doctor to better understand your condition and the do’s and don’t’s.

It is very important that new members (or even seasoned members) provide others with details about their condition(s). It is virtually impossible to help another member when all the details we have are

I’ve had this for years, it hurts, I cant move my shoulder – what could this be, what treatment should I get?

Diagnosing spinal problems can be very difficult. In many ways it’s like a game of clue. Especially, when the diagnostic tests come back negative – no trouble found! Then it’s up to the patient and the doctor to start digging deeper. The doctor is like a detective. They need clues to help them move along. So, you as the patient need to provide the doctor with all sorts of clues. That is like it is here. Without having information about a condition, its impossible for anyone here to try to help.

Specific comments :

Personal Opinion, not medical advice :

While you did provide us with a lot of information, giving us some more details about the questions above would be very helpful

--- Ron DiLauro, Spine-Health System Moderator : 09/09/15 19:37 est



  • ItsNotFibroIItsNotFibro Posts: 9
    edited 09/09/2015 - 9:42 PM
    Sorry about missing those questions. I'll answer what I can:
    - When did this first start?
    38, F. Not sure, pain symptoms started insidiously, but I would say they probably 4 years ago. Rib pain attributed to t7/8 started 2012.

    - Was it the result of an accident or trauma?
    Not that I am aware of. I did have an accident in my early 20's with mild whiplash, but I doubt that's related.

    - Are there others in your family with similar medication conditions?

    My father has a "bad back". I'm not sure what that means.

    - What doctors have you seen? (Orthopedic, Neurosurgeon, Spine Specialist, etc)

    Too many. For this specific spine issue - Pain Management doctor - specialty pain management and rehabilitation, Anesthesiologist (Dr that ordered MRI and is supposed to do the injection) and her Physician's Assistant. I haven't seen her at all.

    Chasing down the pain - PCP, Endocrinologist (x2), Rheumatologist (x2), Neurologist (x2), Hand Surgeon, Pain Management Doctor (x2), sleep doctor, Integrative Medicine doctor, who's also a sports medicine doctor. Psychologist specializing in chronic pain. Hand Surgen
    . Which doctor did you start with? Ie Primary Care Physician

    . Who are you currently seeing?

    PCP, Pain Management doc, Sleep doc, anesthesiologist at different pain management clinic, therapist

    - What Conservative treatments have you had? Which ones?

    Physical Therapy, but it was general for fibromyalgia
    Injections are next

    - What diagnostic tests have you had? And their results (MRI, CTScan, XRay, EMG, etc)

    MRIs, EMG, Xrays. The EMG was done in 2012, early in the stage of symptoms and came back negative.

    . Summarize the results, please do not post all details, we cannot analyze them

    Thoracic MRI (8/2015) indicated protrusion/herniation at t7/8. Also mild degenerative changes and narrowing. I think.
    Emg - negative
    Cervical MRI (2012) small pseudo pannus of the dens
    Lumbar MRI (2012) - L5-S1 minor disc bulge and mild facet hypertrophy
    How many different tests have you had over the years? Similar results?
    xrays of the lumbar spine and hips. No previous MRIs than the ones listed above, so nothing to compare to.
    - What medications are you currently using? (details, dosage, frequency, etc)
    Tylenol 3 - 1-6 a day, the very rare no pain day I take 0

    The muscle relaxers do wonder for the pain and tightness, but they only prescribe to take at night. I'm in pain most days, and the tylenol 3 and ibuprofen only help someone. I have a lot of medication intolerances, leaving me with out a lot of options.


    - Is there any nerve pain/damage associated?

    Unsure. I was reading about thoracic radiculopathy, and worry that I may suffer from that. Some of the pain feels like muscle tightness and spasms, some of it feels like nerve pain.

    - What is your doctor’s action plan for treating you?

    Steroid injection first, if that doesn't work a nerve block for the intercostals. Not much plan discussed; I'm not sure what doctors to speak with to create a plan.
  • We have a similar issue with protrusion at T7-8, among other issues...

    Where are you at with this? Any success with testing/meds?

    I'm in misery & it's getting worse. Do you have numbness/sharp pains in your hands?
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    edited 01/27/2016 - 5:08 PM
    While fibromyalgia should be a diagnosis of exclusion there are requirements that's should be met before the diagnosis is given? Do you agree with the diagnosis of fibromyalgia and why/why not? ( I believe answer in your name)
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Sorry to hear about your pain. 21 male. I can relate with a T10 disc protrusion and what THEY call "Mild" cord compression. DDD. Probably some more going on in my neck, they don't seem to show much interest in....
    Unfortunately none  of the treatments have worked much for me either (physio, myofascial massage, acupuncture, more physio, yoga, anesthesia injections, and a bunch of other things) longer than 3 hours after receiving treatment.
    Also unfortunate, tylenol 3 does not even touch my pain whatsoever! It is simple like I did not take anything. I've also been through all of the other meds, ibuprofen, tylenol, gabapentin, etc.... and non of those work.
    I'm current going from surgeon to surgeon trying to get opinions, but they all say surgery does not seem to be an option for me.. what? I have no idea what to do either. Hope you find something that helps! 
    All I can say is, I totally understand what you are dealing with, just HANG IN THERE! Never give up!

  • Sholub153 said:

    We have a similar issue with protrusion at T7-8, among other issues...

    Where are you at with this? Any success with testing/meds?

    I'm in misery & it's getting worse. Do you have numbness/sharp pains in your hands?

    My bad! I only just saw this. I know your misery; it's been getting worse for me for the past 4 years. Do you have any ideas

    Yes, I have pain and numbness in my hands. I don't know if it is related. I was a web designer, and now I can't work- if it's not the pain sitting, it's the wrists. It *shouldnt* be related based on the dermatome level. But I wonder if there isn't something to do with muscle spasms and tightness that causes it anyway. A couple friends, one nurse one massage therapist, thought it might be possible.

    Where I'm at with this- I've done 3 epidurals now; my alottment until Sept. They helped for the short term. I also gained weight and got a bit of facial hair (yay!) but it's light so far, so hoping with time it fades as I can't afford more extensive treatment now. Dropped the weight too. I don't know if I'll do epidurals again- the last one was the least effective, and so many people have told me that they tend to have good luck towards the beginning but later they work less. That, and one problem I have is that I started with rob and widespread upper back symptoms, but since the ESIs, I now feel localized pain in the back. It's like someone is grinding their knuckle into my spine. Maybe it would have happened anyway, or maybe being able to get up and moving has caused this new pain.

    Do you have any lower body symptoms? I have some hips-buttocks-thigh issues that I've been told are not related, but the relief after the ESI's also provided relief to the lower body symptoms. They said that should only be the case if there is cord impingement. But... I'm not sure that there is not.

    But! I'm also questioning a number of issues on my MRIs. I've spent a bunch of time trying to understand how to read them. There are some things that make me suspicious. I think that my protrusion might be impinging on the cord. There is a lot of noise and image problems and so I'm not totally confident in what I'm seeing (I went to a cheap non-hospital facility and regardless of what people say, there is a difference in quality) but from what I could see, it looks like the protrusion may be doing more than being near the cord. But it's so hard to tell. I think what I'm seeing is something from the disk or t7 ( the axial image is right in the edge of the disk and vertebrae) that is sticking right into the spinal cord. Or nearly touching. The problem is that it's basically the same shade of grey as the cord so it's hard to see where it ends and the cord begins. And then if it's just a weird artifact since the image quality isn't great. Though I don't believe it is.

    Then there are other "interesting" findings. The endplate degeneration on t7 looks to be on multiple vertebrae. I think. Basically the endplates look "rough" but it was only noted on t7-8. I see a few light colored spots in the vertebrae bodies that I think are probably vertebral haemangiomas. Even if they are benign, I don't know why they wouldn't be noted. I thought radiologists were supposed to note everything and let the doctor decide. I'm just guessing it's haemangiomas. I have no way of knowing if that's right because I'm not a doctor.

    i think there might be some compression fracturing as well. Between being a novice and the artifacting of the images, I can't swear to that, but something isn't right. It looks similar to some compression fracture MRIs I've viewed online. But as I don't know what I'm doing, I could easily be misinterpreting. And lastly, very few disks show the "jelly donut" shading with the light inside and dark outside. So much so I was wondering if thoracic disks are different than lumbar and cervical. But I don't think so. So bad images or havd many of my disks desiccated significantly already? Seeing a few nice donut shaped disks though, so it's not all the disks.

    My grandmother has pretty significant osteoporosis, and my mother is shrinking. I'm only in my late 30s, but I'm beginning to wonder if I am not facing the same fate. It would explain the DDD I think I'm seeing- though not why it isn't in the report.

    I've not had a lot of luck with meds. I use  Tylenol 3 and ibuprofen during the day, and muscle relaxers at night. The Tylenol 3 doesn't work well anymore; the ibuprofen has chewed my stomach to hell again. Muscle relaxers (baclofen and cyclobenzaprine) do an okay job, but I get too sleepy in the day to take them. I have tried a bunch of the non-narcotic pain meds with poor results. I believe this is due to a genetic issue; I had some testing done and i don't produce enough of a couple key liver enzymes. And I have poor tolerance towards SSRIs and SNRI's, also a genetic predisposition. But it puts me in the position of looking like a drug seeker. :/ most doctors seem yo think I'm making it up or am not trying hard enough so finding this out via genetic testing has given me concrete evidence that is well supported to explain why so many meds (and not just pain relievers) don't work for me. To be honest, codeine shouldn't work that well but it does where tramadol and Vicodin I didn't tolerate. I can only guess it's due to codiene breaking down into several metabolites- one of them must work for me. But now I have a tolerance. So that was a long way of saying that my meds aren't worked out yet. I'm not sure if they ever will.

    I'm starting a modified physical therapy program. My insurance has poor coverage, and so there is a $40 copay per physical therapy session. I'm only going every other week for 4 sessions. It's not ideal, but it's what I can afford.

    Sholub153, I'm not sure if you are a man or a woman, but as a woman, generous breasts are causing a lot of problems. I can't wear a bra anymore. I slouch, both to help with the weight and to hide my ample chest. Subconscious on both counts. The physical therapist was certain that is what's giving me troubles now, and could even be the cause because of poor body mechanics trying to compensate. My pain doc has recommended a breast reduction, and the therapist said the same. I am 34 F-FF, I meet the criteria, the plastic surgeon said I'd be a great candidate before we take into account the spine issues and that would put it over the top. And then I found out that my husband's employer excluded breast reductions to save money. So  that sucks. My next step is to find out what my durable medical equipment coverage is, and get a a custom made medical bra at the physical therapists recommendation. I'm skeptical it will work, but if it's covered, I'll try it.

    A few parting thoughts. I have had a cervical and lumbar MRI in 2012 and then just w few weeks ago to see about the wrist issues and the lower body symptoms. The 2012 MRI came back with some findings, though they didn't think they would cause those symptoms. In 2016, the findings magically went away. Except they didn't. I went in to the MRI images myself and was able to find the same problems that the 2012 report had. Of note was a tiny protrusion at c6-7 and a "pseudopannus" at the dens. They are both still there and c6-7 II's a little bigger. Lumbar I was less sure on, mainly because once I found the cervical issues, I got distracted looking into what the pannus of the dens was. It indents the dura pretty significantly without impinging on the cord. But I wonder if that's positional. Anyway, either sound like they could be causing the hand/wrist pain, a strike against the idea that it's the thoracic causing the hand issues.

  • While fibromyalgia should be a diagnosis of exclusion there are requirements that's should be met before the diagnosis is given? Do you agree with the diagnosis of fibromyalgia and why/why not? ( I believe answer in your name)

    The only requirement is widespread pain for three months or more. They threw out the tender point test in 2011.

    I don't agree with it, as you surmised from my username. I never fit with what other people described. I was never particularly sensitive to the touch like many people with fibro have had. No allodynia. No tender points. Just pain. It wasn't even a diagnosis of exclusion; not really. Just the obvious ones.

    I don't mean to suggest fibromyalgia doesn't exist or anything of that nature. Just that I so clearly did not and have it.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    They didn't throw it out many Drs still use the tender point test they just added another criteria and it is a bit more than just widespread pain I believe.  I do not see any blood work done , but I would be certain you did have it?
    the diagnosis of exclusion is a fairy tale term honestly, you cannot reasonably test a person for everything that mimics fibromyalgia it's just impossible and would be expensive.
    I had T6-7 herniation and while it possibly could have positional implications they are less with thoracic due to rib support, but ESI were the go to treatment.  I had a similar experience where my pain was spread over spine and once on meds it became localized right over damaged area. 
    Who actually gave the fibromyalgia diagnosis?
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • You are right, many doctors do still use the tender point test. However, it is not required to meet a diagnosis of fibriomyalgia. The 2011 criteria three that out. It's now all subjective and pattern of largely vague symptoms that is seen in numerous disease processes. I suppose the tender point test is subjective to, but it is a response and one a doctor could manipulate to throw in control tests.

    I was diagnosed by two rheumatologists and a pain management doctor. I did not come close to the prequisite tender points for the two rheumies, one was 4 and one was 0. I've never been particularly tender. 

    The pain management doctor was eventually able to elicit 14 tender points on a bad day. However, he used considerably more than 4lbs of pressure on each point and gave me some diagnostic criteria that I have not heard or seen before- specifically as opposed to does it hurt, was it a discomfort and would I be able to tolerate someone doing that (the pressure) for hours and still not have discomfort. If I'm honest, I think he really wanted me to fall in that category so made it work.

    He's a very sympathetic doctor, but it seems as though because fibrio is his specialty, that is all he sees. For instance, he is not on board with the t7-8 hernation being the generator of my rib cage pain, even though he sent me to the diagnosis doctor and it's responded to anesthesia and epidurals.

    I agree with you about the diagnosis of exclusion being a fairytale. My experience has just colored me in the belief it is irresponsibly handed out as not just a diagnosis, but the last word on a diagnosis. Once you are labeled as having fibromyalgia, doctors take other concerns less seriously and are slow to address new symptoms that could lead to more definitive diagnoses. It's not just what I experienced but what countless people told me they have experienced. So I'm skeptical.
  • itsautonomicitsautonomic LouisianaPosts: 1,807
    I think you are smart to be skeptical.  Especially with things working on thoracic area and rib cage pain is common with the that area damaged. As patients being open minded and yet skeptical is the best position to take.  You are letting evidence and your body/gut be your guide and I think this serves you well.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
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