Thoracic Disc Herniation Symptoms
Pain is the most common symptom of a thoracic herniated disc and may be isolated to the upper back or it may radiate in a dermatomal (single nerve root) pattern. The pain may be exacerbated when coughing or sneezing.
Radiating pain may be perceived to be in the chest or belly, and this leads to quite a large differential diagnosis that will need to include an assessment of heart, lung, kidney and gastrointestinal disorders as well as other non-spine musculoskeletal causes. Within the spine itself there are also many other disorders that can have similar presenting symptoms of upper back pain and/or radiating pain, such as a spine fracture (e.g. from osteoporosis), infection, tumor, and certain metabolic disorders.
If the disc herniates into the spinal cord area, the thoracic disk herniation may also present with myelopathy (spinal cord dysfunction). This may be evident as sensory disturbances (such as numbness) below the level of compression, difficulty with balance and walking, lower extremity weakness, or bowel or bladder dysfunction.
Pain and Symptoms Correlate with Type of Herniation
Presenting upper back herniated disc symptoms [4] often correlate with the size and location of the disc herniation. The herniated material may protrude in a central, lateral (to the side), or centro-lateral direction with the majority having a central component. Typical symptoms for each include:
- Central disc protrusion. This type of herniation usually causes upper back pain and/or myelopathy, depending on the size of the herniated disc and the amount of pressure on the spinal cord. There is limited room around the spinal cord in the thoracic spine, so a herniation in this area can put pressure on the cord and affect the related nerve function. In serious cases, a thoracic herniated disc can lead to paralysis from the waist down.
- Lateral disc herniation. When the disc herniates laterally, or to the side, it is more likely to impinge on the exiting nerve root at that level of the spine and cause radiating chest wall or abdominal pain.
- Centro-lateral disc herniation. This type of thoracic disc herniation may present with any combination of symptoms of upper back pain, radiating pain, or myelopathy.
Thoracic Disc Herniation Diagnosis
The first step in diagnosing a herniated thoracic disc always includes a good patient medical history and physical examination. This combination of the patient’s description of how the pain feels, where it occurs, when it occurs, etc., as well as the spine physician’s physical examination, should yield clues to help localize the lesion to the thoracic spine.
Next, if a thoracic herniated disc is suspected as the underlying cause of the pain, there are several diagnostic tests that can confirm the diagnosis and provide additional information.
- Plain x-rays may be used to help localize injuries in cases of trauma as well as aid in identifying spinal instability
- An MRI scan is the most useful imaging tool to identify disc pathology.
In cases where an MRI scan is contraindicated, a post-myelogram CT can help identify an area of external compression, but it will not yield information about injury within the substance of the cord (myelomalacia).