What is Thoracic Degenerative Disc Disease?
Thoracic Degenerative Disc Disease is a condition where there is degeneration or wear and tear of the vertebral discs present in the thoracic region. Thoracic Degenerative Disc Disease is not as common as lumbar or cervical degenerative disc disease, as the vertebrae in the thoracic region do not flex or bend frequently, as much as the vertebrae in the neck and lower back do, so the stress is less on the thoracic vertebral discs. However, thoracic degenerative disc disease is every bit as painful as the lumbar and cervical degenerative disc disease.
Thoracic degenerative disc disease is thought to be a normal part of aging process of our body. However, degeneration of thoracic disc can also occur due to injury, trauma, genetics or illness. There can also be narrowing of the spinal canal in thoracic degenerative disc disease. Aging is the primary cause of thoracic degenerative disc disease. The most common symptom Thoracic Degenerative Disc Disease is back pain felt at the level of the thoracic disc. Pain can be localized to the back, or can spread to the sides of the back, or can go all the way to the front over the sternum (breast bone) or the upper abdomen. The location of the pain depends on the damaged disc. The pain from the degenerative thoracic disc disease can be confused with stomach ulcer, heart attack or gall bladder problems.
Treatment for Thoracic Degenerative Disc Disease comprises of therapeutic injections, oral pain medicines and physical therapy. If the conservative treatment is not successful, then surgery is needed.
The Thoracic Spine & its Discs
The spinal discs are the shock absorbing structures which are present between each vertebra. These discs help in movement, shock absorption and stabilizing of the spine. Degeneration of the discs is one of the leading causes of pain in the neck, lower back and also disability. The upper part of the spine is the thoracic spine and contains 12 ribs, which are attached on each side. The thoracic spine is located between the neck and the lumbar region, which is the lower part of the spine. All in all, there are 11 thoracic discs, and the 12th disc is situated between the lumbar and thoracic spine. As mentioned before, thoracic degenerative disc disease occurs as a result of wear and tear of the thoracic discs. Aging is the primary cause of the wear and tear of the thoracic discs. Other causes which can result in thoracic degenerative disc disease include injuries, such as motor vehicle accidents, falls, or injuries sustained from heavy lifting. Thoracic Degenerative Disc Disease usually starts with small tears and progresses to formation of spurs.
Patient experiences upper or mid back pain. If there is severe degeneration of the thoracic discs, then there can be formation of bone spurs, which restrict the mobility of the thoracic spine. The spurs can also cause narrowing of the spinal canal and compress the spinal cord. If there is increased compression on the spinal cord, then patient can also experience numbness, tingling and weakness in the legs.
Causes of Thoracic Degenerative Disc Disease
- Aging is the primary cause of degenerative disc disease of any region including the thoracic region. As the human body ages, there is loss of fluid and dehydration in the discs, which leads to narrowing of the discs and loss in their height. All this compromises the ability of the discs to absorb stress and shock. There is tear or crack in the outer fibrous annular rings, which weakens the walls of the thoracic disc.
- Older individuals are more commonly affected with disc degeneration and this condition involves functional, structural, mechanical, chemical and nutritional changes in the affected disc and its surrounding structures.
- Pain in the disc occurs due to a combination of inflammatory mediators and mechanical deformation of the disc.
- Trauma/injury/falls to the spine and its discs also can trigger the degenerative process of the thoracic spine.
- Being overweight, smoking, participating in activities which involve heavy lifting also leads to thoracic degenerative disc disease.
- Other medical conditions or diseases, such as osteoporosis and arthritis can also contribute to thoracic degenerative disc disease.
- Inflammation can also trigger the process of thoracic degenerative disc disease.
- Environment and autoimmunity can also play a role in degenerative disc disease.
- Thoracic degenerative disc disease can also occur due to hereditary and genetics.
- The spinal discs do not have as much blood supply as muscles; hence they do not possess reparative ability and are more prone to degeneration.
- Certain activities aggravate thoracic degenerative disc disease, such as slumped sitting, bending forwards, carrying and lifting heavy weights, coughing, straining, sneezing, and sudden forced movements.
Signs & Symptoms of Thoracic Degenerative Disc Disease
Symptoms of thoracic degenerative disc disease depend on the location of the disc and the actual disc and structures involved. Thoracic degenerative disc disease affects the back, shoulder blade and travels along the distribution of the ribs. Other medical conditions relating to intervertebral disc, which can develop as a result of disc degeneration include: Bulging disc, herniated disc, annular tear of the disc, prolapsed disc, ruptured disc and slipped disc. Some of the common symptoms of Thoracic Degenerative Disc Disease include:
- One of the thoracic degenerative disc disease symptom involves pain in the upper or mid back.
- Pain can also radiate to chest wall, sternum, ribs and abdomen.
- Patient suffering from thoracic degenerative disc disease also experiences symptoms of sensory changes, such as tingling, numbness or paresthesias in case of compression of spinal cord or any nerve.
- There are muscle spasms felt.
- Patient experiences changes in posture in the thoracic region.
- There is loss of motion with reduced ability to move the trunk during certain movements, such as turning, side bending and backward bending.
- If the patient sits for long periods of time, then he/she experiences back and arm pain.
- Patient suffering from thoracic degenerative disc disease finds it difficult to lift anything and also feels difficulty in performing any over the head activities. Patient can feel stiffness in the morning, which eases with gradual movement but can turn achy at the end of the day.
- In severe cases or later stages of thoracic degenerative disc disease, there may be development of spinal stenosis, which causes loss of coordination and weakness in the lower extremities. Surgery is required in such cases.
Severe Symptoms of Thoracic Degenerative Disc Disease which Require Surgery include:
- Increase in radicular pain or radiating pain.
- Worsening of the pain.
- Worsening of the nerve damage.
- Weakness or increase in weakness, numbness or paresthesias.
- Loss of bladder and bowel control.
Diagnosis of Degenerative Thoracic Disc Disease
- Diagnosis of degenerative thoracic disc disease can be made by taking patient's medical history and physical examination. However, in majority of the cases, many investigations and tests do not reveal clearly about which disc is actually causing the problem.
- X-ray helps in determining if there is any degeneration, bony malformations, fractures, arthritis, infection or tumors in the joints.
- CT scan generates cross section images of the spinal structures.
- MRI helps in assessing the involvement of any soft tissue and also helps in visualizing the discs, nerve roots and spinal cord.
- Electromyography (EMG) is a test, which helps in determining any nerve damage or nerve involvement.
- Myelogram is a test which consists of injecting a dye into the spinal column after which x-rays are taken to see the position of the discs/ spinal cord and to see if there is any compression on them.
- Discography can help in identifying the culprit thoracic disc, which is causing the problems.
Treatment for Thoracic Degenerative Disc Disease
Treatment of thoracic degenerative disc disease depends on its severity and the cause of the disease. The following treatment measures are recommended for thoracic degenerative disc disease:
- Rest and avoiding activities which produce pain, such as lifting, bending, twisting, bending backwards or turning is important.
- Ice application for thoracic degenerative disc disease is beneficial in acute stages. The ice should be wrapped in a towel and applied to the thoracic spine and should never be applied directly to the skin. This helps in alleviating pain and muscle spasm. Ice application should be done for around 20 minutes every couple of hours.
- Application of moist heat also benefits in reducing pain and stiffness associated with thoracic degenerative disc disease.
- Medications for thoracic degenerative disc disease includes painkillers or NSAIDs (Non-Steroidal Anti-Inflammatories), which are given to relieve pain and inflammation.
- Narcotics can be prescribed if the above medications do not help in relieving pain associated with thoracic degenerative disc disease.
- If the patient is suffering from acute muscle spasm, then muscle relaxants are prescribed.
- Exercises, which are specifically designed to address the symptoms of thoracic degenerative disc disease, should be done. These exercises also help in joint flexibility/mobility, posture, spinal alignment and range of motion.
- Supports can also be used in order to reduce the stress on the facet joints, muscles and in the thoracic region of the spine.
- Steroids can be prescribed in moderate to severe thoracic degenerative disc disease for reducing pain and inflammation.
- Epidural injections can be given directly into the affected disc to relieve the symptoms of degenerated thoracic disc.
- Physical therapy comprising of stretching and strengthening exercises can be done to help in reducing inflammation, improving mobility and range of motion, restoring joint function and helps the patient to return to daily activities of living. Physical therapy should be started after healing has occurred. Physical therapy also helps in preventing recurrence of the injury.
- Physical therapy should comprise of strengthening and stretching exercises to prevent recurrence of the injury. Patient should make a gradual return to physical activities.
- Surgery for thoracic degenerative disc disease is needed in severe cases and if there is no improvement in the symptoms. Discectomy is a most common disc related surgical procedure done where the disc is removed through an incision. Other surgeries which can be done for treating thoracic degenerative disc disease include: Spinal laminectomy, laminotomy, foraminotomy, spinal decompression and spinal fusion. The type of surgical procedure done depends on the symptoms.
Prognosis of Thoracic Degenerative Disc Disease
There is no cure for any type of degenerative disc disease including thoracic degenerative disc disease. Degenerative disc disease is not that common of the thoracic spine. Symptoms of many patients improve without surgery. Treatment for thoracic degenerative disc disease depends on the severity of the symptoms and can last anywhere between 4 to 12 weeks. It is important that patient continues with strengthening, stretching and stabilization exercises. Prognosis is good if the patient continues to use proper body mechanics and follows the guidelines and all the do's and don'ts for a healthy back.
Physiotherapy for Thoracic Degenerative Disc Disease
Physiotherapy should be started after the patient has healed. Physiotherapy should be mild initially. Physiotherapy helps in boosting the healing process and decreases the chances of recurrence of an injury. Physiotherapy can comprise of:
- Joint manipulation.
- Joint mobilization.
- Realignment of the spine and pelvis.
- Myofascial release/deep tissue massage.
- Acupuncture /dry needling.
- Exercises, which help in stretching and improving balance, proprioception, core stability, flexibility and strength.
- Neural mobilization.
- Biomechanical assessment.
- Activity modification advice.
- Education on training and gradual return to exercise.
- Advice on use of orthotics/insoles.
- Postural taping/bracing.
- Heat or ice treatment.
- Clinical Pilates.
- Soft tissue massage.
- Using lumbar support when sitting.
- Using an appropriate pillow when sleeping.
- Ergonomic advice.
- Exercises, which help in improving strength, flexibility, posture and core stability.
Exercises for Thoracic Degenerative Disc Disease
Stretching Exercises for Thoracic Degenerative Disc Disease
Corner Chest Stretch for Thoracic Degenerative Disc Disease
- Stand in a corner.
- Lift your arms high till the upper arms are in a parallel position to the floor.
- Rest your forearms on the wall.
- Slowly push straight forward till you can feel a stretch in the chest muscles.
- Lead this stretch with your shoulders.
- Try to keep upper arms at a same level.
- Stretch till you feel some mild discomfort. Do not overstretch.
- Hold this position for 30 seconds and repeat this exercise 3 to 4 times a day.
Upper Back Stretch for Thoracic Degenerative Disc Disease
- Stand in a position with your thumbs down and interlock your hands about chest-high in front of you.
- Gently stretch your arms straight out in front of you.
- Slowly lower your head down and keep reaching down and stretching.
- Hold this position for 30 seconds and slowly relax.
- Repeat this 3 to 4 times a day.
Shoulder Blade Squeezes for Thoracic Degenerative Disc Disease
- Sit or stand with your back straight.
- Squeeze the shoulder blades together as far as possible without feeling any pain.
- You can feel a mild to moderate stretch.
- Hold this stretch for a couple of seconds.
- Repeat this for 8 to 10 times as long as you don't feel any pain.
Rotation when Sitting
- Sit on a chair or a bench with your back straight.
- Keeping your legs still and place your arms across your chest.
- Slowly rotate your body to one side and try to move as far as possible without feeling any pain.
- You should be able to feel a mild to moderate stretch.
- Hold this position for a couple of seconds.
- Repeat this exercise for 8 to10 times on each side; however, you should not feel any pain or other symptoms when doing this exercise.
Strengthening Exercises for Thoracic Degenerative Disc Disease
Opposite Arm & Leg Raising Exercise for Thoracic Degenerative Disc Disease
- Lie on your stomach and keep your arms above your head.
- Keeping your elbows and knees straight.
- Slowly lift your opposite arm and leg while tightening the muscles in your back and buttocks.
- Hold this position for a couple of seconds and return to the starting position.
- Repeat this exercise on the other arm and leg.
- Do this exercise about 8 to 10 times on each side; however, you should not feel any pain or other symptoms when doing this exercise.