[Anne2k]

#27653

I’ve had two microdiscectomies and laminectomies on the L5-S1. In 2015, I had a onset over a few hours of terrible mid-back pain that cause lightening bolts down both arms and legs. I went to the ER and had imagine that revealed a small centrally bulging disc that indented the sac but no contact with the cord. I’ve had moderate pain around the rib cage and over time, it resolved in to mostly right sided pain in the mid back. There is no local thoracic surgeon in my area to consult with. I have been managing the residual pain with ESI treatments.

A few weeks ago, about two weeks after my last ESI, I had horrific pain in my right side, shooting in to my head, and down my right arm and numbness in my legs. It’s greatly aggravated by a ton of things but specifically laying back (the act of doing that), lifting almost anything, and lifting my legs in a seated or laying position. My pain doc sent me in for an MRI and found unremarkable changes in the lumber but the following in the thoracic:

——-
Lower thoracic spine shows minor 2 to 3 mm protrusion right-sided T6-7 indenting CSF
mildly contacting cord. Nerve root canals are widely patent. Facets are unremarkable.
T7-8 shows broad-based bulging indenting CSF mildly contacting cord. Nerve root
canals are widely patent. Facets are unremarkable.
T8-9 shows a small disc protrusion 2-3 millimeters front back right side indenting CSF.
Nerve root canals are widely patent. Facets are unremarkable.

1. Multilevel disc space narrowing and dehydration
2. Small right-sided disc protrusion T 6-7 indenting CSF
3. Broad-based bulging bulging at T7-8 mildly flattening ventral surface cord
4. Small right disc protrusion T8-9

—
So the right sided 6-7 is larger than before and making cord contact but I’m more concerned about the t7-8. Am I barking up the wrong tree? I can’t find information on the net or from local providers about what to expect with a thoracic injury. Does the above mean anything at all? What kinds of conversations should I be having with a provider about this?

Thank you very much in advance! It just hurts like crazy and I feel like it shouldn’t hurt this much.

[Donald Corenman, MD, DC]

#27654

First, thoracic herniations (except T1-2) do not cause arm symptoms (“I had horrific pain in my right side, shooting in to my head, and down my right arm and numbness in my legs”). Thoracic disc herniations can cause local radiating rib pain and lower extremity myelopathy with enough compression in the canal. Did anyone look at the cervical spine with imaging and do a thorough examination?

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Anne2k]

#27657

Yes, I’m sorry I should have described this better but I was trying to be brief. I really appreciate your time.

In 2015, I experienced a sudden onset of mid back pain (it felt like something was stuck in me at the bra line) that radiated everywhere like electrical shocks on the day it began. I was taken to the ER and I had full spine MRIs both with and without contrast. After the first couple of days it calmed down and settled to primarily pain around my rib cage. The results of those MRIs showed the earlier lumbar issue, a mildly protruding disc at T7-8 and a tiny protrusion at T8-9 on the right side. My cervical spine looked fantastic.

Since that time, I’ve had moderate ongoing pain around the ribs at the bra line. It’s been worse on the right side. It’s been fairly well controlled with ESI every 5-6 months. It typically rates 1-2 in the morning, and ramps up to maybe 5-6 by the end of the night.

I started having an increase in pain around that zone in December of 2017 that left me in bed for the last few days of my vacation. I received another ESI at T7-8 mid January.

About two weeks ago my pain started getting steadily worse and within a few days it was really awful. My pain meaning that same spot mid back. It feels like there is a knife in that spot. I don’t know how else to describe it. The pain wrapping around my chest wall is what I would imagine a heart attack feels like and it hurts when I breathe deeply, laugh, or speak forcefully. When the sharpest pain triggers (dull aches and pain is constant, but the sharp pain is triggered by any number of various movements) it causes a painful spasm around my chest and into the right arm but doesn’t travel down the arm. It’s primarily shoulder and back upper portion of the arm. It also for brief seconds, it shoots in to my head like a stabbing pain but those both ease off as quickly as soon the sharp pain mid back does.

I’m active, 42, fit, and I have a really high pain tolerance. I was an ultra runner in 2015 and I’ve given birth without pain meds if that helps put into perspective my ability to push through discomforts. Ever since this episode, I have spent every night in bed and every day at work gasping around the office. I ice constantly and it helps a little but heat seems to make it worse. I wake up in 5-6 pain and go to bed at 8-9 (9 being, I’m not sure if I’m going to throw up or pass out from the pain). I’ve cried myself to sleep a lot lately.

The current MRI done yesterday on the thoracic shows mild scoliosis and kyphosis, which wasn’t there a year ago. I suspect it’s from guarding because movement in that area can produce significantly painful results.

I get a lot of shrugs about all of this and I was hoping that maybe you had experience with thoracic stuff and could help figure out what the heck is going on.

[Anne2k]

#27658

Oh, and my legs get numb or randomly hurt. I completely lost feeling in the last couple of toes on my right foot a week ago so that’s what triggered them to check the lumbar this time too. I’ve had the sensation of water running down the back of my legs and the feeling of sprained ankles (especially right sided). I get numbness bi-laterally on the inside of my thighs. No weakness in the last nine months or so.

[Donald Corenman, MD, DC]

#27659

Other than facial pain and arm pain, your description of symptoms matches with a thoracic disc herniation to the tee. Your history of epidural steroid injections giving relief confirms these symptoms. Since the herniations are not that big, I will assume that the cord is not significantly compressed and your examination notes no long tract signs in your lower extremities.

Your lower extremity symptoms are concerning if the herniations are not that large. You have had an MRI of the lumbar spine so I will also assume that there is no compressive pathology noted in those images.

You might be a candidate for surgery if the symptoms continue after one year and are impairing. This would be a decompression and fusion surgery to stop the painful motion and take out the herniation.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[Anne2k]

#27660

Okay. Thank you. I do have some issues in the lumbar and they think it might be causing the leg symptoms but it’s unchanged from earlier MRIs. This MRI was odd because there was an appearing and disappearing bulge (how it was described to me today) on the films:
——-
L5-S1: The posterior disc margin shows broad-based bulging. Hemilaminotomy
changes are seen with epidural and perineural fibrosis worse on left. Left facet and
right facet have been partially resected. Nerve root canals do not appears significantly
narrowed on the right and mildly narrow on the left. Sagittal images suggest a small
disc protrusion which is not definitely confirmed on axial images. No nerve root
flattening or deformity is apparent

Prior imaging is available for comparison 2015. Upper lumbar levels are
unremarkable with prior study. L5-S1 showed the very similar appearance broad-based
bulging with question small supervised disc protrusion. Hemilaminotomy changes are
present on the prior study with epidural and perineural fibrosis worse on left.

1. Prior surgery L5-S1 with epidural fibrosis bilateral laminotomies and partial
facetectomy
2. Broad-based bulging question small residual recurrent disc protrusion unchanged
since prior study without any nerve root flattening or deformity
3. Upper lumbar levels are unremarkable

———
Can they do thoracic surgery without the dangerous work through the chest cavity? It’s been described to me that they don’t do that unless you’ve lost bowl control because the risks are too high.

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