[Redbird]

#23064

HI Dr, Corenman,

A recent MRI just showed I have a herniated disc in my thoracic region. I wouldn’t have known it, otherwise, except a “suspected mass” appeared on a x-ray which led to the MRI: this turned out to be a herniated disc which is calcified. I consulted with a neurosurgeon who recommended surgery.

The herniation is pushing on my spinal column and both my doctor and the neurosurgeon were surprised I haven’t been in much pain or had more severe symptoms. I’ve been told the risk with this herniation is weakness, loss of balance or control of my bladder, pain and numbness in my extremities. However, these symptoms are also a risk with the surgery, as well as other risks. Up to now, I’ve only had occasional back pain (mild) and some restlessness in my legs. So at this point, I’m concerned with undergoing surgery that could actually cause me more harm.

So I have a few questions:
1) What causes a disc to become calcified and what are the concerns regarding calcification?
2) Can a “wait and see” approach to managing this cause greater risks?
3) Are there other treatments, such as exercise or therapy, that could help control worsening symptoms?

I’d appreciate any feedback you can offer.

Thanks,
Redbird

[Donald Corenman, MD, DC]

#23065

First, a thoracic disc herniation is not too rare. I am curious as to why you had a thoracic MRI if you had no symptoms.

Old disc herniations can calcify. The herniation tears the annulus and “pushes it into the canal” This creates traction on the bone/annulus interface and this tractions causes new bone formation. The calcification is characteristic of a herniation that has been there for some time (at least 6 months to one year).

One of the factors in considering surgery is how significant the size of the herniation. Some can cause severe cord compression and signal change in the cord (a white signal on T2 scans) and probably need to be addressed surgically. Other herniations might be smaller and minimally cord compressive without generating signs and symptoms and can be watched without surgical intervention.

If you have no symptoms but do have signs of cord compression (called long tract signs), then the decision becomes somewhat more murky. If long tract signs are present, there is at least some cord dysfunction. These probably can be watched but there is more concern of continued compression and cord injury.

There is always the possibility of recurrent disc herniation (another disc herniation at the same level due to the annular tear) but I cannot remember seeing one of these in the thoracic spine (they do occur in the cervical and lumbar spines).

Symptoms from cord compression cannot be “treated” with exercise or manual therapy.

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.

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