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-hello Dr. Coreman. thank you for your great forum and valuable feedback.
-I am 33 y/o. about 5 months ago early one morning after wakening up, i was moving around some boxes at my apartment, and suddenly i heard a click sound in middle back accompained by sharp pain that lasted about 2 hours. within a few days my pain got better and within two weeks pain was completely gone.
-then within three weeks while getting ready to move out to a new apartment , i was moving around some furniture the pain suddenly started. pain was sharp and intense at the same area in mid back, however this time i started to feel sharp pain in my arms and legs and within a few days the pain got worse and started to expand further in my arms and hand and legs (( both left and right arms and legs))
-I have not had any back pain history ( before this incidence) and generally in good health.
-so, for a couple of months now i tried to not do much hoping that it will get better. but so far i felt very mild improvement .
-then i started to see a chiropractic doctor. after discussing the history of my back pain the doctor ordered a MRI of the T-spine.
-the finding of the MRI by the radiologist were:
-There is small slightly right paracentral disc protrusion at T7-T8. this disc protrusion indents the cord along the right lateral aspect anteriorly (( there is no spinal stenosis or abnormal signal in the cord))
-There is mild disc space narrowing at T10-T11 disc level. minimal diffuse disc bulge is identified . there is mild flattening of the thecal sac. there is no spinal stenosis.
-1.5 cm hemangioma present at T3
-there is no spinal stenosis throughout.-after reviewing and discussing the findings with the chiropractic doctor, he recommended some therapy at his office along with use of OTC meds which i followed with very closely for a couple of months so far.
-5 months later, i am still having pain in mide pain (( I think at T-7-T8)) accompained with sharp pain in my legs (right and left -front and back and sides -but more on left leg) the the sharp pain in my arm and hands got better but I still feel it every now and then.
-I am able to walk around, i feel no weakness in my arms or legs but i feel the sharp pain in my legs and some times in in my arm and in middle of my back (( general pain index in my middle back is 7-8 constant. sciatica pain in my legs 4-6 pain index . no bowl or bladder problem.
and i have no pain in the side or front of my rib cage. pain mostly in my middle back and sharp pain in my legs ( right and left ( front and back and sides) -more so on the left leg. some sharp pain in left and right arm– i have no lower back pain and from what i heard and read sciatica pain is involve with issues with lower back.
-It has been five months and the pain and sciatica still active.
-i have read that surgery is the last resort for thoracic spine problem.
-will the disc problem between T-7 T-8 affect other thoracic disc with time and cause more disc problem with time.
-my life has completely come to sudden stop because of it. I have not been working for the past 5 months because i did not want it to get worse (( my job require and bending and side to side movement all the time))
-if there is a disc bulge at T7-8 is it going to get better with time or it will not change or possibly get worse.
-if I wait another several months will it heal up.
-i tried pasting some of the images of the mri but could not do it. i looked at the image in your website of the thoracic spine disc herniation and it looks very very similiar.
-any feedback will be greatly appreciated. thank you for taking the time to help.
Let me summarize your history and complaints. 5 months ago you were lifting boxes and felt and heard a click or pop type sound from your midback (I assume the area in between the bottom of your shoulder blades). This pain disappeared and three weeks later the same pain reappeared with lifting again. Pain also occurred in both arms and legs.
You rested for two months without improvement and then saw a chiropractor. He or she treated you without relief and obtained an MRI that noted a small herniated disc at T7-8 that slightly compresses the cord or at least distorts the cord pathway.
Your arm symptoms improved but your leg symptoms are just as significant as at onset of initial pain. You have no weakness. Your thoracic pain is a 7-8 on a VAS scale and the pain does not radiate around the ribs. I imagine you have no bowel or bladder symptoms and have no imbalance. The leg pain is less than your thoracic pain and is bilateral with left leg more intense.
First off- if the thoracic disc herniation is causing your thoracic pain and is not causing cord compression (you report no myelopathy- see web site), continue non-surgical treatment. Surgically treating thoracic disc herniations is difficult and can cause symptoms that were not present previously. Epidural injections can be helpful and occasionally, the facets can cause local pain. Facet blocks and rhizotomies (see web site) can be helpful.
Your leg pain is most likely not originating from the thoracic spine. You indicate that you have no lower back pain but there are circumstances that nerve compression may not be associated with back pain. If you underwent a thorough physical examination, was there any evidence of nerve root pathology?
It would be unusual to have onset of a thoracic disc herniation and onset of a lumbar disc herniation at the same time, especially a lumbar herniation that caused compression of both sides but stranger things have happened. You could have a systemic neurological problem and a neurological consult may be in order.
Another set of eyes may be helpful to determine what disorder is causing your symptoms.
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.-thank you Dr. Corenman for your valuable feedback. greatly appreciated. thank you.
-just have a couple of follow up questions. if there is a disc herniation between T7-8, what is the likely possibility that it can cause other disc herniation for example between T9-10 or other areas that are close to T7-8?
-the disc herniation between T7-8, given time what would happen to this herniation, would get worse or would it heal?
-the sciatica pain in my legs only started when I started having pain @middle back.
I have no lower back pain either before this or now. Is it possible if there is compression on T7-8 which can compress the spinal cord to cause the sciatica in my hand and legs ?thank you Dr. Corenman
A disc herniation at one level in the thoracic spine will not by itself cause another disc herniation at a different level. That being said, you may have a genetic predisposition for disc herniations.
Over time, many symptomatic thoracic disc herniations will “heal” or become much less symptomatic. Some don’t and need treatment like epidural injections or facet blocks. Rarely, one might need surgical intervention.
It is exceedingly rare to have a thoracic disc herniation cause leg pain. I have seen one case in my career. A thoracic disc herniation will not cause arm symptoms.
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.I too am suffering from a t7-t8 herniation/protrusion that is pressing against my spinal cord, my pain onset was in Aug 2012, I recently was referred to another orthopedic surgeon for review, since my pain has not subsided and signs have gradually increased. I have done medicine treatment and physical therapy, which has not helped. After care full review of my MRI my new orthopedic feels that the only option I have is to have a posterior spine fusion and instr. of t7-t8 due to the protrusion to my spinal cord, we do not know the extent of damage to the spinal cord. My surgeon has advised me that this is rare very rare, but feels it is needed before irreversible damage is done to my spinal cord. My search online for information has not been very helpful, this is not a procedure that is common. I know what your going through, it is hard for me to deal with this pain day in and day out, while trying to manage a household and kids. I will be having my surgery in May, our goal is to get me back to some what the way I was before my injury, but it looks like I still have a long road ahead of me!
A posterior fusion for a thoracic disc herniation is an acceptable procedure. Is the surgeon also going to use a lateral approach to remove this herniation?
While most likely it is, one question is whether this herniation is causing your pain. Have you had an epidural or facet blocks at this level? Have you had a discogram? What testing have you undergone to determine that this thoracic disc herniation is causing your pain?
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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