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  • zahul
    Member
    Post count: 8

    Dr. Corenman, I’ve been having back pain for over a year now. I’ve had an MRI of my entire spine and it showed multiple disc herniations. The one I’m more afraid of are the ones in my thoracic spine due to the risk of myelopathy and invasive surgery that can cause more chronic pain after.

    The MRI report said there is no radicular contact but I feel like I have a knife stuck in my upper back. The pain doesn’t radiate down my ribs but it’s constant (goes away when lying flat).

    A few images of my thoracic MRI can be seen here: imgur.com/a/vHXrd
    The last three images are from the T8-T9 disc which looks the worst.
    I’m confused because my MRI report also said there is cord compression without myelopathy but I’ve seen two neurologists and the both said the MRI doesn’t show any sign of cord compression and I don’t have any neurological signs, only brisk reflexes.

    I would really like your opinion regarding whether or not I have cord compression. I’m only 24 and I don’t understand how I’ve got so many disc herniations.

    Thank you very much for the support you give to those with neck and back pain

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Thoracic disc herniations can cause numerous symptoms. The typical three types of symptoms are cord compression causing myelopathy, radicular pain (from nerve root compression) causing radiating pain around the chest wall and finally local spine pain from pain generated by the disc itself.

    Myelopathy is covered on the website but suffice it to say that myelopathy is by itself painless as the cord does not have pain nerve endings in it. The symptoms are unusual paresthesias, imbalance, incoordination of the legs and bowel/bladder dysfunction.

    Radicular pain is radiating pain, normally only found only on one side (unilateral) that radiates from the spine “down and around” the chest wall into the front of the body. This pain is normally accompanied by numbness of that particular dermatome in a three inch swath.

    Disc pain is local spine pain that increases with loading (prolonged standing, lifting or impact) and is relieved with extension (bending the spine backwards or retracting the shoulders) or lying down.

    You do have some distortion of the anterior cord by the herniations but no compression. I rarely see any evidence of myelopathy with that type of cord presentation. More likely, you have local disc pain from the degenerative discs. Your disc hernations at your young age are most likely from genetics along with your advocation or occupation.

    Dr. Corenman

    zahul
    Member
    Post count: 8

    Thank you for your prompt and detailed answer.

    I also thought I can see a little distortion of the cord but I hoped I was wrong. Is this distortion an indication for future surgery? Should I get periodic MRIs to make sure it doesn’t turn into myelopathy ?

    My pain does get worse with loading and it’s almost gone when lying flat so I guess it’s the disc themselves hurting. I didn’t even know dics could hurt.

    I often get paresthesias in my hands and feet, much more frequent in my hands (when waking up from sleep) and in my feet only when siting in the same position too long but I didn’t gave them too much importance.

    Can I do anything to stop these herniations from expanding or even get them to shrink? The pain is bearable but the though of myelopathy and extensive thoracic surgery (that causes more chronic pain) makes me very anxious.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    “Distortion” of the cord is really of no concern generally. Spinal cords can tolerate some pressure without malfunction. You do not obtain serial MRIs to look for myelopathy. This is done with a visit to a knowledgeable surgeon who can monitor you on a biannual basis.

    Paresthesias in both hands and feet would not be generated by spinal cord compression in the thoracic spine as the “arm nerves” originate higher and are not affected by the thoracic spine. There are entrapment neuropathies having nothing to do with the spinal cord (carpel, cubital tunnel syndrome) that cause hand numbness and are aggravated by sleep.

    Do not worry about the disc herniations in the thoracic spine causing cord injury at this point. Most likely this will never become a cord issue.

    Dr. Corenman

    zahul
    Member
    Post count: 8

    Thank you again for another great answer.

    I have one more question. Should I see a surgeon every 6 months or once every two years? English is not my native language and in my language the word biannual is a little ambiguous.

    Donald Corenman, MD, DC
    Moderator
    Post count: 8465

    Every two years.

    There is a section on this website describing myelopathy. Understand that this section also discusses cervical myelopathy. I assume that you do not have cervical cord compression and so when revewing that section, ignore the symptoms in the arms and concentrate on the thoracic and leg symptoms (along with bowel and bladder).

    If you understand what symptoms can be generated from compression of the cord, you can “monitor” yourself as well as any spine surgeon. The exception is that there are signs which can occur that can only be revealed by a physical examination.

    Dr. Corenman

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