Thoracic Degenerative Disc Disease

The progression of disc degeneration can be classified in the following phases:

1. Dysfunction

• The annular rings of the disc tear and the irritation of the facet joints at the corresponding spinal level may occur.
• There is loss of joint mobility, localized back pain, muscle spasm, and loss of movement especially extension or backward motions.

2. Instability

• Loss of disc fluid with dehydration and disc narrowing. The facet joints and capsule may develop laxity resulting in instability.
• A patient will present with pain, sharp catching, giving way, a shift in spinal alignment and loss of motion.

3. Restabilization

• The body reacts to the instability by laying down bone in the form of osteophytes to stabilize the spine. This increase in bone formation can result in Stenosis.
• Back pain will usually decrease, but remain present in a less severe form. Individuals may develop stenotic-like symptoms.

• Aging is the most common cause of disc degeneration. As the body ages the discs start to lose fluid and dehydrate. The discs start to narrow and lose their height, compromising their ability to absorb shock and stress.
• The outer fibrous annular rings may begin to crack and tear, weakening the disc walls.
• Individuals who smoke, are obese, or are involved in activities that require heavy labor are more likely to develop disc degeneration.
• A sudden fall or trauma to the spine or disc may begin the degenerative process.
• A disc herniation may initiate the stages of disc degeneration.
• Unlike muscles, there is minimal blood supply to the discs, so they lack the ability to repair themselves.

The symptoms associated with degenerative disc disease of the thoracic spine will depend on the location and structures that are affected. Thoracic disc degeneration can affect the back, shoulder blades, and run along the distribution of the ribs.

• Please Note: Many patients with DDD (degenerative disc disease) do not exhibit symptoms.
• Chronic thoracic pain with or without radiation to the chest wall or ribs
• Sensory changes such as numbness or tingling if the nerve is compromised.
• Muscle spasms and changes in posture in the thoracic area.
• Loss of motion with decreased ability to move the trunk when performing motions like turning, backward bending, and side bending.
• Sitting for extended periods of time may produce back and arm pain.
• Difficulty with lifting and over-the-head activities.
• In later stages, spinal stenosis may develop resulting in lower extremity weakness and loss of coordination. In these cases surgical intervention will be required.

In mild cases patients often found that rest, ice and medication were enough to reduce the pain. Once the pain is reduced, physical therapy is recommended to develop a series of stretching and strengthening exercises to prevent re-occurrence of the injury. Return to activity should be gradual to prevent a flare up of symptoms.

If the problem persists, consult with your health care provider. Your physician will perform a thorough evaluation to determine the possible cause of your symptoms, the structures involved, the severity of the condition, and the best course of treatment.

In addition to performing a thorough examination your physician may order the following tests to make a more concise diagnosis:

• X-ray to determine if there is any joint degeneration, fractures, bony malformations, arthritis, tumors or infection present.
• MRI to determine any soft tissue involvement including visualization of the discs, spinal cord and nerve roots.
• CT scans, which can give a cross section view of the spinal structures.
• EMG which is used to determine nerve involvement or damage.
• Myelogram, which involves the injection of dye into the spinal column followed by an X-ray to visualize the position of, and the pressure being applied to, the discs or spinal cord.

Your physician may recommend several medication options individually or in combination to reduce the pain, inflammation and muscle spasm that may be associated with disc injuries.

• Over the counter medications for mild to moderate pain.
• Narcotics, if over the counter medications are not effective your physician may prescribe stronger pain medication.
• Anti-inflammatory drugs or prescription NSAIDS to reduce inflammation following acute injury.
• Muscle relaxers to reduce acute muscle spasm.
• Nerve pain medication by prescription, designed specifically to reduce pain from nerve damage.
• Injections like facet injections, nerve blocks or an epidural. These may involve the injection of corticosteroids to a specific structure to reduce local inflammation.