Spinal stenosis, or the narrowing of the spinal canal, can strike along any part of the spine. It most commonly occurs in the lumbar area (lower back), followed by the cervical area (neck). The American Academy of Orthopedic Surgeons (AAOS) calls spinal stenosis a “growing epidemic” that affects between eight and 11 percent of the population—increasingly impacting the Baby Boomer generation. Thoracic spinal stenosis is relatively rare but can be concerning simply because of where the thoracic region is located.
The thoracic spine has 12 vertebrae, T1 through T12, each of which is separated by a disc. These vertebrae are attached to the ribs. T1 and T12, at the top and bottom, are also connected to the cervical and lumbar spine, respectively. It’s important to understand the physiological structure because the thoracic portion of the spine plays a very strong protective role in the body; The thoracic spine, sternum, and ribs, form part of the thoracic cage, which together protect the heart and lungs.
Because the thoracic vertebrae are attached to the ribs, the area is less flexible than other parts of the spine. That means that the temporary pain relief patients may get from leaning forward against, say, a shopping cart, is largely ineffective with this type of stenosis. Leaning forward over a shopping cart flexes the spine slightly, which reduces the compression on the spine and therefore the pain felt while walking; That’s why we call it the “shopping cart sign.” The thoracic spine simply doesn’t flex.
Do you have thoracic spinal stenosis symptoms?
Many spinal conditions have overlapping symptoms that can make it challenging to know what you’re dealing with. This is why we always recommend those who are experiencing back pain come in and be seen.
Many spinal conditions can progress, becoming more dangerous and debilitating. Spinal stenosis could eventually cause permanent nerve damage if left untreated. Regardless of your condition, you don’t want to be in pain any longer than is necessary; a prompt diagnosis and treatment plan can put you on the road to wellness and give you peace of mind.
Diagnosing thoracic spinal stenosis
When back pain hits, it’s not enough to Google your symptoms, assume you know what’s wrong, and wait it out. Spinal stenosis does have some symptoms in common with other spinal conditions, but each has its own treatment protocol.
During the initial appointment at the DISC Spine Institute, patients will have an opportunity to discuss their pain and any other symptoms they may be experiencing. We will study your medical history and your MRI if you have already had one. At that time, we’ll determine if additional tests are needed. CT scans, MRIs, and special spine x-rays called flexion and extension views that can help check the stability of your spine that is useful in diagnosing thoracic spinal stenosis.
Key thoracic spinal stenosis symptoms
There are common symptoms of thoracic spinal stenosis, but not every individual will experience them the same way. One patient may have only one symptom, while another can check every one of them off the list.
The most common symptoms include:
- Extreme weakness in one or both legs and/or feet
- Numbness in the legs and/or the feet
- Heaviness or stiffness in the legs
- Loss of balance or difficulty standing or walking
Less common symptoms can include:
- Pain or discomfort in the middle back, in the ribs, or the legs
- A constricted feeling in the chest or abdomen
- Pain that extends down one side of the body
- Bowel or bladder issues*
*It’s important to note that loss of bladder or bowel control is extremely serious and requires immediate care and intervention. Patients should go to the emergency room right away if they experience this symptom.
Treatment for thoracic spinal stenosis
Unlike other types of spinal conditions that often respond well to non-surgical treatment, thoracic spinal stenosis typically requires surgical intervention to address the compression of the spinal cord or nerve roots.
For mild cases of thoracic myelopathy, which is compression of the middle area of the spinal cord, a combination of physical therapy and medications may be used initially with extensive follow-up to monitor the condition. For more severe cases and where there is a progression of mild cases, however, surgery is needed.
Types of surgery to treat thoracic spinal stenosis
Minimally invasive laminectomy—The most common surgical procedure to treat spinal stenosis, minimally invasive laminectomy is a non-fusion surgery that creates more space in the spinal canal and takes the pressure off of the nerves. During a minimally invasive laminectomy, a small incision is made on the back and the muscles are moved aside, providing access to the affected portion of the spine. A hole is then made in the lamina, which is part of the vertebral arch, to eliminate compression. We perform this procedure endoscopically, through an incision less than an inch long, with no sutures to remove and minimal muscle disruption. Patients need only a BAND-AID after surgery. Because more than 95 percent of all minimally invasive laminectomy procedures are performed on an outpatient basis, patients can expect to go home the same day.
Spinal fusion—At the DISC Spine Institute, we often perform thoracic spinal fusion procedures in conjunction with a laminectomy to fuse the vertebrae with bone graft or other materials. This can strengthen and stabilize the spine. There are several factors we use to determine whether we can perform minimally invasive procedures or if the patient needs an open fusion procedure. When performed as a minimally invasive procedure, spinal fusion is done on an outpatient basis, with a one-inch-long incision and no stitches to remove afterward.
Minimally invasive foraminotomy—Using specialized instruments, we can expand the space where the nerves leave the spinal canal, so they’re not compressed. During minimally invasive foraminotomy, a small piece of bone and soft tissue is removed through a small incision that is less than an inch long. This is performed as an outpatient procedure and is sutureless.
Causes of thoracic spinal stenosis
Spinal stenosis occurs when the canal in which the spinal cord is located becomes narrowed, compressing the spinal cord and/or spinal nerves. This condition is most common in older patients and is the result of osteoarthritis. Osteoarthritis is when the cartilage that naturally protects the ends of our bones breaks down, causing them to rub together.
Spinal stenosis can also be caused by:
- Herniated discs—Also called bulging or protruding discs, herniated discs. are often the result of wear and tear from aging, a traumatic event, or injury.
- Spondylolisthesis—This condition involves one or more vertebrae slipping out of place.
- Bone spurs—They can grow into the spinal canal, putting pressure on the nerves.
- Enlarged facet joints—Degeneration of the joints between the vertebrae can cause the cartilage inside the facet joint to become inflamed.
- Inflammation of the spinal canal ligament—This inflammation can cause constriction.
The Road to Recovery
The period after spinal surgery is just as important to the overall health and wellness of our patients as the surgery itself. My fellow surgeons, myself, and our staff at the DISC Spine Institute commit ourselves to guide patients through the entire process, from the first diagnosis to the moment they realize they are healed. We provide continued recovery support with any necessary pain medications, muscle relaxants, bracing for support, metabolic supplements for maximal healing of bones/nerves/soft tissue, topical scar healing medications, and physical therapy when indicated. Our staff of experienced medical assistants and physician assistants provide an enhanced level of support to help guide patients through the recovery phase.
If you’re concerned that your back pain is spinal stenosis or simply want to move forward with feeling better, contact the DISC Spine Institute, leading DFW disc and spine centers and experts in minimally invasive treatments, the most effective medical procedures to treat and eliminate chronic back pain. Treating back pain in Texas is easier than ever, with minimally invasive treatments that mean short hospital stays, and shorter recoveries.