Spinal stenosis affects between eight and 11 percent of people and is on the rise in lockstep with an aging population. Thoracic spinal stenosis is a relatively rare condition, however. Stenosis most commonly affects the lower back or lumbar region. The second most common region is the neck or cervical area.
While lumbar and cervical spinal stenosis often responds well to conservative, non-surgical treatment, thoracic spinal stenosis typically requires surgery to address the compressed spinal cord or nerve roots.
It’s important to know a little bit about the anatomical structure of the thoracic spine to understand what makes thoracic spinal stenosis so unique. The 12 vertebrae of the thoracic spine, numbered T1 through T12, are each separated by a disc and attached to the ribcage. The vertebra at the top of the thoracic spine, T1, is also attached to the cervical spine, while T-12 at the bottom is connected to the lumbar spine.
The thoracic spine and the sternum and ribs play a key role in protecting the heart and lungs. But its location in the body also makes it less flexible than other parts of the spine and therefore less susceptible to temporary pain relief. With other types of stenosis, patients are often able to lean forward, over a shopping cart, for example, and relieve their pain temporarily. This is a telltale symptom of stenosis that we refer to as the “shopping cart sign.” Because the thoracic vertebrae are attached to the ribs, patients can’t flex to reduce the compression the way they would if they had cervical or lumbar stenosis.
Causes of thoracic spinal stenosis
The most common cause of spinal stenosis is osteoarthritis. This condition affects millions of people, mostly after the age of 50. It can impact not just the spine, but any joint in the body. Osteoarthritis occurs when the protective cartilage that exists at the ends of our bones gradually breaks down. When it occurs in the spine, the spinal canal is narrowed, which compresses the spinal cord and/or spinal nerves, causing pain.
Spinal stenosis can also be caused by:
- Herniated discs—Herniated discs can happen because of normal wear and tear as a result of aging, an injury, or a traumatic event. Herniated discs are also sometimes called bulging or protruding discs.
- Spondylolisthesis—This painful condition occurs when one or more vertebra slips from their normal place in the spine. Most commonly, a vertebra slides over the one that lies just beneath it. This condition typically affects the lower back but can also affect the middle back, triggering thoracic spinal stenosis.
- Bone spurs—A common complication of osteoarthritis and joint damage, bone spurs can grow into the spinal canal, putting pressure on the nerves and causing great discomfort.
- Enlarged facet joints—When the joints between the vertebrae degenerate, the cartilage inside the facet joints can become inflamed.
- Inflammation of the spinal canal ligament—This ligament can thicken with age, becoming inflamed and causing constriction.
Symptoms of thoracic spinal stenosis
Symptoms of spinal stenosis can vary widely depending on the placement and the individual. If you only have one easy-to-manage symptom, consider yourself one of the lucky ones. Some others may have multiple symptoms that are extremely painful.
The most common symptoms of thoracic spinal stenosis include:
- Extreme weakness in the feet and/or legs
- Numb feet and/or legs
- A feeling of heaviness or stiffness in your legs
- Loss of balance or difficulty when walking and/or standing
Less common symptoms of thoracic spinal stenosis may include:
- Pain that is concentrated in the middle of your back or ribs or along one side of your body
- Pain in one or both legs
- Chest or abdominal constriction
- Bowel or bladder problems*
*Loss of bladder or bowel control is an indicator of cauda equina syndrome, a rare but very serious condition that requires immediate care and intervention. If this is happening to you, go to the emergency room immediately.
Getting a diagnosis
Whether you have only one symptom or many, it’s crucial to get to the doctor. Make an appointment and come see us. Not only is an immediate diagnosis the only way to put you on a path to a pain-free life, but delaying your diagnosis could be dangerous if your condition progresses and becomes increasingly debilitating.
During the initial appointment at the DISC Spine Institute, you will have an opportunity to discuss your pain and any other symptoms you’re 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. For thoracic spinal stenosis diagnoses, we use CT scans, MRIs, and special spine x-rays called flexion and extension views to help check the stability of your spine.
Treatment for thoracic spinal stenosis
The anatomical structure involved in thoracic stenosis can make it harder to treat conservatively, so pain management will be key right away while we consider the best surgical options. The severity of your condition, your overall health, and other details of your lifestyle are some of the determining factors that will help us devise the best treatment plan for you.
It should be noted that thoracic myelopathy is a term that refers to compression of the middle area of the spinal cord. When this is the diagnosis and the case is mild, we generally approach treatment with a combination of physical therapy and medications first, followed by thorough monitoring. If the condition progresses or if it’s a more severe case, we make a surgery plan.
Minimally invasive laminectomy is the most common surgical procedure to treat spinal stenosis. During this non-fusion surgery, a small incision is made on the back. The muscles are gently moved aside, so we can easily access the affected portion of the spine and create more space in the spinal canal to take the pressure off of the impacted nerves. We do this by making a hole in the part of the vertebral arch called the lamina to eliminate the compression.
More than 95 percent of minimally invasive laminectomies are outpatient procedures. They are performed endoscopically, through a tiny incision less than an inch long. There is minimal muscle disruption and no sutures to remove afterward. Patients typically only need a BAND-AID on their incision site and go home the same day as their surgery.
Thoracic spinal fusions are often performed in conjunction with a laminectomy to fuse the vertebrae with bone grafts or other materials. This is done to strengthen and stabilize the spine. Spinal fusions may be done as a minimally invasive or open procedure depending on the condition of the patient and various other determining factors. 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 after.
We remove a small piece of bone and soft tissue during a minimally invasive foraminotomy procedure through a small incision in the back that is less than an inch long. This is done by using specialized instruments to expand the area where the spinal nerves leave the spinal canal, eliminating the compression. Minimally invasive foraminotomy is performed as an outpatient procedure and is sutureless.
About DISC Spine Institute
If you’re concerned that your back pain is thoracic 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.
Today’s minimally invasive procedures include outpatient treatments and easier surgical treatments with small incisions and a quicker recovery time instead of a long hospital stay. With several DISC spine centers located throughout Dallas-Fort Worth and staffed by top Board-certified orthopedic spine surgeons, the DISC Spine Institute is well-prepared to help patients through their spinal conditions to get back to a pain-free life.