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Identification and Treatment of Thoracic Spinal Stenosis

Posted on: 11/30/1999
Spinal stenosis occurs with the spinal canal narrows to the point that it begins to press on the spinal nerves. This can cause pain and nerve problems, such as weakness in the area below the nerve level. When the stenosis happens in the cervical region (the neck and extreme upper back), this results in weakness in the arms, while lumbar spinal stenosis (the lower back) results in problems with the legs. Thoracic spinal stenosis, the mid-back, is more complicated.

Thoracic spinal stenosis is rare on its own. It can be congenital (your are born with it), age-related deterioration, or some diseases. The authors of this article reviewed the results of seven patients who has surgery for thoracic spinal stenosis and reviews from the literature discussing the treatments.

The seven patients were followed for at least two years, longer in some cases. The patients, ranging in age from 36 to 80 years were all diagnosed after lengthy periods. All patients had been treated nonsurgically with combinations of pain medications, relaxant medications, physical therapy, injections into the stenosis area, bed rest, and chiropractics. Before the surgery, all the patients underwent further testing with x-rays, magnetic resonance imaging (MRI), and dyes followed by computed tomography (CT) scans.

The surgery for the patients involved opening the narrowed section of the spinal canal, relieving pressure on the nerves, fusing bone together, removing bone, and/or grafting, depending on each patient's condition. The surgeries lasted anywhere from 170 to 527 minutes. After surgery, the patients' stay in hospital ranged from four to 13 days.

Results from the seven patients showed that none had any major complications as a result of the surgery. Five patients saw an improvement in function and were able to walk normally, while one had only some improvement and one remained in a wheelchair after surgery. The surgery improved bowel and bladder control for two patients who had lost it prior to the treatment. One patient needed to undergo surgery a second time to remove hardware and to examine the spinal area.

The authors of this article write that this type of stenosis may actually be present for quite a while before symptoms begin to show. And, although cervical and lumbar stenosis have a set pattern for treatment, thoracic stenosis doesn't, seemingly because of its rarity. It's suggested that patients with thoracic stenosis often are delayed in getting a proper diagnosis because it is so unusual and this delay results in the signs and symptoms worsening. Careful examination of neurological symptoms may provide earlier clues to the patients' physicians. While MRIs are useful tools, a myelogram, the test that uses dye to see the bones, is much better in helping locate stenosis.

It's vital that patients receive proper treatment as soon as diagnosis is made and that surgery be done to relieve the pressure on the nerves before more permanent complications set in.

John R. Dimar II, MD, et al. Identification and Surgical Treatment of Primary Thoracic Spinal Stenosis. In The American Journal of Orthopedics. December 2008. Vol. 37. No. 11. Pp. 564-568.

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