FAQ Category: Thoracic Spine

If the protruding disc takes up more than 40 percent of the spinal canal, then it’s called a giant herniated disc. Without surgery, there is a risk of permanent damage to the spinal cord.

The body will try to heal itself. An inflammatory process is started. After some time the disc material can become infiltrated with bone, a process called ossification.

With an ossified or calcified disc herniation, your chances of neurologic injury go up. If you aren’t having any neurologic symptoms at the present time your chances for a complete recovery are good.

Bilateral symptoms of leg pain and/or bladder signal a more serious problem. Surgery is likely to be more important. Most doctors will say “the sooner the better” for a good outcome.

A firm, but not too hard mattress is always a good idea. Sometimes, just rotating or turning your mattress over is enough. This should be done every six months at least. If your mattress is soft, sagging, or in disrepair, replace it soon.

The problem may not be in the mattress. Upper back and arm pain can be coming from the neck, shoulder, or upper thoracic spine. An exam by a physician or physical therapist can help identify the problem.

A past history of automobile (or other) accident is often present in patients with these symptoms. Good neck support in bed is important. Keeping the arm by the side or supported by a pillow is also helpful. Cortisone treatment into the shoulder may alleviate the symptoms altogether.

There are no hard and fast rules about returning to sports after back surgery. Every surgeon looks at each patient separately. Some of the factors the doctor looks at include the patient’s age, the amount and kind of surgery, and how long ago the surgery was done.

One other important part of this decision is the kind of sport or activity in question. Contact or collision sports are not advised at all for the first year after surgery. These include wrestling, gymnastics, basketball, football, and ice hockey. Many doctors advise against these kinds of activities for life.

Noncontact, low-impact activities are generally allowed after six months. These include swimming, cross country skiing, tennis, and running. Returning to gym class at school usually happens somewhere between six months and one year.

A new procedure called kyphoplasty is showing promising results for patients with compression fractures from osteoporosis. The procedure is done by a neurosurgeon either in the office or hospital. A needle is inserted in the fractured vertebra, and a balloon is inflated to help restore the height of the vertebra. Then a “bone cement” is placed in the bone to stabilize the fracture and maintain the height of the bone. Ask your health care provider for more information about this new procedure.

Yes. If the spine is affected by osteoporosis, the vertebrae become fragile from a loss of bone density. This in turn causes each vertebra to become slightly shorter. The combined loss of height in the vertebrae can account for the decrease in a person’s stature.

Another explanation is that the affected vertebrae can be compressed merely from the weight of the body or from minor trauma. This is called a compression fracture. Such a fracture can result in loss of height as well as the “humpback” appearance sometimes seen in those with osteoporosis.

Absolutely. Braces are designed to prevent further sideways curvature of the spine. A recent study demonstrated that teens with large spinal curves (greater than 35 degrees) had better results the more they wore the brace. Teens who wore the brace more than 18 hours a day avoided further curvature of the spine 80 percent of the time. When teens wore the brace 12 to 18 hours, the success rate fell to 50 percent. And for teens who wore the brace less than 12 hours a day, the success rate was only 30 percent.

This is clearly a case of “parent knows best.” The more your teen wears the brace, the better his or her outcome will be.

A study looked at the results of bracing for teens with large spinal curves from scoliosis. Ages of participants in the study didn’t make a difference in whether bracing prevented further curvature of the spine. Others markers of maturity, such as time of growth spurt or first period, also didn’t affect the success of the treatment. From these results, researchers decided that it may be appropriate to suggest bracing for teens at all stages of development.

In a recent study, about half of the teens who wore braces for scoliosis had good results. However, 30 percent wound up needing surgery within three years. Information from X-rays may predict whether bracing will work. Researchers have found that, for teens with two spinal curves in an S-shape, the exact pattern of the curves may suggest how successful bracing will be. If the pelvis is tilted too far (over 12 degrees), there may also be less success from bracing.

Sometimes you can’t tell how a treatment will work until you try it. Your daughter’s doctor may be able to tell early on how effective the brace will be. Research says that, for teens with double spinal curves, a 25 percent correction of the bigger curve early on suggests a good final result from bracing. The number of hours teens wear the brace also makes a difference. Generally, the more hours, the better. Teens who wear their braces more than 18 hours a day may avoid further curvature of the spine 80 percent of the time.

X-rays are only one of several important tests used for problems of TOS. X-rays are useful for seeing whether symptoms are coming from a cervical rib. In addition to standard X-rays, doctors perform clinical tests to help sort out where the symptoms are coming from. To help confirm the diagnosis, other special tests, such as a venogram or ultrasound, may be used.

Expert surgeons who deal with TOS perform various types of surgery with good results, especially when they are certain the symptoms are from TOS and not from some other cause. Before going ahead with surgery, most surgeons will prescribe up to 12 weeks of nonsurgical treatment to see if the problem can first be corrected without surgery.

A compression fracture can take about three months to heal. Bones will continue to remodel for up to 18 months. This means you are only about halfway through the first steps of healing. There is no reason to believe you’ll always have pain, though people who’ve had a fracture like this often end up with some ongoing, low-grade pain. This is especially true when doing heavier activities.

Be patient, and follow the advice of your doctor. You should notice more pain relief once you’ve started your rehabilitation program, which usually begins about six weeks after the injury.  

Vertebral compression fractures (VCFs) can be very painful. For many patients, the symptoms can’t be managed by rest and medication alone.

Fortunately, there are a few minimally invasive treatments to help patients with VCFs. A technique called vertebroplasty was introduced in 1987. In this procedure, a special kind of cement is injected into the broken vertebral body. This method strengthens the broken bone and is very effective in relieving pain.

An even newer procedure called kyphoplasty uses a balloon-like instrument to “inflate” the broken vertebral body back to its original height. The instrument makes a space within the fractured vertebral body. The space is then filled with thick bone cement.

Both procedures seem to give patients excellent pain relief. However, kyphoplasty may have some advantages. According to a recent paper, kyphoplasty has a better chance of restoring the proper height of the vertebra. Also, the thicker cement used in kyphoplasty seems less likely to leak into other areas.

Ask your doctor whether either of these procedures may be helpful in your case.

As you know, osteoporosis results in bone loss and changes in skeletal structure. These can leave the spine vulnerable to compression fractures. Vertebral compression fractures (VCFs) happen when the vertebral body collapses in height. VCFs don’t necessarily come from intense activity. They can happen suddenly, after little or no trauma.

VCFs are common among patients with osteoporosis. There are about 700,000 VCFs in the United States each year. One-third of them results in ongoing pain. These fractures can also cause spinal problems and loss of function.

Talk with your doctor about what you can do to manage your osteoporosis and keep your spine healthy.

Vertebral compression fractures (VCFs) happen when a vertebral body collapses in height. Patients with osteoporosis are especially prone to VCFs because their bones weaken. Something as simple as coughing, twisting, or lifting can cause their vertebrae to fracture.

Round in shape, the vertebral body crumbles into the shape of a wedge. The spine angles forward and becomes hunched in appearance. This is called spinal kyphosis. A severe kyphosis can put pressure on the lungs and digestive system, hampering breathing and appetite.

VCFs can be very painful, making it hard to do daily activities. And VCFs can produce a host of spine problems, such as pressure on the nerves or spinal cord. All of these factors point to a higher mortality rate for patients who have VCFs.

Treatment may include bed rest, pain medication, and bracing. A new, minimally invasive procedure called kyphoplasty is showing promise for easing pain and helping patients achieve improved posture. This procedure uses a balloon-like device to renew the space inside the fractured vertebra. A special bone cement is then injected into the cavity formed by the balloon. By fixing the vertebral body in its correct size and position, kyphosis is reduced.

In a recent study, patients felt much better and had improved function after this procedure. In many cases, the treatment also restored the original height of the vertebral body. Kyphoplasty adds a new and effective dimension to nonsurgical treatment of VCFs due to osteoporosis.

According to a recent study of factory workers, staying physically fit may be the best way to keep low back pain at bay. Workers who said they were physically fit were less likely to develop low back pain over a two-year period. These workers tended to have strong thigh and spine muscles, and they could move their trunks up and down quickly. Keeping your back, legs, and trunk strong will help you use the good lifting techniques that ward off back pain.

That hump is called kyphosis and is usually related to osteoporosis. Osteoporosis is thinning of the bones associated with aging and is sometimes hereditary. The bones in the back become thin, and areas of weakness compress into the shape of a wedge. This often results in the outward curving of the spine. It does make sense that if a person is slouching constantly while these spine bones are thinning, the spine will more readily compress in that “slouched” direction. In your case, it is most likely a result of the other factors, such as osteoporosis. If you have not done so already, it would be a good idea to have your bone density checked to see if that is a problem.

Kyphosis, or dowager’s hump, is associated with osteoporosis. Osteoporosis is thinning of the bones associated with aging, which can be hereditary. The bones in the back become thin, and areas of weakness compress the spine bones into the form of a wedge. These are called compression fractures and can be quite painful. Lots of things can be done to prevent and treat osteoporosis, but the earlier you act the better. Talk to your health care provider about this. It is much easier to maintain bone than to rebuild it once it’s lost.

Upper back pain can be caused by osteoarthritis (OA). OA does seem to run in families. It is possible your symptoms are from OA, and there’s a chance it was handed down from your parents.

Age has a lot to do with OA too.  It is often the result of the wear and tear of aging. The older you are, the more likely you are to be showing the signs of OA.

But there are also other common causes of upper back pain. Poor posture, an injury that strained the upper back, weak upper back muscles, or neck problems can all cause upper back pain. Your doctor can help you find the cause of your pain, and help you find ways to relieve the pain and prevent future problems.

They can be. Changes in posture can cause changes in the alignment of the rib cage. If the change becomes permanent, as can happen with scoliosis, the shoulder blade may begin to thump or snap as it glides over the rib cage. Talk to your doctor or physical therapist to see if exercises could improve your spine and shoulder blade alignment.

Work postures, especially holding your arms out or overhead for long periods, can contribute to symptoms of thoracic outlet syndrome (TOS). Hairdressers have to use these positions for much of the day. Your work may be constantly aggravating your TOS. A specialist, such as a physical or occupational therapist, could check your work station and watch the way you do your work. He or she could then make suggestions about steps you could take, such as taking breaks more frequently or holding your equipment at a different level. Another idea is to schedule clients so that you don’t have back-to-back appointments that require holding your arms up. Talk to your doctor for other ideas to reduce your pain.

Thoracic outlet syndrome (TOS) is a condition where the nerves or arteries that go to the arm and hand get squeezed between soft tissues near the side of the neck. It is difficult to diagnose. The process can be frustrating, as you know too well. There is no one test that shows TOS. And TOS symptoms are similar to the symptoms of many other conditions, including a herniated disc in the neck and carpal tunnel syndrome. Your doctor has to rely on your medical history, a thorough physical examination, and various tests to rule out other possible causes.