Thoracic Disc Herniation
A thoracic disc herniation occurs when the soft inner portion of a spinal disc in the upper or mid-back pushes through a tear in the outer layer and extends into the spinal canal or nearby nerve openings. The thoracic spine is the least common region for symptomatic disc herniation because the rib cage helps stabilize this portion of the spine. When thoracic disc herniations do occur, they may cause mid-back pain, band-like chest or abdominal discomfort, nerve irritation, or, less commonly, spinal cord compression.
What is it?
The thoracic spine consists of twelve vertebrae located in the middle portion of the back, each connected to a pair of ribs. Between the vertebrae are intervertebral discs that act as cushions and allow controlled movement.
Each disc contains a tough outer layer called the annulus fibrosus and a softer gel-like center known as the nucleus pulposus. Over time, aging, repetitive stress, degeneration, or injury may weaken the outer portion of the disc, allowing the inner material to bulge or protrude outward. Depending on severity, this may appear as a disc bulge, protrusion, extrusion, or sequestration.
Because the thoracic spinal canal is relatively narrow, even moderately sized disc herniations can compress the spinal cord.
When the herniation irritates or compresses a thoracic nerve root, it may cause thoracic radiculopathy, producing band-like pain, numbness, tingling, or burning sensations wrapping around the chest, ribs, or abdomen.
Larger central herniations may compress the spinal cord itself and lead to thoracic myelopathy. Symptoms of spinal cord compression may include leg weakness, gait instability, balance problems, sensory changes below the level of compression, or bowel and bladder dysfunction.
Risk factors include aging, repetitive strain, heavy lifting, degenerative disc disease, prior spinal injury, and calcified thoracic discs, which are more common in the thoracic region than in the cervical or lumbar spine.
MRI of the thoracic spine is the preferred imaging test for evaluating thoracic disc herniation because it provides detailed views of the discs, spinal cord, nerve roots, ligaments, and surrounding soft tissues. MRI helps determine the exact size and location of the herniation and whether spinal cord compression is present.
CT and X-ray are less sensitive for evaluating soft disc material but may help assess calcified disc herniations, bone spurs, fractures, or spinal alignment abnormalities.
Electrodiagnostic studies may occasionally be used when symptoms and imaging findings do not clearly correlate.
Important to Know
Many thoracic disc herniations are discovered incidentally on imaging and never cause symptoms.
When symptoms are present, most patients improve with conservative treatment including physical therapy, posture correction, ergonomic modifications, activity modification, and anti-inflammatory medications.
Image-guided spinal injections may help reduce inflammation and pain in selected patients.
Surgery is generally reserved for patients with significant spinal cord compression, progressive neurological symptoms, severe pain that does not improve with conservative care, or worsening weakness or gait problems.
Because chest, rib, or upper abdominal pain can also arise from cardiac, pulmonary, gastrointestinal, or other medical conditions, thoracic spine disorders are typically considered after more urgent causes have been evaluated when appropriate.
Imaging findings are interpreted together with symptoms and neurological examination results rather than in isolation, since some thoracic disc abnormalities may not produce symptoms.
Red flag symptoms include progressive leg weakness, worsening balance or coordination, sensory loss below the chest or abdomen, bowel or bladder dysfunction, or severe back pain following trauma. These symptoms require urgent medical evaluation because they may indicate spinal cord compression or another serious spinal condition.