Question
I was involved in a MVA on 12/11/2008.  I have been on anti-inflammatories and muscle relaxers since 12/16/2008.  As well as pain medication.  I have been seeing a chiropractor since 12/23/2008.  Due to my severe pain my doctor decided to do an MRI on 2/27/2009.  My results are that there is a thoracic disc protrusion at the T4-5 level.  I am finding it hard to any research on what to do next due to this being a rare area for disc protrusion.  Where can I find information about this condition?  Is surgery my next option?  I want my life back.

Answer
Dear Robyn,

You are absolutely correct that thoracic disc bulges/herniations occurs less frequently than lumbar and cervical disk pathologies. Unfortunately, thoracic disk conditions fail to respond to conservative treatment much more frequently than the cervical or lumbar spine, and the patient lives with pain. In many cases, simple treatments such as heat, chiropractic, physiotherapy, rest, exercise, and pain medication bring relief...but other sufferers are not so fortunate.

If one or more of the vertebral disks rupture and press on the nerve roots, the pain radiating along the chest and spine can be incapacitating and severe. For many, the only treatment to offer long term pain reduction is the surgical removal of part of the herniated disk.  Until recently, this has required a major traumatic operation. Traditional thoracic discectomy  requires general anesthesia, the dissection of muscle and removal of bone, and bone fusion. Thoracic disks are difficult to approach surgically because of the ribs, the narrow spinal canal, and the critical position of the spinal cord. I have seen cases where the surgeon actually has to go through the chest, resecting part of ribs and part of the vertebral body, collapsing of the lung, often requiring bone fusion and metal plate screws. This constitutes risk of spinal cord injury or other traumatic complications. A long post surgical recuperation and hospitalization are also needed for this traumatic surgery.  I would not recommend this approach.

However, they now have less invasive techniques.  Percutaneous arthroscopic thoracic discectomy is different from the standard traumatic thoracic disk surgery because there is no muscle dissection, bone removal, bone fusion, or a long incision, except for a puncture wound to accommodate the needle, micro-instruments, and the laser probe that are inserted into the herniated disk. This is performed under the guidance of a flouroscope to allow for the proper placement of all surgical instruments etc...Therefore, many of the complications that occur with conventional surgery are eliminated with this less traumatic procedure.  I would suggest that you research this technique as it may be an appropriate option for you, discuss it with your chiropractor is care is not effective (they may be able to refer you to a good neurosurgeon), or discuss this with your medical doctor.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net