Question
Hi,

My husband has disc herniation of his T6-T8 in his thorasic. His Dr has gone through all non surgical procedures and has determined that he has to have surgery. He lives on pain meds just to get through a day. 5-6 times a year I have to call an ambulance because he no longer can breathe. Recently he has started to have problems in his arms and his hands. He can't feel them, move them, or use them. He is very afraid because they told him they have to break his ribs to do the surgery. how evasive is this surgery and do you know the probability that it will work? We live in NJ and are having a very hard time finding a surgeon who will do the surgery in that region. Is that a common when it comes to the thorasic region?

Answer
Dear Nicole,

I am not a surgeon, but I can tell you that operating on a thoracic disk bulge is not a common procedure.  This is the likely reason you are having trouble finding a local surgeon to perform the operation.  I can tell you that it is common to break a rib to be able to get into the chest cavity for surgical procedures, however, you may not need this if they are operating from the posterior aspect of the body (like they do in lumbar cases).    

I am not quite sure what exact procedure they will be using to get to the disk, so if you can get me the name of the procedure I may be able to offer a better explanation.  The rib cage does pose more obstacles to disk surgery in that area because it is not as easy to get to the disk material.  I would recommend that you specifically ask a neurosurgeon or an orthopedic surgeon with a spine fellowship to completely explain and describe the procedure to you first along with alternative surgical routes.

Having said that, I am not quite sure why they are relating the problems with the arms and hands to the disks AT T6-T8.  The reason I say this is that the nerve supply to the arms and hands comes from C4-C8, with fibers from T1 and T2 as well.  Although there is some overlap in neurological structure, T6 is just too far away from the neurological supply to the arms and hands.  To illustrate this point, please check out the below link so that you can appreciate the nerve innervation to the body:

http://www.apparelyzed.com/dermatome.html

The breathing problems make more sense due to the fact that the nerve innervation to the lungs, and musculature of the chest wall which include the intercostal muscles (between the ribs) partially comes from the thoracic nerve roots (they form part of the sympathetic chain ganglia that travels up and down the spine).  However, the main stimulus to the lung and diaphragm comes from cranial nerve ten and the phrenic nerve which shouldn't really be affected by the disk issues.

Good luck Nicole.

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