Thoracic Spinal Stenosis

Anatomy of the Spine

The spinal column is made up of small bones (vertebrae) stacked on top of one another, creating the natural curves of the back. Between the vertebrae are flat, round, rubbery pads (intervertebral disks) that act as shock absorbers and allow the back to flex or bend. Muscles and ligaments connecting the vertebrae allow motion while providing support and stability for the spine and upper body. Each vertebra has an opening (foramen) in the center and these line up to form the spinal canal. Protected by the vertebrae, the spinal cord and other nerve roots travel through the spinal canal. Nerves branch out from the spinal column through vertebral openings, carrying messages between the brain and muscles. Facet joints align at the back of the spinal column, linking the vertebrae together and allowing for rotation and movement. Like all joints, cartilage covers the surface where facet joints meet.

The spine contains three segments: lumbar, thoracic and cervical.

Thoracic—The thoracic spine consists of 12 vertebrae and begins at the upper chest, extending to the middle back and connecting to the rib cage.

Cervical—The cervical spine includes the neck and consists of seven small vertebrae, beginning at the base of the skull and ending at the upper chest.

Lumbar—The lumbar spine consists of five vertebral bones located in the lower back (L1 to L5) with 5 intervertebral discs located between them; lumbar vertebrae are larger because they carry more of the body’s weight.

What is Thoracic Spinal Stenosis?

Thoracic spinal stenosis is a narrowing of the spinal canal and/or the root passages in the thoracic spine, which compresses the spinal cord and/or nerves. Thoracic spinal stenosis is an uncommon condition, primarily because this region of the spine is more stable and less prone to degeneration than the cervical and lumbar spine. Due to the anatomical location of the thoracic spine, this form of stenosis can lead to complications involving the heart and lungs. Seeking immediate treatment is crucial.

What Are Symptoms of Thoracic Spinal Stenosis?

Symptoms of this condition differ from those associated cervical or lumber spinal stenosis. Symptoms of thoracic spinal stenosis may include:

  • Difficulty or limited ability to rotate the torso or move from side to side
  • Pain in the ribs
  • Pain wrapping into the chest or abdomen
  • Numbness, tingling, or weakness in the chest or abdomen
  • Loss of balance
  • Leg spasms or weakness
  • In severe cases, loss of bladder or bowel control may occur
  • Paralysis is rare, but can occur

What Are the Causes and Risk Factors?

Although thoracic spinal stenosis can occur at any age and the causes vary widely, age is the primary cause and it is most common in patients over 50.

Risk factors include:

  • Advancing age
  • Herniated or bulging disks
  • Arthritis or osteoarthritis
  • Degenerative disk disease
  • Bone spurs or thickened tissues
  • Congenital factors, such as being born with a narrower spinal canal
  • Vertebral compression fractures
  • Spondylolisthesis

How is Thoracic Spinal Stenosis Diagnosed?

A diagnosis of thoracic spinal stenosis is based on your symptoms and their onset, complete medical history, and a thorough physical examination that includes tests to assess current symptoms, their severity, and any movements that trigger pain. Your doctor may also perform tests to evaluate function, sensation, muscle strength, reflexes, balance and more. Diagnostic imaging studies are also valuable tools that allow your physician to view the spinal canal and determine the extent of stenosis. Magnetic Resonance Imaging (MRI) provides the detailed images of the spinal cord, spinal nerves, disks, ligaments and tendons required to allow detection of both large and small abnormalities.

Nonsurgical Treatment

The goal of nonsurgical treatment is to relieve pain and symptoms by reducing irritation and nerve pressure  Your doctor may recommend one therapy or combine several types of treatment.

Ice, heat other modalities—Careful application of cold or heat (ice pack or heating pad), and other local therapies can offer some relief of symptoms.

Physical therapy—Strengthening and stretching weakened or strained muscles and improving posture can help to relieve pain and pressure on the nerves. Other approaches such as massage therapy may also be considered. Physical therapy programs vary, and your physical therapist will recommend what’s most appropriate for you.

Medications—Nonsteroidal anti-inflammatories (NSAIDs) such as ibuprofen and naproxen are often prescribed for several weeks in combination with acetaminophen to address both pain and swelling. If you have serious contraindications to NSAIDs or your pain is not well-controlled, other types of pain medication can be considered. Painful muscle spasms may be treated with muscle relaxants, such as cyclobenzaprine or tizanidine. For severe cases, prescription medications may be considered to help block nerve pain.

Acupuncture—Acupuncture can be helpful in treating some of the pain in less severe cases of cervical spinal stenosis. Although the treatment can be very safe, long-term success has not been proven scientifically.

Steroid-based injections—Many patients find short-term pain relief from steroid injections. Although less invasive than surgery, steroid-based injections are prescribed only after a complete medical evaluation.

Surgery

Surgical options are reserved for patients who have severe pain that has not been relieved by other treatment or if there is a risk of nerve damage or myelopathy. Advancements in spinal surgery have made it possible for some procedures to be performed on an outpatient basis, using minimally invasive techniques, which allows smaller incisions and faster recovery times. Your doctor will explain whether you are a candidate for surgical treatment and discuss any recommendations with you.

Surgical treatment has the potential to offer significant relief from symptoms associated with spinal cord prevention, and prevent further deterioration of neurological function, contributing to an enhanced quality of life.

Among the most common surgical procedures performed to treat thoracic spinal stenosis are:

  • Laminectomy or laminotomy
  • Foraminectomy or foraminotomy
  • Discectomy
  • Spinal fusion

Complications

As with any surgery, there are some risks, and these vary from person to person. For most people, surgery can provide relief of symptoms and return to function with relatively low risk of complications. Overall, elderly patients have higher rates of complications from surgery, as do patients who are overweight, diabetics, smokers, or suffering from multiple medical problems. Among the general, potential risks associated with surgery are infection, bleeding and blood clots, and reactions to anesthesia. Be sure to discuss the potential risks and benefits with your surgeon prior to surgery.