The thoracic spine is the middle portion of the spine, extending from the base of the neck to the upper lower back. It contains 12 vertebrae, labeled T1 through T12.
Please review the Thoracic spine anatomy section for more information.
Although degenerative problems are less common in the thoracic spine than in the cervical or lumbar spine, narrowing around the spinal cord or nerves can be particularly important because the spinal cord travels through the entire thoracic spinal canal.
Thoracic spinal cord or nerve root compression may be caused by arthritis, disc degeneration, bone spurs, thickened or calcified ligaments, or abnormal bone formation around the spinal canal.
Major Diagnosis Types
Below are the major types we see in our clinic. Click on available links to learn about our approach to the problems.
Thoracic Spinal Stenosis
Thoracic spinal stenosis is narrowing of the spinal canal in the middle portion of the spine.
The spinal canal contains the spinal cord. When the canal becomes too narrow, the spinal cord may become compressed.
Thoracic stenosis is less common than cervical or lumbar stenosis, but it can cause significant neurologic symptoms when it develops.
Patients with mild symptoms and no significant neurologic impairment may sometimes be observed.
When spinal cord compression causes progressive weakness, walking difficulty, myelopathy, or other significant neurologic symptoms, surgical decompression may be recommended.
Depending on the cause and location of the stenosis, surgery may include thoracic laminectomy, removal of compressive bone or ligament, and sometimes spinal fusion.
Minor Diagnosis Types
These terms are often encountered, but are either less often treated or described within one of the above diagnoses.
Thoracic Foraminal Stenosis
Thoracic foraminal stenosis is narrowing of the openings through which the thoracic spinal nerves leave the spinal column.
These openings are called the neural foramina.
Unlike central thoracic spinal stenosis, which primarily threatens the spinal cord, foraminal stenosis usually affects an individual thoracic nerve root.
Thoracic foraminal narrowing may result from:
- Degenerative disc disease
- Loss of disc height
- Bone spurs
- Facet joint arthritis
- Thoracic disc herniation
- Spondylolisthesis or instability
- Spinal deformity
- Previous spinal fusion
- Fracture
- Tumor or other lesions
Thoracic nerve roots travel around the chest and abdomen between the ribs.
Compression of one of these nerves may therefore produce:
- Mid-back pain
- Pain wrapping around one side of the chest
- Rib pain
- Burning or shooting pain
- Numbness or tingling
- Abnormal sensation along the chest or abdominal wall
This type of pain is sometimes called thoracic radiculopathy.
Because thoracic radicular pain may resemble conditions involving the heart, lungs, ribs, or abdominal organs, appropriate evaluation is important before symptoms are attributed to the spine.
Many patients can initially be treated without surgery.
Options may include:
- Anti-inflammatory or pain medications
- Physical therapy
- Activity modification
- Selective nerve root injections or epidural injections
Surgery may be considered when there is severe or persistent nerve compression despite nonsurgical treatment.
Depending on the location of the compression, treatment may involve a thoracic foraminotomy or another decompression procedure
Thoracic Myelopathy
Several thoracic compression disorders can ultimately produce the same neurologic condition: thoracic myelopathy.
Myelopathy means that the spinal cord is not functioning normally because of compression or injury.
Signs of thoracic myelopathy may include:
- Difficulty walking
- Poor balance
- Leg weakness
- Increased muscle tone or stiffness
- Numbness in the legs
- Abnormal reflexes
- Difficulty coordinating leg movements
- Bowel or bladder dysfunction
Unlike a pinched nerve in the lumbar spine, spinal cord compression may affect both legs and multiple neurologic functions at the same time.
Progressive thoracic myelopathy generally deserves prompt evaluation.