What is Thoracic Myelopathy?
Thoracic myelopathy is a disorder resulting from severe spinal cord compression in the thoracic region. The spinal cord in this region typically gets compressed as a result of bulging or herniated discs, spinal trauma, or bone spurs causing severe pain and discomfort. Thoracic decompression surgery is one of the effective ways to treat thoracic myelopathy.
Thoracic Spine Anatomy
The thoracic spine is the central part of the spine. The spine consists of 33 vertebral bones stacked one on top of the other with cushioning discs lying between each vertebrae. It is divided into 7 cervical vertebrae (neck), 12 thoracic vertebrae (mid back), 5 lumbar vertebrae (lower back), 5 sacral bones, and 4 coccyx bones. The sacral and the coccyx bones are fused and do not provide any movement in the spine. The spine plays a key role in the smooth movement, stability, and protection of the delicate spinal cord, and giving symmetry and support to the body.
Causes of Thoracic Myelopathy
Thoracic myelopathy typically develops due to gradual degeneration of the spine as well as compression of the nerve roots and spinal cord resulting from conditions such as:
- Spinal stenosis
- Autoimmune disorders, such as rheumatoid arthritis of the spine
- Hematomas, cysts, hernias, and spinal tumors, including bone cancer
- Spinal trauma, spinal infection, neurological disorders, inflammatory disease, radiation therapy
- Congenital disorders
- Central disc herniations
Symptoms of Thoracic Myelopathy
Usually, spinal cord trauma or compression results in loss of function, loss of sensation, and discomfort or pain around the area. Thoracic myelopathy symptoms may also include:
- Numbness, tingling, or weakness
- Neck, arm, lower back or leg pain
- Difficulty walking
- Difficulties with balance and coordination
- Loss of bowel or urinary control
- Increased or abnormal reflexes in the extremities
- Complications with fine motor skills, such as buttoning a shirt or writing
Diagnosis of Thoracic Myelopathy
Proper diagnosis is crucial for effective management of thoracic myelopathy. To arrive at an accurate diagnosis, a detailed review of medical history coupled with a physical and neurological examination is conducted. Neurological examination helps identify any signs of neurological injury and involves evaluation of reflexes and muscle weakness. Your doctor may also recommend the following tests for a detailed view of the spine and spinal canal to assess for any abnormalities and to confirm the diagnosis of thoracic myelopathy:
- MRI scan
- Electrical tests, such as somatosensory evoked potentials or electromyogram
Treatment for Thoracic Myelopathy
Treatment usually depends on the causes of thoracic myelopathy and include both non-surgical as well as surgical methods.
Non-Surgical Treatment Non-surgical methods are typically employed to treat mild forms of thoracic myelopathy and are aimed at alleviating pain and discomfort with physiotherapy, bracing, and medication. The non-surgical approach does not treat compression.
Surgical Treatment Thoracic spine decompression surgery is the common surgical treatment employed to treat spinal cord compression. Decompression surgery is designed to take the pressure off the spinal cord or nerve root and provide relief from pain and discomfort. Thoracic herniated disc surgery is also an option to eliminate herniated discs or bone spurs that are found to be pressing against the spinal cord.
For advanced thoracic myelopathy that occurs because of stenosis (narrowing of the spinal canal), your physician may recommend a surgery called laminoplasty. Laminoplasty is a motion-sparing procedure that creates more space for the spinal cord and nerve roots to relieve abnormal pressure on the spinal cord while retaining flexibility of the spine at the area of compression.
For patients who are not a candidate for laminoplasty, decompression and spinal fusion is employed as an alternative. During spinal fusion, two or more vertebrae are fused together so that they heal into a single, solid bone. This is done to eliminate painful motion and to restore stability to the spine.
Minimally invasive spine surgery is also an option as it offers lower risks and complications with a faster recovery due to minimal surgical incisions and reduced trauma to the body when compared to conventional open surgery. This type of surgery is usually performed using tiny instruments and an endoscope to visually guide the surgery.