Mid-Back & Spinal Cord Conditions
Thoracic Disc Disease
Thoracic disc disease affects the discs in the rib-bearing mid-back. It is less common than cervical or lumbar disc disease but can cause local pain, radiating trunk symptoms, or spinal-cord compression.
Overview
The thoracic spine extends from the base of the neck to the upper lumbar region and is stabilized by the rib cage. Thoracic discs experience less motion than cervical or lumbar discs, so symptomatic herniations are less common.
A disc may degenerate, bulge, herniate, or calcify. Central or paracentral protrusions are clinically important because the thoracic spinal canal contains the spinal cord and provides relatively limited reserve space.
Symptoms can arise from the disc and surrounding joints, an irritated thoracic nerve root, or compression of the spinal cord. Many thoracic disc findings are incidental, making correlation with the level, side, and neurologic examination essential.
Other conditions—including compression fracture, rib or chest-wall disorders, shingles, tumor, infection, and cardiopulmonary or abdominal disease—can mimic thoracic pain and must be considered when the pattern is atypical.
Symptoms
Thoracic symptoms can wrap around the chest or abdomen and may be mistaken for non-spine conditions. Spinal-cord signs may appear in the legs even when mid-back pain is modest.
Mid-back pain
Pain may be focal or diffuse between the shoulder blades or around the lower rib cage and may vary with posture or movement.
Band-like trunk pain
An irritated thoracic nerve can produce burning, sharp, or electric pain around one side of the chest or abdomen.
Numbness & tingling
Altered sensation may follow a narrow band around the trunk rather than travel into an arm or leg.
Leg heaviness or weakness
Cord compression can affect strength, coordination, balance, walking, and reflexes below the involved level.
Balance & gait change
Stiff, unsteady, or poorly coordinated walking may be an early clue to thoracic myelopathy.
Systemic or non-spine patterns
Chest pain, shortness of breath, fever, rash, abdominal symptoms, weight loss, or unrelenting night pain require broader medical consideration.
Evaluation
Evaluation determines whether symptoms arise from the thoracic spine, an individual thoracic nerve, the spinal cord, or a non-spine condition. Neurologic findings strongly influence urgency.
History
Reviews pain distribution, trauma, rash, systemic symptoms, leg function, balance, and bowel or bladder changes.
Neurologic examination
Tests leg strength, sensation, reflexes, tone, coordination, balance, and gait along with trunk sensation.
X-rays
Show alignment, disc calcification, arthritis, deformity, and compression fractures.
MRI
Defines thoracic discs, the spinal cord, nerve roots, and any cord signal change.
CT or CT myelography
Clarifies calcified herniations and bone anatomy or assists when MRI cannot be obtained.
Medical differential
Additional testing or referral is used when chest, abdominal, infectious, oncologic, or other causes are possible.
Treatment
Treatment depends on whether the problem is pain-only, radicular, or causing spinal-cord dysfunction. Stable pain without neurologic loss is usually approached nonoperatively; myelopathy changes the threshold for surgery.
Nonoperative treatment
When neurologic function is intact, care focuses on symptom control, conditioning, and monitoring for change.
Activity & medication
Temporary modification of provocative activity and carefully selected medication may help an acute flare while avoiding prolonged deconditioning.
Physical therapy
Programs may address thoracic mobility, posture, breathing mechanics, trunk and shoulder strength, and graded return to activity.
Targeted injection
Selected thoracic epidural or nerve-root injections may help persistent radicular pain but require careful risk-benefit discussion.
Operative treatment
Surgery may be considered for progressive myelopathy, meaningful weakness or gait dysfunction, or persistent disabling symptoms from a clearly concordant disc despite appropriate care.
Thoracic discectomy
The disc is removed through an approach selected for its location, size, calcification, and relationship to the cord.
Decompression with stabilization
Fusion may be added when bone removal, instability, deformity, or the surgical approach requires stabilization.
Approach selection
Posterolateral, lateral, thoracoscopic, or open approaches each carry different access and neurologic considerations.
Specialized planning
Because the spinal cord is present, complete imaging review and careful technique are essential, especially for large or calcified discs.
When to seek prompt evaluation
Walking or leg changes should not be dismissed as mid-back pain.
Seek prompt evaluation for new leg weakness, balance or walking difficulty, numbness spreading below the trunk, bowel or bladder change, fever, severe chest symptoms, or rapidly progressive pain.
Mission Viejo · Orange County
Understand the source of your mid-back symptoms.
Schedule an individualized spine evaluation with Omid Jalali, MD.