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Suggest treatment for chronic thoracic back pain

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Neurologist
Practicing since : 2004
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Good morning, I have been having thoracic back pain for about 18 months and it’s been a progressive pain that gradually got worse and worse to the point that it is a 24/7 pain. The pain is a excruting pain that has affected many aspects of my life. Sleeping is difficult as well as doing any type of physical activity. I had a mri in XXXXXXX that showed I had a paracentral disc herniation of the t5-t6 with mild narrowing of the spinal canal. Also showed bone spurs from t5,t6,t7,t8,t9. Significant spurring in t5,t6. Also disc degenerative disease across the entire thoracic spine. I also had a mri if the lumbar as well at that time that showed L4-L5 disc herniation along with bone spurs and DDD (disc degenerative disease). The pain from XXXXXXX until now got a lot worse. I went to a pain clinic and they did steroid nerve block from T5 -T9 on both sides. It didn’t work so they did nerve burnings (rhazotomy) from T5 to T9. Also did not help. I started getting hand and leg tremors so I went to a neurosurgeon that ordered a new mri of the cervical, thoracic and brain. I had this mri last week. I got the results today and the brain mri was normal, the cervical mri showed c3-c6 small right para-central disc protrusions indenting the thecal sac at the midline. Now the thoracic mri showed the t5-t6 herniation as well as a new herniation on the t6-t7. It said t6-t7 small paracentral disc protrusion on the left side distorting the thoracic spinal cord left of midline. Marrow signal appears to be with in normal limits. It also shows mild DDD on multiple disc levels in the thoracic back. My question would be how would you interpret this? Is this bad news? My thoracic back pain is very bad and it never goes away. I have a very difficult time sleeping. They put me on percocets and naproxen and I have been at home resting for 4 weeks trying to get it to calm down but rest is not helping either. I just got the results this morning but I have not spoken to my neurosurgeon yet. He is out until Tuesday. My Ferritin blood levels are really elevated so I don’t know if that has anything to do with this. I have also had several cat scans of the abdomen to rule out other diseases. Any thoughts? I have not been in any accidents or injuries. I have a desk job so it’s not physical labor. So I am guessing it’s bad genetics
Tue, 24 Apr 2018 in Brain and Spine
 
 
Answered by Dr. Olsi Taka 7 hours later
Brief Answer:
Recent MRI is worse than first, surgery may be considered.

Detailed Answer:
I read your question carefully and I understand your concern.

The recent MRI is not good news, it does indeed show an increase in the degenerative changes in the spine, with impending compression of the spinal cord (fortunately no changes of the spinal cord which could cause neurological deficits).

So the question at this point is how to manage pain. generally it is preferred to avoid surgery and try to handle it conservatively. However in your case you seem to have exhausted conservative means, you have tried pain killers, steroid shots, rhizotomy. I suppose you have tried physical therapy as well. So at this point as usual options have been tried and failed yours is a case in which I would consider surgery for the disc herniation.

Of course after surgery physical therapy should be continued.

I remain at your disposal for other questions.
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for chronic thoracic back pain 5 hours later
Is thoracic back surgery safe? I hear thoracic back injuries are rare and not many surgeons operate on them.
 
 
Answered by Dr. Olsi Taka 16 hours later
Brief Answer:
Read below.

Detailed Answer:
Sorry for answering a little late, due to time difference the notification for your answer had come just as I had gone to sleep.

Regarding your question, naturally every surgery done under general anesthesia entails some risks, depending on patient's age and other medical conditions, such risks are minor but present in any patient independently from the type of surgery.

As for thoracic procedures, while it is true that cervical or lumbar disc herniations are much more common, the success rate remains high (figures may vary among studies but remain similar in that over 75% of patients are satisfied with outcome).

Let me know if I can further assist you.
Above answer was peer-reviewed by
 
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