Just like myelopathy on the neck, thoracic or mid back (upper back) myelopathy occurs when the spinal cord is compressed. This can occur in the mid back for a range of reasons. Technically speaking, myelopathy refers to any condition of the spinal cord. In this article, we are specifically speaking about compressive thoracic myelopathy.
Cause of thoracic myelopathy
The most common reasons for a thoracic myelopathy are a bulged or herniated intervertebral disc due to spinal degeneration, fracture of the vertebrae or a bone spur. However, there are many other causes, including:
- Post-traumatic deformities
- Infections (e.g., tuberculosus)
- Inflammatory conditions
- Angular kyfose (e.g., congenital disease)
- Neurodegenerative disease
- Neoplastic disease
- Vascular disorder (e.g., vascular malformations, spinal cord infarct and epidural hematoma)
- Idiopathic (i.e., unknown cause)
- Nutritional disorders
These causes above are much less common than discogenic (i.e., intervertebral disc-related degeneration) conditions.
Symptoms of thoracic myelopathy
In the mid back, the most common form of thoracic myelopathy is compressive. Clinical features are centred about the mechanical compression of the spinal cord. Compressive thoracic myelopathy typically leads to a slow and steady decline in nerve function. Symptoms typically include, numbness or tingling, weakness in the legs that presents as a loss of coordination or the ability to walk in a straight line. This can progress to complete impairment of the extremities (paraplegia).
Diagnosing thoracic myelopathy
Myelopathy is primarily diagnosed by clinical exam findings. Because myelopathy is clinical syndrome that can be caused by many pathologies, finding an exact diagnosis can be challenging. The diagnosis depends on the neurological localisation in the spinal cord, rather than the brain or peripheral nervous system. Also, the presence or absence of significant pain or trauma and the mode of onset is important when assessing myelopathy into clinical categories.
Once a clinical diagnosis has been made, the underlying cause needs to be investigated. This usually involves medical imaging techniques, such as magnetic resonance imaging (MRI) for assessing pathology of tissues, plain radiographs (i.e., X-rays) for detecting arthritic changes of the bones, and Computer Tomography (CT) that is used for pre-operative planning of surgery.
To determine the grade of severity of the myelopathy clinicians use the Nurick classification. The classification is based on abnormalities in the patient’s gait (i.e., walking pattern). This evaluation has demonstrated reasonable sensitivity and validity.
Treatment of thoracic myelopathy
At Sydney Spine & Sports Centre (S3C), fixing your back pain is what we have a passion for. However, our chiropractors and physiotherapists cannot fix thoracic myelopathy and you will need a prompt diagnosis and referral for specialist care. Thoracic myelopathy will typically need a spinal surgical intervention know as decompression surgery. There are various decompression procedures that a surgeon may use known as corpectomy and thoracotomy.
Follow the links to our blogs for more information about this topic:
- Lumbar disc herniation risk factors
- Lumbar disc herniation pathophysiology
- When are scans indicated in disc herniation?
- Chronic Pain: why does it still hurt?
- When to worry about back pain?
- Diagnostic imaging in chiropractic
- How chiropractors treat back pain
- Muscle pain
- Joint pain
- Thoracic myelopathy
- Thoracic spine trauma
- Thoracic osteophytes
- Thoracic bone Spurs
- Thoracic spine stenosis
- Thoracic degenerative disc disease
- Thoracic disc herniation
- Thoracic arthritis
- Thoracic foraminal stenosis
- Thoracic pinched nerve
- Thoracic facet syndrome
- Thoracic facet joint pain
- Thoracic disc bulge
- Thoracic disc protrusion
- Thoracic spondylosis
- Thoracic spondyloarthropathies
- Thoracic radiculopathy
- Thoracic discogenic pain
- Acute mid back pain
- Chronic mid back pain
- Stiff mid back
- Thoracic spine tumour
- Upper back arthritis