Thoracic spine stenosis
Thoracic spine stenosis describes the narrowing of the thoracic spinal canal due to accumulation of space-occupying degenerative material. The spinal canal is the passageway that neurological structures go through. These neural structures are called the spinal nerves and spinal cord. The nerves and spinal cord control vital body functions. Compression of the spinal cord and spinal nerves is a very serious condition. Spine stenosis can in fact occur in any part of the back such as neck, mid back or low back. Symptoms will present differently depending on where the spinal stenosis occurs along the spine. Thoracic spinal stenosis is more common as we age and as such is most common in people over 60 years or older.
How does thoracic spine stenosis arise?
Thoracic spine stenosis results from progressive narrowing of the central spinal canal and the lateral recesses. It arises from a cascade of degenerative changes to several surrounding tissues:
- With ageing, the intervertebral disc begins to degenerate and collapses, leading to the formation of osteophytes of the vertebrae (i.e., spine bones).
- A relative decrease in motion of the spine at specific vertebral levels subsequently causes an increase in spinal motion at adjacent levels.
- The spine responds to this increased physiological stress with more abnormal bone growth (i.e., osteophytes, aka bone spurs), which can grow inwards towards the spinal canal causing spinal cord or nerve root impingement.
- Furthermore, degeneration causes the formation of synovial cysts and abnormal growth of face joints of the vertebrae, which further compromises the mobility of the spine and spinal canal.
- The outer fibrous layers (i.e., annulus fibrosis) of the degenerated spinal discs become slack and weak, which leads to bulging or protrusion of the intervertebral disc annulus. The surrounding spinal ligaments also thicken in response to increased stress.
- All these degenerative changes and abnormal spinal motion can lead instability of the vertebrae, leading to anterolisthesis or retrolisthesis (i.e., abnormal displacement of the vertebral bones forwards or backwards).
- In this circumstance, the spinal cord can become compressed or impinged by the structures around the vertebrae pushing on it. These static and dynamic compressive forces on the cord lead to spinal cord injury and the clinical myelopathic syndrome.
Symptoms of thoracic spine stenosis
Excessive compression on the spinal cord or spinal nerves can lead to permanent injury. Compression of one of the individual spinal nerves usually leads to pain and discomfort on one side, the side that is being compressed. Excessive pressure on the spinal cord may not have any pain associated with it at all, patients are likely to describe weakness, and loss of coordination, fine motor control and balance, and numbness and tingling. Other symptoms may include increased pain with forward bending, cold and pale extremities, heavy feeling in the legs and arms, and a change in bowel and bladder function.
Treatment of thoracic spine stenosis
Many interventions could be used in the management of spinal stenosis. Treatment plans must be individualised based on each specific patient’s presentation. Spinal stenosis rarely leads to progressive neurological injury; therefore non-operative interventions should be attempted first. Current research suggests that multimodial non-operative management strategies have the highest effect on reducing pain and disability in patients with spine stenosis. These include:
- Flexion-based (i.e., bending forward) exercise programs such as single and double leg knees to chest laying on your back that is held for 30 seconds, and treadmill talking)
- Isometric and stretching exercises
- Static and dynamic postural exercises (e.g., McKenzie aka Mechanical Diagnosis and Therapy exercises)
- Individualised muscle strengthening
- Endurance exercises
- Stabilisation of abdominal and back muscles to avoid excessive lumbar extension (i.e., backward bending
- Postural and ergonomic advice
- Aerobic fitness including cycling, home exercises and aqua-therapy (e.g., aquatic walking and jogging)
- Education (Back school, pain management) and counselling to avoid the onset of catastrophization and mental health disorders.
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- Thoracic myelopathy
- Thoracic spine trauma
- Thoracic osteophytes
- Thoracic bone Spurs
- Thoracic spine stenosis
- Thoracic degenerative disc disease
- Thoracic disc herniation
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