What is spinal disc herniation (prolaps) of the upper back?
Spinal disc herniation (disc prolaps), or herniation of the nucleus pulposus (HNP), occurs when part of an intervertebral disc bulges out; it is most commonly seen in the lower back (lumbar vertebrae) or in the neck (cervical vertebrae), but can also occur in the upper back (thoracic vertebrae). When the intervertebral disc bulges out, it puts pressure on a nerve root. This can cause the nerve root to become irritated or trapped, leading to symptoms in the area of the nerve root. The herniation can also put pressure on the spinal cord, resulting in pain.
Ageing can cause the inner part of the intervertebral disc to bulge out and a tear may even occur in the outer layer of the intervertebral disc. This causes the inner part of the intervertebral disc to be pushed forwards in the direction of the spinal canal, which is exactly where the nerve root is found. These age-related changes in intervertebral discs are normal and happen to everyone. Therefore, anyone can suffer from a herniated disc of the upper back. A herniated disc of the upper back is also seen more frequently in certain families. Smoking appears to influence the development of a herniated disc, particularly the severity.
Signs and symptoms
The major symptom in a herniated disc of the upper back is the radiating pain in the chest. This pain in the chest usually occurs before or at the same time as the pain in the upper back. The pain worsens with coughing, sneezing or straining while defecating, but the symptoms in the chest can also worsen upon stretching or turning sideways or bending the upper back. A sharp and stabbing pain is often felt. In addition, there may be a loss of feeling, tingling sensations, or muscle weakness. If the herniated disc puts pressure on the spinal cord, this may cause pain in the legs and interfere with the coordination of the legs.
How is spinal disc herniation diagnosed?
If you have a radiating pain in the chest, which worsens upon coughing, sneezing or straining, there is a strong chance that you have a herniated disc of the upper back. The neurological examination includes several tests that can confirm this. In addition to the neurological examination, the movements of the upper back are checked for limitation and pain. The upper back is also examined in order to feel which vertebrae are painful when pressure is put on them.
Do I need any additional examinations?
- Diagnostic examination for other non-physical factors important for your pain, have already been done by yourself trough filling out your pain questionnaires.
- Additional examinations are not always necessary since the neurological examination usually confirms the diagnosis. It is important to note that an MRI scan can reveal herniation of an intervertebral disc in many people who do not have symptoms. It is also possible for a person with radiating chest pains, whose doctor suspects a herniated disc, to have an MRI scan of the upper back that does not show a herniated disc.
- An MRI scan is only useful in cases where there are doubts regarding the diagnosis, or when surgery is considered. An MRI scan visualises the herniated disc and may show other possible causes.
- A CT scan is not usually worthwhile, since this only provides good images of the bones.
- A muscle scan (EMG) can be performed in order to discover which nerve root in the upper back is causing the pain.
- Nerve root test blocks are used to discover which nerve root is causing the pain in your arm.
What are my treatment possibilities?
Depending on the cause of your pain, your pain specialist will decide whether or not to embark on physical treatment. Based on the results of the completed pain questionnaire, additional examinations can be carried out and, apart from physical treatment, other methods of treatment will be suggested.
If the results of your pain questionnaire are abnormal, your pain specialist will offer you one of the non-physical treatments listed below:
- Psychological Treatment
- Depression Treatment
- Cognitive-Behavioural Treatment
- Rehabilitation Treatment
Interventional Pain Treatments
In case of neurological symptoms and/or problems such as pain in the legs and disturbed coordination of the legs, due to spinal disc prolaps in the upper back, you will be referred to a neurosurgeon for an operation.