Thoracic Spine Pain Syndromes

THORACIC FACET SYNDROME

The facet joints connect the bones that align to make up the spine. The natural aging process, injury, arthritis, and certain spine conditions can change the way that the facet joints move and lead to pain and restricted motion. Such symptoms are referred to as facet joint syndrome.

Signs and Symptoms:

  • Mid back pain
  • Pain with movement
  • Burning pain
  • Back pain associated with activities such as: Sitting, Bending forward, Coughing, Sneezing

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT (computed tomography)

Diagnosis:

A comprehensive physical exam and medical history by clinician, medical history, along with above tests to help your doctor identify structural abnormalities. A facet joint injection (block) may be performed to determine the specific source of your pain.

Treatment:

  • Drug therapy
  • Physical therapy
  • Anesthetic and neurosurgical pain management
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

What is Postherpetic Neuralgia?

Postherpetic neuralgia is caused when a nerve is irritated or inflamed as a result of a recent viral infection from herpes zoster (shingles). Shingles is caused by a reactivation of the varicella-zoster virus, the same virus that causes chickenpox.

Signs and Symptoms:

  • Sharp and jabbing, burning, or deep and aching pain
  • Extreme sensitivity to touch and temperature changes
  • Itching and numbness

Testing:

Testing is generally used to identify other treatable coexisting diseases or to rule out the underlying disease responsible for the patient’s immunocompromised state.

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician identify and properly treat this condition.

Treatment:

  • Lidocaine skin patches
  • Drug therapy (Antidepressants, Anticonvulsants, Pain Medication, Steroids)
  • TENS
  • Spinal Cord Stimulation

What causes vertebral compression fractures?

The leading cause of vertebral body fractures is osteoporosis. The following factors will increase the likelihood of acquiring osteoporosis:

  • Thin or underweight
  • Elderly
  • Low calcium intake
  • Female
  • Steroid use
  • Post menopausal
  • Smoking
  • Eating disorders
  • Family history of osteoporosis

Signs and Symptoms:

  • Sudden, severe back pain
  • Worsening of pain when standing or walking
  • Some pain relief when lying down
  • Difficulty and pain when bending and twisting
  • Loss of height
  • Deformity of the spine

Testing:

  • Plain X-Rays
  • CT Scan
  • MRI

Diagnosis:

A targeted history and physical examination combined with appropriate testing should help the clinician to identify and properly treat this condition.

Treatment:

  • Drug Therapy
  • Application of Heat/Cold
  • Orthotic Device
  • Bed Rest
  • Vertrobroplasty

HNP within the thoracic spine is relatively uncommon because the rib cage protects this area of the spine, reducing the motion and forces transmitted to and through the discs here. Never-the-less, discs can herniate in this area, and may cause significant mid-back pain.

Many factors increase the risk for disc herniation:

  • Lifestyle choices
  • tobacco use
  • Inadequate nutrition
  • Age
  • Natural biochemical
  • Poor posture
  • Incorrect body mechanics
  • daily wear and tear,
  • Injury
  • Incorrect lifting
  • Twisting

Sign and Symptoms:

  • Mid back pain
  • Radiating chest pain
  • Subtle bladder problems
  • Difficulty in completely emptying the bladder
  • Urinary urgency
  • Urinary frequency
  • Progressive weakness to the legs
  • Loss of bowel or bladder control

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

A comprehensive medical history along with proper testing as well as what type of herniation is involved.

  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Treatment:

  • Drug therapy
  • Physical therapy
  • Anesthetic and neurosurgical pain management
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
  • Neurosurgical procedures

What is Spinal Nerve Root Neuritis?

Neuritis is a complex process involving inflammation of the nerves, resulting in irritation that interferes with normal nerve function and the areas served. Specifically, it affects the peripheral nerves (those outside the brain, spinal cord, or central nervous system), blocking sensory and motor functions, with pronounced symptoms.

Sign and Symptoms:

  • Low back pain
  • Sharp pain
  • Burning pain
  • Stabbing pain
  • Numbness
  • Tingling
  • Motor deficit
  • Diminished reflexes
  • Weakness
  • Prior back surgeries
  • Impotence
  • Bowel or Bladder dysfunction

Testing:

  • Physical exam
  • MRI
  • X-Ray
  • CT or CAT scan
  • Discography
  • Myelograms
  • EMG
  • Ultrasound imaging

Diagnosis:

Obtaining a comprehensive medical history along with proper testing can determine diagnosis as well as what type of herniation is involved.

  • Disc Degeneration: chemical changes associated with aging causes discs to weaken, but without a herniation.
  • Prolapse: the form or position of the disc changes with some slight impingement into the spinal canal. Also called a bulge or protrusion.
  • Extrusion: the gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
  • Sequestration or Sequestered Disc: the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal (HNP).

Treatment:

  • Drug therapy
  • Physical therapy
  • Spinal Nerve Root Injection
  • Facet Joint Nerve Rhizotomy
  • Spinal Cord Stimulator
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