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Thoracic Myelopathy

What is a Thoracic Myelopathy?

A Thoracic Myelopathy is a condition where the spinal cord in the mid-back is compressed. This often causes neurological problems which require treatment.

What causes a Thoracic Myelopathy?

Here are some of the common causes of a Thoracic Myelopathy:

  1. Large Disc Herniations placing pressure on the spinal cord
  2. Trauma to the spine where either a disc or bone is pushed into the spinal cord.
  3. Bone spurs which are large enough to compress the spinal cord.
  4. An Infection of the spine where an abscess forms and compresses the spinal cord.
  5. Cancer of the spinal bones, spinal nerves or spinal cord itself.

What are some of the symptoms from a Thoracic Myelopathy?

Here are some of the common symptoms:

  1. Unstable gait: in severe cases it can look like someone is intoxicated
  2. Weakness in the legs
  3. Weakness in the abdominal muscles
  4. Numbness and tingling in the legs
  5. Problems emptying the bladder
  6. Problems with controlling bowel movements

How do Spine Specialists diagnose a Thoracic Myelopathy?

Spine specialists use a patient history, a physical examination and specific spinal tests to make the diagnosis:

  1. History

The following questions can help make the diagnosis:

  1. Do you have a difficult time walking?
  2. Do you feel like you are having problems with your balance? Do you lose your balance if you are in a darker room?
  3. Do you have weakness in the legs?
  4. Do you have numbness or tingling in your legs?
  5. Do you have trouble emptying your bladder?
  6. Do you ever lose control over your bowels?

 

      2. Examination:

The spine specialist often examines the following:

  1. Gait for stability
  2. Reflexes testing in the legs
  3. Ankle clonus (link)
  4. Strength testing (motor) of legs(link)
  5. Sensation testing (sensory) of the legs(link)
  6. Babinski test (link)
  7. Spurling’s test (link)
  8. Lhermitt’s sign (link)
  9. Rectal Examination

       3. Imaging

a. X-Ray

X-Rays can be helpful to establish the anatomy of the mid-back. They can offer some information about the height of a disc, but not compression of the spinal cord.

b. MRI

MRI information is critical when evaluating the severe spinal stenosis and spinal cord compression found in a Thoracic Myelopathy. It can show the spinal cord and spinal nerves in detail and can accurately assess how much compression of each exists. It can also determine if there is swelling present in the spinal cord (gliosis, myelomalacia). This can be a sign of impending damage or existing damage to the spinal cord.

c. CT scan

CT scans can show the spinal canal accurately. However they have the disadvantage of not being able to show the spinal nerve and spinal cord in detail. Due to that, CT myelograms can be performed where dye is injected into the spinal fluid to be able to see the spinal cord and the spinal nerves directly.

What treatments are available for a Thoracic Myelopathy?

The treatment for a Cervical Myelopathy depends on the severity of the case. Surgery is reserved for severe conditions not responding to non-surgical care.

  1. Non-Surgical Care

A. Medications

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Steroids
  3. Muscle Relaxants
  4. Pain Killers
  5. Nerve Pain Medications

B. PT

Traction can help with compressed spinal nerves, but not compression of the spinal cord. It is not commonly used for this condition, unless the patient is not a candidate for surgery.

Ultrasound and electrical stimulation can help with the muscle spasms common in this condition.

Strengthening exercises can help maintain muscle strength.

C. Injections

Epidural steroid injections can help with the symptoms from a Thoracic Myelopathy. However, with severe spinal cord compression, injections are usually not done out of fear that the injected fluid places more pressure on the spinal cord.

For milder cases of a Thoracic Myelopathy, epidural injections such as Thoracic Interlaminar Epidural Injections can be used.

D. Brace

A brace may be needed for a Thoracic Myelopathy to protect the spinal cord from further injury. Motion is restricted to prevent significant forward bending (flexion) which could increase the pressure on the spinal cord.

      2. Surgical Care

The decision for surgery usually takes the following factors into account:

  1. Severity of the symptoms, especially neurological symptoms such as weakness in the arms and legs, gait problems, and problems with the bowels and bladder.
  2. Severity of the spinal cord compression
  3. Overall health of the patient
  4. Risks versus benefits of the surgery

Here are some surgical options which are available for a Thoracic Myelopathy:

Thoracic Laminectomy and Fusion

Thoracic Vertebrectomy (for cancer or fracture)