Thoracic Patient-Please Help!

[Scared]

Thanks guys! Well I basically have a herniation in the thoracic spine. Ive done everything. Im too young to be on pain meds for the rest of my life and I just want it to be fixed. Ive seen a couple of surgeons and finally found one that is willing to do it. I just dont know if its worth it?

[mmglobal]

Scared, welcome to the forum! I'm sorry that you find yourself here... not a good place to be in your life.

You have a lot of pathology mentioned, but they all seem to be small, mild, subtle, etc... All of this could be completely asymptomatic, or it could be highly symptomatic. Be very careful because the pathology that looks the worst may not be where the pain is coming from. Are they talking about fusiing from T4 to T9???

There are many different ways to accomplish thoracic fusion. They used to do open thorocotomies; opening your chest to get to the spine from the front. Posterior fusions with pedicle screws and rods are not nice to think about because of the damage done to the musculature and other supporting elements.

In the 90's, Video Assisted Thoracic Surgery (VATS) was developed, allowing much less invasive access to the thoracic spine through small portals on your side. Better than the other styles (if you are a candidate), but still not a great surgery.

Now, many surgeons can offer XLIF, (eXtreme Lateral Interbody Fusion). I believe that this is the least innvasive approach... especially for multi-level procedures. I'd only consider this from someone with GREAT experience in this technique... they know how to stay out of trouble (from learning on their early patients). You may not be a candidate for XLIF.

Again, identifying the pain generator; not guessing about it, is key. For thoracic spine surgery, consider looking for the scoliosis specialists because they will have more experience and will have been through the progression of technologies. That gives them an understanding that the younger surgeons will not have.

Good luck! Please keep us posted. I hope the end of this process is you finding some relief.

Mark

PS... what does your cervical MRI show? Can you describe your symptoms in detail?

[Scared]

Thank u so much! I think he just wants to fuse T8-9. It basically feels like a hot sword through my back right about where my bra strap is.

[Scared]

He wants to remove T8-9 and fuse 7-10.

[jsewell]

Scared,
Before i had the VATS surgery, i had discography to see if the bad discs were causing the pain so i did not have surgery for the wrong problem , or not correcting the pain generator.
I did have positive findings on discography that proved the discs at T7-9 and T11-12 were in fact causing the most pain. I do suggest you make sure before you have surgery.
Judy

[John Galt]

An additional caution or two. A good surgeon will not operate based only on an MRI, they will do a physical exam also. I would run from a surgeon who does not use both. Many people have herniated disks and do not report backpain. Why? Because as Jsewell touched on, herniated disks are often NOT the pain generators.

For example, my MRI shows a herniated disk, I declined surgery and chose Prolotherapy and Ozone instead and I'm now virtually pain free and I still have a herniated disk (L4-L5).

[Aaron]

I had great success with ESI in thoracic area, but not until discogram done and showed tear at level above herniation was also pain gen. Was it coincidence that the first couple I had only at herniation level did nothing and I got immediate relief from ESI done at herniation level and around tear, cant answer but my opinion is no, medicine got to tear which may have bee causing more pain than herniation.
I would suggest looking into non-fusion option also. Once fused thats it, but could try min. invasive then have fusion if that not success. Look into Dr. Richard Fessler ( TMED ) surgury. That is what I will be having if the thoracic issue ever gets that bad again. But all my time spent on new lumbar/cervical issues, one step forward two back. This was stolen from another site but just about describes what I think occured. I was waking with no pain and immediatly on movement started feeling a tearing, stabbing feeling. that progressed as day passed.

"Chemical radiculitis” is important in the generation of back pain. A primary focus of surgery is to remove mechanical compression on a nerve or the spinal cord. Back, neck, leg and arm pain, rather than being solely due to compression, may also be due to chemical inflammation. This may cause the nerve root to adhere to the canal, leading to nerve root traction with movement. The "hydraulic effect" of a fluid being placed directly within the adherent tissue causes the tissue to separate and allows the nerve to slide in it's channel more easily. For these reasons, epidural steroid injections often result in substantial pain relief, reduction of scar tissue, and return to functional activity. An advanced form of epidural, the transforaminal epidural or nerve root injection, provides the components of the "hydraulic effect" to separate the adherent tissue, proximity to the irritated nerve root and disk tear, and an anti-inflammatory delivered directly to the nerve, all helpful benefits resulting in pronounced and lasting effects in many patients.
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