Thoracic Patient-Please Help!
 

I am a female in my 20's who has been suffering from extreme pain in my thoracic spine. I found a surgeon that thinks he can help me by doing a fusion. I just wanted someone who understands to tell me if it's the right decision. How painful is it? Is it worth it? How was your experience? I'm absolutely terrified! Here is what has been found:





Findings: On the scout localizer there is reversal of the normal cervical lordosis with mild disc osteophytic ridging in the cervical spine with still mild spinal canal and neural foraminal stenosis. There is a mild dextroconvexity within the thoracic spine. There is no definite subluxation of vertebra and no compression fractures. At least mild to moderate degenerative space narrowing in the mid thoracic spine. There is mild associated degenerative endplate irregularity and mild associated endplate spurring anterior in the mid and lower thoracic spine. Overall the neural foramina in the thoracic spine appears mildly narrowed.
T4/5: Disc space narrowing on the left side with a left lateral disc osteophyte complex, this is foraminal and subarticular without significant spinal canal narrowing and no more than mild narrowing of the left neural foramen. T5/6: Disc space narrowing on the left side. Mild anterior and posterior disc osteophytic ridging with a slightly more focal left lateral, subarticular and foraminal disc hernia with mild mass effect on the left lateral recess. Only mild spinal canal narrowing is present. The left neural foramen is mildly narrowed. T8/9: Right central there is a disc herniation with mild extrusion of disc
material. The disc remains unchanged compared to the previous exam and measures approximately 5 mm from anterior to posterior and approximately 8-9 mm from superior to inferior. On the right side the spinal canal is mild to moderately narrowed with mild mass effect on the right ventral aspect of the thoracic
spinal cord. There is no frank spinal cord compression or spinal cord edema. This is still relatively small to medium sized right central disc herniation. This is unchanged compared to the previous exam. Minimal disc osteophytic ridging at other levels for example T6/7 and T7/8. Mild or subtle degenerative facet arthritis for example on the left side at T9/10. Mild degenerative endplate signal changes best seen at T8/9 representing a
combination of Modic Type-I and Type-II. Impression: 1. Mild scoliosis in the spine with mild degenerative disc and facet disease. Small left lateral disc herniations at T5 and T5/6 with only mild narrowing of the left neural foramina. 2. Right central disc herniation at T8/9 remains stable with mild to moderate spinal canal narrowing and minimal mass effect and displacement of the thoracic spinal cord. This appearance remains unchanged. No spinal cord edema and no frank spinal cord compression. 3. Mild degenerative changes in the cervical spine.

Hi, I don't understand all of the details of the MRI findings but I can say that you should get more than one opinion before having surgery. Also, check with Doctors who treat backpain using non-surgical methods.
Finally, if you do get surgery you want to be confident and not scared. Find out all that you can, learn all that you can and your confidence will grow in your decision.

Hi,
I agree with everything John said. I don't understand a lot of what your test reveals.
I did have a thoracic fusion a few years ago when i was in pretty bad pain as well. It didn't help at all. what did help, was removing a few of the painful thoracic discs. I can't recommend the surgeon who did it , unfortunately. Just get as many opinions as possible. find the surgeon you are confident in.
judy

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?

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?

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.

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

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

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).

minimally invasive Tspine surguries
 

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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thoracic spine
 

i also have a herniation at t5-6, i also am terrified at having surgery, i have seen 4 surgeons, 3 who want to operate, 1 said to try physical therapy, i'm doing a phsyical therapy called feldenkreist method, this is for people that can't do normal physical therapy, i've seen a pysiatrist (spelling?), this is a md, who isn't a surgeon and looks at all possible alternatives, injections, physical therapy, etc., i'm using dr. vlachos in beverly hills, she can tell you if you must have surgery, in her office, is a thoracic spine surgeon john regan, a vats pioneer, he should be one of the surgeons you talk to, heard some bad things about him, also dr patrick johnson at cedars in los angeles, he also does vats

Jeff, I was a person who experienced bad things after having surgery with DrJohn Regan. A nerve was nicked or something when doing my vats surgery. I had severe breathing problems in surgery. He still gave up on the vats and turned me over and started removing my posterior fusion from a different surgeon. He never discussed this with me. I stopped breathing after surgery, was on a ventilator , never again saw DrRegan. I now have a permanent loss of lung function . I also had to endure lung surgery shortly after my surgery with Regan. He said nothing happened to me. That was only when i made an apt. to see what he had to say about what happened and why did he never show up. I could go on. You can send me a private message if you would like. I cannot recommend that man. I would say only to stay far away. Pioneer or not,. i also have become friends with a man who was paralized by Regan about the same time i had my surgery.

Sorry you find yourself with this horrible problem. Good luck finding a good , surgeon,.
judy

I am having a minimally invasive procedure done tomorrow, so no big scar from fusion and the risk is minimallized. I will write how it goes tomorrow!

thoracic spine surgery options
 

do you have contact info for dr richard fessler
do you have contact info for extreme lateral interbody fusion

Sorry i don't Jeff , but hopefully someone will be on soon to help you. I was just reading on xLIF and it is not possible to do it with L5-S1 and in some people not on L4 -L5. Good luck in your search
judy

you have either a disc or a bone spur pinching a nerve or nerves in an area or areas, depending on where your burning pain or pains are, I get some burning pain between my shoulder blades, when I lift or carry something heavy, or even when I am sleeping, sometimes it will wake me up, and it feels like someone is stabbing me with a hot poker, I have to get up and bend side to side and walk around for a while, sometimes it lasts for hours, even with pain meds,