Thoracic Disc Injuries Treatment & Management

Updated: May 30, 2017
  • Author: Kambiz Hannani, MD; Chief Editor: Sherwin SW Ho, MD  more...
  • Print
Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

For the acute phase of a thoracic disc injury, the focus of physical therapy is to decrease the patient's symptoms with cold/heat therapy, ultrasound, and rest. Mild ROM exercises and very low-impact exercises that do not worsen the patient's symptoms are acceptable.

Medical Issues/Complications

Activity modification to minimize the patient's symptoms is important. Proper posture can help to prevent further disc injury. If oral drug usage fails to alleviate the patient's symptoms, consider steroid injection for intercostal nerve blocks. An orthosis (ie, brace) is initially acceptable for pain control but causes deconditioning over time. Thus, long-term bracing should be avoided.

Surgical Intervention

Surgical decompression is indicated in patients with myelopathy (unless improving), progressive neurologic symptoms, and worsening symptoms [12, 13, 14] or lack of improvement in the patient's symptoms by 4-6 weeks of conservative management. [10, 15]

An analysis of 25,413 patients who were treated surgically for thoracic disc herniation by Yoshihara et al compared anterior and nonanterior approach procedures and reported that anterior approach procedures were associated with a higher overall in-hospital complication rate (26.8% vs. 9.6%), mortality rate (0.7% vs. 0.2%), longer hospital stays (7.6 vs. 4.8 d) and increased hospital charges ($84,199 vs. $46,837). [16]

Consultations

Myelopathy and progressive neurologic symptoms require emergent neurosurgical/orthopedic consultation.

Next:

Recovery Phase

Rehabilitation Program

Physical Therapy

When the patient's acute symptoms have resolved, general cardiovascular conditioning and abdominal muscle strengthening with ROM may be introduced. [17]

Previous
Next:

Maintenance Phase

Rehabilitation Program

Physical Therapy

Home exercises for abdominal and paraspinal muscle strengthening and cardiovascular conditioning is helpful in preventing recurrences. [17]

Previous