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 [13, 14, 15] or lack of improvement in the patient's symptoms by 4-6 weeks of conservative management. [11, 16]
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). [17]
A retrospective study by Cummins et al that included 697 patients who underwent surgery for thoracic disc herniations found that anterior operations had significantly lower rates of neural injury than posterior operations (4.6% vs. 11.4%). Neural deficit was associated with an increased length of hospital stay and a greater likelihood of discharge to a skilled nursing facility. [18]
Consultations
Myelopathy and progressive neurologic symptoms require emergent neurosurgical/orthopedic consultation.
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. [19]
Return to Play
Thoracic disc disease is usually self-limiting; return to play depends on the success of conservative management in controlling the pain/radiculopathy that is associated with the disc herniation.
Maintenance Phase
Rehabilitation Program
Physical Therapy
Home exercises for abdominal and paraspinal muscle strengthening and cardiovascular conditioning is helpful in preventing recurrences. [19]
Prevention
Exercises, including cardiovascular training and abdominal/lumbar muscle training, are the primary preventive measure for thoracic disc disease.
