Thoracic spinal stenosis is a condition in which the spinal cord or spinal nerves are compressed by narrowing of the spinal canal or the openings between vertebrae. The thoracic spine has some unique characteristics that make thoracic spinal stenosis a little different than stenosis in other areas. Thoracic spinal stenosis rarely occurs in isolation, but is almost always accompanied by stenosis in the lumbar area, and sometimes also the cervical spine.
There are 12 thoracic vertebra and they articulate with the 12 sets of ribs that protect our major organs. The thoracic spine curves outward, and the curve is gentler than the cervical or lumbar curves. Because of the ribs, the thoracic spine is more fixed than the cervical or lumbar areas, too. Most of the motion of the thoracic spine is rotation, with little flexion or extension.
The spinal canal is naturally narrower in the thoracic area, even though the size of the spinal cord remains the same. That means there is less extra space, so it takes less obstruction to cause problems.
Like cervical and lumbar spinal stenosis, thoracic spinal stenosis can be congenital or acquired. There is a great deal of difference, however, in how it is manifested.
Most thoracic spinal stenosis is due to degenerative changes–arthritis in the joints, bone spurs, disc degeneration and other changes due to aging. As the degeneration progresses, you may experience pain in your back and legs, either aching in your legs when you walk that gets better when you rest, or pain that radiates down your back or legs. You may develop problems with walking or loss of bowel or bladder function.
Because the thoracic spinal canal is already naturally narrow, people with congenital spinal stenosis cannot tolerate any extra pressure on the spinal cord. They tend to develop symptoms of cord compression (loss of sensation or movement below the injury) rapidly after minor injury.
Degenerative thoracic spinal stenosis may get better with conservative treatment, which includes anti-inflammatory medications, pain management and physical therapy. Steroid injections or nerve blocks may help manage the pain.
If the pain is uncontrolled or if there are signs of cord compression, however, surgery is necessary to relieve pressure on the cord or spinal nerves. Traditional surgical options are laminectomy or corpectomy to provide more room in the spinal canal and spinal fusion to stabilize the spine and prevent damage to the cord.
Minimally invasive surgery may be an option for some cases of thoracic stenosis. Surgery is done through an endoscope using a microscope to directly visualize the spine. Microsurgical techniques allow the surgeon to perform precise, delicate maneuvers to remove the nerve pressure and repair structures.