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The majority of thoracic disc prolapses will resolve by themselves. A combination of rest, analgesia and anti-inflammatories, and a graduated exercise program targeted at strengthening back and abdominal muscles (including physiotherapy, hydrotherapy, pilates) will be beneficial during the acute period.
Occasionally a guided injection of steroids or analgesia directly around the affected nerve root will be performed to good effect.
Surgery is indicated if there is no resolution of symptoms or worsening of neurological function.
There are several approaches to surgery in the thoracic spine region. These include:
The choice of surgery will be discussed with you prior to operation. Whichever approach is used is determined by the size, site and level of the disc prolapse. A microsurgical excision of the disc is performed and a fusion using cages, bone grafts and/or screws may be required. A chest tube will be left in place for several days if a thoracotomy is required.
Surgical treatment is to relieve pressure on the nerve roots/spinal cord. Back pain in itself is not an indication for surgery and may not be relieved by removing the disc prolapse.
The risks of this operation includes the following. A detailed discussion with your surgeon is recommended prior to surgery.
You should expect any trunk pain to improve after the operation if it was there pre-operatively. Any numbness or weakness will take longer to improve and if there is permanent damage to the nerve root from the disc prolapse this may not fully resolve. It is important for you to continue back and abdominal exercises after your operation to minimise the small risk of a recurrent disc prolapse.
For more information on St Vincent's Neuroscience services and additional resources visit our dedicated Neuroscience site here.