Thoracic Radiculopathy due to Rare Causes: Two cases of thoracic radicular syndrome were reported. In case 1, the patient had been diagnosed with a lumbar disc herniation and treated by surgery. After 6 months, he complained of severe back pain radiating down his right leg. He was found to have a thoracic disc herniation compressing the T6 nerve root. Case 2 presented with left lower extremity weakness and numbness.
A CT scan showed a mass lesion in the anterior epidural space causing compression of the L1 nerve root. MRI revealed a giant posterior epidural lipoma. Both patients underwent decompression surgeries. The symptoms improved after surgery.
The authors suggest that rare causes of thoracic radiculopathies should be considered when treating patients with thoracic radicular symptoms. Clinicians need to make an accurate diagnosis because some conditions can be cured by simple treatments such as conservative therapy or surgical intervention.
Thoracic Radiculopathy details
Thoracic radiculopathies are the least common type of radiculopathy. Symptoms usually wrap around the front of the body. They include tingling, burning, or electric shocks along the path of the affected nerve roots.
The most common cause of thoracic radiculopathy is spinal stenosis. Other causes include tumors, infections, trauma, and degenerative diseases. Thoracic radiculitis occurs when inflammation spreads from the spine into the nerves. This condition may occur with any infection, including tuberculosis or syphilis. It may also result from injury to the spinal cord or vertebral column.
Risk factors of Thoracic radiculopathy
Problems in your spinal cord cause thoracic radiculopathies. Herniated discs are standard among people who suffer from thoracic radiculopathy.
Bone spurs are also present in many cases. Degenerative disc diseases are common as well. Muscle spasms and trauma to the spine can cause damage to the nerves. If you have these risk factors, you will likely develop thoracic radiculopathy.
If you have any of these conditions, you’re at a greater risk of having thoracic radiculopathy. You may want to see a doctor if you experience any of the following risk factors:
- Pain in the neck, shoulder, arm, hand, or wrist
- Numbness or tingling in the arms or hands
- Weakness in the legs or feet
- Difficulty walking and spasms in the spine
Symptoms of Thoracic radiculopathy
Thoracic radiculopathies are caused by damage to the nerves in your spine. This causes numbness and pain in your arms and legs. Your muscles become weak and painful because you aren’t using them as much. You may feel pain traveling down your arms and into your chest. You may notice muscle spasms in your back. These symptoms often get worse over time.
Let’s discuss Thoracic radiculopathy
Extraskeletal Ewing Sarcoma (EES), also known as intraskeletal ES or peripheral primitive neuroectodermal tumor (PPNET), is a rare type of cancer that affects children and young adults. This disease usually occurs in bones but may spread to other parts of the body.
It is more likely to affect boys than girls. The cause of EES is unknown. Symptoms include pain, weakness, numbness, or problems walking. Treatment involves surgery, chemotherapy, and radiation therapy. Thoracic disc disease and diabetes mellitus are common causes of thoracic radicular symptoms.
Although these diseases may present with similar symptoms, they differ significantly in their progression and prognosis. Patients with thoracic disc disease usually have low back pain or leg numbness, while those with DM tend to experience weakness in the legs.
Thoracic disc disease does not progress very quickly, but DM progresses rapidly. Diagnosing thoracic radiculopathy early is essential because it affects the treatment outcomes of both conditions’ neurogenic tumor (schwannoma) is suggested based on MRI. This type of tumor grows slowly, but it may cause pain if it extends into the spinal canal.
Treatment involves surgery. Thoracic radiculopathies are challenging to diagnose because there aren’t many ways to evaluate them. Needle EMGs of the thoracic paraspinal are helpful, and the levels of abnormality can help us narrow down the location of the lesion.
We need to check multiple levels, including those above the lesion site. Ultrasonic guided electromyographic examination of the rectus abdominis, and intercostals muscles revealed ASA in the rectus muscle but not in the intercostals muscle.
Thoracic radiculopathies were diagnosed based on this finding present in the first case of EES and the rare case of bony spur causing thorax radiculopathy without spinal cord involvement. In conclusion, if thoracic or upper abdomen pain is accompanied by abnormal neurology examination, electrophysiology, CT, or MRI scan of the thoracic spine should be considered to find the cause of pain.
Supplemental and assessment tools for Thoracic radiculopathy
Thoracic Radiculopathy is a challenge in Electromyography because it requires an invasive procedure. It is usually done when other tests fail. The test is expensive and risky. The patient might get a lung puncture. And there is no sure way to know if you got the right spot. So doctors mostly avoid it. But it does give us some information about what’s going on inside your brain.
The most common problem is nerve compression from a herniated disk. What happens when a small piece of bone chips off a vertebra and presses against a nerve root. Nerve roots carry messages between your brain and your organs. They’re like electrical wires carrying signals. If something gets in the way, the message doesn’t go through. You feel pain.
Another common problem is scar tissue around a nerve root. Scar tissue forms after injury. It makes it hard for nerves to send messages. This can happen after a stroke or a car accident. Sometimes people don’t have any symptoms at all. Doctors call that asymptomatic. It means no pain.
Treatment guidelines available for it
Thoracic radiculopathies are treated by nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, physical therapy, TENS, and opioids. Given their effectiveness in treating other Types of neuropathy, these medications should be considered first-line therapies for this condition.
Nonsteroidal anti-inflammatory agents (NSAIDs) are commonly used to treat neuropathic pain. NSAIDs work by reducing inflammation. They also reduce swelling and relieve stiffness. These medications include ibuprofen, naproxen, ketoprofen, aspirin, indomethacin, diclofenac, piroxicam, etc.
Corticosteroid injections are often used to treat chronic back pain. Corticosteroids are potent anti-inflammatories. They reduce swelling and pain caused by inflammation. Corticosteroids come in different strengths and are injected directly into the painful area.
Some studies suggest that they can improve short term outcomes. However, long term use has been associated with side effects such as weight gain, diabetes, high blood pressure, cataracts, osteoporosis, and increased risk of heart attack or stroke.
Thoracic Radiculopathy and Cervical
Radiculopathy means irritation of the spinal cord. This causes symptoms of pain, numbers and tingling in the affected area. The cervical or thoracic spines are responsible for the nerves that go to the shoulders, arms, hands, trunk, and ribs. A problem with the spinal column’s bones, discs, or tissues can cause this type of injury.
Cervical radiculopathy is often treatable with epidural steroids and other treatments. Chronic, irreversible cervical radiculopathy is best treated with implantable pain controls.
Cervical Radicular Syndrome (CRS) is a condition that can be caused by trauma or injury to the neck, back, shoulder or arms. The syndrome affects the nerves in your arm and hand. It causes numbness, weakness and tingling in your fingers and thumb.
It’s important to note the difference between acute and chronic cervical radiculopathy. Acute cervical radiculopathy refers to an injury that occurs suddenly. For example, if you fall on your head, you may experience immediate sharp shooting pains down your arm. This is because the muscles and ligaments holding your spine together have been stretched out.
Treatment of Thoracic radiculopathy
Thoracic Radiculopathy is a condition that causes severe back pain. Pain relief treatments include exercise programs, medications, injections, and surgery.
Physical Therapy:- You may work with an experienced physical therapist to learn exercises that help relieve your pain, strengthen your back muscles, and improve your range of movement.
Medication:- You may need to use medication to reduce your pain, control your swelling, and reduce inflammation.
Steroid Injection. Asteroid medication injected into your spinal canal may be used to reduce your symptoms.
Surgical Treatment:- If other, more traditional treatment options aren’t working, you may need to consider surgical intervention. Surgery may involve removing damaged tissue from your spine or replacing it with bone grafts.
Let’s take a look at Treatment Options for Thoracic Radiculopathy in short.
There are several different types of treatment available to people who suffer from spinal stenosis. Your doctor will recommend one of them based on your specific needs.
- Exercise Programs.- Physical therapy focuses on strengthening your back and improving flexibility. Exercises for treating spinal stenosis include stretching, bending, twisting, lifting, and standing.
- Medications.- Certain medications can ease some of the symptoms of spinal stenosis. Examples include anti-inflammatory drugs, muscle relaxants, and antidepressants.
- Injections.- Spinal stenosis can cause nerve damage. This can cause numbness, tingling, and muscle weakness. Doctors inject steroids directly into the area where the nerve is being affected to treat this problem.
- Surgery.- Sometimes, non-invasive treatments aren’t enough to provide complete pain relief. If this happens, your doctor may suggest surgery. During surgery, a surgeon removes part of the bones that form your spine (vertebrae). The vertebrae are then replaced by metal rods and screws. After surgery, you’ll wear a brace until your bones heal.
What Is Thoracic Radiculopathy?
Thoracic radiculopathies are caused by compression of the neck or lower back nerves. This causes pain and numbness in the affected area. Doctors may miss these conditions if they focus on the lower back instead of the neck.
Symptoms include pain and numbness radiating into the arm. Thoracic Radiculopathies can be treated with physical therapy, chiropractic care, and injections. Patients should see a doctor who specializes in treating back problems.
What Are Effective Thoracic Radiculopathy Treatments?
Physical therapy teaches you how to strengthen and lengthen your back. Pain management helps if you’ve got a pinched nerve. Thoracic steroid shots help if you’ve got a bad case of asthma.
Surgery is the last resort. Your doctor might recommend this option if your physical therapy doesn’t work or if you’ve had an unsuccessful thoracic steroid shot. A discectomy is the removal of a portion of a vertebra. A laminectomy is the removal of part of the lamina.
What are the Symptoms of Cervical Radiculopathy?
A person with cervical radiculopathy experiences pain radiating down the arm and into the neck. This condition causes muscle weakness and numbness in the fingers and hands. Someone who suffers from cervical radiculopathy may also suffer from occipital neuralgias. Occipital neuralgia refers to neck pain and headaches in the back of your head.
How is Cervical Radiculopathy Diagnosed?
Neck pain can be caused by many things, including muscles, nerves, bones, joints, discs, ligaments, tendons, blood vessels, or organs. A thorough physical exam can reveal the source of the pain. Tests may include X-rays, MRIs, EMGs, nerve conduction studies, and other imaging scans.
How to Avoid Cervical Radiculopathy?
Preventing cervical radiculopathy is not easy, but staying physically fit and maintaining proper posture can help. Maintaining a healthy weight can also help prevent this injury. Also, keeping your head up straight when you’re sitting down, doing sports or lifting heavy things can help prevent this injury.