Jeffrey R. Carlson, MD
As a busy Orthopaedic Physician, I often see and treat patients for and write articles about the cervical spine (neck) and the lumbar spine (lower back). Today, I’m going to focus on the thoracic spine or the middle back, the area where the rib cage is located. Percentage wise, I do tend to see far fewer injuries to this area of the spine, and I will explain why in a moment. However, for those patients who do have thoracic issues, it’s time I discuss some of the injuries and conditions in this region and how they are treated.
So first, let’s start with a quick anatomy lesson. The thoracic spine has ten segments or vertebrae, which start immediately below the seven cervical or neck vertebrae. These vertebrae do not have much movement, unlike other parts of the spine, due to the ribcage being connected to the sternum. This is called the thoracic cage, which protects the heart, lungs and other vital organs. The thoracic vertebrae have spinal discs in between them to provide cushioning and shock absorption, but these discs are thinner and more rigid than the discs in the lumbar or cervical regions. The spinal canal housing the spinal cord in the thoracic region is also skinnier, and more prone to neurologic damage, which we will discuss later.
Because this thoracic cage and spinal area is rigid and toughly designed, it takes a lot of force or energy to be applied for fractures, dislocations or other spinal injuries to occur here. These are typically caused by high-speed motor vehicle accidents, falls, sports injuries or blunt force trauma (violence and gunshots). However, due to bone insufficiency, like osteoporosis or in the case of a bone tumor, the bones can weaken over time and break with minimal trauma, like a violent sneeze or a twist.
Because of the traumatic nature of most of these injuries, patients will be rushed to an emergency room or trauma unit for evaluation and treatment. The first order of business will be to save the patient’s life, if necessary, and attend to the most threatening injuries first. Everything else will be gotten to in order of priority. X-rays, a CT scan and a MR scan will be ordered and will be extremely useful tools in helping the ER and Orthopaedic physicians determine the severity of the injuries – x-ray and CT for broken and dislocated bones, and MR scan for nerves and spinal cord damage and other soft tissue damage, such as tendons, ligaments, spinal discs, etc.
These tests will also determine if the patient should be rushed into surgery immediately, if surgery should be delayed or if surgery is necessary at all. A few paragraphs back, I said the spinal canal in the thoracic area being very skinny and fairly rigid, made it unforgiving and prone to damage. Unfortunately, a neurologic deficit is often the result of an injury to this area of the spine. That is why it is so important for a thorough and immediate evaluation of the patient’s diagnostic imaging to be done by a skilled spine surgeon. If the spinal cord or nerves are compromised by bone fragments, it is imperative to quickly remove those fragments, to allow plenty of room for the spinal cord and nerves to function and to realign and stabilize the spine for the best possible chance at neurologic recovery for the patient.
There are three main types of fractures to the spinal bones: flexion, extension and rotation, and each of these have types within each category. Based on the type of fracture(s) the patient has, the skilled spine surgeon will figure out the best approach to take surgically and decide if the patient needs a simple laminectomy to give the spinal cord more room or a multi-level spinal fusion to correct a dislocation and instability. The patient with the spinal tumor will also have surgery with the same goal of preserving structural stability and neurologic function. The patient with osteoporosis, however, will probably be a candidate for an in-office procedure called a kyphoplasty. This is where we inject a type of cement into the fractured vertebrae to restore it to its original shape and size. The cement creates an internal cast, within the bone, that hardens quickly, so that the patient is able to leave the office in an hour, almost pain free.
While the thought of spine surgery often scares people, in this instance, it is often the best-case scenario, vs. trying to heal while staying still in a brace or cast for twelve to sixteen weeks. With today’s modern and minimally-invasive surgical techniques, patients are often released from the hospital soon after surgery to recover at home.
Make an appointment with Dr. Carlson or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.