Thoracic disc herniation

Overview

Thoracic disc herniation (a ruptured or slipped disc in the mid-back) is far less common than in the neck or low back. Symptoms of a ruptured thoracic disc are often confusing: mid-back pain, band-like pain wrapping around the chest or abdomen along a rib line, and sometimes pain that mimics heart, lung or abdominal problems. Most cases settle with conservative care. Because the spinal canal is narrow in the thoracic spine, signs of spinal cord compression - leg weakness, clumsy walking, numbness below the chest, or bladder and bowel changes - need urgent medical review.

Symptoms

• Mid-back pain, often worse with coughing, sneezing or bending
• Band-like pain wrapping around the chest or abdomen along a rib line
• Numbness, tingling or burning in a strip around the trunk
• Thoracic stiffness and pain with rotation
• Red flags: leg weakness or heaviness, unsteady walking, numbness below the chest, bladder or bowel changes - seek urgent review

Causes

• Age-related disc degeneration (most common, often calcified discs)
• Trauma, falls or heavy lifting
• Repetitive twisting or thoracic loading

Treatment

• Rule out cardiac, visceral and other serious causes of chest or trunk pain
• Education, reassurance and pain management
• Graded thoracic mobility, breathing and strengthening exercises
• Activity modification and gradual return to load
• Urgent specialist referral and MRI if spinal cord signs appear