Healing Rare (But Serious) Problems In The Upper Back

February 18, 2011

Top spine surgeon Dr. Liu explains better and safer alternative to traditional disc surgery.
Edison, NJ, February 2011 – When pain develops in the thoracic region of the spine—the area between your neck and your lower back—it can be a sign of serious trouble. Unlike the lower back, which routinely gets tweaked and strained, the thoracic spine is typically protected from injury because of its location: anchored by the rib cage on both sides, joining the lower back and neck to provide a safe enclosure for the heart and other vital organs.

All this means that dysfunction in the upper back can spell serious pain—and even paralysis, says Kaixuan Liu, MD, PhD and chief surgeon at Atlantic Spinal Care in Edison, N.J. A common cause of upper back pain is a herniated disc: A condition in which the gel-like center (the nucleus pulposus) of one or more of the discs in your spine has bulged or broken through the disc’s tough outer membrane (the annulus), expanding into the surrounding area and possibly irritating the nerves there.

Most patients with thoracic disc herniations are asymptomatic and do not need treatments. For those patients, who suffer from constant pain, surgical discectomy is indicated. The good news today is that specially trained spine surgeons can help alleviate patients’ pain with a new treatment called an endoscopic thoracic discectomy which is much less traumatic (and risky) than open spinal surgery.

A herniated thoracic disc can produce a variety of symptoms, he says, the most common of which are dull or burning pain plus muscle tightness or stiffness. In more serious cases, a herniated thoracic disc can cause you to feel numbness or tingling, weakness or spasticity (uncontrolled movements) in your torso and legs; you can even lose bladder or bowel control and experience localized paralysis, as the nerves that are being impinged by the bulging disc lose function. In those cases, Dr. Liu says, you should seek medical help right away.

Here are some of the most common questions Dr. Liu gets from patients with herniated thoracic discs:

Q: Why does my upper back hurt? Is it necessarily a herniated disc?

A: Pain in this area can be caused by strain or injury to the muscles and ligaments in the area, poor posture, or osteoarthritis. And it can also be the result of pressure on the spinal nerves caused by a herniated disc, Dr. Liu says. Herniated discs are most common in young and middle-aged adults, and, when they occur in the thoracic spine, are often caused by a sudden, traumatic event, such as a fall or a car accident, that subjects the disc to a great amount of force.

Q: Why is a herniated thoracic disc such a big deal?

A. Although most patients with thoracic herniated disc do not notice their problems, some patients with severe pain in the torso associated neurological defects need special attention. A herniated disc in your thoracic spine can cause problems,

The discs that separate the 12 vertebrae that make up the thoracic spine are very thin and narrow, he explains, and the spinal canal there is narrower, as well, with less extra space for the spinal cord than in other parts of the back. That means that any nucleus pulposus that gets pushed out of a disc here is more likely to hit—and potentially damage—a nerve.

Q: How does a tiny bulge in a disc in my back cause so much trouble?

A: Herniated discs affect the surrounding nerves in two ways, Dr. Liu says. First, the pulposus material can press against the nerves that surround the neighboring vertebrae. “We also know that the disc material contains a chemical that irritates the nerves,” Dr. Liu says. Both of these things can cause the nerve to lose functionality and produce numbness, weakness and other symptoms of nerve damage in the areas that that nerve connects to the spinal cord.

Q: What are my options in treating a herniated thoracic disc?

A: As with other types of herniated discs, most doctors prescribe rest, physical therapy, anti-inflammatory medications, muscle relaxants, and pain medications. But if your symptoms aren’t getting better after a few weeks, or if they’re getting steadily worse, you’ll probably be advised to have surgery.

The traditional surgical approach to herniated thoracic discs is what’s known as “open” spinal surgery: An operation in which the doctor makes an incision to “open” the skin, muscles and other tissues that cover your spine in order to get to the damaged disc. Often removal of ribs and dropping of the lungs is required.

While traditional spinal surgery can be an effective course of treatment, in many cases it is not, says Dr. Liu. “Open back surgery is a traumatic procedure that has a fairly high rate of failure and complications,” he says, and the recovery process is long, a few months to a year.

Instead, Dr. Liu performs a much less invasive procedure known as endoscopic thoracic discectomy, which is much less traumatic (and risky) than open spinal surgery. In this operation, the surgeon makes a tiny incision and inserts a small metal tube, about a few millimeters in diameter, into the spine; the tube carries a camera, which helps the surgeon “see” the problem and repair it with very little effort: He or she can eliminate the bulging pulposus with a laser, and remove any larger bits of disc material with a small grasper. In most cases, the patient can go home the same day and be back to normal activities within a few weeks.

Endoscopic surgery represents an enormous advancement in treating thoracic spinal disc problems,” Dr. Liu says. “We no longer have to subject patients to even more stress and pain, and can get them back on their feet in a really short time—in most cases with no residual pain.

About: Kaixuan Liu, M.D., Ph.D., Dr. Liu is a nationally recognized leader in endoscopic spinal surgery. He has substantial experience in this rapidly developing field, and he treats disc herniations, spinal stenosis, failed neck or back surgeries, spondylolisthesis, and many other diseases and conditions in the cervical, thoracic, and lumbar spine. Dr. Liu is certified by American Board of Pain Medicine and American Board of Anesthesiology. After fellowship training in Minimally Invasive Spine Surgery at the Advanced Orthopedic of South Florida, Dr. Liu founded Atlantic Spinal Care, LLC, in Edison, New Jersey. www.laser-spine.com

Dr. Liu graduated from Hubei Medical College in China in 1985. He completed resident training in Beijing Medical University and was awarded a Master of Surgery in 1989. He subsequently received an additional year of postgraduate training in thoracic surgery at the China-Japan Friendship hospital in Beijing.  In 1990, Dr. Liu immigrated to the United States as a physician scientist to develop innovative therapies for human lung cancer at the University of Medicine and Dentistry of New Jersey (UMDNJ). He completed his master's and doctoral study focusing on breast cancer research and gene therapy in Auburn University, Alabama where he also earned a PhD degree in Molecular Medicine. Subsequently, Dr. Liu developed a strong interest in pain medicine and received one year clinical training in surgery and three years of training in Anesthesia at Columbia University College of Physicians and Surgeons.

As a renowned physician scientist, Dr. Liu is frequently invited to speak at national and international conferences. Dr. Liu is currently a member of International Society for Advancement of Spine Surgery, American Society of Interventional Pain Physicians (ASIPP), American Academy of Pain Medicine (AAPM), International Intradiscal Therapy Society (IITS), and American Society of Anesthesiologists (ASA). He also serves as an international surgeon for the Spinal Foundations in England.