Thoracic Spinal Cord Injuries

A look into what you can expect if you injure your thoracic spine

You probably haven't thought about your thoracic spine. That is, unless you've thrown your back out.

Having your back "go out" is a temporary problem generally caused by sleeping wrong or lifting a box incorrectly, and the usual culprit is a muscle spasm rather than a bone issue.

When your back goes out, you feel it immediately in your mid- or low-back, and you know that you'll be flopped on the couch like a beached whale for at least a day or two.

True thoracic injuries, on the other hand, are far less common because the ribcage does a good job protecting most of the area. You have to hit the spine dead-on to hurt it or have your body hit with enough force that it cracks under the pressure, which can happen in a car accident. If you manage to do that, compared to the lumbar or cervical areas of the spine, the prognosis is actually somewhat brighter.

What does the thoracic spine do?

There are 12 thoracic vertebrae protecting the spinal cord, a delicate bundle of nerves that carries messages from the brain to other areas of the body. The thoracic spine lords over a wide range of the body – it is in charge of the abdomen, the torso, the back and the trunk. Basically, if there is anything in your midsection that requires moving, your thoracic spine controls it.

What happens when the thoracic spinal column is damaged?

When the thoracic spinal column is damaged, this is when you get to legitimately say, "I broke my back."

There are many conditions that can affect your thoracic spine, such as:

• Scoliosis (abnormal curvature of the spine or lack of curvature)
• Kyphosis (variation of scoliosis resulting in a hunchback)
• Spinal stenosis (narrowing of the spinal canal)
• Disc degeneration (loss of cushioning; fragmenting and breakdown)
• Spondylosis (arthritis developing in the spine),
• Spondylolisthesis (normal relationship between two adjacent vertebrae is lost)
• Vertebral compression fractures (when vertebrae are broken because of trauma or because of the aging process).

These can happen naturally as you age; a compression fracture can occur just because the discs are losing fluid as you get older. Still, you get to say, "I broke my back." It sounds impressive, so you might as well own it.

A thoracic fracture leads to decreased range of motion. Bones calcify and can develop arthritic restrictions after fractures, so twisting, moving and bending might be far more difficult. The likely result will be constant back pain.

Some thoracic spinal cord injury patients recover without difficulty, but because it's a high-traffic area that cannot be completely rested during recovery (how do you entirely rest a back injury?), restrictions tend to develop in the fractures while they heal.

Despite that, the prognosis is still far brighter than cervical spine or lumbar injuries. A cervical injury could severely restrict movement in the head and neck; a lumbar injury could result in paraplegia or the inability to move the legs to their fullest extent.

While a thoracic injury might also result in paraplegia, it mainly depends on where the patient was hurt. 

The vast majority of spinal column injuries (75% to 90%) occur without damaging the cord. This means that the only issue is the fracture itself. If the fracture isn't caught by doctors early enough, it might cause malunion, which is when the bones don't realign properly. This means any calcification could occur on an area where it's not meant to be, like nerves. As healing usually takes up to 12 weeks, this might allow the bones to heal incorrectly – leaving the patient in intractable pain. This also leaves the window open for additional compression fractures.

Intractable spinal column pain is different than a thrown-out back. It's constant and overwhelming, and it might require the patient to reassess his job situation if he works something like construction or delivery. Even desk jobs can be too much to bear. There are currently no treatments other than strengthening the core and pain control in the form of medication, so unfortunately, concessions might have to be made.

What about the spinal cord itself?

Most injuries to the thoracic cord occur in the lower region, T11 to T12 to be specific. This usually results in paraplegia.

The T1 through T8 vertebrae control a significant portion of the upper body, so an injury there could affect chest and abdominal functions. Coughing, swallowing and talking are under the purview of these nerves, so damage to that area might result in the use of a ventilator. While arm and hand function are generally normal, as these are primarily controlled by the cervical nerves (C6 to C7), they might be significantly weakened because of the corresponding damage to the upper chest and torso.

A person who has suffered injuries to the upper thoracic region can likely expect to have an independent lifestyle, using modified cars or standing frames if he was rendered a paraplegic. However, if the injures were only to the upper thoracic, the patient will likely be able to walk normally.

T9 through T12 injuries, however, might result in paraplegia as well as damage to the back muscles. This patient would have to use a wheelchair and relearn other tasks like dressing and being self-sufficient in order to live alone. However, there are cars that can be modified for these patients, and he or she would very likely be able to retain a large measure of independence after relearning specific tasks.

What if I think I have just had a thoracic spinal cord injury?

Do not move. Even if you think it might not be a spinal cord injury, don't move. It's better to be safe than sorry in these situations, so just call emergency services and wait for them to arrive. They'll have a rigid board to transfer you to the hospital, which will keep the damage from getting worse. The last thing you want to do is aggravate the injury.

Doctors will take X-Rays and MRIs to see what the damage is, and if you do have a spinal cord or spinal column injury, they will put you in a brace for the acute phase and take it from there. They might need to perform surgery to reduce swelling and realign any fractures that won't heal on their own. They might end up using hardware to reinforce the area.

Spinal cord injuries can be the center of a patient's universe. Look through our resources to see if there are groups that can help. These injuries are very difficult to deal with, but with your family and friends helping, you will be able to regain a sense of peace and happiness in your life. Don't sweat the bad days, and look forward to the good days – they will be here again.