The Common Upper Back Pain Causes and Treatment options in India

 Although upper back pain is not a very common spinal disorder, it can cause significant discomfort and pain when it does occur. The most common causes of upper back pain are muscular irritation (myofascial pain) and joint dysfunction.

There can be an injury to a disc in the upper back (such as a thoracic herniated disc or degenerated disc) that causes upper back pain, but such injuries are very rare.

It is important to note that the thoracic spine (also called upper back, middle back, or mid-back) is very different in form and function than the cervical spine (neck) or the lumbar spine (lower back). While the neck and lower back are designed to provide us with mobility, the thoracic spine is designed to be very strong and stable to allow us to stand upright and to protect the vital internal organs in the chest. Because this section of the spinal column has a great deal of stability and only limited movement, there is generally little risk of injury or degeneration over time in the upper back.

Anatomy of the Upper Back

The word "thoracic" means pertaining to the chest, and the thoracic spine (also called the upper back or mid-back) is the portion of the spinal column that corresponds to the chest area.

·         Twelve vertebrae in the middle of the spine with ribs attached make up the thoracic spine. When viewed from the side, this section of the spine is slightly concave.

·         Each vertebra in the thoracic spine is connected to a rib on both sides at every level and these in turn meet in the front and attach to the sternum (the breastbone). This creates a cage (the thoracic cage) that provides structural protection for the vital organs of the heart, lungs, and liver, and also creates a cavity for the lungs to expand and contract.

·         The upper nine ribs start at the spine, curve around and are joined at the front of the chest. Because the ribs are firmly attached at the back (the spine) and the front (the sternum), they allow for very limited motion in the spine.

·         The lower three ribs do not join together at the front, but do function to protect the vital organs while allowing for slightly more motion.

·         The joints between the bottom thoracic vertebra (T12) and the top lumber vertebra (L1 in the lower back) allow twisting movement from 

Traditional decompression surgical options include:

·        

Corpectomy(or Vertebrectomy): Occasionally, surgeons will need to take out the entire vertebral body because disc material becomes lodged between the vertebral body and the spinal cord and cannot be removed by a discectomy alone. In other cases, bone spurs (osteophytes) form between the vertebral body and spinal cord. In these situations, the entire vertebral body may need to be removed to gain access to the disc material that's pressing on your nerve-that's a corpectomy.

·         Discectomy: If you have a bulging disc or a herniated disc, it may be pressing on your nerves. In a discectomy, the surgeon will remove all or part of the disc. The surgeon can do a discectomy using a minimally invasive approach.

Minimally invasive means that there are smaller incisions and the surgeon works with a microscope and very small surgical tools. You'll have a shorter recovery period if you have a minimally invasive discectomy.

·         Facetectomy: There are joints in your spine are called facet joints; they help stabilize your spine. However, facet joints can put pressure on a nerve. Ectomy means "removal of." So a facetectomy involves removing the facet joint to reduce that pressure.

·         Foraminotomy: If part of the disc or a bone spur (osteophyte) is pressing on a nerve as it leaves the vertebra (through an exit called the foramen), a foraminotomy may be done. Otomy means "to make an opening." So a foraminotomy is making the opening of the foramen larger, so the nerve can exit without being compressed.

·         Laminectomy: At the back of each vertebra, you have a bony plate that protects your spinal canal and spinal cord; it's called the lamina. It may be pressing on your spinal cord, so the surgeon may make more room for the cord by removing all or part of the lamina.

·         Laminotomy: Similar to the foraminotomy, a laminotomy makes a larger opening, this time in your bony plate protecting your spinal canal and spinal cord (the lamina). The lamina may be pressing on a nerve structure, so the surgeon may make more room for the nerves using a laminotomy.

After part of a disc or vertebra has been taken out, your spine may be unstable, meaning that it moves in abnormal ways. That makes you more at risk for serious neurological injury, and you don't want that. The surgeon will need to stabilize your spine. Traditionally, this has been done with a fusion.

In spine stabilization by fusion, the surgeon creates an environment where the bones in your spine will fuse together over time (usually over several months or longer). The surgeon uses a bone graft (usually using bone from your own body, but it's possible to use donor bone as well) or a biological substance (which will stimulate bone growth). Your surgeon may use spinal instrumentation—wires, cables, screws, rods, and plates—to increase stability as the bones fuse. The fusion will stop movement between the vertebrae, providing long-term stability.

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