Diagnosis
Thoracic disc herniation. Lower back and thoracic spine pain. Intervertebral disc protrusions.
Patient:
Male, 58 years old, Kazakhstan
Physician:
Dr. med. Andrei Bitter, Head of Spine Surgery Department
Patient’s Complaints:
- Persistent back fatigue, predominantly in the lower back and thoracic region. Neck fatigue towards the end of the day. A lack of restorative sleep—waking up feeling fatigued despite a normal sleep duration of 8–10 hours. Difficulty finding a comfortable sleeping position due to persistent aching and pulling sensations.
- Over the past six months, intermittent sharp lower back pain has developed. Occurring while standing, walking, or twisting, it causes a sudden tightening sensation that temporarily restricts mobility before gradually easing.
- Recently, severe weakness accompanied by numbness developed in the left leg under exertion, lasting two to three weeks before resolving completely.
- In early October, acute pain arose in the thoracic region at the most prominent point of the spine. The pain resembled a severe muscle strain, severely limiting torso rotation and preventing the lifting of light objects. After two to three days of continuous aching, manual palpation along the spine isolated the painful focus; gentle manual traction between the painful vertebrae provided immediate relief, with symptoms normalizing by the next day.
Expert Opinion by Dr. Andrei Bitter:
Cervical spine MRI imaging demonstrates no significant pathological changes. In the thoracic spine, a pronounced disc herniation is present at the T7-T8 level, which may cause persistent, aching pain in this region over time. In the lumbar spine, degenerative osteochondrosis is noted in the lower two lumbosacral segments.
These degenerative changes, combined with facet joint involvement and sacroiliac joint dysfunction, can cause lower back pain radiating into the leg or localized lumbar discomfort. The identified spinal cyst is benign in nature but requires periodic MRI surveillance every two years.
Postoperative Recommendations:
Surgical intervention is currently not indicated. Thoracic disc discectomy via a transthoracic or transrib approach represents a complex, high-risk surgical procedure. While surgery is not required at this stage, heavy lifting—especially without proper physical conditioning—must be avoided. The primary underlying cause of these complaints is typically age-related muscular imbalance and progressive facet joint arthrosis secondary to osteochondrosis. Targeted, regular physical exercise usually minimizes or completely resolves the pain syndrome, though intermittent acute flare-ups may still occur.
Conservative management focuses on maintaining physical fitness by engaging in enjoyable, low-impact daily activities. Suitable disciplines include running, swimming, therapeutic gymnastics, and structured bodyweight exercises (workouts), provided exercise intensity remains strictly within personal tolerance limits.
During acute pain flare-ups, consultation with a local medical specialist is recommended.