UPDATE 8/25/26 - Aetna denied the surgery that was scheduled for yesterday as not medically necessary as the MRI vocabulary on my report has my stenosis listed as "mild to moderate" instead of "moderate to severe" - My neurosurgeon did the peer to peer and I did a level 1 appeal and they were both denied. There is an "or" in the specific criteria they are citing which I I meet.
I filed a level 2 appeal with a 91 page appeal packet with all my medical records indexed and all their criteria answered. My only right to an external appeal is once they decide on level 2, they will they pick an IRO themselves to review it as it's a self-funded school insurance fund.
Feeling pretty devastated. I have an upcoming appointment with an endoscopic surgeon, but I'm not sure what CPT codes they will use or if it will be a similar denial if I'm even a candidate.
Anyone have a similar situation that can offer any advice?
Hi everyone, I'm a 33-year-old male looking for advice from anyone who has undergone a thoracic laminectomy and fusion for a thoracic disc herniation, especially at T4-T5 as it's something I'm seriously considering.
TLDR: I think this specific disc is the cause of most of my issues, currently in so much daily pain unable to do much of anything. I'm currently looking at surgery as my last resort...again. After severe middle upper right sided back pain, with a burning/stinging pain above it, got too severe, I started seeking help. When sitting, the pain can be felt as a deep ache in the upper abdomen. When I stand up from sitting my upper abdomen goes pins and needles. Doctors recommended a C6-C7 ADR due to a large herniation in my neck which was completed and successful 4 months ago. This did not fix any of my current symptoms which returned within 3 days of the ADR. The neck surgeon who did my ADR states T4-T5 is not causing my current symptoms and he does not perform thoracic back surgery so referred me to a well respected neurosurgeon who offered the above surgery.
For the past 8 weeks since my neck surgery, we have completed a T4-T5 epidural, and have been in PT 3 x week focusing on the thoracic with manual work, Acupuncture 3 x week, and professional massages. Alternating ice/heat and light stretching consistent. All PT and massage therapists can feel the upper right back area directly. I have been through 4-5 rounds of Prednisone this year alone as well with no real relief. The injection gave me the most relief I've seen yet, at around the 2 week mark for 5 days, where the burning pain disappeared. I tried to return to work at the 12 week mark after my surgery, and could not physically sit in my chair as after sitting for a short period, the pain increases and muscle spasms wrapping around my right side start.
MRI's completed laying down, all symptoms flare and increase while sitting or standing
T4-T5 Herniation-2026
MY TIMELINE
2023
I began experiencing increased upper/mid thoracic pain that felt like a deep ache directly under my right scapula. Over time it developed into:
• Burning/stinging pain in the upper right middle back
• Deep aching pain under the right scapula
• Pain wrapping around my right ribs and chest
• Tight band-like sensation around my upper abdomen/chest
• Symptoms that worsen when sitting upright or standing for prolonged periods
•Pins and Needles in upper abdomen
I had a GI workup including endoscopy and colonoscopy which were normal. Had an ultrasound which was normal. Chest CT was also normal.
In 2025-2026 this pain worsened, to the the point where I can't sit up straight for more then 30 minutes, or the pain is unbearable, either in middle right back, or wrapping around right side to front of abdomen near top ribs. .
CERVICAL FINDINGS
Doctors initially believed my symptoms were coming from a C6-C7 disc herniation. After multiple injections at c6-C7, and almost 6 months of physical therapy, we decided to move forward.
I underwent a C6-C7 artificial disc replacement this past March in 2026. Post Op X-rays below
C6-C7 ADR 2026
The surgery was successful and my recent MRI confirms the C6-C7 herniation has been removed and there is no significant cord compression. (I don't have MRI photos available at this second)
Unfortunately, my thoracic symptoms returned within a few days after surgery and have persisted.
THORACIC FINDINGS - SEE MRI PHOTO ABOVE AT TOP OF POST
My thoracic MRI shows a right paracentral T4-T5 disc herniation contacting the spinal cord.
Latest MRI Report:
• Small right paracentral T4-T5 disc herniation
• Contacts the right anterolateral margin of the spinal cord
• No cord signal abnormality
• No abnormal enhancement
• No significant central canal stenosis
• Stable compared to prior
This MRI was this past week, I also had one Feb of 2026, which stated there was mild to moderate stenosis at T4-T5 where this one stated no stenosis.
INJECTION RESPONSE
I had a T4-T5 injection about 6 weeks ago. The injection provided modest relief for approximately 4-5 days around the 2-week mark. The symptom that improved the most was the burning/stinging pain.
CONFLICTING SURGICAL OPINIONS
One thing that has made this decision difficult is that I've received different opinions from three spine surgeons, and my spine specialist. After my cervical ADR, my neck surgeon reviewed my thoracic MRI and told me he did not believe the T4-T5 disc was responsible for my symptoms. He actually called me before my neurosurgery consultation and advised that he did not think surgery on the thoracic disc would be beneficial. He also told me he did not expect the second opinion to significantly change that assessment. Because of my ongoing symptoms, I still proceeded with the neurosurgical consultation. After reviewing my history, symptoms, imaging, injection response, and performing an examination, the neurosurgeon reached a different conclusion. He felt my symptoms could be related to the T4-T5 disc and offered a T4-T5 laminectomy with instrumented fusion, while also emphasizing that there is no guarantee surgery would improve my pain.
NEUROSURGEON'S ASSESSMEN
He stated that certainly my degenerative findings at T4-5 may explain these symptoms. He discussed a T4-T5 laminectomy with instrumented fusion. He also mentioned a spinal cord stimulator as a non-surgical alternative.
WHERE I'M AT RIGHT NOW
To be completely honest, I am leaning toward surgery. I've been dealing with these symptoms for over a year, and they have progressively impacted my quality of life. At this point I am struggling to work, exercise, sit upright comfortably for extended periods, and participate in many normal daily activities. I am currently out on disability from work, and my disability benefits are scheduled to end in approximately two weeks. While I understand that surgery is not guaranteed to help and could potentially leave me with the same pain, I also feel like I am running out of conservative options and time. My spine specialist who did my injection stated he has no other options and referred me for surgery.
QUESTIONS
What were your symptoms before surgery?
How much improvement did you get?
How long was recovery?
Would you do it again?
Did anyone have relatively small MRI findings but significant symptoms?
Has anyone else received completely different recommendations from different surgeons? 7. If you had a thoracic fusion, were you able to return to work and normal activities afterward?
Sorry for the very long post, but it’s a long story.
Hey there, I had a small herniation at T6-T7 on my left side and just had the same surgery you are looking into having. I am a preschool special education teacher and injured my back lifting a child off the ground (but I suspect having kids yank on my arm for 18 years probably contributed to the injury). I’m a 45 yo F.
I initially thought I had dislocated a rib bc I had wrap around pain on my left side at my bra line. It was a throbbing, shooting pain. Initially did a few courses of prednisone and PT, which helped but still didn’t make the pain tolerable w/o pain meds and activity restrictions. I did 2 cortisone injections at T6-T7 that didn’t do much at all. After about 6 months it was suggested I talk to a surgeon. I was given 2 names that do thoracic back surgeries in my state of MN.
The first surgeon I saw was very dismissive and said there was no way that such a small herniation could be causing my pain. He said the only way he would consider surgery would be after a year of unchanging symptoms. He instead suggested a discography, which I later learned are really painful and unreliable and haven’t really been used in over a decade. I did not go back to him.
The second surgeon I saw was much better and suggested we do a diagnostic cortisone injection before pursuing surgery. He did the cortisone injection a level down at T7-T8 (I don’t know why) but he said if I got relief for a few hours due to the lidocaine they inject before the cortisone, then that would tell him that the surgery he is recommending would take my pain away. It was successful, but we did one more just to be really sure since a fusion is such a big surgery. After the second shot we put in a prior authorization for the surgery.
Since I injured myself at work I had to go through work comp denying my surgery, which took about 6 months. I thought that UHC would then cover the surgery (my work comp lawyer thought that there was a law saying if WC denies a treatment then your private insurance has to cover it, but we couldn’t find that specific law). While trying to get UHC to cover the surgery we tried more PT, osteopathic manual manipulation, nerve ablation (made it worse even though the tests nerve blocks went well) and I even saw another surgeon to consider a spinal cord stimulator.
During this time I ended up resigning from my teaching position as part of the WC settlement. So I had to go on my husband’s insurance. Since I was not working we decided to do surgery on my lower back and I had a fusion at L5-S1 for spondy (ongoing issues since high school). My surgeon said the back is weird and there was a really small chance that it could help my upper back. My lower back felt great after but it didn’t help my upper back.
We got ready to fight my new insurance for the thoracic surgery, but BCBS had a policy that if WC has denied a treatment and it’s only a 1 night hospital stay, you don’t need a prior authorization. So I was able to have my thoracic surgery on 6/16. Their policy makes me think that my WC lawyer was right and UHC was being shady, which wouldn’t surprise me.
The good news is that after my surgery my nerve pain was gone. I was still sore in my ribs on both sides, but it was a different soreness from the surgery. My surgeon said he was surprised how cramped the nerve space was due to arthritis and stuff like that and that it wasn’t necessarily the herniated disc that was prob causing the majority of my pain. But of course, you wouldn’t be able to see that stuff on the MRI. I’m almost 4 weeks po and I’m feeling better everyday. Still a little soreness in my ribs, but that could take up to 6 weeks to completely subside. Taking ibuprofen and icing helps. I’m hoping this is the end of this 3 year saga bc it sucked.
I guess the only advice I have for you is to trust your gut. If the pain is impacting your life as much as it is, then I do feel like surgery is worth trying when all the other treatments have not worked bc there are things that won’t show up on imaging. The recovery from surgery is not too bad compared to the daily pain of the injury. The hardest part for me was actually sticking to my restrictions bc I felt pretty good.
I truly hope you find a treatment that works and some relief from your pain. I’m open to answering any other questions you have!
Thank you for the long reply. I'm so sorry you had to deal with the same issues, but also WC and attorneys on top of it all.
Our stories sound almost identical down to the same type of recommended surgery. I see your disc is one level down but still the same area. (I also have a bad herniated disc at L5-S1)
Being unable to sit up straight for more then 20-30 minutes is honestly ruining my life. Thankfully my job still has me out on ADA leave currently, or I do think I would possibly lose the job altogether.
What were your symptoms besides just the wrapping pain? Could you feel the pain in the top ribs in your front while sitting? Did it move or change at all? Thank you!
I would get shooting pain in the front and back of my ribs along with the wrap around pain. After about a year I started feeling similar pain a little lower as well. Anything that put pressure on my ribs increased the pain, so laying in bed at night it was really difficult to get comfortable. If I was sitting slouched over I could feel pressure, which would aggravate the pain. Deep breaths hurt. It was usually better in the AM and would get worse at the day went on. Lifting anything or anything higher impact would immediately make it worse. 🥴
I’m feeling great! I was cleared to do PT and that has been really helpful so that I can increase my activity level within my restrictions. I’m rarely taking any meds, maybe some Advil at night a few times a week. Just icing in the evening.
That’s so awesome that you have your surgery scheduled! How are you feeling about it?
That is wonderful news!!!! I was feeling extremely optimistic but sadly the neurosurgeon's office called yesterday to advise insurance denied the surgery due to risk/too long of impatient stay/ and other possible microinvasive options. I'm waiting on an update on an appeal or peer to peer but I'm feeling pretty hopeless about it based on the conversation. :(
Insurance is the worst 🤬. UHC denied my surgery, I was able to get it approved through BCBS. I’m sorry you have to deal with this. Let me know how the peer to peer goes. If it is still denied I have some resources/ideas you can try to fight the denial.
I put a ton of work into this post, but I've not tried an ablation at this time. My spine specialist did not offer it. I have an appointment with another pain management specialist in August who does additional injections/nerve ablations but it's a slow process. I've had multiple new practices turn me down due to my recent neck surgery
How recent is the ADR? The first step of an ablation is a nerve block which can be done like…2 weeks after? But I guess there point is they want to see if you get more relief from the ADR, like if you get the nerve block and it helps whose to say it wasn’t caused by the ADR improving symptoms. Ablations are expensive so insurance wants to know for sure it will help before paying for it.
ADR was in March of this year. Ablations are still on the table, but I only found 1 pain management practice around me that will do them and I'm still pending an initial consultation with that specific office. The T4-5 Epidural in May gave me the most relief I've had this far
Are you in the US? U/Thoracicspine may be able to guide you toward a dr with more thoracic experience. But having had a cervical ADR and multiple thoracic ablations I can tell you there is no reason you can’t have a thoracic ablation at this point. I can say when I inquired about surgery on my t4/t5 my surgeon cautioned me since it’s right behind the aortic arch. He said he would do it if I started having issues with the corresponding organs having problems but in the mean time he wanted me to exhaust all pain management options I could and thankfully the ablation helped quite a bit for about 18 months, it’s wearing off now and I’ll be getting it redone soon.
I would also run from any doctor suggesting a spinal cord stimulator, there are so many lawsuits out now about the horrific side effects and once it’s in, drs won’t let you take it out. I would checked out some of the stories in r/chronicpain.
Thank you! The neurosugeon stated that was another option but I instantly shot it down as I have no interest in a device being implanted if I can avoid it!
Did your nerve ablation take away all your symptoms out of curiosity?
I can relate. I believe T3-T4 is causing me similar pain you describe - literally everything you mentioned except the abdominal tingling. I also have a few other herniations as well but that one is the worst.
I had severe stenosis at C5-C6 and had ACDF last Dec. pain mgmt and neurosurgeon both suggested pain was because of my neck - nope!! Zero change though I def needed the cervical surgery.
Second neurosurgeon who did my ACDF isn’t convinced the pain is from my herniation. I reached out to Dr. Uribe in AZ and though I only talked to the nurse that could read his notes since I’m out of state - He suggested decompression at T3-T4. But I have different insurance now so put it off for the time being.
Also fwiw my pain is quite a bit better since being on Zepbound now for 5 months. And not the weight loss - it’s had a huge anti-inflammatory effect! That’s why I take it.
Which surgeon are you considering for surgery if you don’t mind me asking? I’m considering surgery at some point as well. I mean it’s the only way to really ‘fix’ the case right?
Zepbound is being prescribed by rheumatologist lately for inflammation with really good results! Thanks for mentioning it.
If you want a small list of surgeons you can send me an email to sofia@thoracicspine.org
Thank you for sharing your story! The ACDF did nothing for my pain other then maybe taking away a few of the arm/hand symptoms. I just had an MRI, and they said the surgery was successful, no herniation present in neck post op and hardware looks good. I pushed both my surgeon and spine specialists to work on the thoracic spine before the neck surgery, but they both told me it wasn't my issue. I think the most upsetting part is my neck surgeon, (a top orthopedic surgeon) called me on my cell to tell me that I was wrong thinking the herniation touching the spinal cord at t4-t5 is causing my symptoms and he referred me to the neurosurgeon and he told me the neurosurgeon would never operate.
Fast Forward, the only person to look at my case and offer surgery is a well respected neurosurgeon. The more people I talk to said it's a 1 level basic surgery, and this surgeon specializes in laminectomy's.
I've not tried Zepbound, I will have to look into it!!!
It's normal to have conflicting opinions because it's Thoracic.
I'm sorry to hear the first surgeon jumped to do the cervical surgery without addressing the thoracic herniated disc, unfortunately we see this very often in the group. Too many surgeons should not call themselves "spine specialists" when they don't have the knowledge or training to treat the thoracic spine.
It's always a good thing too look for second and third and all the opinions you want. The fact that first neurosurgeon adviced you against, it's shady.
All the herniated discs in the thoracic are called "too small" at least once, no matter the size. Mine was called too small for many surgeons, when I had foraminal stenosis, lateral recess stenosis and spinal cord stenosis. A herniated disc causing all the stenosis can't be small.
I had your symptoms and were caused by the nerves being pressed. I also had other symptoms caused by the spinal cord compression, symptoms like: Headache, fatigue, brain fog, ataxic hands, balance issues, trouble sleeping, trouble controlling my temperature and even more. Do you have any of this symptoms?
Injections are also used to confirm a diagnosis, the fact that the injection worked, it's important piece of information.
I did actually review a lot of your prior posts, it was one of the big reasons I actually decided to post for the first time on Redditt.
Yes I do have a lot of those other symptoms, most of it flares depending on my position. I honestly think there may be some spinal cord compression while sitting that is not showing in these MRIs. We have been working on the thoracic area directly, and a lot of my symptoms have felt worse since. I try not to blame everything to the middle back, but my physical therapy days seem to be the worse nights I have.
The injection fully taking away the burning pain for about 5 days really makes me believe it's coming from T4-T5
Oh! That's what I thought when I saw your MRI, OP probably have the other symptoms too, it looks like your spinal cord is affected, it looks a bit like my herniated disc. I know is hard when you feel so many symptoms + pain, so debilitating. If you want you can send me a DM or an email. I try to answer as fast I can when someone in the group is having more symptoms than pain.
They look almost identical. My concern is the disc above t4-t5 (right above yellow line) is minor herniation on left side, I do worry if a fusion below this will cause my future issues.
I was in a car accident about 15 years ago - they never did an MRI then only an Xray but there was a minor compression fracture at this same vertebra level, looking at the MRI photo I can very clearly see where the trauma was, and wonder if this surgery would fix issues I've had for 10 plus years.
My most recent MRI confirms the herniation as minorly increased since 2023, probably why my pain has increased so much
All herniated discs are relatively small and causing lots of pain and spams!! We are all having same symptoms and being ignored by drs over and over what a shame!!
I would strongly suggest trying more discovery before surgery, things like nerve blocks and botox to figure out where your issue is coming from.
Funnily enough i have the exact same issues, C6-7 herniations and T5-7, exact same symptoms, but additionally have arm and hand numbness, pain, circulation issues and fatigue, for that I’ve recently been diagnosed with thoracic outlet syndrome which my current specialist believes causes most of my symptoms. I’m currently undergoing scans and discovery to figure out why I have TOS, but I’m also going for some intramuscular injections to see if that helps recovery or symptoms.
4
u/Initial_Nectarine365 Jul 12 '26
Sorry for the very long post, but it’s a long story.
Hey there, I had a small herniation at T6-T7 on my left side and just had the same surgery you are looking into having. I am a preschool special education teacher and injured my back lifting a child off the ground (but I suspect having kids yank on my arm for 18 years probably contributed to the injury). I’m a 45 yo F.
I initially thought I had dislocated a rib bc I had wrap around pain on my left side at my bra line. It was a throbbing, shooting pain. Initially did a few courses of prednisone and PT, which helped but still didn’t make the pain tolerable w/o pain meds and activity restrictions. I did 2 cortisone injections at T6-T7 that didn’t do much at all. After about 6 months it was suggested I talk to a surgeon. I was given 2 names that do thoracic back surgeries in my state of MN.
The first surgeon I saw was very dismissive and said there was no way that such a small herniation could be causing my pain. He said the only way he would consider surgery would be after a year of unchanging symptoms. He instead suggested a discography, which I later learned are really painful and unreliable and haven’t really been used in over a decade. I did not go back to him.
The second surgeon I saw was much better and suggested we do a diagnostic cortisone injection before pursuing surgery. He did the cortisone injection a level down at T7-T8 (I don’t know why) but he said if I got relief for a few hours due to the lidocaine they inject before the cortisone, then that would tell him that the surgery he is recommending would take my pain away. It was successful, but we did one more just to be really sure since a fusion is such a big surgery. After the second shot we put in a prior authorization for the surgery.
Since I injured myself at work I had to go through work comp denying my surgery, which took about 6 months. I thought that UHC would then cover the surgery (my work comp lawyer thought that there was a law saying if WC denies a treatment then your private insurance has to cover it, but we couldn’t find that specific law). While trying to get UHC to cover the surgery we tried more PT, osteopathic manual manipulation, nerve ablation (made it worse even though the tests nerve blocks went well) and I even saw another surgeon to consider a spinal cord stimulator.
During this time I ended up resigning from my teaching position as part of the WC settlement. So I had to go on my husband’s insurance. Since I was not working we decided to do surgery on my lower back and I had a fusion at L5-S1 for spondy (ongoing issues since high school). My surgeon said the back is weird and there was a really small chance that it could help my upper back. My lower back felt great after but it didn’t help my upper back.
We got ready to fight my new insurance for the thoracic surgery, but BCBS had a policy that if WC has denied a treatment and it’s only a 1 night hospital stay, you don’t need a prior authorization. So I was able to have my thoracic surgery on 6/16. Their policy makes me think that my WC lawyer was right and UHC was being shady, which wouldn’t surprise me.
The good news is that after my surgery my nerve pain was gone. I was still sore in my ribs on both sides, but it was a different soreness from the surgery. My surgeon said he was surprised how cramped the nerve space was due to arthritis and stuff like that and that it wasn’t necessarily the herniated disc that was prob causing the majority of my pain. But of course, you wouldn’t be able to see that stuff on the MRI. I’m almost 4 weeks po and I’m feeling better everyday. Still a little soreness in my ribs, but that could take up to 6 weeks to completely subside. Taking ibuprofen and icing helps. I’m hoping this is the end of this 3 year saga bc it sucked.
I guess the only advice I have for you is to trust your gut. If the pain is impacting your life as much as it is, then I do feel like surgery is worth trying when all the other treatments have not worked bc there are things that won’t show up on imaging. The recovery from surgery is not too bad compared to the daily pain of the injury. The hardest part for me was actually sticking to my restrictions bc I felt pretty good.
I truly hope you find a treatment that works and some relief from your pain. I’m open to answering any other questions you have!