Upper Back HNP or Hernia

What is an upper back hernia?

A hernia, fully herniated nuclei pulposi (HNP), is a protrusion of an  intervertebral disc , and is most common in the lower back (lumbar vertebrae) or in the neck (neck vertebrae) but also in the vertebral column of the chest

Upper Back HNP or Hernia

. By bulging the intervertebral disc, it is pressed against the nerve root. This can irritate the nerve root or get stuck, causing complaints in the area of ​​the nerve root. The hernia can also push against the spinal cord, causing pain.


Aging can cause the intervertebral disc to protrude and a tear may even occur in the intervertebral disc. The interior of the intervertebral disc can hereby be pushed forward in the direction of the  spinal canal , just where the nerve root runs. This aging of the intervertebral disc is normal and is common to everyone. Everyone can also get an HNP from the upper back. HNPs of the upper back are also more common within certain families. Smoking also seems to have an influence on the development of an HNP and especially on the severity.

Complaints / symptoms

The most important complaint with an upper back HNP is a radiating pain in the chest. Usually this pain occurs before or simultaneously with pain in the upper back. The pain is often exacerbated by coughing, sneezing and pressing, but turning the back or sideways and bending the upper back can aggravate the chest complaints. The pain is then often sharp and stabbing. In addition, a reduced feeling may occur, tingling or muscles may become weaker. If the hernia presses against the spinal cord, pain in the legs can occur and coordination of the legs is hampered.

How is the diagnosis made?

If you come with radiating pain in the chest, which is exacerbated by coughing, sneezing or pressing, the chance that there is an HNP of the upper back is very high. There  are a number of tests in the  neurological examination that can confirm this. 
In addition to the neurological examination, the movements of the upper back are examined for limitations and pain. It is also felt in the upper back which vertebrae are painful when pressed.

Should other investigations be carried out on me?

  • You have already done diagnostic research into other non-physical factors that are important for your pain complaints by completing the  pain questionnaires  .
  • Because the neurological examination usually confirms the diagnosis, additional examination is therefore not always necessary. It is important that many people, who incidentally have no complaints,  still have a bulge of the intervertebral disc during an  MRI scan examination. It also happens that people with radiating pain in the chest, where the doctor thinks of a hernia, the MRI scan of the upper back shows no hernia.
  • It is only useful to make an MRI scan when there is doubt about the diagnosis or when an operation is envisaged. The hernia can be made visible on an MRI scan and possible other causes can be seen.
  • A  CT scan  is usually not useful, because only the bones can be seen properly.
  • A muscle examination ( EMG ) can also be done to investigate which nerve root of your upper back causes the pain.
  • By means of  nerve root pilot blocks  can be examined which nerve root can cause pain in the arm.

What are the treatment options?

Multidisciplinary Treatment

Based on the cause of your pain, your pain specialist will decide whether or not to opt for physical treatment. On the basis of the results of the pain questionnaires that you have completed, it can be decided that additional examinations still need to be done and / or that you will be offered another treatment in addition to physical treatment.

Non-physical treatments

If the results of your pain questionnaires are different, your pain specialist will propose one of the following non-physical treatments:
  • Psychological guidance
  • Depression Treatment
  • Cognitive-Behavioral Treatment
  • Rehabilitation Treatment

Physical Treatments

  • Anti-inflammatory drugs  (short-term)
  • Medications for nerve pain
Interventional pain treatment
  • Epidural injections
  • Sleeve injection of the nerve root
  • PRF treatment of the nerve root
Invasive treatment
For neurological complaints and / or loss of symptoms, such as pain in the legs and coordination disorders of the legs, based on an upper back hernia, you will be referred to a neurosurgeon.

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