Osteochondrosis of the thoracic spine is a chronic degenerative-dystrophic process of damage to the intervertebral discs and vertebral bodies of the thoracic spine. This disease is slightly less common than osteochondrosis of the cervical or lumbosacral spine. However, this does not mean that it does not cause problems for the person. Osteochondrosis of the thoracic spine is manifested mainly by back and chest pain, but it can also cause pain in the heart, in the abdomen, similar to angina pectoris or hepatic colic. In rare cases, osteochondrosis of the thoracic spine causes the development of paresis of the muscles of the lower extremities, impaired sensitivity in them, disorders of Organs pelvic organs. The treatment of the disease consists of the use of medicated and non-medicated methods, sometimes requiring surgery. With this article, you will learn about the symptoms of osteochondrosis of the thoracic spine and the methods of its treatment.
Thoracic spine
The thoracic spine is represented by 12 vertebrae, between the bodies of which are the intervertebral discs. The discs consist of a pulpy nucleus and a fibrous ring. Pathological changes in these discs, as well as in adjacent facet joints, proliferation of bony spines along the edges of vertebral bodies, dystrophic processes in the spinal ligaments and become the immediate cause of back pain.
It should be understood that osteochondrosis, as a disease, rarely affects only a part of the spine. This process is usually diffuse, more or less pronounced in various parts of the spine.
Some structural features of the thoracic spine make it less frequently affected by osteochondrosis than other regions of the spine. Let's list these resources:
- less mobility of the thoracic spine;
- the presence of joints of the vertebrae with the ribs (which, in combination with the sternum, creates a strong thoracic structure, less prone to injury);
- small thickness of the intervertebral discs;
- physiological kyphosis (curvature in the anteroposterior direction with a protrusion facing backwards) of the thoracic spine and, therefore, the maximum axial load falls on the anterior and not posterior parts of the discs.
Another characteristic not of the structure, but of the development of osteochondrosis of the thoracic spine, which also determines the lower frequency of pain in the thoracic spine, is that the morphological bases of osteochondrosis in this part can remain clinically "silent" for a long time. That is, there are changes, but they do not bother the patient.
And yet, in the presence of provocative factors, such as sedentary lifestyle (including years of working at a table or driving a car), injuries, poor posture, flabby back muscles, heavy physical work in forced position, osteochondrosis of thethoracic spine shows its true face.
Symptoms of osteochondrosis of the thoracic spine
The main clinical symptom of osteochondrosis of the thoracic spine, as elsewhere, is pain. Back pain, chest pain and even internal organs. In medicine, it is common to distinguish several painful (and not only painful) syndromes from osteochondrosis of the thoracic spine. In total, they are divided into two groups:
reflex- ;
- compression.
Reflex syndromes are clinical manifestations of spinal receptor stimulation. These are receptors for ligaments, intervertebral joint capsules, intervertebral discs, which receive pathological impulses in osteochondrosis. In addition to pain, reflex syndromes may be accompanied by muscle tension, vegetative disorders in soft tissues and internal organs. These changes are based on the following fact: stimulation of receptors leads to the spread of excitation to structures close to the spinal cord (to be more precise, to segments of the spinal cord). And these can be neurons responsible for the transpiration of a certain area of the skin, regulating the temperature of the same area, participating in guaranteeing the activity of Organs internal organs (heart, liver, intestines and so on), maintaining the tone of the muscles and blood vessels that supply all of these structures. And when the excitement is transmitted to these neurons, the corresponding symptoms of disruption of the activity of certain formations appear. Therefore, such a situation is quite possible when pains in the abdomen or in the heart region are caused by osteochondrosis of the thoracic spine.
Compression syndromes occur when the nerve root is compressed (less often stretched) when it leaves the intervertebral foramen, the spinal cord tissue or the vessels that feed it. Compression syndromes are almost always caused by an existing herniated disc. The most common are hernias in the lower thoracic segments. Depending on the direction and location of the hernia, a person has certain symptoms. This can be represented as follows:
- Median (median) hernias are accompanied by the development of muscle weakness symmetrically in both legs, loss of sensation in them. At the same time, the painful nerve root compression syndrome is absent;
- lateral (lateral) hernias manifest exclusively pain associated with nerve root compression;
- mediolateral hernias combine the clinical symptoms of the two previous groups, only muscle weakness and sensory disturbances predominate on the protruding disc side.
What type of syndromes are considered in the context of osteochondrosis of the thoracic spine? Let's talk in more detail about the types of reflex and compression syndromes at that level.
Reflex syndromes
Dorsago- sharp and sudden pain in the thoracic spine. It is sharp in nature, often described by patients as a dagger stroke. Basically, it is felt between the shoulder blades, it can be applied to the heart, the sternum. Patients are afraid to move and even take a deep breath, because the pain intensifies (as if shooting again) with it. Often, these symptoms occur after a long stay in an uncomfortable fixed posture, while doing monotonous work. A sudden movement after this causes back pain in people with osteochondrosis of the thoracic spine. When palpating the thoracic spine, the tension of the roll-shaped paravertebral muscles and their pain is revealed.
Sometimes this pain can be considered a heart attack, so severe and sudden that it seems to the patient. However, the electrocardiogram performed shows no abnormalities and the use of nitroglycerin under the tongue does not eliminate the pain.
Back painis another type of thoracic reflex syndrome. It is a painful syndrome that occurs gradually. Pain can be located anywhere on the back, chest. Painful, opaque pain, sometimes with a touch of burning (which is associated with irritation of vegetative structures). It intensifies with the movements of the spine, bending, turning around its axis, coughing or sneezing, driving on an uneven road.
Pain can be felt along intercostal spaces on one or both sides. This characteristic is due to the course of the nervous conductors (the intercostal nerves and vessels are located in the intercostal space). In this case, the pain is called intercostal neuralgia, by analogy with herpes zoster pain.
If the pain is located in the anterior chest wall, it is also called pectalgia. However, it can only be felt in some places with an intact back. For example, in the area of the xiphoid appendix or at the insertion site of the sternocleidomastoid muscle. Often, due to the painful and opaque nature of the pain, it is difficult to find out exactly where it hurts: either within the chest or in the area of the superficial soft tissues.
Back pain can be accompanied by reflex tension in the paravertebral muscles, more pronounced on the pain side. In this case, of course, muscle tension is not as pronounced as in a similar situation in the lumbar spine. Even so, on palpation, muscle compaction is felt and the touch itself causes discomfort or pain. It is also painful to palpate interspinous spaces and paravertebral points in the area of the segment affected by osteochondrosis.
Reflex syndromes in osteochondrosis of the thoracic spine are much more common than compression.
Compression syndromes
Nerve root compressionis accompanied, first of all, by the pain syndrome. The pain is acute in nature. The direction of pain spread corresponds to the course of the nerve fibers. In the case of thoracic osteochondrosis, they are intercostal spaces. Since some of the nerve fibers form plexuses that are involved in the innervation of internal organs, the pain can be felt inside the chest, abdomen. The pain intensifies when moving, bending the body, coughing, sneezing, laughing (because in those moments the root tension increases). In the area in which the compressed root innervates, sensitivity disorders can be observed: crawling sensation, numbness, tingling. Touching this area may not feel right. In cases where the nerve root is subjected to compression for a long time, movement disorders may occur, that is, weakness of the muscles innervated by it. The muscles gradually atrophy. However, movement disorders are very rare because they are the most recent in the chronology of the onset of all symptoms. Usually, a person seeks medical help in the phase of pain and sensory disorders.
Spinal cord compressionmanifests as weakness in the legs with simultaneous increase in muscle tone (if the spinal cord is compressed in the lower thoracic spine, muscle tone decreases). Pathological symptoms may appear in the feet (Babinsky and others). Sensitivity in the lower extremities is lost, the sensation of cold and hot touch does not differ, the difference between just touching and an injection. In cases of severe spinal cord compression, urinary disorders may occur.
The compression of blood vessels,that supply the spinal cord, leads to the development of myeloiscemia, that is, malnutrition of the spinal cord tissue. This, like spinal cord compression, is accompanied by the development of muscle weakness (patients say "legs have failed"), loss of sensation and pelvic disturbances.
It is fair to say that compression of the spinal cord and its vessels in osteochondrosis of the thoracic spine is very, very rare.
Vegetative components of thoracic spine osteochondrosis
Due to the fact that nerve fibers from the thoracic spine contain autonomic conductors, irritation or violation of these fibers may be accompanied by autonomic symptoms. They can be:
- dryness and flaking of the skin in the innervation area of a separate nerve;
- local violation of sweating and thermoregulation (also according to the innervation zone);
- chills in the lower extremities, brittle nails;
- pain that simulates diseases of the gastrointestinal tract (for example, gastritis, gastric ulcer, cholecystitis and so on);
- kidney pain, which actually has nothing to do with kidney pathology (there are no changes in urine and ultrasound);
- pain in the heart region, very similar to angina pectoris and even myocardial infarction.
The peculiarity of this pain may be that the person does not feel pain in the back. This is initially misleading for both the patient and the medical team when seeking medical help. However, the performance of a series of additional research methods makes it possible to exclude the pathology of Organs internal organs, and therefore osteochondrosis of the thoracic spine is considered the cause of such pain.
Treatment of thoracic spine osteochondrosis
All methods of treating thoracic spine osteochondrosis are divided into medicated and non-medicated. In most cases, only a combination of both groups has an effect and the disease recedes. Although you need to understand that it is simply impossible to completely get rid of osteochondrosis of the thoracic spine. The degenerative process can be stopped, slowed down, but has no reverse development.
Medication
The main directions of exposure to the medication for osteochondrosis of the thoracic spine are the elimination of pain, the elimination of muscle tension, the improvement of microcirculation and tissue trophism.
Nonsteroidal anti-inflammatory drugs are used successfully to eliminate pain syndrome. The drugs in this group have the ability to reduce the inflammation process, eliminate pain and block platelet aggregation. The drugs are prescribed, on average, for 7 to 14 days. This is usually sufficient to eliminate the pain. Many of them are available in various forms (tablets, capsules, injectable solutions, rectal suppositories), which guarantees ease of use. In the first days of treatment, the drugs are used in an injectable form, and then they are exchanged for pills or suppositories. The same drugs can be used simultaneously topically: on the thoracic spine. In addition, for this purpose there are also several forms of release: creams, ointments, gels, plasters.
Sometimes, non-steroidal anti-inflammatory drugs are not enough to relieve pain. In such cases, resort to the use of analgesic mixtures. The mixtures are injected intravenously in saline or glucose.
Paravertebral block has a very good and fast analgesic effect. This is a type of medical manipulation, when a medicinal substance is injected close to the spine, intracutaneously, subcutaneously, in the thickness of muscle tissue, perineurally (directly close to the nerve or root). The procedure requires certain skills and experience from the doctor.
In addition, irritating and distracting local ointments can be used to relieve pain in osteochondrosis of the thoracic spine. These are ointments containing snake venom, bee venom and pepper extracts.
Muscle tension is relieved by non-medicated methods.
Diuretics, hormones, Escina Lysinat are used to relieve edema of the nerve root.
Pentoxifylline, dipyridamole, complamine, nicotinic acid are used to normalize blood circulation, improve tissue nutrition and restore trophism.
In osteochondrosis of the thoracic spine, B vitamins are presented, which have analgesic and neurotrophic effects.
When the exacerbation of osteochondrosis of the thoracic spine is stopped, the use of drugs that improve the metabolism of intervertebral discs and joints can be used. These are called chondroprotectors. These drugs stimulate the regeneration of the articular cartilage, suspend the degenerative process in the intervertebral discs. They are prescribed for a long period (3-6 months).
Non-medication methods
This includes:
- massage (classic, punctual, reflex-segment);
- physiotherapy exercises;
- stretching of spasmodic muscles (there are special techniques, stretching is not done according to the "as you want" principle);
- acupuncture;
- swimming (very useful for all patients with any location of osteochondrosis);
- physiotherapy (ultrasound, electrophoresis, amplipulse, diadynamic currents, mud therapy and so on).
If a hernia formed as a result of osteochondrosis of the thoracic spine compresses the spinal cord, its vessels or nerve roots, and at the same time causes muscle weakness, dysfunction of Organs pelvic organs, pronounced pain syndrome (resistant to drug use) , the problem is considered about performing surgical treatment.
Osteochondrosis of the thoracic spine is not a deadly disease, but it does a lot of damage to a sick person. It limits your life, interferes with work and good rest. The main symptom of osteochondrosis of the thoracic spine is pain. It is impossible to get rid of this disease completely, but it is possible to suspend the degenerative process and minimize its manifestations.