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 somewhat less common than osteochondrosis of the cervical or lumbosacral spine. However, this doesn't mean that it doesn't cause problems for the person. Thoracic spine osteochondrosis occurs mainly with back and chest pain, but can also give pain in the heart, abdomen, similar to angina pectoris or hepatic colic. In rare cases, osteochondrosis of the thoracic spine provokes the development of paresis of the muscles of the lower extremities, reduced sensitivity in them, disorders of the pelvic organs. Treatment of the disease consists in the use of pharmacological and non-pharmacological methods, and sometimes even surgical intervention is required. From this article you will learn 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 whose bodies are intervertebral discs. The discs consist of a pulpy nucleus and a fibrous ring. Pathological changes in these discs, as well as in the adjacent joint facets, proliferation of bone spines along the edges of the vertebral bodies, dystrophic processes in the ligaments of the spine and become the immediate cause of back pain.
It should be understood that osteochondrosis, as a disease, rarely affects only part of the spinal column. Usually this process is widespread, more or less pronounced in different parts of the spine.
Certain structural features of the thoracic spine mean that it is less frequently affected by osteochondrosis than other regions of the spine. We list these features:
- 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 chest structure, less prone to injury);
- small thickness of the intervertebral discs;
- physiological kyphosis (anteroposterior flexion with a backward swelling) of the thoracic spine, and thus the maximum axial load falls on the anterior rather than posterior parts of the discs.
Another feature 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 existing morphological basis of osteochondrosis in this part can remain clinically"mute" for a long time. That is, there are changes, but they do not bother the patient.
Yet, in the presence of provoking factors, such as a sedentary lifestyle (including years of working at a desk or driving a car), injuries, poor posture, relaxation of the back muscles, hard physical work in forced position, osteochondrosis of the thoracic spineshows its true face.
Symptoms of osteochondrosis of the thoracic spine
The main clinical symptom of osteochondrosis of the thoracic spine, as well as of other parts, is pain. Back pain, chest pain, even pain in internal organs. In medicine, it is customary to distinguish several painful (and not just painful) syndromes of osteochondrosis of the thoracic spine. In total, they are divided into two groups:
- reflex;
- compression.
Reflex syndromes are clinical manifestations of stimulation of spinal receptors. These are receptors for ligaments, capsules of the intervertebral joints, intervertebral discs, which receive pathological impulses in osteochondrosis. In addition to pain, reflex syndromes can be accompanied by muscle tension, vegetative disorders in soft tissues and internal organs. Such changes are based on the following fact: stimulation of receptors leads to the spread of excitation to neighboring structures of the spinal cord (to be more precise, to segments of the spinal cord). And these can be the neurons responsible for the perspiration of a certain area of the skin, regulating the temperature of the same area, participating in ensuring the activity of internal organs (heart, liver, intestines, etc. ), maintaining the tone of muscles andblood vessels that supply all these structures. And when excitation is transmitted to these neurons, there are corresponding symptoms of a violation of the activity of certain formations. Therefore, such a situation is quite possible when pains in the abdomen or in the region of the heart are caused by osteochondrosis of the thoracic spine.
Compression syndromes occur when the nerve root is compressed (less often stretched) as it leaves the intervertebral foramen, spinal cord tissue, or the vessels that supply it. Compression syndromes are almost always caused by an existing herniated disc. The most common are hernias of the lower thoracic segments. Depending on the direction and location of the hernia, a person experiences certain symptoms. This can be represented as follows:
- Median (median) hernias are accompanied by the development of symmetrical muscle weakness in both legs, loss of sensation in them. At the same time, the pain syndrome typical of nerve root compression is absent;
- lateral (lateral) hernias manifest exclusively pain associated with nerve root compression;
- mid-lateral hernias combine the clinical symptoms of the two previous groups, only muscle weakness and sensory disturbances on the side of the protruding disc predominate.
What kind 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 of this level.
Reflex syndromes
Dorsago- sudden severe pain in the thoracic spine. It is acute in nature, often described by patients as a blow with a dagger. Basically, it is felt between the shoulder blades, it can be given to the heart, to the sternum. Patients are afraid to move and even take a deep breath, as the pain intensifies (as if recovering) from this. Most often, these symptoms occur after a long stay in a fixed uncomfortable posture, while performing monotonous work. A sudden movement after this causes the backbone in people with osteochondrosis of the thoracic spine. When palpating the thoracic spine, the tension of the paravertebral muscles in the form of a roller and their pain is revealed.
Sometimes this pain can be considered a heart attack, so severe and sudden it seems to the patient. However, the electrocardiogram taken is not abnormal, and the use of nitroglycerin under the tongue does not eliminate the pain.
Back painis another type of reflex thoracic level syndrome. It is a pain syndrome that occurs gradually. Pain can be located in any part of the back, chest. Aching, dull pain, sometimes with a tinge of burning (which is associated with irritation of vegetative structures). It is aggravated by movements of the spine, flexion, rotation around its axis, coughing or sneezing, driving on rough roads.
Pain can be felt along the intercostal spaces on one or both sides. This feature is due to the course of the nerve conductors (the intercostal nerves and vessels are located in the intercostal space). In this case, the pain is called intercostal neuralgia, by analogy with the pain of shingles.
If the pain is localized on the anterior chest wall, it is also called pectalgia. However, it can only be felt in some places with the back intact. For example, in the area of the xiphoid process or at the attachment site of the sternocleidomastoid muscle. Very often, due to the aching and dull nature of the pain, it is difficult to understand exactly where it hurts: either something inside the chest or in the area of superficial soft tissues.
Back pain may be accompanied by reflex tension of 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. However, on palpation, muscle compaction is felt and the touch itself causes discomfort or pain. Palpation of the interspinal spaces and paravertebral points in the area of the segment affected by osteochondrosis is also painful.
Reflex syndromes in osteochondrosis of the thoracic spine are much more common than compression.
Compression syndromes
Compression of the nerve rootis accompanied, first of all, by the pain syndrome. Pain is shooting into nature. The direction of pain diffusion corresponds to the course of the nerve fibers. In the case of thoracic osteochondrosis, these are intercostal spaces. Since some nerve fibers form plexuses involved in innervating internal organs, it is possible to feel pain inside the chest, abdomen. The pain intensifies when moving, bending the body, coughing, sneezing, laughing (because in these moments the tension of the root increases). Sensitivity disorders can be observed in the area innervated by the compressed root: sensation of crawling, numbness, tingling. Touching this area may not be felt well. In cases where the nerve root is subjected to compression for a long time, movement disorders can occur, i. e. weakness of the muscles it innervates. Muscles gradually atrophy. However, movement disorders are very rare because they are the most recent in the history of the onset of all symptoms. Usually, a person seeks medical help in the stage of pain and sensory disturbances.
Spinal cord compressionmanifests itself as weakness in the legs with a simultaneous increase in muscle tone (if the spinal cord is compressed in the lower thoracic spine, muscle tone decreases). Pathological symptoms of the foot may appear (Babinsky and others). Sensitivity in the lower limbs is lost, the sensation of touching cold and hot does not differ, the difference between just touching and an injection. In case of severe spinal cord compression, urinary disorders can occur.
Compression of the blood vessels,which supplies the spinal cord, leads to the development of myeloischemia, ie malnutrition of the spinal cord tissue. This, as well as compression of the spinal cord, is accompanied by the development of muscle weakness (patients say "the legs have given way"), loss of sensation and pelvic discomfort.
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 osteochondrosis of the thoracic spine
Due to the fact that nerve fibers from the thoracic spine contain autonomic conductors, irritation or violation of these fibers can be accompanied by autonomic symptoms. These can be:
- dryness and peeling of the skin in the innervation area of a separate nerve;
- local violation of sweating and thermoregulation (also according to the innervation zone);
- cold in the lower limbs, brittle nails;
- pains that simulate diseases of the gastrointestinal tract (eg gastritis, gastric ulcer, cholecystitis, and so on);
- pain in the kidneys, which actually has nothing to do with kidney pathology (there are no changes in urine and ultrasound)
- pain in the region of the heart, very similar to angina pectoris and even myocardial infarction.
The peculiarity of such pain may be the fact that at the same time a person may not feel pain in the back. This is initially misleading to both the patient and medical staff when seeking medical help. However, carrying out a number of additional research methods makes it possible to exclude the pathology of internal organs, so osteochondrosis of the thoracic spine is considered the cause of such pain.
Treatment of osteochondrosis of the thoracic spine
All methods of treatment of osteochondrosis of the thoracic spine are divided into drugs and non-drugs. In most cases, only a combination of both groups has an effect and the disease regresses. 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 suspended, slowed down, but it has no reverse development.
Medication
The main directions of exposure to the drug for osteochondrosis of the thoracic spine are the elimination of pain, the elimination of muscle tension, the improvement of microcirculation and tissue trophism.
Non-steroidal anti-inflammatory drugs are successfully used to eliminate the pain syndrome. Drugs in this group have the ability to reduce the inflammation process, eliminate pain and block platelet aggregation. Drugs are prescribed, on average, for 7-14 days. This is usually enough to get rid of the pain. Many of them are available in various forms (tablets, capsules, injectable solutions, rectal suppositories), which ensures ease of use. The first days of treatment, the drugs are used in injectable form, and then they are switched to tablets or suppositories. The same drugs can be used simultaneously locally: on the thoracic spine. In addition, for this purpose there are also various 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.
The paravertebral block has a fairly good and rapid analgesic effect. This is a type of medical manipulation, when a medicinal substance is injected near the spine intracutaneously, subcutaneously, in the thickness of the muscle tissue, perineural (directly near the nerve or root). The procedure requires certain skills and experience of 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-pharmacological methods.
Diuretics, hormones, Escin Lysinat are used to relieve nerve root edema.
Pentoxifylline, Dipyridamole, Complamin, Nicotinic acid are used to normalize blood circulation, improve tissue nutrition and restore trophism.
In osteochondrosis of the thoracic spine, vitamins of group B are shown, which have analgesic and neurotrophic effects.
When the exacerbation of osteochondrosis of the thoracic spine is arrested, it is possible to resort to the use of drugs that improve the metabolism of the intervertebral discs and joints. These are the so-called chondroprotectors. These drugs stimulate the regeneration of articular cartilage, suspend the degenerative process in the intervertebral discs. They are prescribed for a long time (3-6 months).
Non-pharmacological methods
These include:
- massage (classic, punctual, reflex-segmental);
- physiotherapy exercises;
- stretching of spasmodic muscles (there are special techniques, stretching is not done according to the principle "as you want");
- acupuncture;
- swimming (very useful for all patients with any localization of osteochondrosis);
- physiotherapy (ultrasound, electrophoresis, amplipulse, diadynamic currents, mud therapy and so on).
If the hernia formed due to osteochondrosis of the thoracic spine compresses the spinal cord, its vessels or nerve roots and at the same time causes muscle weakness, dysfunction of the pelvic organs, pronounced pain syndrome (resistant touse of drugs), the question is taken into account on the execution of surgical treatment.
Osteochondrosis of the thoracic spine is not a fatal disease, but it causes a lot of harm to a sick person. It limits his life, interferes with work and good rest. The main symptom of osteochondrosis of the thoracic spine is pain. It is impossible to completely get rid of this ailment, but it is possible to suspend the degenerative process and minimize its manifestations.