Osteochondrosis of the thoracic spine is a degenerative-dystrophic chronic process of damage to the intervertebral discs and the body of the thoracic spine. This disease is somewhat rarer 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 pain in the back and chest, but it can also cause pain in the heart, abdomen, similar to angina pectoris or hepatic colic. In rare cases, osteochondrosis of the thoracic spine becomes the cause of the development of paresis of the muscles of the lower extremities, impaired sensitivity in them, disorders of the pelvic organs. Treatment of the disease consists of the use of drugs and non-medical methods, and sometimes surgery is required. In this article, you will learn about the symptoms that manifest osteochondrosis of the thoracic spine and ways to treat it.
Thoracic spine
The thoracic spine is represented by 12 vertebrae, between the bodies of which are the intervertebral discs. The discs consist of a pulposus nucleus and an annular fiber. Pathological changes on these discs, as well as on the adjacent facet joints, proliferation of bone spines along the edges of the vertebral body, 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 one part of the spine. Usually this process is diffuse, more or less pronounced in different parts of the spine.
Some structural features of the thoracic spine cause osteochondrosis to be less commonly affected than other parts. Here are the features:
- less mobility of the thoracic spine;
- the presence of connecting points of the vertebrae with ribs (which in combination with the sternum creates a strong chest frame, less susceptible to injury);
- small thickness of intervertebral discs;
- physiological kyphosis (bending in the anteroposterior direction with the bulge directed backwards) of the thoracic spine, and therefore the maximum axial load falls on the anterior rather than the posterior parts of the discs.
And yet, in the presence of provoking factors, such as a sedentary lifestyle (including years of working at a table or driving a car), injuries, poor posture, relaxed back muscles, heavy physical work in a forced position, thoracic spine osteochondrosis shows its true face.
Symptoms of osteochondrosis of the thoracic spine
The main clinical symptom of osteochondrosis of the thoracic spine, as well as other parts, is pain. Pain in the back, chest, even internal organs. In medicine, it is common to distinguish several pain syndromes (and not only pain) of 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, capsules of intervertebral joints, intervertebral discs, which receive pathological impulses in osteochondrosis. In addition to pain, reflex syndromes can be accompanied by muscle tension, autonomic disorders in soft tissues and internal organs. Such changes are based on the following fact: stimulation of the receptor leads to the spread of the stimulus to nearby spinal cord structures (more precisely to the segments of the spinal cord). And these can be neurons responsible for sweating a particular area of skin, regulating the temperature of the same area, participating in ensuring the activity of internal organs (heart, liver, intestines and so on), maintaining muscle tone and blood vessels that supply all these structures. And when the excitation is transmitted to these neurons, there are corresponding symptoms of disturbances in the activity of certain formations. Therefore, such a situation is quite possible when the pain in the abdomen or in the area of the heart is caused by osteochondrosis of the thoracic spine.
Compression syndromes occur when a nerve root is compressed (rarely stretched) when it leaves the intervertebral foramen, 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 of the lower thoracic segments. Depending on the direction and location of the hernia, a person has certain symptoms. This can be represented as follows:
- Medial (median) hernias are accompanied by the development of muscle weakness symmetrically on both legs, loss of sensitivity on them. At the same time, the pain syndrome typical of nerve root compression is absent;
- lateral hernias are manifested exclusively by pain associated with nerve root compression;
- medio-lateral hernias combine the clinical symptoms of the two previous groups, only muscle weakness and sensory disturbances predominate on the side of the protruding disc.
What syndromes are considered in the context of thoracic spine osteochondrosis? Let's talk in more detail about the types of reflex and compression syndromes of this level.
Reflex syndromes
Dorsago- sharp sudden pain in the thoracic spine. It is sharp in nature, which patients often describe as a dagger blow. It is basically felt between the shoulder blades, it can be given to the heart, the sternum. Patients are afraid to move and even take a deep breath, because the pain intensifies (as if shooting again) from it. Often these symptoms occur after a long stay in a fixed uncomfortable posture, while doing monotonous work. Sudden movement after this causes dorsago in people with osteochondrosis of the thoracic spine. Palpation of the thoracic spine reveals tension of the paravertebral muscles in the shape of a cylinder and their soreness.
Sometimes such pain can be considered a heart attack, so strong and sudden that it seems to the patient. However, taking an electrocardiogram has no abnormalities, and the use of nitroglycerin under the tongue does not eliminate the pain.
Dorsalgiais another type of reflex syndrome at the thoracic level. It is a pain syndrome that occurs gradually. The pain can be localized in any part of the back, chest. Painfully painful, dull, sometimes with an admixture of burning (which is associated with irritation of vegetative structures). It is aggravated by movements of the spine, bending, turning around its axis, coughing or sneezing, driving on uneven roads.
Pain may be felt along the intercostal spaces on one or both sides. This characteristic is due to the flow of nerve conductors (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 herpes zoster.
If the pain is localized to the anterior chest wall, it is also called pectalgia. However, this can only be felt in places with an intact back. For example, in the area of the xiphoid process or at the site of attachment of the sternocleidomastoid muscle. It is often difficult to understand exactly where it hurts due to the painful and dull nature of the pain: either inside the chest or in the area of the superficial soft tissues.
Dorsalgia may be accompanied by reflex tension of the paravertebral muscles, more pronounced on the pain side. In this case, of course, the muscle tension is not as pronounced as in a similar situation in the lumbar spine. But still, palpation feels muscle contraction, 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 thoracic spine osteochondrosis are much more common than compression.
Compression syndromes
Nerve root compressionis accompanied, above all, by pain syndrome. Pain is shooting in nature. The direction of pain distribution corresponds to the flow of nerve fibers. In the case of thoracic osteochondrosis, these are the intercostal spaces. Because some nerve fibers form plexuses that are involved in the innervation of internal organs, pain can be felt in the chest, abdomen. The pain increases with movement, bending of the body, coughing, sneezing, laughing (because in those moments the tension of the roots increases). In the zone innervated by the compressed root, sensitivity disorders can be noticed: a feeling of crawling, numbness, tingling. Touching this area may not feel good. In cases when the nerve root has been subjected to compression for a long time, movement disorders can occur, ie weakness of the innervated muscles. The muscles gradually atrophy. However, movement disorders are very rare, as they are the latest in the chronology of the appearance of all symptoms. Usually, a person seeks medical help in the phase of pain and sensory disorders.
Spinal cord compressionmanifests as leg weakness with a simultaneous increase in muscle tone (if the spinal cord is compressed in the lower thoracic spine, then muscle tone decreases). Pathological foot symptoms may occur (Babinsky et al. ). Sensitivity on the lower extremities is lost, the sensation of touching cold and hot does not differ, the only difference is touching and injection. In cases of severe spinal cord compression, urination disorders can occur.
Compression of blood vessels,which supplies the spinal cord, leads to the development of myelochemistry, or malnutrition of spinal cord tissue. This, as well as spinal cord compression, accompanies the development of muscle weakness (patients say "legs have failed"), loss of sensation and pelvic disorders.
It is fair to say that compression of the spinal cord and its vessels in thoracic spine osteochondrosis is very, very rare.
Vegetative components of thoracic spine osteochondrosis
Due to the fact that nerve fibers coming from the thoracic spine contain autonomic conductors, irritation or violation of these fibers may be accompanied by autonomic symptoms. These can be:
- dryness and peeling of the skin in the area of innervation of a separate nerve;
- local violation of sweating and thermoregulation (also according to the zone of innervation);
- coldness of the lower extremities, brittle toenails;
- pains that simulate 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 (no changes in urine and ultrasound);
- pain in the heart area, very similar to angina pectoris, and even myocardial infarction.
The peculiarity of such pain may be the fact that the person may not feel back pain. This is initially misleading for both the patient and the medical staff when seeking medical help. However, by conducting a series of additional research methods it is possible to exclude the pathology of internal organs, and then 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 medical and non-medical. In most cases, only a combination of both groups gives an effect and the disease recedes. Although you must 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 there is no reverse development.
Medications
The main directions of exposure to the drug osteochondrosis of the thoracic spine are the removal of pain, removal of muscle tension, improvement of microcirculation and tissue trophism.
Nonsteroidal anti-inflammatory drugs have been used successfully to relieve pain syndrome. Drugs from this group have the ability to reduce the inflammatory process, eliminate pain and block platelet aggregation. Medications are prescribed for an average of 7-14 days. This is usually enough to relieve the pain. Many of them are available in different forms (tablets, capsules, solution for injection, rectal suppositories), which ensures ease of use. In the first days of treatment, the drugs are used in the form of injections, and then they are transferred to tablets or suppositories. The same drugs can be used topically at the same time: in the area of the thoracic spine. Moreover, for this purpose there are different forms of release: creams, ointments, gels, patches.
Sometimes nonsteroidal anti-inflammatory drugs are not enough to relieve pain. In such cases, resort to the use of analgesic mixtures. The mixture is injected intravenously in saline or glucose.
Paravertebral block has a pretty good and quick analgesic effect. This is a type of medical manipulation, when the medicinal substance is injected near the spine intracutaneously, subcutaneously, into the thickness of the muscle tissue, perineurally (directly near the nerve or root). The procedure requires certain skills and experience of a doctor.
Also, locally irritating and disturbing fats can be used to reduce pain in osteochondrosis of the thoracic spine. These are fats that contain snake venom, bee venom and pepper extracts.
Muscle tension is relieved by non-drug methods.
Diuretics, hormones, Escina 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, B vitamins have been shown to have analgesic and neurotrophic effects.
When the worsening of osteochondrosis of the thoracic spine stops, you can 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, stopping the degenerative process on the intervertebral discs. They are prescribed for a long time (3-6 months).
Non-medical methods
These include:
- massage (classical, pointed, reflex-segmental);
- physiotherapy exercises;
- stretching of spasmodic muscles (there are special techniques, stretching is not done according to the principle "as you wish");
- acupuncture;
- swimming (very useful for all patients with any localization of osteochondrosis);
- physiotherapy (ultrasound, electrophoresis, ampulsion, diadynamic currents, mud therapy and so on).
If a hernia resulting from osteochondrosis of the thoracic spine compresses the spinal cord, its vessels or nerve roots, and at the same time causes muscle weakness, pelvic organ dysfunction, severe pain syndrome (resistant to the use of drugs), then the issue is considered for surgical treatment.
Osteochondrosis of the thoracic spine is not a deadly disease, but it causes a lot of damage to the sick person. It limits his life, disrupts his work and good rest. The main symptom of osteochondrosis of the thoracic spine is pain. It is impossible to completely get rid of this disease, but it is possible to stop the degenerative process and minimize its manifestations.