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 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 give pain in the heart, in the 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. The treatment of the disease consists of the use of medicinal and non-pharmacological methods and, sometimes, even surgery is required. From this article you will learn about the symptoms of osteochondrosis of the thoracic spine and the methods of their treatment.
Thoracic spine
The thoracic spine is represented by 12 vertebrae, between whose bodies are the intervertebral discs. The discs consist of a nucleus pulposus and an annulus fibrosus. Pathological changes in these discs, as well as in the adjacent facet joints, the growth of bone spines along the edges of the vertebral bodies, dystrophic processes in the ligaments of the spine and become the direct cause of theBack pain.
It should be understood that osteochondrosis, as a disease, rarely affects only part of the spine. In general, this process is diffuse, more or less pronounced in various parts of the spine.
Some structural features of the thoracic spine cause osteochondrosis to affect it less frequently than other regions of the spine. Let's list these characteristics:
- 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 framework of the thorax, less prone to injury);
- small thickness of the intervertebral discs;
- Physiologic kyphosis (anteroposterior flexion with a rearwardly directed bulge) of the thoracic spine, and therefore the maximum axial load is on the anterior and non-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 existing morphological bases of osteochondrosis in this part can remain clinically "dumb "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 a sedentary lifestyle (including years of working at a desk or driving a car), injuries, poor posture, sagging of the back muscles, hard physical workIn a forced position, osteochondrosis of the thoracic spine shows its true face.
Symptoms of osteochondrosis of the thoracic spine
The main clinical symptom of osteochondrosis of the thoracic spine, as well as elsewhere, is pain. Back pain, chest pain, even pain in internal organs. In medicine, it is customary to distinguish various pain syndromes (and not only pain) of osteochondrosis of the thoracic spine. In total, they are divided into two groups:
- reflection;
- 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, vegetative disorders in soft tissues and internal organs. Such changes are based on the following fact: stimulation of the receptors leads to the propagation of excitation to the nearby structures of the spinal cord (to be more precise, to the segments of the spinal cord). And these can be 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 themuscles and blood vessels that supply all these structures. And when excitement is transmitted to these neurons, the corresponding symptoms of a violation of the activity of certain formations appear. Therefore, such a situation is quite possible when the 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) as it exits 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 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 (medium) hernias are accompanied by the development of symmetrical muscle weakness in both legs, loss of sensation in them. At the same time, the typical pain syndrome of nerve root compression is absent;
- Lateral (lateral) hernias are manifested exclusively by pain associated with compression of the nerve root;
- Mediolateral 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 types of syndromes are considered in the setting of osteochondrosis of the thoracic spine? Let's talk in more detail about the types of reflex and compression syndromes at this level.
Reflex syndromes
Dorsago: sudden, sharp pain in the thoracic spine. It is cutting in nature, often described by patients as being struck with a dagger. Basically it is felt between the shoulder blades, it can be delivered to the heart, to the sternum. Patients are afraid to move and even take deep breaths, as the pain intensifies (as if to shoot up again). Most often, these symptoms occur after a long stay in a fixed uncomfortable posture, while doing monotonous work. A sudden movement after this provokes dorsagus in people with osteochondrosis of the thoracic spine. Palpation of the thoracic spine reveals the tension of the roller-shaped paravertebral muscles and their pain.
Sometimes that pain can be considered a heart attack, so severe and sudden that it seems to the patient. However, the electrocardiogram taken does not show abnormalities and the use of nitroglycerin under the tongue does not eliminate the pain.
Dorsalgiais another type of reflex syndrome at the chest level. It is a pain syndrome that occurs gradually. The pain can be located in any part of the back, the chest. Painful, dull pain, sometimes with a burning tinge (which is associated with irritation of vegetative structures). It intensifies with movements of the spine, stooping, turning around its axis, coughing or sneezing, driving on an uneven road.
Pain can be felt along the intercostal spaces on one or both sides. This feature is due to the course of nerve conductors (the intercostal nerves and vessels meet 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 to 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 process or at the insertion site of the sternocleidomastoid muscle. Very often, due to the aching and dull nature of the pain, it is difficult to know exactly where it hurts: something inside the chest or in the area of the superficial soft tissues.
Dorsalgias can 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 even so, on palpation, muscle compaction is felt and the touch itself causes discomfort or pain. The palpation of interspinous 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 pain. Pain shoots up in nature. The direction of pain propagation corresponds to the course of the nerve fibers. In the case of thoracic osteochondrosis, these are intercostal spaces. Since some of the nerve fibers form plexuses involved in the innervation of internal organs, pain can be felt within the chest and abdomen. The pain intensifies when moving, bending the body, coughing, sneezing, laughing (because at these moments the tension of the root increases). In the area that innervates the compressed root, sensitivity disorders can be observed: tingling sensation, numbness, tingling. It may not feel right to touch this area. In cases where the nerve root is under compression for a long time, movement disorders can occur, that is, weakness of the muscles it innervates. 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 at the stage of pain and sensory disturbances.
Compression of the spinal cordmanifests as weakness in the legs with a simultaneous increase in muscle tone (if the spinal cord is compressed in the lower thoracic spine, the muscle tone decreases). Pathological foot symptoms may appear (Babinsky and others). Sensitivity in the lower extremities is lost, the sensation of hot and cold touching does not differ, the difference between just touching and an injection. In cases of severe compression of the spinal cord, urinary disorders can occur.
Compression of the blood vesselsthat supply the spinal cord leads to the development of myeloischemia, that is, 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 they "failed the legs"), loss of sensation and pelvic disorders.
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 coming from the thoracic spine contain autonomic conductors, irritation or infringement of these fibers can be accompanied by autonomic symptoms. These can be:
- dryness and peeling of the skin in the area of innervation of a separated nerve;
- local violation of sweating and thermoregulation (also depending on the zone of innervation);
- coldness of the lower extremities, brittle nails;
- pain simulating diseases of the gastrointestinal tract (eg gastritis, gastric ulcer, cholecystitis, etc. );
- pain in the kidneys, which in fact has nothing to do with kidney disease (no changes in urine or 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 back pain. Initially, this is misleading to both the patient and the medical staff when seeking medical help. However, conducting a number of additional research methods makes it possible to exclude the pathology of internal organs, and then osteochondrosis of the thoracic spine is considered the cause of such pain.
Treatment of osteochondrosis of the thoracic spine
All treatment methods for osteochondrosis of the thoracic spine are divided into drugs and non-drugs. In most cases, only a combination of both groups produces 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 does not have a reverse development.
Medications
The main directions of drug exposure for osteochondrosis of the thoracic spine are elimination of pain, elimination of muscle tension, improvement of microcirculation and tissue trophism.
Nonsteroidal anti-inflammatory drugs are used successfully to eliminate pain syndrome. The drugs of this group have the ability to reduce the inflammation process, eliminate pain, and block platelet aggregation. Medications are prescribed, on average, for 7-14 days. This is usually enough to eliminate the pain. Many of them are available in various forms (tablets, capsules, solutions for injection, rectal suppositories), ensuring ease of use. The first days of treatment, the drugs are used in injectable form and then switched to tablets or suppositories. The same drugs can be used simultaneously topically - on the thoracic spine. In addition, for this purpose there are also various forms of release: creams, ointments, gels, plasters.
Sometimes nonsteroidal 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 fast analgesic effect. This is a type of medical manipulation, when a 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 from the doctor.
Additionally, distracting and irritating local ointments can be used to relieve pain in osteochondrosis of the thoracic spine. These are ointments that contain snake venom, bee venom, and pepper extracts.
Muscle tension is relieved with non-pharmacological methods.
Diuretics, hormones, Aescin Lysinat are used to relieve nerve root edema.
Pentoxifylline, Dipyridamole, Complamin and Nicotinic Acid are used to normalize blood circulation, improve tissue nutrition and restore trophism.
In osteochondrosis of the thoracic spine, B vitamins are shown, which have analgesic and neurotrophic effects.
When the exacerbation of osteochondrosis of the thoracic spine is stopped, 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, 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);
- physical therapy exercises;
- spasmodic muscle stretching (there are special techniques, stretching is not done on the "as you like" principle);
- acupuncture;
- swimming (very useful for all patients with any location of osteochondrosis);
- physiotherapy (ultrasound, electrophoresis, amplipulse, diadynamic currents, mud therapy, etc. ).
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 the pelvic organs, pronounced pain syndrome (resistant to useof medications), then the problem of performing a surgical treatment is considered.
Osteochondrosis of the thoracic spine is not a fatal disease, but it causes a lot of harm 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 completely get rid of this ailment, but it is possible to suspend the degenerative process and minimize its manifestations.