Osteochondrosis of the thoracic spine is a degenerative-dystrophic chronic 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 trouble 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 causes 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 in the use of medication and non-drug methods, and sometimes even surgery is required. From this article you will learn about the symptoms that manifest 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 there are intervertebral discs. Discs consist of a nucleus pulposus and an annulus fibrosus. Pathological changes in these discs, as well as in the adjacent facet joints, 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 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 it to be less frequently affected by osteochondrosis than other spine regions. Let's 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 frame of the chest, less prone to injury);
- small thickness of intervertebral discs;
- physiological kyphosis (bending in the anteroposterior direction with a bulge directed backward) of the thoracic spine, and therefore the maximum axial load falls on the anterior rather than posterior parts of the discs.
Another feature of not the structure, but the development of osteochondrosis of the thoracic spine, which also determines the lesser 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 provoking factors, such as a sedentary lifestyle (including years of work at a desk or driving a car), injuries, poor posture, sagging back muscles, hard physical labor in a forced position, osteochondrosis of the thoracic spineshows his 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. Back pain, chest pain, even pain in the internal organs. In medicine, it is customary to distinguish several pain (and not only pain) syndromes 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, 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 nearby structures of the spinal cord (to be more precise, to 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, and so on), maintaining the tone of muscles and blood vessels that supply all these structures. And when excitement 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 pain in the abdomen or in the region of the heart is 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 tissue of the spinal cord or the vessels feeding 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 muscle weakness symmetrically in both legs, loss of sensitivity in them. At the same time, the pain syndrome typical for compression of the nerve root is absent;
- lateral (lateral) hernias manifest exclusively pain associated with compression of the nerve root;
- 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 kind of syndromes are considered within the framework 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- sharp sudden pain in the thoracic spine. It is of a sharp 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, sternum. Patients are afraid to move and even take a deep breath, as the pain intensifies (as if re-shooting) from this. Quite often, these symptoms occur after a long stay in a fixed uncomfortable posture, while performing monotonous work. A sharp movement after this provokes dorsago 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 soreness is revealed.
Sometimes such pain can be regarded as a heart attack, so severe and sudden it seems to the patient. However, the taken electrocardiogram has no abnormalities and the use of nitroglycerin under the tongue does not eliminate the pain.
Dorsalgiais another type of thoracic reflex syndrome. It is a pain syndrome that occurs gradually. The pain can be localized in any part of the back, chest. Painful aching, dull, sometimes with a tinge of burning (which is associated with irritation of vegetative structures). It intensifies with movements of the spine, bending, rotating 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 (intercostal nerves and vessels are located in the intercostal space). In this case, the pain is called intercostal neuralgia, by analogy with shingles pain.
If pain is localized on the anterior chest wall, it is also called pectalgia. However, it can be felt only in some places with an intact back. For example, in the area of the xiphoid process or at the site of attachment of the sternocleidomastoid muscle. Quite often, due to the aching and dull nature of the pain, it is difficult to figure out exactly where it hurts: either something inside the chest, or in the area of superficial soft tissues.
Dorsalgias may be accompanied by reflex tension of the paravertebral muscles, more pronounced on the side of pain. In this case, of course, muscle tension is not as pronounced as in a similar situation in the lumbar spine. But still, on palpation, muscle compaction is felt, and the touch itself causes discomfort or pain. Also painful is palpation of 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
Compression of the nerve rootis accompanied, first of all, by pain syndrome. The pain is shooting in nature. The direction of the spread of pain 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 that are involved in the innervation of internal organs, pain can be felt inside the chest, abdomen. The pain intensifies when moving, bending the body, coughing, sneezing, laughing (because at these moments the tension of the root increases). In the zone that the compressed root innervates, sensitivity disorders can be observed: a feeling 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 may occur, that is, the 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 disorders.
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, then muscle tone decreases). Pathological foot symptoms may appear (Babinsky and others). Sensitivity in the lower extremities is lost, the sensation of touching cold and hot does not differ, the difference between just a touch and an injection. In cases of severe compression of the spinal cord, urinary disorders may occur.
Compression of blood vessels,supplying the spinal cord, leads to the development of myeloischemia, that is, malnutrition of the spinal cord tissue. This, as well as the compression of the spinal cord, is accompanied by the development of muscle weakness (patients say "the legs have failed"), 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 the nerve fibers coming from the thoracic spine contain autonomic conductors, irritation or infringement 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);
- chilliness of the lower extremities, brittle toenails;
- pains simulating diseases of the gastrointestinal tract (for example, gastritis, gastric ulcer, cholecystitis, and so on);
- pain in the kidneys, which in fact have 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 a person may not feel pain in the back. This is initially misleading for both the patient and the medical staff when seeking medical help. However, carrying out a number of additional research methods makes it possible to exclude the pathology of the internal organs, and then osteochondrosis of the thoracic spine is considered the cause of such pain.
Treatment of osteochondrosis of the thoracic spine
All methods of treatment for osteochondrosis of the thoracic spine are divided into medication and non-medication. In most cases, only a combination of both groups gives 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 suspended, slowed down, but it has no reverse development.
Medication
The main directions of drug exposure for osteochondrosis of the thoracic spine are the elimination of pain, elimination of muscle tension, improvement of microcirculation and tissue trophism.
Non-steroidal anti-inflammatory drugs are successfully used to eliminate pain syndrome. Drugs in this group have the ability to reduce the process of inflammation, eliminate pain, and block platelet aggregation. The drugs are prescribed, on average, for 7-14 days. This is usually enough to eliminate pain. Many of them are available in various forms (tablets, capsules, solutions for injections, rectal suppositories), which ensures ease of use. The first days of treatment, drugs are used in injectable form, and then they are switched to tablets or suppositories. The same drugs can be used locally at the same time: on the area of the thoracic spine. Moreover, 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.
Paravertebral blockade has a fairly good and quick analgesic effect. This is a type of medical manipulation, when a medicinal substance is injected near the spine intracutaneously, subcutaneously, into the thickness of muscle tissue, perineurally (directly near the nerve or root). The procedure requires certain skills and experience of the doctor.
Also, local irritating and distracting 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-drug methods.
Diuretics, hormones, Escina Lysinat are used to relieve edema of the nerve root.
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 are shown, which have analgesic and neurotrophic effects.
When the exacerbation of osteochondrosis of the thoracic spine is arrested, you can resort to the use of drugs that improve the metabolism of 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-drug methods
These include:
- massage (classic, point, 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 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 the use of drugs), then the question is consideredabout carrying out surgical treatment.
Osteochondrosis of the thoracic spine is not a deadly 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.