In the case of thoracic osteochondrosis, the organs associated with areas of the spinal cord, located at the level of the affected thoracic region and below, often suffer. Violation of the normal activity of the spine leads to immobility of the arms, legs and trunk as a whole, dysfunction of Organs pelvic organs, respiratory muscles and internal organs.
Osteochondrosis is a degenerative-dystrophic disease of the spine, which is based on an alteration in the intervertebral discs with involvement in the pathological process of neighboring vertebrae and intervertebral joints with the entire ligament apparatus.
Features of spinal anatomy
The mobility and stability, elasticity and elasticity of the spine largely depend on the intervertebral discs, which are one of the types of cartilaginous connection between bones and provide a strong connection between the bodies of neighboring vertebrae. The total length of the intervertebral discs is a quarter of the length of the spine.
The most important function of discs is to reduce the vertical load on the vertebrae. The disc consists of three parts:
- hyaline plates (well adjacent to the vertebrae);
- nucleus pulposus (fills the space between the plates);
- annulus fibrosus (encloses the nucleus on the outside).
The nucleus contains cartilage cells, tightly intertwined collagen fibers and chondrin (proteoglycans). The anterior surface of the discs is covered by the anterior longitudinal ligament, which is firmly fused with the vertebrae and freely rotates over the discs. The posterior longitudinal ligament is firmly fused with the surface of the disc and forms the anterior wall of the spinal canal. The intervertebral disc does not have its own blood supply, so it feeds on substances that come by diffusion from the vertebral bodies.
The distribution of vertical loads on the spine occurs due to the elastic properties of the discs. As a result of the pressure, the nucleus pulposus expands and the pressure is redistributed to the annulus fibrosus and hyaline plaques. During movement, the nucleus moves in the opposite direction: when flexed - towards convexity, when not bent - anteriorly. When the spine moves, muscles, ligaments and discs are included in the work. Therefore, a violation in one link leads to a violation in the entire kinetic chain.
Causes and mechanism of disease development
In the development of osteochondrosis, a special role is played by the mechanical effect on the spine. Under the influence of unfavorable static and dynamic loads, the nucleus pulposus gradually loses its elastic properties (as a result of the depolymerization of polysaccharides), forms protrusions and sequesters.
The process of disc degeneration is influenced by a genetic predisposition, which causes the development of changes in the neuromuscular apparatus of the back, a change in the structure of glucosamines and a violation of the distribution of collagen fibers in the disc. The genetic factor is paramount in the occurrence of thoracic osteochondrosis, subject to increased functional activity.
Risk factors for the development of degenerative changes in the spine include the anatomical characteristics of the discs, which are imperfections in evolution. One of these characteristics is the nutritional characteristics of the structures. In the human body, the disc consists of poorly perfused tissue. Closure of blood vessels occurs already in childhood. After nutrition occurs due to the diffusion of substances through the end plates.
The nutrient penetration stimulator is a dosed load that excludes static postures and great stress. Physical inactivity is one of the main risk factors for thoracic osteochondrosis. Therefore, regular exercise is an important preventive measure.
The peculiarity of the microscopic structure - few cells - reduces the intensity of regenerative capacity and the rate of recovery of disc components. An anatomical feature is the weakness and lack of strength of the discs in the posterior sections. This contributes to the appearance of wedge-shaped discs in the lower thoracic and lumbar regions.
Great importance in the development of osteochondrosis is given to involutive changes. Actively degenerative changes begin to increase after 30 years. The synthesis of components needed by the disc (glycosaminoglycans) continues, but their quality is deteriorating. Hydrophilicity decreases, fibrosity increases, sclerosis appears.
Intervertebral disc degeneration stages:
- prolonged asymptomatic course, degenerative changes in intradiscal components, displacement of the nucleus within the disc;
- pronounced radicular symptoms of thoracic osteochondrosis, spinal cord compression, nucleus pulposus protrusion (protrusion, 1 degree);
- disc rupture with hernial protrusion (hernia, 2nd degree);
- degenerative changes in extradiscal components (note 3).
The pathological protrusion compresses the nerve roots, blood vessels or spinal cord at various levels (cervical, thoracic, lumbar), which determines the clinical picture.
The restriction of mobility in the thoracic spine, which is due to the presence of the thorax, contributes to less trauma to the intervertebral discs and, therefore, to osteochondrosis. Physiological thoracic kyphosis contributes to weight redistribution from the upper half of the body to the lateral and anterior sections of the vertebrae. Therefore, intervertebral hernias and osteophytes are formed on the anterior and lateral surfaces of the spine. Posterior osteophytes and hernias are extremely rare.
Osteochondrosis contributes to the narrowing of the intervertebral foramina and compression of the spinal cord roots and sympathetic fibers. Sympathetic fibers originate in the gray matter of the spinal cord, then gather in nodes, from which they are sent to all internal organs. This leads to the fact that thoracic osteochondrosis, in addition to typical neurological disorders, leads to dysfunction of internal organs (vegetative, vasomotor, trophic) and imitation of somatic diseases. This characteristic of osteochondrosis of the thoracic discs explains the difficulties in diagnosing and prescribing the correct treatment.
Symptoms of Thoracic Osteochondrosis
Thoracic osteochondrosis is more typical for people with a sedentary lifestyle. At the same time, there is no stimulating effect of dosed loads on the spine, which contributes to the interruption of disc recovery. Diseases develop in people who work at a computer for a long time, bend over, etc. these people need to perform therapeutic exercises independently.
Most often, thoracic osteochondrosis is manifested by dull, less often painful and burning pains. The pain is located between the shoulder blades. The patient is disturbed by the feeling of chest compression. When feeling the spinous processes of the thoracic vertebrae, local pain is detected, which increases with axial loads on the spine, deep inspiration and body turns.
Many patients have sharp pains in the scapula and lower chest (posterior costal syndrome). This symptomatology develops as a result of dislocation of the lower ribs. The pain sharply increases when turning the trunk. More often, the pain syndrome disappears abruptly.
Often chest pain becomes waist, corresponds to the course of the intercostal nerve. Sensitivity in the area of innervation of the corresponding nerve ending is disturbed, paresthesias appear, and there is usually a decrease in superficial and deep sensitivity. Possible violation of the function of the abdominal press, a change in knee reflexes and the Achilles tendon.
Violation of the function of internal organs occurs when any nerve root is compressed at the level of 1 to 12 of the chest. In the thoracic region there are structures responsible for the innervation of the lungs, heart, intestines, liver, pancreas and kidneys. Therefore, there are no characteristic signs just for thoracic osteochondrosis.
The disease is manifested by symptoms characteristic of another pathology:
- difficulty breathing;
- intense night pains;
- "heart", anginal pains;
- pain in the mammary glands;
- pain in the right or left upper quadrant (symptoms of cholecystitis and pancreatitis);
- sore throat and esophagus;
- pain in the epigastrium, abdomen (symptoms of gastritis, enteritis and colitis);
- sexual dysfunction.
Diagnosis
The greatest value in the diagnosis of thoracic osteochondrosis is the radiographic examination of the chest. The image shows a decrease in the height of the intervertebral disc, sclerosis of the endplates, formation of osteophytes.
Computed tomography makes it possible to clarify the condition of the vertebrae, joints of the spine, the size of the spinal canal, determine the location of the hernia protrusion and its size.
When performing the differential diagnosis, it is necessary to carefully collect a history and compare all clinical signs of thoracic osteochondrosis with symptoms of other diseases. For example: heart pain with osteochondrosis is not stopped by nitroglycerin, epigastric pain is not associated with food intake, it is not seasonal, all symptoms appear mainly at night and completely disappear after a night of rest.
How to treat thoracic osteochondrosis?
The treatment of osteochondrosis of the thoracic spine in almost all cases is conservative. The therapeutic indication is the predominance of visceral syndromes with neurological disorders. The main orthopedic treatment should be adequate spinal traction:
- active vertical traction under water;
- Passive horizontal traction on an inclined bed using the Glisson loop in case of injury at the level of 1-4 thoracic vertebrae, by the axillary straps in case of injury at the level of 4-12 thoracic vertebrae.
Drug treatment consists of performing paravertebral blocks with novocaine solution. With an exacerbation of the disease, analgesics and sedatives are used. With an unexpressed pain syndrome, it is permissible to use ointments with analgesics and anti-inflammatories at home.
After eliminating acute phenomena, a massage of the muscles of the back and lower extremities is used. Manual therapy is indicated for 1-3 degrees of osteochondrosis in the event that functional blocks develop. It includes several options for smooth and rough effects on the back muscles.
Therapeutic exercise allows you to load all parts of the spine in a dosed way, which stimulates the recovery processes. An important condition for exercise therapy for osteochondrosis is to exclude vertical loads.
Physiotherapy: UHF treatment, ultrasound, indothermia, radon and pine-coniferous salt baths. In the spa phase, underwater traction and whirlpool are actively used.
Surgical treatment is rarely used. The indication for surgical intervention is spinal cord compression by a prolapsed disc fragment.