In the case of thoracic osteochondrosis, the organs associated with the spinal cord area, which are 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 chest as a whole, dysfunction of the pelvic organs, respiratory muscles and internal organs.
Osteochondrosis is a degenerative-dystrophic disease of the spine, which is based on changes in the intervertebral discs with involvement in the pathological processes of neighboring vertebrae and intervertebral joints with the entire ligamentous apparatus.
Anatomical features of the spine
The mobility and stability, elasticity and elasticity of the spine are highly dependent on the intervertebral discs, which are a type of cartilage connection between bones and provide a strong bond between neighboring vertebral bodies. The total length of the intervertebral discs is a quarter of the length of the spine.
The most important function of the discs is to reduce the vertical load on the spine. The disc consists of three parts:
- hyaline plates (closely adjacent to the vertebrae);
- nucleus pulposus (fills the gap between the plates);
- fibrous ring (surrounds the nucleus from the outside).
The nucleus contains cartilage cells, tightly interwoven collagen fibers and chondrins (proteoglycans). The anterior surface of the disc is covered by the anterior longitudinal ligament, which is tightly fused with the vertebrae and freely turns the disc. The posterior longitudinal ligament is firmly attached to the disc surface and forms the anterior wall of the spinal canal. The intervertebral disc does not have its own blood supply, therefore it feeds on substances that come from diffusion from the vertebral bodies.
The distribution of vertical loads in 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 the hyaline plate. During movement, the core moves in the opposite direction: when bent - in a convex direction, when not bent - forward. When the spine moves, muscles, ligaments and discs are included in the work. Therefore, a breach in one link leads to a breach in the entire kinetic chain.
Causes and mechanisms of disease development
In the development of osteochondrosis, a special role is played by mechanical effects on the spine. Under the influence of unfavorable static and dynamic loads, the nucleus pulposus gradually loses its elastic properties (as a result of depolymerization of polysaccharides), forming protrusions and sequestrations.
The process of disc degeneration is influenced by genetic predisposition, which leads to the development of changes in the neuromuscular apparatus of the back, changes in the structure of glycosamines, and a violation of the distribution of collagen fibers in the disc. Genetic factors are the most important in the occurrence of thoracic osteochondrosis, depending on the increase in functional activity.
Risk factors for the development of degenerative changes in the spine include the anatomical features of the discs, which are imperfections in evolution. One of these features is the nutritional feature of the structure. In the human body, the disc is composed of poorly perfused tissue. Closure of blood vessels already occurs in childhood. After nutrition occurs due to the diffusion of substances through the end plate.
The stimulator of nutrient penetration is a closed load that excludes static postures and great stress. Lack of physical activity is one of the main risk factors for thoracic osteochondrosis. Therefore, regular exercise is an important preventive measure.
The uniqueness of the microscopic structure - a few cells - reduces the intensity of the regenerative abilities and the recovery rate of disk components. Anatomical features are weakness and lack of strength of the disc in the posterior part. 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. Active degenerative changes begin to increase after 30 years. Synthesis of the components necessary for the disc (glycosaminoglycans) continues, but their quality deteriorates. Hydrophilicity decreases, fiber increases, sclerosis appears.
Stages of degeneration of the intervertebral discs:
- prolonged asymptomatic course, degenerative changes in the intradiskal component, displacement of the nucleus within the disc;
- pronounced radicular symptoms of thoracic osteochondrosis, compression of the spinal cord, protrusion of the nucleus pulposus (protrusion, 1 degree);
- disc rupture with herniated protrusion (hernia, grade 2);
- degenerative changes in the extradiscal component (grade 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, caused by the presence of the chest, contributes to the least trauma to the intervertebral discs, and hence to osteochondrosis. Physiological thoracic kyphosis contributes to the redistribution of the weight of the upper body to the lateral and anterior parts of the vertebrae. Therefore, intervertebral hernias and osteophytes form on the anterior and lateral surfaces of the spinal column. Posterior osteophytes and hernias are very 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 into nodes, from where they are sent to all internal organs. This leads to the fact that thoracic osteochondrosis, in addition to characteristic neurological disorders, causes dysfunction of internal organs (vegetative, vasomotor, trophic) and mimics somatic diseases. This feature of osteochondrosis of the thoracic discs explains the difficulty 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 the dose load on the spine, which contributes to impaired disk recovery. The disease develops in people who work at the computer for a long time, bend over, etc. such people need to independently carry out therapeutic exercises.
Most often, osteochondrosis of the chest is manifested by dull pain, less often pain and burning. The pain is localized between the shoulder blades. The patient is disturbed by the feeling of chest compressions. When feeling the spinous processes of the thoracic vertebrae, local pain is detected, which increases with axial load on the spine, deep inspiration and rotation of the body.
A number of patients experience sharp pain in the scapula and lower chest (posterior costal syndrome). This symptom develops as a result of displacement of the lower ribs. The pain increases sharply when twisting the torso. More often, the pain syndrome disappears suddenly.
Often the pain in the chest becomes corset, according to the course of the intercostal nerves. Sensitivity in the innervation zone of the corresponding nerve endings is impaired, paresthesias appear, and there is often a decrease in superficial and deep sensitivity. Possible violation of the function of the abdominal press, changes in the reflexes of the knee and calcaneal tendons.
Violation of the function of internal organs occurs when the nerve roots are compressed at a level from 1 to 12 chest. In the chest area there are structures that are responsible for the innervation of the lungs, heart, intestines, liver, pancreas and kidneys. Therefore, there are no typical signs only for thoracic osteochondrosis.
The disease is manifested by symptoms characteristic of other pathologies:
- hard to breath;
- intense night pain;
- "heart", anginal pain;
- pain in the mammary glands;
- pain in the right or left hypochondrium (symptoms of cholecystitis and pancreatitis);
- pain in the throat and esophagus;
- pain in the epigastrium, stomach (symptoms of gastritis, enteritis and colitis);
- sexual dysfunction.
Diagnostic
The greatest value in the diagnosis of thoracic osteochondrosis has a chest X-ray examination. Image shows decreased intervertebral disc height, end plate sclerosis, osteophyte formation.
Computed tomography allows you to clarify the condition of the spine, spinal joints, the size of the spinal canal, determine the location of the herniated protrusion and its size.
When carrying out a differential diagnosis, it is necessary to carefully collect a history and compare all clinical signs of thoracic osteochondrosis with the symptoms of other diseases. For example: pain in the heart with osteochondrosis is not stopped by nitroglycerin, epigastric pain is not associated with food intake, is not seasonal, all symptoms appear mainly at night and disappear completely after a night's rest.
How to treat thoracic osteochondrosis?
Treatment of osteochondrosis of the thoracic spine in almost all cases is conservative. The indication for therapy is the predominance of a visceral syndrome with neurological disorders. The main orthopedic treatment should be adequate spinal traction:
- active vertical traction under water;
- passive horizontal traction in the inclined bed using Glisson loops in case of damage at the level of 1-4 thoracic vertebrae, by the axillary cord in case of damage at the level of 4-12 thoracic vertebrae.
Drug treatment consists in performing paravertebral blockade with a solution of novocaine. 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-inflammatory drugs at home.
After eliminating acute phenomena, massage of the muscles of the back and lower extremities is used. Manual therapy is indicated for 1-3 degrees of osteochondrosis in the case of the development of functional blockade. It includes a variety of options for both gentle and rough effects on the back muscles.
Therapeutic exercises allow you to cover all parts of the spine, which stimulates the recovery process. An important condition for exercise therapy for osteochondrosis is to exclude vertical loads.
Physiotherapy: UHF treatment, ultrasound, inductothermy, radon and pine salt baths. At the spa stage, underwater traction and hydromassage are actively used.
Surgical treatment is rarely used. The indication for surgical intervention is compression of the spinal cord by a prolapsed disc fragment.