In the case of thoracic osteochondrosis, the organs associated with spinal cord areas, 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 torso 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 a change in the intervertebral discs with participation in the pathological process of neighboring vertebrae and intervertebral joints with the entire ligamentous apparatus.
Characteristics of the anatomy of the spine.
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 the bones and provide a strong link between the bodies of neighboring vertebrae. The total length of the intervertebral discs is a quarter of the length of the spinal column.
The most important function of the discs is to reduce the vertical load on the vertebrae. The disc consists of three parts:
- hyaline plates (closely adjacent to the vertebrae);
- nucleus pulposus (fills the space between the plates);
- annulus fibrosus (surrounds the nucleus from the outside).
The core contains cartilage cells, closely intertwined collagen fibers, and chondrin (proteoglycans). The anterior surface of the discs is covered by the anterior longitudinal ligament, which is strongly fused to the vertebrae and freely flips over the discs. The posterior longitudinal ligament is firmly fused 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 is fed by substances that reach it by 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 hyaline plates. During movement, the core moves in the opposite direction: when flexed - towards the convexity, when flexed - forward. When the spine moves, the 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 the development of the disease
In the development of osteochondrosis, the mechanical effect on the spine plays a special role. Under the influence of unfavorable static and dynamic loads, the nucleus pulposus gradually loses its elastic properties (as a result of depolymerization of polysaccharides), forms bulges and sequestrants.
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 appearance 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 the evolution. One of these characteristics is the nutritional characteristics of the structures. In the human body, the disc consists of poorly perfused tissue. The 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 -a few cells- reduces the intensity of the regenerative capacity and the recovery rate of the 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 involutional changes. Active degenerative changes begin to increase after the age of 30. The synthesis of the components necessary for the disc (glycosaminoglycans) continues, but their quality is deteriorating. Hydrophilicity decreases, fibrosity increases, sclerosis appears.
Stages of degeneration of the intervertebral discs:
- prolonged asymptomatic course, degenerative changes in intradiscal components, 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 hernial protrusion (second degree hernia);
- degenerative changes in extradiscal components (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, which is due to the presence of the chest, contributes to less traumatization of the intervertebral discs, and therefore osteochondrosis. Physiological thoracic kyphosis contributes to the redistribution of weight from the upper half of the body to the lateral and anterior sections of the vertebrae. Thus, 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 roots of the spinal cord 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 feature 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 the dosed loads on the spine, which contributes to the disruption of disc recovery. Diseases develop in people who work at a computer for a long time, slouch, etc. such people need to independently perform therapeutic exercises.
In most cases, thoracic osteochondrosis is manifested by dull pains, less often pain and burning. The pain is localized between the shoulder blades. The patient is disturbed by the feeling of compression of the chest. When palpating the spinous processes of the thoracic vertebrae, local pain is detected, which increases with axial loads on the spine, deep inspiration and turns of the body.
Several patients have sharp pains in the scapula and lower chest (posterior rib syndrome). This symptomatology develops as a result of displacement of the lower ribs. The pain increases sharply when turning the torso. More often, the pain syndrome abruptly disappears.
Often the pain in the chest turns into the waist, it corresponds to the course of the intercostal nerve. Sensitivity in the innervation zone of the corresponding nerve ending is disturbed, paresthesias appear, and often there is a decrease in superficial and deep sensitivity. Possible violation of the function of the abdominal press, a change in the knee and calcaneal tendon reflexes.
Violation of the function of the internal organs occurs when any nerve root is compressed at the level from 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 signs characteristic only of thoracic osteochondrosis.
The disease is manifested by symptoms characteristic of another pathology:
- labored breathing;
- intense night pains;
- "heart", anginal pains;
- 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, abdomen (symptoms of gastritis, enteritis and colitis);
- sexual dysfunction.
Diagnosis
The greatest value in the diagnosis of thoracic osteochondrosis has an X-ray examination of the chest. The image shows a decrease in the height of the intervertebral disc, sclerosis of the end plates, formation of osteophytes.
Computed tomography allows you to clarify the state of the vertebrae, the joints of the spine, the size of the spinal canal, determine the location of the hernia protrusion and its size.
When conducting differential diagnosis, it is necessary to carefully collect an anamnesis and compare all clinical signs of thoracic osteochondrosis with 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 completely disappear 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 visceral syndromes with neurological disorders. The main orthopedic treatment should be adequate spinal traction:
- active vertical pull under water;
- passive horizontal traction on inclined bed using the Glisson loop in case of damage at the level of 1-4 thoracic vertebrae, by axillary straps in case of damage at the level of 4-12 thoracic vertebrae.
Pharmacological 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-inflammatory drugs at home.
After the elimination of 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 case of the development of functional blockages. Includes several options for soft and rough effects on the back muscles.
Therapeutic exercise allows you to load all parts of the spine in a dosed manner, which stimulates recovery processes. An important condition for exercise therapy for osteochondrosis is to exclude vertical loads.
Physiotherapy: UHF treatment, ultrasound, inductothermy, radon and pine-coniferous 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.