In the case of thoracic osteochondrosis, organs related to areas of the spinal cord, 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 changes in the intervertebral discs with the involvement in the pathological process of adjacent vertebrae and intervertebral joints with the entire ligament apparatus.
Characteristics of spinal anatomy
Mobility and stability, elasticity and resilience 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 connection between the bodies of adjacent vertebrae. The total length of the intervertebral discs is one quarter of the length of the spine.
The most important function of the discs is to reduce the vertical load on the vertebrae. The disk consists of three parts:
- hyaline plates (close 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 intertwined collagen fibers and chondrines (proteoglycans). The anterior surface of the discs is covered with an anterior longitudinal ligament, which is firmly connected to the vertebrae and rotates freely over the discs. The posterior longitudinal ligament is firmly connected to 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 body.
The distribution of vertical loads in the spinal column is 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 nucleus moves in the opposite direction: when it bends - towards convexity, when it bends - forward. When the spine moves, muscles, ligaments and discs are involved. Thus, 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 depolymerization of polysaccharides), forming protrusions and sequesters.
The process of disc degeneration is influenced by genetic predisposition, which causes the development of changes in the neuromuscular apparatus of the back, changes in the structure of glycosamine and violation of the distribution of collagen fibers in the disc. Genetic factor is the most important in the development 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 in childhood. After feeding it occurs due to the diffusion of the substance through the end plates.
Nutrient penetration stimulator is a dosed load that excludes static positions and high stress. Physical inactivity is one of the leading risk factors for thoracic osteochondrosis. Therefore, regular exercise is an important preventive measure.
The peculiarity of the microscopic structure - several cells - reduces the intensity of regenerative ability and the speed of recovery of disc components. The anatomical feature is the weakness and lack of strength of the discs in the posterior parts. This contributes to the appearance of wedge discs in the lower thoracic and lumbar region.
Great importance in the development of osteochondrosis is attached to involutional changes. Active degenerative changes begin to grow after 30 years. The synthesis of components necessary for the disc (glycosaminoglycans) continues, but their quality deteriorates. Hydrophilicity decreases, fibrosis increases, sclerosis appears.
Stages of degeneration of intervertebral discs:
- prolonged asymptomatic course, degenerative changes of intradiscal components, displacement of the nucleus within the disc;
- pronounced radicular symptoms of thoracic osteochondrosis, spinal cord compression, nucleus pulposus protrusion (protrusion, grade 1);
- rupture of the disc with hernial protrusion (grade 2 hernia);
- degenerative changes in extradiscal components (grade 3).
The pathological protrusion compresses the nerve roots, blood vessels or spinal cord at different levels (cervical, thoracic, lumbar), which determines the clinical picture.
Restriction of mobility in the thoracic spine, which is due to the presence of the thorax, contributes to the least trauma to the intervertebral discs, and thus osteochondrosis. Physiological thoracic kyphosis contributes to the redistribution of weight of the upper half of the body to the lateral and anterior parts of the vertebrae. Therefore, intervertebral hernias and osteophytes form on the anterior and lateral surfaces of the spine. Posterior osteophytes and hernias are extremely rare.
Osteochondrosis contributes to the narrowing of the intervertebral openings and compression of the spinal cord roots and sympathetic fibers. Sympathetic fibers are formed 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 thoracic disc osteochondrosis explains the difficulty in diagnosing and prescribing the correct treatment.
Symptoms of thoracic osteochondrosis
Chest 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 disc recovery disorders. Diseases develop in people who work at a computer for a long time, bend over, etc. such people need to perform therapeutic exercises on their own.
Osteochondrosis of the chest is most often manifested by dull pain, less often by pain and burning. The pain is localized between the shoulder blades. The patient is disturbed by the feeling of tightness of the chest. Palpation of the spinous processes of the thoracic vertebrae reveals local pain that increases with axial load on the spine, deep inspiration and body turns.
A number of patients have severe pain in the shoulder blade and lower chest (posterior-costal syndrome). This symptomatology develops as a result of displacement of the lower ribs. The pain sharply intensifies when turning the torso. More often, the pain syndrome disappears abruptly.
Often, chest pain becomes a girdle, corresponding to the course of the intercostal nerve. Sensitivity in the zone of innervation of the corresponding nerve ending is disturbed, paresthesias appear, and there is often a decrease in surface and deep sensitivity. Possible violation of the function of the abdominal press, changes in the reflex of the knee and calcaneal tendon.
Impairment of the function of internal organs occurs when any nerve root is compressed at the level of 1 to 12 chest. In the thoracic region are the structures responsible for innervating 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 other pathologies:
- difficulty breathing;
- intense night pains;
- "heart", anginal pain;
- pain in the mammary glands;
- pain in the right or left hypochondrium (symptoms of cholecystitis and pancreatitis);
- sore throat and esophagus;
- pain in the epigastrium, abdomen (symptoms of gastritis, enteritis and colitis);
- sexual dysfunction.
Diagnosis
Chest X-ray examination is of the greatest value in the diagnosis of thoracic osteochondrosis. The picture shows a decrease in the height of the intervertebral disc, sclerosis of the end plates, the formation of osteophytes.
Computed tomography allows you to clarify the condition of the vertebrae, spinal joints, the size of the spinal canal, determine the location of the hernial protrusion and its size.
When conducting a differential diagnosis, it is necessary to carefully collect the anamnesis and compare all the clinical signs of thoracic osteochondrosis with the symptoms of other diseases. For example: heart pain in osteochondrosis does not stop nitroglycerin, epigastric pain is not related to food intake, is not seasonal, all symptoms occur mainly in the evening and disappear completely after a night's rest.
How to treat thoracic osteochondrosis?
Treatment of thoracic spine osteochondrosis 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 traction of the spine:
- active vertical traction under water;
- passive horizontal traction in an oblique bearing using Glisson's loop in case of damage at the level of 1-4 thoracic vertebrae, axillary strips in case of damage at the level of 4-12 thoracic vertebrae.
Drug treatment consists of performing paravertebral blockade with a solution of novocaine. As diseases worsen, analgesics and sedatives are used. In unexpressed pain syndrome it is allowed to use ointments with analgesics and anti-inflammatory drugs at home.
After the removal 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 case of development of functional blockades. Includes various options for soft and rough effects on the back muscles.
Therapeutic exercise allows dosed loading of all parts of the spine, which stimulates recovery processes. An important condition for exercise therapy for osteochondrosis is the exclusion of vertical loads.
Physiotherapy: UHF treatment, ultrasound, inductothermy, radon and pine-coniferous salt baths. Underwater traction and hydromassage are actively used in the spa phase.
Surgical treatment is rarely used. The indication for surgical intervention is compression of the spinal cord with a prolapsed fragment of the disc.