In the case of thoracic osteochondrosis, organs associated with 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 arms, legs and torso as a whole, dysfunction of 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 involving the pathological process of neighboring vertebrae and intervertebral joints with the entire ligament apparatus.
Functions of the anatomy of the spine
The mobility and stability, elasticity and resilience of the spine depends to a large extent on the intervertebral discs, which are one of the types of cartilage connections between the bones and provide a strong bond between the bodies of neighboring vertebrae. The total length of the intervertebral discs is a quarter of the length of the spine.
The main 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 space between the plates);
- fibrous ring (surrounds the core from 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 tightly fused to the vertebrae and freely flaps over the discs. The posterior longitudinal ligament is firmly fused 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, therefore it feeds on substances that come 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 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 it bends - towards the convexity, when it does not bend - anteriorly. When the spine moves, muscles, ligaments and discs are involved in the work. Therefore, a violation in a joint leads to a violation in the entire kinetic chain.
Causes and mechanism of development of the disease
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 (due to depolymerization of polysaccharides), forming protrusions and sequestrations.
The process of disc degeneration is influenced by a genetic predisposition which causes the development of changes in the neuromuscular apparatus in the spine, a change in the structure of glycosamines and a violation of the distribution of collagen fibers in the disc. The genetic factor is crucial in the incidence of thoracic osteochondrosis, subject to increased functional activity.
The risk factors for developing degenerative changes in the spine include the anatomical features of the discs, which are imperfections in evolution. One of these properties is the nutritional properties 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 diffusion of substances through the endplates.
The stimulator of nutrient penetration is a dosed load that excludes static postures and great stress. Physical inactivity is one of the leading risk factors for thoracic osteochondrosis. Therefore, regular exercise is an important preventative measure.
The peculiarity of the microscopic structure - a few cells - reduces the intensity of the regenerative ability and the rate of recovery of the disk components. An anatomical feature is 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. Active degenerative changes begin to increase 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 in intradiscal components, displacement of the nucleus inside the disc;
- pronounced radicular symptoms of thoracic osteochondrosis, compression of the spinal cord, protrusion of the nucleus pulposus (protrusion, 1 degree);
- disc herniation with hernial protrusion (hernia, 2nd degree);
- degenerative changes in extradiscal components (grade 3).
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 due to the presence of the breast contributes to the least traumatisation of the intervertebral discs and therefore osteochondrosis. Physiological thoracic kyphosis contributes to the redistribution of weight of the upper half of the body to the lateral and anterior sections 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 narrowing of the intervertebral foramina and compression of the roots and sympathetic fibers of the spinal cord. Sympathetic fibers originate from the gray matter in the spinal cord, then collect in nodules, 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 mimicry of somatic diseases. This feature of osteochondrosis of the thoracic discs explains the difficulty of diagnosing and prescribing the correct treatment.
Symptoms of thoracic osteochondrosis
Thoracic osteochondrosis is more typical of 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 regeneration. Diseases develop in people who work at a computer for a long time, bend over, etc. such people have to perform therapeutic exercises independently.
Most often, osteochondrosis of the chest is manifested by dull pain, less often sore and burning. The pain is localized between the shoulder blades. The patient is disturbed by the feeling of compression of the chest. When you feel the spinal processes of the thoracic vertebrae, local pain is detected, which increases with axial loads on the spine, deep inspiration and twists in the body.
A number of patients have sharp pain in the scapula and lower part of the chest (posterior costal syndrome). This symptomatology develops as a result of displacement of the lower ribs. The pain increases sharply when turning the upper body. More often, the pain syndrome disappears abruptly.
Often the pain in the chest becomes a belt, similar to the course of the intercostal nerve. The sensitivity in the innervation zone of the corresponding nerve ending is disturbed, paresthesias appear, and there is often 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 internal organs occurs when any nerve root is compressed at the level of 1 to 12 breast. In the thoracic region, there are structures that are 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 another pathology:
- difficulty breathing;
- intense night pain;
- "heart", angina pain;
- soreness in the mammary glands;
- pain in the right or left hypochondrium (symptoms of cholecystitis and pancreatitis);
- pain in the pharynx and esophagus;
- pain in the epigastrium, abdomen (symptoms of gastritis, enteritis and colitis);
- sexual dysfunction.
Diagnostics
The greatest value in the diagnosis of thoracic osteochondrosis has an X-ray examination of the breast. The image shows a decrease in the height of the intervertebral disc, sclerosis of the endplates, the formation of osteophytes.
Computed tomography allows you to clarify the condition of the vertebrae, the joints of the spine, the size of the spinal canal, determine the location of the hernial protrusion and its size.
When performing differential diagnosis, it is necessary to carefully collect a medical history 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 in the evening and disappear completely after a night's sleep.
How to treat thoracic osteochondrosis?
Treatment of osteochondrosis of the thoracic spine is conservative in almost all cases. The indication for therapy is the predominance of visceral syndromes with neurological disorders. The main orthopedic treatment should be sufficient traction in the spine:
- active vertical traction under water;
- passive horizontal traction in a sloping bed using the Glisson loop in case of damage in the level 1-4 thoracic vertebrae, of the axillary straps in case of damage in the level 4-12 thoracic vertebrae.
Drug treatment consists of performing paravertebral blockades with novocaine solution. With an exacerbation of the disease, analgesics and sedatives are used. With an unexplained pain syndrome, it is permissible to use ointments with analgesics and anti-inflammatory drugs at home.
After 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 case of development of functional blockages. It contains various options for soft and rough effects on the back muscles.
Therapeutic training allows you to load all parts of the spine in a dosed manner, which stimulates recovery processes. An important condition of exercise therapy for osteochondrosis is to exclude vertical loads.
Physiotherapy: UHF treatment, ultrasound, inductothermia, radon and forty-conifer salt baths. At the spa stage, underwater traction and hydromassage are actively used.
Surgical treatment is rarely used. The indication for surgery is compression of the spinal cord by a disc fragment that has prolapsed.