With thoracic osteochondrosis, 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 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 adjacent vertebrae and ligamentous joints with the entire ligament apparatus.
Features 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 create a strong connection between the bodies of adjacent vertebrae. The total length of the intervertebral discs is a quarter of the length of the spine.
The most important function of intervertebral discs is to reduce vertical stress on the vertebrae. The disc consists of three parts:
- hyaline plates (near vertebrae);
- nucleus pulposus (fills the gap between the plates);
- Fibrous ring (surrounds the cell nucleus from the outside).
The nucleus contains cartilage cells, closely intertwined collagen fibers, and chondrin (proteoglycans). The anterior surface of the intervertebral discs is covered by the anterior longitudinal ligament, which is firmly attached to the vertebrae and rotates freely over the intervertebral discs. 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, so it feeds on substances that come from the vertebral bodies by diffusion.
The distribution of vertical loads in the spine occurs due to the elastic properties of the intervertebral 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 bending - in the direction of convexity, when relaxing - forward. When the spine moves, muscles, ligaments and discs are involved in the work. Therefore, an injury in one link leads to an injury in the entire kinetic chain.
Causes and mechanism of development of the disease
In the development of osteochondrosis, the mechanical impact 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 protrusions and sequestra.
The process of intervertebral 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 glycosamines and a violation of the distribution of collagen fibers in the intervertebral disc. The genetic factor is of paramount importance in the occurrence of thoracic osteochondrosis, which is subject to increased functional activity.
The risk factors for the development of degenerative changes in the spine include the anatomical peculiarities of the intervertebral discs, which represent imperfections in evolution. One of these characteristics is the nutritional characteristics of the structures. In the human body, the intervertebral disc consists of tissue that is poorly supplied with blood. The occlusion of blood vessels already occurs in childhood. Post-nutrition occurs due to the diffusion of substances through the endplates.
Nutrient penetration stimulator 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 preventive measure.
The peculiarity of the microscopic structure - few cells - reduces the intensity of the regenerative ability and the recovery rate of the intervertebral disc components. An anatomical feature is the weakness and weakness of the intervertebral discs in the posterior sections. This contributes to the appearance of wedge-shaped intervertebral discs in the lower thoracic and lumbar regions.
Great importance in the development of osteochondrosis is attached to involutional changes. Actively degenerative changes begin to increase after 30 years. The synthesis of the components necessary for the intervertebral disc (glycosaminoglycans) continues, but their quality deteriorates. Hydrophilicity decreases, fibrousness 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);
- herniated disc hernia (second degree hernia);
- degenerative changes in extradiscal components (grade 3).
The pathological protuberance compresses the nerve roots, blood vessels or spinal cord at different levels (cervical, thoracic, lumbar), which determines the clinical picture.
Restrictions on movement in the thoracic spine, which are caused by the presence of the rib cage, contribute to the least traumatization of the intervertebral discs and, as a result, osteochondrosis. Physiological thoracic kyphosis contributes to the redistribution of weight from the upper half of the body to the lateral and anterior portions 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 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 and then gather into nodes from which they are sent to all internal organs. As a result, in addition to typical neurological disorders, thoracic osteochondrosis leads to functional disorders of internal organs (vegetative, vasomotor, trophic) and imitation of somatic diseases. This feature of osteochondrosis of the breast 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 disruption of intervertebral disc regeneration. Diseases develop in people who work at the computer for a long time, bend over, etc. such people have to independently conduct therapeutic exercises.
Most often, chest osteochondrosis 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 compression of the chest. When palpating the spinous processes of the thoracic vertebrae, local pain is noted, which increases with axial loads on the spine, deep inspiration and body rotations.
A number of patients experience shooting pains in the shoulder blade and lower chest (posterior rib syndrome). This symptomatology develops as a result of a displacement of the lower ribs. The pain increases sharply when the upper body is rotated. More often, the pain syndrome disappears abruptly.
Often the pain in the chest becomes a girdle, corresponding to the course of the intercostal nerve. Sensitivity in the innervation zone of the corresponding nerve ending is disturbed, paresthesia appears, 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.
A violation of the functioning of internal organs occurs when squeezing a nerve root at the level of 1-12 chest. The thoracic region contains 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:
- difficulty breathing;
- severe night pains;
- "heart", angina 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, abdomen (symptoms of gastritis, enteritis and colitis);
- sexual dysfunction.
diagnosis
The greatest value in diagnosing thoracic osteochondrosis has an X-ray examination of the chest. The picture 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, the location of the hernial protrusion and its size.
When conducting differential diagnosis, it is necessary to carefully collect anamnesis and compare all clinical signs of thoracic osteochondrosis with symptoms of other diseases. For example: pain in the heart in 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 completely disappear after a night's rest.
How to treat thoracic osteochondrosis?
Treatment of osteochondrosis of the thoracic spine is conservative in almost all cases. Indication for therapy 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 in the inclined bed with the Glisson loop for damage at the level of 1-4 thoracic vertebrae, through the shoulder straps at the level of damage at 4-12 thoracic vertebrae.
Drug treatment consists in conducting paravertebral blocks with novocaine solution. With an exacerbation of the disease, analgesics and sedatives are used. With an unspoken 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 osteochondrosis 1-3 degrees with the development of functional blocks. It includes different options for soft and rough effects on the back muscles.
Therapeutic exercises allow you to put a dosed load on all parts of the spine, which stimulates recovery processes. An important prerequisite for exercise therapy for osteochondrosis is the exclusion of vertical loads.
Physiotherapy: UHF treatment, ultrasound, induction thermal therapy, radon and stone pine salt baths. In the spa phase, 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 herniated disc fragment.