In the case of thoracic osteochondrosis, the organs associated with the areas of the spinal cord, which is 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 involvement in the pathological process of neighboring vertebrae and intervertebral joints with the entire ligament apparatus.
Characteristics of the anatomy of the spine
The mobility and stability, elasticity and resilience of the spine depend mainly on the intervertebral discs, which are one of the types of cartilaginous connections between the bones and provide a strong connection between the bodies of neighboring vertebrae. The total length of the intervertebral discs is a quarter of the length of the spine.
The most important function of disks is to reduce the vertical load on the beads. The disk consists of three parts:
- hyaline plates (tightly attached to the beads);
- 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 chondri (proteoglycan). The anterior surface of the discs is covered by the anterior longitudinal ligament, which is tightly fused to the vertebrae and rotates freely over the discs. The posterior longitudinal ligament is strongly fused to the surface of the disc and forms the anterior wall of the spinal canal. The intervertebral disc has no blood supply of its own, so it feeds on substances that come from diffusion from the vertebral bodies.
The distribution of vertical loads on the spine occurs due to the elastic properties of the disks. As a result of the pressure, the pulposus nucleus expands and the pressure is redistributed to the annulus fibrosus and hyaline plates. During movement, the nucleus moves in the opposite direction: when bent - towards convexity, when not bent - forward. When the spine moves, muscles, ligaments, and discs are involved in the work. Therefore, a violation in a bond 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 pulposus nucleus gradually loses its elastic properties (as a result of depolymerization of polysaccharides), forms extensions and sequester.
The process of disc degeneration is influenced by a genetic predisposition, which causes the development of changes in the neuromuscular apparatus of 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 primary in the occurrence of thoracic osteochondrosis, subject to increased functional activity.
Risk factors for the development of degenerative changes in the spine include the anatomical features of the discs, which are evolving imperfections. One of these features is the nutritional properties of the structures. In the human body, the disc is made up of poorly perfused tissue. Closure of blood vessels already occurs in childhood. After feeding occurs due to the spread of substances through the end plates.
Nutrient penetration stimulant is a dosed load that excludes static postures and great stress. Physical inactivity is one of the major risk factors for thoracic osteochondrosis. Therefore, regular exercise is an important preventative measure.
The peculiarity of the microscopic structure - some cells - reduces the intensity of the regenerative ability and the degree of recovery of the disk 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 chest and lumbar regions.
Great importance in the development of osteochondrosis is given to involuntary changes. Degenerative changes actively begin to increase after 30 years. The synthesis of the necessary components for the disc (glycosaminoglycans) continues, but their quality is deteriorating. Hydrophilicity decreases, fibrosis increases, sclerosis appears.
Stages of degeneration of 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, elongation of the nucleus pulposus (protrusion, 1 degree);
- disc rupture with hernial protrusion (hernia, grade 2);
- degenerative changes in extradiscal components (grade 3).
Pathological output compresses the nerve roots, blood vessels or spinal cord at different levels (cervix, chest, lumbar), which determines the clinical picture.
Restriction of mobility in the thoracic spine, which is due to the presence of the chest, contributes to less trauma to the intervertebral discs, and consequently osteochondrosis. Physiological chest kyphosis contributes to the redistribution of the 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. Osteophytes and posterior hernias are extremely rare.
Osteochondrosis contributes to narrowing of the intervertebral foramina and compression of the spinal cord roots and sympathetic fibers. The sympathetic fibers originate in the gray matter of the spinal cord, then accumulate in the nodes, from which they are sent to all the 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 difficulties in diagnosing and prescribing appropriate 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 disruption of disc recovery. Diseases develop in people who work for a long time on the computer, bend over, etc. such people should independently perform therapeutic exercises.
Most often, osteochondrosis of the chest is manifested by dull pain, less often pain and burning. The pain is localized between the shoulders. The patient is disturbed by the feeling of chest tightness. When the spinous processes of the thoracic vertebrae are felt, local pain is detected, which increases with axial loads on the spine, deep inspiration, and body curves.
A number of patients have sharp pain in the shoulder and lower chest (posterior rib syndrome). This symptomatology develops as a result of displacement of the lower ribs. The pain increases significantly when turning the torso. Most often, the pain syndrome disappears suddenly.
Often the chest pain becomes girdle, corresponding to the flow of nerve between the ribs. Sensitivity in the innervation area of the corresponding nerve ending is disturbed, paresthesias appear, and there is often a decrease in superficial and deep sensation. Possible violation of the function of the abdominal press, a change in the reflexes of the knee and calcaneal tendon.
Violation of the function of internal organs occurs when each nerve root is compressed at the level from 1 to 12 chest. In the chest region there are structures responsible for innervating the lungs, heart, intestines, liver, pancreas and kidneys. Therefore, there are no characteristic signs only for thoracic osteochondrosis.
The disease is manifested by characteristic symptoms of another pathology:
- difficulty breathing;
- severe night pain;
- "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.
Diagnosing
X-ray examination of the chest has 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, the joints of the spine, the size of the spinal canal, determine the location of the hernial extension and its size.
When performing the differential diagnosis, it is necessary to carefully collect a medical history and compare all the clinical signs of thoracic osteochondrosis with the symptoms of other diseases. For example: heart pain with osteochondrosis is not stopped by nitroglycerin, epigastric pain is not associated with food intake, it is not seasonal, all symptoms appear mainly in the evening and disappear completely after a night's rest.
How to treat chest 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 spinal traction:
- active vertical traction underwater;
- passive horizontal traction on a sloping bed using the Glisson loop in case of injury at the level of 1-4 thoracic vertebrae, from the armpit belts in case of injury at the level of 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 unexpressed pain syndrome, the use of ointments with analgesics and anti-inflammatory drugs at home is allowed.
After eliminating the 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 blockades. It includes various options for smooth 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 the exclusion of vertical loads.
Physiotherapy: UHF treatment, ultrasound, inductotherm, radon and baths with pine-coniferous salt. In the spa phase, underwater retreat and hydromassage are actively used.
Surgical treatment is rarely used. The indication for surgical intervention is compression of the spinal cord from a prolapsed disc fragment.