Osteochondrosis of the thoracic spine: symptoms and treatment

7 November 2020

Osteochondrosis of the thoracic spine is a chronic degenerative-dystrophic process of injury to the intervertebral discs and vertebral bodies of the thoracic spine. This disease is somewhat less common than osteochondrosis of the cervical or lumbosacral spine. However, that doesn't mean that it doesn't cause a problem for the person. Osteochondrosis of the thoracic spine is mainly manifested by pain in the back and chest, but it can also cause pain in the heart, abdomen, similar to angina pectoris or hepatic colic. In rare cases, osteochondrosis of the thoracic spine provokes the development of paresis of the muscles of the lower extremities, impaired sensitivity, disorders of the pelvic organs. Treatment of the disease involves the use of drugs and non-drug methods, and sometimes even surgery is required. From this article you will learn about the symptoms that manifest osteochondrosis of the thoracic spine and methods of its treatment.

Thoracic spine

The thoracic spine is represented by 12 vertebrae, between the bodies of which are intervertebral discs. The discs consist of a nucleus pulposus and an annulus fibrosus. Pathological changes in these discs, as well as in the joints of the adjacent facets, proliferation of bone spines along the edges of the vertebral bodies, dystrophic processes in the ligaments of the spine and become the immediate cause of back pain.

It should be understood that osteochondrosis, as a disease, rarely affects only one part of the spine. Usually this process is diffuse, more or less pronounced in different parts of the spine.

Certain structural features of the thoracic spine make it less frequently affected by osteochondrosis than other parts. Let's list these features:

less mobility of the thoracic spine;
the presence of joints of the vertebrae with the ribs (which, in combination with the sternum, creates a strong framework of the chest, less prone to injury);
thin intervertebral discs;
Physiological kyphosis (flexion in the anteroposterior direction with a bulge directed towards the rear) of the thoracic spine, and therefore the maximum axial load falls on the anterior rather than posterior parts of the discs.

Another feature not of the structure, but of the development of osteochondrosis of the thoracic spine, which also determines the lower frequency of pain in the thoracic spine, is that the existing morphological bases of osteochondrosis in this partcan remain clinically "silent" for a long time. In other words, there are changes, but they do not bother the patient.

And yet, in the presence of provoking factors, such as a sedentary lifestyle (including years of working at a desk or driving a car), injuries, poor posture, sagging back muscles, hard physical labor in a forced position, osteochondrosis of the thoracic spine shows his true face.

Symptoms of osteochondrosis of the thoracic spine

The main clinical symptom of osteochondrosis of the thoracic spine, as well as other parts, is pain. Back pain, chest pain, even pain in internal organs. In medicine, it is customary to distinguish several pain syndromes (and not just painful) from osteochondrosis of the thoracic spine. In total, they are divided into two groups:

reflex

;
compression.

Reflex syndromes are clinical manifestations of spinal receptor stimulation. These are receptors for ligaments, capsules of intervertebral joints, intervertebral discs, which receive pathological impulses in osteochondrosis. In addition to pain, reflex syndromes can be accompanied by muscle tension, vegetative disorders of soft tissues and internal organs. Such changes are based on the following fact: stimulation of receptors leads to the spread of excitation to nearby structures of the spinal cord (to be more precise, to segments of the spinal cord). And these can be neurons responsible for the sweating of a certain area of the skin, regulating the temperature of the same area, participating in ensuring the activity of internal organs (heart, liver, intestines, etc. ), bymaintaining the tone of the muscles and blood vessels that supply all of these structures. And when excitement is transmitted to these neurons, the corresponding symptoms of disturbance of the activity of certain formations appear. Therefore, such a situation is quite possible when the pain in the abdomen or in the region of the heart is caused by osteochondrosis of the thoracic spine.

Compression syndromes occur when the nerve root is compressed (less often stretched) as it leaves the intervertebral foramen, spinal cord tissue, or the vessels that feed it. Compression syndromes are almost always caused by an existing herniated disc. Hernias of the lower thoracic segments are the most common. Depending on the direction and location of the hernia, a person has certain symptoms. This can be represented as follows:

Median (median) hernias are accompanied by the development of muscle weakness symmetrically in both legs, loss of sensitivity in them. At the same time, the typical pain syndrome of compression of the nerve root is absent;
lateral (lateral) hernias exclusively manifest pain associated with compression of the nerve root;
combine the clinical symptoms of the two previous groups, only muscle weakness and sensory disturbances predominate on the side of the protruding disc.

What types of syndromes are considered in the setting of osteochondrosis of the thoracic spine? Let's talk in more detail about the types of reflex and compression syndromes of this level.

Reflex syndromes

Dorsago- sharp, sudden pain in the chest spine. It is sharp in nature, often described by patients as stabbing. Basically it is felt between the shoulder blades, it can be given to the heart, to the sternum. Patients are afraid to move and even take a deep breath, as the pain intensifies (as if starting again). Very often, similar symptoms occur after a long stay in a fixed uncomfortable position, while performing monotonous work. Sudden movement after this causes back pain in people with osteochondrosis of the thoracic spine. When palpating the thoracic spine, the tension of the paravertebral muscles in the form of a roller and their pain is revealed.

Sometimes such pain can be thought of as a heart attack, so severe and sudden that it seems to the patient. However, the electrocardiogram taken does not show any abnormalities and the use of nitroglycerin under the tongue does not eliminate the pain.

Back painis another type of thoracic reflex syndrome. It is a pain syndrome that occurs gradually. Pain can be localized in any part of the back, chest. Painful, dull pain, sometimes with a burning tinge (associated with irritation of vegetative structures). It intensifies with movements of the spine, bending, rotating around its axis, coughing or sneezing, driving on an uneven road.

Pain may be felt along the intercostal spaces on one or both sides. This feature is due to the evolution of nerve conductors (the intercostal nerves and vessels are located in the intercostal space). In this case, the pain is called intercostal neuralgia, by analogy with the pain of shingles.

If the pain is localized to the anterior chest wall, it is also called pectalgia. However, it can only be felt in certain places with an intact back. For example, in the area of the xiphoid process or at the site of attachment of the sternocleidomastoid muscle. Quite often, due to the aching and dull nature of the pain, it is difficult to pinpoint exactly where it hurts - either something inside the chest or in the area of superficial soft tissue.

Back pain may be accompanied by reflex tension of the paravertebral muscles, more pronounced on the pain side. In this case, of course, the muscle tension is not as pronounced as in a similar situation in the lumbar spine. But still, on palpation, muscle compaction is felt, and the touch itself causes discomfort or pain. Palpation of interspinous spaces and paravertebral points in the area of the segment affected by osteochondrosis is also painful.

Reflex syndromes in osteochondrosis of the thoracic spine are much more common than compression.

Compression syndromes

The

Compression of the nerve rootis accompanied, first of all, by a pain syndrome. The pain is nagging in nature. The direction of the spread of pain corresponds to the evolution of nerve fibers. In the case of thoracic osteochondrosis, these are intercostal spaces. As some nerve fibers form plexuses involved in innervation of internal organs, pain can be felt inside the chest, abdomen. The pain intensifies when moving, bending the body, coughing, sneezing, laughing (because at these times the tension of the root increases). In the innervated area of the compressed root, disturbances of sensitivity can be observed: feeling of crawling, numbness, tingling. Touching this area may not be well felt. In cases where the nerve root is subjected to compression for a long time, movement disorders may occur, that is, the weakness of the muscles that it innervates. The muscles gradually atrophy. However, movement disorders are very rare, as they are the most recent in the timeline of the onset of all symptoms. Usually a person seeks medical help at the stage of pain and sensory disturbances.

Spinal Cord Compressionmanifests as weakness in the legs with a simultaneous increase in muscle tone (if the spinal cord is compressed in the lower thoracic spine, muscle tone decreases). Pathological symptoms of the foot may appear (Babinsky et al. ). The sensitivity of the lower limbs is lost, the feeling of touching cold and hot does not differ, the difference between just a touch and an injection. With severe compression of the spinal cord, urinary problems may occur.

Compression of the blood vessels,supplying the spinal cord, leads to the development of myeloischemia, that is, malnutrition of the bone marrow tissue. This, along with the compression of the spinal cord, is accompanied by the development of muscle weakness (patients say "the legs failed"), loss of sensation, and pelvic disorders.

It's fair to say that compression of the spinal cord and its vessels in osteochondrosis of the thoracic spine is very, very rare.

Vegetative components of osteochondrosis of the thoracic spine

Due to the fact that nerve fibers originating from the thoracic spine contain autonomic conductors, irritation or violation of these fibers may be accompanied by autonomic symptoms. These can be:

dryness and peeling of the skin in the area of innervation of a separate nerve;
local violation of sweating and thermoregulation (also depending on the area of innervation);
chills in the lower limbs, brittle nails;
pains simulating diseases of the gastrointestinal tract (eg gastritis, gastric ulcer, cholecystitis, etc. );
pain in the kidneys, which in fact has nothing to do with kidney disease (there are no changes in urine and ultrasound)
pain in the region of the heart, very similar to angina and even myocardial infarction.

The peculiarity of such pain may be the fact that a person may not feel pain in the back. This is initially misleading for the patient and the medical staff when seeking medical help. However, the implementation of a number of additional research methods allows to exclude the pathology of internal organs, then osteochondrosis of the thoracic spine is considered to be the cause of this pain.

Treatment of osteochondrosis of the thoracic spine

All methods of treating osteochondrosis of the thoracic spine are divided into drugs and non-drugs. In most cases, only a combination of the two groups gives an effect and the disease recedes. Although you need to understand that it is simply impossible to get rid of osteochondrosis of the thoracic spine completely. The degenerative process can be suspended, slowed down, but it does not have a reverse development.

Drugs

The main directions of exposure to drugs for osteochondrosis of the thoracic spine are elimination of pain, elimination of muscle tension, improvement of microcirculation and tissue trophism.

Nonsteroidal anti-inflammatory drugs are used successfully to eliminate pain syndrome. Drugs in this group have the ability to reduce the process of inflammation, eliminate pain and block platelet aggregation. Medication is prescribed on average for 7-14 days. This is usually enough to eliminate the pain. Many of them are available in various forms (tablets, capsules, solutions for injection, rectal suppositories), which ensures ease of use. In the first days of treatment, the drugs are used in injectable form, then they are replaced by tablets or suppositories. The same drugs can be used locally at the same time: on the area of the thoracic spine. In addition, for this purpose there are also various forms of release: creams, ointments, gels, plasters.

Sometimes nonsteroidal anti-inflammatory drugs are not enough for pain relief. In such cases resort to the use of pain relieving mixtures. The mixtures are injected intravenously in saline or glucose solution.

Paravertebral blockage has a fairly good and rapid analgesic effect. This is a type of medical manipulation, when a drug substance is injected near the spine intracutaneously, subcutaneously, into the thickness of muscle tissue, perineural (directly near the nerve or root). The procedure requires certain skills and experience of the doctor.

In addition, irritating and distracting local ointments can be used to relieve pain in osteochondrosis of the thoracic spine. These are ointments containing snake venom, bee venom and pepper extracts.

Muscle tension is relieved by non-drug methods.

Diuretics, hormones, Escina Lysinat are used to relieve edema of the nerve root.

Pentoxifylline, dipyridamole, complamine and nicotinic acid are used to normalize blood circulation, improve tissue nutrition, and restore trophism.

In osteochondrosis of the thoracic spine, B vitamins are shown, which have analgesic and neurotrophic effects.

When the exacerbation of osteochondrosis of the thoracic spine is stopped, you can resort to the use of drugs that improve the metabolism of the intervertebral discs and joints. These are the so-called chondroprotectors. These drugs stimulate the regeneration of articular cartilage, suspend the degenerative process in the intervertebral discs. They are prescribed for a long time (3-6 months).

Non-drug methods

These include:

massage

(classic, punctual, reflex-segmental);
physiotherapy exercises;
stretching of spasmodic muscles (there are special techniques, stretching is not done according to the principle "as you want");
acupuncture;
swimming (very useful for all patients with localized osteochondrosis)
(ultrasound, electrophoresis, amplipulse, diadynamic currents, mud, etc. ).

If the hernia formed as a result of osteochondrosis of the thoracic spine compresses the spinal cord, its vessels or nerve roots and at the same time causes muscle weakness, pelvic organ dysfunction, pronounced pain syndrome (resistantto the use of drugs), then the question is consideredabout carrying out surgical treatment.

Osteochondrosis of the thoracic spine is not a fatal disease, but it causes great harm to a sick person. It limits his life, interferes with work and good rest. The main symptom of osteochondrosis of the thoracic spine is pain. It is impossible to get rid of this disease completely, but it is possible to suspend the degenerative process and minimize its manifestations.