Osteochondrosis of the thoracic spine: symptoms and treatment

Osteochondrosis of the thoracic spine is a degenerative-dystrophic chronic process of affecting intervertebral discs and vertebral bodies of the thoracic spine. This disease occurs a little less often than osteochondrosis of the cervical or lumbosacral spine. However, this does not mean that it does not cause trouble to a person. The osteochondrosis of the thoracic spine is manifested, mainly, by pains in the back and chest, but it can also give pains in the heart, in the abdomen, similar to angina or hepatic colic. In rare cases, osteochondrosis of the thoracic spine becomes the cause of paresis of the muscles of the lower extremities, a violation of sensitivity in them, disorders of the pelvic organs. Treatment of the disease consists in the use of medication and non-drug methods, and sometimes even surgery is required. From this article you will learn about the symptoms that manifest the osteochondrosis of the thoracic spine and the methods of its treatment.

Thoracic spine

The thoracic spine is represented by 12 vertebrae, between the bodies of which the intervertebral discs are located. Disks consist of a gelatinous (pulpous) nucleus and a fibrous ring. Pathological changes in these discs, as well as in a number of located arcuate joints, proliferation of bone spines along the edges vertebral bodies, dystrophic processes in the ligaments of the spine and become the direct cause of the appearance of back pain.

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

Some features of the structure of the thoracic spine cause its less frequent lesion with osteochondrosis than other departments. Let's list these features:

• less mobility of the thoracic spine;
• the presence of joints of the vertebrae with the ribs (which, together with the sternum, creates a strong chest frame that is less prone to injury);
• small thickness of intervertebral discs;
• physiological kyphosis (anterior-posterior bend with a bulge directed posteriorly) of the thoracic region spine, in connection with which the maximum axial load falls on the front, rather than the rear sections of the disks.

Another feature of not the structure, but the development of osteochondrosis of the thoracic spine, which also affects the lower frequency of occurrence of pain in the thoracic region, is that the existing morphological bases of osteochondrosis in this part can remain clinically "mute" for a long time. That is, there is a change, but do not disturb the patient.

And yet, in the presence of provocative factors, such as a sedentary lifestyle (including years of work at the table or driving a car), trauma, violation posture, flaccidity of the back muscles, heavy physical labor in a forced posture, osteochondrosis of the thoracic spine shows its true face.

Symptoms of osteochondrosis of the thoracic spine

In osteochondrosis, pain can occur between the shoulder blades, along the course of the intercostal spaces. in the region of the heart. Its feature is the strengthening of the body, bends, deep inspiration.

The main clinical symptom of osteochondrosis of the thoracic spine, like other departments, is pain. Back pain, chest pain, even pain in the area of ​​internal organs. In medicine, it is customary to allocate several painful (and not only painful) syndromes of osteochondrosis of the thoracic spine. In total, they are divided into two groups:

• reflex;
• compression.

Reflex syndromes are a clinical reflection of stimulation of the spinal receptors. These are receptors of 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, autonomic disorders from the soft tissues and internal organs. The basis for such changes is the following fact: irritation of the receptors leads to the spread of excitation on a number of located structures of the spinal cord (to be more precise, then to the segments of the spinal cord). And it can be neurons, responsible for sweating a certain area of ​​skin, regulating the temperature of the same site involved in providing the activity of internal organs (heart, liver, intestine, etc.), supporting the tone of muscles and blood vessels that supply all these structures. And when excitation is transferred to these neurons, there are corresponding symptoms of disruption of the activities of certain formations. Therefore, it is quite possible that the pain in the abdomen or in the heart region is due to osteochondrosis of the thoracic spine.

Compression syndromes occur when the nerve root is squeezed (rarely stretched) when it leaves the intervertebral foramen, the spinal cord tissue or the vessels feeding it. Compression syndromes are almost always due to the existing herniated intervertebral disc. The most common are hernia of the lower thoracic segments. Depending on the direction and location of the hernia, a person experiences certain symptoms. This can be represented as follows:

• The median (median) hernia is accompanied by the development of muscle weakness symmetrically in both legs, a loss of sensitivity in them. In this case, the pain syndrome, characteristic of the compression of the nerve root, is absent;
• lateral (lateral) hernias manifest solely by pain associated with compression of the nerve root;
• Medio-lateral hernia combines the clinical symptoms of the two previous groups, only muscle weakness and sensitivity disorders predominate on the side of the bulged disc.

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

Reflex Syndromes

Dorsago- sudden sudden pain in the thoracic spine. It is acute, often described by the sick as a blow with a dagger. Basically, it is felt between the shoulder blades, can give into the heart area, sternum. Patients are afraid to move and even breathe in full, as the pain intensifies (as it were, re-shoots) from it. Quite often, these symptoms occur after a long stay in a fixed uncomfortable position, when performing monotonous work. A sharp movement after this provokes dorsago in people with osteochondrosis of the thoracic spine. When palpation of the thoracic spine, the tension of the near-vertebral muscles in the form of a roller and their soreness is revealed.

Sometimes such a pain can be regarded as a heart attack, so pronounced and sudden it seems to the patient. However, the removed electrocardiogram has no deviations and the use of nitroglycerin under the tongue does not eliminate the pain.

Dorsalgia- this is another type of reflex syndrome of the thoracic level. It is a pain syndrome that occurs gradually. Pain can be localized in any part of the back, chest. Painful, dull, sometimes with a touch of burning (which is associated with irritation of vegetative structures). It is strengthened by the movements of the spine, slopes, rotation around its axis, when coughing or sneezing, driving on an uneven road.

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

If the pain is localized on the anterior thoracic wall, it is also called pectalgia. In this case, it can be felt only in some places with the intact back. For example, in the region of the xiphoid process or at the attachment site of the sternocleidomastoid muscle. Quite often, due to the aching and dull nature of the pain, it is difficult to understand exactly where it hurts: either something inside the chest, or in the area of ​​superficial soft tissues.

Dorsalgia can be accompanied by reflex tension of the near-vertebral muscles, more pronounced on the side of pain. In this case, of course, the muscle tension is not as pronounced as in a similar situation in the lumbar spine. But nevertheless at palpation the compression of a muscle is felt, and the touch itself causes unpleasant sensations or a pain. Also painful palpation of interstitial spaces and paravertebral points in the zone of osteochondrosis affected segment.

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

Compression syndromes

Nerve root compressionis accompanied, first of all, by a painful syndrome. The pain is of a shooting nature. The direction of the spread of pain corresponds to the course of nerve fibers. In the case of chest osteochondrosis, these are intercostal spaces. Since some of the nerve fibers form plexuses involved in the innervation of internal organs, pain can be felt inside the chest, abdomen. The pain intensifies with movement, the torso of the trunk, coughing, sneezing, laughing (because at these moments the tension of the spine increases). In the zone innervated by the squeezed spine, there may be a sensitivity disorder: a feeling of crawling, numbness, tingling. It may not be easy to touch this area. In cases where the nerve root is subjected to compression for a long time, there may be motor disorders, that is, the weakness of the innervated muscles. Gradually, the muscles atrophy. However, motor disorders occur very rarely, because they are the latest in the chronology of the onset of all symptoms. Usually a person seeks medical help at the stage of the onset of pain and sensitive disorders.

Spinal cord compressionmanifests itself by the appearance of weakness in the legs with a simultaneous increase in the muscle tone (if the spinal cord is squeezed in the lower thoracic spine, then the muscle tone decreases). Pathological stop symptoms may appear (Babinsky and others). Sensitivity in the lower extremities is lost, there is no sensation of a touch of cold and hot, the difference between just touching and pricking. In cases of severe compression of the spinal cord, there may be disorders of urination.

Vascular depression, blood supplying the spinal cord, leads to the development of myelo-ischemia, i.e. impaired nutrition of the spinal cord tissue. This is the same as the compression of the spinal cord, accompanied by the development of muscle weakness (patients say "legs refused"), loss of sensitivity and pelvic disorders.

In fairness, it should be said that the compression of the spinal cord and its vessels in the osteochondrosis of the thoracic spine are very, very rare.

Vegetative components of the osteochondrosis of the thoracic spine

A painful attack can resemble that of angina pectoris, but with osteochondrosis, pain points are usually detected and there are no changes on the electrocardiogram.

In view of the fact that the nerve fibers from the thoracic spine contain vegetative conductors, irritation or infringement of these fibers may be accompanied by autonomic symptoms. It can be:

• dryness and peeling of the skin in the zone of innervation of an individual nerve;
• local impairment of sweating and thermoregulation (also according to the innervation zone);
• chilliness of the lower extremities, fragility of the nails on the legs;
• pain simulating diseases of the gastrointestinal tract (for example, gastritis, peptic ulcer, cholecystitis, and so on);
• pain in the kidneys, which in fact have nothing to do with the pathology of the kidneys (there are no changes in urine and ultrasound);
• pain in the heart, very similar to angina and even myocardial infarction.

The peculiarity of such pains can be the fact that the person with back pain can not feel it. This is misleading at first both the patient and the medical staff when seeking medical help. However, the implementation of a number of additional methods of investigation makes it possible to exclude the pathology of internal organs, and then the cause of such pains is osteochondrosis of the thoracic spine.

Treatment of osteochondrosis of the thoracic spine

All methods of treatment for osteochondrosis of the thoracic spine are divided into medicamentous and non-medicamentous. In most cases, only a combination of both groups gives an effect, and the disease recedes. Although you need to understand that it is simply impossible to completely get rid of the osteochondrosis of the thoracic spine. The degenerative process can be suspended, slowed down, but it has no reverse development.

Medication Methods

The main directions of the effect of drugs in the osteochondrosis of the thoracic spine are elimination of pain syndrome, elimination of muscle tension, improvement of microcirculation and trophism of tissues.

To eliminate the pain syndrome, non-steroidal anti-inflammatory drugs are successfully used. Preparations of this group have the ability to reduce inflammation, eliminate pain, block platelet aggregation. Diclofenac (Voltaren), Ibuprofen, Ketoprofen (Ketonal, Arthrosilen), Orthofen, Piroxicam, Lornoxicam (Xefokam), Meloxicam (Movalis), Celecoxib (Celebrex), Nimesulide (Naise) are most commonly used. The drugs are prescribed, on average, for 7-14 days. This is usually enough to eliminate the pain syndrome. Many of them are available in various forms (tablets, capsules, injectable solutions, rectal suppositories), which provides ease of use. The first days of treatment, drugs are used in the injection form, and then switch to tablets or suppositories. These same drugs can simultaneously be used topically: on the thoracic spine area. Moreover, for this purpose, there are also various forms of release: cream, ointments, gels, patches. Locally also work well applications with Dimexide and Hydrocortisone, Novocain. Dimexide ensures the penetration of medicinal substances into deeply lying tissues. A prerequisite for the use of applications is a preliminary check for the tolerability of Dimexide (apply to a small area of ​​the skin and observe the local reaction).

Sometimes non-steroidal anti-inflammatory drugs are not enough to eliminate the pain syndrome. In such cases, resort to the use of analgesic mixtures. They can include Analgin, No-shpa, Novocaine, Lasix, Dexamethasone, Vitamin B12. The mixtures are intravenously dripped in physiological saline or glucose.

Paravertebral blockades have a fairly good and fast analgesic effect. This is a kind of medical manipulation, when a drug substance (more often Novocaine or Hydrocortisone) is injected near the spine intracutaneously, subcutaneously, into the thickness of muscle tissue, perineural (directly near the nerve or rootlet). The procedure requires certain skills and experience of the doctor.

Also, to reduce pain in osteochondrosis of the thoracic spine, locally irritating and distracting ointments can be used. These are ointments containing snake venom, bee venom, pepper extracts.

Muscle tension is removed by non-drug methods, as well as using drugs such as Sirdalud, Midokalm, Baclofen.

To remove the edema of the nerve root, diuretics (Lasix), hormones (Dexamethasone, Hydrocortisone), L-lysine escinate, Cyclo-3-fort are used.

In order to normalize blood circulation, improve tissue nutrition and restore trophics, Pentoxifylline (Trental), Dipyridamole (Curantil), Complamine, Nicotinic acid are used.

In osteochondrosis of the thoracic spine, B group vitamins are shown that have analgesic and neurotrophic effects. It could be Milgamma, Neurovitan, Neurobeks and others.

When the exacerbation of the osteochondrosis of the thoracic spine will be 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 (Rumalon, Arteparon, Chondroitin-sulfate, Structum, Alflutop, Glucosamine). These drugs stimulate the regeneration of articular cartilage, stop the degenerative process in the intervertebral discs. They are appointed for a long term (3-6 months).

Non-pharmacological methods

They include:

• massage (classical, point, reflex-segmental);
• exercise therapy;
• stretching spazmirovannym muscles (there are special techniques, stretching is not done on the principle of "as you want");
• acupuncture;
• swimming (very useful for all patients with any localization of osteochondrosis);
• physiotherapy (ultrasound, electrophoresis, amplipulse, diadynamic currents, mud therapy, and so on).

If the hernia that is formed as a result of the osteochondrosis of the thoracic spine presses the spinal cord, its vessels or nerve roots, and at the same time causes muscle weakness, a violation functions of pelvic organs, severe pain syndrome (resistant to the use of medicines), then the question of conducting surgical treatment is being considered.

Osteochondrosis of the thoracic spine is not a fatal disease, but it does much harm to the sick person. He restricts his life, interferes with work and recreation. The main symptom of osteochondrosis of the thoracic spine is pain. Completely get rid of this ailment is impossible, but you can suspend the degenerative process and minimize its manifestation.

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