In the case of thoracic osteochondrosis often suffer organs associated with areas of the spinal cord, which is located at the level of the affected thoracic area and below. Disruption of the normal functioning of the spine leads to immobility of the arms, legs and torso in general, 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 involved in the pathological process of adjacent 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 largely depend on the intervertebral discs, which are one of the types of cartilaginous connection 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 the discs is to reduce the vertical load on the vertebrae. The disk consists of three parts:
- hyaline plates (tightly attached to the vertebrae);
- 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 chondrin (proteoglycans). The anterior surface of the discs is covered by the anterior longitudinal ligament, which is tightly fused to the vertebrae and rotates freely on 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, so it feeds on substances that come by diffusion from the vertebral bodies.
The distribution of vertical loads in the spine is due to the elastic properties of the discs. As a result of pressure, the pulpal nucleus expands and the pressure is redistributed to the fibrous ring and hyaline plates. During movement, the nucleus moves in the opposite direction: when bending - to the protrusion, when unfolding - in front. When the spine moves, muscles, ligaments and discs become involved. Therefore, a disruption in a relationship leads to a disruption in the entire kinetic chain.
Causes and mechanisms 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 pulpal nucleus gradually loses its elastic properties (as a result of depolymerization of polysaccharides), forming protrusions and sequesters.
The process of 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 glucosamines and impaired distribution of collagen fibers in the disc. The genetic factor is of paramount importance for the occurrence of thoracic osteochondrosis, subjected to increased functional activity.
Risk factors for the development of degenerative changes in the spine include the anatomical features of the discs, which are imperfections in evolution. One of these features is the nutritional characteristics of the structures. In the human body, the disc consists of poorly perfused tissue. Closure of blood vessels occurs in childhood. After feeding occurs due to diffusion of substances through the end plates.
The stimulator of nutrient penetration is a dosed load, which excludes static postures and great stress. Lack of physical activity is one of the leading risk factors for thoracic osteochondrosis. Therefore, regular exercise is an important preventive measure.
The peculiarity of the microscopic structure - several cells - reduces the intensity of the regenerative ability and the speed of recovery of the components of the disk. An anatomical feature is the weakness and lack of strength of the discs in the posterior areas. This contributes to the appearance of wedge-shaped discs in the lower chest and lumbar region.
Great importance in the development of osteochondrosis is given to involutional changes. Active degenerative changes begin to increase after 30 years. The synthesis of the components necessary for the disc (glycosaminoglycans) continues, but their quality deteriorates. Hydrophilicity decreases, fibrosis increases, sclerosis occurs.
Stages of intervertebral disc degeneration:
- prolonged asymptomatic course, degenerative changes in the intradiscal components, displacement of the nucleus inside the disc;
- pronounced radicular symptoms of thoracic osteochondrosis, spinal cord compression, bulging of the pulpal nucleus (protrusion, 1st degree);
- rupture of the disc 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 thorax, contributes to the least trauma to the intervertebral discs and therefore to osteochondrosis. Physiological thoracic kyphosis contributes to the redistribution of the weight of the upper half of the body to the lateral and anterior 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 the narrowing of the intervertebral foramina and compression of the roots of the spinal cord and sympathetic fibers. Sympathetic fibers originate from the gray matter of the spinal cord, and then gather in nodes, from which they are sent to all internal organs. This leads to the fact that thoracic osteochondrosis, in addition to the typical neurological disorders, leads to dysfunction of internal organs (vegetative, vasomotor, trophic) and imitation of somatic diseases. This feature of osteochondrosis of the thoracic discs explains the difficulties in diagnosing and prescribing the right treatment.
Symptoms of thoracic osteochondrosis
Chest osteochondrosis is more common in people with a sedentary lifestyle. At the same time there is no stimulating effect of dosed loads on the spine, which contributes to impaired disc recovery. Diseases develop in people who work on a computer for a long time, hunched over, etc. Such people must perform therapeutic exercises on their own.
Osteochondrosis of the chest most often manifests itself with dull pain, less often pain and burning. The pain is localized between the shoulder blades. The patient is disturbed by the feeling of tightness in the chest. Palpation of the spinous processes of the thoracic vertebrae reveals local pain, which increases with axial loads on the spine, deep inspiration and curves of the body.
Many patients have severe pain in the shoulder blade and lower chest (posterior rib syndrome). These symptoms develop as a result of displacement of the lower ribs. The pain increases sharply when turning the torso. More often the pain syndrome disappears abruptly.
Often the pain in the chest becomes lumbar, corresponding to the course of the intercostal nerve. Sensitivity in the area of innervation of the nerve ending is impaired, paresthesias occur and a decrease in superficial and deep sensitivity is often observed. Possible dysfunction of the abdominal press, change in the reflexes of the knee and tendon.
Dysfunction of the internal organs occurs when a nerve root is compressed at the level of 1 to 12 chest. In the thoracic region there are structures responsible for the innervation of the lungs, heart, intestines, liver, pancreas and kidneys. Therefore, there are no signs unique to thoracic osteochondrosis.
The disease manifests itself with symptoms characteristic of another pathology:
- difficulty breathing;
- severe night pain;
- "heart", anginal pain;
- soreness 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.
Diagnosis
Chest X-ray examination is of the greatest value in the diagnosis of thoracic osteochondrosis. The photo 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, joints of the spine, the size of the spinal canal, to determine the location of the hernial protrusion and its size.
When making a differential diagnosis, it is necessary to carefully collect the anamnesis and compare all clinical signs of thoracic osteochondrosis with symptoms of other diseases. For example: heart pain with osteochondrosis is not stopped by nitroglycerin, epigastric pain is not related to food intake, is not seasonal, all symptoms appear mainly in the evening and completely disappear after a night's rest.
How to treat osteochondrosis of the chest?
Treatment of thoracic osteochondrosis in almost all cases is conservative. An indication for therapy is the predominance of visceral syndromes with neurological disorders. The main orthopedic treatment should be adequate traction of the spine:
- active vertical traction under water;
- passive horizontal traction in an inclined bed with the help of the Glisson loop in case of damage at the level of 1-4 thoracic vertebrae, through the axillary straps in case of damage at the level of 4-12 thoracic vertebrae.
Drug treatment consists of performing paravertebral blockades with a solution of novocaine. In exacerbation of the disease, analgesics and sedatives are used. In mild pain syndrome, it is permissible to use ointments with analgesics and anti-inflammatory drugs at home.
After the elimination of the acute phenomena, a massage of the muscles of the back and lower limbs is used. Manual therapy is indicated for 1-3 degrees of osteochondrosis in case of development of functional blockades. Includes various options for soft and rough effects on the back muscles.
Therapeutic exercise allows you to load all parts of the spine in doses, which stimulates the recovery process. An important condition for training therapy for osteochondrosis is to exclude vertical loads.
Physiotherapy: UHF treatment, ultrasound, inductothermy, radon and pine-coniferous salt baths. Underwater traction and hydromassage are actively used at the spa stage.
Surgical treatment is rarely used. An indication for surgery is compression of the spinal cord by a prolapsed disc fragment.