Unnatural changes in the cartilage and bones of the spine cause the development of the disease, which according to the ICD-10 code refers to the localization of M42 and is called thoracic osteochondrosis. The middle part of the spine is under less stress than the lower back and neck, but deformities are difficult to heal. The load is distributed unevenly due to the rounded configuration of the sternum, osteophytes and other dysplastic manifestations appear.
Symptoms and signs
The disease occurs in the nucleus pulposus of the intervertebral disc, spreads to the fibrous annulus and other parts of the vertebral segment, which provide mobility of the spine. The changes are manifested by compressive, reflex or mixed neurological disorders and syndromes.
The pain is manifested by physical exertion. There are different types of sensations:
- prolonged mild pain in the chest area is called back pain;
- sharp and sharp colic, causing difficult inspiration or exhalation, resulting in immobility of the muscles - dorsago.
Symptoms and treatment of osteochondrosis of the thoracic spine depend on the degree of wear and tear of the bone apparatus and the stage of aging, which is generalized and local.
Symptoms include:
- damage to peripheral processes of the nerves (neuralgia), characterized by painful attacks along the intercostal vasoconstrictors;
- concentration of pain in the left side of the chest or the onset of a strong painful sensation of a shingles nature;
- decreased mobility of the spine in the chest area;
- numbness in the arms and hands;
- decreased sexual function;
- the appearance of pain in the area of internal organs, can give to the heart, stomach, liver;
- lumbago in the neck, cheekbones and head, cough or lump in the throat;
- arrhythmia, tachycardia, fever.
Signs of osteochondrosis are disguised as manifestations of related diseases, so the symptoms are ambiguous. The spinal nerves are concentrated around the spine; when clamped, signals are sent to different parts of the body and organs.
Causes of osteochondrosis
There is no exact information about the factors that deform the intervertebral discs. A common cause of osteochondrosis is scoliosis or curvature of the spine, which is most often recorded during childhood and adolescence.
The theory considers these factors of spinal deformity:
- dysontogenetics;
- hormonal;
- vascular;
- functional;
- involutive;
- infectious;
- immune;
- dysmetabolic;
- mechanical;
- hereditary.
The deterioration and aging of bones and cartilage occur as a result of previous exposure to adverse conditions. Atrophic degenerations of the spine are predetermined by a genetic factor, and a disease with clinical symptoms occurs under the influence of an exogenous and endogenous environment.
The consequence in the form of complications in the work of the vertebrae occurs when the process of destruction of complex substances outweighs their synthesis. An exacerbation occurs when the power supply to the disc is disturbed and there is a shortage of useful elements. The penetration of elements and concealment products decreases, cell viability decreases, and parts of cells accumulate due to self-destruction. The production of complex proteins is reduced, the collagen fibers are destroyed.
The mechanical effect on the annular connective tissue formation increases, the layered structure is disorganized, the fibrous skeleton is torn. The disc is bruised under the influence of biomechanical factors and bodily movements, and its binding capacity decreases. Blood vessels and nerves can develop in the ring due to a decrease in hydrostatic pressure.
Diagnostic methods
In the process of recognition, root, pain, reflex, myotonic, autonomic and vascular factors are identified. The best method of examination is difficult to identify, since in each case the diagnosis is made individually.
The main methods are:
- x-ray diagnostics;
- computed tomography;
- Magnetic resonance imaging.
The radiography analyzes the condition of the spine, the images are given in oblique, lateral and direct projections. Sometimes for a photo a person bends over, unfolds, or leans to the side.
Contrast radiography is divided into the following studies:
- pneumomyelography - 20-40 ml of air is injected into the spinal canal;
- angiography - 10 ml of contrast agent is injected into the spinal lumen and 7-9 images are taken within 2-3 seconds;
- myelography - an injection of a coloring liquid is performed into the subarachnoid lumen, followed by transillumination of the structure;
- discography - the colored substance is injected directly into the disc for localized examination.
Computed tomography assesses bone and tissue structure, the condition of blood vessels. The painless method takes three-dimensional images in minutes.
Advantages of CT:
- high detection speed;
- detection of "dumb" areas during on-the-go diagnostics;
- the possibility of multispiral angiography;
- recognition of long objects with obtaining high quality thin sections.
MRI uses the magnetic field of a machine that builds hydrogen atoms in the human body in parallel with the action. The particle signal, the response is recorded. The tomograph recognizes the waves and displays the result on the screen. With MRI there is no radiation, the method is less dangerous, but is not recommended for pregnant women.
Treatment and prevention
It is necessary to treat osteochondrosis in several stages, the complexity depends on the severity of the disease, contraindications and body resources.
Methods :
- drugs and medicines;
- physiotherapy methods, exercises for removing the clamps, alleviating the patient's condition;
- operation.
There is a direction of physiotherapy, in which it is possible to cure problems with the spine in the form of a hernia, spondylosis with rehabilitation gymnastics. In addition, a method of recovery after surgery has been developed.
Yoga exercises help adult men, women and children overcome pain, warning that the main thing is a psychological attitude.
Medications
Medications are prescribed by a neurosurgeon or neuropathologist based on the medical history and chart. Patients take drugs in the hospital or at home, the main thing is to follow the instructions and not to deviate from the admission regimen.
Common medications:
- NSAIDs relieve pain, fever and inflammation;
- muscle relaxants lower the muscle tone of the skeletal skeleton;
- hormones reduce nerve pain;
- vitamins B2, B6, B12, A and C are taken during remission and for simple prophylaxis;
- diuretics relieve swelling and free pinched root nerves;
- neurometabolic stimulants improve metabolism in nervous tissue;
- chondroprotectors restore the cartilage of the vertebrae after damage.
Sometimes the patient does without medication at the first stage of the appearance of unpleasant sensations. Just exercise, use a massager.
Physiotherapy
This type of exposure is used in conjunction with drug therapy or separately. In addition, bed rest is applied, heat is applied to the affected area. Folk recipes are used to relieve pain.
Physiotherapy in a medical institution includes the procedures:
- ultrasound and phonophoresis;
- shock wave therapy;
- stress relieving impact;
- laser therapy;
- electrotherapy;
- magnetic waves;
- mud therapy and balneotherapy;
- massage.
Ultrasound involves the effect of high frequency waves on tissue, which reduces sensitivity to pain. With ultraphonophoresis, pain relievers and anti-inflammatory drugs are added for better delivery to the affected areas.
Shock wave therapy is the transmission of sound wave to the painful area, it is used to improve blood circulation, speed up metabolism. Stress relief therapy involves stretching the spine using the patient's body weight.
Laser therapy is based on the generation of helium-neon lasers to activate bioelectric currents in nerve fibers. The laser works on inflamed nerve roots from the paravertebral region along the thoracic region.
Electrotherapy improves nutrition and metabolism of products in tissues, and impulse currents affect sensory nerve endings. Low frequency waves relieve acute pain and are used as an initial aid.
Magnetic therapy is used to relieve swelling, spasms, and inflammation. A magnetic wave inducer is placed over the affected chest region. Balneotherapy and mud therapy consist of swimming in pools, taking baths, contrast showers for treatment and during recovery. Metabolism is normalized, blood flow to the affected areas is accelerated, pain and inflammation are reduced.
Therapeutic massage for osteochondrosis of the thoracic spine is vacuum, punctual and lymphatic drainage, improves blood microcirculation, tissue nutrition and tones muscles. Sessions are conducted by a competent specialist, if you entrust the spine to amateurs, dangerous consequences can ensue. Massage is prescribed after the end of the acute phase, the first session should not exceed 10 minutes.
Operative treatment
The patient is indicated for an operation if medical treatment, massage, and other procedures do not alleviate the condition.
The intervention is divided into 2 stages:
- elimination of the cause of severe pain (decompensation);
- stabilization of the spine.
Posteriorly, a facetomy is performed because the facet joints can put pressure on the nerves. Foraminotomy is the expansion of the root canal through which the nerve leaves the vertebra. Laminectomy removes the posterior part of the vertebra, which protects the lumen of the spine and puts pressure on the brain due to the deformity. Laminotomy involves widening the opening of the canal, where the spinal cord is located, while removing a separate fragment from the posterior region of the vertebra.
Previous surgery is done if there is a protrusion (bulging of the spinal disc towards the spinal lumen) or a protruding hernia towards the canal.
The following methods are used for frontal decompression:
- discectomy - removal of an entire disc or a separate part of it;
- corpectomy - removal of an entire vertebra and an adjacent disc followed by implantation.
Discectomy and corpectomy lead to destabilization of the spine and increase the risk of neurological defects. Rigid fixation or fusion of three vertebrae (fusion) is used.
Prevention of thoracic osteochondrosis
The exacerbations of the disease reduce the working capacity and the quality of human life. Therefore, special attention is paid to prevention. As a result, spinal degeneration appears later and disability is avoided.
Methods of disease prevention:
- decrease in physical activity on the spine;
- you cannot stand still for a long time without changing the supporting limb, you can lean on an improvised object or on a wall;
- sitting at a desk for a long time is not recommended, and when working with a computer, you need to take active breaks, take a walk;
- orthopedic mattresses and headrests are chosen for sleeping;
- when running and walking you should avoid sudden and sudden turns and jumps, walk in shock-absorbing shoes with small heels;
- wear weights not exceeding 10 kg, lift gradually from a sitting position.
In the car, you should use bolsters for the back and headrests, while the driver's seat should be rigid. The work can not be done in a half-recline position, you can stand or sit. Well-developed muscles support the skeleton, so they pay attention to achievable physical education and hardening.
Possible complications
The disease develops for a long time, sometimes the symptoms of pain do not appear immediately. Any degenerative change in the thoracic region leads to the appearance of pathologies.
Types of complications:
- pathology of heart vessels with subsequent myocardial infarction or angina pectoris;
- intercostal neuralgia or inflammation of peripheral nerves with chest pain due to root compression;
- protrusion of the intervertebral discs.
Complications arise with advanced forms of osteochondrosis, so timely treatment in the early stages will help to avoid concomitant diseases.