Degenerative disc disease (osteochondrosis) of the thoracic spine is a relatively rare disease compared to other spines. This is because the rib cage stabilizes the thoracic vertebrae, limiting movement and injury due to constant flexion and extension, as happens in the rest of the spine. If osteochondrosis develops in the thoracic spine, its development is most often associated with trauma.
Degeneration, destruction, and inflammation in the disc area can cause a range of symptoms, depending on the severity of the problem. Disc pathology can lead to symptoms such as reduced range of motion in the back, back pain that may radiate to the intercostal space, numbness, tingling, muscle spasms, or some combinations of these symptoms. The most common manifestations of osteochondrosis in the thoracic region occur at the T8-T12 level. As a rule, the manifestations of osteochondrosis in the thoracic region are: protrusion, extrusion of the disc, herniated disc with sequestration, spondylolisthesis.
Treatment of osteochondrosis of the thoracic spine is most often conservative, but in the presence of complications such as spinal cord compression, surgical treatment is possible.
Osteochondrosis (degenerative disc disease) is not actually a disease, but a term used to describe the progressive changes in discs associated with progressive wear and the development of symptoms secondary to disc degeneration. Disc degeneration is a normal involutive process, but in some situations the degeneration process can be accelerated, for example as a result of trauma, overuse, and musculoskeletal imbalances such as scoliosis. Disc degeneration in itself is not a problem, but the conditions associated with it can lead to the development of advanced symptoms.
Disc degeneration stages
The progression of disc degeneration can be classified into the following stages:
Dysfunction
- Tears are possible at the level of the fibrous ring, with irritation of the facet joints at the corresponding level of the spine.
- Loss of joint mobility, local back pain, muscle spasms and limitations in trunk mobility, especially extension.
Instability
- Loss of fluid by a disc with dehydration and decrease in the height of the disc. Weakness of the facet joints and capsules may develop, causing instability.
- The patient will experience pain of a throbbing nature, straightening of the spine and a sharp decrease in the range of motion in the trunk.
Re-stabilization
- The human body responds to instability by forming additional bone formations in the form of osteophytes, which to some extent help stabilize the spine. But excessive bone formation can lead to spinal stenosis.
- Back pain generally decreases but remains less intense. Some people may develop stenosis-like symptoms.
The reasons
- Involutive changes in the body are the most common cause of disc degeneration. As the body ages, the discs gradually lose their fluid part and become dehydrated. The discs begin to shrink and lose height, which impairs their ability to absorb shock and stress.
- The outer annular fibrous structures of the disc may begin to crack and rupture, weakening the walls of the disc.
- People who smoke, are obese, and engage in strenuous activities are more likely to experience disc degeneration.
- Injuries to the spine or disc caused by a fall or impact can trigger the process of degeneration.
- A herniated disc can initiate the development of disc degeneration.
- Unlike muscles, discs have a minimal blood supply, so they have no restorative capacity.
Symptoms
Symptoms associated with osteochondrosis of the thoracic spine will depend on the location and structures involved in this process. Degeneration of thoracic spine discs can affect the back, the area under the scapula, or along the ribs.
- Many patients with degenerative thoracic spine disc disease may not have symptoms.
- Chronic chest pain with / without radiation to the ribs.
- Sensory changes such as numbness, tingling or paresthesia in case of nerve compression.
- Muscle spasms and changes in posture in the thoracic back.
- Loss of range of motion, with reduced ability to move the trunk, especially when rotating or bending to the side.
- Sitting for long periods of time can cause back pain and arm pain.
- Difficulty lifting weights and lifting the arms above the head.
- In later stages, spinal stenosis can develop, leading to weakness in the lower limbs and loss of coordination of movement. In these cases, surgery will be necessary.
Diagnostic
In addition to performing a thorough examination, the doctor may order the following tests to have the diagnosis verified:
- Radiography,helps determine if there is joint degeneration, fractures, bone deformities, arthritis, tumors, or infection.
- MRIto determine morphological changes in soft tissue, including visualization of discs, spinal cord and nerve roots.
- computed tomographyan analysis that can provide cross-sectional images of vertebral structures.
- EMG,this diagnostic method is used to determine the damage to the nerves and the level of damage.
- MyelogramAs a rule, this method of research is necessary to clarify morphological changes in the degree of impact on the roots and spinal cord and to plan surgical intervention.
Treatment
Treatment for osteochondrosis of the thoracic spine will depend on the severity of the condition.
Treatment of acute pain syndrome:
- Rest: Avoid activities that cause pain (bending, lifting, twisting, twisting, or lying backwards).
- Medicines to reduce inflammation (anti-inflammatories and pain relievers).
- Ice in acute cases can relieve spasms, relieve pain.
- Local heat exposure can help relieve pain and muscle tension.
- Light gymnastic exercises to eliminate biomechanical disorders associated with osteochondrosis and improve joint mobility, normal spine configuration, posture and range of motion.
- It may be necessary to use a splint to relieve stress on the facet joints and muscles of the thoracic spine.
- Corticosteroids are used to reduce inflammation in moderate to severe cases.
- Epidural injections directly into the area of the damaged disc.
In mild cases, using a topical cold and medication may be enough to relieve the pain. After pain relief, exercise therapy (physical therapy) and exercises to stretch and strengthen the back muscles are recommended. The return to normal activity should be gradual to avoid recurrence of symptoms.
The main conservative methods of treating osteochondrosis of the thoracic spine
Medical treatment
The task of the use of drugs in the treatment of osteochondrosis of the thoracic spine, especially in acute pain syndrome, is to reduce pain, inflammation and muscle spasms.
- Over-the-counter medications for mild to moderate pain.
- Narcotic pain relievers for severe pain that cannot be controlled by other methods of treatment.
- Muscle relaxants to reduce acute muscle spasms.
- Prescription pain relievers.
- Injections such as facet joint injections, blockages, or epidural injections. These may include injecting corticosteroids into specific areas to reduce local inflammation.
- Manual therapies, including soft tissue massage, stretching and mobilization of joints performed by a specialist, improve the geometry, mobility and range of motion of the thoracic spine. The use of mobilization techniques also makes it possible to modulate the pain.
- Exercise therapy (therapeutic exercises), including stretching and muscle strengthening exercises, to restore range of motion and strengthen the muscles of the back and abdomen, support, stabilize and reduce stress on them. discs and back. An exercise program, especially exercise with weights or weights, should be started after the pain, muscle spasms and inflammation have subsided. An improperly chosen exercise program can make symptoms worse. Therefore, the selection of exercises should be done with an exercise therapy doctor.
- Neuromuscular rehabilitation to improve posture, restore stability, teach the patient the correct biomechanics of movement to protect damaged discs and spine.
- Physiotherapy, including the use of ultrasound, electrical stimulation, and cold laser, helps reduce pain and inflammation in spinal structures.
- Home exercise programs including muscle building, stretching and stabilization exercises, and lifestyle changes to reduce stress on the spine.
- Acupuncture. This method of treatment can be used in the presence of sensory disturbances or to restore conduction and reduce pain.
Surgical treatments
Most hernias located in the thoracic spine of the thoracic disc can be treated successfully without surgery. However, when conservative treatment of osteochondrosis of the thoracic spine is ineffective, surgery may be recommended, especially if the patient has some of the following symptoms:
- Increased root pain.
- Increased pain and nerve damage.
- Development or increase in muscle weakness.
- Increased numbness or paraesthesia.
- Loss of control of bowel and bladder function.
The most common surgery associated with disc degeneration is a discectomy, in which the disc is removed through an incision. However, there are several surgical procedures that may be recommended for osteochondrosis and disc degeneration. The choice of surgical method depends on the cause of the symptoms. Basic surgical techniques - include foraminotomy, laminotomy, spinal laminectomy, spinal decompression, and spinal fusion.
Provide
Most of the problems associated with osteochondrosis of the thoracic spine can be resolved without surgery and people return to normal work. Osteochondrosis of the thoracic spine due to anatomical rigidity develops less than in other parts. The duration of treatment, as a rule, does not exceed 4-12 weeks and depends on the severity of the symptoms. Patients should continue with the stretching, strengthening and stabilizing exercise program. A good long-term prognosis requires the use of appropriate bodily movements and mechanisms and an awareness of the importance of maintaining a healthy spine.