Degenerative disc disease (osteochondrosis) in the thoracic spine is a relatively rare condition compared to other spines. This is because the rib cage stabilizes the thoracic vertebrae, limiting movement and injuries from constant flexion and extension, as occurs in the rest of the spine. If osteochondrosis develops in the thoracic spine, then most of the time its development is associated with trauma.
<1_img_leftxx>Degeneration, destruction and inflammation in the area of the disc can cause a range of symptoms, depending on the severity of the problem. Disc pathology can cause symptoms such as decreased range of motion in the back, back pain that may radiate to the intercostal space, numbness, tingling, muscle spasm, or certain 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, disc extrusion, herniated disc with sequestration, spondylolisthesis.
The treatment of osteochondrosis of the thoracic spine is mostly conservative, but in the presence of complications, such as spinal cord compression, surgical treatment is possible.
Osteochondrosis (degenerative disc disease) is not really a disease, but a term used to describe progressive changes in the discs associated with progressive wear and development of symptoms secondary to disc degeneration. Disc degeneration is a normal involutive process, but in certain situations the degeneration process can be accelerated, for example, as a result of trauma, overuse, and musculoskeletal imbalances such as scoliosis. Disc degeneration itself is not a problem, but the conditions associated with it can lead to the development of advanced symptoms.
Stages of disc degeneration
The progression of disc degeneration can be classified into the following phases:
Dysfunction
- Lacerations are possible in the ring fibrous area, with irritation of the facet joints at the corresponding level of the spine.
- Loss of joint mobility, local back pain, muscle spasm and limitations in trunk mobility, especially extension.
Instability
- Fluid loss from a disc with dehydration and decreased disc height. Weakness of joints and capsules can occur, leading to instability.
- The patient will experience severe pain, straightening of the spine, and a marked decrease in trunk range of motion.
Restabilization
- The human body reacts to instability by forming additional bone formations in the form of osteophytes, which to some extent help to stabilize the spine. But excessive bone formation can lead to spinal stenosis.
- Back pain usually subsides but remains less intense. Some people can develop stricture-like symptoms.
The reasons
- Involutional changes in the body are the most common cause of disc degeneration. As the body ages, the discs gradually lose their liquid portion and become dehydrated. The discs begin to narrow and lose their height, impairing their ability to absorb shock and stress.
- The outer annular fibrous structures of the disc may begin to crack and tear, weakening the disc walls.
- People who smoke, are obese, and engage in strenuous activities are more likely to experience disc degeneration.
- Spinal or disc injuries from a fall or impact can trigger the degeneration process.
- A herniated disc can initiate the development of disc degeneration.
- Unlike muscles, discs have a minimal blood supply, so they have no repair capacity.
Symptoms
The symptoms associated with osteochondrosis of the thoracic spine will depend on the location and structures involved in this process. Degeneration of discs in the thoracic spine can affect the back, the area under the scapula or along the ribs.
- Many patients with degenerative disc disease of the thoracic spine may have no symptoms.
- Chronic chest pain with/without irradiation to the ribs.
- Sensory changes, such as numbness, tingling or paresthesia, in cases where there is nerve compression.
- Muscle spasm and posture changes in the thoracic back.
- Loss of range of motion, with reduced ability to move the trunk, especially when turning or bending to the side.
- Sitting for long periods of time can cause back and arm pain.
- Difficulty lifting weights and raising arms above head.
- In later stages, spinal stenosis can occur, causing weakness in the lower extremities and loss of movement coordination. In these cases, surgery will be necessary.
Diagnosis
<2_img_rightxx>In addition to performing a complete exam, the doctor may order the following tests to verify the diagnosis:
- X-ray,helps determine if there is joint degeneration, fractures, bone malformations, arthritis, tumors or infection.
- magnetic resonanceto determine morphological changes in soft tissue, including visualization of discs, spinal cord, and nerve roots.
- Computed tomographya scan that can provide cross-sectional images of spinal structures.
- IN G,this diagnostic method is used to determine the damage to the nerves and the level of damage.
- myelogramas a rule, this research method is needed to clarify morphological changes in the degree of impact on the roots and spinal cord and to plan surgical interventions.
Treatment
The treatment of osteochondrosis of the thoracic spine will depend on the severity of the disease.
Treatment of acute pain syndrome:
- Rest: Avoid activities that cause pain (flexing, lifting, twisting, twisting or extending backwards).
- Medicines to reduce inflammation (anti-inflammatories and pain relievers).
- Ice in acute cases can relieve spasm, relieve pain.
- Local exposure to heat can help relieve muscle pain and tension.
- Light gym 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 wear a brace to relieve stress on the joints and muscles of the thoracic spine.
- Corticosteroids are used to reduce inflammation in moderate to severe cases.
- Epidural injections directly into the damaged disc area.
In mild cases, the use of a topical cold and medication may be sufficient to relieve pain. After pain relief, exercise therapy (physiotherapy) and exercises to stretch and strengthen the back muscles are recommended. The return to normal activity must be gradual to avoid the recurrence of symptoms.
The main conservative methods of treating osteochondrosis of the thoracic spine
drug treatment
The task of using medication to treat osteochondrosis of the thoracic spine, especially in acute pain syndrome, is to reduce pain, inflammation and muscle spasm.
- OTC medications for mild to moderate pain.
- Narcotic analgesics for severe pain that cannot be controlled by other treatment methods.
- Muscle relaxants to reduce acute muscle spasm.
- Prescription painkillers.
- Injections such as facet joint injections, blockages or epidural injections. This may include injecting corticosteroids into specific areas to reduce local inflammation.
- Manual therapies, including specialist soft tissue massage, stretching and joint mobilization, improve the geometry, mobility and range of motion of the thoracic spine. The use of mobilization techniques also helps to modulate pain.
- Exercise therapy (therapeutic exercises), including stretching and muscle strengthening exercises, to restore range of motion and strengthen back and abdominal muscles, support, stabilize and reduce stress on the 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 incorrectly selected exercise program can make symptoms worse. Therefore, exercise selection should be performed with a physical therapist.
- Neuromuscular retraining to improve posture, restore stability, teach the patient the correct biomechanics of movement to protect damaged discs and spine.
- Physical therapy, including the use of ultrasound, electrical stimulation and cold laser, helps to reduce pain and inflammation of the spinal structures.
- Home exercise programs, including muscle strengthening, stretching and stabilization exercises, and lifestyle changes to reduce spinal stress.
- 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 successfully treated without surgery. However, when conservative treatment of osteochondrosis of the thoracic spine is ineffective, surgery may be recommended, especially if the patient has any of the following symptoms:
- Increased root pain.
- Increased pain and nerve damage.
- Development or increase in muscle weakness.
- Increased numbness or paresthesia.
- Loss of control of bowel and bladder function.
The most common surgery associated with disc degeneration is discectomy, in which the disc is removed through an incision. However, there are several surgical procedures that can be recommended in cases of 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.
Prediction
Most of the problems associated with osteochondrosis of the thoracic spine can be resolved without surgery and people return to normal work. Osteochondrosis in the thoracic spine due to anatomical rigidity develops less than elsewhere. The duration of treatment, as a rule, does not exceed 4-12 weeks and depends on the severity of the symptoms. Patients need to continue with the stretching, strengthening, and stabilizing exercise program. A good long-term prognosis requires the use of proper movement and body mechanics and awareness of the importance of maintaining spinal health.