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 injury from constant bending and extension, as occurs in the rest of the spine. If osteochondrosis develops in the thoracic spine, then most often its development is 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 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, 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 compression of the spinal cord, surgical treatment is possible.
Osteochondrosis (degenerative disc disease) is not actually a disease, but a term used to describe progressive changes in discs associated with gradual wear and the development of symptoms secondary to disc degeneration. Degeneration of the disc is a normal involutionary process, but in certain situations, the process of degeneration 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 extensive symptoms.
Disc degeneration stages
The progression of disc degeneration can be classified into the following stages:
Dysfunction
- Tears are possible in the area of the annulus fibrosus, 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
- Loss of fluid by a disc with dehydration and a decrease in disc height. Weakness of the facet joints and capsules may develop, leading to instability.
- The patient will experience pain of a shooting nature, straightening of the spine and a sharp decrease in the range of motion in the trunk.
Re-stabilization
- The human body reacts to instability by forming additional bone formations in the form of osteophytes, which, to a certain extent, helps stabilize the spine. But excess bone formation can lead to spinal stenosis.
- Back pain usually decreases but remains less intense. Some people may develop stenosis-like symptoms.
The reasons
- Involutional changes in the body is 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 can 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.
- Injury to the spine or disc from a fall or impact can trigger the degeneration process.
- A herniated disc can initiate the development of disc degeneration.
- Unlike muscles, discs have minimal blood supply, so they do not have a reparative capacity.
Symptoms
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 not have symptoms.
- Chronic thoracic pain with / without irradiation to the ribs.
- Sensory changes such as numbness, tingling, or paresthesias in cases where there is nerve compression.
- Muscle spasm 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 extended periods of time can cause back pain and pain in the arms.
- Difficulty lifting heavy weights and lifting arms overhead.
- In later stages, spinal stenosis may develop, leading to weakness in the lower extremities and loss of coordination of movements. In these cases, surgery will be required.
Diagnostics
In addition to conducting a thorough examination, the doctor may order the following tests to get the diagnosis verified:
- X-ray,helps determine if there is joint degeneration, fractures, bone malformations, arthritis, tumors, or infection.
- MRIto determine morphological changes in soft tissues, including visualization of discs, spinal cord and nerve roots.
- CT scana scan that can provide cross-sectional images of spinal structures.
- EMG,this diagnostic method is used to determine nerve damage and the level of damage.
- Myelogramas a rule, this research method is necessary to clarify morphological changes in the degree of impact on the roots and spinal cord and to plan surgical intervention.
Treatment
Treatment of 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 extending backward).
- Medications to reduce inflammation (anti-inflammatory drugs and pain relievers).
- Ice in acute cases can relieve spasm, relieve pain.
- Local exposure to heat can help relieve pain and muscle tension.
- Light gymnastic exercises to eliminate biomechanical disorders associated with osteochondrosis and to improve joint mobility, normal configuration of the spine, posture and range of motion.
- It may be necessary to use a brace 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, the use of topical cold and medication may be sufficient to relieve pain. After pain relief, exercise therapy (physical therapy) and exercises to stretch and strengthen the muscles of the back are recommended. Return to normal activity should be gradual to prevent recurrence of symptoms.
The main conservative methods of treatment of osteochondrosis of the thoracic spine
Drug treatment
The task of using medications in the treatment of osteochondrosis of the thoracic spine, especially in acute pain syndrome, is to reduce pain, inflammation and muscle spasm.
- OTC drugs for mild to moderate pain.
- Narcotic analgesics for intense pain that cannot be controlled by other treatments.
- Muscle relaxants to reduce acute muscle spasm.
- Prescription analgesics.
- Injections such as facet joint injections, blockages, or epidural injections. These may involve injecting corticosteroids into specific areas to reduce local inflammation.
- Manual therapy, including soft tissue massage, stretching and mobilization of the joints performed by a specialist, can improve the geometry, mobility and range of motion in the thoracic spine. Using mobilization techniques also helps to modulate 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 the discs and back. An exercise program, especially exercises with weights or weights, should be initiated after pain, muscle spasm, and inflammation have subsided. An improperly selected exercise program can aggravate symptoms. Therefore, the selection of exercises must be carried out with an exercise therapy doctor.
- 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 strengthening, 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 successfully treated without surgery. However, when conservative treatment of osteochondrosis of the thoracic spine is ineffective, then surgery may be recommended, especially if the patient has some of the following symptoms:
- Increased radicular 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 for osteochondrosis and disc degeneration. The choice of surgical method depends on the cause of the symptoms. Major surgical techniques - include foraminotomy, laminotomy, spinal laminectomy, spinal decompression, and spinal fusion.
Forecast
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 in other parts. The duration of treatment, as a rule, does not exceed 4-12 weeks and depends on the severity of symptoms. Patients need to continue with the stretching, strengthening, and stabilizing exercise program. Good long-term prognosis requires the use of proper movement and body mechanics and awareness of the importance of maintaining spine health.