What is thoracic osteochondrosis and how does it manifest?

Thoracic osteochondrosis is a degenerative-dystrophic change that occurs in the thoracic spine. The disease of this department is not as common as osteochondrosis of the cervical and lumbar regions. This is due to the fact that the human sternum is not as mobile and is better protected than the rest of the spine. People over 30 years of age are more susceptible to this pathology. For a correct diagnosis of osteochondrosis, you can contact our medical center.

Causes of the disease

These include:

trauma, mechanical damage;
excessive physical activity;
age-related changes in the spine;
hereditary predisposition to degenerative changes;
metabolic disease;
overweight, obesity;
sedentary lifestyle.

Do not underestimate this disease. As a result of changes in the thoracic spine, compression of the nerve roots occurs and disruption of the functions of internal organs occurs.

Causes of thoracic osteochondrosis

Pathological transformations in the intervertebral discs and joints of the spine are the most common causes of osteochondrosis. This may be the destruction of cartilage surfaces, intervertebral hernia, or the formation of osteophytes. Other reasons:

Sedentary and inactive lifestyle;
Presence of thoracic scoliosis;
Dehydration of intervertebral discs: When discs in older people become inelastic, it causes osteochondrosis;
Persistent hypertonicity, as well as spasms of the spinal muscles.

Symptoms of the disease

Osteochondrosis can masquerade as many cardiovascular diseases, which makes its correct diagnosis difficult. The disease can be confused with various pathologies of the respiratory system and abdominal cavity. None of the symptoms are specific and depend on the severity and location of the process.

The main symptoms of thoracic osteochondrosis:

pain in the sternum, aggravated by hypothermia and flexion of the spine;
back pain between the shoulder blades;
numbness of the shoulder and interscapular area;
pain with strong exhalation and inhalation;
tightness in the chest;
shortness of breath and tachycardia.

Diagnostics

The most common method for diagnosing osteochondrosis of the chest is radiography. This method is less expensive financially, but may not always reveal the full picture of the disease. It is advisable to take x-rays on an empty stomach and not to consume gas-forming foods for some time before the examination.

Contraindications to undergoing x-rays are:

pregnancy (radiation negatively affects fetal development);
conditions in which the patient cannot remain motionless in one position;
obesity (diagnosis is difficult due to blurred images).

Medicine does not stand still, and specialists are increasingly using new technologies to diagnose osteochondrosis, such as:

CT (computed tomography);
MRI (magnetic resonance imaging).

Treatment of the disease

The methods used to treat osteochondrosis of the thoracic spine are complex and are prescribed by the doctor individually depending on the medical history and concomitant diseases.

The most common ones include:

physiotherapy;
massage and manual therapy;
physiotherapy;
taking medications.

In our clinic you can get advice from an orthopedist, neurologist and other specialists. Reception is conducted by candidates of sciences and doctors of the highest category with extensive work experience.

Lumbar osteochondrosis: diagnosis, clinical picture and treatment

4 out of 5 people experience back pain at least once during their lifetime.
Among the working population, they are the most common cause of disability
, which determines their socio-economic importance in all countries of the world. Among the diseases that are accompanied by pain in the lumbar spine and limbs, one of the main places is occupied by osteochondrosis.

Spinal osteochondrosis (OP) is a degenerative-dystrophic lesion that begins with the nucleus pulposus of the intervertebral disc, spreading to the fibrous ring and other elements of the spinal segment with frequent secondary effects on adjacent neurovascular formations. Under the influence of unfavorable static-dynamic loads, the elastic pulpous (jellylike) nucleus loses its physiological properties - it dries out and is sequestered over time. Under the influence of mechanical loads, the fibrous ring of the disc, which has lost its elasticity, protrudes, and subsequently fragments of the nucleus pulposus fall out through its cracks. This leads to the appearance of acute pain (lumbago), because... the peripheral parts of the annulus fibrosus contain Luschka nerve receptors.

The intradiscal pathological process corresponds to stage 1 (period) (OP) according to the classification proposed by Ya.Yu. Popelyansky and A.I. Base. In the second period, there is a loss of not only shock-absorbing ability, but also the fixation function with the development of hypermobility (or instability). In the third period, the formation of a disc herniation (protrusion) is observed. According to the degree of their prolapse, disc herniations are divided into elastic protrusion

when there is a uniform protrusion of the intervertebral disc, and
sequestered protrusion
, characterized by an uneven and incomplete rupture of the fibrous ring. The nucleus pulposus moves to these rupture sites, creating local protrusions. With a partially prolapsed disc herniation, all layers of the fibrous ring, and possibly the posterior longitudinal ligament, are ruptured, but the hernial protrusion itself has not yet lost its connection with the central part of the nucleus. A completely prolapsed disc herniation means the prolapse of not individual fragments into the lumen of the spinal canal, but the entire nucleus. According to the diameter, disc herniations are divided into foraminal, posterolateral, paramedian and median. The clinical manifestations of disc herniations are varied, but it is at this stage that various compression syndromes often develop.

Over time, the pathological process can move to other parts of the spinal motion segment. An increase in the load on the vertebral bodies leads to the development of subchondral sclerosis (compaction), then the body increases the area of support due to marginal bone growths along the entire perimeter. Overload of the joints leads to spondyloarthrosis, which can cause compression of the neurovascular formations in the intervertebral foramen. It is these changes that are noted in the fourth period (stage) (OP), when there is total damage to the spinal motion segment.

Any schematization of such a complex, clinically diverse disease as AP, of course, is quite conditional. However, it makes it possible to analyze clinical manifestations in their dependence on morphological changes, which allows not only to make a correct diagnosis, but also to determine specific therapeutic measures.

Depending on which nerve formations are affected by the pathological effect of a disc herniation, bone growths and other affected structures of the spine, reflex and compression syndromes are distinguished.

To compression

include syndromes in which a root, vessel or spinal cord is stretched, compressed and deformed over the specified vertebral structures.
Reflex
include syndromes caused by the influence of these structures on the receptors that innervate them, mainly the endings of the recurrent spinal nerves (Luschka’s sinuvertebral nerve).
Impulses traveling along this nerve from the affected spine enter along the dorsal root into the dorsal horn of the spinal cord. Switching to the anterior horns, they cause reflex tension (defense) of the innervated muscles - reflex-tonic disorders.
.
Switching to the sympathetic centers of the lateral horn of their own or neighboring levels, they cause reflex vasomotor or dystrophic disorders. Neurodystrophic disorders of this kind occur primarily in poorly vascularized tissues (tendons, ligaments) in places of attachment to bony protrusions. Here the tissues undergo fiber disintegration, swelling, and they become painful, especially when stretched and palpated. In some cases, these neurodystrophic disorders cause pain that occurs not only locally, but also at a distance. In the latter case, the pain is reflected; it seems to “shoot out” when you touch the painful area. Such zones are called trigger zones. Myofascial pain syndromes can occur as part of referred spondylogenic pain
. With prolonged tension of the striated muscle, microcirculation is disrupted in certain areas of the muscle. Due to hypoxia and edema, compaction zones in the form of nodules and cords form in the muscle (as well as in ligaments). The pain is rarely local; it does not coincide with the zone of innervation of certain roots. Reflex-myotonic syndromes include piriformis syndrome and popliteal syndrome, the characteristics of which are covered in detail in numerous manuals.

To local (local) pain reflex syndromes

for lumbar osteochondrosis, lumbago is included in the acute development of the disease and lumbodynia in the subacute or chronic course.
An important circumstance is the established fact that lumbago is a consequence of intradiscal movement of the nucleus pulposus
. As a rule, this is a sharp pain, often shooting. The patient seems to freeze in an uncomfortable position and cannot straighten up. An attempt to change the position of the body provokes increased pain. There is immobility of the entire lumbar region, flattening of lordosis, and sometimes scoliosis develops.

With lumbodynia, the pain is usually aching and intensifies with movement and with axial loads. The lumbar region may be deformed, as with lumbago, but to a lesser extent.

Compression syndromes with lumbar osteochondrosis are also varied. Among them are radicular compression syndrome, caudal syndrome, and lumbosacral discogenic myelopathy syndrome.

Radicular compression syndrome

more often develops due to disc herniation at the level of LIV-LV and LV-S1, because It is at this level that disc herniations most often develop. Depending on the type of hernia (foraminal, posterolateral, etc.), one or another root is affected. As a rule, one level corresponds to a monoradicular lesion. Clinical manifestations of compression of the LV root are reduced to the appearance of irritation and prolapse in the corresponding dermatome and to the phenomena of hypofunction in the corresponding myotome.

Paresthesia

(a feeling of numbness, tingling) and shooting pains spread along the outer surface of the thigh, the front surface of the lower leg to the area of the first finger. In the corresponding zone, hypalgesia may then appear. In the muscles innervated by the LV root, especially in the anterior parts of the leg, hypotrophy and weakness develop. First of all, weakness is detected in the long extensor of the affected finger - in a muscle innervated only by the LV root. Tendon reflexes with isolated damage to this root remain normal.

With compression of the S1 root, the phenomena of irritation and loss develop in the corresponding dermatome, extending to the zone of the fifth finger. Hypotrophy and weakness primarily affect the posterior muscles of the lower leg. The Achilles reflex decreases or disappears. The knee reflex decreases only when the L2, L3, L4 roots are involved. Hypotrophy of the quadriceps, and especially the gluteal muscles, also occurs with pathology of the caudal lumbar discs. Compression-radicular paresthesia and pain intensify with coughing and sneezing. The pain increases with movement in the lower back. There are other clinical symptoms indicating the development of compression of the roots and their tension. The most commonly tested symptom is Lasegue's sign.

when there is a sharp increase in pain in the leg when trying to lift it in a straightened state.
An unfavorable variant of lumbar vertebrogenic compression radicular syndromes is compression of the cauda equina, the so-called caudal syndrome
. Most often it develops with large prolapsed median disc herniations, when all the roots at this level are compressed. Topical diagnosis is carried out using the upper root. The pain, usually severe, spreads not to one leg, but, as a rule, to both legs; loss of sensitivity affects the “rider's pants” area. In severe cases and rapid development of the syndrome, sphincter disorders occur. Caudal lumbar myelopathy develops as a result of occlusion of the inferior accessory radiculo-medullary artery (usually at the LV root) and is manifested by weakness of the peronial, tibial and gluteal muscle groups, sometimes with segmental sensory disturbances. Often, ischemia develops simultaneously in the epiconus (L5–S1) and conus (S2–S5) segments of the spinal cord. In such cases, pelvic disorders are also associated.

In addition to the identified main clinical and neurological manifestations of lumbar osteochondrosis, there are other symptoms indicating damage to this part of the spine. This is especially clearly manifested in the combination of intervertebral disc damage against the background of congenital narrowness of the spinal canal and various anomalies of the spine. Diagnosis of lumbar osteochondrosis

is based on the clinical picture of the disease and additional examination methods, which include conventional radiography of the lumbar spine, computed tomography (CT), CT myelography, magnetic resonance imaging (MRI). With the introduction of MRI of the spine into clinical practice, the diagnosis of lumbar osteochondrosis (PO) has significantly improved. Sagittal and horizontal tomographic sections allow us to see the relationship of the affected intervertebral disc with surrounding tissues, including assessment of the lumen of the spinal canal. The size, type of disc herniation, which roots are compressed and by which structures are determined. It is important to establish the correspondence of the leading clinical syndrome to the level and nature of the lesion. As a rule, a patient with compression radicular syndrome develops a monoradicular lesion, and on MRI, compression of this root is clearly visible. This is relevant from a surgical point of view, because this determines surgical access.

The disadvantages of MRI include limitations associated with conducting examinations in patients with claustrophobia, as well as the cost of the examination itself. CT is a highly informative diagnostic method, especially in combination with myelography, but it must be remembered that scanning is carried out in a horizontal plane and, therefore, the level of the suspected lesion must be clinically determined very accurately. Routine radiography is used as a screening examination and is mandatory in hospital settings. Functional imaging is the best way to determine instability. Various types of bone developmental anomalies are also clearly visible on spondylograms.

For PO, both conservative and surgical treatment is performed. With conservative treatment

with osteochondrosis, the following pathological conditions require treatment: orthopedic disorders, pain syndrome, disorders of the fixation ability of the disc, muscle-tonic disorders, circulatory disorders in the roots and spinal cord, nerve conduction disorders, cicatricial adhesive changes, psychosomatic disorders.
Methods of conservative treatment (CT) include various orthopedic measures (immobilization, spinal traction, manual therapy), physiotherapy (massage therapy and exercise therapy, acupuncture, electrotherapy), and prescription of medications. Treatment should be comprehensive, staged. Each of the CL methods has its own indications and contraindications, but, as a rule, the common ones are the prescription of analgesics, non-steroidal anti-inflammatory drugs
(NSAIDs),
muscle relaxants
and
physiotherapy
.

The analgesic effect is achieved by using diclofenac, paracetamol, tramadol. Voltaren Retard has a pronounced analgesic effect

, containing 100 mg of diclofenac sodium.

Gradual (long-term) absorption of diclofenac allows you to increase the effectiveness of the therapy, prevent possible gastrotoxic effects, and make the therapy as convenient as possible for the patient (only 1-2 tablets per day).

If necessary, increase the daily dose of diclofenac to 150 mg, and additionally prescribe Voltaren in the form of non-extended-release tablets. For milder forms of the disease, when the use of relatively small doses of the drug is sufficient, other dosage forms of Voltaren are prescribed. If painful symptoms predominate at night or in the morning, it is recommended to take Voltaren Retard in the evening.

Paracetamol is inferior in analgesic activity to other NSAIDs, and therefore the drug caffetin

, which, along with paracetamol, contains another non-opioid analgesic - propyphenazone, as well as codeine and caffeine. In patients with ischalgia, when using caffetin, muscle relaxation, a decrease in anxiety and depression are noted. Good results have been observed when using caffetin in the clinic to relieve acute pain in myofascial, myotonic and radicular syndromes. According to Russian researchers, with short-term use the drug is well tolerated and causes virtually no side effects.

NSAIDs are the most widely used drugs for PO. NSAIDs have anti-inflammatory, analgesic and antipyretic effects associated with the suppression of cyclooxygenase (COX-1 and COX-2), an enzyme that regulates the conversion of arachidonic acid into prostaglandins, prostacyclin, and thromboxane. Treatment should always begin with the administration of the safest drugs (diclofenac, ketoprofen) in the minimum effective dose (side effects are dose-dependent). In elderly patients and in patients with risk factors for side effects, it is advisable to start treatment with meloxicam and especially with celecoxib or diclofenac/misoprostol. Alternative routes of administration (parenteral, rectal) do not prevent gastroenterological and other side effects. The combination drug diclofenac and misoprostol has certain advantages over standard NSAIDs, which reduces the risk of COX-dependent side effects. In addition, misoprostol can potentiate the analgesic effect of diclofenac.

To eliminate pain associated with increased muscle tone, it is advisable to include central muscle relaxants in complex therapy: tizanidine (Sirdalud)

2–4 mg 3–4 times a day or tolperisone 50–100 mg orally 3 times a day, or tolperisone intramuscularly 100 mg 2 times a day. The mechanism of action of Sirdalud is significantly different from the mechanisms of action of other drugs used to reduce increased muscle tone. Therefore, Sirdalud is used in situations where there is no antispastic effect of other drugs (in so-called cases that do not respond to treatment). The advantage of Sirdalud compared to other muscle relaxants that are used for the same indications is that when muscle tone decreases when Sirdalud is prescribed, there is no decrease in muscle strength. Sirdalud is an imidazole derivative, its effect is associated with stimulation of central a2-adrenergic receptors. It selectively inhibits the polysynaptic component of the stretch reflex and has an independent antinociceptive and slight anti-inflammatory effect. Tizanidine affects spinal and cerebral spasticity, reduces stretch reflexes and painful muscle spasms. It reduces resistance to passive movements, reduces spasms and clonic convulsions, and increases the strength of voluntary contractions of skeletal muscles. It also has gastroprotective properties, which necessitates its use in combination with NSAIDs. The drug has virtually no side effects.

Surgery

with PO it is carried out with the development of compression syndromes. It should be noted that the presence of the fact of detection of a disc herniation on MRI is not enough for a final decision on surgery. Up to 85% of patients with disc herniations among patients with radicular symptoms after conservative treatment do without surgery. With the exception of a number of situations, CL should be the first step in helping patients with PO. If complex CL is ineffective (within 2–3 weeks), surgical treatment (CT) is indicated in patients with disc herniations and radicular symptoms.

There are emergency indications for software. These include the development of caudal syndrome, usually with complete prolapse of the disc into the lumen of the spinal canal, the development of acute radiculomyeloischemia and severe hyperalgic syndrome, when even the administration of opioids and blockades do not reduce the pain syndrome. It should be noted that the absolute size of the disc herniation is not decisive for the final decision on surgery and should be considered in conjunction with the clinical picture, the specific situation that is observed in the spinal canal according to tomography (for example, there may be a combination of a small hernia against the background of spinal canal stenosis or vice versa - the hernia is large, but in the middle location against the background of a wide spinal canal).

In 95% of cases of disc herniation, open access to the spinal canal is used. Various dissection techniques have not yet found wide application, although a number of authors report their effectiveness. The operation is performed using both conventional and microsurgical instruments (with optical magnification). During access, removal of vertebral bone formations is avoided by mainly using interlaminar access. However, with a narrow canal, hypertrophy of the articular processes, or a fixed median disc herniation, it is advisable to expand access at the expense of bone structures.

The results of surgical treatment largely depend on the experience of the surgeon and the correctness of the indications for a particular operation. In the apt expression of the famous neurosurgeon J. Brotchi, who performed more than a thousand operations for osteochondrosis, it is necessary “not to forget that the surgeon must operate on the patient, and not on the tomographic image.”

In conclusion, I would like to once again emphasize the need for a thorough clinical examination and analysis of tomograms in order to make the optimal decision on the choice of treatment tactics for a particular patient.