Treatment of osteochondrosis of the thoracic spine in Moscow at the Dikul clinic: prices, making an appointment

Degenerative disc disease (osteochondrosis) in the thoracic spine is a relatively rare condition compared to other areas of the spine. This is because the rib cage stabilizes the thoracic vertebrae, limiting movement and injury that occurs 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 injury.

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 spasms, 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, disc extrusion, disc herniation 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 progressive changes in the discs associated with gradual wear and tear and the development of symptoms secondary to disc degeneration. Disc degeneration is a normal involutional process, but in certain situations the degeneration process can be accelerated, such as as a result of injury, overuse, and musculoskeletal imbalances such as scoliosis. Disc degeneration in itself is not a problem, but conditions associated with it can lead to the development of extensive symptoms.

Stages of disc degeneration

The progression of disc degeneration can be classified into the following stages:

Dysfunction

Possible tears in the area of the fibrous ring of the disc, with irritation of the facet joints at the corresponding level of the spine.
Loss of joint mobility, local back pain, muscle spasm and restrictions in trunk mobility, especially extension.

Instability

Loss of fluid from the disc with dehydration and decreased disc height. Weakness of the facet joints and capsules may develop, leading to instability.
The patient will experience shooting pain, straightening of the spine and a sharp decrease in the range of motion in the torso.

Restabilization

The human body responds to instability by forming additional bone formations in the form of osteophytes, which, to a certain extent, 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.

Characteristic

Intercostal chondrosis is a pain syndrome caused by compression of the nerve roots by the deformed components of the moving segment of the spine. Degeneration develops for various reasons, including involutive processes leading to age-related changes. This is why intercostal pain is more often diagnosed in people forty years of age and older.

A characteristic feature of this type of pain syndrome is the irradiation of pain to the left scapula and upper limb. Differences in pain by gender are also recorded: in women, the pain is dulled due to the production of the female sex hormone estrogen and gains full strength only after the onset of menopause.

Causes

Involutional changes in the body are the most common cause of disc degeneration. As the body ages, the discs gradually lose fluid 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 rupture, weakening the walls of the disc.
People who smoke, are obese, and participate in activities that require strenuous labor are more likely to develop disc degeneration.
Injury to the spine or disc due to a fall or blow 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 reparative ability.

Symptoms

Symptoms associated with osteochondrosis of the thoracic spine will depend on the location and structures that are involved in this process. Disc degeneration in the thoracic spine can affect the back, the area under the shoulder blade, or along the ribs.

Many patients with osteochondrosis of the thoracic spine may have no symptoms.
Chronic thoracic 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 postural changes in the thoracic back.
Loss of range of motion, with reduced ability to move the trunk, especially when rotating or bending to the sides.
Sitting for long periods of time can cause back and arm pain.
Difficulty lifting heavy objects and using your arms above your head.
In later stages, spinal stenosis may develop, leading to weakness in the lower extremities and loss of coordination. In these cases, surgery will be required.

Radicular symptoms

They occur due to the impact on the nerves leaving the spine.

Spinal nerves

There are many nerves coming out of the spine. They are called spinal nerves. Each such nerve gradually branches and follows a specific area of the body with clearly defined boundaries. This area is called the zone of segmental innervation. Each vertebra, disc, nerve and zone are numbered, strictly corresponding to each other. If a nerve is exposed, the symptoms will appear in the zone of segmental innervation corresponding to that nerve, and not just anywhere - in an arbitrary place.

Radicular symptoms include:

Decreased or lost reflexes;
Impaired sensitivity;
Muscle weakness;
Radicular pain.

Innervation zones of the thoracic segments

Osteochondrosis D1–D2

- Causes pain in the shoulder, collarbone and armpit areas.

Osteochondrosis D3–D6

- causes pain of a girdling nature in the upper part of the chest. Simulates pain in the heart, an attack of angina. In women, it causes pain in the mammary glands.

Osteochondrosis D7–D8

- causes girdle pain at the level of the solar plexus. Simulates pain in the stomach, liver, gallbladder or pancreas. Reduces upper abdominal reflexes.

Osteochondrosis D9–D10

- causes pain in the hypochondrium and upper abdomen. Sometimes it imitates the so-called “acute” abdomen - sharp pain in the abdomen. Reduces mid-abdominal reflexes.

Osteochondrosis D11–D12

- causes pain in the groin area. Simulates pain in female diseases, appendicitis, and intestinal diseases. Reduces lower abdominal reflexes.

Diagnostics

In addition to conducting a thorough examination, your doctor may order the following tests to confirm the diagnosis:

X-rays
help determine if there is joint degeneration, fractures, bone malformations, arthritis, tumors, or infection.
MRI
to determine morphological changes in soft tissues, including imaging of discs, spinal cord and nerve roots.
CT
scan, which can provide cross-sectional images of spinal structures.
EMG
, this diagnostic method is used to determine nerve damage and the level of damage
Myelogram
, as a rule, this research method is necessary to clarify the morphological changes in the degree of impact on the roots and spinal cord and plan surgical intervention.

Diagnosis of the pathological condition

With osteochondrosis, pain in the ribs is periodic, sometimes worsening - usually in the evening and at night, and after a night's rest it subsides. Since the thoracic part of the spine is its most sedentary part, the pain is not as pronounced as with degenerative changes in other areas. It can intensify when breathing, coughing, sighing, but still the vagueness of its manifestations makes patients suspect that they have completely different diseases.

Therefore, it is very important to conduct a thorough differential diagnosis with other pathologies using various types of research:

X-ray of the chest and lungs, heart, spine - in several projections;
Computed tomography or nuclear magnetic resonance scanning of the mediastinal organs and the entire chest, including spinal structures;
Electrocardiography;
Electromyography;
Echocardiography;
Examination of the vital capacity of the lungs, listening to breathing, sputum analysis and other techniques to identify respiratory pathologies;
Dopplerography of mediastinal vessels;
General and biochemical tests, etc.

Step by step, in a clinical setting, it is necessary to exclude the most life-threatening conditions, while simultaneously alleviating the patient’s condition with symptomatic means.

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, turning, or bending backwards).
Medicines to reduce inflammation (anti-inflammatory drugs and pain relievers).
In acute cases, ice can relieve spasms and reduce pain.
Local application of heat can help reduce pain and relieve muscle tension.
Light gymnastic exercises allow you to eliminate biomechanical disorders associated with osteochondrosis and improve joint mobility, normal spinal configuration, posture and range of motion.
The use of a brace may be necessary to reduce 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 local cold and medications may be sufficient to relieve pain. After pain has been reduced, exercise therapy (physical therapy) and exercises to stretch and strengthen the back muscles are recommended. Return to normal activities should be gradual to prevent recurrence of symptoms.

Basic conservative methods of treatment of osteochondrosis of the thoracic spine

Drug treatment

The goal 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.

Over-the-counter medications for mild to moderate pain.
Narcotic analgesics for intense pain that cannot be relieved by other treatment methods.
Muscle relaxants to reduce acute muscle spasms.
Prescription analgesics.
Injections, such as facet joint injections, blocks, or epidural injections. These may include injection of corticosteroids into specific areas to reduce local inflammation.
Manual therapy
, including soft tissue massage, stretching and joint mobilization performed by a specialist, can improve the geometry, mobility and range of motion in the thoracic spine. Using mobilization techniques also helps modulate pain.
Exercise therapy
(therapeutic exercises), including stretching and strengthening exercises to restore range of motion and strengthen the back and abdominal muscles, support, stabilize and reduce stress on the discs and back. An exercise program, especially exercises with weights or weights, should be started after pain, muscle spasm and inflammation have reduced. An incorrect exercise program can worsen symptoms. Therefore, the selection of exercises must be carried out with a physical therapy doctor.
Neuromuscular retraining
to improve posture, restore stability, and teach the patient proper biomechanics of movement to protect damaged discs and the spine.
Physiotherapy
, including the use of ultrasound, electrical stimulation, and cold laser, helps reduce pain and inflammation of the spinal structures.
Home exercise programs
, including core strengthening, stretching and stabilization exercises, and lifestyle changes to reduce stress on the spine.
Acupuncture
. This treatment method can be used in the presence of sensory disturbances or to restore conduction and reduce pain.

Prevention

To prevent the development of intercostal chondrosis, it is enough to follow simple rules in everyday life:

avoid a sedentary lifestyle, do morning exercises, take walks in the fresh air;
eat right, avoid gaining extra pounds;
do not smoke or drink alcoholic beverages;
refuse heavy loads;
treat chronic diseases in a timely manner;
correct deformities of the joints and spine;
do not overcool;
Avoid stress as much as possible.

If pain or unpleasant discomfort appears in the spine, consult a doctor for timely diagnosis and proper treatment to prevent worsening of the condition.

Surgical methods of treatment

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 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 bowel and bladder control

The most common surgery for disc degeneration is a discectomy, in which the disc is removed through an incision. However, there are several surgical interventions that may be recommended in cases of osteochondrosis and disc degeneration. The choice of surgical procedure depends on the cause of the symptoms. Major surgical techniques include foraminotomy, laminotomy, spinal laminectomy, spinal decompression and spinal fusion.

Causes of the disease

The etiology of intercostal chondrosis does not differ from the causes of thoracic osteochondrosis. Injury to this part of the spine often leads to the development of pathology: fractures, severe bruises, prolonged compression of the chest. External and internal negative factors that provoke the disease also include:

systemic joint pathologies: rheumatoid, psoriatic arthritis, osteoarthritis;
benign and malignant neoplasms;
intervertebral hernias localized in any part of the spine;
diseases associated with metabolic disorders: thyrotoxicosis, gouty arthritis, diabetes mellitus;
excess weight, which causes excess stress on the intervertebral discs.

The impetus for the development of intercostal chondrosis can be both excessive physical activity and a sedentary lifestyle. The risk group includes people whose professional activities involve lifting and carrying heavy objects.

Forecast

Most problems associated with osteochondrosis of the thoracic spine can be solved without surgery and people return to normal work. Due to anatomical rigidity, osteochondrosis in the thoracic spine 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 should continue with a program of stretching, strengthening, and stabilization exercises. A good long-term prognosis requires the use of proper movement and body mechanics and awareness of the importance of maintaining spinal health.

The mechanism of pathology development

Osteochondrosis often affects the cervical and lumbosacral spine, but degenerative-dystrophic changes in the thoracic vertebrae are rarely diagnosed. This is explained by the low mobility of this section and good stabilization by the elastic rib frame. Typically, the pathology does not affect the reliably protected intervertebral discs, but the joints connecting the transverse processes and the cartilaginous tissue located between the ribs and vertebrae. The disease develops as follows:

under the influence of dynamic load in cartilage, the rate of tissue breakdown processes begins to exceed the rate of their restoration;
arthrosis, or chronic degenerative damage to articular cartilage, begins to develop;
joints lose stability, their functional activity decreases, which causes the involvement of connective tissue structures - ligaments, muscles, tendons - in the pathological process;
At this stage of intercostal chondrosis, the first symptoms appear: a person feels a certain discomfort when walking and bending over. Since the mobility of the thoracic region is still completely preserved, the patient does not seek medical help;
Over time, the intensity of pain increases due to deformation of the joint structures. The mobility of the spinal column is limited, and the symptoms of thoracic osteochondrosis are combined with clinical manifestations of intercostal neuralgia.

Typically, intercostal chondrosis is diagnosed at this stage of the course, when destructive changes have affected not only the cartilage, but also the bone tissue of the vertebrae and intervertebral discs. Their nature is irreversible, since hyaline cartilage cannot be restored.