Spondylosis is a degenerative process that affects the anatomical structures of the spine. This is a condition that usually develops with age as the bones gradually wear down from prolonged use, leading to the formation of bone spurs (osteophytes). Spondylosis is a general term used to describe the general deterioration of the spine.
X-ray studies show signs of spondylosis in more than 80% of people over 40 years of age. It is believed that most cases are associated with genetic predisposition and previous trauma.
Spondylosis in the thoracic spine develops much less frequently than in the lumbar or cervical spine, which is associated with the anatomical rigidity of this area of the spine. However, timely diagnosis and treatment of spondylosis of the thoracic spine is necessary to avoid neurological complications.
What is thoracic spondylosis?
The basic definition of thoracic spondylosis is that it is a condition that can result in a narrowing of the spinal canal in the upper and middle portion of the spinal column, resulting in compression of the spinal cord and nerve roots. In the long term, this compression can cause damage to these structures, causing symptoms such as weakness and numbness in the upper extremities, difficulty walking, and even pain that radiates to the arms.
Back pain is one of the most common types of pain that affects people as they age. These painful manifestations often appear due to the natural deterioration of the bones of the spine as a result of age-related wear and tear of the musculoskeletal system.
The thoracic vertebrae are located in the middle of the spine, and the range of motion in this part of the spinal column is much less than in the cervical and lumbar regions.
Degeneration of the thoracic spine is not as common as in the neck or lower back. The main cause of degeneration is age-related risk factors. The spinal column consists of several bony segments separated by cartilage pads (discs) that soften the impacts of the vertebrae against each other and reduce the overall load on the spine. These gel-like pads of cartilage are called discs, and over time, natural involutional changes in the body cause the disc cartilage to dehydrate and lose functionality, leading to back pain. There is also a risk of developing disc protrusions or herniations as spondylosis gradually progresses.
The reduction in the thickness of the protective cartilage also allows the vertebrae to move closer together, leading to progressive damage to the spinal structures.
Spondylosis of the thoracic spine can also lead to a condition called spinal stenosis, in which there is a narrowing of the spinal canal, which leads to compression of nerve structures, causing pain and other neurological symptoms. The development of bone spines (osteophytes) can lead to pressure on the spinal nerve roots, which also leads to pain.
Stages of development of spondylosis
The development of spinal spondylosis occurs in several stages.
I. At first, there are practically no symptoms of spondylosis. The size of single spine-shaped osteophytes is not large and does not cause discomfort. Fibrous tissues lose elasticity and undergo initial changes: cracks and breaks. Symptoms are inherent only to lumbosacral spondylosis in the form of periodic, minor lumbar pain, which, as a rule, goes unnoticed. At this stage, osteophytes are located within the boundaries of the vertebrae, which makes early diagnosis difficult. The first stage is considered dangerous and unpredictable, as it goes unnoticed by the patient and doctors.
II. Osteophytes continue to actively grow. Symptoms of spondylosis are manifested by limitation of movements, aching pain, which intensifies with physical exertion and even slight hypothermia of the body.
III. At the third stage, pathological processes acquire a pronounced form. Even incorrigible optimists who tried to cope with spinal spondylosis on their own or ignored its symptoms turn to doctors. There is a significant proliferation of bone formations with the appearance of coarse osteophyte complexes. They connect the vertebrae and completely destroy the cartilage tissue. The person feels severe pain, loses ability to work, and complete immobility and disability are possible.
Causes and symptoms of thoracic spondylosis
Causes of spondylosis of the thoracic spine
Age is the main cause of thoracic spondylosis. Most cases of spondylosis of the thoracic spine develop in people over 45 years of age. Due to the natural involutional process of aging, the discs in the spine begin to wear out and lose their strength and function. This can lead to rupture of the annulus fibrosus and the formation of disc herniations or protrusions. These degrading discs do not perform their shock-absorbing functions, which leads to excessive stress on joints, muscles, ligaments and back pain.
General information
As the body ages, the structures of the spine wear out. Joints, ligaments, and intervertebral discs are especially susceptible to negative changes. All changes that occur in the spinal column are purely individual and depend on many factors.
For some people, this disease is not age-related; its development can be triggered by other reasons. The symptoms of the disease are also highly individual. In some people, the clinical manifestations of degenerative changes are more pronounced, in others they are moderate. Also, the appearance of pain is directly influenced by the location of the pathology, its effect on the spinal cord or spinal roots.
Spondylosis deformans can develop in all parts of the spinal column. And the symptoms are determined by the localization of the pathological process. Doctors often diagnose osteoarthritis or osteoarthritis.
Symptoms
Since the functional thoracic spine is not as loaded as the cervical and lumbar spine, thoracic spondylosis develops as an effect of spinal degeneration in other parts. Some of the common symptoms of thoracic spondylosis are:
- Pain in the upper back, especially in the morning when standing up
- Stiffness in the middle or upper back
- Numbness and tingling in the upper and lower extremities
- Muscle weakness
- Discoordination
- Problems with walking
Which structures are subject to negative changes?
Degenerative age-related changes are most often observed in the following structures:
- intervertebral discs;
- facet joints;
- bone apparatus and ligaments.
Over time, as the body ages, gradual wear and tear of all body tissues occurs. The annulus fibrosus and nucleus pulposus of the intervertebral discs also undergo changes. They weaken, the fibrous ring wears out, and the amount of fluid in the nucleus pulposus decreases.
This negatively affects the shock-absorbing properties of the intervertebral discs. The result is a decrease in the height of the intervertebral discs, increasing the risk of hernia formation and deforming spondylosis.
Facet joints, which are present in each vertebral body. Thanks to these structures, flexion, rotation and extension of the spine occur. The shell of these joints is cartilage tissue. This is a connective type of tissue that contains lubricant and also has a sliding surface.
When age-related degenerative changes occur in the facet joints, the cartilage tissue gradually decreases in size and bone growths called osteophytes are formed. These degenerative changes can lead to osteoarthritis and osteoarthrosis, which are characterized by joint hypertrophy.
Bone spurs form near the edges of the intervertebral disc plates. As a result, the following negative changes are observed:
- deterioration of blood microcirculation in vertebral structures;
- compaction of the end plates due to sclerotic processes;
- thickening or compaction of bone structures under the end plates.
Ligaments consist of fibrous tissue fibers, which are the connecting link for the vertebrae. Thanks to them, the spinal column is protected from excessive load. With pathological changes in this area, a loss of ligament strength occurs, and this is fraught with a direct negative effect on the spinal structures.
Diagnosis of thoracic spondylosis
Specialists who diagnose and treat spondylosis of the thoracic spine are neurologists, neurosurgeons, orthopedists, physiotherapists, and exercise therapy doctors.
Thoracic spondylosis can be diagnosed using a physical examination and medical imaging techniques:
- The doctor will take a medical history and medical history, as well as a detailed physical examination of the spine and neurological tests.
- To confirm the diagnosis, imaging tests such as X-rays, CT scans, or MRIs of the thoracic spine may be ordered to determine the extent of thoracic spine degeneration
Causes of the disease
The most important reason for the appearance of spondylosis is problems with metabolism. In addition, regular overloads will negatively affect the spine, resulting in the constant occurrence of microtraumas. Very often, this disease appears in the strong half of humanity engaged in physical labor.
The disease mainly affects people aged 50 to 55 years, but exceptions are quite common when similar changes are detected at a young age. In particular, the cause of spondylosis may be teenage curvature of the spinal column. If you are at risk, it is much easier to be more attentive to your spine and consult a doctor if you have complaints.
Regular static loads on the neck
The factor that provokes cervical spondylosis deformans is constant overstrain of the neck. This often happens when you have to stare intensely at the monitor, etc.
Frequent dynamic excessive loads
Physical overexertion experienced by athletes or people involved in hard work can easily cause spondylosis. You need to be attentive to your health and not miss “alarm bells”.
Various pathological processes
Any diseases that are untimely or ill-treated and become chronic can provoke the development of deforming spondylosis of the cervical spine, as well as a number of other ailments. Don't put off visiting your doctor if you haven't been feeling well for a long time.
Neck injuries
As a result of injuries, bone tissue may not heal properly, causing osteophytes to form on the surface of damaged vertebrae. Even in the singular, such a “thorn” can cause a lot of discomfort, and multiple growths become the cause of constant complaints.
Treatment of spondylosis of the thoracic spine
Conservative treatment
Symptoms of thoracic spondylosis can range from mild and occasional discomfort to intense and chronic pain. Spondylosis affects the facet joints in the spine, significantly reducing mobility in motion segments. Fortunately, most people with thoracic spondylosis do not require surgery. The most common conservative treatment methods are:
• Acupuncture
is a popular treatment used to relieve back and neck pain. Tiny needles, about the size of a human hair, are inserted into specific points on the body. Each needle can be twisted, electrically stimulated or heated to enhance the treatment effect. Acupuncture is thought to work (in part) by stimulating the body's production of certain chemicals that help relieve pain.
• Bed rest
: In severe cases of spondylosis, bed rest may be required (no more than 1-3 days). Long-term bed rest should be avoided as the risk of deep vein thrombosis increases.
Use of corsets
: Temporary bracing (1 week) may help relieve symptoms, but long-term brace use is not recommended. Corsets worn for long periods of time weaken the back muscles and can increase pain if not worn continuously. Physical therapy (physical therapy) is more beneficial as it strengthens the muscles.
• Manual therapy
: Chiropractors believe that a healthy nervous system is synonymous with a healthy body. Subluxation or misalignment of a vertebra can lead to nervous system disorder and development of back and neck pain. Spinal manipulations, which a chiropractor performs with his hands, can eliminate subluxations and increase the mobility of motion segments.
• Lifestyle modification
: Losing and maintaining a healthy weight, eating healthy, nutritious foods, exercising regularly, and avoiding smoking are important “healthy habits” that help support spinal function at any age.
Medicines
- Muscle relaxants: Muscle relaxants help relieve muscle spasms and pain.
- Drugs (opioids) may be prescribed for short periods of time to relieve acute pain.
- NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) relieve inflammation, which often contributes to pain.
It is not recommended to take NSAIDs on your own, especially for a long time, as this can lead to serious side effects and adverse effects on the body.
• Physical therapy
- combines passive treatment with therapeutic exercises. Passive treatments include heat/ice, ultrasound, and electrical stimulation to relieve muscle spasm and pain. Therapeutic exercises allow the patient to increase flexibility and range of motion while building muscle strength.
Patients should not be afraid of physical therapy. Even patients who experience pain and difficulty walking have found that isometric exercises have some effectiveness.
• Spinal injections
: There are many types of spinal injections, including epidural steroid injections and facet joint injections. These injections use a combination of local anesthetics and steroid drugs to reduce inflammation in nerve tissue and thus often help reduce pain.
•Hydrotherapy
: By harnessing the soothing effects of water, hydrotherapy can treat a variety of bone and joint pain. It differs from swimming in that it involves exercises that the patient does in warm water, usually at a temperature of 35-37 degrees.
•Taping
: This is a technique that is used for injury prevention or rehabilitation. Exercise therapy professionals are specially trained to effectively apply tape to the skin to help maintain the stability of specific muscles or bones. The benefits of using this treatment include:
- Injury Prevention
- The ability to quickly return to sports or work
- Protection of damaged soft tissues such as ligaments, tendons or fascia
- Improved mobility
- Pain reduction
- Reduced risk of re-injury
- Improving joint stability
- Reducing swelling
•Postural restructuring
: If symptoms are the result of years of poor posture, spinal bone realignment combined with postural exercises may help reduce back pain. This often involves assessing your current posture, helping to identify any tight or weak muscles that may be causing back pain. Next, the doctor gives tips on how you can make changes in your posture—sitting, standing, and handling objects properly. A selection of exercises is also carried out to stretch and strengthen the back muscles, which helps improve posture.
•Effect on soft tissues
: Involves the evaluation and treatment of any soft tissue injury causing pain and dysfunction. Soft tissue includes ligaments, tendons, muscles and fascia. Types of soft tissue treatments include myofascial release, massage, heat therapy, stretching and electrotherapy.
Benefits of soft tissue treatment include:
- Faster recovery from injury
- Reduced risk of re-injury
- Increased functionality
- Accelerated healing process
- Increased mobility
- Increased muscle strength
- Reducing swelling
- Increasing the length of soft tissues
- Increased range of motion
- Pain reduction
How is spondylosis treated?
The treatment regimen is determined by the doctor based on diagnostic data. Therapy methods are selected taking into account the individual characteristics of the patient, concomitant diseases, the nature and stage of pathological processes.
Spinal spondylosis is chronic, accompanied by irreversible degenerative processes and cannot be completely cured. Therapeutic measures are aimed at eliminating the causes of the pathology, reducing clinical manifestations and preventing further development of dystrophic changes. It is also important to strengthen the muscles and ligaments of the spine and improve blood circulation.
Drug therapy
When treating spondylosis, several groups of drugs are prescribed.
- Analgesics and non-steroidal anti-inflammatory drugs
, relieving pain. In severe cases, novocaine blockade and narcotic drugs help.
- Antidepressants
. Their action is aimed at reducing chronic pain syndrome and the depressive state caused by it.
- Chondroprotectors,
restoring cartilage and bone tissue. The most recommended is Artradol, which triggers the renewal mechanism of damaged tissues of joints, cartilage, and bones.
- Vitamin complexes.
As maintenance therapy, vitamins of groups A, C and D are especially expensive.
- Hyaluronic acid injections.
It improves cell nutrition and prevents further development of pathology.
An effective addition to the complex treatment of spondylosis are external ointments and gels with analgesic and anti-inflammatory effects. Together with Artradol, they significantly speed up recovery.
The effectiveness of physical therapy and massage
Exercise therapy in the treatment of spondylosis is necessary for:
- strengthening the muscle frame, which prevents displacement of the vertebrae and the appearance of intervertebral hernia;
- eliminating spasms;
- activation of blood flow;
- preventing the development of osteophytes;
- preparing the patient for everyday stress.
Special exercises for the treatment of spondylosis are selected by the attending physician on an individual basis and are initially performed under the supervision of a trainer.
Massage sessions will help get rid of spasms and pain, strengthen muscles, prevent compression of nerves, and activate blood flow.
Other methods
- Shock wave therapy in the treatment of spondylosis activates lymph and blood flow, stabilizes muscle tone, and destroys bone growths. The method is effective in the initial stages of the disease.
- Laser therapy significantly improves microcirculation, reduces muscle tension, and reduces pain.
- Acupuncture is used to reduce pain and improve the conduction of nerve impulses.
- The effect of electrical stimulation and cryotherapy is to reduce pain and slow down the development of pathological processes.
Surgery
Surgery for the treatment of spondylosis is performed as a last resort, when, despite all the methods and means used, conservative therapy has not led to the desired result. After it, severe neurological symptoms are present for a long time, and spinal stenosis or intervertebral hernia often develops.
Surgery
Very few patients with thoracic spondylosis require surgery, as conservative treatment methods usually reduce symptoms.
However, some patients may have persistent neurological deficits; symptoms such as weakness, difficulty walking, or development of spinal instability. The type of surgery is determined by the cause of persistent neurological symptoms. For example, it may be necessary to surgically remove bone spurs (osteophytes) or parts of a disc that are compressing spinal nerve roots or causing compression of the spinal cord. Depending on the extent of the surgery, a spinal fusion may be required to stabilize the spine.
Fortunately, modern minimally invasive surgical methods for treating the spine significantly reduce the risks of surgery, speed up the recovery of spinal function, and allow patients to return to normal activities earlier than with traditional surgery.
Basic therapy methods
Treatment of deforming spondylosis of the cervical spine is carried out by highly specialized doctors - vertebrologists, neurologists, traumatologists, orthopedists. An integrated approach to the treatment of pathology is practiced. Patients are prescribed measures to normalize blood circulation in the neck, reduce the severity of pain, increase range of motion, and restore the normal anatomical relationship between the structural units of the spine. An important stage of treatment is to prevent the progression of spondylosis and the involvement of healthy vertebrae and intervertebral discs in the destructive process.
Pharmacological drugs
To relieve pain, non-steroidal anti-inflammatory drugs (NSAIDs) are included in therapeutic regimens. Tablet forms of nimesulide, ketorolac, diclofenac, meloxicam, and ibuprofen have proven themselves well in the treatment of pathologies of the cervical spine. After reducing the intensity of the pain syndrome, NSAIDs are prescribed in the form of ointments, creams, gels: Fastum, Voltaren, Indomethacin, Dolgit, Dolobene, Artrosilene. They are applied in a thin layer to the back of the neck and lightly rubbed. The following drugs are used in the treatment of spondylosis:
- muscle relaxants Mydocalm, Sirdalud, Baklosan for oral administration or intramuscular administration. Relaxes skeletal muscles, eliminates painful spasms and neurological disorders;
- complex of B vitamins - Pentovit, Milgamma, Combilipen in injection solutions or tablets. Improve innervation in the cervical spine, increase the functional activity of the central and autonomic nervous systems;
- angioprotectors and microcirculation correctors - Agapurin and all drugs with betahistine. Improve blood supply to tissues with nutritional and bioactive compounds, normalize microcirculation, quickly neutralize the symptoms of vestibular dizziness;
- glucocorticosteroids - Diprospan, Kenalog, Triamcinolone, Dexamethasone, Hydrocortisone. Used to relieve severe pain that cannot be relieved by NSAIDs. Hormonal agents are usually used in the form of blockades together with anesthetics or analgesics;
- chondroprotectors - Structum, Alflutop, Glucosamine-Maximum, Chondroitin-Akos, Teraflex, including with ibuprofen. Prevent further damage to vertebral spondylosis. With long-term use, they accumulate in tissues, providing a pronounced analgesic, anti-edematous, and anti-inflammatory effect.
To relieve symptoms and improve blood circulation, ointments, gels, and balms with a warming effect are used in therapy. These are Viprosal, Finalgon, Capsicam, Efkamon, Apizartron. After applying them to the area of pain, a pleasant warmth is felt, and stiffness of movements disappears.
Physiotherapeutic procedures
At any stage of spondylosis deformans, electrophoresis is used. During the procedure, under the influence of electrical impulses, medicinal substances penetrate into the deep tissues of the vertebrae and intervertebral discs. Electrophoresis is carried out with solutions of NSAIDs, analgesics, and chondroprotectors. Other physiotherapeutic manipulations are also used in the treatment of pathology:
- interference therapy. Under the influence of medium-frequency pulse currents of varying frequency, blood circulation in the cervical region accelerates and skeletal muscles relax;
- diadynamic currents. The vertebrae are exposed to low-frequency monopolar pulse currents in various combinations and intermittently. The procedure helps to increase the motor activity of the cervical vertebrae;
- transcutaneous electrical neurostimulation. During the session, electrical impulses are applied to the receptors and sent to the spinal cord and central nervous system. As a result, the transmission of pain impulses from the affected tissues by sensitive nerve endings is blocked.
The disease at the initial stage of development responds well to laser therapy, magnetotherapy, and acupuncture. When choosing physiotherapeutic measures suitable for the patient, the doctor takes into account the stage of spondylosis and the degree of tissue damage.
Diadynamic currents.