Thoracic spondylosis is a degenerative disease of the thoracic spine. It is accompanied by dystrophy of the fibrous rings of intervertebral discs, the formation of osteophytes in the lateral and anterior spine, as well as gradual ossification of the anterior longitudinal ligament. It occurs mainly in middle-aged and older people. For a long time it proceeds asymptomatically, subsequently manifested by pain in the thoracic spine. It may be complicated by the development of intervertebral hernias. In some cases, neurological symptoms are detected. It is diagnosed on the basis of a survey, examination, and radiation examination data. Conservative treatment: drug therapy, blockades, physiotherapy, physical therapy.
Thoracic spondylosis is an involutional lesion of the thoracic spine caused by natural aging and wear of anatomical structures. It is detected in 80% of people over 40 years of age. It usually occurs at the age of 30 years and older, but it can also be detected in younger patients. The cause of early development is usually posture disorders and excessive loads on the spine caused by working conditions or sports. Thoracic spondylosis proceeds more favorably compared to cervical and lumbar, is less often accompanied by severe pain syndrome and neurological disorders. Treatment of this pathology is carried out by vertebrologists, orthopedists and neurologists.
The thoracic spine is represented by 12 vertebrae. Each vertebra consists of a cylindrical body, an arch and processes. The vertebral body bears the main load, its posterior surface together with the inner surface of the arch forms the spinal canal, spinous and transverse processes are the places of attachment of ligaments, and articular processes are connected to each other, forming facet joints. Intervertebral discs resembling rounded elastic pads are located between the vertebral bodies. The discs perform a cushioning function and in some sense play the role of joints, providing an insignificant amount of movement of the vertebral bodies relative to each other. The discs have a complex structure, consist of an elastic pulpous nucleus that dampens vertical loads, and a rigid fibrous ring that holds the nucleus and does not allow the vertebrae to shift to the sides.
Thoracic spondylosis is accompanied by degenerative changes in all connective tissue structures of the spine. Due to fiber dystrophy, the strength of the fibrous ring decreases, and it ceases to hold the pulpous nucleus, resulting in protrusions. The anterior longitudinal ligament is ossified. Bone growths form in the area of the facet joints, osteoarthritis develops. These changes cause the formation of intervertebral hernias and limited mobility of the spine. However, due to the anatomical features of the thoracic spine, these processes can be asymptomatic or almost asymptomatic for a long time.
The main manifestation of the disease is back pain. The cause of the pain syndrome is compression of the nerves by a vertebral hernia or osteophytes located in the area of the facet joints. In addition, pain may occur due to local inflammation or pressure of hernias on the ligaments of the spine. Over time, the pain becomes clearly localized, muscle spasms and trigger points appear. If there is no compression of the nerves, patients are concerned about pain only in the back, with nerve compression, irradiation along the lateral and anterior surface of the chest is possible.
With arthrosis of the facet joints, the pain decreases when straightening the back, increases when standing and walking. With a herniated disc, the pain increases when leaning forward, sitting and standing for a long time, decreases when walking and changing the position of the body. With compression of the spinal cord, myelopathy occurs, accompanied by numbness and tingling in the lower extremities and the underlying parts of the trunk. Very rare complications of thoracic spondylosis are pronounced weakness in the extremities, impaired bowel and bladder function.
To clarify the diagnosis of thoracic spondylosis, radiological methods are used: radiography, CT and MRI. Spine x-ray makes it possible to confirm the presence of osteophytes, a decrease in the height of the vertebral discs and thickening of the joints. CT of the spine allows you to identify or exclude stenosis (narrowing) of the spinal canal. MRI of the spine is the most informative study that allows you to visualize nerves, ligaments and discs. With this method, you can determine the cause of pain and detect compression of nerve trunks. If nerve compression is suspected, a neurologist, an ENG and an EMG are prescribed to assess the degree of conduction disturbances and the extent of nerve damage. In some cases, radioisotope scanning is used.
Currently, there are no methods that can eliminate degenerative changes and restore the normal structure of the spinal tissues. Patients with thoracic spondylosis are prescribed symptomatic treatment, including drug therapy, physiotherapy, exercise therapy, acupuncture, massage, manual therapy and minimally invasive interventions (blockades). Patients are recommended to limit the load on the spine while maintaining moderate physical activity. As with osteochondrosis, with thoracic spondylosis it is very important to regularly perform a specially designed set of exercises to strengthen the back muscles.
Medical treatment may include nonsteroidal anti-inflammatory drugs (naproxen, meloxicam, ibuprofen) used to reduce pain and muscle relaxants (tizanidine, cyclobenzaprine) to reduce muscle spasms. With intense pain during the period of exacerbation, potent analgesics can be prescribed for a short time. In chronic pain syndrome, the use of small doses of antidepressants (duloxetine, doxepine, amitriptyline) is sometimes indicated.
To reduce pain and improve microcirculation, physiotherapeutic procedures are used: paraffin, ozokerite, electrophoresis with novocaine, lithium or peloidine, UFOs, diadynamic currents, ultrasound, etc. Manual therapy also reduces pain, however, the decision to use this method for thoracic spondylosis should be taken individually. Acupuncture is used to reduce pain and improve nerve conduction. With severe pain resistant to the action of other therapeutic techniques, blockades with steroid drugs are prescribed in the area of trigger points and facet joints. Surgical treatment is indicated only in the presence of pronounced compression of the nerve root by osteophyte or herniated disc, as well as with pronounced spinal stenosis.
Prognosis and prevention
A complete cure of thoracic spondylosis is impossible, but in most cases the disease proceeds favorably. Compression of nerve trunks and pronounced pain syndrome are rarely observed, most patients fully retain their ability to work and can lead a habitual lifestyle. Systematic observation, regular treatment and compliance with the doctor’s recommendations can reduce pain and maintain the functionality of the spine.