Thoracic radiculopathy is an inflammatory process localized in the spinal roots of the thoracic spine. His clinic consists of an intense pain syndrome affecting the chest and capable of simulating somatic diseases, limitations of motor activity and symptoms of local loss of sensitivity. Radiography, CT or MRI of the spine, examination of internal organs are used in diagnostics. Treatment consists in the appointment of anti-inflammatory drugs, paravertebral blockades and physiotherapy procedures, stretching of the spine.
Thoracic radiculopathy is an inflammatory lesion of one or more spinal roots located in the thoracic spine. It is most common among men in the age range from 45 to 65 years. In this category of persons, thoracic radiculopathy occurs 2-3 times more often than in all other combined categories of the population. A distinctive feature, in comparison with cervical and lumbar radiculitis, is the presence in the clinic of pain syndromes that mimic the defeat of internal organs (heart, stomach, 12 duodenum, lungs).
This phenomenon is associated with the lesion of vegetative fibers coming out of the spinal column as part of the thoracic spinal roots and innervating the organs of the chest and upper abdominal cavity. In this regard, thoracic sciatica often requires the attention of not only specialists in the field of vertebrology and neurology, but also cardiologists, pulmonologists.
These factors are various effects that lead to irritation and inflammation of the thoracic spinal roots. Depending on the type of etiofactor, thoracic radiculopathy can have a primary and secondary character. Primary sciatica occurs when hypothermia or direct exposure to the root of infectious agents (more often with herpes infection, influenza, chickenpox and other acute respiratory infections). If inflammation in the root occurs as a result of the spread of the inflammatory process against the background of Bekhterev’s disease, tuberculosis of the spine, spondyloarthrosis, then such a lesion of the root is considered secondary.
Secondary radiculitis develops due to irritation of the spinal root with various pathological processes occurring in the immediate vicinity of it, for example, with tumor lesions of the vertebrae (osteoma, osteoblastoma, hemangioma of the spine) and paravertebral tissues (ganglioneuroma), spinal cord tumors, osteophytic growths with osteochondrosis, intervertebral hernia of the thoracic region. Secondary damage to the spine may occur when the relative position of the anatomical structures of the thoracic spine changes. For example, with spinal injuries (subluxation of the vertebra, fracture of the thoracic spine), developmental anomalies and curvature of the spine.
The provoking trigger that causes thoracic radiculopathy may be an excessive load on the thoracic spine associated with professional activities, weightlifting, lifting weights, a sharp torso twisting movement, etc. Predisposing factors are posture disorders, thoracic kyphosis, scoliosis, dysmetabolic processes (hypothyroidism, diabetes mellitus, obesity).
The main clinical manifestation is intercostal neuralgia — intense paroxysmal pain spreading from the spine along the intercostals, due to which it often has a shingling character. The pain can be shooting, baking, cutting in nature. With a chronic course, the pain syndrome is characterized by a constant and aching type of pain. The pain increases with increased chest excursion due to intense deep breathing, coughing, sneezing. A pathognomonic symptom is the occurrence of sharp pain in the intercostal space when pressing on trigger points localized in the intercostal spaces on the lateral surface of the chest and at the exit points of the affected roots from the spine.
In some cases, patients note the presence of a zone of numbness on the surface of the chest. During neurological examination, hypesthesia is observed in this area — reduced skin sensitivity. Trying to reduce pain, patients usually avoid sudden movements, take a forced pose with a tilt of the trunk towards the lesion.
Often, thoracic radiculopathy mimics the pathology of various somatic organs, for example, pleurisy, gastritis, duodenitis, acute pancreatitis. With left-sided sciatica, the pain may look like cardialgia and resemble angina pectoris. With inflammation of the roots of the lower segments of the spine, the pain may resemble the clinical picture of an acute abdomen.
Diagnosis of sciatica, as a rule, does not cause difficulties for a neurologist. However, during the diagnostic search, it is important to establish its cause and exclude the presence of pathology of internal organs. It should be noted that the diagnosis of “thoracic radiculopathy” does not exclude the possibility of the simultaneous existence of a somatic disease with a similar pain syndrome.
Radiography of the spine in the thoracic region allows you to identify signs of osteochondrosis, spondyloarthrosis, “see” the deformation of the spine and the consequences of its injury. CT of the spine provides more detailed information about the state of its bone structures, allows you to diagnose an intervertebral hernia. MRI of the spine better visualizes soft tissue structures, makes it possible to assess the degree of narrowing of the spinal canal, the size and structure of the volumetric formations of the spine (hernias, tumors, hematomas).
In order to exclude/confirm somatic pathology, depending on the symptoms, consultations of narrow specialists, ECG, ultrasound of the abdominal cavity, gastroscopy, duodenal probing, chest X-ray, ultrasound of the pleural cavity, etc. are prescribed.
Treatment and prognosis
Therapy is carried out mainly by conservative methods. Surgical intervention may be required to eliminate the cause of sciatica in the case of volume formation, instability of the spine. It is possible to perform a discectomy or microdiscectomy, removal of the tumor, fixation of the spine. With the persistent nature of the pain syndrome, facetectomy or laminectomy is performed to decompress the affected spinal root.
The main components of conservative therapy are the elimination of pain syndrome and anti-inflammatory treatment. Nonsteroidal anti-inflammatory drugs (voltaren, diclofenac, ketorolac, meloxicam, nimesulide, etc.) reduce inflammation and pain. If they are not enough to relieve pain, paravertebral blockades are additionally performed using local anesthetics (lidocaine) and corticosteroids (diprospan, hydrocortisone), sedatives are prescribed. The relief of inflammation is facilitated by physiotherapy: UHF and hydrocortisone ultraphonophoresis. It is possible to use reflexotherapy. According to the indications, traction therapy can be performed to relieve compression of the spine — dry or underwater stretching of the spine.
The effectiveness of treatment is significantly increased when, along with NSAIDs, neurometabolic therapy is prescribed: intramuscular administration of vitamins B1, B6 or oral administration of combined preparations of vitamins of group B. With chronic sciatica during remission, mud therapy and hydrotherapy (hydrogen sulfide, radon baths) are indicated.
Acute pain syndrome with primary sciatica lasts on average 5-7 days, during treatment, the disease usually passes after 7-14 days. Chronic thoracic radiculopathy is characterized by a long course with periods of exacerbation of the pain syndrome and a relatively prosperous state — remission. The main cause of the chronic course is the preservation of the irritating effect on the spinal root of the etiofactor.