Degenerative disc disease (bone necrosis) of the thoracic spine is a relatively rare condition compared with other spinous pathologies. This is because the rib cage stabilizes the thoracic vertebrae, limiting movement and injury from constant bending and stretching, as occurs in the rest of the spine. If osteonecrosis develops in the thoracic spine, its development is often associated with trauma.
Degeneration, destruction, and inflammation in the disc area can cause a wide range of symptoms, depending on the severity of the problem. Disc disease can lead to symptoms such as decreased range of motion in the back, back pain that may spread to the intercostal space, numbness, tingling, muscle spasms, or some combination of these symptoms. The most common manifestations of osteonecrosis in the thoracic region occur at the T8-T12 level. As a rule, the manifestations of osteonecrosis in the thoracic region are: protrusion, disc, herniated disc with sequelae, spondylosis.
Treatment of osteonecrosis of the thoracic spine is usually conservative, but when complications such as spinal cord compression are present, surgical treatment may be possible.
Osteochondrosis is not actually a disease, but a term used to describe progressive changes in the discs associated with progressive wear and development of symptoms. secondary to disc degeneration. Disc degeneration is a normal evolutionary process, but in certain circumstances the degenerative process can be accelerated, for example by trauma, overactivity and musculoskeletal imbalances. like scoliosis. Disc degeneration itself is not a problem, but the conditions associated with it can lead to the development of advanced symptoms.
Stages of disc degeneration
The progression of degenerative disc disease can be classified into the following stages:
Dysfunction
- There may be lacrimation in the fibrous annular area, with irritation of the facet joints at the corresponding level of the spine.
- Loss of joint mobility, localized back pain, muscle spasticity, and limited trunk mobility, especially extension.
Unstable
- Intervertebral discs become dehydrated due to dehydration and a decrease in disc height. Weakness of the joints and capsules may develop, leading to instability.
- The patient will feel shooting pain, straightening the spine and drastically reducing the range of motion of the torso.
Re-stabilize
- The human body responds to instability by forming additional bone formations in the form of osteoclasts, which to a certain extent help stabilize the spine. But excess bone formation can lead to spinal stenosis.
- Back pain usually subsides but is still less intense. Some people may develop stenosis-like symptoms.
The reasons
- Abnormal changes in the body are the most common cause of disc degeneration. As the body ages, the discs lose fluid and water. The discs begin to narrow and lose height, impairing their ability to absorb shock and stress.
- The outer annular fibrous structures of the disc can begin to crack and break apart, weakening the disc walls.
- People who smoke, are obese, and engage in strenuous activities are more likely to develop degenerative disc disease.
- Trauma to the spine or discs from a fall or impact can trigger the degenerative process.
- A herniated disc can initiate the development of degenerative disc disease.
- Unlike muscles, discs have minimal blood supply, so they are not able to recover.
The symptoms
Symptoms associated with osteonecrosis of the thoracic spine will depend on the location and structures involved in the process. Degenerative discs in the thoracic spine can affect the back, the area below the collarbone, or along the ribs.
- Many patients with thoracic degenerative disc disease may have no symptoms.
- Chronic chest pain with/without irradiation to the ribs.
- Changes in sensation such as numbness, tingling, or paresthesia in the case of nerve compression
- Muscle spasms and position changes in the back of the chest.
- Loss of range of motion, reduced ability to move the trunk, especially when turning or bending to the side.
- Sitting for long periods of time can cause back pain and arm pain.
- Difficulty lifting weights and raising arms overhead.
- In the later stages, spinal stenosis can develop, leading to weakness of the lower extremities and loss of coordination. In these cases, surgery will be required.
Diagnose
In addition to conducting a thorough examination, your doctor may order the following tests to verify the diagnosis:
- X ray,help determine if you have osteoarthritis, fractures, bone deformities, arthritis, tumors, or infections.
- MRIto identify morphological changes in soft tissues, including visualizing intervertebral discs, spinal cord, and nerve roots.
- CT scanScans can provide cross-sectional images of spinal structures.
- EMG,This diagnostic method is used to determine the damage to the nerves and the extent of the damage.
- MyelogramsAs a rule, this method of study is necessary to clarify morphological changes in the extent to which the roots and spinal cord are affected and to plan surgical interventions.
Treatment
Treatment for osteonecrosis 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, twisting, or stretching back).
- Anti-inflammatory drugs (anti-inflammatory drugs and pain relievers).
- Ice in acute cases can reduce spasms, relieve pain.
- Local exposure to heat can help relieve pain and muscle tension.
- Gentle physical exercises to eliminate the biomechanical disorders associated with osteonecrosis and improve joint mobility, normal configuration of the spine, posture and range of motion.
- It may be necessary to use a brace to relieve stress on the joints and muscles of the thoracic spine.
- Corticosteroids are used to reduce inflammation in moderate to severe cases.
- Epidural injection directly into the affected disc area.
In mild cases, the use of cold compresses and topical medications may be enough to relieve pain. After pain relief, therapeutic exercise (physical therapy) and exercises to stretch and strengthen the muscles of the back are recommended. Returning to normal activities should be gradual to prevent a recurrence of symptoms.
The main conservative treatment methods of osteonecrosis of the thoracic spine
Medicines for treatment
The task of using drugs in the treatment of degenerative diseases of the thoracic spine, especially in acute pain syndrome, is to reduce pain, inflammation and muscle spasms.
- Over-the-counter medications for mild to moderate pain.
- Narcotic pain relievers for severe pain that cannot be controlled by other treatments.
- Muscle relaxants to relieve acute muscle spasms.
- Prescription pain relievers.
- Injections such as intra-articular injection, blockade or epidural injection. These may include injecting corticosteroids into specific areas to reduce local inflammation.
- Manual therapies, including specialist soft tissue massage, stretching and joint mobility, help improve the shape, mobility, and range of motion of the thoracic spine. Using movement techniques also helps regulate pain.
- Exercise therapy (therapeutic exercises), including stretching and strengthening exercises, to restore range of motion and strengthen the back and abdominal muscles, supporting, stabilizing, and reducingstress on the discs and back. An exercise program, especially exercises with weights or weights, should be started after the pain, muscle spasms, and inflammation have subsided. An inappropriately chosen exercise program can worsen symptoms. Therefore, the choice of exercises must be done with an exercise therapist.
- Neuromuscular training to improve posture, restore stability, teach patients the correct biomechanics to protect the injured disc and spine.
- Physical therapy, which includes the use of ultrasound, electrical stimulation, and cold lasers, helps relieve pain and inflammation in spinal structures.
- Home exercise programs, including strengthening, stretching and stabilizing exercises, and lifestyle changes to reduce stress on the spine.
- Acupuncture. This treatment may be used when sensory disturbances are present or to restore conduction and relieve pain.
Surgical treatments
Most hernias located in the thoracic spine of the thoracic disc can be successfully treated without surgery. However, when conservative treatment of thoracic osteonecrosis is ineffective, surgery may be recommended, especially if the patient has some of the following symptoms:
- Increased vesicular pain.
- Increased pain and nerve damage.
- Developing or increasing muscle weakness.
- Increased numbness or paresthesias.
- Loss of control over bowel and bladder function.
The most common surgery associated with disc degeneration is discectomy, in which the disc is removed through an incision. However, there are a number of surgical procedures that may be recommended in cases of osteonecrosis and degenerative disc disease. The choice of surgical method depends on the cause of the symptoms. Basic surgical techniques - including spinal ablation, laminectomy, spinal decompression, spinal decompression and spinal fusion.
Forecast
Most problems associated with osteonecrosis of the thoracic spine can be resolved without surgery and people return to normal activities. Bone tumors in the thoracic spine due to anatomical stiffness develop less than other parts. The duration of treatment, as a rule, does not exceed 4-12 weeks and depends on the severity of symptoms. The patient should continue with a program of stretching, strengthening, and stabilizing exercises. A good long-term prognosis requires the use of proper body movement and mechanics and an awareness of the importance of maintaining spine health.