Thoracic osteochondrosis symptoms
spinous processes, arches and articular processes of the thoracic vertebrae imbricate cover each other;articular processes articulate in the frontal plane.The ribs connect all parts of the skeleton of the chest in a relatively rigid system.Intervertebral discs in the thoracic side covered rebernopozvonkovymi joints.An exception is XII, XI and sometimes steam, where there is no joint on the drive level, and directly on the vertebral body.Restricted mobility of the thoracic spine plays a positive role, as this is less injured intervertebral discs.How to cure this disease folk remedies, see here.
important in anatomical and physiological aspect is the presence of physiological thoracic kyphosis.If the cervical and lumbar physiological lordosis leads to maximum load on the rear drive units, the thoracic most of the burden falls on the front spine, thoracic osteochondrosis therefore more common front and side osteophytes, which are generally asymptomatic.The rear is a large osteophytes and herniated discs in
defeats frequency of intervertebral discs in the thoracic region increases from top to bottom.According to our data, the defeat of the three lower thoracic disc Th10-12 was more than half of all cases of breast osteochondrosis.About the same pattern is observed with compression fractures.
height of the intervertebral discs in the thoracic minor;if the cervical total disc height is 40%, in the thoracic region, the figure is only 20%.Oblique disposition of the transverse processes and edge-vertebral joints severely restrict flexion in the spine - to 3-7 ° in each segment.
sectional area of the spinal canal in the thoracic region smaller than in the cervical and lumbar spine, and is 2,3 2,5 cm2.The dura mater is not directly adjacent to the spinal canal inner surface.They shared the epidural space filled with loose fatty tissue containing a rich network of venous plexus.Spinal roots extending at an acute angle, lie in their sheaths, which are protrusions of the dura mater, almost to the intervertebral ganglion.Distal to the intervertebral ganglion sensory and motor roots form a mixed nerve (funiculus).root length increased in the caudal direction.At the level of Th12 it is equal to 81 mm.
In adults, the spinal cord, with an average length equal to 40-50 cm and ends at the men on the L1 disk level, and women - at approximately the middle of the L2 body.Below this vertebra are the lumbar-sacral roots, forming a ponytail.The lateral horns of the spinal cord and the lateral parts of the anterior horn cells are located sympathetic axons that emerge from the spinal cord in the front part of the roots.The sympathetic cells in the spinal cord are concentrated mainly in the thoracic spine, from the neck to the VIII I-IV lumbar segments.Exiting the spinal cord 6 front part of the roots of the sympathetic fibers form rr.communicantes albi, which includes the border sympathetic trunk.These fibers originating in the gray matter of the spinal cord, called preganglionic.After leaving the intervertebral foramen sinuvertebralny nerve is connected to a single trunk with the sympathetic branch, extending from the border of the sympathetic trunk.Most of the fibers extending from the sympathetic ganglia, sympathetic fibers form bundles having a certain relation to the internal organs is a part of visceral plexus or ganglion located in themselves organs (heart, gastrointestinal tract, and others.).
The thoracic border trunk consists of 10-12 sympathetic ganglia, which are located at the level of the joint line in front of the heads of ribs.Osteoarthritis in the spine and rib and cross-rib joints often accompanied by osteochondrosis of the thoracic and is its consequence.The intimate relationship of spinal nerves and the sympathetic trunk with capsules of these joints in these conditions results not only in the type of zoster pain intercostal neuralgia, but also to the vegetative syndromes.
relationship between breast and cervical nodes performed an extensive network of anastomoses.Lower cervical and thoracic components, when combined, form a star-shaped assembly (gangl. Stellatum), which depart from the main branch of the heart n.cardialis, branch to the spine, esophagus, bronchi, to the recurrent nerve and carotid arteries.The innervation of the heart also participate branches from the four upper thoracic sympathetic ganglia, pharyngeal and vagus nerves.The ventral nerve formed by sympathetic fibers from Th5 nodes to Th10, passes through the diaphragm and enters in the solar plexus.Vegetative
any suitable fiber directly to tissue innervated by them and affect their chemical means (diffusion synapses) or to intramural ganglia situated already in the organs (heart, gastrointestinal tract, and others.).
vasomotor nerves of the lower extremities originate from the three lower thoracic and upper lumbar segments of the two that are in communication with the lower lumbar and sacral three top nodes.
defeat thoracic discs other than static disorder, leads to both direct signs of compression of the spinal cord and roots, and to the annoyance of mass efferent fibers manifested vasomotor, autonomic and trophic reactions.
study of literature in recent years shows that a number of cases of acute and chronic spinal cord ischemia is associated with intervertebral disc disease.Of the 52 radicular arteries that penetrate through the intervertebral foramen into the spinal canal, the blood supply to the spinal cord is mainly anterior spinal artery, which is formed from 6-8 radicular artery anastomoses with them.From the pool the anterior spinal artery is supplied with 4/5 from the back - 1/5 spinal cord material.Posterior spinal artery anastomosis is rich, so it is not a blockage usually leads to circulatory disorders.Some departments are always supplied with a radicular artery.Compression of osteophytes or her hernia could lead to a marked deficiency of blood supply or ischemia of the spinal cord area.Arterial blood flow to the spinal cord is divided into several zones.In particular, it is of great importance radicular artery, the spine part of Th10, and L1, - Adamkevicha artery that feeds the entire length of the spinal cord, the underlying Th8 segment.
Thoracic osteochondrosis develops acutely.Typically, after an injury, sometimes small, and depending on the location of the clinical picture is characterized by the tetra or paraparesis with wires fallout sensitivity and pelvic disorders, the cone syndrome with saddle anesthesia the perineum and urinary organs, the lungs paralyzes the individual muscle groups.These cases are reminiscent of the "paralytic sciatica", due to compression of the cauda equina roots disc prolapse.And although in most cases of acute vascular myelopathy characterized by a relatively rapid regression of symptoms, the severity of them quite large.In this respect, I would like to emphasize the danger of root rhizotomy (of course, along with their artery), undertaken to relieve pain in patients with herniated discs.Cases developed after this rough pelvic disorders and anesthesia anogenital crossing roots L5 or Si.By closely related message Corbin (1960) of 13 cases mielomalyatsy, developed after thoracolumbar sympathectomies.The author considers them as a result of accidental damage to one or more thoracic intercostal arteries feeding breast radicular artery.In his opinion, represent a particular danger of manipulation in the root zone Th8-L2 on the left.
Arseni and Nash (1963) observed and operated patients with transient attacks lower paraparesis, the cause of which was a small calcified hernia, squeezing anterior spinal artery in the thoracic region.The presence of some of the symptoms of compression significantly higher loss disk level often indicates secondary violations of the spinal circulation.
These anatomical features of thoracic spine and mostly complex interplay of the autonomic innervation of an impact on hospital thoracic osteochondrosis.First of all we are talking about the symptoms of the internal organs, sometimes simulating organic diseases (eg, abdominalgichesky syndrome).
Along with the topical principle of innervation of internal organs is carried out simultaneously from a number of adjacent segments, and some organs (small intestine, rectum) have a bilateral innervation.The liver, gallbladder, and blind ascending colon right innervated by sympathetic trunk, while the heart, spleen, pancreas, stomach, descending colon and sigmoid colon - the left.
number of patients with thoracic osteochondrosis, apparently, much more than one would expect the frequency of diagnosed cases.The reason lies in the fact that his main complaint of patients is focused on visceral disorders.This explains long-term treatment of patients with therapists.
thoracic osteochondrosis clinical picture is extremely diverse, but none of the symptoms is not strictly specific.They mainly depend on the localization process and its degree.Often clinical attention is directed to the rear disc herniation and surgery if it is not found, the diagnosis is considered erroneous.However, herniated disc - only one of the manifestations of osteochondrosis.In addition, in the thoracic region, it is very rare.In a study of 202 patients with osteochondrosis of the thoracic spine revealed a total of 4 rear hernia and protrusions 26.A significant incidence of a rare disease, probably related to the targeted selection of our patients.
characteristic that pain localized at the outset in a backbone and only radiates over time in another location.However, the new localization of the pain sometimes so strong that they fixed the focus of the patient and the doctor.Irradiation of pain and autonomic dysfunction occur according to the type of radicular disorders or ischemic compression or myelopathy.
pain in the thoracic spine - the main symptom of which was observed in all patients.After strenuous exercise or a long stay in one position the pain intensified, forcing patients to frequently change position, even at night.It is very characteristic of the so-called interscapular sympathalgia manifested burning, aching, or dull pain in the shoulder blade and the interscapular space.Patients complain of a feeling of "iron ticks", squeezing the back, often at night.This peculiar phenomenon is due to the disappearance of reflex muscle tension and ligament in a dream machine.
However, not all authors accept the priority of thoracic osteochondrosis syndrome in interscapular sympathalgia.Based on the fact that the innervation of the muscles of the upper parts of the body (in particular, co rhomboideus.) Unlike the skin of this area is carried out cervical segments C5 - C8, some authors consider interscapular dorsalgia sign of cervical degenerative disc disease.But this symptom is observed in lesions of both the cervical and thoracic spine.It is known that the cervical myelopathy lower boundary of the affected dermatosis projected on 5-6 segments below.
Tenderness to percussion spinous processes detected in 188 patients.Sometimes the pain was very intense and radiate to other parts of the spine and internal organs.
Limitation thoracic spine mobility (mainly extension) is set in 156 patients.Some of them have any sharp turn, shaking cough or pain intensified;of the patients were unable to use public transport.In exacerbations of local pain (sometimes with radiation) at an axial load of the spine was found in 20 patients, 78 found Moderate scoliosis.Defense Protective paravertebral muscles in the thoracic osteochondrosis detected in all 37 patients.The rarity of the symptom as scoliosis bland even under severe pain, is apparently explanation role in immobilizing the rib cage.
Compared with cervical and lumbar localization sensory disturbances in breast osteochondrosis are revealed more clearly.This is due not only metameric segmental, but the common nature of the lesion.Sensitivity was broken in 137 (68%) patients;are hypersensitivity was found in 41, and hypoesthesia - at 96. Paresthesia was seen in patients with osteoarthritis of combined form (usually with the neck).
Change tendon reflexes characteristic of thoracic osteochondrosis, as the lumbar and sacral segments of the spinal cord, which closes the arc of knee and Achilles reflexes, it is at the lower thoracic vertebrae.Degenerate discs can affect both the roots of place here, and in the spinal cord.The defeat of the anterior roots can cause segmental loss of function of the abdominal muscles.Do we observed patients are mostly elevated knee (at 45) and ankle (at 21) reflexes.In 6 patients had clonus stop.Reduced reflexes (mainly Achilles and abdominal) was detected in 33 patients.Frequent bilateral violations.In 3 patients with pathological reflexes (Babinski signs and Rossolimo) were observed in the presence of a hernia on Th11-12 level.Although the violation of reflexes are often, for topical diagnosis of this symptom as opposed to violations maloznachim sensitivity.
study of cerebrospinal fluid showed that increasing the protein levels in the cerebrospinal fluid in the presence of a hernia, or (rarely) a protrusion associated with venous congestion.IM Irger (1965) described a rare case of posterior disc herniation in the thoracic region with a sharp increase in the protein content of up to 26 g / l.We investigated the cerebrospinal fluid in 52 patients.Increasing the protein content (0.99 g / l) was found in only 13. This research has differential diagnostic value.Unlike extramedullary tumor protein-cell dissociation is rarely observed.
Vasomotor disorders of the lower limbs under the influence of a long spasm of pain impulses to the ground - a frequent manifestation of thoracic osteochondrosis.Oscillating index was reduced in half of our patients.Some, along with a reduction in the oscillatory index revealed a decrease limb skin temperature, chill, peeling skin and brittle nails.
In 4 patients (and later operated) patients had typical clinical thoracic myelopathy due back disc herniations (two medial and two paramedial).Clinically, the disease run the type of extramedullary compression of the tumor.However, a typical history (acute or subacute onset of the disease after the injury), as well as data contrast studies (epidurography and myelography) suggested the presence of disc herniation.Clinic thoracic myelopathy, and at the same time compression of the roots - Radik-lolshelopatii, consisted of four main symptoms: pain, motor, sensory and pelvic disorders.Pain, other than the vertebral localization, often wear dermatomny nature of the type of intercostal neuralgia and abdominal or radiating to the lower extremities.Movement disorders manifest paresis of one or both legs (often spastic) with muscular atrophy.Typically a decrease not only the surface but also deep sensitivity and paresthesias.Disorders of the pelvic organs are expressed in the absence of sensation passing urine, urinary retention and constipation, and later - in incontinence.Frequent sexual dysfunction.
According to Abbott and Retter (1956), depending on the location of the prolapse, there are three clinical forms:
Visceral syndromes. pain in the heart (psevdoanginozny syndrome) is often observed in patients with thoracic osteochondrosis.Berlyand JS et al.(1964) observed 25 patients brought to the hospital with suspected myocardial infarction who have been identified in the survey dorsal root syndrome caused by osteochondrosis of the lower cervical and thoracic pozvonochika departments.
recognition of the true causes of pain is often difficult.Art.Art.