Intervertebral hernia in the thoracic region appears under the influence of various factors. Unlike other types of diseases, this type of disc lesion is often detected at a young age.
Late diagnosis of spinal hernia often leads to surgical treatment: the intervertebral discs are so affected that conservative therapy is ineffective. How to detect lesions of the fibrous ring in time? What signs indicate negative processes in the intervertebral disc? How to treat a hernia in the thoracic? Answers in the article.
Why does intervertebral hernia occur?
The main cause of the disease - a violation of metabolism in the intervertebral discs. After protrusion of the fibrous ring, cracks appear, some of the fluid flows out, excessive pressure appears on the nerve roots, and pain syndrome develops.
The longer the patient postpones a visit to the vertebrologist, the more actively the disease progresses. Lack of treatment while maintaining the action of negative factors leads to constant back pain of high intensity.
Herniated disc in the chest area appears in the following cases:
- disrupted metabolism
- the patient suffered a fall, injury with a bruise of the sternum,
- revealed scoliosis, osteochondrosis, spondylolisthesis, other diseases of the spine,
- there is no physical exercise sufficient to maintain the elasticity of the discs, the strength of the muscular system in the back area,
- heavy physical labor over a long period
- taking potent drugs that violate the mineral balance in the body.
The following factors increase the risk of herniation of intervertebral discs:
- computer work
- violation of posture (stoop)
- frequent lifting of heavy loads
- long stay behind the wheel
- lack of calcium, phosphorus, vitamins, poor diet.
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First signs and symptoms
The defeat of the annulus, bulging disc indicates several signs:
- discomfort in the shoulder joint
- soreness in the upper back or chest. Discomfort is aggravated by coughing, taking a deep breath, sneezing,
- it seems that there is a stake in the back, stiffness appears,
- periodically there is a feeling of pressure in the chest.
Types and stages
Herniated disc is formed over a sufficiently long period. The more negative factors, the higher the risk of damage to the fibrous ring, the output of the pulposus core from the established boundaries. Patients with a high degree of obesity, diabetes, gout, osteoporosis, people working at a computer, drivers, porters fall into the risk group.
Stages of hernia formation in the spine:
- The first is protrusion. Under the influence of external and internal factors, the fibrous ring fibers are damaged, but the shell retains its integrity. At the protrusion stage, a moving fragment appears, but the gelatinous shell is in the familiar zone.
- The second is core exit or entrusion. Against the background of progression of the disease, not only the internal, but also the outer fibers forming the fibrous ring are damaged. In the second stage, the formation of an intervertebral hernia ends - the fibrous ring is completely affected, the pulpal nucleus is squeezed into the cavity of the spinal canal. Against the background of a dangerous process, pain increases with pressure on the nerve roots, the mobility of the spinal column is reduced.
Doctors secrete another lesion of the disc - fragmentation or sequestration. The phenomenon develops when the interrupted connection of the exited part of the pulposus nucleus with the base inside the disk. In this process, in some patients, physicians observe scarring of the tissue in the area of fibrous fibrous rupture after incomplete resorption of the fragment.
According to the localization zone, physicians distinguish several types of hernia:
If there are signs of damage to the intervertebral discs, you need to visit the medical facility with modern equipment and experienced staff. It is important to differentiate the hernia of the spine with other pathologies, with the development of which, there are negative symptoms in the chest.
Without the help of a specialist it is impossible to determine all the parameters of the disease. The doctor must identify the type and extent of the lesion of the disc, the location of the hernia, to understand the causes of damage to the fibers of the disc. Incorrect or late diagnosis often leads to serious consequences: with advanced cases of lesions of the vertebrae and discs, an intervertebral hernia has to be performed, which is associated with the risk of nerve damage.
The main types of research:
- x-ray of thoracic,
- tomography. In assessing the state of bone structures and elastic tissues, two types are used: computer (CT) and magnetic resonance (MRI),
- ultrasound to clarify the zone of localization of lesions, the causes of the development of the pathological process,
- myelogram. The technique is used if the patient can not do an MRI.
How to treat intervertebral hernia? In the early stages, a fairly conservative therapy with the inclusion of traditional methods and elements of the impact of Eastern medicine. Launched cases of hernia in the thoracic region of the spine often require surgical treatment. Even an experienced neurosurgeon cannot guarantee that everything will go smoothly: difficult access to the spinal canal in this department makes it difficult to perform the operation.
- complex exercise therapy,
- mud therapy
- electrophoresis with hydrocortisone,
- hardware spinal traction,
- taking analgesics and NSAIDs,
- manual therapy
- the use of a Lyapko or Kuznetsov applicator (only for the purpose of the vertebrologist),
Additional measures to reduce the risk of progression of kyphoscoliosis or lordosis:
- wearing an orthosis - supporting or corrective corset for the spine,
- use of orthopedic pillows and mattresses,
- special adaptations for drivers.
Patients who have identified entrusion, to eliminate pain, stop the negative process is not enough of these methods. The best option is to contact a highly qualified neurosurgeon at a clinic with a good reputation. You need to choose a medical center with advanced technologies in the field of neurosurgeons to minimize the risk of complications. It is important to review the feedback on the work of a specialist before agreeing to an operation.
In severe cases, doctors use minimally invasive techniques when the pulpous nucleus enters the cavity of the spinal canal:
- hernia hydroplasty,
- bone blockade
- laser vaporization,
- cold plasma nucleoplasty.
There is a variant for the surgical treatment of intervertebral hernia:
- microsurgery of the spine,
- unique endoscopic surgery with minimal risk of damage to adjacent areas.
When intervertebral hernia is detected, chondroprotectors are rarely prescribed: disc tissues are so affected that there is almost nothing to restore.
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Against the background of the bulging of the disc, breaking of the fibrous ring, compression of the vessels feeding the spinal cord and compression of the neural tube occur. Difficult access to the thoracic vertebrae complicates surgical treatment, the patient experiences severe pain, cerebral complications manifest themselves.
Intercostal neuralgia is one of the most painful manifestations on the background of intervertebral hernia. Shingles pains the patient constantly, the treatment is long, the quality of life is noticeably reduced.
Thoracic hernia is often "masked" by other pathologies, including heart disease. In the early stages of the lesion of the disk is difficult to determine: the symptoms are mild. A later visit to a specialist to determine the cause of chest pain often shows not severe heart disease, but advanced stages of intervertebral hernia.
Intervertebral hernia of the thoracic
Intervertebral hernia of the thoracic region is much less common than intervertebral hernia of the lumbar and hernia of the cervical. According to some estimates, hernias of the thoracic localization make up no more than 1% of all intervertebral hernias, although there is no accurate data on their prevalence, since in some cases they are characterized by an asymptomatic subclinical course. People of a young and middle age category get sick mainly. The most frequently observed lesion of the intervertebral discs of the lower thoracic spine (Th8-Th12). Depending on the location, the clinical manifestations of a chest hernia can mimic the symptoms of various pathologies of the chest organs and the upper floor of the abdominal cavity. In this regard, their differential diagnosis should cause particular caution in a neurologist and be conducted with the involvement of specialists from other profiles: a gastroenterologist, cardiologist, nephrologist, pulmonologist.
Causes of thoracic hernia
The main etiofactors of intervertebral hernia of the thoracic localization are spinal injuries and osteochondrosis. In young patients, the formation of a hernia is caused either by trauma or by the early development of degenerative changes in the intervertebral discs. In patients older than 40 years, hernias are usually a complication of osteochondrosis.
Traumatic injuries of the thoracic discs can occur during spinal injury, subversion of the vertebrae, fracture of the thoracic spine, excessive load on the thoracic during exercise or weight lifting. Chronic disc injury, leading to their premature degeneration and wear, is usually caused by work in an uncomfortable position (for example, with surgeons, car repairmen, welders, tailors). Early development of osteochondrosis in the thoracic spine is often associated with an uneven load on the spinal column in violation of posture or curvature of the spine (kyphosis, scoliosis), dysmetabolic processes in the body (diabetes, early menopause).
Disc injuries cause the formation of cracks in its fibrous ring. This also leads to degenerative processes, accompanied by a decrease in the hydrophilicity and elasticity of the disk. As a result of tears of the fibrous ring, the disk ceases to be held strictly between the vertebral bodies, a part of it prolapses from the intervertebral space. There is a protrusion of the disc, which, as it progresses, develops into an enlarged herniation of the disc. The main clinical manifestations of the latter are associated with its effect on the spinal nerve root and / or on the substance of the spinal cord itself.
Symptoms of hernia
In neurology, intervertebral hernia of the thoracic is classified into central and lateral. In the first case, the hernia manifests symptoms of compression of the spinal cord - compression myelopathy with the development of lower mono- or paraparesis, pelvic disorders. Due to the fact that the discogenic myelopathy in the thoracic region is caused by the suppression of the conducting motor pathways, the paresis is of a central (spastic) character. Lateral hernia makes its debut with signs of irritation and compression of the corresponding spinal root - pain syndrome (radiculitis) and sensitive disorders in the chest. In the composition of the spinal nerves of the thoracic region there are visceral branches to many internal organs: the trachea, lungs, bronchi, esophagus, liver, duodenum, gall bladder, kidneys. Therefore, breast hernia may be accompanied by functional disorders of the corresponding visceral organs. Localization of these symptoms depends on the level of the hernia, in connection with which the division of breast hernias into upper, middle and lower is made.
Hernia of the upper thoracic department (Th1-Th4) is manifested by pains (thorakalgia) and paresthesias in the upper sections of the chest, the interscapular region. Torakalgiya in the left half can simulate the clinic of angina. Hernia at the level of Th1-Th2 is accompanied by paresthesias and weakness in the hands, numbness of the hands. May be a disorder of the motility of the esophagus, difficulty swallowing.
Hernia of the middle thoracic region (Th5-Th8) often occurs with symptoms of intercostal neuralgia — one or two-sided herpes pains along the intercostal spaces, resembling herpes zoster, but not accompanied by vesicular eruptions. Such pains are able to limit the respiratory excursion of the chest with the formation of more superficial and rapid breathing. Possible pain in the stomach. In some cases, breast hernia can cause dyspepsia, pancreatic enzyme deficiency, insulin secretion disorders, and disorders in carbohydrate metabolism.
Hernia of the lower thoracic region (Th9-Th12) proceeds with pain localized in the area of the kidneys, under the ribs, in the upper abdomen, sometimes simulating a “acute abdomen”. Right-side pains in the hypochondrium can be mistaken for manifestations of liver pathology, acute cholecystitis or appendicitis, and encircling intense pains for acute pancreatitis. A hernia at the level of Th11-Th12 can cause intestinal dyskinesia.
Treatment of hernia of the thoracic
Conservative treatment is aimed at stopping inflammation and pain, stopping an increase in the size of the hernia, restoring lost neurological functions. Anti-inflammatory drugs are prescribed (naproxen, ibuprofen, ketoprofen, carprofen, etc.). A local injection of anesthetics and corticosteroid drugs in the form of paravertebral blocks is performed. In the presence of spastic syndrome, muscle relaxants (tolperisone) are indicated. A positive effect has a course of treatment with vitamins B1 and B6.
Some types of physiotherapy have anti-inflammatory and myorelaxing effects, for example, hydrocortisone ultraphonophoresis, electrophoresis, magnetic therapy, UHF. To relieve spasm of the paravertebral muscles, a myofascial massage is prescribed. Manual therapy and traction therapy help to increase the distance between the vertebrae and thereby relieve pressure on the affected disc. The patient should observe a special regime, more stringent in the acute period and excluding excessive loads on the spine in the future. If the results of conservative measures are positive, in order that the hernia symptoms do not return again, it is necessary to regularly perform a special complex of exercise therapy, aimed at creating a spinal cord holding spine.
Surgical treatment is indicated if the intervertebral hernia of the thoracic region is not amenable to conservative therapy, symptoms of myelopathy occur, and compression of the spinal root progresses. Urgent decompression of the spinal canal is performed by laminectomy. Depending on the size of the hernial protrusion, endoscopic microdiscectomy, microdiscectomy, diskectomy can be performed. After removal of the disk, connective tissue growths that form the fusion of two vertebrae (ankylosis) take its place. It requires the most balanced approach to the question of the need for surgery, since it can have a number of serious complications: bleeding, damage to the spinal nerves, infection with the development of myelitis, spinal arachnoiditis, injury to the dura mater.
How does a hernia in the thoracic spine
The spine consists of discs that are flexible, providing a flexible connection and cushioning. Protective pads between disc vertebrae over time or under the influence of adverse factors may wear out. As a rule, spinal hernia has 3 stages of formation:
- the disk core begins to bulge, the shell stretches, loses its shape. At the same time, the integrity of the shell is still intact, but the core is already pressing on the surrounding tissues, creating discomfort,
- in the place of the greatest pressure a crack forms on the shell, a core appears in the lumen. This stage is the initial in the destructive processes of the body,
- complete rupture of the fibrous membrane and the prolapse of the nucleus, if measures were not taken or timely treatment was not provided.
Causes of intervertebral hernia of the thoracic
- disorders caused by poor nutrition - the disease can occur due to a malfunction of the metabolism, due to a lack of necessary vitamins and elements in the diet, due to a sedentary lifestyle, as a result of which the disks are poorly supplied with blood,
- bad habits - intervertebral hernia occurs as a result of metabolic failure, the prerequisites to which is smoking and the use of strong drinks,
- genetics - predisposition to destructive processes,
- lifting weights in the wrong posture - if you lift weights, then the probability of developing an illness is great. In such situations, you must keep your posture upright,
- presence of concomitant diseases - osteochondrosis, scoliosis,
- Occupational risk of illness - work where constant fading is required in the same position. In the risk zone is the activity at the machine, office employment, the work of a hairdresser, makeup artist, jeweler,
- physical impact and traumatic situations
- excess weight,
- high growth - creates an additional load on the vertebrae,
- infectious diseases.
Hernia of the thoracic spine: symptoms and treatment
Signs of the disease may be absent altogether, the pain is manifested only if the protruding disc presses on the nerve roots. As a rule, the discomfort is aggravated if the person is in the same position for a long time.
The pain has pronounced locality in the upper part of the loin. Sometimes pain gives to the chest. Discomfort can be observed between the shoulder blades. If the patient changes position from lying to sitting, then the pain increases dramatically.
Symptoms of intervertebral hernia are manifested in the form of intestinal disorders (constipation, flatulence, regular diarrhea). In men, there may be sexual problems.
There are failures in the urogenital system (frequent or, on the contrary, rare urging to the toilet). The disease is characterized by rapid fatigue, especially in the limbs. The patient may feel numbness in the arms and upper abdomen.
Breast hernia can cause paralysis, both full and partial. It depends on the location of the violation of the integrity of the shell of the disk. Complete paralysis is characteristic of the development of pathology in the upper chest.
When surgery is required
Drug therapy and LFK for a hernia of the thoracic region does not always guarantee complete recovery. Intervertebral hernia of the thoracic department is a rather complicated process that may require surgical intervention. The basis for this are persistent severe pain, respiratory failure, loss of sensation in the limbs, pathological disorders of the pelvic organs.
The operation can be done in two ways: removal of the affected disc or dissection of the vertebral arch as a whole. The main disadvantage of the operation is the possible risks and complications: infection, recurrence of hernia recurrence, osteochondrosis.
- gymnastics with hernia for the prevention of its appearance - a set of exercises aimed at strengthening the muscles of the back and thoracic. Alternatively, swimming, frequent walks, unhurried jogging,
- weight control
- balanced diet,
- eliminating the risk of spinal injury,
- avoid overwork and stress.
Compliance with simple recommendations will allow you to achieve correction of the bone structure, stabilize metabolic processes, strengthen the immune system and have a beneficial effect on mental health. And the considered questions about hernia of the thoracic spine, symptoms and treatment will help to identify the disease in a timely manner and to conduct an effective therapy.
Classification of hernia formations
According to the forms of manifestation of hernial formation on the disk, there are three stages: protrusion, extrusion and sequestration. They are formed on the spine, depending on the degree of displacement and changes as a result of blood flow disturbances in a particular area and a number of factors (for example, osteochondrosis). As a result, there is a lack of nutrition and the flow of fluid to the tissues, and then the appearance of small cracks.
It is observed in cases where the disk "bulges out", causing pain in the surrounding area, due to compression of the nerve bases and is accompanied by painful sensations (vessels, ligaments, muscle tissues). while the maximum distance in any plane direction beyond the end of the disk is smaller than between its>
The phenomenon of extrusive nature is observed much less frequently with “protrusion” together with a violation in the edges of the disk material when the inner part (core) falls out, held only by the longitudinal ligament with the spine. The most dangerous is the presence of extrusion in the lumbar region, which often leads to pain in the sciatic nerve.
In the case when the continuous connection with the disc tissue of the displaced material is completely lost, the form of the disease is manifested - sequestrum.
Such treatment is prescribed for the diagnosis of pain symptoms that occur when squeezing for three or four weeks. It is also used in the case of an increasing increase in the signs of weakness, subtraction, regardless of the length of time the disease takes. If a violation of actions in the pelvic region is detected, then surgery is immediately carried out.
Today, the most famous are the most methods that are associated with the introduction of a substance into the abdominal region of the human body. That is, intramuscularly or intravenously. At the same time, the effect of surgical intervention in case of degeneracies in vertebral hernial formations is felt much faster, and a regression of pain is achieved.
The most benign of the existing methods, which allows you to fully carry out the removal of a new formation without complications in the intervertebral disc of the lower back - this is endoscopic removal of a hernia of the spine. It is called "percutaneous."
The operation is carried out with the help of a complex instrument, the main elements of which are a combination of high-precision optics and a working channel. For an effective and efficient operation, an endoscope of just 7 mm in diameter is sufficient.
The intervertebral neoplasm is removed through the channel where the junction between the spinal cord passes through the nerve base. The electro-optical device controls the needle travel both outside the channel and later along it. Then the endoscope tube is inserted and the disk and sequestration are partially removed, which presses the nerve base and causes pain. This further allows the intervertebral disc to correctly perform depreciation functions. And due to the disappearance of the root neurological syndrome, sharp pains disappear.
Technically, such an intervention is completely different from such methods when part or all of the whole vertebral disk is removed, including hernial formation. It causes compression of the spinal cord and, as a result, the connection (splicing) of the adjacent vertebral tissues.
When does endoscopic spinal hernia surgery, The very consequence of an operating injury is minimal. At the same time, the contact between the solid formation in the membrane of the spinal cord cells and the periosteum of the spine, which contains the tissue compounds of the vein plexus, is completely excluded.
There is no undesirable postoperative scar and pain. The access method used eliminates damage to the long and short segmental muscles of the dorsal part of the body. Not observed bone resection, which contributes to the stability of the operated area.
Cosmetically, the effect at the end of the operation is far superior to any other traditional surgical incisions after therapeutic procedures.
Be sure to read: rehabilitation after spinal hernia removal.
For proper passage, an x-ray control of the positions of surgical instruments at each stage of the intervertebral formation is performed. And the correctness of the manipulation movements is tracked by the endoscope.
In most cases, intervertebral hernia develops through the fault of man. Inattention to the health of the spine, excessive load, or, conversely, lack of movement, adversely affects the elastic strip. Doctors recommend to carry out preventive measures from a young age.
How to prevent the development of intervertebral hernia? 10 important rules:
- Stop smoking: prolonged exposure to nicotine destroys the vertebrae and the elastic cushioning layer.
- Engage in Pilates, swimming, yoga, perform restorative exercises to increase the flexibility of the spine.
- When working in the office, at the computer to keep your head straight, do not slouch, be sure to lean on the back of the chair. It is important to equip the workplace well: savings in spinal health issues are inappropriate.
- When assembling devices and mechanisms, while periodically lifting the head, two or three times a day, do gymnastics for the neck, massage the neck-collar area.
- Less often there is pickles, pickled vegetables, sorrel, spicy seasonings and spices, fried foods, canned goods, smoked foods. It is important to reduce the consumption of strong black tea and coffee, alcoholic beverages, especially carbonated.
- Watch your posture, do not slouch, keep your back straight while walking.
- To purchase an orthopedic mattress for a comfortable sleep, optimal impact on vertebral structures, it is also desirable to have an orthopedic pillow for the correct position of the spine during rest,
- Take a walk in the fresh air, less nervous, enough to relax.
- Include fresh vegetables, fermented milk products, hard cheese, cottage cheese, sea lean fish, cereals, non-acidic fruits.
- After 40 years, annually visit a vertebrologist or orthopedic traumatologist to monitor the state of the spine. A visit to the doctor is needed even in the absence of acute symptoms: diagnostics using modern equipment reveals the early stages of orthopedic pathologies, which facilitates treatment. You need to know: spinal surgery is always a serious risk and high probability of complications.
Video about the causes of intervertebral hernia in the thoracic region and about the features of the treatment of education:
Osteochondrosis is a consequence of the wear and tear of the vertebrae, expressed in their sedimentation and calcination of the vacated space. This process develops slowly, accompanies a person for 4-6 dozen of life. As a rule, these pains begin to bother long before a person visits a doctor.
The main signs of the disease
A hernia in the thoracic region for a long time can give only one symptom: pain during fatigue or after weight lifting. As a rule, this syndrome goes away after resting or applying warming ointments.
Much depends on what kind of nerve root will be transferred in the process of pathology. In some cases, pinching provokes severe pain, which falsely indicate diseases of the internal organs, especially the gastrointestinal tract.
Symptoms may be similar to bouts of cholecystitis, pancreatitis. And it requires not only a good diagnosis, but also an experienced specialist who will be able to distinguish the disease and make the correct diagnosis.
It is difficult to identify a hernia localized in the thoracic region because its symptoms are similar to other diseases. Many patients who applied for help do not even guess about the development of pathology in themselves. But still there are symptoms that allow to diagnose the disease, which include:
- pain in arms and shoulders
- sharp pains when bending, turning and other body movements,
- heaviness and pain in the chest, similar to the heart,
- constrained movements
- pain with deep breathing.
When a hernia presses on the nerve endings of the spinal cord, tingling appears at the ends of the fingers and toes, muscle weakness and numbness in some parts of the body.
These symptoms are enough to pre-determine the presence of intervertebral hernia, but to establish an accurate diagnosis, it is necessary to conduct an examination in a hospital.
No need to treat joints with pills!
The health of the ridge largely determines the general condition of the person. The thoracic region is the longest, consisting of twelve vertebrae and is the least mobile.
Disks endowed with a small height. This creates an additional condition for reducing the mobility of the vertebrae. In this zone, the ribs are attached to the vertebrae. With their help, create a rigid frame.
The spinal canal is endowed with a relatively narrow lumen. The design of the chest area provides protection against random factors leading to deformation.
Intervertebral hernia of the thoracic region - prolapse of the thoracic intervertebral disc, which normally does not go beyond the boundaries of the vertebral bodies.
Manifested by pain and sensitivity disorder of the chest, weakness in the lower limbs with pelvic dysfunction, various functional changes on the part of somatic organs.
When the symptoms become too pronounced and strong, then inevitably one has to go to the doctor. The treatment that a doctor can offer you can be divided into several groups:
- Auxiliary therapy, this includes physical therapy.
- Surgical intervention.
The choice of treatment depends entirely on the stage of the disease.
To conservative methods include the following treatment:
- The use of anti-inflammatory drugs.These can be pills, injections, sometimes they do epidural injections.
- Treatment must include the use of analgesics to reduce pain. With severe pain, narcotic drugs may be prescribed, but only for a short time.
- Effectively treatment by a chiropractor, only in this matter, the main thing is to get a competent specialist.
- Physiotherapy. Properly selected exercises will strengthen the muscular-ligamentous apparatus.
- In the first days of exacerbation, it is necessary to ensure peace, and then gradually return to the usual way of life.
In addition to basic drugs, vitamin complexes are recommended.
Physical exercise with hernia of the thoracic
Exercise of moderate nature is simply necessary for everyone. No wonder they say - the movement is life. If you still could not prevent the disease, this does not mean that the load is contraindicated to you.
Here are some exercises that you can advise you to perform an exercise therapy doctor when diagnosing a hernia of the thoracic region.
- Raising and lowering shoulders, in a standing position, legs shoulder-width apart.
- In the same initial position, raise the arms up, slightly arched, and then lower and bend forward.
- Kneeling round the back, and then bend in the lumbar region.
- Lying on your back, make a lap girth and press them to your chest.
All exercises should be performed at a slow pace and preferably under the supervision of a physician.
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Signs of the disease does not appear immediately and at first they can be confused with other ailments.
First, the patient has pain, which many blame on fatigue or mild malaise.
Having received confirmation of the diagnosis, do not immediately despair.
Operational intervention is not necessary in all cases, it is always important to pay attention to the big picture.
Treatment begins only after a thorough examination of the patient and a chest radiograph or other studies, such as magnetic resonance or computed tomography.
Based on the general examination, the patient's complaints, the X-ray results, you can make a final diagnosis and proceed directly to the treatment.
The feasibility of a surgical intervention will be with persistent pain, neurological manifestations in the form of paralysis and paresis.
It is also justified to conduct the operation with the adverse effects of conservative treatment. The main methods of surgery for this disease include the following:
- diskectomy and laminectomy - traditional methods of surgery, which take place under general anesthesia and are reduced to dissection of the vertebral arches and the removal of part or all of the disk,
- microdiscectomy, in which there is minimal damage to the paravertebral tissues,
- laser therapy,
- endoscopic nucleotomy, in which the surgeon monitors the process with the help of miniature cameras when removing a part of the disk,
- epidural infiltration.
As for the conservative treatment of hernia, it is appointed in the initial stages of the disease and during remission. The treatment is aimed at relieving pain syndrome and releasing sandwiched intervertebral discs.
The main methods of treatment are therapeutic massage, physiotherapy, including magnetic therapy and acupuncture, as well as manual therapy.
In the period of exacerbation of the disease, the doctor may also be prescribed medical treatment aimed at anesthesia, sometimes even with the help of narcotic drugs, and providing patients with rest.
In some cases, when the usual anesthesia is ineffectively, the pain syndrome is removed for a certain time with the help of epidural anesthesia. This method is also used immediately before the operation.
Also at this stage, anti-inflammatory therapy with nonsteroidal drugs.
If a conservative treatment regimen gives a positive therapeutic effect, there is an improvement in the clinical picture and the disease stops progressing, then the need for surgical intervention is eliminated.
In such cases, further monitoring of the patient's health and periodic preventive examination by the attending physician is sufficient.
Leading signs of the disease
Late treatment to the doctor and the neglect of the disease can bring a lot of problems. In addition to painful sensations in the back, heart problems can begin, the blood circulation of the brain can be disturbed, and as a result of a heart attack or stroke.
The disease gives a complication and the abdominal cavity, colitis, inflammation of the pancreas, gastritis can develop, even if the diet and proper nutrition are observed. In particularly advanced stages, loss of sensation develops and even paralysis of the limbs.
How does this violation manifest itself?
Symptoms of the disease depend on the area in which the pathology was formed. It can affect the so-called nerve roots or form in the spinal cord.
Often the intervertebral hernia is located in the thoracolumbar region, which is located near the lumbar region. This disease is often manifested without noticeable symptoms, so it is difficult to diagnose it. For the same reason, surgery in the thoracic region during the formation of a hernia in it is extremely rare.
If the intervertebral formations do not manifest themselves (that is, they do not have acute symptoms), severe back pain occurs, especially in its upper part. Other reasons are considered, even in the case of intervertebral disorders. The pain may arise from other pathologies, which, by the way, are many.
Why does intervertebral hernia appear? This is due to the extrusion of the inner cores of any intervertebral disk through the outer fibrous rings. As a result, nerve roots or the spinal cord are irritated.
Before you begin treatment for this disease, it is important to understand the reason why it appeared.
It should be noted that most often this occurs in two cases: with osteochondrosis and traumatic injury.
If we consider the first case, here everything happens due to wear of the disc tissues with time, that is, its calcification. In osteochondrosis, the first symptoms that are characteristic of intervertebral hernia occur in people aged 40-60 years. The disease in this case develops extremely slowly, so people rarely turn to specialists, while the painful sensations are constant and pronounced.
In many cases, intervertebral formation occurs due to traumatic injury, that is, due to a particular injury. In this case, as a rule, the patient feels sharp manifestations of symptoms. It is important to understand: those injuries or bruises, which are characterized by increased pressure on the vertebral discs, are the reason that the patient develops the above pathology. This occurs during falls or sports injuries, which, in turn, is characterized by significant loads on the upper back area.
There is intervertebral hernia of the thoracic and in young people who have not yet had degenerative changes in the discs. Injuries that can occur repeatedly exacerbate the symptoms, and traumatic twisting causes the pathology to progress.
In this case, it is very important to determine the true etiology of the disease, so the most important element here is diagnosis, followed by proper treatment.
During the herniation of the intervertebral disk of the thoracic region, there are a number of stages:
- intradisplace displacement of gelatinous core
- the progression of the destruction of the fibrous ring,
- the hernia itself is a complete rupture of the ring and the exit of the gelatinous nucleus into the spinal canal,
- the spread of degenerative changes in the adjacent vertebrae and ligamentous-articular apparatus.
In the first period, the clinical picture is caused by irritation of the fibrous ring receptors and the posterior ligament. This causes local pain in the affected segment, reflected pain syndrome, reflex myotonic syndromes (abnormal muscle contraction), angiospastic reflexes (abnormal vasospasm), trophic reflexes (development of nervous and bone fibrosis). With the introduction of novocaine, the symptoms caused by pathological reflexes disappear. Treatment in this period is conservative.
The second period is characterized by the addition of tonic contractions of the muscles, which is manifested by a constant feeling of fatigue of the corresponding muscle group and discomfort. Surgical treatment - discectomy under the control of the endoscope.
In the third period, when a disk falls out, symptoms of compression of the roots, the spinal cord and its vessels appear, which is manifested by radiculitis and ischemic processes in the spinal cord. The formation of bone growths (osteophytes), squeezing the nerve roots and blood vessels, contributes to the persistent course of thoracic osteochondrosis. The operation is aimed at the elimination of the squeezing factor and stabilization of the affected vertebral segment.
In the fourth period, symptoms of a lesion not only of the thoracic but also of the cervical and lumbar levels appear. Surgical treatment eliminates compression in all pathologically altered levels. Radicular disorders are often combined with signs of diseases of internal organs. The limited range of movements in the thoracic region explains the rarity of the onset of degenerative diseases at this level.
Symptoms of the disease
Physiological kyphosis contributes to the formation of osteophytes on the anterior and lateral surfaces of the vertebrae, which justifies the frequent asymptomatic hernia of the thoracic region. The most frequent is a lesion of the disc between the 11 and 12 thoracic vertebrae, which is almost 24% of all lesions. The close connection between the spinal nerves, the sympathetic trunk and the capsule of the costal-transverse and costal-vertebral joints leads to the emergence of autonomic syndromes with the defeat of these joints.
It is necessary to take into account the peculiarity of the arterial blood flow of the lumbosacral spinal cord. The anterior spinal artery, which has a large diameter, supplies blood to the lumbar region, and any compression at the level of ThXI-ThXII is dangerously serious complications.
The main symptoms of intervertebral hernia of the thoracic include:
- pain in the chest, which increases during movement, axial load, shaking in transport, vibration, sneezing and coughing,
- limited mobility of the thoracic region,
- muscle tension of the back (is an addition to positional scoliosis),
- local sensitivity disorders
- vasomotor disturbances (caused by myelopathy),
- visceral syndromes: pain in the region of the heart, liver or pancreas, abdominal pain (the ineffectiveness of nitroglycerin in angina pectoris pain helps to suspect chest osteochondrosis).
Herniated disc in the lower thoracic region often causes abdominal pain and intestinal discomfort. It is imperative to differentiate the vegetative manifestations from the symptoms of an acute abdomen (emergency surgical pathology requiring immediate surgical intervention). Overdiagnosis in such cases leads to unjustified operations. Pains under the ribs on the right simulate diseases of the biliary tract. With a hernia of the thoracic spine, disorders of urinary function may occur, in men, a decrease in potency and a decrease in sexual desire in women.
In the presence of a hernia in the thoracic spine, treatment begins with therapeutic techniques. Among them are the following areas:
- restriction of physical activity and load on the spine in the first days after the onset of symptoms,
- conducting a special individually developed complex of physical education and gymnastics, which will help strengthen muscles, reduce the load on the spinal column and stabilize the affected area,
- extension using a number of special devices is aimed at increasing the space in the region of intervertebral joints, as a result of which the irritating effect on the nerve bundles is reduced,
- drugs prescribed in the form of injections, ointments or tablets,
- manual therapy together with massage can significantly alleviate the patient’s condition and eliminate pain by normalizing blood circulation in this area.
Among the drugs for the treatment of intervertebral hernia using several groups of drugs:
- painkillers, including narcotic drugs that can eliminate pain,
- anesthetics that are injected directly into the pinching area of the nerve fibers,
- anti-inflammatory drugs reduce swelling and other reactions that increase the symptoms of the disease,
- drugs that improve the blood supply to the thoracic spine contribute to the normalization of the work of the internal organs.
In some cases, when the hernia significantly narrows the lumen of the spinal canal, only surgery can help.
Massage and exercise therapy
Exercises for intervertebral hernia help strengthen muscles located in the immediate vicinity of the protrusion of the gelatinous nucleus. As a result, the intervertebral junction becomes more stable, which reduces the severity of symptoms and contributes to an increase in the diameter of the spinal canal. There are even cases of complete recovery from this disease after several courses of manual therapy and subsequent daily performance of special exercises.
The general principles of physical therapy in the presence of intervertebral hernia are:
- It is necessary to carefully monitor your own feelings and avoid discomfort, and especially pain.
- It is not necessary to perform exercises in the early stages of classes, which are accompanied by twisting movements along the axis of the spine.
- It should be done regularly, otherwise the effectiveness of exercise therapy will drop dramatically.
- It is strictly forbidden to immediately give the maximum load.
- The range of motion should not be large, but only increase with time.
If you reasonably approach the exercises and perform an individual set of exercises, the back muscles will gradually strengthen, your posture will improve, and the load on the vertebrae will decrease.All this will give mobility and flexibility to intervertebral joints.
Methods to eliminate the pathology
In general, treatment of intervertebral hernia occurs without surgery, which violates the integrity of the chest.
So, non-surgical methods include conservative therapy, which is conducted depending on how symptoms of the disease appear. Often, a short period of complete rest is required, and physical activity must also be reviewed, that is, the load that causes discomfort in the spine of the thoracic spine should be completely eliminated.
In addition, narcotic and non-narcotic analgesics are used to reduce pain, however, such drugs are attributed only in severe cases. If the form of the disease is mild or moderate, then medications with anesthetic effect, such as acetaminophen, that are more safe for the patient, are used. In addition, the treatment includes injections, manual therapy, as well as special exercises designed to strengthen the muscles.
But the surgical treatment of a hernia is prescribed only in extreme cases. The so-called thoracic surgery is aimed at eliminating decompression. This surgery has many approaches that are determined in individual cases. But if the level of activity with conservative methods of treatment rises at least after 6 weeks, then surgical intervention will not have to be resorted to. Therefore, at the first above-mentioned symptoms, you should consult a specialist, because only timely treatment will help to avoid surgery and will be as effective as possible.