Hernia Of The Thoracic Spine: Symptoms, Treatment, Causes

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Hernia of the thoracic spine

The content of the article:

1. The reasons
2. Symptoms of a hernia of the thoracic spine

3. Treatment of a hernia of the thoracic spine

   1. Conservative treatment
   2. Surgery
4. Video

A hernia of the thoracic spine is a protrusion of a deformed intervertebral disc into the extra-articular space. Most often, the protrusion occurs anterior to the axis of the vertebrae. The pathogenesis is the compression of the surrounding nerve roots by disc elements. They can be located directly in the spinal canal, as well as leave the spinal cord at different levels, often a hernial protrusion leads to compression of two roots.

Hernia in the thoracic spine, hernias are less common than in other parts

Disease characteristics

1. It belongs to rare diseases and occurs in no more than 1-4% of patients.
2. It can occur on the sites Th8-Th9, Th9-Th10, Th10-Th11, Th11-Th12 (Th is the designation of the thoracic vertebrae).
3. More often middle-aged men are ill.
4. The main symptom is pain of varying intensity and localization.
5. The first signs can occur in organs and tissues that are innervated by a compressed nerve (numbness of the hand, tingling of the fingers).
6. Pathology can occur at the border of different parts of the spinal column, which leads to an increase in the volume of the lesion (cervical zone, lumbar zone).

Intervertebral hernia of the thoracic region, like any other hernial formation of the spine, has several periods of development:

Period	Characteristic	Features:
Protrusion	The initial phase, or pre-hernia	It is associated with the destruction of the inner component of the annulus fibrosus, while the outer shell is preserved. Due to partial subsidence of the nucleus, the intervertebral disc can protrude by 2-4 mm.
Extrusion	Intermediate stage (the probability of recognizing a hernia in the images is 70%)	The annulus fibrosus remains intact, but becomes fragile and deformed throughout. Part of the disc elements can move into the extra-articular space. The occurrence of clinical symptoms due to compression of the nerve roots is possible.
Sequestration (before this stage, one more can be distinguished - prolapse. Difficulties in diagnosis allow combining these stages)	A typical formed hernia with all the characteristic clinical and diagnostic signs.	Severe destruction of the disc with the release of its elements directly into the cavity of the spinal canal. This often leads to disability (80-90% of cases), as there is irreversible damage to the nerve tissue.

Depending on the effect on the spinal canal:

• narrowing by no more than 10% (the clinic occurs relatively rarely);
• narrowing by 10-20% (the clinic is predominantly local in nature);
• narrowing of more than 20% (serious disorder with the occurrence of radicular symptoms).

Classification of the process depending on the direction of growth:

• lateral - growth to the right or left side relative to the center (occurs in 57-65% of cases);
• front - growth forward relative to the center (the safest option);
• median - growth strictly in the center (the most dangerous type of hernia, since growth is carried out in the spinal canal);
• paramedian - growth somewhat sideways relative to the center.

Detailed classifications are given in order to understand the occurrence of certain symptoms of the disease.

If an intervertebral hernia is suspected, a consultation with a neurologist or neurosurgeon is indicated, the main diagnostic method is MRI (magnetic resonance imaging).

The reasons

There are two main reasons that directly lead to hernias:

1. Degenerative-dystrophic diseases of the spine. First of all, we are talking about advanced forms of osteochondrosis. With this disease, serious metabolic changes occur in the inter-articular space, which leads to the fragility of the intervertebral disc. As the disc progresses, the disc finally collapses and a hernial protrusion forms.
2. Traumatic injuries. When struck or falls, fractures occur, ligament ruptures, which lead to a violation of the integrity in any part of the spinal column. In this case, the vertebrae are displaced along the axis and lead to the formation of a non-classical hernia.

Predisposing factors:

1. Long-term and pronounced stress on the spine. Professional athletes fall into this category, as well as people whose profession is associated with muscle tension and the musculoskeletal system (loaders).
2. Orthopedic diseases. Scoliosis of 3-4 degrees leads to pronounced changes in the axis of the spinal column and displacement of the vertebrae by more than 60%. In addition, stretching of the supporting frame of the spine and the intervertebral space, which includes muscles and ligaments, occurs.
3. Obesity 3-4 degrees. Provides a total load on the entire musculoskeletal system.
4. Chest deformities. They do not have a direct connection with the spine, but they cause deformation of the entire chest and ribs - the angle of inclination changes under which the attachment to the vertebrae is carried out.

The risk group, in addition to the categories already mentioned, include:

• patients over 60 years old, since natural processes of bone tissue degeneration occur;
• programmers, accountants and other persons whose professional activity is associated with a long stay in a sitting position.

Symptoms of a hernia of the thoracic spine

Symptoms are directly related to the characteristics of the innervation of this zone. The list of innervated organs and tissues (the most significant are given):

• upper limbs;
• respiratory system;
• chest wall;
• elements of the digestive system (esophagus, liver, duodenum, small intestine);
• partially some elements of the urinary system;
• spleen;
• components of the small pelvis (fallopian tubes).

Innervation is carried out not only by branches emerging from the thoracic spine, but also by a number of other nerve branches, which provides a single nervous network (if any section is damaged, nerve impulses are redirected from another section).

All symptoms can be divided into two groups.

From the nervous system

1. Pain. At the initial stages, it is of a moderate short-term nature and is localized only in the thoracic back. As it progresses, it becomes acute and may radiate to adjacent structures (ribs, lower back, may become encircling).
2. Spasm and muscle tension in the affected area (back, chest). This is a reflex defense of the body.
3. Vertebral thoracalgia. It is manifested by attacks of painful spasms in different areas.
4. Paresthesias (tingling, numbness), which are localized in different areas (hands, forearms, back).
5. Muscle weakness of the upper limbs.

Rarely, with severe disc damage, total paralysis (chest and below) may occur.

From the side of innervated organs

1. Swallowing disorder (choking).
2. Breathing disorder.
3. Total or partial loss of all types of sensitivity in the lower body, as well as the perineum, genitals, lower abdomen.
4. Sexual dysfunction (impotence in men and infertility in women).
5. Rarely in advanced cases of dysfunction of the pelvic organs (urinary and fecal incontinence).

These signs are always associated with pronounced destruction of the structure of the intervertebral discs, at the initial stage do not arise.

Treatment of a hernia of the thoracic spine

Treatment includes the following elements:

• conservative therapy;
• Exercise therapy (physiotherapy exercises);
• physiotherapy and massage;
• surgical correction is the only radical and truly effective method.

The scheme of how to treat this or that variant of the disease is made taking into account its duration, clinical features and instrumental data.

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Conservative treatment

Conservative methods are used as symptomatic therapy; they are not able to eliminate the hernia.

Methods	Characteristic
Drug therapy	1. Non-steroidal anti-inflammatory drugs. They have a pronounced analgesic effect. Appointed during the period of exacerbation. 2. Paravertebral blockade with lidocaine solution. They are prescribed only in extreme cases with severe pain syndrome. 3. Chondroprotectors. Used to prevent further cartilage destruction. 4. Vasodilators. They are prescribed for the purpose of local expansion of blood vessels and enhancing tissue nutrition. 5. Muscle relaxants. Prescribed to relieve muscle spasm.
Exercise therapy	Has a number of features: · It is used only in the phase of remission; · Unacceptable in the acute period or with significant destruction of the vertebrae and discs; · Exercises are performed only in the presence of a specialist and according to an individually drawn up plan; · It is permissible to use in the postoperative period as an element of rehabilitation along with corsets and bandages.
Massage	Provides increased local blood circulation by stimulating cellular metabolism. With pronounced deformities, additional pressure can lead to deterioration, therefore, it is indicated only with a mild form of the disease.
Physiotherapy	Includes: · EHF; · Magnetotherapy; · Laser therapy; · Electromyostimulation. Designed to relieve inflammation and restore metabolic processes in tissues due to physical factors of influence. Used in the postoperative period.

Surgery

Surgical treatment	Characteristic
Microdyscectomy	It consists in complete excision of the hernial sac.
Microendoscopic discectomy	It is performed using an endoscope and refers to minimally invasive interventions.
Chemonucleolysis	Refers to new and relatively poorly studied methods. It is associated with the introduction of a special substance into the articular cavity that destroys the remaining structures, after which they are removed using suction.
Endoprosthetics	It is used for total destruction of the articular surface and loss of function.

With proper treatment, the prognosis is conditionally favorable.

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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