Dorsopathy of the thoracic spine

The term "dorsopathy" (Latin dorsum - back + Greek pathos - suffering, disease) is used for various diseases of the back and/or spine that cause pain, which in ICD-10 serves as a diagnostic code for spinal pathologies - M50-M54.

In the medically accepted version, thoracic dorsopathy refers to nonspecific back pain in the thoracic (thoracic) spine, which includes the Th1-Th12 vertebrae.

That is, dorsopathy is viewed both as a musculoskeletal pain syndrome (although the term "dorsalgia" exists for back pain) and as a generalized definition of spinal disorders.

Epidemiology

The main structural elements of vertebral joints are subject to natural mechanical wear and tear, which is accompanied by aging of the body. In a significant proportion of people, this process can be complicated by the development of vertebrogenic pathologies with pain syndrome.

According to experts, non-specific back pain of various localizations is periodically observed in 72-80% of the adult population. But thoracic dorsopathy due to disc herniation and impingement, according to some data, accounts for up to 30% of cases.

Causes of the dorsopathies of the thoracic spine

ICD-10 diagnosis code M53.84 has "other specified thoracic dorsopathies", code M53.94 means unspecified thoracic dorsopathy, and pain in this part of the spine has the code M54.6. At the same time do not refer to dorsopathies spinal column injuries.

What are the main causes of thoracic dorsopathy? First of all, these are:

• posture disorder, provoking excessive muscle tension;
• osteochondrosis of the cervicothoracic spine;
• herniated disc;
• displacement of the thoracic vertebrae (spondylolisthesis);
• Arthritis of the facet joints of the thoracic vertebrae;
• associated with increased physical activity spinal osteochondropathy at the level of the thoracic vertebrae;
• Small intervertebral joint lesions - spondyloarthrosis;
• Spondylosis - degeneration of the intervertebral disc and adjacent bone structures.
• Possible association of the etiology of thoracic dorsopathy with:
• Bechterew's disease or ankylosing spondylitis;
• rib-vertebral articulation syndrome;
• Scheiermann's disease and other degenerative-dystrophic spine diseases;
• Connective tissue dysplasia, which is characterized by weakness of ligaments and tendons (leading to spinal instability), as well as diffuse idiopathic skeletal hyperostosis (ligamentosis) weakening the ligamentous apparatus of the spine;
• spinal muscular atrophy.

In addition, WHO experts distinguish deforming dorsopathies (codes M40-M43) arising for various reasons with localization in the thoracic region:

• Sagittal imbalance in the form of abnormal kyphosis of the thoracic spine;
• degenerative as well as secondary to neuromuscular disorders scoliosis of the thoracic spine;
• kyphoscoliosis;
• flat back syndrome.

Read also - Spinal deformities and back pain

Risk factors

In addition to poor posture, the presence of skeletal pathologies of a systemic nature and some diseases accompanied by spinal deformity, risk factors for thoracic dorsopathy are weakened defense mechanisms of the spine.

This applies to sedentary work, in which in the sitting position there is a gradual leveling of the natural curves of the spinal column: lordosis (slight inward curve) of the cervical vertebrae and physiological kyphosis (anterior curve) of the middle part of the thoracic region. There is also a stretching of its muscles and ligaments, relaxation of abdominal muscles (which reduces intra-abdominal pressure, creating prerequisites for protrusion of spinal shock absorbers - intervertebral discs) and a general weakening of muscle strength.

Physical overload, sleeping in an uncomfortable position with an unnatural spinal position, obesity, and even frequent stressful situations should also be considered.

Pathogenesis

If we consider thoracic dorsopathy as pain syndrome, its pathogenesis is explained by nociception (from Latin nocere - to cause pain), i.e. Preventing potential damage to the body by a defense mechanism, which is the sensation of pain.

As a function of the nervous system, nociception is mediated by the transmission by neurons of electrical and chemical signals (caused by the expression of special neuropeptides - neurotransmitters), which originate from peripheral nerve endings (pain receptors), pass along type II sensory fibers through the spinal cord (its posterior horn) and along ascending pathways reach a higher level of the nervous system - the somatosensory cortex.

See also:

• Nociceptive pain
• Anatomy of the nociceptin system

Symptoms of the dorsopathies of the thoracic spine

The first signs of dorsopathy of the spine in the thoracic vertebral zone, as well as its key symptoms - this is pain of varying intensity and duration, often radiating to nearby anatomical structures and organs of the thorax. In particular, it is a sudden acute, periodic or constant pain in the middle back (which can occur with certain movements). Many patients complain of painful stiffness of movements, muscle weakness, numbness or loss of sensation.

There can be simultaneous dorsopathy of the cervical and thoracic spine, which develops in cases of common diseases of both spine, including the same osteochondrosis, intervertebral herniation and spinal canal stenosis. Read more in the publication -Neck and back pain

And dorsopathy of the lumbar-thoracic spine or thoracolumbar dorsopathy in most cases is due to scoliosis, the general signs of which are manifested by a difference in the height of the shoulders, asymmetry of the thorax with protruding ribs or shoulder blades, apparent displacement of the head relative to the body, etc.

More details in the articles:

• Pain in the thoracic spine
• Symptoms of spinal ligament injuries

Complications and consequences

Complications and consequences of thoracic dorsopathy depend on the cause of pain and can manifest as motor, sensory and mixed neurological disorders. In scoliotic dorsopathy there is deformation of the thorax; in cases of displacement of the Th1-Th12 vertebrae, there may be problems with the gastrointestinal tract; patients with Bechterew's disease form functional kyphosis, there are spasms of paraspinal muscles, inflammation of the hip joint; with osteochondrosis-related dorsopathy of the cervical and thoracic region, there is a risk of developing vertebral artery syndrome with decreased blood supply to the brain.

Also see. - Osteochondrosis of the spine: neurologic complications

Diagnostics of the dorsopathies of the thoracic spine

To find out the cause of pain, anamnesis is collected and physical examination of patients; instrumental diagnostics is used: X-ray and MRI of the cervical, thoracic and thoracolumbar spine, electromyography.

All the details are in the materials:

• Spinal examination methods
• Methods of diagnosing back pain
• Diagnosis of spinal pain
• Diagnosis of osteochondrosis of the thoracic spine

Differential diagnosis

Differential diagnosis of dorsopathies of any part of the spine excludes the presence of fractures, tumors and nerve root impingement (radiculopathy). In addition, it is extremely important to differentiate not only neuropathic pain, but also to distinguish between vertebrogenic and non-vertebrogenic causes of pain, for example, muscle pain in the presence of thyroid hormone problems, etc.

For details see. - Causes of back pain

Also differentiated is thoracic dorsopathy and thoracalgia - chest pain, which is accompanied by cardiac pathologies and diseases of organs localized in the thorax.

Treatment of the dorsopathies of the thoracic spine

Although the treatment of thoracic spine dorsopathy depends on its etiology and the severity of the condition, its basis is conservative therapy, for more information see:

• Treatment of back pain: strategies for drug therapy
• Nonsteroidal anti-inflammatory drugs and back pain
• Analgesic and anti-inflammatory injections for back pain
• Medication treatment of osteochondrosis of the spine

Physical rehabilitation, including exercises for thoracic dorsopathy, i.e. Therapeutic gymnastics (LFK) for thoracic and cervical dorsopathy, also plays an important role.Read more:

• Complex of exercises for back pain
• Physiotherapy for osteochondrosis of the spine

But if conservative measures do not relieve the pain, surgical treatment of dorsalgia is possible, including removal of the intervertebral herniation or the entire disc, spondylodesis, decompression of the intervertebral disc by laser or by laminectomy, etc.

Prevention

To prevent non-specific back pain in the thoracic spine, measures should be taken to prevent osteochondropathy of the spine and other diseases that cause this pain. The recommendations of vertebrologists relate to following the well-known principles of a healthy lifestyle, correcting posture, and regularly performing exercises to develop and strengthen the back muscles.

Forecast

In thoracic dorsopathy, the prognosis is determined by its etiology, and in many cases the treatment performed contributes to the cessation of nonspecific dorsalgia within a few weeks. In other cases, the pain syndrome is chronic, requiring frequent use of medications to reduce its intensity.