Herniated Chest – Thoracic spine intervertebral disc, normally deviating from the vertebra. Pain and chest sensitivity are manifested, weakness of the lower limbs with pelvic dysfunction, various functional changes in somatic organs. Diagnosis by MRI of the spine and mandatory exception for internal pathology. Conservative treatment includes medical and physiotherapeutic methods, manual therapy or spinal stretching, training, massage. Actions include removing the disk.
Herniated chest is much less common than vertebral hernia in lumbar spine and cervical spindle. According to some estimates, herniated thoracic localization is up to 1% of all vertebral hernia, although accurate data on their prevalence is not, as in some cases they are characterized by asymptomatic latent. Mostly, young and middle aged people suffer. The most common damage is the lower thoracic vertebrae (Th8-Th12). Depending on the localization of clinical symptoms of chest hernia can mimic symptoms of various diseases of the chest and upper abdomen.
The most important etiological factors for intervertebral hernia in chest localization are spinal cord trauma and osteochondrosis. In young patients, hernia formation is due to either trauma or early development of degenerative glandular changes. In patients over 40 years of age, hernia is mainly a complication of osteocondrosis.
Traumatic breastplates may occur with spinal cramps, subluxation of vertebrae, fracture of the breastbone, excessive load during chest exercise or heavy lifting. Permanent injuries to the discs, leading to their premature wear, and degeneration, usually due to the work in an unpleasant position (eg, Surgeons, Car, Welding Equipment, Customized). Early development of osteoarthritis Chest is often associated with an uneven load on the spine against posture and spinal warping (Kyfoosi, scoliosis), dysmetabolic processes in the body (diabetes, early menopause).
Disc injuries cause cracks to form its fibrous ring. The resulting degenerative processes result in a reduction in the hydrophilicity and elasticity of the plate. As a result, the plate ruptures the anulus ceases to be absolutely between the vertebral bodies, the prolapses of the vertebrae. The disc is protruding, which progressively grows into a herniated disc. The most important clinical symptoms of the latter are related to its effect on the spinal cord and / or the substance of the spinal cord.
In neuroscience, the chest compartment is classified as center and lateral. In the first case, the hernia exhibits symptoms of Medullary Compression – compression strength of myelopathy, lower than mono- or paraparesis, pelvic disorders. Due to discogenic myelopathy, the thoracic compression, as the propulsion leading pathways are the key to stroke (spastic) sign. Lateral hernia debut with signs of irritation and corresponding compression of the spine spine – pain (sciatica) and delicate disorders of the thorax. As part of the spinal nerves chest visceral branches are many internal organs: trachea, lungs, bronchi, esophagus, liver, duodenum 12 of the intestines, the gall bladder, the kidneys. Therefore, thoracic hernia may be associated with functional disorders in the internal organs. Localization of the above symptoms depends on the level of the hernia location, and hence the division is done in the thoracic hernias of the upper, middle and lower.
Thoracic chest card (Th1-TH4) manifests in pain (toracalgia) and paresthesia in the upper extremity, intervertebral area. Toracalgia left side can simulate clinic angina. Hernia Th1-Th2 level is associated with paresthesia and weakness in the hands, numbness in the hands. Maybe a motility disorder of the esophagus, swallowing.
The hernia of the middle chest (Th5-Th8) often appears as a symptom of neuralgia – single or double-sided surrounding pain along the ribs of the ribs, resembling shingles, but without blisters. As the pain can limit the airway excursion in the chest formation surface and panting. Possible pain in the stomach. In some cases, chest hernia can cause dyspepsia, enzyme deficiency pancreatic disorder, carbohydrate metabolism.
Depending on the location of the clinic and chest hernia patients often turn to the primary doctor, cardiologist, gastroenterologist urologist. However, a meticulous clinician on the nature of pain syndrome (increased movement time, pain palpation on the breastbone, tension paraverbal muscles) can be suspected of spinal pathology. In such cases, pulmonary x-ray can completely eliminate pneumonia, chest, swelling; ECG and UZDG coronary artery disease – ischemic heart disease; gastroscopy and abdominal ultrasound – GI pathology; urine, kidney ultrasound and urography – glomerulonephritis, urinary tract disease, pyelonephritis.
Spinal irradiation allows diagnosis of osteochondrosis, deformities, traumatic changes. The spine CT visualizes the hernial projection, but it is impossible to properly assess its size and degree of medullary compression. Therefore, the optimal diagnostic method is in the spinal MRI region of the sternum. To determine MRI more precisely the location and amount of hernias, it allows to evaluate inflammatory changes and spinal compression to identify / exclude other diseases of the spine (spinal cord, hematoma, thoracic spondylosis et al.). If MRI studies are contraindicated in patients, the use of CT in myelography.
Treatment of the delicate hernia
Conservative treatment aims to halt inflammation and pain syndrome by stopping the growth of the hernia and restoring the loss of neurological functions. Anti-inflammatory drugs have been prescribed (naproxen, ibuprofen, ketoprofen, carprofen, etc.). Local injection of anesthetic and corticosteroid drugs is carried out in the form of paravertebral blockages. Muscle relaxants (tolperisone) are shown in the presence of spastic syndrome. Positive effect is on vitamins B1 and B6.Anti-inflammatory and myorelaksiruyuschee effects are some kind of physiotherapy, for example, ultrafonofore hydrocortisone, electrophoresis, magnetotherapy, UHF. Paravertebral muscle spasm is released by myofascial massage. Increases the distance between the vertebrae and thus facilitates the effect of pressure from the aid of the hand in the treatment and traction. The patient should monitor a particular treatment that is more difficult during the acute period and excludes excessive stress in the spine in the future. At the positive results of conservative measures hernia symptoms do not come back, you should perform a regular special set of physiotherapy designed to create a state of the spinal muscle corset.
Surgical treatment is appropriate if Herniated vertebrae are not receptive to conservative therapy, there are signs of myelopathy, progressive compression of the spinal roots. Rapid decompression of the spinal canal is performed by laminectomy. Depending on the size of the spleen, the endoscopic microdiscectomy, microdiscectomy, discectomy can be performed. After removal, the plate takes on the site of connective tissue tumors that form a fusion of two vertebrae (ankylosis). The most balanced approach requires dealing with the need for surgery because it can have a number of serious complications: bleeding, damage to the spinal cord, infection, development of myelitis, spinal arachnoiditis, damage to the sclera.