Conditions of the Thoracic Spine
Pathological conditions affecting the vertebrae and adjacent structures of the thoracic spine are not uncommon. Spinal injuries are the most common causes of impaired function of spinal cord due to compression of neural structures at these levels, ultimately resulting in permanent neurological disorders and secondary instability of the thoracic spine.
Some of the more common conditions of the Thoracic spine are: Osteoporisis, thoracic herniated disc, Kyphosis, Scoliosis. Traumatic injuries of the vertebra of the thoracic spine are the most common pathology of the thoracic spine neurosurgeons are required to treat. They often accompany a craniovertebral injury as a result of a motor vehicle accident or a fall from a height and are the second in order or frequency in the region of the spine, after the cervical spine which suffers fracture or dislocation. Due to the anatomical characteristics of the thoracic spine, thoracic spine injuries are accompanied with serious neurological disorders.
Tumors that affect the thoracic spine can be primary or metastatic. The primary tumors emerge from the vertebrae, adjacent soft tissue, the meninges of the spinal cord, the cord itself and its roots. The extramedullary tumors are usually metastases affecting the vertebral bodies which can invade the soft tissues, the articular processes and pressure the dura & the spinal cord located within it. Intradural-extramedullary tumors (meningioma, neuroma) although they may not cause spinal instability, can cause major neurological disorders due to direct pressure on the spinal cord.
Degenerative conditions of the thoracic spine (scoliosis, herniated intervertebral disk, thoraco-lumbar spinal canal stenosis) are less common in comparison to traumatic injuries of this segment, as are tumors. The anatomical structures affected by degenerative spondyloarthropathy are the intervertebral disc, ligaments and articular processes and their membranes. Degeneration of these supportive structures transfers the center of gravity of the thoracic spine. The rotational movement axis is transferred from the gelatinous core to the articular processes of the vertebra, also the coupled motion forces are transferred to the articular processes which are already inadequate to cope with the increased loads. Simultaneous swelling of facet joints and the hypertrophy of the ligaments to maintain the limit in motion of the thoracic spine cause secondary scoliosis and spinal canal stenosis due to the usurpation of space in spinal canal. They show symptoms of root pressure with lumbar pain and intermittent neurogenic lameness.
Osteoporosis
Osteoporisis is a condition where the density of the bone is gradually reduced causing the bone to be thin, fragile and weak.
Risk factors for the development of osteoporosis.
We all have a risk of developing osteoporosis as we age. Specific risk factors are summarized as follows:
In its early stages Osteoporosis does not cause particular symptoms. As it progresses however, diffuse bone pain, progressive loss of height and more frequently fractures in various parts of the body are observed.
Herniated Disc of the Spine
Thoracic disc herniation is relatively rare as the disc is protected by the reduced mobility of the thoracic cage as a whole.
Symptoms.
The herniated disc causes pain in the back, semi- thorax, shoulders which is accentuated by movements of breathing, coughing, laughing and sneezing.
Depending on the size of the disc herniation and the existing pressure on the spinal cord numbness, movement disorders of the lower limbs and difficulty in urination and bowel function appear.
Diagnosis
The initial diagnosis by simple x-ray reveals the stenosis in the space corresponding to the disc herniation.
Computed tomography clearly identifies the osteoporotic lesions while MRI is the examination of choice to reveal the anatomical lesions of soft tissue.
The electromyogram in many cases distinguishes the level of the lesion .The somatosensory evoked potentials confirm lesions which are clinically manifested but lack imagery confirmation.
The treatment of thoracic disc herniation is achieved by surgery with satisfactory results.
Surgery of the Thoracic Spine
The treatment of these disorders should be individualized and depends on the type, extent and level of the lesion, the presence of displacement, dislocation, or instability in the affected area of the vertebrae and finally the patient's neurological condition. The conservative treatment of a diagnosed thoracic herniated disc focuses on combating local aseptic inflammation and mechanical decompression and restoration of the herniated disc. Anti-inflammatory and painkillers are administered. Physiotherapy can contribute to the treatment of aseptic inflammation and partial restoration of the herniated disc.
Conservative treatment is insufficient and surgical intervention advised when neurological signs such as pressure on the spinal cord and/or symptoms of cauda equina syndrome appear or get worse.
Surgical decompression and discectomy through a lateral approach is the treatment of choice in patients with tumors and herniated discs in this area. Most thoracic spinal fractures may be treated conservatively, but surgical decompression and fusion is applied in some patients to improve the final outcome, particularly when there is a risk of kyphosis of the thoracic spine.
When fractures are treated the potential deterioration of the fracture is halted, the fracture is stabilized, the patient is relieved from the pain and in many cases kyphosis is corrected. Usually Kyphoplasty or Spondyloplasty (Vertebroplasty) is the chosen method or in difficult cases spinal fusion is carried out with vertebral screws and support rods.
Kyphosis
When the curvature of the thoracic spine when exceeds 40°, it is called Kyphosis. There are several causes.
Juvenile kyphosis occurs in children aged 12-16 years. It is more common in boys and is found in the thoracic spine. The symptoms are slight pain and a clinical appearance in which the shoulders droop forward and downwards, the shoulder blades are raised backwards and the belly forward.
In mild cases correct posture is recommended and back muscle exercises lying on a hard mattress without a pillow in a supine or prone position. When exceeding the40° the most effective treatment is the application of a specially constructed orthopedic kyphosis brace for about 12 months.
Scoliosis
Scoliosis is a condition of the thoracic spine that causes deformity of the spine characterized by a lateral curvature and bending of the majority of vertebrae. It is an aesthetic problem, but be careful attention must be paid because in severe forms it affects the cardiovascular system.
There are functional and organic types of scoliosis, the most frequent type is idiopathic. Treatment of scoliosis is generally conservative and depends on the curvature. If the curvature is less than 40° surgery is not required, while between 20° and 40° special braces are worn. Patients are monitored regularly and the improvement is usually satisfactory.
Pathological conditions affecting the vertebrae and adjacent structures of the thoracic spine are not uncommon. Spinal injuries are the most common causes of impaired function of spinal cord due to compression of neural structures at these levels, ultimately resulting in permanent neurological disorders and secondary instability of the thoracic spine.
Some of the more common conditions of the Thoracic spine are: Osteoporisis, thoracic herniated disc, Kyphosis, Scoliosis. Traumatic injuries of the vertebra of the thoracic spine are the most common pathology of the thoracic spine neurosurgeons are required to treat. They often accompany a craniovertebral injury as a result of a motor vehicle accident or a fall from a height and are the second in order or frequency in the region of the spine, after the cervical spine which suffers fracture or dislocation. Due to the anatomical characteristics of the thoracic spine, thoracic spine injuries are accompanied with serious neurological disorders.
Tumors that affect the thoracic spine can be primary or metastatic. The primary tumors emerge from the vertebrae, adjacent soft tissue, the meninges of the spinal cord, the cord itself and its roots. The extramedullary tumors are usually metastases affecting the vertebral bodies which can invade the soft tissues, the articular processes and pressure the dura & the spinal cord located within it. Intradural-extramedullary tumors (meningioma, neuroma) although they may not cause spinal instability, can cause major neurological disorders due to direct pressure on the spinal cord.
Degenerative conditions of the thoracic spine (scoliosis, herniated intervertebral disk, thoraco-lumbar spinal canal stenosis) are less common in comparison to traumatic injuries of this segment, as are tumors. The anatomical structures affected by degenerative spondyloarthropathy are the intervertebral disc, ligaments and articular processes and their membranes. Degeneration of these supportive structures transfers the center of gravity of the thoracic spine. The rotational movement axis is transferred from the gelatinous core to the articular processes of the vertebra, also the coupled motion forces are transferred to the articular processes which are already inadequate to cope with the increased loads. Simultaneous swelling of facet joints and the hypertrophy of the ligaments to maintain the limit in motion of the thoracic spine cause secondary scoliosis and spinal canal stenosis due to the usurpation of space in spinal canal. They show symptoms of root pressure with lumbar pain and intermittent neurogenic lameness.
Osteoporosis
Osteoporisis is a condition where the density of the bone is gradually reduced causing the bone to be thin, fragile and weak.
Risk factors for the development of osteoporosis.
We all have a risk of developing osteoporosis as we age. Specific risk factors are summarized as follows:
- Hereditary
- Gender(women)
- Above 50 years of age
- Menopause / Hysterectomy
- Taking glucocorticoids (ie. cortisone)
- Various diseases: Hyperparathyroidism, rheumatoid arthritis, insulin dependent diabetes.
- Lack of exercise
- Diet low in calcium or vitamin D.
- Smoking
- High consumption of alcoholic beverages
- Excessive coffee and tea
In its early stages Osteoporosis does not cause particular symptoms. As it progresses however, diffuse bone pain, progressive loss of height and more frequently fractures in various parts of the body are observed.
Herniated Disc of the Spine
Thoracic disc herniation is relatively rare as the disc is protected by the reduced mobility of the thoracic cage as a whole.
Symptoms.
The herniated disc causes pain in the back, semi- thorax, shoulders which is accentuated by movements of breathing, coughing, laughing and sneezing.
Depending on the size of the disc herniation and the existing pressure on the spinal cord numbness, movement disorders of the lower limbs and difficulty in urination and bowel function appear.
Diagnosis
The initial diagnosis by simple x-ray reveals the stenosis in the space corresponding to the disc herniation.
Computed tomography clearly identifies the osteoporotic lesions while MRI is the examination of choice to reveal the anatomical lesions of soft tissue.
The electromyogram in many cases distinguishes the level of the lesion .The somatosensory evoked potentials confirm lesions which are clinically manifested but lack imagery confirmation.
The treatment of thoracic disc herniation is achieved by surgery with satisfactory results.
Surgery of the Thoracic Spine
The treatment of these disorders should be individualized and depends on the type, extent and level of the lesion, the presence of displacement, dislocation, or instability in the affected area of the vertebrae and finally the patient's neurological condition. The conservative treatment of a diagnosed thoracic herniated disc focuses on combating local aseptic inflammation and mechanical decompression and restoration of the herniated disc. Anti-inflammatory and painkillers are administered. Physiotherapy can contribute to the treatment of aseptic inflammation and partial restoration of the herniated disc.
Conservative treatment is insufficient and surgical intervention advised when neurological signs such as pressure on the spinal cord and/or symptoms of cauda equina syndrome appear or get worse.
Surgical decompression and discectomy through a lateral approach is the treatment of choice in patients with tumors and herniated discs in this area. Most thoracic spinal fractures may be treated conservatively, but surgical decompression and fusion is applied in some patients to improve the final outcome, particularly when there is a risk of kyphosis of the thoracic spine.
When fractures are treated the potential deterioration of the fracture is halted, the fracture is stabilized, the patient is relieved from the pain and in many cases kyphosis is corrected. Usually Kyphoplasty or Spondyloplasty (Vertebroplasty) is the chosen method or in difficult cases spinal fusion is carried out with vertebral screws and support rods.
Kyphosis
When the curvature of the thoracic spine when exceeds 40°, it is called Kyphosis. There are several causes.
Juvenile kyphosis occurs in children aged 12-16 years. It is more common in boys and is found in the thoracic spine. The symptoms are slight pain and a clinical appearance in which the shoulders droop forward and downwards, the shoulder blades are raised backwards and the belly forward.
In mild cases correct posture is recommended and back muscle exercises lying on a hard mattress without a pillow in a supine or prone position. When exceeding the40° the most effective treatment is the application of a specially constructed orthopedic kyphosis brace for about 12 months.
Scoliosis
Scoliosis is a condition of the thoracic spine that causes deformity of the spine characterized by a lateral curvature and bending of the majority of vertebrae. It is an aesthetic problem, but be careful attention must be paid because in severe forms it affects the cardiovascular system.
There are functional and organic types of scoliosis, the most frequent type is idiopathic. Treatment of scoliosis is generally conservative and depends on the curvature. If the curvature is less than 40° surgery is not required, while between 20° and 40° special braces are worn. Patients are monitored regularly and the improvement is usually satisfactory.
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