Thoracic disc herniation

Introduction to thoracic disc herniation Most of the patients were middle-aged people around 40 years old, and the ratio of male to female was similar. According to reports in the literature, 75% of cases of thoracic disc herniation occur below the chest 8. Many people have thoracic disc herniation but no clinical manifestations. This is mainly due to the large sagittal diameter of the thoracic spine in these patients. The nucleus pulposus tissue is not enough to achieve the degree of compression of the spinal cord. basic knowledge Proportion of the disease: the incidence of the disease in certain age groups (about 10%) Susceptible people: mostly middle-aged people around 40 years old Mode of infection: non-infectious Complications:

Causes of thoracic disc herniation

Causes

Chronic strain of the spine, injury and posture are not correct, forced position, can cause the disease; thoracic vertebral degeneration is also one of the causes of this disease.

Chronic strain or injury (35%):

Most of the disease is caused by chronic strain or spinal injury. In addition to the posture is not correct, the position is forced to last too long and over-bending and other factors, various injuries, such as falling from a height, falling, repeated spine Sprains, etc., can cause the disease. The prominent lesions are mostly elastic and soft nucleus pulposus tissues; while in the elderly, the prominent nucleus pulposus mostly hardens with the fibroblasts, shrinking and becoming hard. Calcified or ossified induration, and adhesion to the posterior longitudinal ligament, fixed to the posterior border of the vertebral joint, which is often one of the causes of extensive spinal segmental damage caused by this disease.

Thoracic degenerative changes (27%):

Although thoracic degeneration is related to age, and more common in middle age, the incidence of this disease is not proportional to age, so the degeneration of the vertebral segment is one of the causes of the disease, when the disc is degenerated The nucleus pulposus swells backwards and even ruptures and forms calcification in the later stage. In addition to its own characteristics, thoracic disc herniation also has a similar pathogenesis to cervical spondylosis or lumbar spondylosis. The spinal intervertebral disc is the earliest degenerative in human organs. One of the changes, its degenerative changes from early to the manifestations of disc degeneration, narrowing of the gap, unstable segments, ligament relaxation, nucleus pulposus protruding or prolapse, bone hyperplasia and surrounding soft tissue calcification and other pathological processes, In this case, if the trauma is further caused, even a slight trauma can induce the disease. Therefore, the disease can sometimes occur in patients who are younger and whose disc degeneration is not very obvious. As for the obvious trauma The occurrence of thoracic disc rupture and nucleus pulposus is also related to its own degeneration. According to statistics, the incidence of thoracic disc herniation in the lower thoracic vertebrae is the highest. Ming vertebrae degeneration effect.

Changes in spine posture (25%):

Statistics show that in the case of congenital or acquired hunchback, the nucleus of the apex of the kyphosis is easy to protrude. Of course, abnormal posture is one of the causes of vertebral degeneration.

Prevention of thoracic disc herniation

1 Try to reduce the load on the waist as much as possible on weekdays. It is necessary to carry the heavier objects in the correct way.

2 It is best to use a stool with a back cushion when sitting.

3 If you have mild pain, it may be caused by slight strain. If you have pain, you must seek medical attention.

Thoracic disc herniation complications Complications

When the spinal cord is severely compressed, it can be complicated by lower extremity spasm. When the spinal cord blood supply is impaired, it can be complicated by acute paralysis, sphincter dysfunction, large, urinal and sexual dysfunction.

Symptoms of thoracic disc herniation Common symptoms Spinal compression, back pain, motor dysfunction, intercostal scapula, pain, palsy, thoracic vertebrae, pain, sensory disturbance, muscle tone, nutritional disorder, paraplegia

1. Symptoms and characteristics: The symptoms caused by thoracic disc herniation are mainly caused by the following four factors:

(1) Mechanical factors: due to disc herniation and intervertebral joint disorders, directly cause localized back pain with typical mechanical characteristics, for example, pain relief after bed rest, increased symptoms after activity, acute thoracic disc herniation, can be produced Pain characterized by pleural symptoms.

(2) Root factors: Disc herniation can squeeze the spinal nerve roots at the exit of the root canal nerve, causing pain in the intercostal scapula; high thoracic disc herniation can cause Horner syndrome.

(3) Spinal cord compression: When the intervertebral disc tissue directly compresses the spinal cord itself, it will produce a wide range of symptoms, from mild pain and paresthesia to obvious paralysis, urinary incontinence and lower extremity weakness, and the disease develops rapidly.

(4) Visceral symptoms: Thoracic disc herniation can have a variety of manifestations, which are easily confused with heart, lung or abdominal diseases. At the same time, there may be sphincter dysfunction, bowel movements and sexual dysfunction; neurotrophic disorders may also occur. The lower extremities often have chronic ulcers that are not cured for a long time. Sometimes, patients can be misdiagnosed as neurosis or snoring and long-term mistreatment.

2. General symptoms of thoracic vertebrae: The patient is mainly characterized by paraspinal muscle tension, severely straight and straight; the spine may have mild lateral curvature and localized pain of the vertebrae, tenderness and cramps.

3. Significant differences in the signs: the degree of disc herniation and the size of the sagittal diameter of the spinal canal, the signs of patients with thoracic disc herniation are very different, when the body is carefully examined by shallow sensation, it can be found The apparent sensory plane of the compression segment is consistent, the muscle weakness is usually bilateral, and may be associated with decreased rectal sphincter tension, long spinal cord sign (such as clonic or Babinski sign positive), the shorter the course of disease, the above The more common the signs, the rare occurrence of thoracic disc dural protrusion. These patients usually have severe neurological symptoms, including paraplegia. The function of the posterior column of the spinal cord (positional and vibratory) is relatively light, and most of them can be retained. This is because the spinal cord is The compression site is in the anterior column of the spinal cord; however, the posterior column of the spinal cord can be compressed at the same time to cause complete paralysis.

4. Classification of thoracic disc herniation: There are many types of classification of this disease, but there are 3 types commonly used, which are now described in the following:

(1) According to the rapid onset of disease:

1 urgency: refers to sudden onset of symptoms within a few days or even hours and causes neurological symptoms, in which cases of severe cases can even appear paralysis, half of them have a history of trauma.

2 slow hair style: chronic gradual onset, mostly due to vertebral degeneration, patients unconsciously appear symptoms, and gradually worsened, can also cause paralysis in the late stage.

(2) According to the severity of the symptoms:

1 Light type: refers to the image examination showing thoracic disc herniation, but the clinical symptoms are mild, and even only the general local symptoms.

2 medium: There are obvious clinical symptoms, in addition to local pain and pain in the vertebrae, there may be root irritation or spinal cord symptoms; magnetic resonance (MRI) examination can clearly show positive findings.

3 heavy: mainly manifested as spinal or conical compression symptoms, and even complete paralysis, half of which are more acute, especially young patients.

(3) According to pathological anatomy classification:

1 side type: Because the thoracic spinal canal is narrow, the nucleus pulposus is easy to protrude from the lateral side of the lower pressure. Therefore, it is more common in the clinical side. This type is mainly characterized by unilateral nerve root compression. The patient developed root symptoms without obvious spinal cord symptoms. The spinal nerve roots in the thoracic segment passed through the spinal canal at a very short distance of only 2 to 5 mm. Once compressed, it may be caused by the involvement of the sensory nerve branch and the sympathetic nerve branch. pain.

2 Central type: This type is the disc protruding to the back of the disc, mainly with spinal cord compression, and there are mild or heavy motor dysfunction and pain and paresthesia. The mechanism is mainly due to:

A. Direct compression of the spinal cord: This is the most common cause in the clinic.

B. Spinal cord blood supply disorder: mainly due to the direct compression of the anterior central artery of the spinal cord. Because the blood supply to the spinal cord is terminal, the collateral circulation is very small, so once the blood supply is impeded, acute paraplegia can be induced. The spinal cord is often transversely damaged.

C. When the chest 11~12 disc herniation oppresses the conus and the horsetail, the patient has the thoracic pain and the pain radiated to the lower limbs, and the sphincter function is also disordered, so that the performance of the sensation, motor dysfunction, large and urinal function And sexual function is involved; or it is only manifested as symptoms of ponytail compression, this type is more common in clinical.

Examination of thoracic disc herniation

1. Imaging examination

(1) X-ray examination: the conventional positive and lateral X-ray plain film of the thoracic vertebra is the first choice; it is reported that 20% to 50% of patients with thoracic disc herniation have calcified intervertebral disc in the spinal canal.

(2) Myelography: CT scan with a large dose of water-soluble contrast agent for myelography is a more accurate and accurate diagnosis method. If you do not use myelography first, you will use CT to correct it. The exact segment of the damaged spinal cord, but most scholars now believe that this injury test should be replaced by MRI, which is also a method of longitudinal observation to estimate the entire thoracic spinal canal.

(3) CT and MRI examination: All patients suspected of this disease should have an early MRI examination. The authors found that MRI is the most effective measure for early diagnosis and timely treatment of this disease. In addition, although myelography and CT examinations are used, It is also helpful for the diagnosis of this disease, but because its diagnosis rate is not as good as MRI, it should not be used as the first choice item. It has been used less or only as a reference.

2. Other inspections

Including EMG and somatosensory evoked potentials, it is not helpful for the diagnosis of thoracic disc herniation.

Diagnosis and differentiation of thoracic disc herniation

diagnosis

Because the disease is relatively rare, and the patient is mainly diagnosed with local general symptoms or neurological symptoms, the former is often diagnosed as a general disease such as thoracodorsal fibrosis and is diagnosed and treated in neurology. Because of the high misdiagnosis rate of this disease, To prevent or reduce this phenomenon, each clinician should have a more comprehensive understanding of the disease.

Clinically, the diagnosis of this disease is mainly based on the following three points:

1. History: It can be acutely ill, or it can occur slowly, and the symptoms are different. It should be fully understood, including previous examinations and treatment overview.

2. Clinical manifestations: Because the individual sagittal diameter of the patient's spinal canal is different, the difference in symptoms is also large, from general local pain to complete paralysis of the lower limbs. Therefore, such patients should pay attention to careful examination, in order to seek early Find.

3. Imaging examination:

(1) X-ray examination: the conventional positive and lateral X-ray plain film of the thoracic vertebra is the first choice; it is reported that 20% to 50% of patients with thoracic disc herniation have calcified intervertebral disc in the spinal canal.

(2) Myelography: CT scan with a large dose of water-soluble contrast agent for myelography is a more accurate and accurate diagnosis method. If you do not use myelography first, you will use CT to correct it. The exact segment of the damaged spinal cord, but most scholars now believe that this injury test should be replaced by MRI, which is also a method of longitudinal observation to estimate the entire thoracic spinal canal.

(3) CT and MRI examination: All patients suspected of this disease should have an early MRI examination. The authors found that MRI is the most effective measure for early diagnosis and timely treatment of this disease. In addition, although myelography and CT examinations are used, It is also helpful for the diagnosis of this disease, but because its diagnosis rate is not as good as MRI, it should not be used as the first choice item. It has been used less or only as a reference.

4. Other tests including electromyography and somatosensory evoked potentials are not helpful in the diagnosis of thoracic disc herniation.

Differential diagnosis

In the early stage of the disease, in addition to the need to identify various diseases of the thoracic and lumbar spine before the MRI imaging results are displayed, it should be distinguished from many diseases involving the thoracic spinal cord or spinal nerve roots in the neurology department. Therefore, it should be emphasized: a comprehensive understanding This disease, early MRI examination, is not only for diagnosis, but also the best means for differential diagnosis of this disease.

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