Your thoracic spine is made up of twelve individual vertebrae stacked on top of each other. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, these discs can wear and become thinner over time. This leads to additional changes, including bone spurs and narrowing of the opening where your nerves exit your spine. This process is called “thoracic spondylosis”, or simply, “arthritis”.
How quickly you develop back arthritis is largely a trait you inherited from your parents. Other factors may play a role, including a history of trauma, smoking, operating motorized vehicles, being overweight and/ or performing repetitive movements (i.e. lifting, twisting, bending or sitting). Men seem to be affected slightly more often than women.
Symptoms often begin as back pain that gradually worsens over time. Stiffness may be present upon arising in the morning. Pain is relieved by rest or light activity and aggravated by strenuous work. Sometimes your nerves can become “pinched” in narrowed openings where they exit your spine. This can cause pain, numbness, or tingling radiating around your trunk along the path of the irritated nerve. Be sure to tell your doctor if you notice any weakness or if you have a rash (running along your rib), fever, abdominal pain, change in bowel or bladder function, or pain in your groin crease.
Arthritic changes can be seen on x-rays, but interestingly, the amount of wearing does not seem to correlate directly with the severity of your symptoms. People with the same degree of arthritis may have symptoms ranging from none to severe. Most researchers believe that the symptoms of osteoarthritis are not the direct result of the disease, but rather, from the conditions that preceded the disease and those that develop after it, like joint restrictions and muscle tightness. Fortunately, those conditions are treatable and our office has a variety of tools to help relieve your pain.
In general, you should avoid repeated lifting and twisting and take frequent breaks from prolonged sitting, especially in motorized vehicles. Avoid any position that causes an increase in radiating pain. Light exercise, like walking, stationary cycling, water aerobics, and yoga may be helpful. Smokers should find a program to help them quit and overweight patients will benefit from a diet and exercise program.
Spondylosis” is a complicated diagnosis, broadly describing dynamic, interdependent degenerative changes involving the discs, vertebral bodies, and/or facet joints that develop in response to stress, compounded by time. (1-3)
As a group, thoracic complaints are much less common than symptoms in the neck or low back. (17% versus over 64%) (4) Complaints related to thoracic degeneration follow a similar pattern. Although degenerative change in the thoracic spine is fairly common (71% of asymptomatic men and 48% of asymptomatic women over age 40), pain from those degenerative changes is relatively uncommon- accounting for only 2% of all spinal degeneration-related complaints. (5,6)
The explanation for the higher incidence and intensity of spondlyosis-related complaints in the cervical and lumbar spine is likely due to the increased mobility and biomechanical demands of those regions. (6,7) Not surprisingly, thoracic degeneration also shows a predilection for the most mobile segments: T9-T12. (8)
Kirkaldy-Willis and Benard (9) describe a “degenerative cascade” that begins when repetitive microtraumas initiate small circumferential annular tears. These initial “sprains” may or may not be painful, based upon the degree of innervation of the annular lamellae (outer fibers are highly innervated, while inner fibers lack nerve supply). Weakening of annular fibers allows for diffuse circumferential bulging. Tears that coalesce create “channels” allowing nuclear migration. Continued microtrauma is associated with separation of the annulus from the vertebral end plate, thereby compromising disc imbibition and nutrition. The disc thins from cumulative stressors and by the loss of its normal viscoelastic properties over time. Loss of disc height also reduces the discs ability to absorb impact and leads to disproportionate loading of the facet joints resulting in degeneration and relative instability. As a concurrent hypertrophic response, the body lays down additional bone in the form of osteophytes on the anterior and lateral vertebral body margins. (10) Posterior vertebral body osteophytes may cause central or lateral recess stenosis. (11)