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Thoracic Osteoarthritis

What is Osteoarthritis of the Thoracic Spine?

Osteoarthritis (OA) of the mid-back, called thoracic spondylosis, are age-related changes of the spine. In OA, the cartilage between the vertebrae degenerates. Since cartilage is essentially a cushion between the vertebrae, the breakdown of the cushion will cause joint damage over time.

The cartilage cushions between the vertebrae are the discs in the front of the spine and the facet joints in the back of the spine.

OA of the mid-back can take on many different forms, such as disc degeneration, facet joint degeneration, a change in the curvature of the mid-back (kyphosis), or the development of bone spurs.

While spine specialists may use the term “Arthritis”, they usually classify the problem by a specific condition such as disc degeneration or facet joint degeneration.

What is the difference between Osteoarthritis of the Spine and other Arthritis forms of the spine?

Osteoarthritis is generally related to aging and wear and tear, rather than a specific disease of the body. Rheumatoid arthritis is a condition which is part of a disease process where the body believes that the joint lining (synovium) is foreign material and attacks it.

Is Osteoarthritis of the Spine inherited?

Osteoarthritis of the spine does not have to be inherited. It is often related to aging and wear and tear, rather than just genetics.

How common is Osteoarthritis of the Spine?

This condition is often present in patients over the age of 50. By the age of 60, most people will have signs of OA of the spine on X-Rays. Over the age of 60, 85% of the population has signs of OA on a spine image. However, most patients have either no symptoms or mild symptoms. The presence of Osteoarthritis changes on an X-Ray does not mean that pain has to be present.

Which parts of the spine are affected by Osteoarthritis?

 Osteoarthritis can affect any part of the spine. It is most often seen as degeneration of the spinal discs, facet joints, and ligaments. The disease can also affect the spinal nerves or spinal cord depending on the degree of degeneration. Examples of that are when bone spurs form or discs herniate into the spinal canal, compressing the spinal cord.

What are some of the specific spine conditions seen in patients with Osteoarthritis of the Thoracic Spine?

Spinal Osteoarthritis is usually classified by specific conditions of the Thoracic spine. Here are some of the most common ones:

  1. Thoracic Degenerative Disc Disease
  2. Thoracic Facet Joint Degeneration
  3. Thoracic Spinal Stenosis

What are some risk factors for Spinal Osteoarthritis?

Here are some risk factors for getting OA:

  1. Being Overweight
  2. Lack of Exercise
  3. Being exposed to frequent heavy lifting, twisting and bending
  4. Prior mid-back injuries
  5. History of disc disease
  6. Prior thoracic spine surgery

What are the symptoms from Spinal Osteoarthritis?

Here are some common symptoms of OA of the thoracic spine:

  1. Stiffness of the spine
  2. Spine pain that is worse after standing or sitting
  3. Pain in the mid-back which spreads to the chest or abdomen
  4. Difficulty with gait

How is Osteoarthritis of the spine diagnosed?

Spine specialists use information from the patient history, physical examination and special tests to diagnose this condition.

  1. History

A history of spine stiffness and aching which has progressed slowly over the years and is relieved by rest is often suggestive of Osteoarthritis of the spine.

      2. Physical Examination

Here are some tests done by doctors to assess for OA of the thoracic spine:

  1. Back mobility (range of motion)
  2. Tenderness to touch and pressure over the spine
  3. Muscle strength testing of the legs
  4. Sensation testing of the legs
  5. Gait testing

      3. Imaging

            a. X-Rays         

Basic spine X-Rays are often used to look for OA. They can often show the presence of the disease and the severity. The height of the disc, presence of bone spurs, facet joint degeneration and the spinal curvature can be evaluated.

            b. CT Scans

A CT scan can show the wear on spinal bones and joints in more detail than X-Rays. It can be useful to assess the degree of OA, but is not commonly used to find out if a patient has OA due to the high radiation exposure.

            c. MRI scans

MRI is usually not needed to diagnose the presence of OA. However, patients who have     severe symptoms or show signs of nerve involvement often need an MRI to assess the discs, spinal nerves and spinal cord in detail.

What is the treatment of Osteoarthritis of the Thoracic Spine?

Here are some of the Non-Surgical and Surgical treatments of the mid-back for this condition:

  1. Non-Surgical

Having a diagnosis of OA of the spine does not mean a patient has to have pain. The treatments below are for periods of time which are painful, or if the pain becomes persistent.

A. Medications

  1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)
  2. Muscle Relaxants
  3. Pain Killers
  4. Nerve Pain Medications

B. Physical Therapy (PT)

Physical Therapy techniques such as spinal exercises, aquatic therapy, ultrasound, and manual therapy are some examples of what PT can offer for Spinal Osteoarthritis.

C. Injections

Depending on the exact spine condition which is causing pain from Spinal Osteoarthritis, a specific spine injection can offer significant help.

  1. Thoracic Interlaminar ESI
  2. Thoracic Facet Joint Injection
  3. Thoracic Facet Joint Radiofrequency Rhizotomy
  4. Thoracic Trigger Point Injection

D. Exercising

An exercise routine can be very helpful for the common symptoms from Spinal Osteoarthritis.

E. Chiropractic Care

Chiropractors can help this condition with targeted spinal manipulation.

F. Massage Therapy

Massage Therapists can provide relief of the muscle part of Osteoarthritis pain.

      2. Surgical

Surgical treatment is reserved for patients with severe conditions such as poor quality of life due to pain or nerve dysfunction.

Here are some surgical options:

  1. Thoracic Fusion with Instrumentation
  2. Thoracic Discectomy
  3. Thoracic Laminectomy Decompression