Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine
The dorsal spine is the longest part of the spine. Also called dorsal column, thoracic spine, or thoracic spine, the dorsal spine plays a major role in stability due to its attachments to the ribs.
What is the thoracic spine, and what are the most common symptoms encountered with a problem at this level? When should you be concerned about a more serious attack? And above all, what treatments should be considered to get better?
This popular article explains everything you need to know about this part of the spine.
Definition and anatomy of the dorsal spine
The dorsal spine has 12 vertebrae superimposed on each other, and numbered from D1 to D12. These vertebrae are located between the cervical spine and Lumbar spine, and include several structures:
Dorsal spine and joints
Each dorsal vertebra is formed in front of a circular bone called vertebral body. The size of each vertebra increases from top to bottom, with the widest vertebrae being at the lumbar level. This progressive increase in size helps to support the trunk and support the surrounding muscles.
A posterior arch is attached to the back of each vertebral body. Made up of pedicles and laminae that come together, this arc forms the spinal canal when the vertebrae are stacked on top of each other. Inside the spinal canal are the spinal cord and spinal nerves.
The two blades which meet at the back of the rachis give way to a spinous process. This protrusion can be felt when we pass our fingers over a spine and we denote bony prominences. On either side of the vertebrae, transverse processes are also present.
The vertebrae are articulated to each other by articular facets forming the facet joints. These are part of the posterior arch, and there are two facet joints between each pair of vertebrae (one on each side of the spine).
Intervertebral discs
Between each vertebrae (more precisely the vertebral bodies), there are intervertebral discs.
An intervertebral disc is made up of two parts. In the center, there is the gelatinous core which is spongy and provides shock absorption. This is held in place by the annulus, a series of fibrous rings that surround it. It is also when the annulus is pierced that we speak of herniated disc.
The discs of the dorsal spine are much thinner than those of the cervical and lumbar spine. Consequently, there is generally less movement between the vertebrae of the dorsal spine.
Nerves
On each side of the vertebrae are small tunnels called intervertebral foramina. It is at this level that the spinal nerves emerging from the spinal cord pass to serve the organs and limbs there.
Dorsal spine nerves primarily control the muscles and organs of the chest and abdomen.
Muscles and ligaments
The dorsal spine muscles are arranged in layers (superficial and deep), extending from the neck and shoulder region to the lower back. Together, the muscles allow the movements of the trunk and contribute to stability.
Ligaments connect bones and ribs to each other.
Role of the dorsal spine
Together, the components of the thoracic spine hold several key roles:
- Spinal cord protection
- Heart and lung protection
- Neck and lumbar support
- Trunk stability
Dorsal spine pathologies
The dorsal spine can be the site of several pathologies. These can be traumatic (after an accident) or appear gradually.
Essentially, any damage to the discs, muscles, ligaments, vertebrae, or joints in the neck can cause neck pain. middle back ( between the shoulder blades) and other dysfunctions.
Among the most common pathologies are:
- vertebral fracture
- osteoporosis
- Back osteoarthritis
- Scoliosis
- Dorsal kyphosis
- Degenerative disc disease
- Dorsal hernia
- Chest Parade
- muscle spasm
- Myofascial pain
- Maigne syndrome
Symptoms of the disease
Obviously, the symptoms observed will depend on the pathology. To know the symptoms caused, it is necessary to understand the anatomical and physiological role of the irritated structure.
The symptoms will also depend on the individual concerned, as the body's ability to adapt and tolerance to pain is different for everyone.
Here is a list of symptoms often associated with dorsal spine conditions:
- Pain in the middle of the back and between the shoulder blades
- Pain referred to the side, ribs, stomach
- Numbness and tingling
- Burning sensation
- Breathing difficulties
- Crunches
Physical examination
When consulting a healthcare professional for a thoracic spine disorder, he will generally follow a structure to clarify the situation, and then issue one (or more) diagnostic hypothesis (s).
The examination will most often begin with a medical questionnaire where you will be asked questions about your health, your pain and other symptoms, the impact on your daily life, your goals, etc.
Then, the professional will do a clinical examination. The primary objective is to exclude a serious harm (such as cancer, or spinal cord injury) that would constitute a medical emergency.
This notably involves neurological tests (Clonus, Babinski, reflexes, sensation, muscle strength, coordination, vision, etc.).
Once serious damage has been excluded, movements of the thoracic spine such as flexion, extension, rotations and lateral tilts will generally be evaluated. This will give us information about the irritated structures.
Other more advanced clinical tests will help clarify the diagnosis and guide treatment.
Medical imaging of the dorsal spine
Sometimes, the clinical examination of the health professional is not enough to determine with conviction the pathology of the thoracic spine.
In this case, the doctor will prescribe a test for'medical imagery. It should be noted that these tests are not immediately recommended, because it has been noted that a dysfunction observed on medical imaging does not necessarily explain the patient's pain.
Here are the most common medical imaging tests prescribed by doctors:
- X-ray
- Scanner
- Dorsal MRI
- Bone densitometry
When to worry
As mentioned previously, one of the main objectives during the physical (and radiological) examination is to exclude serious damage to the thoracic spine.
This includes in particular any systemic damage (such as cancer in the most serious cases), or damage to the spinal cord.
Here are the situations where a dorsal spine injury would worry the medical profession. Often, they are emergencies, even going as far as surgery:
- Tingling, numbness and/or weakness in the arms, hands, legs or feet.
- Lack of coordination and difficulty walking
- Abnormal reflexes
- Loss of sensation in the perineum area
- Muscle spasms
- Loss of sphincter control (urinary and fecal incontinence)
- Night sweats
- Constant pain not relieved by rest
- Severe chest or abdominal pain
- Unexplained weight loss
Available treatments
Fortunately, serious damage to the dorsal spine is rare, and the vast majority of pathologies can be treated.
Often, the doctor is consulted in first intention following a back pain. He can then refer to a competent therapist, or even a specialist for more complex cases.
In chronic cases, it should be noted that a multidisciplinary team where providers work as a team generally provides the best results.
Here are the most used treatment modalities to treat the thoracic spine:
- Repos
- Medication
- Physiotherapy (physiotherapy)
- Osteopathy
- Alternative medicine
- Homeopathy
- Infiltration
- surgery
Conclusion
The dorsal spine is located in the middle of the vertebral column. Due to its anatomical structures and its relationship with the ribs, it has several important roles in the stability of the trunk.
Certain pathologies of the dorsal spine can limit daily activities, and cause more or less severe pain. In some rare cases, these conditions constitute medical (and sometimes surgical) emergencies.
A health professional is best able to help you relieve your back pain, and to direct the treatment according to your symptoms and objectives.
Good recovery !