Question
I have just had a chest xray and CT Thoracic Spine.

I have had mild to severe neck should and back pain.  Also pain in the chest area numbness in should arms and fingers, and sometimes can hear my heart beat or palpitate.

I have been to a heart specialist, done a treadmill test. All okay.

The findings of the latest xrays and ct scan - chest and lungs clear cardiovascular silhouette normal no pleural base abnormality
CT Thoracic Spine - there is a generalised mildly degenerative  spondylotic disease denoted by the presence of enplate hypertrophic bony outgrowth.  


what is the bony outgrowth is there treatment and could the chest pain and heart palpitations with numbness be something else.

Answer
Dear Robyn,

First, it is possible that the degenerative changes in the upper back can result in altered nerve function to the heart, this is actually called T4 syndrome and often improves with chiropractic spinal adjustments to the upper back.  We know that asthma can be improved as well with spinal adjustments to the T2 area of the spine.  This has been documented in the clinical literature.  So yes it could be related, but the direct correlation is hard to document unless spinal manipulative care improves the issue/symptoms.  Concerning the numbness in the chest and into the arms, this is more likely due to dysfunction in the lower neck regions with an association of the upper back, which supply nerve information from the arms such as sensory information and motor function from the spinal cord to the arms. The associated nerve roots to look at would be C5, C6, C7, and T1.

The upper back (thoracic) spondylosis that you have described is usually due to long term stress over the course of years.  Specifically, the spine will degenerate in response to altered movement patterns and increased gravitational stresses.  This is usually the result of chronic poor posture and the lack of appropriate movement.  If you are sedentary this will be worse than in someone who is relatively active. Let me explain this more fully below.

Degeneration in the thoracic spine is not a rare condition, but it is less common than neck and low back degeneration.  It can definitely be the result on long term abnormal biomechanical stress in relation to gravity.  If you spend numerous hours a day at you desk with analysis, reports, computer work etc... over time this has the net effect of promoting degeneration of the normal spinal curves due to improper posture (global flexion) while working.  The overall most common presentation is that the lumbar lordosis tends to flatten out, the thoracic kyphosis is accentuated, and the cervical lordosis is lost and may even be reversed. This is a deconditioned posture.

Chronic micro-trauma is how abnormal postural loads can deform the spine to include the disk material.  Basically the spine, ligaments, disk, etc... all have VISCOELASTIC properties (time dependent behavior under loading) and will respond in a specific manner.  Just like a building, the spine needs to be structurally sound and positioned correctly on the sacrum and pelvis.  The normal spinal curves act to stabilize movement and posture while dispersing compressive forces.  If the curves are altered form their normal positions, then the spine cannot disperse the forces correctly and that is when degenerative conditions begin.  The spine will remodel to that stress....abnormal loads lead to tissue deformation   

Engineering and physics principles can be applied to the spine, and again the mechanical properties of the spine will deform under stress.  Wolfe's law states that bone will remodel to stress...it is laid down where needed and resorbed where not needed.  We see this all the time with bone spurs just like what has occurred in your spine (spondylosis/osteoarthritis).  The disk however responds like a cartilage, not like bone, so it will yield under constant biomechanical load and thin while the vertebra tend to develop spurring at the front and sides.  The principles of CREEP, STRESS RELAXATION, HYSTERESIS, and SET are inn play and need to be explained.

Creep:  Progressive deformation of the soft tissues due to constant low loading over an extended period of time

Stress Relaxation: Typically a viscoelastic solid responds with a high initial stress followed by a slow time dependent decreasing stress required to maintain a deformation

Hysteresis:  "deficiency", or "lagging behind"...basically meaning that the tissue creep results in deficiency/ deformation, which predisposes it to further damage due to a weakened state

Set: The resultant shape of the altered spine, which is now neurologically recognized as the normative state

All of this does not happen in a vacuum, it is intricately woven together:  as the bone remodels to stress it affects the surrounding soft tissue, and as the soft tissue remodels to stress is affects the bone.  As a matter of fact, cartilage degeneration around the disk leads to disruption of the normal load bearing capacity, and thus disrupts the lubrication and fluid exchange.  

This leads to the nucleus pulposus (Gelatinous inner portion of the of the disc) hardening (dessication/loss of fluid content), and lubrication deficiency is a factor in spondylosis/osteoarthritis.  Not to mention that the annulus fibrosis (fibrous outer portion of the disc), tend to tear in response to the abnormal loads created by the altered curve structure.  This is because the disk is now being subjected the higher loads of shear stress in relation to gravity rather than compressive stress.  A simple positive feedback loop of degradation in relation to stress.

Once this process has occurred it is fairly easy to correct the functional posture problems with specific exercises and postural training, and you can generally fix the positional problems in a month or so...your desk ergonomics should be considered as well.  However, the structural issue is much harder.  The spinal curves take time to remodel and you have to do this with the same principles that created the problem and the degenerative changes will remain.  Less that 10 percent of degenerative changes will remodel back to a more normal presentation.  So you will have the spondylosis for ever, but that doesn't mean that it has to continue progressing.

Stress over time to move the curves back toward a normal position so that the anatomy can be under reduced loading will help reduce the continued degenerative changes.  This is accomplished with the utilization of directional traction under gravitational load which is in direct opposition to the abnormal curve and in direct correlation with the optimal curve.  These values have been published in SPINE and accepted as the normal structure of the spine.  If you would like to learn more about the technique and application of forces, please check out the website of the Chiropractic Biophysics Organization.  WWW.IDEALSPINE.COM  The technique has been widely researched (and criticized) for the past 25-30 years.  They have published over 90 papers in the index medicus on this technique, and I have used it with success on my patients.

Now, I cannot say for a fact that this is the exact cause of the problem, as I do not have access to you for examination or your other medical file work.  However, I see this happen frequently in my patient population, and I have colleagues that see it in their practices frequently as well.  I would encourage you to explore the above information, and feel free to write back if you feel the need.  Good luck!

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net