Dorsalgia

Salud
By Dr. José Luis Sánchez Mejía | Ortopedia y Traumatología
408

Cuando consideramos a la columna “como un todo” debemos también tener en cuenta que se divide para su estudio en cuatro zonas: cervical, torácica (dorsal), lumbar y sacrococcígea.

Y los síntomas nos llevan a establecer una:

  • Cervicalgia cuando es a nivel cervical.
  • Dorsalgia cuando el dolor está situado en la región dorsal.
  • Lumbalgia a nivel lumbar.
  • Sacralgia a nivel sacro y coccigodinia a nivel coccígeo; las causas de todas ellas es variable.

La columna dorsal o torácica, está compuesta por doce vértebras desde la T1 (D1) hasta la T12 (D12), la característica anatómica importante es la disposición de las costillas a izquierda y derecha de cada una de las 12 vértebras torácicas que junto con el esternón en la zona anterior, reduce la movilidad de la columna vertebral. A todo este conjunto óseo, es lo que se conoce como “caja torácica”.

Comúnmente, el paciente refiere malestar en la parte superior de la espalda y los músculos de la nuca, esto es porque los angulares de los omóplatos y los romboides se contracturan excesivamente; a veces pueden presionar una arteria que irriga al cerebro, provocando mareos, zumbidos, problemas de visión y adormecimiento de manos; afortunadamente esto no es frecuente.

Por lo general, el dolor muscular se debe a actividades donde la columna cervical esta tensa y la vista fija en un mismo punto, derivados del trabajo continúo en la computadora o al manejar durante muchas horas. Otro origen frecuente es utilizar los brazos como palanca para levantar peso; tal es el caso de las mamás cuando alzan a los bebes de la cuna, o al cargar bolsas del supermercado.

Incluso se manifiesta en personas que manejan con los brazos extendidos, llegan a su destino ya con una contractura, provocándoles dolor y mal humor. Esto ortopédicamente hablando esta contraindicado, pero hay muchas personas sobre todo hombres que llevan los codos totalmente extendidos y manejando en esta posición, aparte de reducir su movimiento circular de las extremidades torácicas (brazos, codos, antebrazos), pueden provocar lesiones que al cabo del tiempo, provocarán dolor en todas las articulaciones desde columna. Así mismo, la tensión emocional y la presión del trabajo, originan un porcentaje elevado de contracturas en esta zona. Los brazos deben estar siempre flexionados, para que los trapecios no se tensen. 

Un tipo frecuente de dorsalgias es el producido por giros bruscos del tronco o por episodios de tos que afectan a las articulaciones costo-vertebrales. También tras la exposición al frío, en personas que se quedan dormidas sin taparse o se exponen al aire acondicionado.

Los padecimientos inflamatorios e incapacitantes como la espondilitis anquilosante; la escoliosis, cifosis, o la artrosis tan frecuente, se encuentran en dos de cada tres personas mayores de 30 años, derivadas de múltiples factores como la actividad forzada laboral y deportiva y falta de movilidad por el sedentarismo, sobre todo.

Otra de las causas de dolor dorsal es por protrusiones discales (hernias). Las protrusiones de disco dorsales son poco frecuentes, y se considera que sólo un 11% de todas las hernias discales, ocurren en la región dorsal. Normalmente a partir de la 8ª vértebra dorsal suelen ser severas y llevar un tratamiento de urgencia. En algunos casos, pueden llegar a requerir la cirugía, son las producidas por traumas (accidentes por caída, armonyterapias_osteopatia_chamberi_madridchoques de autos, volcaduras).

Hernias inter-esponjosas, los famosos nódulos de Schmörl, que provocan síntomas y requieren tratamientos diferentes, debido principalmente a fracturas aplastamientos de las plataformas superior o inferior de los cuerpos vertebrales. La principal causa es la osteoporosis (OP). Además de los aplastamientos de los cuerpos vertebrales, originados por la osteoporosis, que producen una pérdida de altura de la vértebra y las vuelven más frágiles, sobre todo en los cuerpos vertebrales T-10-T-11 y T-12.

Siempre hay que tener en cuenta la existencia de enfermedades en órganos distantes a la columna dorsal que pueden provocar como síntoma más destacado una dorsalgia, tal es el caso de los problemas pulmonares, cardiacos, úlcera duodenal, páncreas o vesícula.

Es importante realizar una evaluación minuciosa, en ocasiones las dorsalgias pueden originarse por la toma de corticoides por largo plazo, alcoholismo, diabetes, o en procesos malignos como los tumores. El antecedente de traumatismo, junto a un examen clínico de rutina, permitirán sospechar la magnitud de la lesión o enfermedad, que incluya una radiografía AP (antero posterior) y lateral de tórax y unos estudios de laboratorio de rutina, permitirán sospechar o concluir un problema.

En los casos de tumor maligno, las vértebras se vuelven frágiles y sufren un aplastamiento. Las metástasis de cáncer de pulmón, de mama y de próstata son los que más frecuentemente producen dorsalgias por su capacidad de lesionar al hueso. Dentro de los tumores benignos, podemos encontrar al osteoma osteoide, osteoblastoma, hemangioma. Las células tumorales invaden el cuerpo vertebral que provocan el colapso de la misma. El paciente se queja de dolor y de la aparición de una giba (joroba) en la espalda. Llegando en algunos casos a producir una paraplejía por lesión de la médula espinal. Se calcula que el 20% de todas las consultas reumatológicas y traumatológicas son por dorsalgias crónicas. Pocas están en relación con tumores malignos que han hecho metástasis en las vértebras.

Las infecciones de la columna dorsal, pueden ser producidas por gérmenes de todo tipo, tanto el sida como la tuberculosis, provocan grandes alteraciones en la anatomía de las vértebras dorsales con deformidades de espalda considerables.

El diagnóstico de las infecciones se hace a través de análisis de sangre, cultivos de gérmenes, y radiografías, a veces la tomografía (TAC) o la resonancia magnética (RM) son necesarias.

Los principales síntomas en las dorsalgias son:

  • sensación de carga y pesadez
  • aumento del dolor sobre todo en posturas prolongadas (el paciente describe el malestar localizado entre los omoplatos y la columna, sobre los músculos romboides, “en la nuca”)
  • dolor que irradia al pecho dando una sensación punzante (en ocasiones, el paciente lo asocia con un infarto, un tumor de pulmón o de mama, la molestia aumenta en al momento de estar acostado, incluso cuando el afectado está sentado o apoyado sobre el respaldo de una silla)

La contractura muscular causa dolor de espalda por varios mecanismos e impacta a la calidad de vida.

  • La contractura de un músculo irrita directamente los nervios nociceptivos (de dolor), desencadenando dolor dorsal. El músculo contracturado comprime el paquete vascular, disminuyendo su riego sanguíneo, lo que ocasiona una isquemia regional, lo que a su vez va a provocar mayor dolor. Es así como se forma un círculo vicioso – dolor-contractura-isquemia-dolor; ya que el músculo con menos riego tiende a contracturarse más fácilmente y, además, la falta de sangre irrita más los nervios nociceptivos. El estrés o la ansiedad producida por el dolor continuo, mantiene la contractura y así sucesivamente.
  • Si esa situación se mantiene por un período prolongado o se repite con frecuencia, el músculo se contractura cada vez con mayor facilidad. En esa situación, hacer el ejercicio físico adecuado es fundamental para romper la tendencia, además de la aplicación de calor (directo o indirecto), masaje, ultrasonido, corrientes analgésicas, etc.

Además de una higiene postural, es necesario evitar cargar demasiado peso con los miembros superiores, sobre todo cuando están en extensión y evitar las posturas de flexión mantenida de la columna dorsal por tiempos prolongados, cada dos horas sería el tiempo adecuado para realizar ejercicios de relajación.

La recomendación esencial es que debe evitarse la sobre medicación, es importante que se realicen pruebas médicas y estudios de gabinete para ofrecerle al paciente el tratamiento indicado. Los ejercicios de relajación y de fortalecimiento de las masas musculares del cuello y región dorsal tienen que ser de los más importantes.

No olvide acudir con su médico ortopedista de confianza.

Dr. José Luis Sánchez Mejía. Ortopedia y Traumatología.

pepeluigi58@yahoo.com.mx  | www.drsanchezmejia.com.mx

Referencias bibliográficas
http://www.luisbernal.es/descargas/g/11algias.pdf
Copyright © 1999-2008 Institut Ferran de Reumatología, S.L.
www.institutferran.org/dorsalgia.htm
Dr. José Luis Sánchez Mejía | Ortopedia y Traumatología

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