The thoracic form of osteochondrosis is characterized by degenerative damage to the intervertebral cartilage and secondary changes in the thoracic vertebrae. The diagnosis of the disease is sometimes quite problematic, as it is often "masked" as other pathologies: myocardial infarction, angina pectoris, pathology of the gastrointestinal tract.
Characteristics of thoracic osteochondrosis
This type of disease is quite rare compared to cervical and lumbar.
The reason lies in the peculiarities of the anatomical structure of the chest region:
- is the longest (consists of 12 beads);
- in this area there is a slight natural bend - physiological kyphosis, which relieves part of the load that comes from walking straight;
- the chest region articulates with the ribs and sternum, which perform the functions of a physiological frame and receive the main load;
- in cross section, the spinal canal of the thoracic region has the smallest dimensions;
- Thoracic vertebrae are thinner and smaller in size, but have long spinous processes.
As a result of these factors, the thoracic part is not particularly mobile, so osteochondrosis in this part of the spine is rare, but its symptoms are quite pronounced: they are quite strong and unpleasant pains associated with nerves ofSpinal compression, which irritates the shoulder. belt and organs of the upper limbs located in the abdominal cavity and chest. For the same reasons, the manifestations of the thoracic form of osteochondrosis are often atypical, which significantly complicates the diagnosis of the pathology and subsequent treatment.
The narrowness of the spinal canal, the presence of physiological kyphosis and the relatively small size of the vertebrae create the most favorable conditions for the formation of intervertebral disc herniation. Since a significant part of the load falls mainly on the front and lateral parts of the vertebral bodies and discs, the disc is displaced backwards and a disc herniation, or Schmorl's hernia, is formed.
The front part of the vertebrae is subjected to greater stress than the back part. For this reason, very often the growth of osteophytes and prolapse of the intervertebral discs occurs outside the spine and does not affect the spinal cord.
Stages of thoracic osteochondrosis
The manifestations of thoracic osteochondrosis are determined by the changes that occur in the discs and vertebrae, depending on which the four main stages of the disease are distinguished:
- Stage I is characterized by dehydration of the intervertebral discs, as a result of which they lose elasticity and stability, but still retain the ability to withstand normal loads. The process of disc flattening begins, its height decreases and protrusions are formed. The pain at this stage is mild.
- In stage II, cracks are created in the annulus fibrosus and instability of the entire segment is recorded. Painful sensations become more intense and intensify when bending and some other movements.
- A characteristic sign of stage III is the rupture of the fibrous ring and the beginning of the formation of an intervertebral disc herniation.
- During the transition to stage IV, due to the lack of resistance from the disc, the vertebrae begin to come closer together, which provokes spondyloarthrosis (disorders in the intervertebral joints) and spondylolisthesis (twisting or displacement of the vertebrae). The mobilization of compensatory forces to reduce the load leads to the growth of the vertebra, an increase in its area and flattening. The affected part of the fibrous ring begins to be replaced by bone tissue, which significantly limits the motor skills of the department.
Degrees of thoracic osteochondrosis
Today, many specialists use a different classification principle, according to which the course of osteochondrosis of the thoracic spine is not distinguished by stages, but by degrees with their characteristic features.
How does the disease of the first degree appear? As a rule, it is diagnosed when an intervertebral disc ruptures, caused by overstrain or sudden movements. In this case, a sharp pain suddenly appears in the back. Patients compare it to running an electric current through the spine. This condition is accompanied by reflex tension of all muscles.
The second degree of thoracic osteochondrosis is discussed in cases where the instability of the spine appears and symptoms of intervertebral disc protrusion appear. This condition is very rare, occurs with periods of exacerbation and subsequent remission, and is discovered only with a thorough diagnostic examination.
What symptoms appear in the disease of the third degree? The pain becomes constant, radiates along the damaged nerve and is accompanied by partial loss of sensation in the upper or lower extremities, changes in gait and intense headaches. At this stage, breathing difficulties and disruption of the normal heart rhythm are often observed.
We can talk about movement in the fourth degree when the manifestations of the disease decrease while the symptoms of instability of the spine continue (slipping, twisting of the vertebrae, fixation in relation to each other). Osteophytes begin to grow, gradually compressing the spinal nerves and compressing the spinal cord.
Typical symptoms and signs
Osteochondrosis of the thoracic region has very characteristic signs, based on which this disease can most likely be diagnosed:
- Intercostal neuralgia - often the pain is localized in one area, after which it quickly spreads to the entire chest, forcing patients to be in a certain position and significantly complicating breathing.
- During turning, neck movements, bending, raising arms, acts of breathing (suffocation-exhalation), the pain becomes much more intense.
- The middle and upper back muscles experience severe spasm. It is also possible to contract the muscle fibers of the abdomen, back and shoulder girdle, which is reflexive in nature (it develops in response to a sharp pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness and a feeling of discomfort that appears in the chest and back when moving. The pain can be quite intense and can last for several weeks without spreading further, after which it begins to gradually fade.
- All symptoms become more pronounced at night. In the morning they soften significantly or decrease, intensifying with hypothermia, movement (especially vibrating and sudden) and may appear in the form of stiffness.
Atypical symptoms and signs
Often the symptoms of localized osteochondrosis in the chest area resemble other diseases.
- Imitation of pain characteristic of cardiac pathologies (heart attack, angina). Such pain can be quite long-lasting (unlike cardialgia), while traditional medications used to dilate coronary vessels do not eliminate the pain. The cardiogram also shows no changes.
- In the acute phase of thoracic osteochondrosis, long-term sternum pain (up to several weeks) often occurs, reminiscent of diseases of the mammary glands. They can be excluded through examination by a mammologist.
- Pain in the abdomen (iliac region) resembles colitis or gastritis. When localized in the right hypochondrium, cholecystitis, pancreatitis or hepatitis are often misdiagnosed. Such symptoms are often associated with breakdown of the digestive system due to damage to their innervation. In such cases, it is necessary to identify thoracic osteochondrosis as the main disease that provokes such manifestations.
- If the lower part of the chest is damaged, the pain is concentrated in the abdominal cavity and simulates intestinal pathologies, but is not related to the quality of food taken and diet. The severity of the pain increases mainly due to physical activity.
- Disorders of the reproductive or urinary system also develop as a result of the distortion of the innervation of the organs.
- Damage to the upper segment of the thoracic region leads to the appearance of symptoms such as pain in the esophagus and pharynx and sensation of a foreign body in the pharyngeal cavity or in the retrosternal region.
Atypical symptoms are characterized by manifestation in the late afternoon, absence in the morning and appearance when provocative factors appear.
Dorsago and dorsalgia
Signs of thoracic osteochondrosis include two vertebral syndromes:
- dorsago;
- dorsalgia.
Dorsago is a sudden, sharp pain that occurs in the chest region, mainly when standing up after a long period of standing in a bent position. The intensity of the pain can be so high that the person has difficulty breathing. In this case, there is significant muscle tension and limited range of motion in two sections: cervicothoracic and thoracolumbar.
Dorsalgia is characterized by a gradual, invisible development. The severity of the pain is mild - sometimes it is better to talk about a feeling of discomfort than about a pain syndrome. Main features:
- the duration can be up to 14-20 days;
- intensification of the syndrome is observed when you bend to the sides, forward or take a deep breath;
- with upper dorsalgia, movements in the cervicothoracic region are limited, with lower dorsalgia, movements in the lumbar-thoracic region are limited;
- the pain intensifies at night and can disappear completely while walking;
- increased pain is provoked by deep breathing and prolonged standing in one position.
Diagnosing
To confirm the diagnosis, the following actions are performed:
- Radiography. With its help you can find out:
- changes in the anatomy of the damaged segment;
- disc thickening;
- vertebral deformation and displacement;
- the difference in the height of the intervertebral discs.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate methods because they provide a layer-by-layer image of the affected area.
- Electromyography is performed to differentiate neurological symptoms that develop as a result of nerve root compression in the thoracic type of osteochondrosis. An examination is prescribed if the following signs are present:
- impaired coordination of movements;
- headache;
- dizziness;
- pressure fluctuations.
- Laboratory tests - performed to determine the level of calcium in the blood and ESR (erythrocyte sedimentation rate).