The thoracic form of osteochondrosis is characterized by degenerative lesions of the intervertebral cartilage and secondary changes in the thoracic vertebrae. The diagnosis of the disease is sometimes quite problematic, because it is often "masked" by other pathologies: myocardial infarction, angina, pathologies of the gastrointestinal tract.
Characteristics of thoracic osteochondrosis
This type of disease is quite rare compared to cervical and lumbar diseases.
The reason lies in the peculiarities of the anatomical structure of the thoracic region:
- it is the longest (consists of 12 vertebrae);
- in this area there is a slight natural curvature - physiological kyphosis, which relieves part of the load resulting from standing walking;
- the thoracic region articulates with the ribs and sternum, which perform the functions of the physiological framework and bear the main load;
- in cross section, the spinal canal of the thoracic region has the smallest dimensions;
- The thoracic vertebrae are thinner and smaller, but have long spinous processes.
Due to these factors, the thoracic part is not particularly mobile, therefore osteochondrosis in this part of the spine is rare, but its symptoms are quite pronounced: these are quite strong and unpleasant pains associated with spinal nervespinched, which irritate the shoulder. organs of the girdle and 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 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 herniations. Since a significant part of the load falls mainly on the anterior and lateral parts of the vertebral bodies and discs, the disc shifts backward and leads to the formation of a herniated disc, or Schmorl's herniation.
The front of the vertebrae is subject to greater stress than the back. For this reason, osteophyte growth and intervertebral disc prolapse very often occur outside the spine and do not affect the spinal cord.
Stages of thoracic osteochondrosis
The manifestations of thoracic osteochondrosis are determined by changes occurring in the discs and vertebrae, according to the four main stages of the disease:
- Stage I is characterized by dehydration of the intervertebral discs, as a result of which they lose their elasticity and firmness, while retaining the ability to withstand normal loads. The process of flattening the disc begins, its height decreases and protrusions are formed. The pain at this stage is mild.
- At stage II, cracks form in the annulus fibrosus and instability of the entire segment is recorded. The painful sensations become more intense and intensify when bending and during certain other movements.
- A characteristic sign of stage III is the rupture of the annulus fibrosus and the beginning of the formation of an intervertebral disc herniation.
- When moving to stage IV, due to the lack of disc resistance, the vertebrae begin to move closer together, which causes spondyloarthrosis (disorders of the intervertebral joints) and spondylolisthesis (twisting or displacement of the vertebrae). The mobilization of compensatory forces to reduce the load results in growth of the vertebra, an increase in its surface area and flattening. The affected part of the annulus fibrosus begins to be replaced by bone tissue, which significantly limits the motor capabilities of the department.
Degrees of thoracic osteochondrosis
Today, many specialists use a different principle of classification, according to which the course of osteochondrosis of the thoracic spine is distinguished not by stages, but by degrees with their characteristics.
How does first degree disease manifest? Typically, it is diagnosed when an intervertebral disc ruptures, caused by overexertion or a sudden movement. In this case, sharp pain suddenly appears in the spine. Patients compare it to passing an electric current through the spine. This condition is accompanied by reflex tension of all muscles.
The second degree of thoracic osteochondrosis is mentioned in cases where spinal instability appears and symptoms of protrusion of the intervertebral discs develop. This condition is very rare, occurs with periods of exacerbation and subsequent remission and is detected only by a thorough diagnostic examination.
What symptoms appear in third degree disease? 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 severe headache. At this stage, breathing difficulties and disturbances in the normal heart rhythm are often observed.
We can speak of passing to the fourth degree when the manifestations of the disease diminish while the symptoms of spinal instability persist (sliding, twisting of the vertebrae, fixation in relation to each other). Osteophytes begin to grow, gradually pinching the spinal nerves and compressing the spinal cord.
Typical symptoms and signs
Osteochondrosis of the thoracic region has quite characteristic signs, on the basis of which this disease can most likely be diagnosed:
- Intercostal neuralgia - pain is often 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.
- When turning, neck movements, bending, raising arms, breathing acts (inhalation-exhalation), the pain becomes much more intense.
- The muscles of the mid and upper back experience severe spasms. It is also possible to contract the muscle fibers of the abdominal muscles, lower back and shoulder girdle, which is reflexive in nature (develops in reaction to acute pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness and a feeling of discomfort that occurs in the chest and back during movement. The pain can be quite intense and last for several weeks without spreading further, after which it gradually begins to fade.
- All symptoms become more pronounced at night. In the morning, they significantly soften or subside, intensify with hypothermia, movements (especially vibrating and sharp) and can manifest themselves in the form of some stiffness.
Atypical symptoms and signs
Often the symptoms of osteochondrosis localized in the chest area resemble other diseases.
- Imitation of pain characteristic of cardiac pathologies (heart attack, angina). Such pain can last quite a long time (unlike cardialgia), while traditional drugs used to dilate the coronary vessels do not eliminate the pain. The cardiogram also shows no change.
- In the acute stage of thoracic osteochondrosis, long-term (up to several weeks) pain in the sternum, reminiscent of diseases of the mammary glands, often occurs. They can be excluded by 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. These symptoms are often accompanied by disruption of the digestive system due to damage to their innervation. In such cases, it is necessary to identify thoracic osteochondrosis as the main disease provoking such manifestations.
- If the lower thoracic region is damaged, the pain is concentrated in the abdominal cavity and simulates intestinal pathologies, but has no connection with the quality of food consumed and diet. Pain intensity increases mainly due to physical activity.
- Disorders of the reproductive or urinary system also develop as a result of 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 the sensation of a foreign body in the pharyngeal cavity or in the retrosternal region.
Atypical symptoms are characterized by a manifestation in the late afternoon, an absence in the morning and an appearance when provoking factors appear.
Dorsago and back pain
Signs of thoracic osteochondrosis include two vertebral syndromes:
- dorsal;
- back pain.
Dorsago is a sudden, sharp pain that occurs in the thoracic region, mainly when standing after a long period of sitting in a hunched position. The intensity of the pain may be so severe that the person has difficulty breathing. In this case, there is significant muscle tension and limited range of motion in two sections: the cervicothoracic and the thoracolumbar.
Back pain is characterized by a progressive and imperceptible development. The intensity of the pain is mild - we can sometimes speak of a feeling of discomfort rather than a pain syndrome. Main Features:
- the duration can be up to 14-20 days;
- intensification of the syndrome is observed when leaning to the sides, forward or breathing deeply;
- with upper back pain, movements in the cervicothoracic region are limited, with lower back pain, movements in the lumbar-thoracic region are limited;
- the pain intensifies at night and can disappear completely when walking;
- increased pain is caused by deep breathing and prolonged stay in one position.
Diagnostic
To confirm the diagnosis, proceed as follows:
- X-ray. With its help, you can detect:
- changes in the anatomy of the damaged segment;
- disc thickening;
- vertebral deformation and displacement;
- difference in 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 compression of the nerve roots 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 - carried out to determine the level of calcium in the blood and ESR (erythrocyte sedimentation rate).