The thoracic form of osteochondrosis is characterized by degenerative damage to the intervertebral cartilage and secondary changes in the thoracic vertebrae. Diagnosis of the disease is sometimes quite problematic, as it is often "masked" as other pathologies: myocardial infarction, angina pectoris, pathologies of the gastrointestinal tract.
Features of thoracic osteochondrosis
This type of disease is quite rare compared to cervical and lumbar disease.
The reason lies in the peculiarities of the anatomical structure of the thoracic region:
- 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 walking upright;
- the thoracic region articulates with the ribs and sternum, which perform the functions of a physiological structure and take on the main load;
- in cross section, the spinal canal in the thoracic region has the smallest dimensions;
- The 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: these are quite strong and unpleasant pains associated with compressed spinal nerves, which irritate the shoulder organs. waist 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 hernias. As a significant part of the load falls mainly on the anterior and lateral parts of the vertebral bodies and discs, the disc moves backwards and a herniated disc, or Schmorl's hernia, is formed.
The front part of the vertebrae is subject to greater stress than the back part. For this reason, osteophyte growth and intervertebral disc prolapse 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, depending on which 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 firmness, but still maintain the ability to withstand normal loads. The process of flattening the disc begins, its height decreases and protrusions form. The pain at this stage is mild.
- In stage II, fissures form in the fibrous ring and instability of the entire segment is recorded. Painful sensations become more intense and intensify when bending over 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 disc resistance, the vertebrae begin to move closer together, which causes spondyloarthrosis (disorders in the intervertebral joints) and spondylolisthesis (torsion 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 capabilities of the department.
Degrees of thoracic osteochondrosis
Today, many experts 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 first degree disease manifest? As a rule, it is diagnosed when there is a rupture of an intervertebral disc, caused by excessive effort or sudden movement. In this case, sharp pain in the spine suddenly occurs. Patients compare this to the passage of electrical 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 instability of the spine 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 with a complete diagnostic examination.
What symptoms appear in third degree disease? The pain becomes constant, radiates along the injured nerve and is accompanied by partial loss of sensation in the upper or lower extremities, changes in gait and severe headaches. At this stage, difficulty breathing and disturbances in the normal heart rhythm are often observed.
We can talk about moving to the fourth degree when the manifestations of the disease decrease while the symptoms of spinal instability persist (slipping, twisting of the vertebrae, fixation between them). Osteophytes begin to grow, gradually compressing 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 be diagnosed with greater probability:
- Intercostal neuralgia - often the pain is localized in one area, after which it quickly spreads throughout the chest, forcing patients to take a certain position and significantly complicating breathing.
- When turning, neck movements, bending, raising the arms, respiratory acts (inspiration-exhalation), the pain becomes much more intense.
- The muscles in the middle and upper back go into severe spasm. It is also possible to contract the muscle fibers of the abdomen, lower back and shoulder girdle, which is reflexive in nature (develops as a reaction to an 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 disappear.
- All symptoms become more pronounced at night. In the morning, they soften significantly or decrease, intensifying with hypothermia, movements (mainly vibratory and sudden), which may 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). This 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 stage of thoracic osteochondrosis, prolonged (up to several weeks) pain in the sternum 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 located in the right hypochondrium, cholecystitis, pancreatitis, or hepatitis are often misdiagnosed. Such symptoms are often accompanied by disorders of the digestive system due to damage to its innervation. In such cases, it is necessary to identify thoracic osteochondrosis as the main disease that causes such manifestations.
- If the lower thoracic region is injured, the pain is concentrated in the abdominal cavity and simulates intestinal pathologies, but there is no relationship with the quality of food and diet. The intensity of pain 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 a 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 occurrence when provoking factors appear.
Back and back pain
Signs of thoracic osteochondrosis include two vertebral syndromes:
- back;
- back pain.
Dorsago is a sudden and sharp pain that occurs in the thoracic region, especially when standing up after a long period of sitting in a hunched 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.
Back pain is characterized by a gradual and imperceptible development. The intensity of the pain is mild - sometimes one can talk more about a feeling of discomfort than a pain syndrome. Main features:
- duration can be 14 to 20 days;
- Intensification of the syndrome is observed when leaning to the sides, forward or taking a deep breath;
- in upper back pain, movements of the cervicothoracic region are limited; in lower back pain, movements in the lumbothoracic region are limited;
- the pain intensifies at night and may disappear completely when walking;
- the increase in pain is caused by deep breathing and prolonged stay in the same position.
Diagnosis
To confirm the diagnosis, the following is performed:
- Radiography. With its help you can detect:
- changes in the anatomy of the injured segment;
- disc thickening;
- vertebral deformation and displacement;
- 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 compression of 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).