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, because it is often "masked" as other pathologies: myocardial infarction, angina pectoris, pathologies 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 thoracic region:
- it is the longest (consists of 12 vertebrae);
- in this area there is a slight natural curve - physiological kyphosis, which relieves part of the load caused by upright walking;
- the thoracic part articulates with the ribs and sternum, which perform the functions of the physiological frame and take 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 pinching of spinal nerves, which irritate the shoulder. organs of the waist and upper extremities 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 occurrence of intervertebral disc herniation. Since a significant part of the load falls mainly on the front and side parts of the bodies of the vertebrae and discs, the disc moves backwards and the disc herniation, or Schmorl's hernia, occurs.
The front part of the vertebrae is subject to greater stress than the back part. For this reason, very often the growth of osteophytes and prolapse of intervertebral discs occurs outside the spinal column and does not involve the spinal cord.
Stages of thoracic osteochondrosis
Manifestations of thoracic osteochondrosis are determined by the changes that occur 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, due to which they lose elasticity and firmness, 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 phase II, cracks are formed in the fibrous ring and the instability of the entire segment is noted. 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 a hernia of the intervertebral disc.
- During the transition to stage IV, due to the lack of resistance of the disc, the vertebrae begin to converge, which causes 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 growth of the vertebra, increase in its surface and flattening. The affected part of the fibrous ring begins to be replaced by bone tissue, which significantly limits the motor abilities of the department.
Degree of thoracic osteochondrosis
Today, many experts 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 characteristic features.
How is the disease of the first degree manifested? As a rule, it is diagnosed when there is a rupture of the intervertebral disc caused by overstrain or sudden movement. In this case, a sharp pain in the spine suddenly appears. Patients compare it to the passage of 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 instability of the spinal column occurs and symptoms of intervertebral disc protrusion develop. This condition is very rare, occurs with periods of exacerbation and subsequent remission, and is discovered only after a thorough diagnostic examination.
What symptoms occur in third degree disease? The pain becomes constant, radiates along the damaged nerve, and is followed by partial loss of sensation in the upper or lower extremities, changes in gait and intense headaches. Difficulty breathing and disturbance of normal heart rhythm are often observed in this phase.
We can talk about the transition to the fourth degree when the manifestations of the disease decrease while the symptoms of spinal instability persist (slipping, twisting of the vertebrae, fixation towards each other). Osteophytes begin to grow, gradually squeezing the spinal nerves and compressing the spinal cord.
Typical symptoms and signs
Osteochondrosis of the thoracic region has quite 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 making breathing significantly more difficult.
- When turning, moving the neck, bending, raising the arms, the action of breathing (inhalation-exhalation), the pain becomes significantly more intense.
- The muscles of the middle and upper back are subjected to severe spasm. A contraction of the muscle fibers of the abdominal muscles, the lower back and the shoulder girdle is also possible, which is of a reflex nature (it develops as a reaction to a sharp pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness and discomfort 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 disappear.
- All symptoms become more pronounced at night. In the morning, they soften significantly or recede, are intensified by hypothermia, movements (especially vibrating and sudden), and can manifest in the form of a certain 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 pectoris). Such pain can be quite long-lasting (unlike cardialgia), while traditional drugs used to dilate coronary vessels do not remove the pain. The cardiogram also shows no changes.
- In the acute phase of thoracic osteochondrosis, long-lasting (up to several weeks) soreness of the sternum, reminiscent of diseases of the mammary glands, often occurs. They can be ruled out by a mammologist's examination.
- Pain in the abdomen (iliac region) resembles colitis or gastritis. When it is localized 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 their innervation. In such cases, it is necessary to identify thoracic osteochondrosis as the primary disease that causes such manifestations.
- If the lower thoracic part is damaged, the pain is concentrated in the abdominal cavity and simulates intestinal pathologies, but has nothing to do with the quality of food taken and diet. The intensity of the pain increases mainly due to physical activity.
- Disorders of the reproductive or urinary system also develop as a result of distortion of organ innervation.
- Damage to the upper segment of the thoracic region leads to symptoms such as pain in the esophagus and pharynx and the feeling 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 provoking 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 thoracic region, mainly when standing up after sitting for a long time 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 parts: cervicothoracic and thoracolumbar.
Dorsalgia is characterized by a gradual, imperceptible development. The severity of the pain is low - sometimes it is better to talk about a feeling of discomfort than a pain syndrome. Main features:
- the duration can be up to 14-20 days;
- intensification of the syndrome is observed when bending to the side, forward or taking 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 may disappear completely when walking;
- increased pain is caused by deep breathing and prolonged stay in one position.
Diagnostics
To confirm the diagnosis, the following is carried out:
- Radiography. With its help you can discover:
- changes in the anatomy of the damaged segment;
- disc thickening;
- deformation and displacement of vertebrae;
- 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 distinguish neurological symptoms that develop as a result of nerve root compression in thoracic type osteochondrosis. Examination is prescribed if the following signs are present:
- impaired movement coordination;
- headache;
- dizziness;
- pressure fluctuations.
- Laboratory tests - performed to determine the level of calcium in the blood and ESR (erythrocyte sedimentation rate).