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, since 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.
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 bend - physiological kyphosis, which relieves part of the load resulting from upright walking;
- the thoracic region articulates with the ribs and sternum, which perform the functions of a physiological frame and take on the main load;
- in cross section, the spinal canal of 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: they are quite strong and unpleasant pain associated with pinched spinal nerves, which irritate the shoulder girdle and upper limbsorgans located in the abdominal cavity and chest. For the same reasons, 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. 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 the formation of a disc herniation, or Schmorl's hernia.
The front of the vertebrae is subject to greater stress than the back. For this reason, very often the growth of osteophytes and prolapse of intervertebral discs occurs outside the spinal column and does not affect the spinal cord.
Stages of thoracic osteochondrosis
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 retain the ability to withstand normal loads. The process of flattening the disc begins, its height is reduced, and protrusions are formed. Pain at this stage is mild.
- At stage II, cracks 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 a herniated intervertebral disc.
- During the transition to stage IV, due to the lack of resistance from the disc, the vertebrae begin to move 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 capabilities 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 distinguished not by stages, but by degrees with their characteristic features.
How does the first degree disease manifest itself? As a rule, it is diagnosed when an intervertebral disc ruptures, caused by overexertion or sudden movement. In this case, a sharp pain suddenly occurs in the spine. Patients compare it to the passage of electric current through the spine. This condition is accompanied by reflex tension of all muscles.
The second degree of thoracic osteochondrosis is spoken of in cases where instability of the spinal column 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 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 intense headaches. At this stage, difficulty breathing and disruption of 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 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 be most likely diagnosed:
- Intercostal neuralgia - often 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.
- When turning, neck movements, bending, raising arms, breathing acts (inhalation-exhalation), the pain becomes much more intense.
- The muscles of the middle and upper back undergo severe spasm. It is also possible to contract the muscle fibers of the abs, lower back, and shoulder girdle, which is reflexive in nature (develops as a reaction to a sharp pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness, and a feeling of discomfort that occurs 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 subside, intensifying with hypothermia, movements (especially vibrating and sudden ones), and 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). Such pain can be quite long-lasting (unlike cardialgia), while traditional drugs used to dilate coronary vessels do not eliminate pain. The cardiogram also shows no changes.
- In the acute stage of thoracic osteochondrosis, long-term (up to several weeks) soreness of the sternum, reminiscent of diseases of the mammary glands, often occurs. 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 mistakenly diagnosed. Such 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 primary disease that provokes such manifestations.
- If the lower thoracic region is damaged, the pain is concentrated in the abdominal cavity and simulates intestinal pathologies, but there is no connection with the quality of food taken and diet. The severity 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 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 manifestation in the late afternoon, absence in the morning and occurrence 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 a long period of sitting 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: the cervicothoracic and thoracolumbar.
Dorsalgia is characterized by a gradual, imperceptible development. The severity of the pain is slight - sometimes one can rather talk about a feeling of discomfort than a pain syndrome. Main features:
- duration can be up to 14-20 days;
- intensification of the syndrome is observed when bending to the sides, 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 completely disappear when walking;
- increased pain is provoked 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 detect:
- changes in the anatomy of the damaged segment;
- thickening of the disc;
- vertebral deformation and displacement;
- difference in the height of 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).