The thoracic form of osteochondrosis is characterized by degenerative damage of the intervertebral cartilages 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.
Features of thoracic osteochondrosis
This type of disease is quite rare compared to neck and back.
The reason lies in the features of the anatomical structure of the thoracic region:
- is the longest (consists of 12 vertebrae);
- there is a slight natural bend in this area - physiological kyphosis, which relieves part of the load caused by upright walking;
- the thoracic region is connected to 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 chest is not particularly mobile, so osteochondrosis in this part of the spine is rare, but its symptoms are quite clear: they are very strong and unpleasant pains associated with compressed spinal nerves that irritate the shoulder. girdle and upper limb organs 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 herniations. As a significant part of the load falls mainly on the anterior and lateral parts of the vertebral bodies and discs, the disc slips backwards and a disc herniation or Schmorl's hernia occurs.
The front of the spine is more stressed than the back. For this reason, very often the growth of osteophytes and prolapse of intervertebral discs occurs outside the spine and does not affect the spinal cord.
Stages of thoracic osteochondrosis
Manifestations of thoracic osteochondrosis are determined by the changes 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 strength, but still retain the ability to withstand normal loads. The process of straightening the disc begins, its height decreases, protrusions form. At this stage, the pain is mild.
- In stage II, cracks are formed in the fibrous annulus and instability of the whole segment is recorded. Painful sensations are more intense and intensify when bending and during some other movements.
- The characteristic sign of stage III is the rupture of the fibrous annulus and the beginning of the formation of a herniated intervertebral disc.
- During the transition to stage IV, due to the lack of resistance of the disc, the vertebrae begin to move closer together, which provokes spondyloarthrosis (intervertebral joint disorders) and spondylolisthesis (vertebrae bending or displacement). The mobilization of compensatory forces to reduce the load leads to the growth of the vertebra, increasing 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, so the course of thoracic lumbar osteochondrosis is distinguished not by stages, but by degrees with its characteristic features.
How does primary disease manifest itself? As a rule, it is diagnosed when the intervertebral disc ruptures due to excessive stress or sudden movement. At this time, there is a sudden sharp pain in the spine. 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 instability of the spine appears and signs 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 comprehensive diagnostic examination.
What are the symptoms of third degree disease? Pain stabilizes, radiates along the damaged nerve and is accompanied by partial loss of sensation in the upper or lower limbs, changes in gait, severe headaches. At this stage, difficulty in breathing and a violation of the normal heart rhythm are often observed.
When the signs of instability of the spine continue (slippage, twisting of the vertebrae, fixation in relation to each other), we can talk about moving to the fourth degree when the manifestations of the disease decrease. 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 symptoms, on the basis of which this disease can be diagnosed most often:
- 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.
- The pain is stronger when turning, neck movements, bending, lifting arms, breathing movements (inhalation-exhalation).
- Middle and upper back muscles undergo severe spasm. It is also possible to contract the muscle fibers of the abs, back and shoulder girdle, which are reflexive in nature (developing in response to acute pain syndrome).
- Intercostal neuralgia is often accompanied by pain, stiffness and discomfort in the chest and back when moving. The pain can be quite strong and last for several weeks before spreading, after which it gradually begins to subside.
- All symptoms are more pronounced at night. In the morning, they soften or decrease significantly, intensify with hypothermia, movements (especially tremors and sudden ones) and may manifest themselves in the form of some stiffness.
Atypical symptoms and signs
Symptoms of osteochondrosis, often localized in the chest region, are similar to other diseases.
- Imitation of pain characteristic of heart pathologies (heart attack, angina). Such pain can be quite long-lasting (unlike cardialgia), traditional drugs used to expand coronary vessels do not relieve pain. Cardiogram also shows no changes.
- In the acute stage of thoracic osteochondrosis, long-term (up to several weeks) pains in the sternum, reminiscent of diseases of the mammary glands, often occur. They can be excluded by a mammologist's examination.
- Pain in the abdomen (iliac region) is similar to colitis or gastritis. When localized in the right hypochondrium, cholecystitis, pancreatitis or hepatitis are often mistakenly diagnosed. 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 main disease causing 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 and diet. The intensity of pain increases mainly due to physical activity.
- Reproductive or urinary system disorders also develop as a result of organ innervation disorders.
- Damage to the upper segment of the thoracic region causes the appearance of symptoms such as pain in the esophagus and pharynx and the sensation of a foreign body in the pharyngeal cavity or retrosternal region.
Atypical symptoms are characterized by the appearance in the afternoon, absence in the morning and the appearance of provoking factors.
Dorsago and dorsalgia
Symptoms of thoracic osteochondrosis include two vertebral syndromes:
- dorsago;
- dorsalgia.
Dorsago is a sudden, sharp pain in the chest, mainly when standing up after sitting in a bent position for a long time. The intensity of pain can be so high that a 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, invisible development. The intensity of the pain is low - sometimes we can talk about a feeling of discomfort rather than a pain syndrome. Main features:
- the duration can be up to 14-20 days;
- the syndrome is aggravated when bending to the sides, forward or taking a deep breath;
- movements in the cervicothoracic region are limited with upper dorsalgia, movements in the lumbothoracic region are limited with lower dorsalgia;
- pain intensifies at night and may disappear completely during walking;
- increased pain is provoked by deep breathing and staying in one position for a long time.
Diagnostics
To confirm the diagnosis, the following is done:
- Radiography. With its help, you can discover:
- 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.
- In the thoracic type of osteochondrosis, electromyography is performed to distinguish neurological symptoms that develop as a result of compression of nerve roots. Examination is prescribed if the following symptoms are present:
- violation of coordination of movements;
- Headache;
- dizziness;
- pressure fluctuations.
- Laboratory tests are performed to determine the level of calcium in the blood and ESR (the rate of erythrocyte sedimentation).