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 often "masks" as other pathologies: myocardial infarction, angina pectoris, pathology of the gastrointestinal tract.
Characteristics of thoracic osteochondrosis
This type of disease is relatively rare compared to cervical and lumbar.
The reason lies in the peculiarities of the anatomical structure of the thoracic region:
- it is the longest (consisting of 12 vertebrae);
- in this area there is a slight natural bend - physiological kyphosis, which relieves part of the load due to walking upright;
- the thoracic region articulates with the ribs and sternum, which perform physiological skeletal functions 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 a long spinous process.
As a result of these factors, the thoracic part is not very mobile, so osteochondrosis in this part of the spine is rare, but the symptoms are quite noticeable: they are quite strong and unpleasant pain associated with a pinched spinal nerve, which irritates the shoulder. girdle and upper limb organs located in the abdominal and chest cavity. For the same reason, the manifestation of the thoracic form of osteochondrosis is often atypical, which significantly complicates pathological diagnosis 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 herniation. Since most of the load falls mainly on the anterior and lateral parts of the vertebral body and disc, the disc shifts backwards and the formation of disc herniation, or Schmorl's hernia.
The front part of the vertebrae is subjected to greater pressure than the back part. For this reason, osteophyte growth and intervertebral disc prolapse often occur outside the spinal column and do not affect 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, as a result of which they lose elasticity and firmness, but still retain the ability to withstand normal loads. The disc flattening process begins, its height is reduced, and protrusions are formed. Pain at this stage is mild.
- In stage II, a crack forms in the fibrous ring, and the instability of the whole segment is recorded. Painful sensations become more intense and intensify when bending and some other movements.
- The 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 causes spondyloarthrosis (disruption of 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 vertebrae, increasing their area, and flattening. The affected part of the fibrous ring begins to be replaced by bone tissue, which significantly limits the motor ability of the department.
Stages of thoracic osteochondrosis
Today, many experts use different principles of classification, 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 the first stage disease manifest itself? As a rule, it is diagnosed when the intervertebral disc ruptures, due to too much energy or sudden movement. In this case, a sharp pain suddenly occurs in the spine. The patient compares it to the passage of an electric current through the spine. This condition is accompanied by reflex tension of all muscles.
The second stage of thoracic osteochondrosis is discussed in cases where instability of the spinal column appears and symptoms of intervertebral disc protrusion develop. This condition is very rare, occurs with periods of exacerbation and subsequent remission and is detected only with a thorough diagnostic examination.
What are the symptoms that appear in the third stage disease? The pain becomes constant, radiating along the damaged nerve, and is accompanied by partial loss of sensation in the upper or lower extremities, changes in gait, and severe headaches. At this stage, breathing difficulties and normal heart rhythm disturbances are often observed.
We can talk about moving to the fourth level when the manifestations of the disease decrease while the symptoms of spinal instability continue (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.
Common symptoms and signs
Osteochondrosis in the thoracic region has rather special signs, based on which this disease is most likely to be diagnosed:
- Intercostal neuralgia - often the pain is localized in one area, after which it quickly spreads to the entire chest, forcing the patient to be in a certain position and significantly complicating breathing.
- When turning, moving the neck, bending over, raising hands, breathing (inhalation-exhalation), the pain becomes stronger.
- The muscles of the middle and upper back experience severe spasms. It is also possible to contract the muscle fibers of the abs, lower back, and shoulder girdle, which are reflex (develop in response to a sharp pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness, and discomfort that occurs in the chest and back when moving. The pain can be quite strong 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, intensify with hypothermia, movement (especially shaking and sudden), and may manifest in the form of some stiffness.
Atypical symptoms and signs
Often the symptoms of localized osteochondrosis in the chest area resemble other diseases.
- Imitation of pain characteristic of cardiac pathology (heart attack, angina). Such pain can be quite long-lasting (unlike cardialgia), while traditional drugs used to widen coronary vessels do not relieve pain. The cardiogram also showed no changes.
- In the acute stage of thoracic osteochondrosis, long-term pain (up to several weeks) of the sternum, reminiscent of mammary gland disease, 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 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 main disease that causes such manifestations.
- If the lower thoracic region is damaged, the pain is concentrated in the abdominal cavity and resembles intestinal pathology, but has nothing to do with the quality of food taken and diet. The severity of the pain increases mainly due to physical activity.
- Disorders of the reproductive or urinary system also develop as a result of organ conservation distortions.
- 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 area.
Atypical symptoms are characterized by manifestation in the late afternoon, absence in the morning and occurrence when the provoking factor appears.
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, especially 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 areas: cervicothoracic and thoracolumbar.
Dorsalgia is characterized by a gradual, imperceptible development. The severity of the pain is slight - sometimes a person prefers to talk about the discomfort rather than the pain syndrome. Main characteristics:
- period 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, movement in the cervicothoracic region is limited, with lower dorsalgia, movement in the lumbar-thoracic region is limited;
- pain increases at night and may disappear completely when 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 carried out:
- Radiography. With its help you can detect:
- changes in the anatomy of the damaged segment;
- disc thickening;
- Vertebral deformation and displacement;
- intervertebral disc height difference.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate methods because they provide layer-by-layer images of the affected area.
- Electromyography is performed to distinguish neurological symptoms that develop due to nerve root compression in the thoracic type of osteochondrosis. Examination is prescribed if the following signs are present:
- impaired movement coordination;
- Headache;
- dizziness;
- pressure fluctuations.
- Laboratory tests - carried out to determine the level of calcium in the blood and ESR (erythrocyte sedimentation rate).