The thoracic form of osteochondrosis is characterized by degenerative damage to the intervertebral cartilages and secondary changes in the thoracic vertebrae. Diagnosing the disease is sometimes quite problematic, as it is often "masked" by other pathologies: heart attack, angina pectoris, pathologies of the gastrointestinal tract.
Features of thoracic osteochondrosis
This type of disease is quite rare compared to neck and lumbar disease.
The reason for this lies in the peculiarities of the anatomical structure of the chest region:
- it is the longest (consisting of 12 vertebrae);
- in this area there is a slight natural curve - physiological kyphosis, which relieves part of the load from vertical walking;
- the thoracic region articulates with the ribs and sternum, which perform the functions of the physiological frame and bear the main load;
- in cross-section, the spinal canal of the thoracic region is the smallest;
- 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 rarely occurs in this part of the spine, but its symptoms are quite pronounced: quite strong and unpleasant pain, which is accompanied by pinching of the spinal nerves, which irritates the shoulder. girdle and upper limb organs 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 development of disc herniation. Since a significant part of the load falls mainly on the front and lateral parts of the vertebral bodies and discs, the disc is pushed back and a disc herniation, or Schmorl's hernia, develops.
The front of the vertebrae is exposed to more stress than the back. Because of this, very often the growth of osteophytes and prolapse of the intervertebral discs occurs outside the spinal column and does not affect the spinal cord.
Stages of thoracic osteochondrosis
The manifestations of thoracic osteochondrosis are determined by changes in the discs and vertebrae, depending on which four main stages of the disease are distinguished:
- Stage I is characterized by desiccation of the intervertebral discs, as a result of which they lose their elasticity and firmness, but are still able to withstand normal loads. The process of flattening the disc begins, its height decreases and protrusions are formed. The pain at this stage is mild.
- The II. section, cracks appear in the fibrous ring and instability of the entire segment can be detected. Painful sensations become more intense and intensify during bending and some other movements.
- The III. a characteristic sign of stage 1 is the rupture of the fibrous ring and the beginning of the development of an intervertebral disc herniation.
- The IV. during transition to stage 1, due to the lack of resistance of the disc, the vertebrae come closer to each other, which provokes spondyloarthrosis (disorders 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 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 skills of the class.
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 stages with their characteristic features.
How does the first degree disease manifest itself? It is usually diagnosed when an intervertebral disc ruptures due to overuse or sudden movement. In this case, there is a sudden sharp pain in the spine. 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 appears and symptoms of protrusion of the intervertebral discs develop. This condition is very rare, occurs with periods of exacerbation and subsequent remission, and can only be detected with a thorough diagnostic examination.
What are the symptoms of 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 limbs, changes in gait, and severe headaches. During this stage, difficulty in breathing and disruption of the normal heart rhythm are often observed.
We can talk about moving into the fourth degree if the manifestations of the disease decrease, while the symptoms of spinal instability still exist (slipping, twisting of the vertebrae, fixation 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, based on which this disease can be diagnosed with high probability:
- Intercostal neuralgia - often the pain is localized in one area, and then quickly spreads to the entire chest, forcing the patients in a certain position and making breathing significantly more difficult.
- The pain becomes much more intense when turning, neck movements, bending, lifting the arms, breathing operations (inhalation-exhalation).
- The muscles of the middle and upper back go through a severe spasm. It is also possible to contract the muscle fibers of the abdominal muscles, the lower back and the shoulder girdle, which is reflexive (it develops as a result of sharp pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness and discomfort in the chest and back during movement. The pain can be quite intense and last for several weeks without spreading and then gradually fades.
- All symptoms become more pronounced at night. By morning, they soften significantly or subside, intensify with hypothermia, movements (especially vibrating and sudden), and may also manifest in the form of some stiffness.
Atypical symptoms and signs
Often, the symptoms of osteochondrosis localized in the chest area are similar to other diseases.
- Imitation of pain typical of cardiac pathologies (heart attack, angina). Such pain can be quite long-lasting (unlike cardialgia), while conventional drugs used to dilate coronary arteries do not eliminate the pain. The cardiogram shows no changes either.
- In the acute stage of thoracic osteochondrosis, long-term (up to several weeks) pain in the sternum often occurs, reminiscent of diseases of the mammary glands. They can be ruled out by a mammologist.
- Abdominal pain (hip 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, thoracic osteochondrosis should be identified as the primary disease causing such manifestations.
- If the lower part of the chest 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 strength of the pain increases mainly due to physical activity.
- As a result of the distortion of the innervation of the organs, disorders of the reproductive or urinary system also develop.
- Damage to the upper segment of the thoracic region leads to the appearance of symptoms such as pain in the esophagus and pharynx, as well as the sensation of a foreign body in the pharyngeal cavity or retrosternal region.
Atypical symptoms are characterized by late afternoon manifestation, absence in the morning and the appearance of provoking factors.
Dorsago and dorsalgia
Signs of thoracic osteochondrosis include two vertebral syndromes:
- dorsago;
- dorsalgia.
Dorsago is a sudden, sharp pain in the chest region, especially when standing up, after sitting bent over for a long time. The intensity of the pain can be so strong that the person has difficulty breathing. In this case, there is significant muscle tension and limited range of motion in two sections: the cervical chest and the chest section.
Dorsalgia is characterized by a gradual, imperceptible development. The severity of the pain is mild - sometimes we can talk about an unpleasant feeling rather than a pain syndrome. Main features:
- its 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;
- in the case of upper dorsalgia, the movements of the cervicothoracic region are limited, in the case of lower dorsalgia, the movements of the lumbar-thoracic region are limited;
- the pain intensifies at night and may disappear completely when walking;
- increased pain is triggered by deep breathing and staying in one position for a long time.
Diagnostics
To confirm the diagnosis, the following should be done:
- Radiography. It allows you to detect:
- changes in the anatomy of the injured segment;
- disc thickening;
- deformation and displacement of a vertebra;
- difference in the height of the intervertebral discs.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are more accurate methods, as 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 osteochondrosis. An examination is prescribed if the following symptoms appear:
- movement coordination disorder;
- headache;
- dizziness;
- pressure fluctuations.
- Laboratory tests - used to determine blood calcium levels and ESR (erythrocyte sedimentation rate).