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" under other pathologies: myocardial infarction, angina pectoris, pathologies of the gastrointestinal tract.
Characteristics of thoracic osteochondrosis
This type of disease is rather rare compared to cervical and lumbar disease.
The reason lies in the peculiarities of the anatomical structure of the thoracic region:
- it is the longest (it is made up of 12 vertebrae);
- in this area there is a slight natural curvature - physiological kyphosis, which relieves part of the load resulting from upright walking;
- the thoracic region is articulated with the ribs and the sternum, which perform the functions of the physiological structure 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 rather strong and unpleasant pains associated with compression of the spinal nerves, which irritate shoulder. Organs of the girdle 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 formation of intervertebral disc herniations. Since a significant part of the load falls mainly on the anterior and lateral parts of the vertebral bodies and discs, the disc moves backwards and a herniated disc, or Schmorl's hernia, is formed.
The front part of the vertebrae is subjected to greater stress than the back part. For this reason, very often the growth of osteophytes and the prolapse of the intervertebral discs occur outside the spinal column and do not affect the spinal cord.
Stages of thoracic osteochondrosis
Manifestations of thoracic osteochondrosis are determined by changes that occur in the discs and vertebrae, depending on the four main stages of the disease:
- 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 of the disk begins, its height is reduced and protrusions are formed. The pain at this stage is mild.
- In stage II, cracks form in the fibrous ring and the instability of the entire segment is recorded. Painful sensations become more intense and intensify when bending and performing other movements.
- A characteristic sign of stage III is the rupture of the fibrous ring and the beginning of the formation of an intervertebral disc herniation.
- During the transition to stage IV, due to the lack of resistance of the disc, the vertebrae begin to move closer together, causing spondyloarthrosis (disorders of the intervertebral joints) and spondylolisthesis (torsion or displacement of the vertebrae). Mobilization of compensatory forces to reduce the load leads to growth of the vertebra, 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 principle of classification, according to which the course of osteochondrosis of the thoracic spine is distinguished not by stages, but by degrees with their characteristics.
How does first degree disease manifest itself? It is usually diagnosed when an intervertebral disc ruptures, caused by excessive strain or a sudden movement. In this case, a sharp pain in the spine suddenly occurs. 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 referred to in cases in which instability of the spinal column appears and symptoms of protrusion of the intervertebral discs develop. This condition is very rare, manifests itself 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, breathing difficulties and interruption of the normal heart rhythm are often observed.
We can speak of a 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 with respect 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 rather characteristic signs, on the basis of 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 significantly complicating breathing.
- When you turn, move your neck, bend, raise your arms, breathe (inhale-exhale), the pain becomes much more intense.
- The muscles of the middle and upper back experience severe spasms. It is also possible to contract the muscle fibers of the abdominals, lower back and shoulder girdle, which is reflexive in nature (develops as a reaction to an acute pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness and a feeling of discomfort that occurs in the chest and back during movement. The pain can be quite intense and can last for several weeks without spreading further, after which it gradually begins to fade.
- All symptoms become more pronounced at night. In the morning they noticeably soften or fade, intensifying with hypothermia, movements (especially vibrating and sudden) and can manifest themselves in the form of 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 the coronary vessels do not eliminate the pain. The cardiogram also shows no changes.
- In the acute phase 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 examination by a mammologist.
- Pain in the abdomen (iliac region) resembles colitis or gastritis. When located 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 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 the food consumed and the diet. The severity of pain increases mainly due to physical activity.
- Disorders of the reproductive or urinary system also develop due to 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 foreign body sensation in the pharyngeal cavity or retrosternal region.
Atypical symptoms are characterized by manifestation in the late afternoon, absence in the morning and onset when provoking factors appear.
Dorsago and dorsalgia
Signs of thoracic osteochondrosis include two spinal 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 great that the person has difficulty breathing. In this case, there is significant muscle tension and limited range of motion in two sections: cervicothoracic and thoracolumbar.
Dorsalgia is characterized by a gradual and imperceptible development. The severity of the pain is mild: sometimes it is preferable to talk about a feeling of discomfort rather than a painful syndrome. Main features:
- the duration can reach up to 14-20 days;
- an intensification of the syndrome is observed when bending sideways, forward or taking a deep breath;
- with upper dorsalgia the movements of the cervicothoracic region are limited, with lower dorsalgia the movements of the lumbothoracic region are limited;
- the pain intensifies at night and may disappear completely when walking;
- the increase in pain is caused by deep breathing and prolonged stay in one position.
Diagnostics
To confirm the diagnosis, the following is done:
- X-ray. With its help you can detect:
- changes in the anatomy of the damaged segment;
- disc thickening;
- vertebral deformation and displacement;
- difference in 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 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;
- heachache;
- dizziness;
- pressure fluctuations.
- Laboratory tests: carried out to determine the level of calcium in the blood and the ESR (erythrocyte sedimentation rate).