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, as 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 spine.
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 some of the load of upright walking;
- the chest area 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, but have long spinous processes.
Due to these factors, the thoracic area is not particularly mobile, so osteochondrosis in this part of the spine is rare, but the symptoms are quite pronounced: it is a fairly strong and unpleasant pain that is accompanied by pinched spinal nerves and irritates the shoulder belt and organsthe upper limbs, which are 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 development of intervertebral disc hernias. Since a significant part of the load falls mainly on the front and side parts of the vertebral bodies and intervertebral discs, the intervertebral disc shifts backwards and a herniated disc, also known as Schmorl's hernia, forms.
The front of the vertebrae is subjected to more stress than the back. For this reason, osteophyte growth and disc herniation very often occurs outside the spine and does not affect the spinal cord.
Stages of thoracic osteochondrosis
The manifestations of thoracic osteochondrosis are determined by changes in the intervertebral discs and vertebrae, depending on which four main stages of the disease are distinguished:
- Stage I is characterized by dehydration of the intervertebral discs, causing them to lose elasticity and strength but still retain the ability to withstand normal loads. The process of flattening of the intervertebral disc begins, its height decreases and protrusions form. The pain at this stage is mild.
- In stage II, cracks form in the fibrous ring and instability of the entire segment is noted. When bending over and some other movements, the pain sensations become more intense and intensify.
- A characteristic sign of stage III is the rupture of the fibrous ring and the beginning of the formation of a herniated disc.
- As the disease progresses to stage IV, the vertebrae begin to move closer together due to the lack of resistance from the intervertebral disc, resulting in spondyloarthrosis (disorders of the intervertebral joints) and spondylolisthesis (twisting or displacement of the vertebrae). The mobilization of compensatory forces to relieve pressure 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 stages with their characteristic features.
How does the first degree disease manifest itself? Typically, the diagnosis is made when a disc ruptures caused by overexertion or sudden movement. In this case, a sharp pain suddenly appears in the spine. Patients compare it to the passage of an electric current through the spine. This condition is accompanied by a reflex tension of all muscles.
The second degree of thoracic osteochondrosis occurs when instability of the spine occurs and symptoms of a bulging disc develop. This condition is very rare, occurs with periods of exacerbation and subsequent remission, and is detected only during 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 extremities, changes in gait and severe headaches. Difficulty breathing and disturbances in the normal heart rhythm are often observed at this stage.
One can speak of a transition to the fourth degree when the symptoms of the disease subside and the symptoms of spinal instability persist (sliding, 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 by 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 the patient to a certain position and significantly complicating breathing.
- The pain becomes significantly more intense when turning, moving the neck, bending, raising the arms, or breathing (inhaling-exhaling).
- The muscles of the middle and upper back undergo severe spasms. It is also possible to contract the muscle fibers of the abdominal muscles, lower back and shoulder girdle, which is of a reflex nature (develops in response to a sharp pain syndrome).
- Intercostal neuralgia is often preceded by pain, stiffness, and discomfort in the chest and back during movement. The pain can be very severe and last for several weeks without spreading before gradually subsiding.
- All symptoms worsen at night. In the morning they become noticeably softer or subside, are aggravated by hypothermia, movements (especially vibrating and sudden ones) and can manifest themselves in the form of a certain stiffness.
Atypical symptoms and signs
Often the symptoms of osteochondrosis localized in the chest area are similar to other diseases.
- Imitation of pain characteristic of heart disease (myocardial infarction, angina pectoris). Such pain can last for quite a long time (unlike cardialgia), while conventional drugs to dilate the coronary arteries do not eliminate the pain. The cardiogram also shows no changes.
- In the acute stage of thoracic osteochondrosis, pain in the sternum often occurs for a long period of time (up to several weeks), which is reminiscent of diseases of the mammary glands. They can be ruled out by an examination by a mammologist.
- Pain in the abdomen (iliac region) is similar to colitis or gastritis. When localized in the right hypochondrium, cholecystitis, pancreatitis or hepatitis are often incorrectly diagnosed. Such symptoms are often accompanied by disruption of the digestive system due to damage to its innervation. In such cases, it is necessary to identify thoracic osteochondrosis as the primary disease provoking such manifestations.
- If the lower chest area is damaged, the pain is concentrated in the abdominal cavity, simulating intestinal diseases, but there is no connection with the quality of food consumed and diet. The severity of the pain increases primarily with physical activity.
- Disorders of the reproductive or urinary system also arise from disruptions in the innervation of organs.
- Damage to the upper part of the thoracic region leads to the appearance of symptoms such as pain in the esophagus and throat, as well as the feeling of a foreign body in the pharynx or retrosternal area.
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 stabbing pain in the chest area that occurs primarily when standing up after sitting in a bent position for a long time. The intensity of the pain can be so great that the person has difficulty breathing. In this case, significant muscle tension and limited range of motion occur in two sections: the cervicothoracic and thoracolumbar areas.
Dorsalgia is characterized by a gradual, imperceptible development. The intensity of the pain is mild - sometimes it can be described as more of a feeling of malaise than of a pain syndrome. Main features:
- The duration can be up to 14-20 days.
- An exacerbation of the syndrome is observed when bending to the side or forward or taking deep breaths.
- with upper dorsalgia, movements are limited in the cervicothoracic area, with lower dorsalgia, movements are limited in the lumbar-thoracic area;
- the pain increases at night and may disappear completely when walking;
- Increased pain is caused by deep breathing and staying in one position for a long time.
diagnosis
To confirm the diagnosis the following is carried out:
- Radiography. With its help you can identify:
- Changes in the anatomy of the damaged segment;
- thickening of the intervertebral disc;
- 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-slice image of the affected area.
- Electromyography is performed to differentiate neurological symptoms that arise as a result of compression of nerve roots in thoracic osteochondrosis. An examination is prescribed if the following signs are present:
- impaired coordination of movements;
- Headache;
- Dizziness;
- Pressure fluctuations.
- Laboratory tests – are performed to determine blood calcium levels and ESR (erythrocyte sedimentation rate).