The thoracic form of osteochondrosis is characterized by degenerative damage to the intervertebral cartilage and secondary changes in the thoracic vertebrae. The diagnosis of the disease is sometimes quite problematic, as it is often "masked" with other pathologies: myocardial infarction, angina pectoris, pathologies of the gastrointestinal tract.
Characteristics of thoracic osteochondrosis
This type of disease is quite rare compared to cervical and lumbar.
The reason lies in the peculiarities of the anatomical structure of the thoracic region:
- it is the largest (consists of 12 vertebrae).
- in this area there is a slight natural bend - normal kyphosis, which relieves part of the load resulting from upright walking.
- the thoracic region articulates with the ribs and sternum, which perform the functions of a normal frame and bear 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 intense: it is quite strong and unpleasant pain associated with pinched spinal nerves, whichorgans of the belt and upper extremities located in the abdominal cavity and chest irritate the shoulder. For the same reasons, the manifestations of the thoracic form of osteochondrosis are often atypical, which greatly complicates the diagnosis of the pathology and subsequent treatment.
The narrowness of the spinal canal, the presence of normal kyphosis and the relatively small size of the vertebrae create the most favorable conditions for the creation of intervertebral disc herniations. Since a significant part of the load falls mainly on the anterior and lateral part of the vertebral bodies and discs, the disc is displaced backwards and a herniated disc or Schmorl hernia is created.
The front of the vertebrae is under more pressure than the back. For this reason, very often osteophyte growth and intervertebral disc prolapse occurs outside the spine and does not affect the spinal cord.
Stages of thoracic osteochondrosis
The manifestations of thoracic osteochondrosis are determined by 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 retain the ability to withstand normal loads. The process of flattening the disk begins, its height decreases and protrusions form. The pain at this stage is mild.
- In stage II, cracks form in the annulus fibrosus and instability of the entire segment is recorded. Painful sensations become more intense and intensify when you bend and some other movements.
- A characteristic sign of stage III is the rupture of the annulus fibrosus and the beginning of the formation of an intervertebral disc herniation.
- 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 (disorders of the intervertebral joints) and spondylolisthesis (twisting or displacement of the vertebrae). The mobilization of compensatory forces to reduce the load leads to growth of the vertebra, an increase in its area and flattening. The affected part of the annulus fibrosus begins to be replaced by bone tissue, which significantly limits the movement capabilities of the part.
Grades of thoracic osteochondrosis
Today, many experts use a different classification principle, 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 first degree disease manifest itself? As a rule, it is diagnosed when an intervertebral disc rupture, caused by overexertion or sudden movement. In this case, a sharp pain in the spine suddenly appears. 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 occurs and symptoms of protrusion of the intervertebral discs develop. This condition is very rare, occurs with periods of exacerbation and subsequent remission and is detected only with a thorough diagnostic examination.
What symptoms occur 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 severe headaches. At this stage, difficulty in breathing and disturbance of the normal heart rhythm are often observed.
We can talk about a transition to the fourth degree when the manifestations of the disease decrease while the symptoms of spinal instability persist (slipping, twisting of vertebrae, fixation between them). Osteophytes begin to grow, gradually pinching the spinal nerves and compressing the spinal cord.
Typical symptoms and signs
Osteochondrosis of the thoracic region has several characteristic signs, based on which this disease can probably 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 turning, neck movements, bending, raising hands, breathing (inhalation-exhalation), the pain becomes much more intense.
- The muscles of the waist and upper back undergo a severe spasm. It is also possible to contract the muscle fibers of the abdominals, lower back and shoulder girdle, which has a reflex character (develops in reaction to a sharp 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 intense at night. In the morning they soften significantly or subside, intensify with hypothermia, movements (especially vibrating and sudden) and may manifest in the form of some stiffness.
Atypical symptoms and signs
Often the symptoms of osteochondrosis located in the chest area resemble other diseases.
- Imitation of pain characteristic of cardiac pathologies (heart attack, angina pectoris). This pain can be quite long-lasting (unlike heart pain), and traditional drugs used to dilate coronary vessels do not eliminate the pain. The cardiogram also shows no changes.
- In the acute stage of thoracic osteochondrosis, long-lasting (up to several weeks) sternum pain often occurs, reminiscent of diseases of the mammary glands. They can be ruled out by an 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 a disorder of the digestive system due to damage to their innervation. In such cases, it is necessary to recognize thoracic osteochondrosis as the main disease causing such manifestations.
- If the lower chest area is damaged, the pain is concentrated in the abdominal cavity and simulates intestinal pathologies, but there is no relation to 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 the distortion of the innervation of the organs.
- Damage to the upper 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 retrosternal region.
Atypical symptoms are characterized by onset in the late afternoon, absence in the morning, and onset when precipitating factors appear.
Dorsago and dorsalgia
Signs of thoracic osteochondrosis include two spinal syndromes:
- dorsago?
- dorsally.
Dorsago is a sudden sharp pain that occurs in the chest area, 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 parts: the cervical and the thoracic.
Dorsalgia is characterized by a gradual, imperceptible development. The severity of the pain is small - sometimes one can talk about a feeling of discomfort rather than a pain syndrome. Main characteristics:
- the duration can be up to 14-20 days.
- intensification of the syndrome is observed when you bend sideways, forward or take a deep breath.
- with the upper back, the movements in the cervical region are limited, with the lower back, the movements in the lumbo-thoracic region are limited.
- the pain intensifies at night and may disappear completely when walking.
- increased pain is caused by deep breathing and prolonged stay in one position.
Diagnostics
To confirm the diagnosis, the following are performed:
- X-ray. With its help you can detect:
- changes in the anatomy of the damaged part.
- disc thickening;
- vertebral deformity and displacement.
- 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 picture of the affected area.
- Electromyography is performed to differentiate neurological symptoms that develop as a result of nerve root compression in the thoracic type of osteochondrosis. An examination is prescribed if the following points are present:
- impaired coordination of movements.
- headache;
- dizziness;
- pressure fluctuations.
- Laboratory tests - performed to determine the level of calcium in the blood and ESR (erythrocyte sedimentation rate).