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" under 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.
The reason lies in the peculiarities of the anatomical structure of the chest area:
- it is the longest (consists of 12 vertebrae);
- in this area there is a slight natural kink - physiological 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 physiological framework and bear the main load;
- in the cross-section, the spinal canal of the thoracic region has the smallest dimensions;
- 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: these are quite strong and unpleasant pains associated with pinched spinal nerves that irritate the shoulder. organs of the girdle and upper limbs located in the abdominal cavity and chest. 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 physiological kyphosis and the relatively small size of the vertebrae create the most favorable conditions for the formation of herniation of the intervertebral discs. Since a significant part of the load falls mainly on the front and lateral parts of the vertebral bodies and discs, the disc is displaced backward and a disc herniation or Schmorl hernia is formed.
The front part of the vertebrae is subjected to a greater load than the back. For this reason, very often the growth of osteophytes and prolapse of the intervertebral discs occurs outside the spine and does not affect the spinal cord.
Stages of thoracic osteochondrosis
Manifestations of thoracic osteochondrosis are determined by the changes occurring 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 stiffness, but still retain their ability to withstand normal loads. A process of disc flattening 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. The painful sensations become more intense and intensify when bending and some other movements.
- A characteristic sign of stage III is the rupture of the fibrous ring and the beginning of the herniation of the intervertebral disc.
- During the transition to stage IV, due to the lack of resistance from the disc, the vertebrae begin to move closer, which provokes spondyloarthrosis (disorders in 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, increasing its area and flattening. The affected part of the fibrous ring begins to be replaced by bone tissue, which significantly limits the movement 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 chest is distinguished not by stages, but by degrees with their characteristic features.
How does the disease manifest itself in the first degree? As a rule, it is diagnosed when the intervertebral disc ruptures, 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 referred to in cases where instability of the spine occurs and symptoms of bulging of the intervertebral discs appear. This condition is very rare, occurs with periods of exacerbation and subsequent remission, and is discovered only during a thorough diagnostic examination.
What symptoms appear in the third degree of the 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 intense headache. Difficulty breathing and disruption of the normal heart rhythm are often observed at this stage.
We can talk about moving to the fourth degree, when the manifestations of the disease decrease, while the symptoms of spinal instability continue (slipping, twisting of the vertebrae, fixation relative to each other). Osteophytes begin to grow, gradually compressing the spinal nerves and compressing the spinal cord.
Typical symptoms and signs
Osteochondrosis of the chest has quite characteristic signs, based on which this disease can most likely be diagnosed:
- Intercostal neuralgia - often the pain is localized in one area, then quickly spreads to the entire chest, forcing patients to take a certain position and greatly complicate breathing.
- When turning, moving the neck, bending, raising the arms, breathing (inhalation-exhalation), the pain becomes much more intense.
- The muscles of the middle and upper back are subjected to a strong spasm. It is also possible to contract the muscle fibers of the abdomen, lower back and shoulder girdle, which has a reflexive 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 when moving. The pain can be quite intense and 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 significantly soften or decrease, intensify with hypothermia, movements (especially vibrating and sudden) and can manifest in the form of some 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 prolonged (unlike cardialgia), while traditional drugs used to expand coronary vessels do not eliminate the pain. The cardiogram also showed no changes.
- In the acute stage of thoracic osteochondrosis, long-lasting (up to several weeks) soreness of the sternum, reminiscent of diseases of the mammary glands, often occurs. They can be ruled out by an 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 disruption 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 provokes 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 severity of pain increases mainly due to physical activity.
- Disorders of the reproductive or urinary system also develop as a result of disruption of the innervation of the organs.
- Damage to the upper segment of the chest leads to the appearance of symptoms such as pain in the esophagus and pharynx and a 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 appearance when provoking factors appear.
Dorsago and dorsalgia
Signs of thoracic osteochondrosis include two vertebral syndromes:
- dorsago;
- dorsalgia.
Dorsago is a sudden sharp pain that occurs in the chest area, mainly 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 sections: cervicothoracic and thoracolumbar.
Dorsalgia is characterized by a gradual, imperceptible development. The severity of the pain is light - sometimes we can talk about a feeling of discomfort rather than a pain syndrome. The main functions:
- the duration can be up to 14-20 days;
- intensification of the syndrome is observed when bending to the sides, forward or taking a deep breath;
- with upper dorsalgia, movements in the cervico-thoracic region are limited, with lower dorsalgia, movements in the lumbar-thoracic region are limited;
- the pain intensifies at night and can completely disappear when walking;
- increased pain is provoked by deep breathing and prolonged stay in one position.
Diagnosis
To confirm the diagnosis, the following is done:
- Radiography. With its help you can find:
- changes in the anatomy of the damaged segment;
- disc thickening;
- deformation and displacement of the vertebrae;
- 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 image 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. The examination is prescribed if the following signs are present:
- impaired coordination of movements;
- headache;
- vertigo;
- pressure fluctuations.
- Laboratory tests - conducted to determine the level of calcium in the blood and ESR (erythrocyte sedimentation rate).