Osteochondrosis of the thoracic spine

General Information

Such a disease of the human musculoskeletal system as osteochondrosis is basically a degeneration of articular cartilage and nearby bone tissue, with frequent involvement of adjacent vessels, muscles and nerve endings in the pathological process. In principle, this term can mean numerous osteoarticular pathologies of various localizations, including joints of the extremities, but it is most often used to denote degenerative-dystrophic changes in the structure of the direct spine and, above all, intervertebral discs.

As a result of the progression of intervertebral osteochondrosis, the human body loses its shock-absorbing properties, its inherent mobility and elasticity. In general, this disease of the spinal column is very widespread and in one or different degrees of severity it is present in most people up to the age of 40. Depending on the affected segment of the spine in clinical practice, cervical, lumbar and thoracic osteochondrosis are distinguished, as well as their mixed forms, which are considered the most severe.

Osteochondrosis of the thoracic spine, which will be discussed in this article, is the rarest form of this pathology, which is especially due to the anatomical structure of the upper part of the human skeleton. Thus, in the thoracic region, the osteochondral system consists of 12 vertebrae connected by joints with ribs that join a relatively monolithic sternum at their anterior ends. Such a skeletal structure provides a sufficiently rigid and strong frame that protects the organs of the thoracic cavity (heart, lungs) from injury. In addition, the vertebrae of this segment of the spinal column are characterized by a small height and a significant length of spinous processes, which gives them a view of well-placed plates. All this together limits the mobility of this part of the back and the negative effect of physical activity on it, protecting the intervertebral discs from destruction.

As another reason for the lower frequency of detection of osteochondrosis of the chest in a person, compared to lumbar and cervical osteochondrosis, physiological kyphosis (natural backward bending) is present in this area, due to which the majority of external load falls on the anterior and lateral fragments of the spine. and disks. With the development of the pathological process in the segment of spinal movement, these areas are primarily exposed to degenerative changes, however, due to the absence of nerve endings and membranes of the spinal cord in them, pain is usually not noticed. However, in some cases, negative transformations in the thoracic segment of the spinal column are affected by posterior fragments of discs and vertebrae and / or spinal-rib joints, which often leads to compression of the spinal nerve roots. In such conditions, osteochondrosis of the thoracic spine occurs with radicular syndrome, which is accompanied by pain of various localizations (sometimes very distant), as well as violation of the functionality of many organs of the human body (liver, lungs, pancreas, heart, etc. ).

Due to such ambiguous and diverse manifestations of thoracic osteochondrosis, doctors often call this form of pathology "chameleon's disease", because it can be skillfully disguised as symptoms of respiratory and digestive diseases, heart muscle, etc. In this situation, a correctly performed differential diagnosis is very important, which will help determine the symptoms and treat osteochondrosis of the thoracic spine through various specific studies.

The tactics and effectiveness of further therapy will largely depend on the degree of progression of the degenerative-dystrophic process in the spinal tissues. Recognition of pathology in the initial stages of its development is important for improving the patient's condition with the help of simple physiotherapeutic techniques and exercise therapy, but in case of late detection, it may be necessary to perform complex surgery. That is why vertebrologists warmly recommend that any frequent and / or long-lasting back pain seek professional help as soon as possible.

Pathogenesis

The incidence of osteochondrosis of the thoracic spine in women and men is almost identical, because in the pathogenesis of this disease there is no gender predisposition for the occurrence of degeneration of the intervertebral disc. Nevertheless, many years of clinical experience in the treatment of osteochondrosis indicate that the first symptoms in men appear at an earlier age than similar negative symptoms in women. This is especially due to the fact that the osteochondral tissues of the female body are protected by the hormone estrogen until a certain age, whose decline during climate transformations serves as a trigger for spine problems.

According to statistical evidence, generally intervertebral osteochondrosis of varying severity is found in most elderly people, which automatically classifies it as a group of age-related diseases. In the meantime, lately there has been a significant "rejuvenation" of this pathology, all the way to its appearance in preschool age. For that reason, it has not been possible to determine the exact etiology and initial pathogenesis of spinal osteochondrosis until today. At one time, more than a dozen theories about its origin and development were developed, including hormonal, infectious, mechanical, vascular, hereditary, allergic and others, but in practice none of them found complete confirmation.

Today, doctors explain the occurrence of osteochondrosis by the sum of complementary negative effects on spinal tissues, among which they point out the constant overload of one or more movements of the spinal segments formed by two adjacent vertebrae (upper and lower) and the disc located in their middle. Paradoxically, such overload can be a consequence of excessive physical work of the spine, and the result of its long-term finding in an unnatural back position. For example, prolonged work or learning in a sitting position at a table is one of the primary factors in the development of degenerative-dystrophic changes in the structure of the intervertebral disc.

The initial formation or worsening of osteochondrosis of the thoracic spine can be affected by improper diet, uneven development of the back and chest muscles, overweight (obesity), pathology of the lower extremities (for example, straight legs), back injuries, etc. In the pathogenesis of this disease, the disorganization of segmental blood circulation plays a significant role, which causes dehydration of the pulpal (gelatinous) nucleus, which in turn leads to loss of amortization qualities of the intervertebral disc, change of load on the surrounding annular fibrosus and further gradual destruction of this segment of spine.

In the process of its progression, thoracic osteochondrosis goes through 4 consecutive stages of development, each of which is characterized by its own anatomical and morphological changes in the structure of the disc, adjacent vertebrae and facet joints. In addition, the negative metamorphoses that take place in this disease can directly affect other nearby tissues (muscles, blood vessels, connective tissue) or indirectly affect the work of distant organs and systems of the human body. (intestines, heart, lungs, etc. ).

First degree

In the initial phase of thoracic osteochondrosis formation, microcracks form on the inner membrane of the fibrous ring into which the nucleus pulposus gradually begins to penetrate, irritating the nerve endings in the distal layers of the fibrous rings and in the longitudinal posterior ligament. At this stage of the disease, the patient may already feel pain in the middle of the back or apparent pain in the heart area. He may also be haunted by a convulsive contraction. in the back muscles.

Second degree

Grade 2 osteochondrosis of the thoracic spine is characterized by further destruction of the annular fibrosus, which is accompanied by instability of the spinal column, which is a consequence of excessive mobility of its affected vertebrae. Pain sensations from the 2nd phase of pathology development intensify and can take place as dorsalgia (mild permanent pain, intensified by back movements) or dorsago (which suddenly occurs in the background of a long stay in one position, strong "shooting" pain).

Third degree

In the third period of thoracic osteochondrosis, there is a complete rupture of the structure of the annular fibrosus with the protrusion of the nucleus pulposus outside its borders and the formation of an intervertebral hernia. Most often, such formations occur in the direction of the vertebral canal, which leads to compression of the spinal cord, spinal nerves and adjacent vessels. This is accompanied by radicular syndrome (radiating pain to different parts of the body), thoracalgia on the background of osteochondrosis (severe pain behind the sternum, nalixed), myelopathy (sensory disorders and movement disorders) and other symptoms of neurovascular and muscular-tonic nature. Fixed thoracic kyphosis, scoliosis, or kyphoscoliosis may begin at this stage.

Fourth degree

During the final phase of thoracic osteochondrosis, degenerative processes spread to the interspinous and yellow ligaments, other spinal tissues and nearby muscles. Intervertebral disc dystrophy continues to progress, all the way to the tendons and further fibrosis. Deforming arthrosis develops in the lunar and intervertebral joints, osteophytes (bone growths) occur in the processes of the vertebrae. The clinical picture in this period of the disease can be quite versatile, because the degree of damage to individual discs is often different. In uncomplicated osteochondrosis, fibrosis of the problematic disc may mark the transition of the disease to a phase of stable remission, but with the loss of normal functionality to one degree or another. spinal column.

Reasons

Thoracic osteochondrosis in men and women can develop due to the following predisposing factors:

• natural process of physiological aging, accompanied by age-related changes in the structure of bone and cartilage tissue of the spine;
• genetic predisposition for abnormal formation of spinal movement segments;
• physically inactive lifestyle leading to back muscle dystrophy;
• strength sports involving excessive mechanical stress on the spine (primarily weightlifting);
• spinal injuries (even those that have occurred in the distant past);
• endocrine disorders in the human body, disrupting the nutrition of spinal tissues;
• significantly above normal body weight (obesity);
• unhealthy diet (lack of vitamins, minerals and fluids);
• pathology of the spine with its unnatural bending;
• imbalance in the development of the muscular framework;
• extended learning or work in a sitting position with the body bent forward;
• physically difficult working conditions (constant improper weight lifting);
• serious metabolic disorders;
• flat feet and other diseases of the lower extremities, which affect the redistribution of the load on the spine;
• vascular diseases that impede blood flow to the back;
• severe infectious, allergic and autoimmune processes;
• frequent hypothermia;
• stressful situations and nervous exhaustion;
• bad habits and smoking.

Symptoms of osteochondrosis of the thoracic spine

Signs of thoracic osteochondrosis, due to the structural characteristics of this segment of the spine described above, may not bother the patient for a long time and appear only if the pathological process spreads to the lateral and / or back parts of the affected segments of the spine and second or third degree. In general, all symptoms of thoracic osteochondrosis are expressed in the form of vertebral syndromes (painful effects directly related to functional disorders in the bone and cartilage tissue of the spine) and extravertebral or compression syndromes (negative phenomena arising from pathological impulses from the problematic segment of the spine).

Vertebral syndromes

Vertebral symptoms of osteochondrosis of the thoracic spine are mainly manifested by two pain syndromes, called dorsago and dorsalgia.

Dorsago

It is an acute and sudden attack of pain, the so-called "lumbago", which is localized in the interscapular space and can occur at any time. Dorsago syndrome most commonly affects patients who have already been in a sitting position with the body tilted forward and a sharp change in body position. Patients themselves describe the moment of the attack as a "dagger blow", followed by a sharp spasm of the spinal muscles. In addition to severe pain, there are also subjective sensations with the back expressed by shortness of breath and a significant restriction of freedom of movement in the chest. A similar worsening of osteochondrosis with periodic attacks can last up to two weeks.

Dorzalgia

This syndrome differs from the previous one by the gradual development of unpleasant and painful sensations, which can intensify over two to three weeks. The pain in dorsalgia itself is not so pronounced, but its prolonged presence causes a constant feeling of anxiety. The back muscles, as well as during the back muscle, are exposed to significant stress, due to which the patient can feel the lack of inhaled air. Back pain increases with torso movements (especially when bending), deep breathing, coughing, etc. Separately, upper dorsalgia (main localization of negative phenomena in the cervical spine segment) and lower dorsalgia (main localization of negative phenomena in the Tuesday-lumbar segment of the spine).

Extravertebral syndromes

Extravertebral syndromes of thoracic osteochondrosis, due to the large volume of this part of the spine, can be very diverse, which greatly complicates the accurate diagnosis of the disease. They occur as a result of mechanical compressions of the corresponding nerve roots, nearby veins or the spinal cord itself. The symptoms of compression in men and women are generally similar and differ only when pathological impulses spread to the spolsphere (for example, in men, erectile dysfunction is sometimes observed in the background of the disease). In almost all cases, extravertebral symptoms are caused by already formed intervertebral hernias, which most often occur in the lower part of the thoracic region, but in principle they can be formed in any segment of the spine from the D1 vertebra to the D12 vertebra. As you can see in the picture below, it is the localization of osteochondrosis in them that is involved in the pathological process of certain systems and organs of the human body with negative manifestations characteristic of them.

Radicular syndromes

Within the symptoms of compression of thoracic osteochondrosis, radicular syndromes are most often and clearly noticed, caused by compression of nerve endings in one or another segment of the spinal column. Depending on the concentration, such problems of patients can disrupt the following painful phenomena:

• in case of injury in the area of ​​T1 spine - painful sensations and paresthesias from the upper segment of spinal cord movement usually spread along the suprascapular zone in the area of ​​one of the armpits to the elbow joint;
• in case of injury in the area of ​​the vertebrae T2-T6 - pain such as intercostal neuralgia may extend from this part of the spine along the interscapular region and semicircularly round the axillary and scapulae, as well as 2-6 intercostal space of the sternum;
• in case of injury in the area of ​​T7-T8 vertebrae - the pain in the waist mostly spreads from the lower level of the shoulder blades to the upper parts of the rib arch and affects the epigastric region, where it causes muscular defense (strong muscle tension);
• in case of injury in the area of ​​the vertebrae T9-T10 - intercostal neuralgia spreads from the lower segments of the spinal cord to the lower parts of the rib arch and further to the umbilical region, changing the tone of the middle part of the abdominal muscles;
• in case of injury in the area of ​​T11-T12 vertebrae - the pain also arises from the lower thoracic segments of the spine and reaches the hypogastric (below the stomach) and groin along the corresponding lateral zones of the chest.

In addition to pain, radicular syndromes of thoracic osteochondrosis are often accompanied by negative symptoms of certain internal organs of the abdominal cavity and / or chest. Moreover, in some cases such symptoms are so similar to the pathological manifestations of other diseases that it is almost impossible to accurately identify their affiliation without targeted research. For example, the medical literature describes a case of inappropriate behavior of appendectomy (surgery to remove the appendix) according to the unequivocal clinic of acute appendicitis, which in fact proved to be one of the pronounced osteochondrosis syndromes.

Thus, when the process of osteochondrosis is localized in the upper thoracic spine (T1 to T4), patients may experience pain and / or various discomfort in the esophagus or pharynx, which is often perceived as the presence of a foreign body. Such sensations are often paroxysmal (sometimes permanent) and are intensified by severe strain on the problematic part of the back. Sometimes the manifestations of radicular syndrome in the upper thoracic segment are confused with signs of obstructive bronchitis or pneumonia, because reflex cough with osteochondrosis of the thoracic region and chest pain resemble the symptoms of this group of diseases. Also, chest pain can occur in the form of thoracalgia, which reminds of its intensity is an attack of angina pectoris, pulmonary thromboembolism, myocardial infarction and other similar pathologies of a serious nature, which requires a detailed differential analysis by a doctor.

Patients with osteochondrosis in the middle thoracic segment of the spine (T5 to T7) most often have discomfort and pain in the solar plexus and stomach, which is called vertebral gastralgia. On the spinal movements of the T8-T9 segments, it is possible to develop pain in the duodenal area, called - vertebrogenic duodenalgia. . . Both these and other painful sensations in different patients or in different intensity of time can vary from mild and "painful" to extremely acute. They are intensified, as a rule, by prolonged stay of the body in one position (sitting at a table, lying on your back, etc. ), in case of sudden body movements, and also at the moment of sneezing or coughing. Often these pains are accompanied by paresthesias. (numbness, tingling, tingling) in the middle of the abdominal wall.

With radicular manifestations of osteochondrosis in the lower thoracic spine (T8 to T12), some patients may complain of pain in the lower abdominal cavity, mimicking intestinal disorders or pathology. Sometimes the pain spreads to the gallbladder and is localized in the back of the right hypochondrium. Even less frequently, patients experience pain in the suprapubic region similar to a pathological bladder clinic. As in the previous case, the nature of such pains can vary in a fairly wide range (from mild to intense), and their severity increases with prolonged physical or static stress on the spine, sneezing, coughing, etc.

Compression myelopathy

This compression syndrome of thoracic osteochondrosis is quite rare and represents compression of the spinal cord directly caused by intervertebral hernia. . . Characteristic symptoms at the beginning of the formation are expressed by local pain in the corresponding area of ​​the back or pain in the waist in the problem area, as well as a feeling of weakness and / or numbness in the legs. As it progresses, the pain intensifies, may affect the lower diointercostal space, abdominal organs, groin area, and is significantly felt in the lower extremities. In severe cases with compression myelopathy, pelvic organ dysfunction can develop, leading to disorders of the defecation process and / or urination. In addition, there may be severe superficial and deep paresthesias and sensory disturbances, all the way to spastic paresis of one or even both legs.

Vascular compression

Compression of the vessels along the thoracic segment of the spine leads to myelochemistry, which leads to a violation of the blood supply, and thus the proper nutrition of the spinal cord. Manifestations of this syndrome are actually completely repeat the symptoms of compression myelopathy, they are mainly characterized by pelvic disorders, as well as loss of sensation in the lower limbs and a decrease in their functionality. Patients often describe this problem with the phrase - "legs fail".

Vegetative syndromes

In so many cases, in thoracic osteochondrosis, the vegetative nerve nodes (ganglia) are damaged, as a result of which the patient can experience a wide range of negative symptoms. These can be various paresthesias. , itching and changes in the pigmentation of the skin in the area of ​​the problematic ganglion, burning of the painful half of the body, local temperature disorders, hyper or exhaustion of the muscles, disorganization in the work of the limbs or internal organs, etc. According to him, these visceral vertebrogenic symptoms are similar to the manifestations of radicular syndromes, but differ from them in the lack of clear localization and the presence of secretory and motor disorders. When a stellate node is involved in the pathological process affecting the upper thoracic spine, it can lead to a violation of the arms, upper chest and heart. In case of damage to the lower thoracic ganglia, functional disorders of the pelvic organs, abdominal and thoracic cavities, as well as trophic changes in the lower extremities and the rest of the body can occur.