Osteochondrosis of the thoracic spine

General information

Such a disease of the human musculoskeletal system as osteochondrosis is essentially 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 a number of osteoarticular pathologies with different localization, including the joints of the limbs, but most often it is used to denote degenerative-dystrophic changes in the structure directly of the spine and especially the intervertebral discs.

As a result of the progression of intervertebral osteochondrosis, the human body loses its cushioning properties, its inherent mobility and elasticity. In general, this disease of the spine is very common and in varying degrees of severity is present in most people up to 40 years of age. Depending on the affected segment of the spine in clinical practice there are cervical, lumbar and thoracic osteochondrosis, as well as their mixed forms, which are considered the most difficult.

Chest osteochondrosis, which will be discussed in this article, is the rarest form of this pathology, which is mainly due to the anatomical structure of the upper human skeleton. Thus, in the area of ​​the thorax, the osteochondral system consists of 12 vertebrae, which are connected by joints with ribs, which with their front ends adhere to a relatively monolithic sternum. 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 spine are characterized by a small height and considerable length of the spinous processes, which gives them the appearance of densely spaced 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 incidence of chest osteochondrosis in humans compared to lumbar and cervical osteochondrosis, physiological kyphosis is present in this area (natural curvature of the spine backwards), which is why mostfrom the external load falls on the anterior and lateral fragments of the vertebrae and discs. With the development of a pathological process in the segment of the spine, it is these areas are exposed mainly to degenerative changes, due to the lack of nerve endings and membranes of the spinal cord in them, the pain is most often not observed. However, in some cases, negative transformations in the thoracic segment of the spine affect posterior fragments of discs and vertebrae and / or spinal ribs, often leading to compression of the spinal nerve roots. In such conditions, osteochondrosis of the thoracic spine occurs with radicular syndrome, which is already accompanied by pain with different localization (sometimes very distant), as well as dysfunction of many organs of the human body (liver, lungs, pancreas, heartand others. ).

Due to such ambiguous and varied manifestations of thoracic osteochondrosis, doctors often call this form of pathology "chameleon disease", as it can be cleverly disguised as symptoms of respiratory and digestive diseases, heart muscle and others. In this situation, a properly conducted differential diagnosis is very important, which through various specific studies will help determine the symptoms and treatment of osteochondrosis of the thoracic spine.

The tactics and effectiveness of further therapy will largely depend on the degree of progression of the degenerative-dystrophic process in the tissues of the spine. Once the pathology has been recognized in the early stages of its development, it is important to improve the patient's condition as completely as possible with the help of simple physiotherapy techniques and exercise therapy, but in case of late detection, complex surgery may be required. That's why vertebrologists strongly recommend that you seek professional help as soon as possible for any frequent and / or prolonged back pain.

Pathogenesis

The incidence of osteochondrosis of the thoracic spine in women and men is practically identical, as in the pathogenesis of this disease there is no sexual predisposition to the occurrence of degeneration of the intervertebral discs. However, many years of clinical experience in the treatment of osteochondrosis show that its first symptoms in men appear at an earlier age than similar negative symptoms in women. In particular, this is due to the fact that osteochondral to a certain age the tissues of the female body are protected by the hormone estrogen, the decrease in the level of which during menopausal transformations serves as a trigger for spinal problems.

According to statistics, in general, intervertebral osteochondrosis of varying severity occurs in most elderly people, which automatically classifies it in the group of age-related diseases. Meanwhile, the latter time is followed by a significant "rejuvenation" of this pathology, until its appearance in preschool age. For this reason, to date it is not possible to establish the exact etiology and initial pathogenesis of spinal osteochondrosis. At one time, more than a dozen theories were developed about its origin and development, including hormonal, infectious, mechanical, vascular, hereditary, allergic and others, but in practice none of them has been fully confirmed.

Today, doctors explain the appearance of osteochondrosis with the sum of additional negative effects on the tissues of the spine, among which emphasize the constant overload of one or more spinal movementssegments formed by two adjacent vertebrae (upper and lower) and a disc located in the middlethem. Paradoxically, such overload can be a consequence of both excessive physical work on the spine and the result of its long-term finding in an unnatural posture for the back. For example, prolonged work or learning in a sitting position at the table is one of the main factors for the development of degenerative-dystrophic changes in the structure of the intervertebral disc.

The initial formation or exacerbation of osteochondrosis of the chest can be affected by poor nutrition, uneven development of the back and chest muscles, overweight (obesity), pathology of the lower extremities (eg, flat feet), back injuries and. In the pathogenesis of this disease, the disorganization of the segmental blood circulation plays a significant role, which causes dehydration of the pulpal (gelatinous) nucleus, which in turn leads to loss of amortization of the intervertebral disc, change in the loads of the surrounding fibrous ring and further gradual destruction. this segment of the spine.

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

First degree

In the initial stage of the formation of thoracic osteochondrosis in the inner membrane of the fibrous ring microcracks are formed, into which gradually begins to penetrate the nucleus pulposus, 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 directly in the middle of the back or apparent pain in the heart. He may also be haunted by a feeling of convulsive contraction. in the back muscles.

Second degree

Osteochondrosis of the thoracic spine of the 2nd degree is characterized by further destruction of the annular fibrosis, which is accompanied by instability of the spine, as a result of excessive mobility of the affected vertebrae. The pain sensations from the 2nd stage of pathology development intensify and can continue as dorsalgia (mild constant pain aggravated by the movements of the back) or dorsago (occurring abruptly against the background of prolonged stay in one position, strong "shooting" pain).

Third degree

During the third period of thoracic osteochondrosis there is a complete rupture of the structure of annular fibrosis with the nucleus pulposus going beyond its boundaries and the formation of an intervertebral hernia. Most often, such formations occur in the direction of the spinal canal, which leads to compression of the spinal cord, spinal nerves and adjacent vessels. This is accompanied by radicular syndrome (radiating pain in different parts of the body), thoracalgia on the background of osteochondrosis (severe pain behind the sternum, resembling the heart), myelopathy (sensory and motor disorders) and other symptoms of neurovascular and muscular-tonic nature. At this stage, fixed thoracic kyphosis, scoliosis or kyphoscoliosis may begin.

Fourth degree

During the last stage of thoracic osteochondrosis, degenerative processes spread to the intervertebral and yellow ligaments, other tissues of the spine and nearby muscles. Discography of the intervertebral discs continues to progress, to its scars and additional fibrosis. Deforming arthrosis develops in the moon and the intervertebral joints, osteophytes (bone growths) are formed on the processes of the vertebrae. The clinical picture in this period of the disease can be quite universal, as the degree of damage to individual discs is often different. In uncomplicated osteochondrosis, fibrosis of the problem disc may mark the transition of the disease to a stage of stable remission, but with a loss of normal functionality to one degree or another. spine.

Causes

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

• the natural process of physiological aging, accompanied by age-related changes in the structure of bone and cartilage tissue of the spine;
• genetic predisposition to abnormal formation of spinal segments;
• physically inactive lifestyle leading to back muscle dystrophy;
• strength sports, which involve excessive mechanical stress on the spine (mainly weightlifting);
• spinal injuries (even those that occurred in the distant past);
• endocrine disorders in the human body, disrupting the nutrition of the tissues of the spine;
• significantly above normal body weight (obesity);
• unhealthy diet (deficiency of vitamins, minerals and fluids);
• pathology of the spine with its unnatural bending;
• imbalance in the development of the muscular framework;
• continuous study or work in a sitting position with the body bent forward;
• physically difficult working conditions (permanent improper lifting of weights);
• serious metabolic disorders;
• flat feet and other diseases of the lower extremities affecting the redistribution of loads on the spine;
• vascular diseases that disrupt the blood supply 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 above structural features of this segment of the spine, may not directly bother the patient for a long time and appear only if the pathological process spreads to the lateral and / or posterior parts of the affected segments of the spine andthe transition of the disease to the 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

The vertebral symptoms of osteochondrosis of the thoracic segment of the spine are manifested mainly by two pain syndromes called dorsago and dorsalgia.

Dorsago

This 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. Most often, dorsago syndrome affects patients who have been sitting with the body tilted forward and abruptly changing body position. Patients describe the moment of the attack as a "dagger blow", accompanied by a sharp spasm of the spinal muscles. In addition to severe pain, subjective sensations with the back expressed by shortness of breath and a significant restriction of freedom of movement in the chest and back. Such exacerbations of osteochondrosis with periodic attacks can last up to two weeks.

Dorsalgia

This syndrome differs from the previous one in the gradual development of discomfort and pain, which may increase over two to three weeks. The pain itself in dorsalgia 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 subjected to significant stress, which can make the patient feel short of breath. Back pain increases with movements of the trunk (especially when bending over), deep breathing, coughing and more. Separately, the upper dorsalgia (the main localization of negative phenomena in the cervicothoracic segment of the spine) and the lower dorsalgia (the main localization of the negative phenomena in the thoracolumbar segment of the spine).

Extravertebral syndromes

Extravertebral syndromes of thoracic osteochondrosis, due to the greatest degree of this part of the spine, can be very diverse, which greatly complicates the correct diagnosis of the disease. They occur as a result of mechanical compression of the respective nerve roots, adjacent vessels or the spinal cord itself. The symptoms of compression in men and women are usually similar and differ only when the pathological impulses spread in the genital area (for example, in men, against the background of the disease, sometimes there is erectile dysfunction). In almost all cases, extravertebral symptoms are caused by already formed intervertebral hernias, which most commonly occur in the lower thoracic region, but can generally occur in any spinal segment from the D1 vertebra to the D12 vertebra. As you can see in the picture below, it is on the localization of osteochondrosis in them involved pathological process of certain systems and organs of the human body with their characteristic negative manifestations.

Radical syndromes

Within the compression symptoms of thoracic osteochondrosis, radicular syndromes provoked by compression of nerve endings in one or another segment of the spine are most often and clearly observed. Depending on the concentration, such problems of patients can be affected by the following painful phenomena:

• in violation of the T1 vertebra - painful sensations and paresthesias from the upper thoracic spine segment of the spine most often spread to the suprascapular area in the area of ​​one of the armpits to the elbow joint;
• in case of T2-T6 vertebral disorder - pain such as intercostal neuralgia may extend from this part of the spine along the interscapular area and surround the axillary and scapular areas in a semicircle, as well as 2-6 intercostal spacessternum;
• in case of vertebral disorder T7-T8 - the pain in the waist spreads mainly from the lower level of the scapulae of the spinal-costal joints to the upper parts of the costal arch and affects the epigastric region, where it causes muscular protection (strong muscle tension);
• in case of a disorder in the area of ​​the vertebrae T9-T10 - the intercostal neuralgia extends from the lower thoracic vertebral segments of the spine to the lower parts of the costal arch and further to the umbilical region, changing the tone of the middle abdominal muscles;
• in case of a disorder in the area of ​​the vertebrae T11-T12 - the pain is also emitted from the lower thoracic spinal segments of the spine and reaches the hypogastric (under the stomach) and groin areas on the respective lateral areas of the chest.

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

Thus, when the process of osteochondrosis is localized in the upper part of the thorax of the spine (from T1 to T4), patients may experience pain and / or various discomfort in the esophagus or pharynx, which are often perceived as the presence of foreignbody. Such sensations are often paroxysmal (sometimes permanent) and are exacerbated by severe strain on the problem part of the back. Sometimes the manifestations of radicular syndrome in the upper thoracic segment are confused with signs of obstructive bronchitis or pneumonia, as the reflex cough with osteochondrosis of the chest and chest pain resemble the symptoms of this group of diseases. Also, chest pain may appear in the form of thoracic pain, reminiscent 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 doctors.

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

With radicular manifestations of osteochondrosis in the lower part of the 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 often, patients experience pain similar to the pathological clinic of the bladder in the suprapubic region. As in the previous case, the nature of such pain can vary quite widely (from mild to intense) and their severity increases with prolonged physical or static tension in the spine, sneezing, coughing, etc.

Compression myelopathy

This compression syndrome of thoracic osteochondrosis is quite rare and is a compression of the spinal cord directly from the resulting intervertebral hernia. . . Its characteristic symptoms in the beginning are expressed by local pain in the relevant area of ​​the back or pain in the waist in the problem area, as well as a feeling of weakness and / or tingling in the legs. As the pain progresses, it may increase downstream of the intercostal space, abdominal organs, groin, and may be significantly felt in the lower extremities. In severe cases, on the background of compression myelopathy, pelvic dysfunction may develop, leading to impaired defecation and / or urination. In addition, there may be severe superficial and deep paresthesias and sensory disturbances, up to spastic paresis or even both legs.

Vascular compression

Compression of the vessels adjacent to the thoracic segment of the spine leads to myeloischaemia, resulting in impaired blood supply, and hence proper nutrition of the spinal cord. The manifestations of this syndrome actually completely repeat the symptoms of compression myelopathy and are characterized mainly by pelvic disorders, as well as loss of sensation in the lower extremities and a decrease in their functionality. Patients often describe this problem with the phrase "legs fail. "

Vegetative syndromes

In many cases, thoracic osteochondrosis damages the autonomic nerve nodes (ganglia), as a result of which the patient may experience a wide variety of negative symptoms. These can be various paresthesias. , itching and changes in skin pigmentation in the area of ​​the problem ganglion, pain when burning half of the body, disturbances in local temperature, hyper- or muscle loss, disorganization in the work of limbs or internal organs, etc. According to him, in fact, these visceral vertebrogenic symptoms are similarof the manifestations of radicular syndromes, but differ from them in the absence of clear localization and the presence of secretory and motor disorders. When involved in the pathological process of an asterisk affecting the upper thoracic vertebrae, there may be disorders in the arms, upper chest and heart. In case of damage to the lower thoracic ganglia, functional disorders of the pelvis, abdominal and thoracic cavities, as well as trophic changes in the lower extremities and the rest of the body may occur.