Osteochondrosis of the thoracic spine

General information

Diseases of the human musculoskeletal system such as osteochondrosis are essentially the deterioration of nearby articular cartilage and bone tissue, with frequent involvement of nearby channels, muscles and nerve endings in pathological processes. In principle, this term can mean a number of osteoarticular pathologies of various localizations, including with the extremity joint, but is most often used to indicate degenerative-dystrophic changes in the structure directly to the spine and especially the intervertebral disc.

As a result of the development of intervertebral osteochondrosis, the human body loses the inherent qualities of shock absorption, mobility and elasticity. In general, the disease in the spine is very widespread and occurs at a different or severe degree of severity found in most people at the age of 40 years. Depending on the segment of the spine affected in clinical practice, cervical, lumbar and thoracic osteochondrosis are distinguished, as well as their mixed forms, which are considered the most difficult.

Osteochondrosis of the thoracic spine, which will be discussed in this article, is the most rare form of pathology, which, in particular, is due to the anatomical structure of the upper part of the human skeleton. Thus, in the chest area, the osteochondral system consists of 12 vertebrae, which are connected through a joint with the ribs, which with its anterior end adjacent to the relatively monolithic sternum. Such a skeletal structure provides a rigid, strong skeleton that protects the chest cavity (heart, lungs) from injury. In addition, the spinal segment of this spinal segment is characterized by the small height and length of the spinous process, which gives them a proximity tile display. All of this together limits the movement of this back and the negative effects of physical activity on it, protecting the intervertebral disc from damage.

As another reason for the frequency of detecting chest osteochondrosis in a lower person, compared to lumbar and cervical osteochondrosis, physiological kyphosis (bending of the back of the natural spine) appears in this area, as most of the external load falls on vertebrae and disc fragments. anterior and lateral. With the development of pathological processes in the spinal movement segment, this area is prone to degenerative changes, however, due to the absence of nerve endings and spinal cord membranes in them, pain is most often overlooked. However, in some cases, negative transformation of the thoracic segment of the spinal space affects the posterior fractures of the disc and vertebral and / or vertebra-costal joints, which often lead to compression of the spinal nerve roots. In such cases, osteochondrosis of the thoracic spine occurs with radicular syndrome, which is accompanied by pain of various localization (sometimes very distant), as well as a violation of the function of many organs of the human body (liver, lungs, pancreas, heart, etc. ).

Due to the vague and varied manifestations of thoracic osteochondrosis, doctors often refer to this form of pathology as "chameleon disease", as it can disguise itself as respiratory and digestive disease skills, heart muscle, etc. In this situation, the correct differential diagnosis is very important, which, through various specialized studies, will help determine the symptoms and treatment of thoracic spine osteochondrosis.

The tactics and effectiveness of advanced therapy will largely depend on the degree of development of degenerative-dystrophic processes in the spinal tissues. Having identified the pathology in the early stages of its development, it is important to improve the patient's condition as much as possible with the help of simple physiotherapeutic techniques and exercise therapy, but if the detection is late, it may be necessary to perform complex surgical operations. That is why vertebrologists strongly recommend frequent and / or prolonged back pain as soon as possible seek specialist help.

Pathogenesis

The incidence of thoracic spine osteochondrosis in women and men is almost the same, because in the pathogenesis of this disease there is no gender predisposition to the occurrence of intervertebral disc degeneration. Even so, years of clinical experience in the treatment of osteochondrosis show that the 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, a decrease in the level of which at the time of climax transformation serves as a trigger for problems in the spine.

According to statistical evidence, in general, intervertebral osteochondrosis at varying degrees of severity is present in most elderly people, who automatically classify it into age-related disease groups. Meanwhile, the latter is followed by significant "rejuvenation" of this pathology, until its occurrence at preschool age. For this reason, it is not possible to determine the etiology and early pathogenesis of spinal osteochondrosis to this day. At one time, more than a dozen theories of origin and development were developed, including hormonal, infectious, mechanical, vascular, hereditary, allergic and others, but in practice no one found full confirmation.

Today, doctors describe the occurrence of osteochondrosis with a number of complementary negative effects on spinal tissue, among which they emphasize the constant excessive load on one or more spinal movements formed from two adjacent vertebrae (upper and lower) and discs located inthe middle. Paradoxically, such an overload can be the result of both excessive physical work of the spine, and as a result of its long-term discovery in an improper position for the back. For example, prolonged work or study in a sitting position at a desk is one of the major factors in the development of degenerative-dystrophic changes in the intervertebral disc structure.

Early formation or worsening of osteochondrosis of the thoracic spine can be influenced by improper nutrition, development of uneven back and thoracic muscles, overweight (obesity), pathology of the lower extremities (e. g. , flat feet), back injuries, etc. . In the pathogenesis of the disease, segmental circulatory disorganization plays an important role, leading to dehydration of the pulp (gelatinous) nuclei, which in turn leads to loss of quality of the intervertebral disc, loss of load on the surrounding fibrous rings and gradual destruction of this spinal movement segment.

In its developmental process, thoracic osteochondrosis goes through 4 consecutive stages of development, each characterized by distinct anatomical and morphological changes in the structure of the disc, vertebrae and adjacent facets of the joint. In addition, the negative metamorphosis that occurs with this disease can directly affect other nearby tissues (muscle, vascular, connective) or indirectly affect the work of organs and systems away from the human body. (intestine, heart, lungs, etc. ).

First degree

In the early stages of the formation of thoracic osteochondrosis, microcrats form on the inner membrane of the fibrous ring, where the nucleus of the pulposus gradually begins to penetrate, irritating the nerve endings in the distal layer of the fibrous ring and in the longitudinal posterior ligaments. At the stage of development of the disease, the patient may already feel pain directly in the middle of the back or feel pain in the heart. He may also be haunted by feelings of contraction cramps. on the back muscles.

Second degree

2nd degree thoracic spine osteochondrosis is characterized by destruction of the annulus fibrosus, which is accompanied by instability of the spinal space, caused by excessive movement of the affected spine. Painful sensation from the 2nd stage of pathological development is increasing and can persist as dorsalgia (slight persistent pain, exacerbated by back movement) or dorsago (arising sharply with a prolonged stay background 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 annulus fibrosus with the exit of the pulposus nucleus beyond its borders and the formation of an intervertebral hernia. Often, such formations arise in the direction of the vertebrae, leading to compression of the spinal cord, spinal cord and adjacent ducts. This is accompanied by radicular syndrome (transmitting pain to different parts of the body), thoraxalgia against the background of osteochondrosis (severe pain in the back of the sternum, resembling the heart), myelopathy (sensory and motor disorders) and other neurovascular and muscle-tonic symptoms. Improving thoracic kyphosis, scoliosis, or kyphoscoliosis may begin at this stage.

Fourth grade

During the final stages of thoracic osteochondrosis, the degenerative process spreads to the interspinous and yellow ligaments, spinal tissue and adjacent muscles. Intervertebral disc dystrophy continues to progress, leading to scarring and subsequent fibrosis. In the lunate and intervertebral joints, deformed arthrosis develops, osteophytes (bone growth) form in the vertebral process. The clinical picture in this disease can be versatile, as the degree of damage to individual discs often varies. In uncomplicated osteochondrosis, problematic disc fibrosis can signal the transition of the disease to a stable degree of remission, but with loss of normal function to one degree or another. spinal chamber.

Reason

Thorax 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 tissue structure of the cartilage of the spine;
• genetic predisposition to the formation of abnormal spinal movement segments;
• a physically inactive lifestyle that causes dystrophy of the back muscles;
• strength sports involving excessive mechanical stress on the spine (especially weightlifting);
• spinal injuries (even in the past);
• endocrine disorders in the human body, disrupting the nutrition of spinal tissues;
• far above normal weight (obesity);
• unhealthy diet (lack of vitamins, minerals and fluids);
• pathology of the spine with its improper bending;
• imbalance in muscle skeletal development;
• prolonged study or work in a sitting position with body bent forward;
• physically difficult working conditions (irregular weight gain);
• serious metabolic disorders;
• flat feet and other diseases of the lower extremities, affecting the redistribution of load on the spine;
• vascular disease that interferes with blood supply to the back;
• severe infection, allergic and autoimmune processes;
• frequent hypothermia;
• depressed state and nervous exhaustion;
• bad habits and smoking.

Symptoms of osteochondrosis of the thoracic spine

The signs of thoracic osteochondrosis, due to the structural features of the spinal segment described above, may not directly affect the patient for a long time and appear only if the pathological process spreads to the lateral and / or the posterior segments of the affected spinal cord andthe transition of the disease to the second or third stage. In general, all symptoms of thoracic osteochondrosis are expressed in the form of vertebral syndrome (painful effects directly related to functional disorders of the cartilage tissue of the spine) and extrvertebral syndrome or compression (negative phenomena arising from pathological impulses from problem segments in the spine). zxp>

Vertebral syndrome

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

Dorsago

This is an acute and sudden onset of pain, called "lumbago", which is localized in the interscapular space and can occur at any time. Often, dorsago syndrome affects a patient who is in a sitting position with the body tilted forward and changes body position sharply. The patient described the moment of attack as a "dagger blow", accompanied by a sharp spasm of the spinal muscles. In addition to severe pain, subjective sensations with the back are expressed by shortness of breath and significant restriction of freedom of movement in the posterior chest. The worsening of osteochondrosis similar to periodic attacks can last up to two weeks.

Dorsalgia

This syndrome is different from the previous one by the gradual development of uncomfortable and painful sensations, which can increase for two to three weeks. The pain itself with dorsalgia is not very noticeable, but its prolonged presence causes a constant feeling of anxiety. The back muscles, as well as the back muscles, experience significant stress, which can cause the patient to feel short of breath. Back pain increases with trunk movement (especially when bending), deep breathing, coughing, etc. Upper dorsalgia (primary localization of negative phenomena in the cervical cothorax segment) and lower dorsalgia (localization of major negative phenomena in the thoracicumbar spine).

Extravertebral Syndrome

Throat extrvertebral osteochondrosis of the thorax, because most of these parts of the spine, can be very diverse, which greatly complicates the correct diagnosis. They arise as a result of mechanical compression of the appropriate nerve root, the adjacent duct or the spinal cord itself. Symptoms of compression in men and women are generally similar and differ only when pathological impulses spread to the sexual sphere (e. g. , in men, against the background of the disease, erectile dysfunction is sometimes observed). In almost all cases, extravertebral symptoms are caused by an already formed intervertebral hernia, which most often appears in the lower part of the thoracic region, but in principle it can form in the segment of spinal movement from vertebra D1 to vertebra D12. As you can see in the picture below, this is the localization of osteochondrosis in those involved in the pathology of certain human body systems and organs with negative manifestations of their characteristics.

Radicular syndrome

In the framework of symptoms of thoracic osteochondrosis compression, radicular syndrome is most often and clearly observed, caused by compression of the nerve endings on one or another segment of the spinal space. Depending on the concentration, such a problem the patient may be disturbed by the following painful phenomena:

• in the event of a violation in the T1 vertebral area - painful sensations and paresthesia from the segment of movement of the upper thoracic spine most often spread along the suprascapular zone to the area of ​​one armpit to the elbow joint;
• in the event of a violation in the T2-T6 vertebral area - pain such as intercostal neuralgia can extend from this part of the spinal space along the interscapular area and around the axillary and scapular zones in a semicircle, as well as the intercostal space 2-6 to the sternum;
• in the event of a violation in the T7-T8 vertebral region - girdle pain mainly spreads from the lower level of the shoulder blade of the spine-costal joint to the upper part of the costume arch and affects the epigastric region, where it causes muscle resistance (strong muscle tension);
• in the event of a violation in the T9-T10 vertebral region - intercostal neuralgia develops from the segment of thoracic spine movement to the lower part of the costume arch and then to the umbilical region, changing the tone of the central abdominal muscles;
• in the event of a violation in the T11-T12 vertebral region - the pain also stems from the segment of movement of the lower thoracic spine and reaches the hypogastric area (below the abdomen) and the crotch along the appropriate lateral zone of the chest.

In addition to pain, radicular osteochondrosis of the thorax is often accompanied by negative symptoms from certain internal organs of the abdominal and / or chest cavities. Moreover, in some cases, such symptoms are so similar to the pathological manifestations of other diseases that it is almost impossible to identify their belonging accurately without directed research. For example, the medical literature describes cases of unauthorized behavior appendectomy (surgical intervention to remove the appendix) according to the clinic of unclear acute appendicitis, which actually turns out to be one of the osteochondrosis syndromes.

Thus, when the osteochondrotic process is localized in the thoracic area of ​​the upper spine (from T1 to T4), the patient may feel pain and / or various discomfort in the esophagus or pharynx, which is often thought of as the presence of a foreign body. Such sensations often become paroxysmal (sometimes permanent) and increase with serious load on the problematic 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 area and chest pain resemble the symptoms of this group of diseases. Also, chest pain can occur in the form of thoraxalgia, which reminds of its severity are angina pectoris attacks, pulmonary thromboembolics, myocardial infarction and other serious similar pathologies, which require detailed differential analysis from a physician.

Patients with osteochondrosis in the mid-thorax segment of the spinal space (T5 to T7) most often feel discomfort and pain in the solar plexus and abdomen, called gastralgia vertebra. In the defeat of the T8-T9 spinal movement segment, pain in the duodenal region is possible, referred to as vertebral duodenalgia. . . Both and other painful sensations in different or distinct patients vary in intensity from mild and “painful” to very acute. They intensify, as a rule, with prolonged body conditions in one position (sitting at a table, lying on the back, etc. ), in case of sudden body movements, as well as when sneezing or coughing. Often this pain is accompanied by paresthesia. (numbness, tingling, burning) in the middle of the abdominal wall.

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

Compressed myelopathy

This thoracic osteochondrosis compression syndrome is relatively rare and is a direct spinal compression by the resulting intervertebral hernia. . . Symptoms especially at the onset of formation are expressed by local pain in the appropriate area of ​​the back or girdle pain in the problem area, as well as feelings of weakness and / or numbness in the legs. With development, the pain increases, it can affect the downstream of the intercostal space, abdominal organs, groin area and significantly on the lower part of the foot. In severe cases with compressive myelopathy the function of the pelvic organs can develop, which causes disruption of the process of defecation and / or urination. In addition, there may be severe superficial and sensory paresthesia and sensory disturbances, up to one-sided spastic paresis or both legs.

Vascular Compression

Compression of the ducts adjacent to the thoracic part of the spine leads to myeloischemia, as a result of which blood supply is disrupted, and therefore proper spinal cord nutrition. The manifestation of this syndrome actually completely repeats the symptoms of compression myelopathy and is mainly characterized by pelvic disorders, as well as loss of sensation in the lower limbs and a decrease in their function. Patients often describe this problem with the expression - "legs fail".

Vegetative syndrome

In some cases, with thoracic osteochondrosis, the vegetative nerve nodes (ganglia) are damaged, as a result of which patients may experience a variety of negative symptoms. This can be a variety of paresthesia. , itching and changes in skin pigmentation in problem areas of the ganglion, pain in the burning half of the body, disturbances in local temperature, waste of hyper or muscle, structuring in the work of limbs or internal organs, etc. According to him, these visceral vertebrogenic symptoms are similar to the manifestations of radicular syndrome, but differ from them in the absence of clear localization and the presence of secretions and movements. While involved in the pathological process of the knot stellateurat affecting the upper thoracic vertebrae, there may be violations in the arms, upper chest and heart. In the event of damage to the lower thoracic ganglia, functional disorders may occur in the small pelvic organs, abdominal and thoracic cavities, as well as trophic changes in the lower legs and other parts of the body.