Thoracic osteochondrosis is a chronic pathology in which the bone vertebrae and the intervertebral discs located between them undergo degenerative changes. Destructive injuries in this area are quite rare due to the low mobility and good protection of the costal frame. Osteochondrosis of the thoracic spine develops imperceptibly, progresses slowly but persistently, and is also distinguished by a number of specific symptoms, disguised as diseases of the internal organs. In this sense, it is very important to seek medical help at the first signs, even mild, of back problems. Timely treatment helps prevent serious complications.
Causes and provoking factors.
Degenerative-dystrophic processes in the thoracic segments of the spine occur against the background of endogenous alterations and under negative external influences. Its development is usually caused by the following factors:
- hereditary predisposition, the presence of a certain set of defective genes;
- excessive physical exertion, especially lifting and carrying various heavy objects;
- a sedentary lifestyle, which causes congestion in the area of the vertebral bodies and intervertebral discs;
- congenital or acquired structural anomalies, for example, accessory vertebrae, lordosis, kyphosis;
- back and/or chest injuries - fractures, prolonged compression;
- flat foot, clubfoot;
- impaired blood circulation in any area, not only in the thoracic spine;
- frequent hypothermia;
- over weight;
- endocrine pathologies, metabolic disorders, such as diabetes, gout, hypothyroidism, hyperthyroidism;
- systemic diseases: rheumatoid arthritis, systemic lupus erythematosus, scleroderma;
- ankylosing spondyloarthritis.
The strength and mobility of the spine as a whole directly depends on the state of each section. The disease may be a consequence of severe and untreated lumbar or cervical osteochondrosis.
Smoking, alcohol addiction and poisoning, including occupational hazards, predispose to the destruction of intervertebral joints with discs composed mainly of cartilage. Thoracic osteochondrosis is diagnosed more often in older people than in young and middle-aged people. This is due to the natural aging of the body, a slowdown in recovery processes and the presence of one or more somatic pathologies.
Symptoms and signs of the disease
The main symptom of the degenerative process is pain. Unlike cervical and lumbar osteochondrosis, it is very rarely sharp, burning and stinging. Patients often describe the discomfort as dull, painful, or oppressive. The pain syndrome can intensify when bending or twisting the body, with sudden and clumsy movements, during a coughing attack or during temperature changes. Its irradiation is noticeable: it extends beyond the affected area. Osteochondrosis of the thoracic spine also manifests itself as follows:
- stiffness, feeling of oppression;
- specific clicks, crunches when changing body position;
- loss of sensitivity, paresis in the form of a sensation of "goosebumps", burning, numbness;
- muscle spasms, which further limit range of motion;
- adoption of a forced position in which discomfort does not arise or is weakly expressed;
- pathological changes in posture, in later stages: gait;
- a slight decrease in growth as a result of the destruction of the intervertebral joints and the convergence of the vertebral bodies.
Due to the constant tension of the back muscles, the muscles of the neck and lower back also undergo spasm, which is expressed in pain in these parts.
The clinical picture of thoracic osteochondrosis is a combination of pain syndromes. The fact is that the affected segments are located in a zone of common innervation with many internal organs. If a displaced disc has pinched a nerve root located near the spine, then pain can be felt in them, simulating common pathologies:
- severe heart pain resembles angina and even myocardial infarction;
- pain in the mammary glands becomes a reason for urgent differential diagnosis to exclude tumor processes;
- Constant or periodic pain in the right hypochondrium, stomach or intestines resembles those characteristic of gastritis, cholecystitis and ulcerative lesions.
When osteochondrosis worsens, the lower back or abdomen may hurt. Patients confuse discomfort with signs of kidney pathology or gynecological disease. They turn to specialized specialists, who then refer patients to a neurologist or vertebrologist after the examination.
Classification, main types.
The common classification of osteochondrosis of the thoracic spine is based on the nature of the pain syndrome. There are two kinds:
- dorsago - a sharp, sharp pain in the sternum, occurring mainly during prolonged stay in one body position, often complicated by a feeling of lack of air when inhaling;
- back pain in the form of mild painful sensations in the back, which appear periodically and disappear after rest.
This division of pathology into groups allows the doctor to quickly decide on the choice of analgesic.
Stage-by-stage development of thoracic osteochondrosis.
In its development, osteochondrosis of the thoracic spine goes through four stages. Each has its own symptoms and radiological markers. The more pronounced the deformation of the discs and vertebrae, the more intense the pain, stiffness of movement and paresthesia. The stage of the disease determines the therapeutic tactics.
Stage I
There are still no changes on the x-ray. However, the intervertebral disc no longer retains moisture well, without which its timely restoration is impossible. It begins to gradually become thinner, lose strength and elasticity. Only in some cases does slight discomfort occur in the thoracic region. A person perceives it as muscle fatigue and does not consult a doctor. Therefore, disease at this stage is usually an incidental diagnostic finding during examination for another reason.
Stage II
The structure of the annulus fibrosus becomes loose and fibrous. An enlargement of a crack in the disc occurs with the protrusion of the nucleus pulposus in this direction. The distance between adjacent vertebrae decreases as disc height decreases, which is clearly visualized on radiographic images. To compensate for the distribution of loads, muscle tissue is constantly tense. Stiffness increases, pain intensity remains moderate.
Stage III
The annulus fibrosus ruptures and the nucleus pulposus is compressed beyond its limits. A herniated disc occurs, causing severe symptoms and serious complications. There is significant deformation of the vertebral bodies and the formation of single osteophytes (compensatory bone growths). The pain syndrome becomes constant, movements in the back are significantly limited.
stage IV
At this stage, diagnosing thoracic osteochondrosis is not difficult. Connective tissues have grown and multiple osteophytes have formed. The adjacent vertebrae in the segment are blocked, completely or partially immobilized. Nerve roots are often pinched by inflammatory swelling, bone growths, and spasmodic muscles. This manifests itself as a stabbing, burning pain. The patient copes poorly with household chores and has difficulty moving.
Complications
Dangerous is the development of discogenic myelopathy, a dystrophic disease of the spinal cord that results primarily from compression by a herniated disc. It is worth noting that with osteochondrosis of the thoracic spine, this complication is rare. However, in clinical practice, cases of discogenic myelopathy localization in one of the lower segments have been observed. Due to a gradually increasing neurological deficit, muscle strength decreases and tendon reflexes change. Ischemic areas form and nerve cells die (spinal cord infarction). This is characterized by movement disorders, loss of sensitivity and trophic disorders.
Diagnostic measures
At the first consultation, the doctor listens to the patient's complaints, examines him, evaluates the level of sensitivity, controls tendon reflexes, studies the medical history and history of spinal injuries. Its diagnosis is confirmed by instrumental and laboratory studies:
- x-ray in two projections, according to indications: a specific image of a certain segment;
- magnetic resonance imaging;
- evoked potentials;
- electroneurography;
- electromyography;
- General clinical blood and urine tests.
To find out the cause of specific symptoms and exclude somatic diseases with similar clinical manifestations, electrocardiography, ultrasound of cardiac structures and electroencephalography may be prescribed.
Treatment methods for thoracic osteochondrosis.
The therapy is comprehensive, aimed at eliminating symptoms and preventing the spread of the pathological process to other segments of the spine. In the acute stage, unbearable, burning pain is eliminated by injecting medications, including directly into the affected area. The use of glucocorticosteroids in combination with anesthetics (pharmacological blockers) is generally practiced. In other cases, drug therapy consists of taking tablets, capsules, rubbing ointments and balms. The use of drugs from the following groups has proven to be effective:
- muscle relaxants to relieve muscle spasms;
- non-steroidal anti-inflammatory drugs with pronounced analgesic activity;
- antispasmodics for pinched nerves;
- means to improve blood circulation;
- Preparations with vitamin B6, which improve the transmission of nerve impulses and activate regeneration.
If a radicular syndrome has formed and other complications have arisen, then the person constantly lives in fear of experiencing unbearable pain again, and this can cause mental disorders. The prescription of sedatives and antidepressants can prevent these events. In addition to medications, the following methods are used in the treatment of osteochondrosis of the thoracic spine:
- therapeutic massages, including vacuum and acupuncture;
- physiotherapeutic procedures: electrophoresis/ultraphonophoresis, magnetic therapy, pulsed currents, UHF therapy, applications with ozokerite or paraffin, acupuncture, hirudotherapy;
- physiotherapy and gymnastics;
- spinal traction.
In cases of significant damage to the vertebral discs and myelopathy, surgical treatment is always prescribed immediately. The hernia protrusion is removed, microdiscectomy, puncture evaluation or laser reconstruction of the disc is performed, an implant is installed or the spinal segment is stabilized.
Prevention of thoracic osteochondrosis.
The main goal of primary prevention of thoracic osteochondrosis is to eliminate factors that can provoke thinning and cracking of the intervertebral disc. What doctors recommend:
- avoid excessive strain on the back;
- quickly treat all diseases: infectious, endocrine, inflammatory;
- immediately seek medical help for back injuries, even those that seem minor at first glance;
- quit alcohol and smoking or at least limit them;
- replenish your diet with fatty fish, fresh vegetables, fruits and dairy products;
- avoid hypothermia;
- Do physical therapy for at least 15 minutes every day.
These preventive measures are effective for already diagnosed diseases of the thoracic, cervical or lumbar spine. With its help, it will be possible to prevent exacerbations and the progression of the degenerative-dystrophic process.
If you have signs of osteochondrosis of the thoracic spine and want to get rid of them, contact the clinic for complete and competent treatment.
Question answer
What is the difference between intercostal neuralgia and thoracic osteochondrosis?
In fact, intercostal neuralgia is an injury to the intercostal nerves that can complicate the course of osteochondrosis. There are two main differences between these pathological processes. Neuralgia is characterized by paroxysmal stabbing or burning pain, which intensifies even with inhalation. Thoracic osteochondrosis without violation of sensitive nerve endings is manifested by dull pain, as if it were distant.
And the second difference is the prognosis. Once the cause of intercostal neuralgia is eliminated, it disappears without a trace. Osteochondrosis responds well to treatment only in the initial stages of development.