Osteochondrosis of the thoracic spine

General information

A disease of the human musculoskeletal system such 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. NOIn principle, this term can mean a series of osteoarticular pathologies from various locations, including in the joints of the limbs, however, it is most often used to denote degenerative dystrophic changes in the structure directly of the spine and, above all, the intervertebral discs.

As a result of the progression of intervertebral osteochondrosis, the human body loses its inherent shock-absorbing qualities, mobility and elasticity. In general, this disease of the spine is very widespread and to a different degree of severity is present in most people at age 40. Depending on the spine segment affected in clinical practice, cervical, lumbar and thoracic osteochondrosis occur, in addition to their mixed forms, which are considered the most difficult.

Osteochondrosis of the thoracic spine, which will be discussed in this article, is the rarest form of this pathology, which, in particular, is due to the anatomical structure of the upper part of the human skeleton. Thus, in the region of the chest, the osteochondral system consists of 12 vertebrae, which are connected by means of rib joints, which with their front ends join to a relatively monolithic sternum. This skeletal structure provides a sufficiently rigid and strong structure that protects the organs of the chest cavity (heart, lungs) from injury. In addition, the vertebrae of this segment of the spine are characterized by a small height and significant length of the spinous processes, which gives them a view of well-spaced tiles. All of this together limits the mobility of that 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 chest osteochondrosis in a person, compared to lumbar and cervical osteochondrosis, physiological kyphosis (natural curvature of the spine backwards) appears in this area, due to which most of theexternal load falls on the anterior and lateral fragments of the vertebrae and discs. With the development of a pathological process in the movement segment of the spine, it is these areas that are mainly exposed to degeneration changes, however, due to the absence of nerve endings and spinal cord membranes in them, the pain is most often not observed. However, in some cases, negative transformations in the thoracic spine segment affect posterior fragments of discs and vertebrae and / or vertebral costal joints, which often leads to compression of the spinal nerve roots. Under these conditions, osteochondrosis of the thoracic spine occurs with radicular syndrome, which is already accompanied by pain from various locations (sometimes very distant), as well as a violation of the functionality of various organs of the human body (liver, lungs, pancreas, heart, etc. ).

Due to these ambiguous and varied manifestations of thoracic osteochondrosis, doctors often call this form of pathology "chameleon disease", as it can cleverly disguise itself as symptoms of respiratory and digestive diseases, heart muscle, etc. In this situation, a differential diagnosis performed correctly is very important, which, through several specific studies, will help to determine the symptoms and treatment of osteochondrosis of the thoracic spine.

The tactics and effectiveness of additional therapy will largely depend on the degree of progression of the degenerative dystrophic process in the spinal tissues. Having recognized the pathology in the early stages of its development, it is important to improve the condition of the patient. It is quite possible with the help of simple physiotherapy techniques and exercise therapy exercises, but in case of late detection, it may be necessary to performcomplex surgical operation. That is why vertebrologists strongly recommend whenAny frequent and / or prolonged low back pain as early as possible, seek the help of a specialist.

Pathogenesis

The incidence of osteochondrosis of the thoracic spine in women and men is virtually identical, since in the pathogenesis of this disease there is no gender predisposition for the occurrence of intervertebral disc degeneration. However, many years of clinical experience in treating osteochondrosis indicate 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 osteochondrality up to a certain age, the tissues of the female body are protected by the hormone estrogen, whose decrease at the time of climacteric transformations serves as a trigger for spinal problems.

According to statistical evidence, in general, intervertebral osteochondrosis in varying degrees of severity is found in the majority of the elderly, which automatically classifies it in the group of age-related diseases. Meanwhile, the lastThe time is followed by a significant "rejuvenation" of this pathology, until its occurrence at preschool age. For this reason, it has not yet been possible to establish the exact etiology and initial pathogenesis of spinal osteochondrosis. At the same time, more than a dozen theories about its origin and development have been developed, including hormonal, infectious, mechanical, vascular, hereditary, allergic and others, but in practice none of them has found complete confirmation.

Today, doctors explain the occurrence of osteochondrosis by the sum of complementary negative effects on the tissues of the spine, among which they highlight the constant excessive load in one or more movements of the spine segments formed by two adjacent vertebrae (upper and lower)and a disc located in the middle of them. Paradoxically, this overload can be a consequence of both the excessive physical work of the spine and the results of long-term finding in an unnatural position for the back. For example, prolonged work or study in a sitting position at the table is one of the main factors in the development of degenerative-dystrophic changes in the structure of the intervertebral disc system.

The initial formation or exacerbation of osteochondrosis of the thoracic spine can be influenced by malnutrition, uneven development of the dorsal and thoracic muscles, excessive weight (obesity), pathology of the lower extremities (eg flat feet), back injuries, etc. In the pathogenesis of this disease, the disorganization of the segmental blood circulation plays a significant role, which causes dehydration of the nucleus pulposus (gelatinous), which in turn leads to loss of the amortization qualities of the intervertebral disc, change in the loads in the surrounding fibrous ring andsubsequent gradual destruction of this segment of spinal movement.

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

First degree

In the initial stage of the formation of thoracic osteochondrosis, microcracks form in the inner membrane of the fibrous ring, into which the pulpous nucleus gradually begins to penetrate, irritating the nerve endings in the distal layers of the fibrous ring and in the longitudinal posterior ligament. At this stage of the development of the disease, the patient may already experience pain directly in the middle part of the back or apparent pain in the heart region. It can also be haunted by a convulsive contraction. in the dorsal muscles.

High school

Osteochondrosis of the 2nd degree thoracic spine is characterized by subsequent destruction of the fibrous annulus, which is accompanied by spinal instability due to excessive mobility of its affected vertebrae. Painful sensations of the 2nd stage of development of the pathology intensify and can continue as back pain (mild persistent pain, aggravated by movements of the back) or back pain (appearing sharply in the context of a prolonged stay in a position, strong pain of "shooting").

Third grade

In the third period of thoracic osteochondrosis, there is a complete rupture of the fibrous ring structure with the pulpal nucleus exiting beyond its borders and formation of intervertebral hernia. Most of the time, these formations appear in the direction of the spinal column, which leads to compression of the spinal cord, spinal nerves and adjacent vessels. This is accompanied by root syndrome (radiating pain to different parts of the body), chest pain in the context of osteochondrosis (severe pain behind the sternum, cardiac similarity), myelopathy (sensory and movement disorders) and other symptoms of a neurovascular and muscle tonic nature. Fixed thoracic kyphosis, scoliosis or kyphoscoliosis can begin at this stage.

Fourth grade

During the final stage of thoracic osteochondrosis, degenerative processes spread to the interspinous and yellow ligaments, other tissues of the spine and nearby muscles. Dystrophy of the intervertebral disc continues to progress, even with succinatrices and more fibrosis. Deforming arthrosis develops in the semilunar and intervertebral joints, osteophytes (bone growths) are formed in the processes of the vertebrae. The clinical picture in this period of the disease can be quite versatile, since the degree of damage to individual discs is usually different. In uncomplicated osteochondrosis, problematic disk fibrosis can mark the transition from the disease to the stable remission stage, but with 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:

• the natural physiological aging process, accompanied by age-related changes in the structure of the bone-cartilaginous tissue of the spine;
• genetic predisposition for the abnormal formation of movement segments of the spine;
• a physically inactive lifestyle that leads to dystrophy of the back muscles;
• strength sports that involve excessive mechanical stress on the spine (mainly weightlifting);
• spinal injuries (even those that occurred in the distant past);
• endocrine diseases in the human body, disrupting the nutrition of spinal tissues;
• significantly above normal body weight (obesity);
• unhealthy diet (deficiency of vitamins, minerals and fluids);
• pathology of the spine with its unnatural curvature;
• imbalance in the development of muscle structure;
• prolonged study or work in a sitting position with the body leaning forward;
• physically difficult working conditions (constant incorrect lifting of weights);
• severe metabolic disorders;
flat feet and other lower limb diseases, affecting the redistribution of loads on the spine;
• vascular diseases that impair 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

The signs of thoracic osteochondrosis, due to the structural characteristics of this spine segment described above, may not directly bother the patient for a long time and appear only if the pathological process spreads to the laterale / or the posterior parts of the segments ofaffected spinal movement and the 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-cartilaginous tissue of the spine) and extravertebral or compression syndromes (negative phenomena resulting from pathological impulses in the problematic spine segmentvertebral).

Vertebral syndromes

The vertebral symptoms of osteochondrosis of the thoracic spine segment are mainly manifested by two pain syndromes, called dorsal and back pain.

Dorsago

It is a sudden and acute pain crisis, the so-called "lumbago", which is located in the interscapular space and can occur at any time. Most of the time, dorsago syndrome affects patients who have been in a sitting position with their bodies leaning forward and abruptly altering their position. Patients describe the exact moment of the attack as a "dagger stroke", accompanied by an acute spasm of the spine muscles. In addition to severe pain, subjective sensations with back pain expressed due to shortness of breath and a significant restriction of freedom of movement in the chest part of the back. A similar exacerbation of osteochondrosis with periodic attacks can last up to two weeks.

Back pain

This syndrome differs from the previous one by the gradual development of uncomfortable and painful sensations, which can increase over two to three weeks. The pain with back pain is not as pronounced, but its prolonged presence causes a constant feeling of anxiety. The dorsal muscles, as well as during the dorsal muscle, are subject to significant stress, which can cause the patient to experience shortness of breath. Back pain increases with torso movements (especially when bending over), deep breathing, coughing, etc. Separately, the upper back (the main location of negative phenomena in the cervicothoracic spine segment) and the lower back (the main location of negative phenomena in the thoracolumbar spine segment).

Extravertebral syndromes

The extravertebral syndromes of thoracic osteochondrosis, due to the greater extension of this part of the spine, can be very diverse, which makes the diagnosis of the disease very difficult. They arise as a result of mechanical compression of the corresponding nerve roots, nearby vessels or the spinal cord itself. Compression symptoms in men and women are generally similar and differ only when pathological impulses spread to the sexual sphere (for example, in men, in the context of the disease, erectile dysfunction is sometimes observed). In almost all cases, extravertebral symptoms are caused by already formed intervertebral hernias, which most often appear in the lower thoracic regions, but, in principle, can form in any spinal movement segment from vertebra D1 to vertebra D12. As you can see in the photo below, it is in the location of osteochondrosis in them that pathological involvement in the process of certain systems and organs of the human body with its characteristic negative manifestations.

Root syndromes

In the context of compression symptoms of thoracic osteochondrosis, root syndromes are more frequently and clearly observed, caused by the compression of nerve endings in one or another segment of the spine. Depending on the concentration, such patient problems can be disturbed by the following painful phenomena:

• in case of infringement in the area of ​​the vertebra T1 - painful sensations and paraesthesias of the movement segment of the upper thoracic spine most often spread along the suprascapular zone in the area of ​​one of the armpits up to the elbow joint;
• in case of infringement in the T2-T6 vertebrae area - pains such as intercostal neuralgia can extend from this part of the spine along the interscapular region and surround the axillary and scapular zones in a semicircle, as well as 2-6 spaceintercostal for the sternum;
• in case of infringement in the area of ​​the T7-T8 vertebrae - pain in the waist spreads predominantly from the lower level of the shoulder blades of the spinal-costal joints to the upper parts of the costal arch and affects the epigastric region, where it causes muscular defense (strongmuscle tension);
• in case of infraction in the T9-T10 vertebrae region - intercostal neuralgia expands from the movement segments of the lower thoracic spine to the lower parts of the costal arch and later to the umbilical region, changing the tone of the mid section of the musclesabdominals;
• in case of infringement in the area of ​​the T11-T12 vertebrae - pain also emanates from the movement segments of the lower thoracic spine and reaches the hypogastric regions (below the stomach) and groin along the corresponding lateral areas of the chest.

In addition to pain, the root syndromes of thoracic osteochondrosis are often accompanied by negative symptoms of certain internal organs of the abdominal cavity and / or chest. In addition, in some cases, these symptoms are so similar to the pathological manifestations of other diseases that it is virtually impossible to accurately recognize their belonging without targeted research. For example, the medical literature describes a case of unjustified conduct for appendectomy (surgical intervention to remove the appendix) according to the unequivocal clinic of acute appendicitis, which in fact ended up being one of the most pronounced syndromes of osteochondrosis.

So, when the osteochondrosis process is located in the upper thoracic region 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 a bodyweird. These sensations are often paroxysmal (sometimes permanent) and intensify with a severe load on the affected part of the back. Sometimes, the manifestations of root syndrome in the upper thoracic segment are mistaken for signs of obstructive bronchitis or pneumonia, since reflex cough with osteochondrosis of the thoracic region and chest pain are similar to the symptoms of this group of diseases. In addition, chest pain can occur in the form of chest pain, reminiscent of its intensity is an attack of angina pectoris, pulmonary thromboembolism, myocardial infarction and other similar pathologies of a serious nature, which require a detailed differential analysis by doctors.

Patients with osteochondrosis in the mid-thoracic spine (T5 to T7) usually experience discomfort and pain in the solar plexus and stomach, which are called vertebral gastralgia. In defeatsegments of spinal movement T8-T9, pain in the duodenal region, referred to as vertebral duodenalgia, is possible. . . These and other painful sensations in different patients or at different times can vary in intensity from mild and "sore" to extremely acute. They intensify, as a rule, with a prolonged permanence of the body in one position (sitting at the table, lying on its back, etc. ), in the case of sudden movements of the body, and also at the time of sneezing or coughing. These pains are often accompanied by paresthesias. (numbness, tingling, burning) in the middle of the abdominal wall.

In case of radicular osteochondrosis in the lower thoracic region of the spine (from T8 to T12), some patients may complain of pain in the lower abdominal cavity, simulating intestinal disorders or pathology. Sometimes the pain spreads to the gallbladder and is located in the posterior region of the right hypochondrium. Less frequently, patients experience pain in the suprapubic region similar to the pathological bladder clinic. As in the previous case, the nature of such pain can vary over a very wide range (from mild to severe), and its 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 is a compression of the spinal cord directly by the resulting intervertebral hernia. . . Its 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. With progression, the pain intensifies, can affect the lower part of the intercostal space, abdominal organs, groin and can be felt significantly in the lower extremities. In severe cases with compression myelopathy, dysfunction of the pelvic organs may develop, leading to interruption of the processes of defecation and / or urination. In addition, there may be severe superficial and deep paresthesias and sensory disturbances, even spastic paresis or even both legs.

Vascular Compression

The compression of the vessels adjacent to the thoracic spine segment leads to myeloiscemia, as a result of which the blood supply is interrupted and, therefore, adequate nutrition of the spinal cord. The manifestations of this syndrome are in fact completely repeating the symptoms of compression myelopathy and are characterized mainly by pelvic disorders, as well as loss of sensation in the lower limbs and decreased functionality. Patients often describe this problem with the phrase - "legs fail".

Vegetative syndromes

In some cases, with thoracic osteochondrosis, the vegetative nerve nodules (ganglia) are damaged, and as a result the patient may experience a wide variety of negative symptoms. There may be several paresthesias. , itching and changes in skin pigmentation in the problematic ganglion area, burning in one half of the body, local disturbances in temperature, muscle hyper or wasting, disorganized work in the limbs or internal organs, etc. According to their truth, these visceral vertebrogenic symptoms are similar to the manifestations of root syndromes, but differ from them in the absence of a clear location and in the presence of secretory and movement disorders. When involved in the pathological process of a star that affects the upper thoracic vertebrae, there may be violations in the arms, upper chest and heart. In case of damage to the lower thoracic ganglia, functional disorders may occur in the organs of the small pelvis, abdominal and thoracic cavity, as well as trophic changes in the lower extremities and the rest of the body.