Osteochondrosis of the thoracic spine

General information

Such a disease of the human musculoskeletal system as osteochondrosis is essentially a degeneration of the articular cartilage and nearby bone tissue, often involving neighboring vessels, muscles and nerve endings in the pathological process. In principle, this term can mean a number of osteoarticular pathologies of different localization, including the joints of the extremities, but most often it is used to denote degenerative-dystrophic changes in the structure, directly affecting the spine, and especially the intervertebral discs.

As a result of the progression of osteochondrosis of the intervertebral vertebrae, the human body loses its shock-absorbing properties, inherent mobility and elasticity. In general, this spinal disorder is very common and in one or more cases, most people over 40 years of age have a different severity. Depending on the affected spinal segment in clinical practice, cervical, lumbar and thoracic osteochondrosis and their mixed forms are considered to be the most difficult.

The osteochondrosis of the thoracic spine, discussed in this article, is the rarest form of this pathology, due in particular to the anatomical structure of the upper part of the human skeleton. So, in the thoracic area, the osteochondral system consists of 12 vertebrae, which are connected by joints with ribs, the front ends of which border a relatively monolithic sternum. Such a skeletal structure provides sufficientA rigid and strong framework 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 significant length of the spinous processes, which gives themview of closely spaced tiles. All of this together limits the mobility of this part of the back and the negative effects of physical activity on it, and protects the intervertebral discs from destruction.

Another reason for the lower frequency of detection of breast osteochondrosis in a person compared to lumbar and cervical osteochondrosis is physiological kyphosis (natural backward bending of the spine) in this area. as a result, most of the external load falls on the anterior and lateral fragments of the vertebrae and intervertebral discs. With the development of a pathological process in the segment of spinal movement, these areas are mainly exposed to degenerative diseases, but changes due to the lack of nerve endings and membranes of the spinal cord in them, pain is most often not observed. In some cases, however, negative transformations in the thoracic segment of the spine affect posterior fragments of intervertebral discs and vertebrae and / or vertebral-articular joints, often resulting in compression of the roots of the spinal nerves. Under such conditions, there is already osteochondrosis of the thoracic spine with radicular syndrome accompanied by pain of various localization (sometimes very far away), as well as a violation of the functionality of many organs of the human body (liver, lungs, pancreas, heart, etc. ).

Because of these ambiguous and varied manifestations of thoracic osteochondrosis, doctors often call this form of pathology "chameleon disease" because it can be cleverly disguised as symptoms of respiratory and digestive diseases. Heart muscle, etc. In this situation, a correctly performed 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 largely depends on the degree of progression of the degenerative-dystrophic process in the tissues of the spine. Having identified the pathology at the initial stages of its development, it is important to improve the patient's condition, with the help of simple physical therapy techniques and exercise therapy exercises, it is quite possible, but if it is detected late, it may require complex surgical intervention. Therefore, vertebrates strongly recommend whenIf you have frequent and / or persistent back pain, contact a specialist as soon as possible.

Pathogenesis

The incidence of osteochondrosis of the thoracic spine in women and men is practically identical, since in the pathogenesis of this disease there is no gender-specific predisposition for the occurrence of disc degeneration. However, many years of clinical experience in the treatment of osteochondrosis shows 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, up to a certain age, the tissues of the female body are protected by the hormone estrogen, the decrease of which at the time of climacteric transformations serves as a trigger for problems with the spine.

According to statistical data, most older people generally have intervertebral osteochondrosis of varying degrees of severity, which they automatically classify into the group of age-related diseases. Meanwhile, the last on time is followed by a significant "rejuvenation" of this pathology up to its appearance in preschool age. For this reason it has not been possible to date to determine the exact etiology and initial pathogenesis of spinal osteochondrosis. At one time, more than a dozen theories about its origin and development have been developed, including hormonal, infectious, mechanical, vascular, hereditary, allergic, and others, but none of them have found complete confirmation in practice.

Today doctors explain the occurrence of osteochondrosis by the sum of the complementary negative effects on the tissues of the spine, including a constant excessive load on one or more spinal movements, segments composed of two adjacent vertebrae (upper and lower) and a disc located in the center. Paradoxically, such overload can be due to both excessive physical work on the spine and the result of its 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.

The initial formation or exacerbation of thoracic osteochondrosis can be caused by inadequate nutrition, uneven development of the back and chest muscles, excessive weight (obesity), lower extremity pathology (e. g. flat feet), back injuries, etc. in the pathogenesis of theseDisease, the disorganization of the segmental blood circulation plays a significant role, which leads to dehydration of the pulp core (gelatin core), which in turn leads to loss of the amortization properties of the intervertebral disc, change in the load on the surrounding fibrous ring and further gradual destruction of this segment of movement of the spine.

Thoracic osteochondrosis goes through four successive stages of development in the course of its progression, each of which is characterized by its own anatomical and morphological changes in the structure of the intervertebral disc, the adjacent vertebrae and the facet joints. In addition, negative metamorphoses that occur in this disease can directly affect other nearby tissues (muscles, vessels, connective tissues) 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, microcracks form in the inner membrane of the fibrous ring, into which the nucleus pulposus gradually begins to penetrate and irritate the nerve endings in the distal layers of the fibrous rings and in the posterior longitudinal ligament. At this stage in the development of the disease, the patient may already experience pain in the middle of the back or apparent pain in the heart area. He can also experience a feeling of convulsive contraction. in the back muscles.

Second degree

Degree of osteochondrosis of the thoracic spine of the 2nd degree is characterized by further destruction of the annulus fibrosus, which is accompanied by instability of the spine, which is due to excessive mobility of the affected vertebrae. Painful sensations from the 2nd stage of the development of the pathology intensify and can appear as dorsalgia (mild persistent pain, aggravated by movements of the back) or dorsago (strong against the background of a long stay in one position, strong "shooting" pain).

Third degree

In the third period of osteochondrosis of the thoracic cavity, there is a complete rupture of the structure of the annulus fibrosus with the exit of the nucleus pulposus beyond its borders and the formation of an intervertebral hernia. Most often, such formations appear in the direction of the vertebralcanal, which leads to compression of the spinal cord, spinal nerves and adjacent vessels. This is accompanied by a radicular syndrome (radiation of pain to different parts of the body), thoracic algia against the background of osteochondrosis (severe pain behind the sternum, similar to the heart), myelopathy (sensory and motor disorders) and other neurovascular and muscle-strengthening symptoms. At this stage, firm breast kyphosis, scoliosis, or kyphoscoliosis can begin.

Fourth degree

In the final stages of thoracic osteochondrosis, degenerative processes spread to the interspinous and yellow ligaments, other tissues of the spine, and nearby muscles. Disc dystrophy progresses to the end of scarring and further fibrosis. Deforming osteoarthritis develops in the lunate and intervertebral joints, osteophytes (bone growth) form on the processes of the vertebrae. The clinical picture in this period of the disease can be very varied, since the degree of damage to individual discs is often different. With uncomplicated osteochondrosis, the fibrosis of the problem disc can mark the transition of the disease to the stage of stable remission, but with the loss of normal functionality to one degree or another. Spine.

reasons

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 the bone-cartilaginous tissue of the spine;
• genetic predisposition for abnormal formation of spinal segments of movement;
• a physically inactive lifestyle that leads to dystrophy of the back muscles;
• Weight training in which the spine is exposed to excessive mechanical loads (mainly weightlifting);
• injuries to the spine (including 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 (lack of vitamins, minerals and fluids);
• Pathology of the spine with its unnatural curve;
• imbalance in the development of the muscle frame;
• prolonged study 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 that affect the redistribution of the load on the spine;
• vascular diseases that affect 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 structural features of this segment of the spine described above, may not be able to directly bother the patient for a long time and appear only if the pathological process spreads laterallyand / or the posterior parts of the affected segments of the spinal column movement and the transition of the disease to thesecond or third degree. In general, all symptoms of thoracic osteochondrosis are expressed in the form of vertebral syndromes (painful effects that are directly related to dysfunctions in the bone-cartilaginous tissue of the spine) and extravertebral or compression syndromes (negative phenomena due to pathological impulses from the problem segment of the spine).

vertebral syndromes

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

Dorsago

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

Dorsalgia

This syndrome differs from the previous one in the gradual development of unpleasant and painful sensations, which can increase over the course of two to three weeks. The pain, even with dorsalgia, is not as pronounced, but its continued presence causes a constant feeling of fear. The back muscles and the back muscles are exposed to considerable stress, which can lead to the patient feeling a lack of inhaled air. Back pain increases with the movements of the trunk (especially when stooping), deep breathing, coughing, etc. Separately, upper dorsalgia (the main localization of negative phenomena in the cervicothoracic segment of the spine) and lower dorsalgia (the main localization of negative phenomena in the inthoracolumbar segment of the spine).

Extravertebral syndromes

Extravertebral syndromes of thoracic osteochondrosis can be very different due to most of this part of the spine, which makes the correct diagnosis of the disease much more difficult. They arise due to mechanicalcompression of the corresponding nerve roots, the nearby vessels or the spinal cord itself. Compression symptoms in men and women are generally similar and differ only when pathological impulses are transmitted to the sexual sphere (for example, in men against the background of the disease is sometimeserectile dysfunction detected). In almost all cases, extravertebral symptoms are caused by intervertebral hernias that have already formed, most commonly in the lower thoracic regions, but in principle they can form in any segment of spinal motion 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 pathologythe process of certain systems and organs of the human body with negative manifestations characteristic of them.

Radicular Syndromes

In the context of compression symptoms of thoracic osteochondrosis, most often and clearly radicular syndromes are observed, which are caused by compression of nerve endings in one or the other segment of the spine. Depending on the concentration, zpatients' problems can be disturbed by the following painful phenomena:

• in the case of an injury in the area of ​​the T1 vertebra - painful sensations and paresthesias from the upper moving segment of the thoracic spine most often spread along the suprascapular zone in the area of ​​one of the armpits to the elbow joint;
• In the event of an injury in the area of ​​the T2-T6 vertebrae, pain 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 the 2-6 intercostal space to the sternum;
• in case of injury in the area of ​​the T7-T8 vertebrae - girdle pain predominantly spreads 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 is causedmuscular defenses(strong muscle tension);
• in the case of an injury in the area of ​​the T9-T10 vertebrae - the intercostal neuralgia extends from the lower moving segments of the thoracic spine to the lower parts of the costal arch and further to the umbilical region, changing the tone of the middle section of the abdominal muscles;
• in the event of an injury in the area of ​​the T11-T12 vertebrae - the pain also emanates from the movement segments of the lower thoracic spine and reaches the hypogastric (below the stomach) and groin regions along the corresponding lateral zones of the chest.

In addition to pain, radicular syndromes of breast osteochondrosis are often accompanied by negative symptoms of certain internal organs of the abdominal cavity and / or the chest. In addition, in some cases, such symptomsare so similar to the pathological manifestations of other diseases that it is practically impossible to accurately determine their affiliation without proper research. For example, the medical literature describes a case of inappropriately behaving appendectomy (surgery to remove the appendix) after the definitive clinic for acute appendicitis, which in fact turned out to be one of the most pronounced syndromes of osteochondrosis.

If the process of osteochondrosis is localized in the upper thoracic region of the spine (from T1 to T4), then patients may feel pain and / or various discomfort in the esophagus or throat, often perceived as the presence of a foreign body. Such sensations are often paroxysmal (sometimes constant) and intensify with a serious load on the problem part of the back. Sometimes the manifestations of radicular syndrome in the upper chest segment are confused with signs of obstructive bronchitis or pneumonia, since reflex cough with osteochondrosis of the chest region and chest pain are similar to the symptoms of this group of diseases. Chest pain can also appear in the form of thoracic pain, reminiscent ofIts intensity is an attack of angina pectoris, pulmonary thromboembolism and myocardial infarction, and other similar pathologies of a serious nature that require detailed differential analysis by doctors.

Patients with osteochondrosis in the middle thoracic segment of the spine (T5 to T7) most commonly experience discomfort and pain in the solar plexus and stomach, known as vertebral gastralgia. When defeatspinal movement segments T8-T9, it is possible to develop pain in the duodenum, called - vertebral duodenum. . . 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 usually aggravated when the body stays in one position for a long time (sitting at a table, lying on the back, etc. ) with sudden movements of the body. and also at the moment of 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, imitating intestinal disorders, or pathology. Sometimes pain spreads to the gallbladder and is localized in the back of the right hypochondrium. Even less often patients suffer from pain similar to that in the pathological clinic of the bladder in the suprapubic area. As in the previousin this case, 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 spine, sneezing, coughing, etc.

Compression myelopathy

This compression syndrome of thoracic osteochondrosis is quite rare and compression of the spinal cord directly through the resulting intervertebral hernia. . . Its characteristic symptoms at the beginning education is manifested in local pain in the corresponding area of ​​the back or girdle pain in the problem area, as well as a feeling of weakness and / or numbness in the legs. With the progression, the pain intensifies, it can affect the lowerintercostal space, abdominal organs, groin area and clearly felt in the lower extremities. In severe cases with compression myelopathy, there may be a dysfunction of the pelvic organs, which leads to a disruption of the processesof defecation and / or urination. In addition, severe superficial and deep paresthesia and sensory disturbances up to spastic paresis can occur in one or even both legs.

vascular compression

The compression of the vessels next to the thoracic segment of the spine leads to myelo ischemia, which disrupts the blood supply and thus the proper nutrition of the spinal cord. The manifestations of this syndrome are, in fact, fully repeat symptoms of compression myelopathy, and are mainly characterized by pelvic disorders, as well as a 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 some cases of osteochondrosis of the chest cavity, the autonomic nerve nodes (ganglia) are damaged, which can lead to a variety of negative symptoms in the patient. These can be various paresthesias. , Itching and changes in skin pigmentation in the area of ​​the problem ganglion, burning pain in one half of the body, local temperature disturbances, muscle excess or wasting, disorganization in the work of the limbs or internal organs, etc. According to its, in fact, these visceral vertebral symptoms resemble the manifestations of radicular syndromes, but differ from them in the absence of a clear localization, and there are secretory and motor disorders. If involved in the pathological process of a star, in a lump that affects the upper thoracic vertebrae, injuries to the arms, upper chest and heart can occur. With damage to the lower thoracic ganglia, there may be dysfunctional organs of the pelvis, abdominal and thoracic cavities, as well as trophic changes in the lower extremities and the rest of the body.