Thoracic osteochondrosis is a chronic pathology in which the bone vertebrae and 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 structure. Osteochondrosis of the thoracic spine develops unnoticed, progresses slowly but persistently, and is also distinguished by a number of specific symptoms, disguised as diseases of internal organs. In this sense, it is very important to seek medical help at the first signs, even mild ones, 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 disturbances and under negative external influences. Its development is most often provoked by the following factors:
- hereditary predisposition, the presence of a certain set of defective genes;
- excessive physical exertion, especially lifting and carrying several heavy objects;
- sedentary lifestyle, causing congestion in the region of the vertebral bodies and intervertebral discs;
- congenital or acquired structural anomalies, e. g. accessory vertebrae, lordosis, kyphosis;
- back and/or chest injuries - fractures, prolonged compression;
- flat feet, club feet;
- impaired blood circulation in any area, not just in the thoracic spine region;
- frequent hypothermia;
- overweight;
- endocrine pathologies, metabolic disorders such as diabetes, gout, hypothyroidism, hyperthyroidism;
- systemic diseases - rheumatoid arthritis, systemic lupus erythematosus, scleroderma;
- ankylosing spondylitis.
The strength and mobility of the spine as a whole directly depends on the condition of each department. The disease may be a consequence of untreated severe lumbar or cervical osteochondrosis.
Smoking, alcohol dependence and intoxication, including occupational hazards, predispose to the destruction of intervertebral joints with discs consisting mainly of cartilage. Thoracic osteochondrosis is diagnosed more often in the elderly than in young and middle-aged people. This is due to the natural aging of the body, the 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 extremely rarely acute, burning and penetrating. Patients often describe the discomfort as dull, aching, or pressing. The pain syndrome can intensify when bending/turning the body, sudden and awkward movements, during a coughing fit or during temperature changes. Its irradiation is noted – spread beyond the affected area. Osteochondrosis of the thoracic spine also manifests itself as follows:
- stiffness, feeling of embarrassment;
- specific clicks, clicks when changing body position;
- loss of sensitivity, paresis in the form of "goosebumps", burning, numbness;
- muscle spasms, further limiting range of motion;
- adoption of a forced position in which discomfort does not arise or is expressed weakly;
- 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 experience spasms, 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 compressed a nerve root located near the spine, then pain may be felt in them, simulating common pathologies:
- severe heart pain resembles angina pectoris and even myocardial infarction;
- pain in the mammary glands becomes a reason for urgent differential diagnosis to exclude tumor processes;
- constant or periodic pains in the right hypochondrium, stomach or intestines, resemble those characteristic of gastritis, cholecystitis and ulcerative lesions.
When osteochondrosis worsens, the lower back or abdomen may hurt. Patients mistake discomfort for signs of kidney pathology or gynecological disease. They turn to specialized specialists, who refer patients to a neurologist or vertebrologist after 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 types:
- dorsago - sharp, sharp pain in the sternum, which occurs mainly during prolonged stay in one position of the body, often complicated by a feeling of shortness of breath when inhaling;
- Dorsalgia in the form of mild painful sensations in the back, appearing periodically and decreasing after rest.
This division of the pathology into groups allows the doctor to quickly decide on the choice of analgesic.
Phase-by-phase development of thoracic osteochondrosis
In its development, osteochondrosis of the thoracic spine goes through four stages. Each has its own symptoms and radiographic 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 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 thin, losing strength and elasticity. Only in some cases does mild discomfort occur in the thoracic region. The person perceives this 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 fibrous ring becomes loose and fibrous. The widening of a fissure in the disc occurs with protrusion of the nucleus pulposus in that direction. The distance between adjacent vertebrae decreases as the height of the disc decreases, which is clearly visualized on radiographic images. To compensate for the distribution of loads, muscle tissue is constantly tense. Stiffness increases, pain intensity is still moderate.
Stage III
The fibrous ring ruptures and the nucleus pulposus is compressed beyond its limits. A herniated disc occurs, which causes severe symptoms and serious complications. There is significant deformation of the vertebral bodies and formation of single osteophytes (compensatory bone growths). The pain syndrome becomes constant, back movements are significantly limited.
Stage IV
At this stage, the diagnosis of thoracic osteochondrosis is not difficult. Connective tissues grew and numerous osteophytes formed. Adjacent vertebrae in the segment are locked, fully or partially immobilized. Nerve roots are often compressed by inflammatory swelling, bone growth, and muscle spasms. This manifests as a burning, sharp pain. The patient copes poorly with household chores and has difficulty moving around.
Complications
The development of discogenic myelopathy, a dystrophic disease of the spinal cord resulting primarily from compression by a herniated disc, is dangerous. It is important to highlight that in osteochondrosis of the thoracic spine, such a complication is rare. However, in clinical practice there have been cases of localization of discogenic myelopathy in one of the lower segments. Due to a neurological deficit that gradually increases, 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, assesses the level of sensitivity, checks tendon reflexes, studies the medical history and history of spinal injuries. Its diagnosis is confirmed by laboratory and instrumental studies:
- x-ray in two projections, according to indications - targeted image of a specific 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, an electrocardiogram, ultrasound of cardiac structures and electroencephalography can be prescribed.
Treatment methods for thoracic osteochondrosis
Therapy is comprehensive, aimed at eliminating symptoms and preventing the spread of the pathological process to other segments of the spine. In the acute phase, unbearable and burning pain is eliminated by injecting medications, including directly into the affected area. The use of glucocorticosteroids in combination with anesthetics (drug blocks) is generally practiced. In other cases, drug therapy consists of taking tablets, capsules, rubbing ointments and balms. The use of medications from the following groups has been shown to be effective:
- muscle relaxants to relieve muscle spasms;
- non-steroidal anti-inflammatory drugs with pronounced analgesic activity;
- antispasmodics for pinched nerves;
- means for improving 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, the person constantly lives in fear of experiencing unbearable pain again, and this can cause mental disorders. Prescribing sedatives and antidepressants can prevent such developments. In addition to medications, the following methods are used in the treatment of osteochondrosis of the thoracic spine:
- therapeutic massage, 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 hernial protrusion is removed, microdiscectomy, puncture enhancement or laser disc reconstruction is performed, an implant is installed, or the spinal segment is stabilized.
Prevention of thoracic osteochondrosis
The main objective of primary prevention of thoracic osteochondrosis is to eliminate factors that can trigger thinning and fissure of the intervertebral disc. What doctors recommend:
- avoid excessive stress on the back;
- promptly treat all diseases - infectious, endocrine, inflammatory;
- seek medical help immediately for back injuries, even those that at first glance seem minor;
- give up 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.
Such preventive measures are effective for already diagnosed diseases of the thoracic, cervical or lumbar spine. With their help, it will be possible to prevent exacerbations and progression of the degenerative-dystrophic process.
If you have signs of osteochondrosis of the thoracic spine and want to get rid of it, 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 a lesion of the intercostal nerves, which 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 a dull pain, as if it were a distant pain.
And the second difference is prediction. After eliminating the cause of intercostal neuralgia, it disappears without a trace. Osteochondrosis responds well to treatment only in the initial stages of development.