Such a disease of the human musculoskeletal system 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. INin principle, this term can mean a number of osteoarticular pathologies of various localization, including with the joints of the extremities, but most often it is used to denote degenerative-dystrophic changes in the structuredirectly to the spine and especially the intervertebral discs.
As a result of the progression of intervertebral osteochondrosis, the human body loses its shock-absorbing qualities, its inherent mobility and elasticity. In general, this disease of the spinal column is very widespread and in one ora different degree of severity is present in most people by the age of 40. Depending on the affected segment of the spine in clinical practice, there are cervical, lumbar and thoracic osteochondrosis, as well as their mixed forms, whichare considered the most difficult.
Osteochondrosis of the thoracic spine, which will be discussed in this article, is the most rare form of this pathology, which, in particular, is due to the anatomical structure of the upper part of the human skeleton. So, in the chest area, the bone-cartilaginous system consists of 12 vertebrae, which are connected by means of joints with ribs, which, with their front ends, adjoin a relatively monolithic sternum. Such a skeletal structure provides sufficienta rigid and strong frame that protects the organs of the chest cavity (heart, lungs) from injury. In addition, the vertebrae of this segment of the spinal column are characterized by a small height and a significant length of the spinous processes, which gives themview of tightly spaced tiles. All this together limits the mobility of this 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 detecting osteochondrosis of the chest in a person, in comparison with lumbar and cervical osteochondrosis, physiological kyphosis (natural backward bending of the spine) appears in this area, due to which the bulk of the external load falls on the anterior and lateral fragments of the vertebrae and discs. With the development of a pathological process in the spinal motion segment, it is these areas that are primarily exposed to degenerativechanges, however, due to the absence of nerve endings and membranes of the spinal cord in them, pain is most often not observed. Nevertheless, in some cases, negative transformations in the thoracic segment of the spinal column affectposterior fragments of discs and vertebrae and / or vertebral-costal joints, which often leads to compression of the roots of the spinal nerves. In such conditions, osteochondrosis of the thoracic spine with radicular syndrome occurs, which is alreadyaccompanied by pain of various localization (sometimes very distant), as well as a violation of the functionality of many organs of the human body (liver, lungs, pancreas, heart, etc. ).
Due to such ambiguous and varied manifestations of thoracic osteochondrosis, doctors often call this form of pathology "chameleon disease", as it can skillfully disguise itself as symptoms of respiratory and digestive diseases, heart muscle, etc. In this situation, a correctly carried out 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 will largely depend on the degree of progression of the degenerative-dystrophic process in the tissues of the spinal column. Having recognized the pathology at the initial stages of its development, it is significant to improve the patient's conditionit is quite possible with the help of simple physiotherapeutic techniques and exercises of exercise therapy, but in the case of its late detection, it may be necessary to carry out a complex surgical operation. That is why doctors-vertebrologists strongly recommend whenany frequent and / or prolonged back pain as soon as possible seek the help of a specialist.
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 to the onset of intervertebral disc degeneration. Nevertheless, many years of clinical experience in the treatment of osteochondrosis indicates 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 osteochondralthe tissues of the female body up to a certain age are protected by the hormone estrogen, a decrease in the level of which at the time of climacteric transformations serves as a trigger for problems with the spine.
According to statistical evidence, in general, intervertebral osteochondrosis in varying degrees of severity is found in most elderly people, which automatically classifies it in the group of age-related diseases. Meanwhile, the lasttime is followed by a significant "rejuvenation" of this pathology, up to its occurrence in preschool age. For this reason, it has not been possible to establish the exact etiology and initial pathogenesis of spinal osteochondrosis until today. At one time, more than a dozen theories of its origin and development were developed, including hormonal, infectious, mechanical, vascular, hereditary, allergic and others, but in practice none of them has found full confirmation.
Today, doctors explain the occurrence of osteochondrosis by the sum of complementary negative effects on the tissues of the spine, among which they emphasize the constant excessive load on one or more spinal motionsegments formed from two adjacent vertebrae (upper and lower) and a disc located in the middle of them. Paradoxically, such an overload can be a consequence of both excessive physical work of the spinal column, and the resultits 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 primary factors in the development of degenerative-dystrophic changes in the structure of the intervertebraldisk.
The initial formation or exacerbation of osteochondrosis of the thoracic spine can be influenced by poor nutrition, uneven development of the dorsal and thoracic muscles, excessive weight (obesity), pathology of the lower extremities (for example, flat feet), back injuries, etc. In the pathogenesis of this disease, disorganization of segmental blood circulation plays a significant role, which causes dehydration of the pulpous (gelatinous) nucleus, which in turn leads toloss of amortization qualities of the intervertebral disc, change in loads on the surrounding fibrous ring and further gradual destruction of this spinal motion segment.
In the process of its progression, thoracic osteochondrosis goes through 4 consecutive stages of development, each of which is characterized by its own anatomical and morphological changes in the structure of the disc, adjacent vertebrae and facetjoints. In addition, the negative metamorphoses taking place in this disease can directly affect other nearby tissues (muscle, vascular, connective) or indirectly affect the work of remote organs and systems of the human body. (intestines, heart, lungs, etc. ).
At 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, irritating the nerve endings in the distal layers of the fibrousrings and in the longitudinal posterior ligament. At this stage of the development of the disease, the patient may already feel soreness in the middle of the back or seeming pain in the heart area. He may also be haunted by a feeling of convulsive contraction. in the dorsal muscles.
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 spinal column, resulting from excessive mobility of its affected vertebrae. Painfulsensations from the 2nd stage of development of pathology intensify and can proceed as dorsalgia (slight persistent pain, aggravated by movements of the back) or dorsago (arising sharply against the background of a prolonged stay in one position, strong"Shooting" pains).
In the third period of thoracic osteochondrosis, 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 arise in the direction of the vertebralchannel, which leads to compression of the spinal cord, spinal nerves and adjacent vessels. This is accompanied by radicular syndrome (radiating pain to different parts of the body), thoracalgia against the background of osteochondrosis (severe pain behind the sternum, resemblingcardiac), myelopathy (sensory and movement disorders) and other symptoms of a neurovascular and muscle-tonic nature. Fixed thoracic kyphosis, scoliosis, or kyphoscoliosis may begin at this stage.
During the final stage of thoracic osteochondrosis, degenerative processes spread to the interspinous and yellow ligaments, other tissues of the spine and nearby muscles. Intervertebral disc dystrophy continues to progress, up to itsscarring and further fibrosis. Deforming arthrosis develops in the lunate and intervertebral joints, osteophytes (bone growths) form on 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 often different. In uncomplicated osteochondrosis, 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. spinal column.
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 spinal column;
- genetic predisposition to abnormal formation of spinal motion segments;
- a physically inactive lifestyle leading to dystrophy of the back muscles;
- strength sports that involve excessive mechanical stress on the spine (primarily weightlifting);
- spinal column injuries (even 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 (deficiency of vitamins, minerals and fluids);
- pathology of the spine with its unnatural bending;
- imbalance in the development of the muscle frame;
- prolonged study or work in a seated 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, 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
Signs of thoracic osteochondrosis, due to the above-described structural features of this segment of the spine, may not directly bother the patient for a long time and appear only if the pathological process spreads to the lateraland / or the posterior parts of the affected spinal motion segments 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 relatedwith functional disorders in the bone-cartilaginous tissue of the spine) and extravertebral or compression syndromes (negative phenomena arising from pathological impulses from the problem segment of the spinal column).
Vertebral symptoms of osteochondrosis of the thoracic segment of the spine are mainly manifested by two pain syndromes, called dorsago and dorsalgia.
It is an acute and sudden attack of pain, the so-called "lumbago", which is localized in the interscapular space and can occur at any time. Most often, dorsago syndrome affects patients who have beenin a sitting position with the body tilted forward and sharply changing the position of the body. Patients describe the very moment of the attack as a "dagger blow", accompanied by a sharp spasm of the spinal muscles. In addition to severe pain, subjective sensations with dorsalexpressed by 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.
This syndrome differs from the previous one by the gradual development of uncomfortable and painful sensations, which can increase over the course of two to three weeks. The pain itself with dorsalgia is not so pronounced, but its prolonged presence causesa constant feeling of anxiety. The dorsal muscles, as well as during the dorsal muscle, are subjected to significant stress, which can cause the patient to feel a lack of inhaled air. Back soreness increases with trunk movements(especially when bending over), deep breathing, coughing, etc. Separately distinguish between upper dorsalgia (the main localization of negative phenomena in the cervicothoracic segment of the spine) and lower dorsalgia (the main localization of negative phenomena inthoracolumbar segment of the spine).
Extravertebral syndromes of thoracic osteochondrosis, due to the greatest extent of this part of the spine, can be very diverse, which greatly complicates the correct diagnosis of the disease. They arise as a result of mechanicalcompression 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 sexualsphere (for example, in men, against the background of the disease, erectile dysfunction is sometimes noted). In almost all cases, extravertebral symptoms are caused by already formed intervertebral hernias, which most often appear in the lowerthoracic regions, but in principle can form in any spinal motion segment from the D1 vertebra to the D12 vertebra. As you can see in the picture below, it is on the localization of osteochondrosis in them that involvement in pathologicalthe process of certain systems and organs of the human body with negative manifestations characteristic of them.
Within the framework of compression symptoms of thoracic osteochondrosis, radicular syndromes are most often and clearly observed, provoked by compression of nerve endings in one or another segment of the spinal column. Depending on the concentration, suchthe problems of patients may be disturbed by the following painful phenomena:
- in case of infringement in the region of the T1 vertebra - painful sensations and paresthesias from the upper thoracic spinal motion segment most often spread along the suprascapular zone into the area of one of the armpits up to the elbow joint;
- in case of infringement in the area of the T2-T6 vertebrae - soreness like intercostal neuralgia can extend from this part of the spinal column along the interscapular region and encircle the axillary and scapular zones in a semicircle, as well as 2-6 intercostal spaceto the sternum;
- in case of infringement 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 causesmuscular defense (strong muscle tension);
- in case of infringement in the region of the T9-T10 vertebrae - intercostal neuralgia expands from the lower thoracic spinal motion segments 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 case of infringement in the area of the T11-T12 vertebrae - the pain also emanates from the lower thoracic spinal motion segments and reaches the hypogastric (below the stomach) and groin regions along the corresponding lateral zones of the chest.
In addition to pain, quite often radicular syndromes of thoracic osteochondrosis are accompanied by negative symptoms from certain internal organs of the abdominal cavity and / or chest. Moreover, in some cases, such symptomsare so similar to the pathological manifestations of other diseases that it is virtually impossible to accurately recognize their belonging without directed research. For example, the medical literature describes a case of unjustified conductappendectomy (surgical intervention to remove the appendix) according to the unambiguous clinic of acute appendicitis, which in fact turned out to be one of the pronounced syndromes of osteochondrosis.
So, when the osteochondrotic process is localized in the upper thoracic region of the spine (from T1 to T4), patients may feel soreness and / or various discomfort in the esophagus or pharynx, which are often perceived asthe presence of a foreign body. Such sensations are often paroxysmal (sometimes permanent) and intensify with a serious load on the problem part of the back. Sometimes the manifestations of radicular syndrome in the upper thoracic segment are confused with signsobstructive bronchitis or pneumonia, since a reflex cough with osteochondrosis of the thoracic region and chest pain resemble the symptoms of this group of diseases. Also, chest pain can occur in the form of thoracalgia, reminiscent ofits intensity is an attack of angina pectoris, pulmonary thromboembolism, myocardial infarctionand other similar pathologies of a serious nature, which requires a detailed differential analysis from doctors.
Patients with osteochondrosis in the mid-thoracic segment of the spinal column (T5 to T7) most often feel discomfort and pain in the solar plexus and stomach, which are called vertebral gastralgia. On defeatspinal motion segments T8-T9, it is possible to develop pain in the duodenal region, called - vertebrogenic duodenalgia. . . Both those and other painful sensations in different patients or in differenttimes can vary in intensity from mild and "aching" to extremely acute. They intensify, as a rule, with a prolonged stay of the body in one position (sitting at a table, lying on your back, etc. ), in the case of sudden movements of the body, and also at the moment of sneezing or coughing. Often these pains are accompanied by paresthesias. (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 disordersor pathology. Sometimessoreness spreads to the gallbladder and is localized in the posterior region of the right hypochondrium. Even less often, patients experience pain in the suprapubic region similar to the pathological clinic of the bladder. As in the previouscase, the nature of such pain can vary over a fairly wide range (from mild to intense), and their severity increases with prolonged physical or static stress on the spinal column, sneezing, coughing, etc.
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 beginningformation is expressed by 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 progression, the pain intensifies, it can affect the lowerintercostal space, abdominal organs, groin area and significantly felt in the lower extremities. In severe cases with compression myelopathydysfunction of the pelvic organs may develop, leading to disruption of processesdefecation and / or urination. In addition, there may be severe superficial and deep paresthesias and sensory disturbances, up to spastic paresisone or even both legs.
Compression of the vessels adjacent to the thoracic segment of the spine leads to myeloischemia, as a result of which the blood supply is disrupted, and hence the proper nutrition of the spinal cord. The manifestations of this syndrome are actuallycompletely repeat the symptoms of compression myelopathyand are mainly characterized by pelvic disorders, as well as loss of sensation in the lower limbs and a decrease in their functionality. Patients often describethis problem with the phrase - "legs fail".
In a number of cases, with thoracic osteochondrosis, the vegetative nerve nodes (ganglia) are damaged, as a result of which the patient may experience a wide variety of negative symptoms. These can be various paresthesias. , itching and changes in skin pigmentation in the area of the problem ganglion, burning soreness of one half of the body, local temperature disturbances, muscle hyper- or wasting, disorganization in the work of the limbs or internal organs, etc. According to hisin fact, these visceral vertebrogenic symptoms are similar to the manifestations of radicular syndromes, but differ from them in the absence of clear localization and the presence of secretory and motor disorders. When involved in the pathological process of a stellatea node affecting the upper thoracic vertebrae, there may be abnormalities in the arms, upper chest and heart. In case of damage to the lower thoracic ganglia, functional disorders may occur inorgans of the small pelvis, abdominal and thoracic cavity, as well as trophic changes in the lower extremities and the rest of the body.