Thoracic osteochondrosis is a chronic pathology in which the bony vertebrae and intervertebral discs located between them undergo degenerative changes. Destructive lesions in this zone are relatively rare due to low mobility and good protection by the rib cage. Osteochondrosis of the thoracic spine develops unnoticed, develops slowly but continuously, and is also distinguished by some specific symptoms, masquerading as a disease of internal organs. In this case, it is very important to seek medical help at the first signs of back problems, still mild. Timely treatment helps to avoid severe complications.
Causes and provoking factors
The degenerative-dystrophic process in the thoracic segment of the spine occurs against the background of endogenous disorders and under negative external influences. Their development is most often provoked by the following factors:
- hereditary predisposition, the presence of a certain set of defective genes;
- excessive physical exercise, especially lifting and carrying various heavy objects;
- an inactive lifestyle, causing congestion in the area of the vertebral body and intervertebral disc;
- congenital or acquired structural anomalies, for example, accessory vertebrae, lordosis, kyphosis;
- back and/or chest injuries - fractures, prolonged compression;
- flat foot, club foot;
- blood circulation is affected everywhere, not just the thoracic spine area;
- frequent hypothermia;
- overweight;
- endocrine pathology, 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. This disease can be a result of untreated, severe lumbar or cervical osteochondrosis.
Smoking, alcohol addiction, and drunkenness, including occupational hazards, predispose to the destruction of intervertebral joints with discs that are mostly composed 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, slowness in the recovery process, 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 acute, burning, piercing. Patients usually describe the discomfort as dull, painful, or pressing. The pain syndrome may worsen with bending/turning, sudden awkward movements, during coughing fits, or during temperature changes. The radiation is observed—spreading beyond the affected area. Osteochondrosis of the thoracic spine also manifests itself as follows:
- stiffness, sense of constraint;
- certain clicks, pulsating when changing the position of the body;
- loss of sensitivity, paresis in the form of "crawling goosebumps" sensations, burning, numbness;
- muscle spasms, further limiting range of motion;
- adopting a forced position in which discomfort does not arise or is weakly expressed;
- pathological changes in posture, at a later stage - gait;
- slight decrease in growth due to destruction of intervertebral joints and convergence of vertebral bodies.
Due to the constant tension of the back muscles, the muscles of the neck and lower back also spasm, which is expressed in the pain of these parts.
The clinical picture of thoracic osteochondrosis is a combination of pain syndromes. The fact is that the affected segment is located in the normal conservation zone with many internal organs. If the displaced disc has pinched the nerve root located near the spine, then pain can be felt in it, simulating a common pathology:
- severe heart pain resembling angina pectoris and also myocardial infarction;
- pain in the mammary gland is a reason for an urgent differential diagnosis to exclude a tumor process;
- persistent or periodic pain in the right hypochondrium, in the stomach or intestines, resembling the characteristics of gastritis, cholecystitis, and ulcerative lesions.
When osteochondrosis worsens, the lower back or abdomen may hurt. Patients consider discomfort as signs of kidney pathology or gynecological diseases. They turn to a specialist, who then refers the patient to a neurologist or vertebrologist after examination.
Classification, main types
The usual classification of osteochondrosis of the thoracic spine is based on the nature of the pain syndrome. There are two types:
- dorsago - sharp acute pain in the sternum, which occurs mainly during a long stay in one body position, often complicated by a feeling of lack of air when inhaling;
- dorsalgia in the form of a mild painful sensation in the back, appears periodically and subsides after rest.
The division of these pathologies into groups allows the doctor to quickly decide on the choice of analgesics.
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 radiographic markers. The more significant the deformation of the disc and vertebrae, the stronger the pain, stiffness of movement, and paresthesia. The stage of the disease determines the therapeutic tactics.
Stage I
No change on the x-ray yet. However, the intervertebral disc no longer retains moisture well, without which timely recovery is impossible. It begins to gradually thin, lose strength and elasticity. Only in some cases, mild discomfort occurs in the thoracic region. Someone thinks it's muscle fatigue and doesn't consult a doctor. Therefore, the disease at this stage is usually an incidental diagnostic finding during examination for other reasons.
Stage II
The fibrous ring structure becomes loose and fibrous. Enlargement of a fissure in the disc occurs with the protrusion of the nucleus pulposus in this direction. The distance between adjacent vertebrae decreases, as the height of the disc decreases, which is clearly depicted on radiographic images. To balance the distribution of the load, the muscle tissue is constantly tense. Stiffness increases, pain severity remains moderate.
Stage III
The fibrous ring is ruptured with the nucleus pulposus squeezed beyond its borders. Disc herniation occurs, which causes severe symptoms and severe complications. There is a significant deformation of the vertebral body and the formation of a single osteophyte (compensatory bone growth). Pain syndrome becomes constant, movement in the back is very limited.
stage IV
At this stage, diagnosing thoracic osteochondrosis is not difficult. Connective tissue has developed and various osteophytes have formed. Adjacent vertebrae in a segment are stuck, completely or partially immobile. Nerve roots are often pinched by inflammatory swelling, bony growths, and muscle spasms. This manifests itself as a burning, shooting pain. The patient is unable to cope with household tasks and has difficulty moving.
Complications
The development of discogenic myelopathy, a dystrophic disease of the spinal cord resulting primarily from compression by a herniated disc, is dangerous. It should be noted that with osteochondrosis of the thoracic spine, such complications are rare. However, in clinical practice there are cases of localization of discogenic myelopathy in one of the lower segments. Due to the increasing neurological deficit, muscle strength decreases and tendon reflexes change. Areas of ischemia form and nerve cells die (spinal cord infarction). This is characterized by movement disorders, loss of sensitivity, and trophic disorders.
Diagnostic steps
At the first consultation, the doctor listens to the patient's complaints, examines them, assesses the level of sensitivity, checks the tendon reflexes, reviews the medical history, and the history of spinal injuries. The diagnosis is confirmed by laboratory and instrumental studies:
- radiography in two projections, according to the indication - the target image of a certain segment;
- magnetic resonance imaging;
- evoke potential;
- electroneurography;
- electromyography;
- general clinical blood and urine tests.
To find out the cause of certain symptoms and to exclude somatic diseases with similar clinical manifestations, electrocardiography, ultrasound scan of the heart structure, and electroencephalography can be prescribed.
Methods of treatment for thoracic osteochondrosis
This 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 drugs, including directly into the affected area. The use of glucocorticosteroids in combination with anesthetics (blocking drugs) is usually practiced. In other cases, drug therapy consists of taking tablets, capsules, rubbing in ointments and balms. The use of drugs from the following groups has been shown to be effective:
- muscle relaxant to relieve muscle spasms;
- nonsteroidal anti-inflammatory drugs with pronounced analgesic activity;
- antispasmodic for pinched nerves;
- means to improve blood circulation;
- preparation with vitamin B6, which improves the transmission of nerve impulses and activates regeneration.
If radicular syndrome has formed and other complications have arisen, then the person always lives in fear of experiencing excruciating pain, and this can cause mental disorders. Prescribing sedatives and antidepressants can prevent such development. In addition to drugs, the following methods are used in the treatment of osteochondrosis of the thoracic spine:
- therapeutic massage, including vacuum and acupuncture;
- physiotherapeutic procedures - electrophoresis/ultrahonophoresis, magnetic therapy, pulsed current, UHF therapy, application with ozokerite or paraffin, acupuncture, hirudotherapy;
- physical therapy and gymnastics;
- spinal traction.
In the case of significant damage to the vertebral disc and myelopathy, surgical treatment is always prescribed immediately. Hernia protrusion is removed, microdiscectomy, puncture valorization or disc laser reconstruction is performed, implants are installed or spinal segments are stabilized.
Prevention of thoracic osteochondrosis
The main goal of primary prevention of thoracic osteochondrosis is to eliminate factors that can trigger thinning and cracking of the intervertebral disc. What the doctor recommends:
- avoid excessive pressure on the back;
- immediately 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;
- supplement 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 diseases that have been diagnosed in the thoracic, cervical or lumbar spine. With their help, it is possible to prevent the aggravation and development of the degenerative-dystrophic process.
If you have signs of osteochondrosis of the thoracic spine, and you want to get rid of them, contact the clinic for full and efficient treatment.
Question answer
What is the difference between intercostal neuralgia and thoracic osteochondrosis?
In fact, intercostal neuralgia is a lesion of the intercostal nerve, which can complicate the course of osteochondrosis. There are two main differences between these pathological processes. Neuralgia is characterized by paroxysmal shooting or burning pain, which increases even with inhalation. Thoracic osteochondrosis without violation of sensitive nerve endings is indicated by a dull, seemingly 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 early stages of development.