Osteochondrosis of the thoracic spine
Last reviewed: 23.04.2024
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Unlike discogenic lumbar and cervical syndromes, the neurological complications of disc protrusions in the thoracic region remain to this day a lot of clinical casuistry.
The rarity of clinical manifestations of thoracic osteochondrosis is all the more evident that the number of disks in this department is twice that of disks in the cervical and lumbar regions. In addition, the spondylographic signs of osteochondrosis occur in the thoracic region much more often than in the cervical and lumbar.
A certain role is played by a smaller mobility of the thoracic vertebrae, as well as some features of the structure of the thoracic discs - a small thickness of the discs.
Physiological kyphosis of the thoracic region determines here the concentration of the maximum mechanical load on the front, rather than on the rear sections of the discs. The consequence of this is a much higher probability of developing in the thoracic region not the posterior but the anterior hernias and osteophytes, which, as we know, are devoid of clinical significance.
Th 10, Th 11 are most often affected ; Th 12. The protrusions of these three discs account for more than half of all cases of chest discopathy.
Accordingly, the location of protrusions in the clinical picture is divided into three main syndromes:
- With a medial hernia - symmetrical paraparesis and parahypesthesia without radicular syndromes;
- With medio-lateral hernia - an asymmetric spinal complex with a predominance of lesions on the side of a bulging disc, combined with root pains;
- Isolated radicular syndrome, usually due to lateral hernia.
The first symptom of the disease is pain; less often the disease begins with numbness or weakness of the legs and even more rarely - pelvic disorders.
Depending on the localization of the affected disc, the pains are intercostal, abdominal or inguinal neuralgia, or spread from the thoraco-abdominal region to the lower limbs.
Protective muscular contractures are observed with thoracic radiculospasmalgia much less frequently than in patients with discogenic lumbar sciatica.
The pathogenetic basis of complications of thoracic protrusions is compression radiculo- and myelopathies. Dyscirculatory disorders are undoubtedly important.
The presence of a large number of sympathetic fibers in the thoracic roots not only causes a peculiar vegetative coloring of the thoracic radiculopathies, but it can also lead to the development of visceral pains and dyskinesias. For example, with protrusions of the upper thoracic discs, pseudo-anginal seizures are observed. A special variant of the pain syndrome associated with thoracic protrusions is "transversal" or "sagittal" pain in the chest and upper abdomen.
Vasomotor disorders of the lower limbs under the influence of a prolonged spasm on the basis of pain impulses are a common manifestation of chest osteochondrosis.
[Reflex syndromes (thoracalgia)
Dorsalgia. Heavy character, which increases with movement, when driving on a rough road, cooling. Pain localization:
- in the interblade area (has a burning nature);
- in the intercostal spaces (pain increases with forced inspiration, sipping).
The reflex stress of the paravertebral muscles is observed with dorsalgia, often asymmetric, more pronounced on the convex side of the deformation.
ATTENTION! The tension of the paravertebral muscles, as a rule, is not as pronounced as at the cervical or lumbar level.
Syndrome of anterior thoracic wall. The onset of pain can be caused by reflex stress and a dystrophic change:
- sternocleidomastoid muscles starting on the sternum;
- stair muscles attached to the I-II ribs;
- subclavian muscle (contributes to the abnormality of the costal-clavicular gap);
- large pectoral muscle and other tissues of the anterior thoracic wall.
Pain increases with physical exertion on the muscles of the chest, with the turns of the head and trunk.
ATTENTION! Stenocardiac pain occurs most often after emotional, general physical loads or food intake.
The most painful zones are in the middle-clavicular line (level III-IV of the bone chondral joint) and along the free margin of the large pectoral muscle.
Syndrome of the sternum (zone of the beginning of the sternocleidomastoid muscle). Pain from the zone of the xiphoid process extends:
- in both subclavian areas;
- on the anteroideal surfaces of the upper extremity belt.
In the pathology of syndesmosis (synchondrosis) of the VII-X ribs, the increased mobility of the end of a cartilage leads to its slipping and traumatization of neural formations (receptors, trunks, including sympathetic ones). Irritation of the surrounding fiber causes aching pain, sometimes radiating to the area of the shoulder joint.