Chest spine tumors

General information

A disease of the human musculoskeletal system such as osteonecrosis is basically the degeneration of the cartilage and neighboring bone tissue, with regular involvement of the vessels, muscles and nerve endsNeighboring menstruation in the pathological process. IN This term can, in principle, mean certain types of osteoarthritis in a variety of locations, including the joints of the extremities, but is commonly used to denote degenerative-dystrophic changes. in structure. directly the spine and above all the intervertebral discs.

As a result of the progression of disc bone necrosis, the human body loses its inherent shock-absorbing qualities, mobility and elasticity. In general, this disease of the spine is very common and in one or another severity present in most people in their 40s. Depending on the affected segment of the spine in clinical practice, bone tumorsDifferentiated cervix, lumbar and thorax, as well as their mixed forms, are considered the most difficult.

The thoracic spine tumor, which will be discussed in this article, is the most rare form of this pathology, in particular, due to the anatomical structure of the upper part of the human skeleton. Therefore, in the thoracic region, the skeletal system - cartilage consists of 12 vertebrae, connected by joints with the ribs, with their anterior ends, adjacent to the relatively monolithic sternum. Such a skeletal structure provides a sufficiently rigid and durable framework that protects the organs in the chest cavity (heart, lungs) from injury. In addition, the vertebrae of this segment of the spine are characterized by a small height and considerable length of the spiny processes, which gives them a close gap of bricks. All of these together limit the mobility of this part of the back and the negative effects of physical activity on it, protecting the disc from damage.

As another reason why the frequency of detecting breast osteoporosis in a person is lower, compared to lumbar and neck osteoporosis, physiological scoliosis (naturally arched spine) appearsis present in this area, so most of the external load falls on the anterior and lateral fragments of the vertebrae and the disc. With the development of a pathological process in the motor segment of the spine, it is these areas that are mainly exposed to altered degeneration, however, due to the absence of nerve ends and membranes of the spinal cord in them. , most of the pain is usually not observed. However, in some cases, negative changes in the thoracic segment of the spine affect the posterior disc fragments and the vertebrae and / or vertebrae joints, often leading to compression of the roots of the cord. spinal nerves. Under such conditions, bone necrosis of the thoracic spine occurs with lens syndrome, which has been accompanied by pain in many different (sometimes very distant) sites, as well as a violation of the function of many organs. in the human body (liver, lungs, pancreas, heart, etc. ).

Due to the vague and varied manifestations of thoracic neoplasms, doctors often call this form of pathology "chameleon disease", as it can skillfully disguise symptoms ofrespiratory and digestive diseases, myocardium, v. v. In this situation, correctly made differential diagnosis is very important that, through various specific studies, will help identify symptoms and treat necrosis of the thoracic spine.

The tactics and effectiveness of follow-up therapy will largely depend on the progression of the degenerative-dystrophy in the tissues of the spine. Having realized the pathology at an early stage of development, it is important to improve the patient's condition, which is entirely possible with the help of simple physical therapy techniques and exercises. treatment, but in the case of late detection, complicated surgery may be required. That is why spine specialists recommend any frequent and / or persistent back pain as soon as possible, seek the help of a specialist.

The mechanism of the pathogenesis

The incidence of thoracic spondylolisthesis in women and men is almost the same, since in the pathogenesis of this disease there is no gender for the onset of disc degeneration. However, years of clinical experience in the treatment of bone necrosis indicate that its first symptoms in men appear earlier than similar negative symptoms in women. In particular, this is due to the fact that the bones of the female body up to a certain age are protected by the hormone estrogen, a decrease in the level of this hormone at the time of climate change will be the cause. problems with the spine.

According to statistical evidence, in general, disc osteoporosis of varying severity is found in most elderly people, which automatically classifies age-related diseases. Meanwhile, eventually followed by a significant "rejuvenation" of this pathology, until it occurs in kindergarten. For this reason, to this day it has not been possible to determine the exact etiology and primary pathogenesis of spinal necrosis. At one point in time, more than a dozen theories about its origin and development were developed, including hormonal, infectious, mechanical, vascular, genetic, allergic and other theories, but in practice, no theory has been fully confirmed.

Nowadays, doctors interpret the emergence of osteonecrosis by the sum of additional negative effects on the tissues of the spine, in which continuous excessive loads onto one or more column movementssegments formed from two adjacent vertebrae (upper and lower) and a disc located between them. Paradoxically, such an overload can be the result of both the spinal work being overworked, and the result of its long-term finding in an unnatural rear position. For example, prolonged work or study while sitting at a table is one of the main factors leading to degenerative-dystrophic changes in the structure of the disc. plate.

The initial formation or exacerbation of necrosis of the thoracic spine can be affected by poor nutrition, uneven back and chest muscle growth, and overweight (obesity), pathology of the lower extremities (eg flat feet), back injury, v. v. In the pathogenesis of this disease, disorganization of the intermittent blood circulation plays an important role, dehydration of the myeloid nucleus (colloid), thus leading to a gradual loss of quality of the disc, load on the surrounding fibrous ring and gradually destroys this spinal motion.

During its progression, thoracic fibroids undergo four successive developmental stages, each characterized by morphological and anatomical changes in the disc structure, vertebrae. adjacent and face joints. In addition, the negative metamorphisms that occur with this disease can directly affect other nearby tissues (muscles, blood vessels, connections) or indirectly affect the work of organs and magnetic systems. away from the human body. (intestines, heart, lungs, etc. ).

First Level

In the early stages of thoracic tumor formation, small cracks form in the inner membrane of the annular fiber, in which the medullary nucleus gradually begins to penetrate, stimulating the nerve endsin the distal layers of the ring and in the posterior longitudinal ligament. At the advanced stage of the disease, the patient may feel pain directly in the middle part of the back or seemingly pain in the heart area. He may also be haunted by a feeling of convulsions. in the back muscles.

The second level

Skeletal tumors of the 2nd degree thoracic spine are characterized by further destruction of annular fibers, accompanied by instability of the spine, due to excessive mobility of the affected vertebrae. Pain: Feeling from the 2nd stage of the development of an intensifying pathology and can proceed as back pain (mild persistent pain, aggravated by back movement) or lower back pain (arising strongly based onbackground of a long time in a position, strong, Pain "shot").

The third degree

During the third stage of thoracic degeneration, there is a complete disruption of the structure of the fibrosis with the release of the medullary nucleus outside its boundary and the formation of a herniated disc. Most often, such formation arises in the direction of the canal vertebrae resulting in compression of the spinal cord, spinal nerves and neighboring vessels. This is accompanied by lens syndrome (pain radiating to different parts of the body), chest pain against the background of osteonecrosis (severe pain behind the sternum, like heart), myelopathy (disturbances of sensation and movement) and other symptoms of an increase in muscle tone and nerve vessels. Fixed scoliosis, scoliosis, or scoliosis may begin at this stage.

The fourth level

In the late stages of thoracic degeneration, degenerative processes spread to the golden and interstitial ligaments, other tissues of the spine, and neighboring muscles. Disc dystrophy continues to progress, leading to further scarring and fibrosis. Joint deformation develops in the lunate and the disc joints, and bone-forming substances (bone development) form on the processes of the vertebra. The clinical picture in this stage of the disease can be quite diverse, as the degree of damage to each disc is often different. In uncomplicated osteonecrosis, the fibrosis of a problematic disc may mark the transition of the disease into a steady state of remission, but a loss of normal function to one degree or another. Spine.

Reason

Thoracic tumors in men and women can develop due to the following predisposition factors:

• natural process of physiological aging, accompanied by age-related changes in the bone cartilage tissue structure of the spine;
a genetic predisposition to
• for abnormal formation of spinal movements;
• inactive lifestyle leading to back muscle dystrophy;
• strength sports involving excessive mechanical stress on the spine (mainly weightlifting);
• spinal injuries (even injuries that have occurred in the distant past);
• endocrine disorders in the human body, disrupting the nutrition of the tissues of the spine;
• significantly higher than normal body weight (obesity);
• unhealthy diet (lack of vitamins, minerals and fluids);
Pathological
• of the spine with its unnatural curvature;
• imbalance in muscle development;
• study or work extended in a sitting crouch forward position;
• physically difficult working conditions (improperly lifting weights);
• severe metabolic disorder;
• flat feet and other diseases of the lower extremities affecting redistribution of loads to the spine;
• vascular disease that reduces the blood supply to the back;
• severe infectious, allergic and autoimmune processes;
• frequent hypothermia;
• stressful situations and nervous breakdown;
• bad habits and smoking.

Symptoms of necrosis of the thoracic spine

Signs of thoracic necrosis, due to the structural features described above of this spine, may not bother the patient directly for a long time and appear only ifpathological progression to the lateral and / or posterior part of the affected spinal movement and the transition to the second or third degree. In general, all symptoms of thoracic necrosis disease are manifested in the form of vertebral syndrome (pain effects directly related to functional disorders in the cartilage-bone tissue of the spine) andcompression or ectopic syndrome (a negative phenomenon resulting from pathological impulses from a problematic segment of the spine).

Vertebral Syndrome

Symptoms of degenerative vertebrae of the thoracic segment of the spine are mainly manifested by two pain syndromes called back pain and back pain.

Dorsago

This is an acute and sudden pain, known as "low back pain", is localized in the interstitial space and can occur at any time. Usually, dorsago syndrome affects patients who have been in a sitting position with the body tilted forward and drastically changing the position of the body. The patient describes the very moment of the attack as a "dagger", accompanied by a sharp spasm of the spinal muscles. In addition to severe pain, subjective feelings toward the back are manifested by shortness of breath and significantly limited freedom of movement in the chest and back. A similar exacerbation of osteonecrosis with periodic attacks can last up to two weeks.

Back pain

This syndrome differs from the previous syndrome by the gradual development of unpleasant and painful sensations, which can increase over a period of two to three weeks. Pain itself with back pain is not so obvious, but its prolonged presence induces a constant feeling of anxiety. The muscles in the back as well as during the back muscles are subjected to considerable tension, which can cause the patient to feel a lack of inhaled air. Back pain increases with body movements (especially when bent down), deep breathing, coughing, etc. v. Upper back pain (major localization of negative phenomena in the cervical segment of the spine) and lower back pain (major localization of negative phenomena in the lumbar segment of the spine).

Extra-disc syndrome

The extra-vertebral syndromes of thoracic neoplasms, due to the greatest extent of this part of the spine, can be very diverse, greatly complicating the correct diagnosis of the disease. They arise by mechanically pressing the respective nerve roots, neighboring vessels or the spinal cord itself. Symptoms of compression in men and women are generally the same and differ only when the pathological impulses spread to a globular love (e. g. , in men, on the basis of the disease, dysfunction. erection is sometimes noted). In most cases, extracellular symptoms are due to disc herniation that has formed, usually appearing in the lower thoracic region, but can in principle form any segment of vertebral movement fromvertebrae D1 to vertebra D12. As you can see in the figure below, the localization of osteonecrosis in them is related to the process pathology of certain systems and organs of the human body with their characteristic negative manifestations.

Lens syndrome

In the context of compression symptoms of thoracic necrosis, lens syndromes are most often observed most clearly and often, caused by compression of nerve ends at one or moreanother segment of the spine. Depending on the concentration, the patient's problems can be disturbed by the following painful phenomena:

• in the case of intrusion into the T1 vertebrae - pain and paresthesia sensations from the upper thoracic spinal motion segment usually spread along the upper clavicle into the area of ​​one of the armpits forto the elbow joint;
• in the case of a violation of the T2-T6 vertebra - pain such as intercostal pain may extend from this part of the spine along the intercostal region and surround the axillary and scaly regions to formhalf-moon, as well as 2-6 intercostal space to the sternum;
• in the case of intrusion into the T7-T8 vertebrae - lumbar pain mainly spreads from the lower level of the shoulder blade of the parapetal joint to the upper part of the parapetal arch and affects the epigastric region, where the room ismuscular muscle (strong muscle tension);
• in the case of a violation of the T9-T10 vertebrae - intercostal pain extending from the segments of the lower thoracic spinal movement to the lower parts of the parietal arch and further to the umbilical region, alteringtimbre of the midsection of the abdominal muscles;
• in case of invasion of the vertebral region T11-T12 - pain also radiates from segments of movement of the lower thoracic spine and to the hypotenic region (below the stomach) and the groin area along the reciprocal regionchest irritation.

In addition to pain, lens syndromes of thoracic necrosis are often accompanied by negative symptoms from certain internal organs of the abdominal cavity and / or chest. Furthermore, in some cases, the symptoms seem so similar to the pathological manifestations of other diseases that it is almost impossible to recognize their exact belongings without direct research. For example, the medical literature describing a case of clinic-based improper appendicectomy (surgical intervention to remove the appendix) is clearly acute appendicitis, which is actually one of the syndromes. pronounced bone necrosis disease.

Therefore, when bone destruction is localized in the upper thoracic region of the spine (T1 to T4), the patient may experience various pain and / or discomfort in the esophagus or pharynx, which is generally consideredis the presence of a foreign body. Such feelings are often paroxysmal (sometimes permanent) and increase with a severe load on the problematic part of the back. Sometimes the manifestations of the upper thoracic lens syndrome are confused with the signs of an obstructive bronchitis or pneumonia, due to the cough reflex accompanied by necrosis of the thoracic region and chest pain similar to symptomsof this group of diseases. In addition, chest pain can occur in the form of chest pain, reminiscent of its severity as angina pectoris, pulmonary embolism, myocardial infarction. and other similar diseases of a serious nature, requiring detailed analysis of the doctor.

Patients with bone necrosis in the middle thoracic segment of the spine (T5 to T7) often experience discomfort and pain in the solar and gastric tangles, known as spina bifida. When the T8-T9 spinal movement segment fails, it is possible to develop pain in the duodenal area, known as - duodenal pain due to vertebrae. . . Both those sensations and other painful sensations in different patients or at times can vary in intensity from mild and "achy" to extremely acute. They strengthen, as a rule, when the body stays in a prolonged position (sitting at a table, lying on his back, etc. ), in case of sudden body movement, and also when sneezing or coughing. Often these pains are accompanied by paresthesia. (numbness, tingling, burning) in the middle of the abdominal wall.

With the lens manifestations of osteonecrosis in the lower thoracic region of the spine (from T8 to T12), some patients may complain of pain in the lower abdominal cavity, resembling an intestinal disorder. or pathology. Sometimes the pain spreads to the gallbladder and is localized to the posterior part of the right lower hypotension. Even less often, patients experience pain in the upper GI region similar to the pathology of a bladder clinic. As in the previous case, the nature of such pains can vary in a rather wide range (from mild to intense) and their severity increases with prolonged physical or static stress onspine, sneezing, cough, etc. v.

Compression myelopathy

This compression syndrome of thoracic necrosis is quite rare and is compression of the spinal cord directly resulting in disc herniation. . . Its characteristic symptoms at the onset of formation are manifested by local pain in the respective area of ​​the back or hip pain in the problem area, as well as feeling weak and / or numb in the legs. As the pain progresses, the pain gradually increases, can affect the intercostal hypovolemia, abdominal organs, the groin, and can be noticeably felt in the lower extremities. In severe cases against the background of compression myelopathy, dysfunction of the pelvic organs may develop, leading to an interruption of bowel and / or urination processes. In addition, there may be superficial and deep paresthesia and severe sensory disturbances, up to spastic paralysis. one or even both legs.

Compression circuit

Compression of the vessels adjacent to the thoracic segment of the spine leads to ischemia, resulting in an interrupted blood supply, and thus proper nutrition of the spinal cord. Manifestations of this syndrome are essentially a complete repetition of symptoms of myelosuppression and are mainly characterized by pelvic disorders, as well as loss of sensation in the lower extremities and impaired function. Patients often describe this problem with the phrase - "vacuum success".

Vegetative syndrome

In some cases, with thoracic necrosis, the vegetative nerve nodes (lymph nodes) become damaged, so the patient can experience many negative symptoms. These can be different paresthesia. , itching and changes in skin pigmentation in the area with problem lymph nodes, burning pain in one half of the body, local temperature disturbances, muscle increase or loss, loss of organization in the work of the limbs or organsinternal organs, v. v. According to it, in fact, these visceral spondylitis symptoms are similar to those of lens syndrome, but differ from them in the lack of localization and the presence of movement disorders and postactivity. details. When involved in the pathological process of a star a node affecting the upper thoracic vertebra, there may be a violation in the arm, upper chest and in the heart. In the case of sub thoracic lymphadenopathy, dysfunction may occur in the organs of the small pelvis, abdominal cavity and thoracic cavity, as well as nutritional changes in the lower extremities and the rest of the thoracic cavity. body.