Clinical manifestations and degenerative changes
The main manifestations of degenerative processes in the thoracic spine are pronounced smooth kyphosis and pain that progresses over time. Within the classification of Scheuermann's disease, several types of kyphotic deformities are distinguished depending on the location of their apex: thoracic (type I with the apex at the level of Th7–Th9), thoracolumbar (type II at the level of Th10–Th12), and lumbar (type III). Wedge-shaped deformed vertebrae are located at the apex of the deformity. Starting from the third decade of life, patients develop osteochondrosis and spondylarthritis, with the long-term consequences proposed by E.V. Kalashnikova to be considered as a separate stage IV.
Diagnostic criteria and neurological status
Establishing a diagnosis is based on a combination of a characteristic clinical picture and the results of instrumental studies. During the diagnostic workup, the severity, duration, and dynamics of complaints are necessarily evaluated.
Additional manifestations may include:
- Neurological deficit (decreased sensitivity and motor function below the level of deformity)
- Impairments of internal organ functions
- Secondary joint changes, including manifestations of knee and hip joint arthrosis
Associated pain syndromes and cardialgia
Spinal pathologies often require differential diagnosis with cardiac manifestations. Chest pain can vary greatly in character:
- Coronary insufficiency: squeezing pain strictly behind the sternum with radiation, associated with exertion.
- Pericarditis: dependence of pain sensations on respiration and changes in body position.
- Psychogenic cardialgia: stabbing or burning pain in the apex of the heart area in emotionally labile individuals.
- Extracardiac pain: occurs in osteochondrosis and other spinal pathology, myositis, and nervous system lesions (Herpes zoster).
Scheuermann's kyphosis by levels: seven to nine — thoracic, ten to twelve — thoracolumbar.
Class and exam questions
When do degenerative processes manifest in Scheuermann's disease?
Degenerative processes such as osteochondrosis and spondylarthritis manifest in many patients starting from the 3rd decade of life.
What are the main clinical manifestations of thoracic deformities?
The main manifestations include pronounced smooth kyphosis of the thoracic spine and a pain syndrome that progresses over time.
What is the establishment of the diagnosis based on?
The diagnosis is established based on a combination of two factors: the characteristic clinical picture and instrumental diagnostic data.
What else to study on this topic
- Classification of clinical forms of kyphotic deformities according to K. Sorenson and D. Wenger
- Stage of long-term consequences (stage IV) as proposed by E.V. Kalashnikova
- Features of spondylolisthesis and vertebral arch defects
- Differential diagnosis of cardiogenic and psychogenic cardialgia
- Pathogenesis of dyspnea and skin discoloration in cardiology practice
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