Osteochondrosis - dystrophic changes in the spinal column associated with age-related aging of tissues. Pathology is 80% associated with genetic data, the rest is the impact of external factors.
Osteochondrosis- predominantly human disease, the development of which is facilitated by:
- Increased lifespan. Over time, metabolism slows down, tissue nutrition is disrupted, destructive regulatory systems begin to prevail over constructive
- Walking upright. Standing on his feet, the person acquired an uneven load on different parts of the spine, was able to perform a greater amount of movement - for twisting, extension. There were pathological lateral bends - scoliosis - with uneven load on the muscles and small joints of the spine. This increased the likelihood of the formation of the disease even in the department where low mobility and the rib cage protect the vertebrae - thoracic osteochondrosis
- Acceleration. Rapid growth makes bones, muscles, and cartilage more vulnerable. The number and prevalence of blood vessels is insufficient to supply them with oxygen and essential substances
- Lack of adequate physical activity. There are two extremes - sedentary work and movement exclusively by car or excessive stress in the gym, when discs and cartilage wear out at an accelerated pace
- Improper nutrition. The predominance of fast carbohydrates, a lack of proteins, the use of carbonated drinks leads to the fact that the body does not have enough high-quality building materials to maintain tissue health
- Smoking. Causes prolonged vasospasm - disruption of tissue nutrition, acceleration of degenerative processes
- Urbanization, a large number of traumatic objects around lead to spinal injuries, secondary osteochondrosis
Types of osteochondrosis
- Osteochondrosis of the cervical spine
- Injury to the thoracic spine
- Lumbar osteochondrosis
- Common osteochondrosis - cervical and lumbar, thoracolumbar, lumbosacral and other combinations
The most common changes in the most mobile parts are the cervical and lumbar. The sore spot is the transition of the mobile lumbar region to the fixed sacral one.
- Initial - small changes in the center of the disc, compaction of the nucleus, the appearance of cartilage cracks
- The progression of the disease - the cracks deepen, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs - due to a violation of the ratio of the vertebrae to each other, cartilage on the surfaces of small joints is unevenly erased, arthrosis and arthritis develop
- Complicated osteochondrosis - symptoms: further degeneration of the cartilage occurs - ruptures of the cartilaginous ring that connect the bodies of two adjacent vertebrae appear. Part of the nucleus protrudes through the free space and squeezes the roots, the spinal cord - a disc herniation is formed. A more serious problem is the separation of the fallen out part - a sequestered hernia. Disturbed by severe pain, impaired sensitivity and movement in the area for which the compressed nerve is responsible
- The organism responds to the increased load and excess mobility by the growth of bone tissue - osteophytes appear. They stabilize the spine but reduce the range of motion. Bone hooks irritate muscle receptors and press on nearby vessels. With cervical osteochondrosis, this causes symptoms of the "vertebral artery" - dizziness, tinnitus, flickering of dots in front of the eyes
Osteochondrosis of the cervical spine
With the advent of mobile phones and computerscervical osteochondrosiseven in adolescents: a prolonged unnatural position of the head with muscle tension overloads the vertebrae, their discs and joints.
Cervical osteochondrosis - symptoms
- Neck pain extending to the back of the head, upper back
- Sometimes headaches associated with cervical osteochondrosis mimic a migraine - one-sidedness of symptoms, intolerance to sounds and bright light, strong pulsation in the temples, bright flashes before the eyes
- Frequent headaches that do not respond well to conventional tablets
- Pressure drops resistant to antihypertensive drugs
- Dizziness and darkening in the eyes with sudden head turns
- Numbness in the fingers, especially after sleep, a crawling feeling on the skin
- Restriction of movement in the neck, crunching when trying to move. Patients have to turn their whole body to see something behind them
- Upper body sweating
- Tense muscles of the neck and shoulder girdle can be detected by palpation.
If identifiedcervical osteochondrosis, treatment in the initial stages prevents severe complications - compression of the vertebral artery with oxygen starvation of the brain, compression of the spinal cord.
Manifestations of osteochondrosis of the thoracic spine
Changes in the thoracic region develop less often, provoking factors - back injuries, scoliosis, previous diseases of the spine (tuberculous, nonspecific spondylitis, body hemangiomas).
Symptoms of the lesion of the thoracic region:
- Back pain - aching, pulling, worse after prolonged standing or sitting in an uncomfortable position. But with constant complaints of pain, other possible causes must be excluded - pneumonia, pleurisy, tumors, intercostal neuralgia of a different nature, herpes zoster before the appearance of bubbles
- Difficulty breathing, shortness of breath, inability to take a deep breath
- Thoracic osteochondrosis sometimes mimics attacks of angina pectoris - a person is treated for a long time by a cardiologist, and the problem is in a diseased intervertebral disc
Lumbar and lumbosacral osteochondrosis
In the structure of all types of osteochondrosis, these departments are confident leaders, more than half of all cases of diagnosis. The reason is that the greatest load falls on this area of the body, both standing and sitting. Body weight, load in case of improper lifting of weight, for a long time in a bent position - the nucleus pulposus of the intervertebral discs is in a state of compression, is pressed into the vertebral bodies through the cartilaginous plates - Schmorl's hernias are formed. Overstrain and muscle spasm disrupt the location of the small joints of the vertebrae relative to each other - articular cartilage is erased, mobility decreases.
Several vicious circles develop at once: muscle spasm gives pain - pain reflexively increases contraction of muscle fibers, acute pain forces a person to restrict movement, spare the damaged area - the strength of the muscle frame and support of the spine decreases, this increases its instability, lumbar osteochondrosis progresses.
At the transition point of the mobilelumbar spineinto an immobile sacrum fused into a single monolith, there is a danger of slipping of the fifth lumbar vertebra from the surface of the sacrum. This pinches the nerve bundles, the radicular syndrome develops.
Lumbar osteochondrosis symptoms
- Low back pain, especially sitting and standing. After rest, the horizontal position improves. With a prolonged course, the pain is habitual, aching, pulling
- Sharp sudden lumbago when changing the state of the body, lifting weights, heavy load. The patient gets stuck in the position in which he was caught by the attack, it is difficult to straighten up, start moving. Lumbago is usually associated with compression of the spinal nerve root, which developed acutely
- The transition of pain to the gluteal region, legs. The largest nerve in the body, the sciatic, is a direct continuation of the spinal root; therefore, patients with lumbar osteochondrosis are often worried about sciatica
- Due to the fact that nerve fibers control the tone of muscles and blood vessels, regulate tissue nutrition, changes are noted in that part of the trunk for which the diseased nerve is responsible. The limb feels colder than the healthy one. With a prolonged course of the disease, muscle atrophy, dry skin, and swelling are noticeable. Local immunity decreases - any scratch, cut, abrasion easily becomes an entrance gate for infection
- The defeat of sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may get burned or frostbite due to the fact that they did not feel a dangerous change in temperature.
- Very frightening symptoms - numbness of the skin of the perineum, loss of control over the pelvic organs. The patient does not feel a full bladder, does not feel the need to empty the intestines. Over time, urine and feces begin to be excreted on their own, it is not possible to keep them. In this case, the treatment of osteochondrosis of the spine and its complications is performed surgically, on an emergency basis.
Diagnosis of osteochondrosis
It is carried out by a neurologist or orthopedist after the therapist has excluded the pathology of internal organs.
- The specialist finds out the main complaints, the time of their appearance, development, the effect of drugs on the intensity of pain, rest, changes in the rhythm of life
- A mandatory external examination is carried out when the patient undresses to underwear - it is necessary to compare the condition and color of the skin on symmetrical parts of the body, the tone of the tissues, the reaction to various stimuli: pain, touch, cold or heat. Symptoms of tension are determined, indicating muscle tension and irritation of their tendons and integumentary membranes - fascia
- The neurological hammer will reveal the uniformity and symmetry of the reflexes
- The neurologist records the volume of active (independent) and passive (performed by the doctor) movements in the joints, the ability to turn the head, the upper part of the body without involving the lower parts of the spinal column
If necessary, send for additional examination
- Thermal imaging diagnostics
- ENMG (electroneuromyography): Radiography. To obtain the necessary information, it is carried out in at least two projections - direct and lateral. The picture will tell about the state of the bone tissue, the severity of osteoporosis, the size and safety of the vertebral bodies, and will reveal osteophytes. Damaged discs are determined by the width and uniformity of the intervertebral fissures. Unevenness of the lower or upper border of the body will make one suspect a Schmorl's hernia. To clarify the nature of changes in the bone structure of the spinal column, computed tomography is recommended. The multispiral examination allows three-dimensional modeling of the vertebrae. If necessary, to find out the condition of soft tissues - muscles, ligaments, intervertebral disc, MRI is prescribed.
It must be remembered that research results must be compared with complaints and changes found during examination. Detection of signs of spinal osteochondrosis and even disc herniation without complaints does not require any serious measures.
Treatment of osteochondrosis of the spine
Removal of acute manifestations of the disease
- Severe pain and sharp muscle tension reinforce each other, not allowing the exacerbation to subside. Therefore, the first is to relieve pain.
- Prescribe non-steroidal anti-inflammatory drugs in injections, drugs to relax muscles - muscle relaxants
- If these measures are not enough, blockade with painkillers and hormonal drugs is carried out
Bed rest is recommended for several days
After the symptoms have subsided, it is necessary to begin to move, gradually increasing the range of motion and load. At this time, active kneading, massage is undesirable due to possible complications.
Osteochondrosis: treatment without exacerbation
When the patient's condition stabilizes, the usual sluggish remainsosteochondrosis, treatment consists of several components:
- Medication. All the same anti-inflammatory painkillers in tablets, capsules and ointments. A specific drug is selected by the doctor based on the patient's condition, lifestyle, concomitant diseases, the predominance of one or another component of osteochondrosis. A course of B vitamins will improve the conduction of impulses along the nerve, normalize tissue nutrition. While maintaining the increased muscle tone, the use of muscle relaxants will continue. There is no magic pill, an injection that could return the vertebrae and cartilage to its original state. Medicines relieve symptoms, improve mobility and performance. But they are not able to completely stop the progression of the disease.
- Physiotherapy. It is used for the delivery of drugs directly to the sore spot (electrophoresis), warming (paraffin, infrared irradiation). Exposure to therapeutic currents relaxes muscles, improves the functioning of nerve fibers. After several sessions, pain decreases, mobility is restored. Not prescribed for active inflammation
- Manual manipulation, massage, acupuncture, acupressure. Relieve spasm by stretching and relaxing muscles. If during the massage only the upper layer of muscles is affected, then manual therapy penetrates deeper, therefore the requirements for specialists are higher. Be sure to first do an MRI to find out the features of the anatomy of a particular patient
- Spinal traction. The vertebrae move away from each other, the normal distance between them is restored, the pinching of the nerves decreases. The procedure has contraindications, so only a doctor can prescribe it
- Physiotherapy. The most effective method of treatment. The only caveat is that it must be applied for life. Of the advantages - it provides activity, improves mood, increases tissue tone. The best methods are a set of exercises recommended by a doctor, initial yoga asanas, Pilates, swimming. They are carried out smoothly, without sudden and traumatic movements, stretching the tissue, gradually increasing the amplitude
- Proper nutrition and giving up bad habits
- A sufficient supply of nutrients to tissues, a good condition of blood vessels and an adequate blood supply to the vertebrae and structures around them are measures to prevent the progression of osteochondrosis. Proper nutrition normalizes weight, reduces stress on the spine
Surgical treatment of osteochondrosis of the spine.Modern clinics have a large arsenal of minimally invasive interventions:
- Treatment and diagnostic blockade
- Radiofrequency facet ablation
- Cold plasma and laser nucleoplasty
- Endoscopic removal of herniated disc
Radiofrequency thermal ablation of the facet joints
Special needles are placed exactly to the side of the intervertebral joints at the place where the median branch of the Lyushka nerve passes. Electrodes are installed in the needles, the tip of which heats up to 80 degrees for 90 seconds. This leads to coagulation of the nerve. The pain goes away.
Cold plasma nucleoplasty
Through a needle inserted into the disc, a special cold-plasma electrode is applied to the disc tissue. The intradiscal pressure decreases, the hernia (protrusion) is pulled inward.
With a herniated disc, the adjacent nerve roots and vessels are compressed, extremely painful sensations and various disorders of the innervation of the extremities occur. If the effect of conservative treatment is no longer there, then surgery to remove a herniated disc is the only possible solution for many patients. The operation is performed under anesthesia through an incision of 2-3 cm using microsurgical equipment and instruments. The duration of the operation is 45-60 minutes. Pain syndrome significantly decreases or completely disappears immediately after surgery in 95% of patients. The next day the patient is allowed to walk and is soon discharged from the clinic.
Endoscopic removal of herniated discs:
A hernia or free-lying sequestration is removed through the lateral intervertebral foramen. To place the tube, a 5 mm incision is made on the skin. Muscles, fascia and ligaments are not damaged, they are pushed apart using a system of tube retractors with a gradual increase in diameter. The operation is almost bloodless and lasts only 40-50 minutes. Patients can return to their usual regimen after three weeks. The risk of complications is minimal.
Decompression and stabilization operations are performed when complications arise, a large herniated disc, strong compression of the spinal nerve root and spinal cord. If there are signs of a sudden loss of sensitivity, movement, pelvic dysfunction, the patient should be urgently taken to a neurosurgeon. The sooner it is possible to eliminate the compression, the more complete the recovery will come, the person will quickly return to normal life. In this case, surgical treatment is aimed at decompression of the compressed neural structures and stabilization of the affected segment. This is a hemi or laminectomy. Fixation is carried out by a transpedicular system, in combination with an interbody cage, which provides a 360-degree fusion. Interspinous stabilization of the vertebrae is widely used. Today there are several interspinous implants. Microdiscectomy in combination with interspinous stabilization, especially in the elderly, can significantly increase the effectiveness of long-term results and reduce the likelihood of recurrent disc herniation.