Osteochondrosis of the spine is a chronic disease in which degenerative changes in the vertebrae and intervertebral discs located between them occur.Depending on the place of damage to the spine, they distinguish: osteochondrosis of the cervical region, osteochondrosis of the thoracic region and osteochondrosis of the lumbar region.To diagnose osteochondrosis of the spine, it is necessary to conduct radiography, and in the case of its complications (for example, hernia of the intervertebral disc) - MRI of the spine.In the treatment of osteochondrosis of the spine, along with drug methods, it is widely used, reflexology, massage, manual therapy, physiotherapy and physiotherapy exercises.
Etiology and pathogenesis
To one degree or another, osteochondrosis of the spine develops in all people aged and is one of the processes of aging of the body.Earlier or later, atrophic changes occur in the intervertebral disk, however, injuries, diseases and various spine overloads contribute to the earlier occurrence of osteochondrosis.The most common osteochondrosis of the cervical region and osteochondrosis of the lumbar spine.
About 10 theories of osteochondrosis have been developed: vascular, hormonal, mechanical, hereditary, infectious-allergic and others.But not one of them gives a complete explanation of the changes taking place in the spine, rather they are complementary to each other.
It is believed that the main point in the occurrence of osteochondrosis is the constant overload of the vertebral motor segment consisting of two adjacent vertebrae.Such an overload can occur as a result of a motor stereotype - posture, an individual manner of sitting and walking.Poster disorders, sitting in the wrong pose, walking with an uneven spinal column cause an additional load on the discs, ligaments and muscles of the spine.The process can aggravate due to the characteristics of the structure of the spine and the insufficiency of the trophism of its tissues due to hereditary factors.Most often, vices in the structure are found in the cervical region and lead to vascular disorders and the early appearance of signs of osteochondrosis of the cervical spine.
The occurrence of osteochondrosis of the lumbar region is more often associated with its overload during inclinations and lifts of severity.A healthy intervertebral disk can withstand significant loads due to the hydrophilicity of the pulpoose nucleus located in its center.The nucleus contains a large amount of water, and fluids, as you know, are compressed little.The breakdown of a healthy intervertebral disc can occur with a compression of more than 500 kg, while the disk changed as a result of osteochondrosis is torn with a compression of 200 kg.A 200 kg load is experiencing a lumbar of a person’s spine weighing 70 kg, when it holds a 15 kilogram cargo in the tilt position of the body ahead of 200. Such a large pressure is due to the low size of the pulp nucleus.With an increase in inclination to 700, the load on the intervertebral discs will be 489 kg.Therefore, often the first clinical manifestations of osteochondrosis of the lumbar spine occur during or after lifting weights, performing housework, weeding in the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disk, ligaments and capsules of the facet joints causes the reaction of the immune system and the development of aseptic inflammation with the swelling of the facet joints and their surrounding tissues.Due to the displacement of the vertebral bodies, the capsules of the facet joints are stretched, and the altered intervertebral disc is not so firmly fixed by the bodies of neighboring vertebrae.The instability of the spinal segment is formed.Due to instability, infringement of the spinal nerve with the development of radicular syndrome is possible.With osteochondrosis of the cervical spine, this often occurs during head turns, with osteochondrosis of the lumbar region - during the tilts of the body.It is possible to form a functional block of the vertebral motor segment.It is due to the compensation reduction of the vertebral muscles.
The hernia of the intervertebral disc is formed when the disk shifts back, the posterior longitudinal ligament rupture and the protrusion of the disk in the spinal canal occurs.If at the same time the nucleus of the disk is squeezed out in the cerebrospinal canal, then such a hernia is called exploding.The severity and duration of pain with such a hernia is much greater than with unexploded.The hernia of the disk can cause radicular syndrome or compression of the spinal cord.
With osteochondrosis, bone tissue growth occurs with the formation of osteophytes - bone outgrowths on the bodies and processes of the vertebrae.Osteophytes can also cause compression of the spinal cord or cause the development of radicular syndrome.
Symptoms of spine osteochondrosis
The main symptom of osteochondrosis of the spine is pain.The pain can be acute with high intensity, it intensifies with the slightest movement in the affected segment and therefore makes the patient take a forced position.So, with osteochondrosis of the cervical spine, the patient holds his head in the least painful pose and cannot turn it, with osteochondrosis of the thoracic region, the pain increases even with deep breathing, and with osteochondrosis of the lumbar region it is difficult to sit down, get up and walk.Such pain syndrome is characteristic of compressing the spinal nerve spine.
In approximately 80% of cases, there is a dull pain of constant nature and moderate intensity.In such cases, upon examination, the doctor must differentiate the manifestations of osteochondrosis of the spine from the myositis of the muscles of the back.Dumb pain in osteochondrosis is due to excessive muscle tension, holding the affected vertebral motor segment, inflammatory changes or significant stretching of the intervertebral disc.In patients with such pain, a forced position is absent, but the restriction of movements and physical activity is revealed.Patients with osteochondrosis of the cervical spine avoid sharp turns and tilts with their heads, with osteochondrosis of the lumbar region - slowly sit down and get up, avoid tilting of the body.
Complications of osteochondrosis of the spine
Complications of osteochondrosis are associated with the hernia of the intervertebral disc.These include the compression of the spinal cord, which is characterized by numbness, the weakness of certain muscle groups of the extremities (depending on the level of compression), leading to the appearance of paresis, muscle atrophy, a change in tendon reflexes, urination and defecation.Intervertebral hernia can cause compression of the artery feeding the spinal cord with the formation of ischemic areas (spinal cord infarction) with the death of nerve cells.This is manifested by the appearance of a neurological deficit (impaired movements, sensitivity, trophic disorders) corresponding to the level and prevalence of ischemia.
Diagnosis of osteochondrosis of the spine
The diagnosis of spinal osteochondrosis is carried out by a neurologist or vertebrologist.At the initial stage, radiography of the spine is performed in 2 projections.If necessary, they can shoot a separate spinal segment and shooting in additional projections.For the diagnosis of intervertebral hernias, assessing the state of the spinal cord and detect complications of osteochondrosis, magnetic and resonance tomography (MRI of the spine) is used.An important role is played by MRI in the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculosis spondylitis, osteomyelitis, tumors, ankylosing spondel, rheumatism, infectious lesions.Sometimes in cases of complicated osteochondrosis of the cervical spine, the exclusion of syringomyelia is necessary.In some cases, if the MRI is impossible, myelography is shown.
A targeted study of the affected intervertebral disc is possible using discography.Electrophysiological studies are used to determine the degree and localization of damage to the nervous pathways, to monitor the process of their restoration during therapy.
Treatment of osteochondrosis of the spine
In the acute period, peace is shown in the affected vertebral motor segment.To this end, with osteochondrosis of the cervical spine, fixation is used using a chantz collar, with osteochondrosis of the lumbar region - bed rest.Fixation is also necessary for osteochondrosis of the cervical region with instability of the vertebral segment.
In the drug therapy of osteochondrosis, non -steroidal anti -inflammatory drugs (NSAIDs) are used: diclofenac, nimesulide, lornoxicam, meloxicam.With intense pain syndrome, analgesics are shown, for example, an analgesic central action of fluportin.To relieve muscle voltage, muscle relaxants are used - tolperisone, thizanidine.In some cases, it is advisable to prescribe anticonvulsant drugs - carbamazepine, gabapentin;Antidepressants, among which preference is given to the inhibitors of the reverse capture of serotonin (cerseralin, paroxetine).
In the event of a radicular syndrome, inpatient treatment is indicated.It is possible local introduction of glucocorticoids, treatment against edema, use of traction.In the treatment of osteochondrosis, physiotherapy, reflexology, massage, physiotherapy exercises are widely used.The use of manual therapy requires a clear observance of the technique of its implementation and special caution in the treatment of osteochondrosis of the cervical spine.
The spine operations are indicated primarily with a significant compression of the spinal cord.It consists in removing the hernia of the intervertebral disc and decompression of the spinal canal.It is possible to carry out microdisectomy, laser reconstruction of the disk, replacement of the affected disk with an implant, stabilization of the spinal segment.