Spinal osteochondrosis is a chronic disease that causes degenerative changes in the vertebrae and intervertebral discs located between them.Depending on the site of damage to the spine, they distinguish: osteochondrosis of the cervical region, osteochondrosis of the thoracic region and osteochondrosis of the lumbar region.In order to diagnose the osteochondrosis of the spine, it is necessary to perform radiography in the case of its complications (for example, the 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To one degree or another, osteochondrosis of the spine develops in all people who are outdated and is one of the processes of aging of the body.In the early or later, atrophic changes occur in the intervertebral disc, but injuries, diseases and various overloads of the spine contribute to the more osteochondrosis.The most common osteochondrosis of the cervical region and osteochondrosis of the lumbar spine.
About 10 osteochondrosis theories have been developed: vascular, hormonal, mechanical, hereditary, infectious-allergic and others.But none of them gives a complete explanation of the changes that occur in the spine, more recently they complement each other.
It is believed that the main point in the appearance of osteochondrosis is the constant overload of the motor segment of the vertebrae, consisting of two adjacent vertebrae.Such overload can occur as a result of a motor stereotype - stand, individual sitting and walking.Poster disorders sitting in the wrong posture, walking with an uneven spinal column cause additional loads on the discs, ligaments and muscles of the spine.The process can be worsened 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, defects in the structure are located in the cervical region and lead to vascular disorders and the early appearance of signs of osteochondrosis of the cervical spine.
The appearance of osteochondrosis of the lumbar region is more commonly associated with its overload during inclinations and lifts of weight.A healthy intervertebral disc can withstand considerable loads due to the hydrophilic of the pulpulated nucleus located in its center.The nucleus contains a large amount of water, and the liquids, as you know, are compressed a little.The breakdown of a healthy intervertebral disc can occur with compression over 500 kg, while the disc changes as a result of osteochondrosis is torn with a compression of 200 kg.A 200 kg load experiences a lumbar spine per person weighing 70 kg, when it contains 15 kilograms of load in a slope position in front of 200. Such a high pressure is due to the low size of the pulp nucleus.With an increase in a tendency 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 disc, the 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 veneers and their surrounding tissues.Due to the displacement of the vertebrae bodies, the capsules of the veneer joints are stretched and the altered intervertebral disc is not as firmly fixed by the bodies of the adjacent vertebrae.The instability of the spinal segment is formed.Due to instability it is possible to disrupt the spinal nerve with the development of radicular syndrome.With osteochondrosis of the cervical spine, this often happens during turns of the head, with osteochondrosis of the lumbar region - during the inclinations of the body.It is possible to form a functional block of the vertebrae engine segment.This is due to a decrease in the compensation of the spinal muscles.
The hernia of the intervertebral disc is formed when the disc displaces back, the posterior longitudinal ligament occurs and a bulge of the disc in the spinal canal occurs.If at the same time the nucleus of the disc is pulled into the cerebrospinal canal, then such hernia is called exploding.The severity and duration of the pain with such hernia is much longer than in the unsexed.Disc hernia can cause radicular syndrome or spinal cord compression.
With osteochondrosis, bone tissue growth occurs in the formation of osteophytes - bone growths 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 osteochondrosis of the spine
The main symptom of osteochondrosis of the spine is pain.The pain can be acute with high intensity, it is exacerbated by the shortest movement in the affected segment and therefore causes the patient to take a forced position.So, with osteochondrosis of the cervical spine, the patient holds his head in the lowest painful posture and cannot turn it, with osteochondrosis of the thoracic area, the pain increases even with deep breathing and with osteochondrosis of the lumbar region it is difficult to sit and walk.Such pain syndrome is characteristic of compression of the spinal nerve spine.
In approximately 80% of cases there is a dull pain of constant nature and moderate intensity.In such cases, when examined, the doctor should distinguish 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, retaining the affected motor segment, inflammatory changes or significant stretching of the intervertebral disc.Patients with such forced pain are absent, but the restriction of movements and physical activity is revealed.Patients with osteochondrosis of the cervical spine avoid acute turns and tilting with heads, with osteochondrosis of the lumbar region - slowly sitting and getting up, avoiding the tilting of the body.
Complications of osteochondrosis of the spine
The complications of osteochondrosis are related to the hernia of the intervertebral disc.These include compression of the spinal cord, which is characterized by numbness, the weakness of certain muscle groups of the limbs (depending on the level of compression), which leads to the appearance of paresis, muscle atrophy, a change in the reflexes of the tendons, urination and bowel movements.The interior hernia can cause compression of the artery that feeds the spinal cord with the formation of ischemic areas (spinal cord infarction) with the death of nerve cells.This is manifested by the onset of neurological deficiency (impaired movements, sensitivity, trophic disorders) corresponding to the level and spread of ischemia.
Diagnosis of osteochondrosis of the spine
The diagnosis of spinal osteochondrosis is performed by a neurologist or vertebologist.At the initial stage, radiography of the spine is performed in 2 projections.If necessary, they can capture a separate spinal segment and shoot in additional projections.For the diagnosis of intervertebral hernias, the condition of the spinal cord is used and complications of osteochondrosis, magnetic and resonance imaging (spinal cord) are detected.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 complex osteochondrosis of the cervical spine, it is necessary to exclude syringomyelia.In some cases, if MRI is impossible, myelography is shown.
A targeted study of the affected intervertebral discs is possible with the help of a discography.Electrophysiological studies are used to determine the degree and localization of nerve damage to monitor the process of their recovery during therapy.
Treatment of osteochondrosis of the spine
In the acute period, peace is shown in the affected segment of the vertebrae.For this purpose, with osteochondrosis of the cervical spine, the fixation is used using a chantz collar, with osteochondrosis of the lumbar region - rest in bed.Fixing is also necessary for osteochondrosis of the cervical region with instability of the vertebrae segment.
In drug therapy for osteochondrosis, non -steroidal anti -inflammatory drugs (NSAIDs) are used: Diclofenac, Nimesulide, Lornoxicam, Meloxicam.Intense pain syndrome shows analgesics, for example, analgesic central action of flobe.Muscle relaxants are used to relieve muscle tension - tolperisone, tizanidine.In some cases, it is advisable to prescribe anticonvulsant drugs - carbamazepine, gabapentin;Antidepressants, among which preferences are given to the inhibitors of the reverse capture of serotonin (cereralin, paroxetine).
In the case of radicular syndrome, stationary treatment is shown.Local administration of glucocorticoids, edema treatment, adhesion use.In the treatment of osteochondrosis, physiotherapy, reflexology, massage, physiotherapy exercises are widely used.The use of manual therapy requires clear adherence to the technique of its administration and special caution in the treatment of osteochondrosis of the cervical spine.
Spinal surgery is mainly indicated by significant compression of the spinal cord.It consists in removing the hernia of the intervertebral disc and decompression of the spinal canal.Microdyctomy, laser disk reconstruction, replace the affected disc with implant, stabilization of the spinal segment can be performed.