Osteochondrosis of the spine is a chronic disease in which degenerative changes in the vertebrae and the intervertebral discs located.According to the place of damage to the spine, they distinguish: osteochondrosis in the cervical region, osteochondrosis in the chest region and osteochondrosis in the lumbar region.To diagnose osteochondrosis of the spine, it is necessary to carry out radiography, and in the case of its complications (for example, an herniated of the intervertebral disc) - MRI of the spine.In the treatment of osteochondrosis of the spine, as well as medication 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 the elderly and is one of the body's aging process.Earlier or later, atrophic changes occur in the intervertebral disc, however, injuries, diseases and various spine overloads contribute to the anterior occurrence of osteochondrosis.The most common osteochondrosis in the cervical region and osteochondrosis in the lumbar column.
About 10 theories of osteochondrosis 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, they are rather complementary to each other.
It is believed that the main point of the occurrence of osteochondrosis is the constant overload of the vertebral engine composed of two adjacent vertebrae.Such an overload can occur following an engine stereotype - posture, in an individual way of sitting and walking.The poster disorders, seated in poor pose, walking with an uneven spine cause an additional load on the discs, ligaments and muscles of the spine.The process can worsen due to the characteristics of the spine structure and the insufficiency of its tissue trophism due to hereditary factors.Most often, the vices of the structure are in the cervical region and lead to vascular disorders and to the early appearance of signs of osteochondrosis of the cervical column.
The occurrence of osteochondrosis in the lumbar region is more often associated with its overload during the inclinations and elevators of gravity.A healthy intervertebral disc can withstand significant loads due to the hydrophilia of the pulpoose nucleus located in its center.The nucleus contains a large amount of water and fluids, as you know, are not very compressed.The degradation of a healthy intervertebral disc can occur with a compression of more than 500 kg, while the disc has changed due to osteochondosis is torn with a compression of 200 kg.A 200 kg load experiences a lumbar from the spine of a person weighing 70 kg, when she maintains a 15 -kilograms cargo in the body's inclination position before 200. Such 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.Consequently, often the first clinical manifestations of osteochondrosis in the lumbar column occur during or after the weight lifting, carrying out housework, weeding in the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, ligaments and capsules of the facets of facets causes the reaction of the immune system and the development of aseptic inflammation with the swelling of the facets and their surrounding tissues.Due to the displacement of vertebral bodies, the faceted joint capsules are stretched and the altered intervertebral disc is not so firmly fixed by the bodies of the neighboring vertebrae.The instability of the vertebral segment is formed.Due to instability, violation of the vertebral nerve with the development of a radicular syndrome is possible.With osteochondrosis of the cervical column, this often happens during the turns of the head, with osteochondrosis in the lumbar region - during the inclinations of the body.It is possible to form a functional block of the vertebral engine segment.This is due to the reduction in compensation for vertebral muscles.
The hernia of the intervertebral disc forms when the disc retires, the rupture of the posterior longitudinal ligament and the projection of the disc in the vertebral channel occur.If at the same time the core of the disc is pressed in the cerebrospinal canal, then such a hernia is called explosion.The severity and duration of the pain with such hernia are much greater than with unploded.The hernia of the disc can cause radicular syndrome or compression of the spinal cord.
With osteochondrosis, the growth of bone tissue occurs with 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 root syndrome.
Symptoms of osteochondrosis of the spine
The main symptom of osteochondrosis in the spine is pain.The pain can be acute with high intensity, it intensifies with the slightest movement in the affected segment and therefore takes the patient to take a forced position.Thus, with the osteochondrosis of the cervical column, the patient holds his head in the least painful installation and cannot turn it, with osteochondrosis in the thoracic region, pain even increases with deep breathing, and with osteochondrosis of the lumbar region, it is difficult to sit, climb and walk.Such a pain syndrome is characteristic of compression of the spine column.
In about 80% of cases, there is dull pain of a constant nature and moderate intensity.In such cases, during the examination, the doctor must differentiate the manifestations of osteochondrosis from the spine of the myositis of the back muscles.Mute pain in osteochondrosis is due to excessive muscle tension, now the affected vertebral engine segment, inflammatory changes or significant stretch 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 the cervical column osteochondrosis avoid the turns and sharp inclinations with the head, with osteochondrosis in the lumbar region - sit slowly and get up, avoid tilt of the body.
Complications of osteochondrosis of the spine
The 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 the reflexes of the tendon, mation and defecation.The intervertebral hernia can cause compression of the artery supplying the spinal cord with the formation of ischemic zones (infarction of the spinal cord) with the death of the nerve cells.This is manifested by the appearance of a neurological deficit (altered movements, sensitivity, trophic disorders) corresponding to the level and the prevalence of ischemia.
Diagnosis of spine osteochondrosis
The diagnosis of vertebral osteochondosis is made by a neurologist or a vertebrologist.At the initial stage, the radiography of the spine is carried out in 2 projections.If necessary, they can draw a separate vertebral segment and pull in additional projections.For the diagnosis of intervertebral hernias, the evaluation of the spinal cord state and detect complications of osteochondrosis, magnetic tomography and resonance (MRI of the spine) is used.An important role is played by MRI in the differential diagnosis of osteochondrosis and other vertebral diseases: spondylitis of tuberculosis, osteomyelitis, tumors, ankylosing spondel, rheumatism, infectious lesions.Sometimes, in case of complicated osteochondrosis of the cervical column, the exclusion of syringomyelia is necessary.In some cases, if the MRI is impossible, the myelography is shown.
A targeted study of the affected intervertebral disc is possible using discography.Electrophysiological studies are used to determine the degree and location of nerve road damage, to monitor the process of their restoration during treatment.
Treatment of spine osteochondrosis
During the acute period, peace is indicated in the assigned vertebral engine segment.To this end, with the osteochondrosis of the cervical column, the fixing is used using a Chantz necklace, with osteochondrosis in the lumbar region - rest in bed.A fixation is also necessary for osteochondrosis in the cervical region with the instability of the vertebral segment.
In the pharmacotherapy of osteochondrosis, non-steroidal anti-inflammatory drugs (NSAIDs) are used: diclofenac, nimesulide, lornoxicam, melooxicam.With intense pain syndrome, pain relievers are represented, for example, an analgesic central action of fluctortine.To relieve muscle tension, muscle relaxants are used - tolperisone, thizanidine.In some cases, it is advisable to prescribe anticonvulsants - carbamazepine, gabapentine drugs;Antidepressants, among which preference is given to inhibitors of the opposite capture of serotonin (Cerseralin, paroxetine).
In the event of a radicular syndrome, hospital treatment is indicated.Glucocorticoids are possible to be introduced, 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 clear observation of the technique of its implementation and special caution in the treatment of osteochondrosis of the cervical column.
The spine operations are indicated mainly with a significant compression of the spinal cord.It consists in eliminating the hernia of the intervertebral disc and the decompression of the vertebral canal.It is possible to perform a microdissectomy, the laser reconstruction of the disc, the replacement of the disc affected by an implant, the stabilization of the vertebral segment.