Osteochondrosis of the spine is a complex of dystrophic and degenerative changes in the intervertebral discs and adjacent surfaces of the vertebral bodies associated with the destruction of tissues and disruption of their structure. Depending on the degree of damage, cervical, thoracic and lumbar osteochondrosis can be distinguished.
Symptoms
The main symptom that may suggest the presence of osteochondrosis of the cervical spine is a local change in the configuration of one of the segments of the spine (development of lordosis, kyphosis or scoliosis) - a clear visual curvature of the spine. in the longitudinal or transverse plane. The second most common symptom is pain syndrome, which can be localized not only in the vertebral region, but also in areas of the body that are innervated by the corresponding nerve root. Another complaint of these patients is a feeling of discomfort and fatigue in the neck.
Pain with cervical osteochondrosis, as a rule, manifests itself in the neck and can be given to the shoulder and back, can be confused with pain in myocardial infarction, because there are similar symptoms. Also, cervical osteochondrosis can often be accompanied by headache, dizziness. When the blood vessels that supply the brain are constricted (constricted), there may be signs of brain failure (neurological symptoms): fainting, nausea, tinnitus, mood swings, anxiety, etc.
According to the severity of the pain, they are divided into 3 degrees:
- Pain occurs only with clear movements in the spine;
- The pain is relieved by a certain position of the spine;
- The pain is permanent.
Forms
Depending on the syndromes of osteochondrosis, the following differ:
- Compression syndromes - occur with compression (radiculopathy - compression of nerve roots, myelopathy - compression of muscles, neurovascular - compression of blood vessels and nerves);
- Reflex (muscle-tonic, neurodystrophic, neurovascular);
- Myoadaptive syndrome (overload of healthy muscles when taking over the functions of the affected muscles).
Reasons
The mechanism of development of the disease is damage to the intervertebral disc for various reasons and the displacement of the spine with the loss of amortization (pressure reliever) functions. A direct cause of disc damage can be disruption of the blood supply to the intervertebral discs, mechanical damage from injuries, and age-related degenerative changes in the spine associated with strong physical force - such as being overweight.
An important role in the development of osteochondrosis is played by a sedentary lifestyle, which develops disorders of blood supply and intervertebral joints. The mechanism of development of the disease is as follows: if the fibrous ring connecting the vertebral bodies is damaged, the intervertebral disc is pushed back and forth - to the lumen of the spinal canal or laterally - with the formation of the median and lateral discs. hernias. The disc can be pushed into the body of the vertebrae with the formation of a Schmorl hernia - microscopic breaks in the intervertebral disc cartilage tissue into the sponge tissue of the vertebral bone. In the case of posterior dislocation of the disc, it is possible to compress the spinal cord and the roots extending from it with the development of a typical pain syndrome.
Diagnostics
Diagnosis of osteochondrosis of the spine is based on complaints, anamnesis, clinical examination and instrumental examination. Diagnostic measures are to find the causes of the development of neurological symptoms.
From the anamnesis it is possible to learn the presence of injury, the nature of the work - constant physical activity (lifting weights), poor posture, the characteristics of the work and the condition of the spine at the table and while walking. presence of infections.
General clinical studies (clinical blood test, general urine analysis), biochemical blood test have no independent value. They are appointed to assess the current situation, diagnose the underlying disease and the complications that arise.
Diagnosis is based on the clinical picture of the disease and is carried out by the method of sequential exclusion of similar diseases according to clinical signs. The most common and available of the instrumental diagnostic methods is X-ray examination (spondylography is a non-contrast study). This reflects the narrowing of the intervertebral joint spaces and allows the detection of osteophytes (bone growths) in the vertebral bodies, but only indirectly provides information on the degree of damage to the intervertebral discs.
With the help of CT and MRI (computed and magnetic resonance imaging) diagnostics, an accurate diagnosis can be made even in the early stages of the disease. CT allows to perform minimal abnormalities in bone and cartilage tissue, MRI - to perform details of soft tissue structures and determine the location of the disc herniation.
When there is a suspicion of impaired blood supply to the brain, a duplex ultrasound examination of the cerebral vessels is performed.
Differential diagnosis is made with diseases with similar clinical manifestations: pathologies with pain spreading to the shoulder and scapular region (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - enlargement of the cervical lymph nodes, rheumatoid arthritis; oncological diseases (tumors of the vertebrae, roots, spinal cord and membranes), tumors of the pharynx and pharyngeal cavity, Pancost cancer (compression of the brachial plexus in cancer of the upper lobe of the lung), metastases in the cervical region; tuberculous spondylitis - an inflammatory disease of the spine caused by mycobacterial tuberculosis; arachnoid cysts; pseudocysts of dura mater; spinal anomalies; fibromyalgia is a disease that causes pain in muscles, ligaments and tendons, thoracic outlet compression syndrome - a disease caused by excessive pressure on the neurovascular support between the anterior and middle skeletal muscles, on the first rib and under the clavicle, myofascial neck muscle. syndrome and shoulder girdle - a chronic, pathological condition caused by local muscle spasms or the formation of seals, represented by pain points.
The main laboratory tests used:
- Clinical blood test;
- Blood chemistry.
The main instrumental studies used:
- radiography of the spine (spondylography);
- magnetic resonance imaging (MRI);
- computed tomography (CT);
- Ultrasound duplex scanning of cerebral arteries (when blood supply to the brain is suspected).
Additional instrumental research is used:
- Densitometry - measurement of bone density (according to the instructions).
Treatment
Treatment of osteochondrosis of the spine depends entirely on the stage and degree of development of osteochondrosis. At the initial stage, it is possible to use preventive measures, physiotherapy exercises, training in simulators, fitness. Patients with severe pain syndrome need physical rest. Anti-inflammatory and antispasmodic drugs are prescribed. It is possible to perform paravertebral blockades with anesthesia to open the pathological circle, when the pain causes muscle spasm, the intervertebral disc is compressed more strongly, which in turn increases the pain itself.
Topical warming ointments are applied to the skin in the vertebral region to improve the local blood supply and reduce tissue edema. These patients are shown wearing a corset. Chondroprotectors are effective in patients with early stages of osteochondrosis - drugs that improve the regeneration of cartilage tissue, as well as drugs that improve the local blood supply, venotonics, B vitamins. In cases where the pain syndrome does not stop. There is a clinic of spinal cord compression with an intervertebral hernia for a long time medically, surgical removal of the damaged intervertebral disc is indicated. Early surgery is indicated in cases of complete compression of the spinal cord by the disc.
You should not wait until a person begins to urinate or defecate spontaneously - in this case, spinal cord damage may be irreversible. Physiotherapeutic procedures include magnetotherapy, ultrasound, massage, manual therapy, acupuncture and physiotherapy exercises.
Complications
Possible vegetative-vascular dystonia and heart disorders, cerebrovascular accident, hypotension and hypertension (decreased and increased blood pressure), vestibular disorders (impaired coordination of movements), vertebral artery syndrome (disease caused by narrowing of the vertebral artery), periarthritis (immobility)shoulder joint.
Prophylaxis
To prevent osteochondrosis, it is necessary to deal with the factors that cause it, namely: to avoid spinal injuries, stress in the spine (lifting weights) and to fight excess weight. For people who already suffer from the early stages of osteochondrosis, it is recommended to wear a corset at home and during physical exertion. It is recommended to sleep on orthopedic mattresses and pillows to relax the spine during sleep.
What questions should you ask your doctor?
Are there any exercises that can help relieve the symptoms?
What medications will help to cope with cervical spine osteochondrosis?
What will happen if you do not start treatment on time?
Patient advice
Exercise, weight loss when overweight, and the use of cool or hot compresses can help relieve the symptoms of thoracic lumbar osteochondrosis. It is also important to eat properly, monitor your spine, treat chronic diseases and avoid injury.