The spine is a unique biokinematic system, capable of bearing loads without damage, but like any structure it wears out over time. At a young age, a stable condition is maintained thanks to rapid regenerative abilities, but after 50 years, their reserves gradually disappear, which leads to the formation of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spine, which, as it progresses, spreads to the nearby structures of the spinal segment.
Theories of Development
The etiology of osteochondrosis is unknown. The currently existing theories about the development of this disease:
- Metabolic.Changes in the metabolism of the spinal disc due to its dehydration (the amount of water at a young age is 88%, with age the water content decreases to 60%).
- Vascular.Changes in spinal blood circulation (occur in adulthood, but earlier development is possible due to injuries, metabolic disorders, infections).
These theories are sometimes combined into one - involution, which is based on a violation of trophism, especially in those tissues in which there are no vessels. In childhood, there is a vascular network in the intervertebral discs, but after the complete formation of the architecture of the spine, this network is closed by connective tissue.
- Hormonal theorymore controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is inappropriate to talk only about hormone levels. This theory is best suited for postmenopausal women.
- Mechanical theorytalks about the relationship between the occurrence of osteochondrosis and overloading of certain parts of the spine.
- Anomaly theory- an isolated case from the mechanical theory. Anomalies of the vertebral bodies, fusion of the bodies, non-fusion of the arch due to an incorrect biomechanism stimulate the overload of the vertebral discs and cause the destruction of bone tissue.
These theories have a right to exist, but none of them is universal. It is more correct to call osteochondrosis a multifactorial disease, which is characterized by genetic predisposition and provoking factors.
Factors contributing to the development of the disease
- Gravity Factor:for the spine, any non-physiological displacement is nothing more than a trigger for many muscle reactions.
- Dynamic factor: the greater and longer the load on the spine, the more and longer it is subjected to trauma (people prone to forced long-term postures; constant lifting of heavy objects).
- Dysmetabolic factor:insufficient nutrition of the spine due to autoimmune disorders, toxic effects.
It is known that eating food from aluminum dishes leads to its accumulation in the bones, which will subsequently contribute to the formation of osteochondrosis. Eating food from dishes made of an alloy of aluminum and iron has an adverse effect on the human body. When preparing food, microparticles enter the gastrointestinal tract, and since they also contain lead, this metal accumulates in the body, the intoxication of which is expressed in neuroosteofibrosis (defective changes in the tissue at the junction of tendon and muscle).
- Genetic factor.Each person has an individual level of flexibility that directly correlates with the ratio of fibers in the connective tissue (collagen and elastin) and is inherited genetically. Despite all of the above, there are norms in the ratio of fibers, deviations lead to faster wear of the spine.
- Biomechanical factor- non-physiological movements in the articular surface of the spine. This is due to muscle atrophy (the clinical symptom is pain that occurs when bending and turning).
- Aseptic-inflammatory factor- most often a rapid inflammatory process in the intervertebral discs. Microdefects are formed in the spine due to malnutrition of the spinal disc. Areas of dead tissue form in these microdefects.
Symptoms of osteochondrosis of the spine
The main symptom of osteochondrosis is back pain, which can be constant or periodic, painful or acute, most often aggravated by sudden movements and physical activity.
Osteochondrosis is a common disease among athletes. It arises from a mismatch between physiological capabilities and motor loads, which contribute to microtraumas and wear and tear of the spinal tissues.
The localization of symptoms largely depends on the part of the spine in which the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is localized in several parts, then this condition is called mixed osteochondrosis.
| A type of osteochondrosis | Cervical | Chest | Lumbosacral | Mixed |
|---|---|---|---|---|
| Clinical picture |
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the pain is stable or spreads to all parts of the spine. |
| Complications |
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compression myelopathy (spinal cord compression from various neoplasms). |
all complications that are possible with cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| Stages | First | Second | third | Fourth |
|---|---|---|---|---|
| Changes in the spine |
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Rupture and displacement of the spinal disc with immersion of other surrounding elements in its cavity, which provokes the development of local symptoms of inflammation. | Destruction of other elements of the intervertebral articulation, pathological arrangement of the joint surfaces, marginal bone growths. |
| Patient complaints | Lacks or shows discomfort when staying in the same position for a long time. | Discomfort and pain with certain types of exercise. | Pain in the back, neck, lower back, sacrum or coccyx depends on the location. | Constant pain in the whole spine. |
Differential diagnosis
- Acute myocardial infarction.The pain is concentrated in the region of the heart and only from there it radiates (spreads) to the neck, lower jaw and arm. The disease begins for no reason or after physical exertion with the onset of pressing pain unrelated to movement in the spine. After half an hour the pain reaches its maximum, the person develops shortness of breath and fear of death. The diagnosis is confirmed by an electrocardiogram (ECG) and markers of myocardial necrosis.
- Subarachnoid hemorrhage(hemorrhage between the arachnoid and the pia mater of the brain). In some cases, due to the toxic effect of the spilled blood on the spinal roots, severe pain may appear in the spine. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- Abnormalities of the spine.Minimal examination: X-ray of the skull and cervical vertebrae in frontal and lateral projection. The most common anomalies of the spine are: fusion of the atlas (the first cervical vertebra) with the occipital bone, sinking of the edges of the occipital foramen into the cranial cavity, fusion of the vertebrae, changes in the shape and size of the vertebrae.
- Cervical lymphadenitisit may also be accompanied by neck pain, sometimes made worse by bending and turning. Making a diagnosis is not difficult: enlarged, painful lymph nodes; a history of frequent sore throats.
- Multiple myeloma.Pain in the spine appears gradually, against the background of progressive weight loss and intermittent fever. The main laboratory sign is the presence of protein in the urine.
- Tumor or metastases in the spine.Evidence in favor of a malignant neoplasm is: progressive loss of body weight, laboratory changes, as well as ultrasound of the sources of metastases - kidneys, lungs, stomach, thyroid gland, prostate.
- Rheumatic and infectious-allergic polyarthritisdifferentiated by anamnesis, moderately elevated body temperature and predominant damage to large joints.
- Depression in disguise.Patients "impose" non-existent pathologies (in this context, symptoms of osteochondrosis), the attempt to explain to them the essence of what is happening is met with a wall of misunderstanding. The signs of masked depression are: reduced mood, concentration and work ability; sleep and appetite disorders; suicidalthoughts and actions.
- Peptic ulcer of the stomach and duodenum, pancreatitis and cholecystitisare diagnosed by the relationship of pain with food intake, laboratory tests (FGDS, general blood test, biochemical blood test, pancreatic enzyme activity, ultrasound examination of abdominal organs).
Diagnosis of osteochondrosis
- Most often, the patient complains to a neurologist, who collects the history of the patient's life and illness and conducts a neurological examination. The neurologist examines the spine in three ways (standing, sitting and lying down). When examining the back, pay special attention to the posture, the lower angles of the shoulder blades, the crests of the iliac bones, the position of the shoulder girdle and the expressiveness of the back muscles. During palpation, deformation, pain and muscle tension are determined.
- When establishing the diagnosis of osteochondrosis, additional consultation with specialized specialists is necessary to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Conducting mandatory laboratory tests (general blood test, general urinalysis, biochemical blood test).
- Confirmatory studies are essential:
X-ray of the spine in two projections – the simplest method for identifying changes in the spine (narrowing of the gap between the vertebrae);Depending on the degree of radiography, different changes are visible:
Degree First Second third Fourth X-ray signs No radiological signs. Changes in the height of the intervertebral discs. Protrusion (bulging in the spinal canal) of the intervertebral discs or even prolapse (loss). Formation of osteophytes (marginal bone growths) at the point of contact of the vertebrae. computed tomography (CT) and magnetic resonance imaging (MRI) – it is used not only to identify changes in the spine, but also to determine pathologies in other organs;USDG MAG (Doppler ultrasound of the main arteries of the head) - ultrasound examination of the circulatory system of the head and neck, which allows you to diagnose the degree of changes in the blood vessels as early as possible.
What methods of treatment of osteochondrosis are there?
Drug therapymust be strictly individual and differentiated, the prescription of drugs is carried out by a doctor after diagnosis.
The main drugs used in the treatment of osteochondrosis:
- Pain relief is carried out with the help of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Treatment with NSAIDs should be as short as possible, 5-7 days are enough to relieve pain. If the pain is poorly controlled and a constant dose of pain-relieving drugs is needed, you can take selective COX-2 inhibitors.
- Antispasmodics reduce pain and relieve muscle spasms.
- Transcutaneous method for pain relief: ointment, the active ingredient of which is an NSAID; anesthetic cream; applications with anti-inflammatory and analgesic agents, corticosteroids are added for greater effect.
- Treatment designed to regenerate an inflamed or pinched nerve, as well as to improve blood microcirculation: B vitamins, neuroprotective drugs, nicotinic acid.
- Oral chondroprotectors – glucosamine, chondroitin sulfate. They help stop destructive changes in cartilage when taken regularly. Chondroprotectors are embedded in the structure of cartilage tissue, thereby increasing the formation of bone matrix and reducing joint destruction. The most favorable composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.
Non-drug treatment methods:
Neuro-orthopedic measures. An important point in the treatment of osteochondrosis is the observance of a rational regime of physical activity. Prolonged stay in bed and minimal physical activity are not only not beneficial for the spine, but also lead to a permanent symptom - back pain.Physical therapy (physical therapy) is prescribed when the patient is in a satisfactory condition (especially in the period when the signs of the disease decrease), the main purpose is to strengthen the muscle corset.To prevent falls, improve coordination of movements and functioning of the vestibular apparatus (relevant for elderly patients), balancing discs, platforms and paths are used in exercise therapy.
Manual therapy with severe neck pain. It is prescribed with special care and according to strict indications. The main goal is to eliminate pathobiomechanical changes in the musculoskeletal system. The main reason for prescribing manual therapy is the pathological tension of the paravertebral muscles. Do not forget about a number of contraindications for this type of treatment, which are relevant for osteochondrosis - massive osteophytes (pathological growths on the surface of bone tissue), which are formed at the 4th stage of the development of this pathology.Physiotherapy procedures in the acute period: - ultrasound;
- phonophoresis;
- ultraviolet radiation;
- impulse currents;
- neuroelectrical stimulation.
Physiotherapy procedures in the subacute period: - electrophoresis;
- magnetotherapy.
Massage. All types use a superficial, relaxing massage with rubbing elements. As soon as the pain symptom is relieved with the help of massage, they smoothly move to more intense elements of friction. When mastering the technique of acupressure (local) massage, preference is given to this type.The issue of surgical interventions is decided strictly individually, depending on the indications and the condition of the patient.
Preventive actions
- Competent selection of furniture (especially in the workplace). The work chair consists of a flat and solid backrest. The bed includes a mattress with moderate firmness, a pillow with medium softness (orthopedic mattress and pillow if possible).
- Correction of vision, posture, bite.
- Rational choice of shoes (especially important for drivers). The maximum current size is 5 cm.
- Wearing a restraint belt, bandage or corset while working.
- Movement correction: avoid bending and turning, lift weights with a straight back and legs bent at the knees.
- Change body positions more often: do not stand or sit for a long time.
- Proper nutrition: limit the amount of sweet, salty, fatty, spicy foods. The most dangerous food for bones is white sugar, as it leaches calcium from bone tissue. The diet should include fruit, berries, vegetables, eggs, nuts, meat, kidney, liver, fish, legumes and dairy products.
- Beware of sudden changes in temperature, especially hot water in a bath, sauna, swimming pool, etc. is dangerous. , as it relaxes the muscles of the back and even a slight injury in this condition is not felt, but leads to tragic consequences for the spine and even for the musculoskeletal system in general.
- Water procedures are not only a preventive measure, but also a therapeutic one. Swimming combines stretching and muscle relaxation.
- Treatment of chronic diseases.
- Active and regular rest.
Examples of effective exercises to prevent cervical osteochondrosis that can be performed right at the workplace:
- sitting in a chair looking ahead. The brush covers and supports the lower jaw. Pushing the head forward and down through resistance (tension phase); relaxing and stretching the neck muscles, slowly move your head back (relaxation phase);
- sitting in a chair looking ahead. The right palm is on the right cheek. Slowly tilt your head to the left, try to touch your left shoulder with your ear and stay in this position for 3-5 seconds. The left palm on the left cheek and do the same on the right shoulder respectively;
- sitting in a chair looking ahead. Hands are on knees. We tilt our head to the right, hold it for 5-7 seconds and very slowly return to the starting position. Then we tilt our head to the left and do the same accordingly.
Conclusion
The high frequency and social importance of osteochondrosis determines the scientific interest in this problem. The disease affects not only the elderly, but is increasingly occurring among young people, which attracts the attention of neurologists, neurosurgeons, orthopedic traumatologists and other specialists. Timely diagnosis and adequate treatment of this pathology ensures social adaptation and quality of future life.