The spine is a unique biokinematic system, it is capable of bearing loads without damage, but, like any structure, it wears out over time. At a young age, a stable state is maintained thanks to rapid regenerative abilities, but after 50 years, their supply gradually disappears, which leads to the formation of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spinal column, which, as it progresses, spreads to the nearby structures of the spinal segment.
Theories of development
The etiology of osteochondrosis is unknown. Currently existing theories about the development of this disease:
- Metabolic.Changes in the metabolism of the vertebral 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 circulation (appear 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 the violation of trophism, especially in those tissues where there are no blood 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 the level of hormones. This theory is most relevant to postmenopausal women.
- Mechanical theorytalks about the connection between the appearance of osteochondrosis and overloading of certain parts of the spine.
- Anomaly theory- an isolated case from mechanical theory. Anomalies of the vertebral bodies, fusion of the bodies, non-union of the arches due to improper 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, characterized by genetic predisposition and provoking factors.
Factors that contribute to the development of the disease
- Gravity Factor:for the spine, any non-physiological movement is nothing more than a trigger for many muscle reactions.
- Dynamic factor:the greater and longer the load on the spine, the longer it is susceptible to trauma (people prone to forced long-term positions; constant lifting of heavy objects).
- Dysmetabolic factor:insufficient nutrition of the spinal column 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 development of osteochondrosis. Eating food from dishes made of aluminum and iron alloys has a negative effect on the human body. During food preparation, microparticles enter the gastrointestinal tract, and since they also contain lead, this metal accumulates in the body, whose intoxication is expressed by neuroosteofibros (defective tissue changes at the junction of tendon and muscle).
- Genetic factor.Each person has an individual level of flexibility, which is directly correlated 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 relation to fibers, deviations lead to faster wear and tear of the spinal column.
- Biomechanical factor- non-physiological movements in the articular surface of the spine. This is caused by muscle atrophy (the clinical symptom is pain that occurs when bending and turning).
- Aseptic-inflammatory factor- usually a rapid inflammatory process in the intervertebral discs. Microdefects occur in the spine due to malnutrition of the spinal disc. Areas of dead tissue are formed in these microdefects.
Symptoms of osteochondrosis of the spinal column
The main symptom of osteochondrosis is back pain, which can be constant or periodic, painful or acute, and is most often aggravated by sudden movements and physical activity.
Osteochondrosis is a common disease among athletes. It occurs due to a discrepancy between physiological capabilities and motor loads, which contributes to microtrauma and wear and tear of the spinal tissue.
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 by various neoplasms). |
all possible complications of cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| Phases | First | A 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 causes the development of local symptoms of inflammation. | Destruction of other elements of intervertebral articulation, pathological arrangement of joint surfaces, marginal bone growths. |
| Patient complaints | It is absent or indicates discomfort when staying in the same position for a long time. | Discomfort and pain with certain types of exercises. | 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 area 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 activity with the appearance of compressive pain that is not associated with movement in the spine. After half an hour, the pain reaches its maximum, the person experiences difficulty breathing and fear of death. The diagnosis is confirmed by an electrocardiogram (ECG) and markers of myocardial necrosis.
- Subarachnoid hemorrhage(bleeding between the arachnoid and egg substance of the brain). In some cases, due to the toxic effect of the spilled blood on the spinal roots, there may be severe pain in the spine. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- Abnormalities of the spine.Minimal examination: radiograph of the skull and cervical spine in frontal and lateral projection. The most common anomalies of the spine are: fusion of the atlas (first cervical vertebra) with the occipital bone, depression 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 can also be accompanied by neck pain, which is 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 occurs gradually, against the background of progressive weight loss and periodic fever. The main laboratory sign is 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 source of metastases - kidneys, lungs, stomach, thyroid gland, prostate.
- Rheumatic and infectious-allergic polyarthritisit differs according to the anamnesis, a moderately elevated body temperature and dominant damage to the large joints.
- Depression in disguise.Patients "impose" non-existent pathologies (in this context, symptoms of osteochondrosis), an attempt to explain to them the essence of what is happening is met with a wall of misunderstanding. Signs of masked depression are: decreased mood, concentration and performance; sleep and appetite disorders; suicidal thoughts and actions.
- Peptic ulcer of the stomach and duodenum, pancreatitis and cholecystitisthey are diagnosed based on the association 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 an anamnesis about the patient's life and illness and performs a neurological examination. The neurologist examines the spine in three options (standing, sitting and lying down). When examining the back, pay special attention to the posture, the lower angles of the shoulder blades, the ridges of the iliac bones, the position of the shoulder girdle and the expression of the back muscles. During palpation, deformations, pain and muscle tension are determined.
- When establishing the diagnosis of osteochondrosis, additional consultations with specialized experts are necessary to rule out pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Carrying out mandatory laboratory tests (general blood analysis, general urine analysis, biochemical blood analysis).
- Acknowledgment of studies is important:
radiograph of the spine in two projections – the simplest method for identifying changes in the spinal column (narrowing of the gap between the vertebrae);Depending on the degree, different changes are visible on X-rays:
Degree First A second Third Fourth X-ray signs No radiological signs. Changes in the height of the intervertebral discs. Protrusion (protrusion into the spinal canal) of intervertebral discs or even prolapse (loss). Formation of osteophytes (marginal bone growths) at the point of contact of the vertebrae. computed tomography (CT) and nuclear magnetic resonance (MRI) - it is used not only to identify changes in the spine, but also to determine pathologies in other organs;USDG MAG (ultrasound dopplerography of the main arteries of the head) - ultrasound examination of the vascular 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 therapyit should be strictly individual and differentiated, the prescription of drugs is done by the doctor after the 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 nonsteroidal anti-inflammatory drugs should be as short as possible; 5-7 days is enough for pain relief. 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 alleviate muscle spasms.
- Transcutaneous method of pain relief: ointment whose active ingredient is NSAID; anesthetic cream; applications with anti-inflammatory and analgesic drugs, corticosteroids are added for greater effect.
- Treatment intended 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 incorporated into the framework of cartilage tissue, which increases the formation of bone matrix and reduces the destruction of joints. The most favorable composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.
Treatment methods other than drugs:
Neuro-orthopedic measures. An important point in the treatment of osteochondrosis is adherence to a rational regime of physical activity. Longer stays in bed and minimal physical activity are not only bad for the spine, but also lead to a permanent symptom - back pain.Therapeutic exercise (physical therapy) it is prescribed when the patient is in a satisfactory condition (especially in the period when the signs of the disease are decreasing), and the main goal is to strengthen the muscular corset.In order to prevent falls, improve coordination of movements and functioning of the vestibular apparatus (relevant for elderly patients), balancing discs, platforms and tracks are used in exercise therapy.
Manual therapy with severe neck pain. It is prescribed with special caution 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 the numerous contraindications for this type of treatment, which are relevant for osteochondrosis - massive osteophytes (pathological growths on the surface of bone tissue), which are formed in the 4th stage of the development of this pathology.Physiotherapy procedures in the acute period: - ultrasound;
- phonophoresis;
- ultraviolet radiation;
- impulse currents;
- neuroelectric stimulation.
Physiotherapy procedures in the subacute period: - electrophoresis;
- magnetotherapy.
Massage. Of all types, a superficial, relaxing massage with rubbing elements is used. As soon as the pain symptom is alleviated with the help of massage, they smoothly move on to more intense rubbing elements. 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 condition of the patient.
Preventive actions
- Competent choice of furniture (especially in the workplace). The work chair consists of flat and solid backrests. The bed includes a mattress of moderate hardness, a pillow of medium softness (preferably an orthopedic mattress and pillow).
- Correction of vision, posture, bite.
- Rational choice of footwear (especially important for drivers). The maximum heel size is 5 cm.
- Wearing a 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 your body positions more often: don't stand or sit for a long time.
- Proper nutrition: limit the amount of sweet, salty, fatty, spicy food. The most dangerous food for bones is white sugar, because it extracts calcium from bone tissue. The diet should include fruits, berries, vegetables, eggs, nuts, meat, kidney, liver, fish, legumes and dairy products.
- Protect yourself from sudden temperature changes; hot water in the bath, sauna, swimming pool, etc. is particularly dangerous, because it relaxes the muscles of the back and even a small injury in that state is not felt, but it leads to tragic consequences for the spinal column and even for the musculoskeletal system in general.
- Water procedures are not only a preventive, but also a therapeutic measure. Swimming combines stretching and muscle relaxation.
- Treatment of chronic diseases.
- Active and regular rest.
Examples of effective exercises for the prevention of cervical osteochondrosis, which can be performed at the workplace:
- sitting on a chair, looking ahead. The brush covers and supports the lower jaw. Pressing the head forward and down through resistance (tension phase); relaxing and stretching the neck muscles, slowly move your head back (relaxation phase);
- sitting on 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. Left palm on the left cheek, and do the same on the right shoulder;
- sitting on 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, accordingly, do the same.
Conclusion
The high frequency and social importance of osteochondrosis determines the scientific interest in this problem. The disease affects not only older people, but also occurs more often among young people, which attracts the attention of neurologists, neurosurgeons, orthopedic traumatologists and other specialists. Timely diagnosis and adequate treatment of this pathology ensure social adaptation and quality of future life.