Osteochondrosis is a disease of the spine characterized by degenerative-dystrophic damage to the intervertebral discs, vertebral bodies and ligaments.
Osteochondrosis of the spine has a chronic progressive course.The disease does not make itself felt for a long time and symptoms only appear when complications arise.
According to statistics from the World Health Organization, 40-80% of the world's population suffers from osteochondrosis.
Among the patients, people over 30 years old predominate.But recently there has been a trend towards rejuvenation of osteochondrosis.Osteochondrosis ranks first among diseases of the spine in terms of disability among patients.
Brief anatomy of the spine
The spine performs the main functions - the spinal cord channel, support and movement, and also connects the head, shoulder and pelvic girdles.
The structural unit of the spine is a vertebra.
The 24 vertebrae are connected to each other by intervertebral discs, which are the body's shock absorbers.
The spine is divided into five sections: cervical, thoracic, lumbar, sacral and coccyx.
The normal shape of the spine is S-shaped.
This configuration of the organ makes it possible to evenly distribute body weight and load.
Structural and functional elements of the spine
A vertebra is a bone formation consisting of a body, an arch and processes.
The main load falls on the vertebral body, therefore this is its most massive part.
Important!The arches of adjacent vertebrae form the spinal canal—the receptacle for the spinal cord, blood vessels, spinal nerve roots, and fatty tissue.
LigamentsThe spine is represented by the posterior longitudinal ligament, which connects the vertebrae along the posterior surface, and the ligamentum flavum, whose main purpose is to connect the arches of the vertebrae.
Vertebral processes.The vertebra has 7 processes that extend from the arch: the spinous process, two transverse articular processes, two superior and two inferior.The ligaments and muscles of the spine are attached to the spinous processes.Other processes form the intervertebral joints of the spine.
Intervertebral discis a disc-shaped plate consisting of a cartilaginous plate, fibrous ring and nucleus pulposus.The intervertebral disc connects adjacent vertebrae, providing mobility and stability to the spine.
Intervertebral jointsformed by the processes of two adjacent vertebrae.The main function of the intervertebral joints is to move the vertebrae relative to each other and provide flexibility to the spine.
Intervertebral foraminathey are located on the lateral surfaces of the spine and are formed by the articular processes, bodies and pedicles of adjacent vertebrae.Spinal nerve roots exit through the intervertebral foramina and blood vessels enter.
spinal cord- This is a section of the central nervous system that consists of nerve fibers.The spinal cord has three membranes - soft, arachnoid and hard.The spinal membrane of the dura mater consists of two sheets that connect and form the dural sac, filled with cerebrospinal fluid - cerebrospinal fluid.
Spinal nerve roots- They are conductors of nerve impulses from the spinal cord to internal organs and vice versa.Each spinal nerve root has autonomic, sensory and nerve fibers in its structure.
Paravertebral muscles- these are the muscles of the spine that support it and provide inclinations and turns of the body.
The functional unit of the spine isspinal motion segment, which consists of two adjacent vertebrae, an intervertebral disc, ligaments and muscles.
Pathogenesis (development mechanism) of spinal osteochondrosis
In the process of development, osteochondrosis passesfour steps:
- First stage.Pathological changes do not extend beyond the limits of the intervertebral disc.The nucleus pulposus dries out, which leads to a decrease in the height of the intervertebral disc.The fibrous ring does not withstand the load - it cracks and tears.
- Second stage.Due to the decrease in the height of the intervertebral discs, sagging of the ligaments and muscles of the spine occurs, which leads to instability of the motor segment of the spine.The vertebrae can slip and move relative to each other.In this case, spondylolisthesis is formed.
- Third stage.The disease is progressing.There is protrusion of the intervertebral discs and arthrosis of the intervertebral joints, as well as uncovered joints.
- Fourth stage.At this stage, adaptive reactions are activated in the form of bone growths of the vertebral bodies (osteophytes).Thus, the body tries to limit excessive mobility of the vertebrae.Osteophytes with their sharp tips damage the roots of spinal nerves.Fibrous ankylosis of the intervertebral discs and joints forms and the spine becomes immobilized.The ankylosis phase is characterized by the disappearance of pain.
What leads to osteochondrosis?
Osteochondrosis of the backIt is a multifactorial disease in which it is impossible to single out a specific cause.
The basis of osteochondrosis is a violation of microcirculation and metabolism in the tissues of the spine, which may arise due to improper distribution of the load on the spine.
Factors contributing to the development of osteochondrosis include the following:
- improperly formed posture in childhood (scoliosis, kyphosis, kyphoscoliosis, curvature);
- weakness of the back muscles (incompetent spinal muscular corset);
- staying in the same position for a long time (working on the computer, working in the office, doing crafts);
- inappropriate lifting of weights;
- physical inactivity and sedentary lifestyle;
- metabolic pathology, especially lack of calcium, phosphorus, calcium, vitamins, magnesium, zinc;
- genetic predisposition to osteochondrosis;
- infectious diseases;
- frequent hypothermia of the body;
- chronic stress;
- hormonal imbalance;
- weight lifting;
- spinal cord injury;
- overweight and obesity.
Osteochondrosis symptoms
Chronic osteochondrosis can manifest itself with various symptoms.It all depends on the stage of the disease, the level of spinal cord injury and the presence of complications.
Clinically, the disease manifests itself when the degenerative-dystrophic process has already reached the posterior part of the fibrous ring and the posterior longitudinal ligament, then the spinal nerve roots become irritated, compressed and the conduction of nerve impulses through them is disrupted.
At the same time, compression of the spinal cord and blood vessels occurs, which is manifested by reflex and compression syndromes.
Important!Pain syndrome in osteochondrosis occurs due to compression of the spinal nerve roots in the intervertebral foramina by osteophytes, spasming muscles and displaced vertebrae.
Osteochondrosis with its symptoms often imitates acute coronary syndrome, pleurisy, acute pancreatitis, hepatic and renal colic, acute appendicitis and adnexitis.
Therefore, it is important to perform a complete differential diagnosis of the disease to exclude potentially fatal conditions.
Most commonosteochondrosis symptoms:
- pain in the neck, lower back, thoracic spine, which can be painful, throbbing or in the form of low back pain.The pain radiates to the head, upper and lower limbs, shoulder blades, heart and stomach.The pain syndrome increases after physical activity, sneezing, laughing, coughing or remaining in the same position for a long time;
- sensory disturbancedifferent parts of the body at the level of compressed nerve innervation;
- spasmmuscles of the neck, back, upper and lower extremities;
- migraine type headaches;
- painin the joints of the limbs;
- increased fatiguephysical and mental work;
- dizziness and loss of consciousnesswith sudden turning of the head (vertebral artery syndrome);
- visual impairment(floaters before the eyes or colored spots);
- decreased hearing acuity, tinnitus;
- heart pain;
- painalong the intercostal spaces;
- decreased blood supplyupper and lower extremities, which is manifested by coldness of the skin;
- paresthesia– sensation of tingling, tingling and burning in the spine;
- dry skin;
- sweating disorder;
- urinary disorder(dysuria, enuresis);
- decreased sexual desire, impotence.
Early diagnosis of osteochondrosis will greatly facilitate its treatment.
Methods for diagnosing osteochondrosis
A neuropathologist diagnoses osteochondrosis.If necessary, patients can be referred for consultation with a cardiologist, gastroenterologist, orthopedist, surgeon and others.
During the interview, it is necessary to accurately determine the nature of the complaints, when they arose and what the patient associates them with.Be sure to check the patient's medical history, profession and whether any close relatives have osteochondrosis.
Laboratory tests in this case are not informative.When carrying out a biochemical blood test, you can pay attention to the level of calcium, phosphorus and other trace elements.
The main place in the diagnosis of osteochondrosis is occupied by instrumental methods, such as spine radiography, computed tomography and magnetic resonance imaging.
X-ray examination of the spine is the simplest, most accessible and highly informative method for diagnosing osteochondrosis.
Mandatory radiography is performed in direct and lateral projections of the desired part of the spine.Osteochondrosis is characterized by: decreased height of intervertebral discs, presence of osteophytes, osteoporosis and spinal deformity.
Myelography- This is an X-ray examination of the spine with the introduction of a contrast agent into the spinal canal.This method is dangerous due to the occurrence of allergic reactions to the contrast.
Myelography allows us to study the internal structure of the spinal canal.The method is valuable for diagnosing Schmorl's hernias (intervertebral hernias).
Computed and nuclear magnetic tomography– these are modern diagnostic methods that visualize the soft tissues and bones of the spine, layer by layer.
These methods are expensive, which is why they are used in severe cases, mainly for the differential diagnosis of osteochondrosis and diseases with similar symptoms.
Since osteochondrosis is often disguised as diseases of the heart, lungs, pleura, stomach, intestines, kidneys, liver, there is a need for differential diagnosis.
To this end, the patient may be prescribed an electrocardiogram, an ultrasound examination of the heart and internal organs, a blood test for troponins, an ultrasound examination of blood vessels, a chest x-ray, electroencephalography and others.
Treatment methods for osteochondrosis
The treatment of osteochondrosis can beconservative and surgical.
Important!First of all, comprehensive conservative methods are used and surgical treatment is resorted to only in extreme cases.
Let's consider how osteochondrosis can be properly treated.KconservativeTreatment methods for osteochondrosis can be listed:
- drug therapy;
- physiotherapy;
- physiotherapeutic methods;
- manual therapy;
- massage;
- acupuncture.
Drug treatmentOsteochondrosis aims to relieve pain, relax muscles, relieve swelling of nerves and muscles, improve blood flow and conduction of nerve impulses.For this purpose, the following groups of medicines are used:
- nonsteroidal anti-inflammatory drugs;
- chondroprotectors, which include components of cartilaginous tissue.These drugs protect the cartilage of the vertebrae and intervertebral discs from the negative effects of various factors;
- diureticswhich remove excess fluid from the body and relieve swelling of spinal nerve roots and paravertebral muscles;
- muscle relaxantsrelax contracted muscles;
- drugs, improving metabolism and microcirculation in spinal tissues (vitamins B1, B6, B12, C, A and E);
- calcium supplements;
- hormonal drugs, which are prescribed when non-steroidal anti-inflammatory drugs are ineffective.
Therapeutic exercise– these are dosed physical activities that can be carried out both at home and at work for the treatment and prevention of osteochondrosis.
There are many sets of exercises for osteochondrosis.Prescribing exercise therapy and monitoring its implementation is carried out by a qualified specialist - a physiotherapist.
Thanks to properly selected exercise therapy, you can relieve pain, improve mobility and blood supply to the spine, and stop the progression of the disease.
Physiotherapy treatmentosteochondrosis is carried out in special physiotherapy departments of hospitals, sanatoriums and dispensaries by a physiotherapist.
Physiotherapeutic methods include: electrophoresis, magnetic therapy, laser therapy, mud therapy, balneotherapy, ultraviolet exposure to the affected part of the spine, vibration treatment and others.
Manual therapy– this is a dosed manual impact on the spine to restore its mobility, eliminate displacement of the vertebrae and intervertebral discs.
Manual therapy should only be performed by a qualified chiropractor.
Massage and self-massagein osteochondrosis, it is performed to relieve muscle spasm, improve microcirculation in the paravertebral tissues and increase the mobility of the spine.
Acupunctureis a method of treating osteochondrosis in which fine needles are injected into active points.
Under the influence of needles in the body, the level of endogenous opiates and cortisol increases, which have anti-inflammatory and analgesic effects.
Prevention of osteochondrosis
To maintain the health and mobility of the spine until old age, follow several principles for preventing osteochondrosis:
- watch your posture– always keep your back straight, do not relax;
- to choosecorrect postureto sleep;
- sit correctly at the table(relaxed shoulders, straight back, furniture must be suitable for your height);
- during a long stay in one position (working in the office, at the computer, sitting doing crafts), try every 1-1.5 hoursdo some physical exercise, self-back massage, or simply getting up and walking;
- distribute the load correctlyin the spine when lifting and carrying various weights;
- wear orthopedic shoes;
- healthy sleepon a flat, hard to medium-hard mattress.It is better to buy an orthopedic mattress and pillow.
Osteochondrosis of the spineIt is a chronic progressive disease that, unfortunately, has no cure.The effectiveness of treatment directly depends on its timeliness.
Do not self-medicate to avoid making your condition worse.At the first signs of osteochondrosis, consult a neurologist.