The spine is a unique biokinematic system; it is capable of supporting loads without damage, but like any structure, it wears out over time. At a young age, a stable state is maintained thanks to the rapid regenerative ability, but after 50 years their supply gradually decreases, which leads to the development of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spine, which subsequently spreads to neighboring structures of the spinal segment.
Development theories
The etiology of osteochondrosis is unknown. Current theories about the origin of this disease:
- Metabolism.Changes in the metabolism of the intervertebral disc due to its drying out (the amount of water at a young age is 88%, with increasing age the water content decreases to 60%).
- Vessel.Changes in spinal blood flow (occurs 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 where there are no vessels. In childhood, there is a vascular network in the intervertebral discs, but after the spinal architecture has fully developed, this network is closed by connective tissue.
- Hormone theorymore controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is inappropriate to refer only to hormonal levels. This theory is most relevant to postmenopausal women.
- Mechanical theorytalks about the connection between the occurrence of osteochondrosis and overload of certain parts of the spine.
- Anomaly theory- an isolated case from mechanical theory. Anomalies of the vertebral bodies, fusion of the vertebral bodies, non-fusion of the arch due to incorrect biomechanism lead to overloading of the intervertebral discs and lead to the destruction of bone tissue.
These theories have a reason to exist, but none of them are universal. It is more correct to call osteochondrosis a multifactorial disease characterized by genetic predisposition and provoking factors.
Factors contributing to the development of the disease
- Gravity factor:For the spine, any unphysiological shift simply triggers many muscle reactions.
- Dynamic factor:The greater and longer the load on the spine, the greater and longer it is exposed to trauma (people who are prone to prolonged forced positions; constant lifting of heavy objects).
- Dysmetabolic factor:insufficient nutrition of the spine due to autoimmune diseases, toxic effects.
It is known that eating food from aluminum dishes leads to their accumulation in the bones, which subsequently contributes to the development of osteochondrosis. Eating food from dishes made of an aluminum-iron alloy has a negative 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 poisoning of which manifests itself in neuroosteofibrosis (defective tissue changes at the junction of the tendon and muscle).
- Genetic factor.Each person has an individual level of flexibility, which is directly correlated to the ratio of fibers in the connective tissue (collagen and elastin) and is inherited genetically. Despite all this, there are standards in the fiber ratio; Deviations lead to faster wear and tear on the spine.
- Biomechanical factor– unphysiological movements in the articular surface of the spine. This is caused by muscle atrophy (the clinical symptom is pain that occurs when bending and twisting).
- Aseptic-inflammatory factor– usually a rapid inflammatory process in the intervertebral discs. Malnutrition of the intervertebral disc causes microdefects in the spine. 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, and is usually 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 microtrauma and wear and tear on spinal tissue.
The localization of symptoms largely depends on the part of the spine where the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is localized in several parts, it is called mixed osteochondrosis.
| Type of osteochondrosis | Cervical | Breast | 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 (compression of the spinal cord by various neoplasms). |
all complications that are possible with cervical, thoracic and lumbosacral osteochondrosis. |
Stages of osteochondrosis
| stages | First | Second | Third | Fourth |
|---|---|---|---|---|
| Changes to the spine |
|
|
Rupture and displacement of the intervertebral disc with immersion of other surrounding elements into its cavity, which leads to the development of local inflammatory symptoms. | Destruction of other elements of the intervertebral joints, pathological arrangement of the articular surfaces, marginal bone growths. |
| Patient complaints | Absent or indicate discomfort when remaining 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, depending on the location. | Constant pain throughout the spine. |
Differential diagnosis
- Acute myocardial infarction.The pain is concentrated in the area of the heart and only radiates (spreads) from there to the neck, lower jaw and arm. The disease begins for no reason or after physical activity with the appearance of pressure pains that are not associated with movements of 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 pia mater of the brain). In some cases, severe pain in the spine may occur due to the toxic effect of spilled blood on the spinal roots. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- Spinal abnormalities.Minimum examination: X-ray 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 occipital vertebrae.
- Cervical lymphadenitismay also be accompanied by neck pain, sometimes worsened by bending and twisting. The diagnosis is not difficult: enlarged, painful lymph nodes; History of frequent sore throats.
- Multiple myeloma.Pain in the spine appears gradually against the background of progressive weight loss and periodic fever. The most important laboratory sign is protein in the urine.
- Tumor or metastases in the spine.Indications of a malignant neoplasm are: progressive weight loss, laboratory changes and ultrasound of the sources of metastasis - kidneys, lungs, stomach, thyroid, prostate.
- Rheumatic and infectious-allergic polyarthritisdifferentiated according to medical history, moderately elevated body temperature and predominantly damage to large joints.
- Masked depression.Patients "force" non-existent pathologies (in this context, symptoms of osteochondrosis), the attempt to explain to them the essence of what is happening runs into a wall of misunderstanding. Signs of masked depression are: decreased mood, concentration and performance; sleep andAppetite disorders; suicidal thoughts and actions.
- Stomach and duodenal ulcer, pancreatitis and cholecystitisDiagnosis is made based on the connection of pain with food intake, laboratory studies (FGDS, general blood test, biochemical blood test, activity of pancreatic enzymes, ultrasound examination of the abdominal organs).
Diagnosis of osteochondrosis
- Most often, a patient complains to a neurologist, who collects an anamnesis about the patient's life and illness and conducts a neurological examination. A neurologist examines the spine in three variants (standing, sitting and lying). When examining the back, pay special attention to posture, the lower angles of the shoulder blades, the crests of the pelvic bones, the position of the shoulder girdles, and the expression of the back muscles. Palpation reveals deformation, pain and muscle tension.
- When diagnosing osteochondrosis, additional consultation of specialized specialists is required to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Conducting mandatory laboratory tests (general blood test, general urinalysis, biochemical blood test).
- Confirmatory studies are crucial:
- X-ray of the spine in two projections– the simplest method of detecting changes in the spine (narrowing of the gap between the vertebrae);
Depending on the degree, different changes are visible in the x-ray image:
Degree First Second Third Fourth X-ray sign No radiological signs. Changes in the height of the intervertebral discs. Protrusion (bulging into the spinal canal) of the intervertebral discs or even prolapse (loss). Formation of osteophytes (marginal bone growths) at the contact point of the vertebrae. - Computed tomography (CT) and nuclear magnetic resonance (MRI)– 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 circulatory system of the head and neck, which allows you to diagnose the degree of changes in blood vessels as early as possible.
- X-ray of the spine in two projections– the simplest method of detecting changes in the spine (narrowing of the gap between the vertebrae);
What treatment methods are available for osteochondrosis?
Drug therapyshould be strictly individual and differentiated; medication is prescribed by a doctor after the diagnosis.
The main drugs used to treat osteochondrosis:
- Pain relief occurs with the help of analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment with NSAIDs should be as short as possible; 5-7 days are enough to relieve the pain. If pain is poorly controlled and a constant dose of pain-relieving medication is required, you can take selective COX-2 inhibitors.
- Antispasmodics relieve pain and relieve muscle spasms.
- Transcutaneous method of pain relief: ointment, the active ingredient of which is an NSAID; numbing cream; Applications with anti-inflammatory and analgesic medications; Corticosteroids are added to enhance the effect.
- Treatment to regenerate an inflamed or compressed nerve, as well as to improve blood microcirculation: B vitamins, neuroprotective drugs, nicotinic acid.
- Oral chondroprotectors – glucosamine, chondroitin sulfate. When taken regularly, they help stop destructive changes in cartilage. Chondroprotectors are incorporated into the cartilage tissue framework, promoting 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 compliance with rational physical activity. Lying in bed for a long time and minimal physical activity not only does not benefit the spine, but also leads to a permanent symptom - back pain.
Remedial gymnastics (physiotherapy)is prescribed when the patient is in a satisfactory condition (especially during the period when the signs of the disease subside), the main goal is to strengthen the muscle corset.
In order to prevent falls, improve movement coordination and the function of the vestibular system (relevant for older patients), balance discs, platforms and paths are used in exercise therapy.
Manual therapywith severe pain in the neck. 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 pathological tension of the paravertebral muscles. Do not forget about a number of contraindications to this type of treatment that are relevant for osteochondrosis – massive osteophytes (pathological growths on the surface of bone tissue), which form in the 4th stage of development of this pathology.
Physiotherapeutic measures in the acute phase:
- Ultrasonic;
- phonophoresis;
- ultraviolet irradiation;
- impulse currents;
- neuroelectric stimulation.
Physiotherapeutic procedures in the subacute phase:
- electrophoresis;
- Magnetic field therapy.
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 gently move on to more intense rubbing elements. When mastering the technique of acupressure (local) massage, preference is given to this type.
Surgical interventions are decided on a strictly individual basis depending on the indications and condition of the patient.
Preventive measures
- Competent selection of furniture (especially in the workplace). The work chair consists of a flat and solid backrest. The bed includes a mattress of medium hardness, a pillow of medium softness (if possible an orthopedic mattress and a pillow).
- Correction of vision, posture, bite.
- Rational choice of shoes (especially important for drivers). The maximum heel size is 5 cm.
- Wearing a restraint belt, bandage or corset while working.
- Movement correction: Avoid bending and twisting, lift weights with your back straight and your legs bent at the knees.
- Change your posture more often: do not stand or sit for long periods of time.
- Proper nutrition: Limit the amount of sweet, salty, fatty and spicy foods. The most dangerous food for bones is white sugar because it leaches calcium from bone tissue. The diet should include fruits, berries, vegetables, eggs, nuts, meat, kidneys, liver, fish, legumes and dairy products.
- Protect yourself from sudden temperature changes; hot water in a bath, sauna, swimming pool, etc. is especially dangerous because it relaxes the back muscles and even a small injury in this state is not noticeable, but leads to tragic consequences for the human spine and even for the musculoskeletal system in general.
- Water treatments are not only a preventive measure, but also a therapeutic one. Swimming combines stretching and relaxation of the muscles.
- Treatment of chronic diseases.
- Active and regular vacation.
Examples of effective exercises for the prevention of cervical osteochondrosis that can be performed directly at the workplace:
- sitting on a chair, looking forward. The brush covers and supports the lower jaw. Push your head forward and down with resistance (tension phase); Relax and stretch the neck muscles, slowly move the head back (relaxation phase);
- sitting on a chair, looking forward. The right palm lies on the right cheek. Slowly tilt our head to the left, try to touch our ear to our left shoulder and stay in this position for 3-5 seconds. Place your left palm on your left cheek and do the same with your right shoulder.
- sitting on a chair, looking forward. The hands are on the 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 thing.
Diploma
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 in 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 the quality of future life.