The spine is a unique biokinematic system; it is capable of carrying loads without damage, but, like any structure, it wears out over time. At a young age, thanks to rapid regenerative abilities, a stable condition is maintained, but after 50 years, their supply gradually fades, 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. Existing theories for 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 (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 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 refer only to hormone levels. This theory is more relevant for postmenopausal women.
- Mechanical theorytalks about the connection between the occurrence of osteochondrosis and overloading of certain parts of the spine.
- Anomaly theory- an isolated case from mechanical theory. Abnormalities of the vertebral bodies, fusion of the bodies, non-fusion of the arch due to improper biomechanism stimulate the overload of the vertebral discs and cause the destruction of bone tissue.
These theories have the 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 that contribute to the development of the disease
- Gravity factor:for the spine, any non-physiological displacement is nothing more than a trigger for many muscular reactions.
- Dynamic factor:The greater and longer the load on the spine, the more and longer it is subjected to trauma (people prone to long-term forced positions; 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 then contribute to the formation of osteochondrosis. Eating food from dishes made of an alloy of aluminum and iron has a negative effect on the human body. During the preparation of food, microparticles enter the gastrointestinal tract and since they also contain lead, this metal accumulates in the body, the intoxication of which is expressed by neuroosteofibrosis (damaged tissue changes at the junction of tendons and muscles).
- Genetic factor.Each person has an individual level of flexibility, which is directly related to the ratio of fibers in connective tissue (collagen and elastin) and is genetically inherited. Despite all of the above, there are norms in the fiber ratio; deviations lead to faster wear and tear of the spine.
- Biomechanical factor- non-physiological movement on 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– more often a rapid inflammatory process in the intervertebral discs. Microdefects are formed in the spine due to malnourishment of the spinal disc. In these microdefects, areas of dead tissue are formed.
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 intensifying with sudden movements and physical activity.
Osteochondrosis is a common disease in athletes. It arises from a mismatch between physiological abilities and motor loads, which contribute to microtrauma and wear and tear of the spinal tissue.
The localization of symptoms depends mainly 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.
| Type of osteochondrosis | Cervix | breast | Lumbosacral | Mixed |
|---|---|---|---|---|
| Clinical picture |
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the pain is constant or spreads to all parts of the spine. |
| Complications |
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compression myelopathy (spinal cord compression by various neoplasms). |
all complications that are possible with cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| stages | First | Secondly | Third | Fourthly |
|---|---|---|---|---|
| Changes in the spine |
|
|
Fracture and displacement of the spinal disc with the 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 articular surfaces, marginal growths of bones. |
| Patient complaints | Lacks or shows discomfort when staying in the same position for a long time. | Discomfort and pain with some types of exercise. | Pain in the back, neck, 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 heart area 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 accompanied by 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 spine in frontal and lateral projections. The most frequent abnormalities of the spine are: fusion of the atlas (first cervical vertebra) with the occipital bone, depression of the edges of the occipital foramen in the skull cavity, fusion of the vertebrae, changes in the shape and size of the vertebrae.
- Cervical lymphadenitisit can also be accompanied by neck pain, sometimes aggravated by bending and turning. Making a diagnosis is not difficult: enlarged, painful lymph nodes; history of frequent sore throats.
- Multiple myeloma.Back pain occurs gradually, against the background of progressive weight loss and periodic fever. The main laboratory sign is protein in the urine.
- Tumor or metastasis 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 medical history, moderately elevated body temperature and predominant damage to large joints.
- Depression in disguise. Patients "impose" non-existent pathologies (in this context, the symptoms of osteochondrosis), an 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 and appetite disorders; suicidal thoughts and actions.
- Peptic ulcer of the stomach and duodenum, pancreatitis and cholecystitisare diagnosed using 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, a patient complains to a neurologist, who collects an anamnesis of the patient's life and illness and performs a neurological examination. A neurologist examines the spine in three options (standing, sitting and lying down). During the examination of 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 expression of the back muscles. During palpation, deformation, pain and muscle tension are determined.
- When making a diagnosis of osteochondrosis, additional consultation with specialized specialists is necessary to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Carrying out mandatory laboratory tests (general blood test, general urine analysis, biochemical blood analysis).
- Confirmatory studies are instrumental:
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, different changes are visible on radiographs:
diploma First Secondly Third Fourthly X-ray signs There are no radiological signs. Changes in the height of the intervertebral discs. Prolapse (bulging in the spinal canal) of the intervertebral discs or even prolapse (loss). Formation of osteophytes (marginal bone growth) 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 (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 soon as possible.
What treatment methods exist for osteochondrosis?
Drug therapyit must be strictly individual and differentiated, the prescription of drugs is carried out 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). NSAID treatment should be as short as possible; 5-7 days are enough to relieve the 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 of pain relief: ointment, the active ingredient of which is an NSAID; anesthetic cream; applications with anti-inflammatory and analgesic drugs; corticosteroids are added for greater effect.
- Treatment aimed at regenerating an inflamed or compressed nerve, as well as improving 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 built into the framework of cartilage tissue, thereby increasing bone matrix formation and reducing joint destruction. The most favorable composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.
Treatment methods without drugs:
Neuroorthopedic measures. An important point in the treatment of osteochondrosis is the observance of a rational regime of physical activity. Staying 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.Therapeutic exercises (physiotherapy) it is prescribed when the patient is in a satisfactory condition (especially during the period when the signs of the disease are decreasing), the main goal is to strengthen the muscular corset.To prevent falls, to improve the coordination of movements and the 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 vigilance 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 important for osteochondrosis - massive osteophytes (pathological growth 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 current;
- neuroelectric stimulation.
Physiotherapy procedures in the subacute period: - electrophoresis;
- magnetic therapy.
Massage. Of all types, a superficial, relaxing massage with friction elements is used. As soon as the pain symptom is alleviated with the help of massage, they smoothly pass to more intense elements of friction. When you master the acupressure (local) massage technique, 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 strong back. The bed includes a mattress of medium firmness, a pillow of medium softness (if possible, an orthopedic mattress and 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 turning, lift the 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 food: limit the amount of sweet, salty, fatty, spicy foods. The most dangerous food for bones is white sugar, as it removes 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 the bathroom, sauna, swimming pool, etc. it is particularly dangerous, as it relaxes the muscles of the back and even a small 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 vacations.
Examples of effective exercises to prevent cervical osteochondrosis, which can be performed right at the workplace:
- sitting in 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 the 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 our ear and stay in this position for 3-5 seconds. The left palm on the left cheek and do the same, respectively, on the right shoulder;
- sitting in a chair, looking ahead. Hands are on the knees. We turn our head to the right, hold it for 5-7 seconds and very slowly return to the starting position. Then we bend 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 the elderly, but is increasingly appearing 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 quality of life in the future.