Osteochondrosis of the spine is a degenerative-dystrophic lesion of the intervertebral discs, the vertebral body, the ligamentous apparatus, in which the bone and cartilage tissues of the cervical, thoracic and lumbar spine are destroyed.
The pathology affects the entire motor segment of the spine, disc, both vertebral bodies, adjacent nervous and muscle structures. This disease is often referred to as "the disease of civilization" which is associated with upright posture and stress on the spine every day.
The main cause of spinal osteochondrosis is microtrauma during physical exertion, poor diet, sedentary lifestyle and even genetic predisposition. If this disease progresses, the intervertebral disc and adjacent structures suffer first. The central part of the disc changes, which leads to the loss of the shock-absorbing properties of the vertebra, as a result of which cracks and thinning are formed on the fibrous ring.
US statisticians say the number one reason for limiting activity in people under 45 is pain in the back and neck. The majority of city dwellers, drivers, who spend a significant part of their time in a sitting position recharging the spine, are at risk.
Osteochondrosis is the cause of over 70% of back pain cases. The risk of disease increases with age.
Etiology and pathogenesis of spinal osteochondrosis
Spinal osteochondrosis has a long-term pathogenesis (from several months to several decades). It depends on the factors affecting the development of the disease.
Risk factors:
- Age. The elderly (over 60) are at risk. In people under 35, the disease is rare. Due to age-related changes, disruptions occur in the human hormonal background, which makes muscle tissue and blood vessel walls more porous, which means more vulnerable. This causes metabolic disorders, overloads the intervertebral discs.
- Autoimmune diseases that can perceive cartilage tissue as foreign and begin to destroy it.
- Injury to the spine. This is one of the main reasons for the development of osteochondrosis in young people. It is believed that more than half of people with spinal injuries at a young age suffer from osteochondrosis of the spine in old age.
- Overweight, which reduces wear on the intervertebral discs. Cartilaginous discs act as a kind of shock absorber for the spine, which ensures its mobility during physical activity, walking, running, etc. , and protect bone tissue from destruction and the appearance of microcracks. The severity of excess weight makes the load even stronger, which accelerates the destruction of cartilaginous discs.
- Flat feet.
- Genetic predisposition.
- Diseases of the endocrine system, which cause metabolic disorders, which in turn negatively affect the condition of cartilage tissue.
Osteochondrosis can be in a “dormant state” for a long time. Many patients discover the disease in the presence of severe pain, when the dystrophic process in the cartilage tissue has already damaged the nerve roots.
There are such steps in the pathogenesis of spinal osteochondrosis:
- Violation of blood flow in the intervertebral discs and adjacent structures.
- Hormonal and metabolic disorders of the organism and of the intervertebral discs, in particular.
- Degradation process of the nucleus pulposus. At this stage, the structure of the intervertebral disc changes - the nucleus decreases, the disc itself becomes thinner, the load on the fibrosus ring increases, which leads to various stratifications, microcracks and sometimes ruptures.
- Protrusion of intervertebral discs - protrusion of the tissue of the intervertebral discs, often towards the spinal canal, encroaching on it, causing severe pain.
- Intervertebral hernia. The progression of the protrusion leads to the destruction of ligaments, a change in the height and shape of the disc, which in turn causes the formation of hernias.
- Compression of the root arteries.
- Chronic insufficient blood supply to the spinal cord.
Symptoms of spinal osteochondrosis
As osteochondrosis develops, pathologies appear in the intervertebral discs and in the cartilage themselves, which then overlap and can cause the appearance of an intervertebral hernia.
Symptoms can be both general and specific, characteristic of pathological changes in cartilage, intervertebral discs and adjacent tissues.
The very first sign of osteochondrosis should be called back pain, numbness of spinal sections, limited movement, increased pain with exertion.
Specific symptoms of osteochondrosis:
- Cervical osteochondrosis is characterized by impaired blood circulation, which causes dizziness, pain and tinnitus, headache. The brain is poorly enriched with oxygen and nutrients, which causes a person to experience a state of stress.
- Osteochondrosis of the thoracic region, often accompanied by intercostal neuralgia. There is pain in the chest and ribs.
- Osteochondrosis of the lumbar spine causes the development of diseases of lumbago, lumbosacral (sciatica) and lumbar sciatica. With sciatica, the sciatic nerve is affected, pain and hypotension in the buttocks, as well as hypotension in the calves, are observed.
Symptoms of cervical osteochondrosis:
- Cirvicalgia - pain in the cervical spine. The nature of the pain is varied (dull, sharp, aggravated by tilting the head and torso, when coughing), depending on the factor affecting that section of the spine.
- Cervicobrachialgia - pain in the cervical spine, radiating to the arm, numbness.
- Shoulder-scapular retrosis and re-arthrosis - pain in the shoulder joint, in the collarbone, limitation of up and down hand movement.
- Epicondylosis - pain in the elbow joint, limited movement.
- Vertebral artery syndrome - the so-called cervical migraine, headache and neck pain, nausea, sometimes vomiting, impaired coordination of movements - staggering when walking, tinnitus.
One of the most common signs of cervical osteochondrosis is impaired blood flow, which frequently leads to dizziness, fainting, and headaches.
Symptoms of breast osteochondrosis:
- Thoracalgia - pain in the chest, pain associated with immobility (manifested with prolonged sitting, at night), aggravated by physical activity, deep breathing, coughing.
- Heart syndrome.
- Posterior chest wall syndrome - pain in the area of the shoulder blades, pain sensations depend on the position of the body.
- Scalene anterior muscle syndrome.
- Truncalgic Syndrome - pain in half of the chest.
- Aggravation of intercostal neuralgia.
Symptoms of lumbar osteochondrosis:
- Lumbodynia - pain in the lower back, lumbago. The patient feels discomfort when trying to sit or stand up. Pain increases with physical activity, coughing, deep breathing, bending.
- Lumboischialgia - pain in the lower back, radiating to the leg. There may be paresthesia, numbness in the legs, muscle spasms, and joint pain.
- Vascular syndromes - they begin with the compression of blood vessels, are not accompanied by pain, there is weakness in the muscles, cone syndrome - weakness in both feet, dysfunction of the pelvic organs.
The symptoms of osteochondrosis of the lumbar spine are diverse. This part of the spine is more loaded than others.
Diagnosis of spinal osteochondrosis
At the first back pain, an examination should be done to determine the source of the pain. Osteochondrosis is a difficult disease to diagnose because the pain can be caused by other conditions unrelated to the spine. The patient will need consultations from several specialists: a neurologist, first of all, an orthopedist, a vertebrologist.
Methods for diagnosing osteochondrosis:
- X-ray. It is carried out to accurately determine the height of the intervertebral discs or changes in the structure of the vertebrae, changes in the diameter of the holes between the vertebrae. X-rays are most often done in two positions - lying on your back and on your side. Two different image projections make it possible to more precisely determine the presence of a pathology. Sometimes an x-ray is taken with the lower jaw facing down.
- MRI and CT. MRI results are considered more accurate and help quickly determine the location of segments that have been affected by pathology, the presence or absence of intervertebral hernias, and root compression.
- Laboratory tests: blood test to determine the level of calcium in the blood and the rate of erythrocyte sedimentation. Laboratory tests are prescribed by the very first, more recently, based on these results, the doctor directs them to the hardware diagnosis.
It is important to differentiate osteochondrosis of the spine from a number of other diseases with a similar clinical picture, for example: neoplasms of the spine of an oncological nature, violation of the integrity of the cartilage tissue, inflammation, intermittent claudication, cyst formation on internal organs, urolithiasis, gastritis, pyelonephritis, gastric ulcer, angina pectoris, nervous system disorders. For this purpose, studies of the digestive system, nervous system and blood circulation may be prescribed. Such diagnostic methods are used - cardiogram, ultrasound examination, electroencephalography, endoscopic examination (digestive organs).
Complications of osteochondrosis
Most often, the course of this disease is accompanied by neurological complications:
Step- . Complications caused by protrusion - sharp painful shooting sensations.
- Stage. Radiculitis, characterized by pain syndromes and other symptoms, depending on the location of the radiculitis.
- Stage. Pathology of the roots and spinal nerve, presence of intervertebral hernias. Often muscle paresis occurs, resulting in paralysis of the whole body.
- Stage. Violation of blood circulation and blood supply to the entire spinal cord. Symptoms: Persistent severe back pain, paralysis of some muscle groups, ischemic stroke of the spinal cord.
Treatment of osteochondrosis of the spine
The process of treating any type of osteochondrosis pursues one goal: to relieve pain, prevent destruction and deformation of the tissues of the spine. The treatment can be conservative or surgical. The type and method of treatment is prescribed individually for each patient, depending on the diagnosis (stage, type of disease, general well-being of the patient).
In the acute period of the pain syndrome, relaxation and rest are recommended, anti-inflammatory drugs (dicloberl, voltaren), injections of antispasmodic mixtures, vitamin B, preparations for rubbing - dip rileaf, larkspur, etc. , may be prescribed as the pain syndrome improves. physical education and physiotherapy (diadynamic currents, electrophoresis, magnetotherapy).
Conservative treatment lasts about two months. In addition to the listed treatment methods, massage, manual therapy, reflexology and extraction can also be used. The result of conservative treatment directly depends on the perseverance and diligence of the patient.
There is also a surgical method of treatment which is used in the presence of intervertebral hernias over six months, compression of the vertebral roots due to narrowing of the gap between the vertebrae. The principle of surgical treatment is to remove the deformed disc. The rehabilitation period after surgery is approximately six months. Rehabilitation includes exercise therapy, physiotherapy and vitamin intake.
The prevention of osteochondrosis of the spine is to combat risk factors - maintaining an active lifestyle, playing sports, eating a good diet, using special corsets and belts when loading the back, sleep on orthopedic mattresses and pillows, avoid hypothermia and injury.