Osteochondrosis is a disease of the spinal column characterized by degenerative-dystrophic damage to intervertebral discs, vertebral bodies and ligaments.
Osteochondrosis of the spine has a chronic progressive course.The disease is not felt for a long time, and symptoms appear only when complications appear.
According to the statistics of the World Health Organization, 40-80% of the world's population suffers from osteochondrosis.
The majority of patients are over 30 years old.But recently, there is a trend of rejuvenation of osteochondrosis.Osteochondrosis ranks first among spine diseases in terms of patient disability.
Brief anatomy of the spine
The spine performs the main functions - the canal of the spinal cord, support and movement, and also connects the head, shoulders and pelvic girdle.
The structural unit of the spine is the vertebra.
The 24 vertebrae are interconnected by intervertebral discs, which are shock absorbers of the body.
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 organs enables an even distribution of body weight and load.
Structural and functional elements of the spinal column
A vertebra is a bony formation consisting of a body, an arch and a process.
The main load falls on the body of the vertebra, so this is its most massive part.
Important!The arches of the adjacent vertebrae form the spinal canal - the depression of 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 back surface, and the yellow ligament, whose main purpose is to connect the vertebral arches.
Vertebral processes.The vertebra has 7 processes extending from the arch: spinous process, two transverse, two superior and two inferior articular processes.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 cartilage plate, anulus fibrosus and nucleus pulposus.The intervertebral disc connects adjacent vertebrae, ensuring mobility and stability of the spine.
Intervertebral jointsformed from the outgrowths 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 openingsthey are located on the sides of the spine and are formed by the articular processes, bodies and pedicles of the adjacent vertebrae.The spinal nerve roots exit through the intervertebral openings and enter the blood vessels.
Spinal cord- This is the part of the central nervous system that consists of nerve fibers.The spinal cord has three membranes - soft, arachnoid and hard.The dura spinal membrane consists of two sheets that join together to form a dural sac, filled with cerebrospinal fluid.
Spinal nerve roots- These are conductors of nerve impulses from the spinal cord to the 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 tilts 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 (mechanism of development) of spinal osteochondrosis
In the process of development, osteochondrosis passesfour stages:
- The first stage.Pathological changes do not cross the borders of the intervertebral disc.The nucleus pulposus dries out, which leads to a decrease in the height of the intervertebral disc.The fibrous ring cannot withstand the load - it cracks and cracks.
- The second stage.Due to the decrease in the height of the intervertebral discs, the ligaments and muscles of the spine relax, which leads to the instability of the spinal movement segment.Vertebrae can slide and move relative to each other.In this case, spondylolisthesis occurs.
- The third phase.The disease progresses.Protrusions of intervertebral discs and arthrosis of intervertebral joints occur, as well as uncovertebral joints.
- The fourth stage.In this phase, adaptive reactions are activated in the form of bone growths of the vertebral bodies (osteophytes).Thus, the body tries to limit the excessive mobility of the vertebrae.Osteophytes damage the roots of spinal nerves with their sharp edges.Fibrous ankylosis of the intervertebral discs and joints is formed, and the spine is immobilized.The ankylosis phase is characterized by the disappearance of pain.
What causes osteochondrosis?
Osteochondrosis of the backis a multifactorial disease in which it is impossible to single out one specific cause.
The basis of osteochondrosis is a violation of microcirculation and metabolism in the tissues of the spine, which can occur due to improper distribution of the load on the spine.
Factors that contribute to the development of osteochondrosis include the following:
- malformed posture in childhood (scoliosis, kyphosis, kyphoscoliosis, stooping);
- weakness of the back muscles (incompetent muscular corset of the spine);
- longer stay in one position (working at a computer, working in an office, doing manual work);
- improper weight lifting;
- physical inactivity and sedentary lifestyle;
- metabolic pathologies, 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 injury;
- overweight and obesity.
Symptoms of osteochondrosis
Chronic osteochondrosis can be manifested by various symptoms.Everything depends on the stage of the disease, the degree of damage to the spine and the presence of complications.
Clinically, the disease manifests itself when the degenerative-dystrophic process has already reached the back part of the fibrous ring and the back longitudinal ligament, then the roots of the spinal nerves are irritated, constricted and the conduction of nerve impulses through them is disturbed.
At the same time, compression of the spinal cord and blood vessels occurs, which is manifested by reflex and compression syndromes.
Important!The pain syndrome in osteochondrosis is caused by the pinching of the spinal nerve root in the intervertebral openings by osteophytes, spasmed muscles and displaced vertebrae.
With its symptoms, osteochondrosis often imitates acute coronary syndrome, pleurisy, acute pancreatitis, hepatic and renal colic, acute appendicitis and adnexitis.
Therefore, it is important to carry out a thorough differential diagnosis of the disease in order to exclude life-threatening conditions.
The most commonsymptoms of osteochondrosis:
- pain in the neck, lower back, thoracic spine, which can be painful, throbbing or lumbago-like.The pain spreads to the head, upper and lower limbs, shoulder blades, heart and stomach.The pain syndrome intensifies after physical activity, sneezing, laughing, coughing or staying in one position for a long time;
- sensory disorderdifferent parts of the body at the level of innervation of the pinched nerve;
- Greekmuscles of the neck, back, upper and lower extremities;
- migraine-like headaches;
- painsin the joints of the limbs;
- increased fatiguefrom physical and mental work;
- dizziness and loss of consciousnesswith a sharp turn of the head (vertebral artery syndrome);
- visual impairment(floating before the eyes or colored spots);
- reduced hearing acuity, tinnitus;
- pain in the heart;
- painalong the intercostal spaces;
- reduced blood supplyupper and lower extremities, which is manifested by the coldness of their skin;
- paresthesia– crawling, tingling and burning in the spine;
- dry skin;
- sweating disorder;
- urinary disturbances(dysuria, enuresis);
- decreased sexual desire, impotence.
Early diagnosis of osteochondrosis will greatly facilitate its treatment.
Methods of diagnosing osteochondrosis
A neuropathologist diagnoses osteochondrosis.If necessary, patients can be referred for consultations with cardiologists, gastroenterologists, orthopedists, surgeons, etc.
During the interview, it is necessary to precisely determine the nature of the complaints, when they appeared 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.By conducting 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 radiography of the spine, computer tomography and magnetic resonance.
X-ray examination of the spine is the simplest, most accessible and highly informative method for diagnosing osteochondrosis.
Mandatory radiography is done in direct and lateral projection of the desired part of the spine.Osteochondrosis is characterized by: a decrease in the height of the intervertebral discs, the presence of osteophytes, osteoporosis and deformity of the spine.
myelography- This is an X-ray examination of the spinal column with the introduction of a contrast medium 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 hernia).
Computer 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, so they are used in difficult cases, especially 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.
For this purpose, the patient can be prescribed an electrocardiogram, ultrasound examination of the heart and internal organs, blood analysis for troponins, ultrasound examination of blood vessels, chest radiography, electroencephalography, etc.
Methods of treatment of osteochondrosis
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;
- physical therapy;
- physiotherapeutic methods;
- manual therapy;
- massage;
- acupuncture.
Drug treatmentOsteochondrosis is aimed at alleviating pain, relaxing muscles, removing swelling of nerves and muscles, improving blood flow and conduction of nerve impulses.For this purpose, the following groups of drugs are used:
- nonsteroidal anti-inflammatory drugs;
- chondroprotectors, which include components of cartilage tissue.These drugs protect the vertebral cartilage and intervertebral discs from the negative effects of various factors;
- diureticswhich remove excess fluid from the body and relieve swelling of the spinal nerve roots and paravertebral muscles;
- muscle relaxantsrelax tight muscles;
- drugs, improvement of metabolism and microcirculation in spinal tissues (vitamins B1, B6, B12, C, A and E);
- calcium supplements;
- hormonal drugs, which are prescribed when nonsteroidal anti-inflammatory drugs are ineffective.
Therapeutic exercise- these are dosed physical activities that can be performed 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 doctor of physical therapy.
Thanks to properly selected exercise therapy, you can relieve pain, improve mobility and blood flow to the spine, and stop the progression of the disease.
Physiotherapy treatmentosteochondrosis is carried out in special physiotherapy departments in hospitals, sanatoriums and clinics by physiotherapists.
Physiotherapy methods include: electrophoresis, magnetotherapy, laser therapy, mud therapy, balneotherapy, exposure to ultraviolet radiation of the affected part of the spine, vibration treatment and others.
Manual therapy– this is a dosed manual blow to the spine to restore its mobility, eliminate the movement 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 thin needles are injected into active points.
Under the influence of needles in the body, the level of endogenous opiates and cortisol increases, which act as anti-inflammatory and analgesic.
Prevention of osteochondrosis
To maintain your health and keep your spine mobile until old age, follow several principles for the prevention of osteochondrosis:
- watch your posture- always keep your back straight, don't slouch;
- to chooseproper posturefor sleeping;
- sit properly at the table(shoulders relaxed, back straight, furniture should match your height);
- during a long stay in one position (working in the office, at the computer, sitting at handicrafts), try every 1-1.5 hoursdo some physical exercise, self-massage of the back, or just getting up and walking;
- distribute the load properlyon 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 spinal columnis a chronic progressive disease that, unfortunately, cannot be cured.The effectiveness of treatment directly depends on its timeliness.
Do not self-medicate so as not to worsen your condition.At the first signs of osteochondrosis, consult a neurologist.