The spine is a unique biokinematic system; it is able to bear the load without damage, but, like any structure, it wears out over time. At a young age, a stable condition is maintained thanks to the rapid regenerative ability, but after 50 years, their supply gradually disappears, which leads to the formation of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spinal column, which, as it develops, spreads to nearby structures of the spinal segment.
Theory of development
The etiology of osteochondrosis is unknown. Currently the theory of the development of this disease:
- Metabolic.Changes in the metabolism of the vertebral discs due to 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 early development may be due to injuries, metabolic disorders, infections).
These theories are sometimes combined into one - involution, which is based on the violation of trophism, especially in tissues where there are no vessels. In childhood, there is a vascular network in the intervertebral disc, but after the complete formation of the architecture of the spine, this network is covered by connective tissue.
- Hormone theorymore controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is not appropriate to refer only to hormone levels. This theory is most relevant for postmenopausal women.
- Mechanical theorytalk about the relationship between the occurrence of osteochondrosis and the load on certain parts of the spine.
- Anomaly theory- an isolated case from mechanical theory. Vertebral body anomalies, body grafts, not arch grafts due to incorrect biomechanisms stimulate overload of the vertebral disc and cause bone tissue destruction.
These theories have the right to exist, but none of them are 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 muscle responses.
- Dynamic factors:the greater and longer the load on the spine, the longer it is subjected to trauma (people exposed to long-term forced positions; constant lifting of heavy objects).
- Dysmetabolic factors: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 aluminum and iron alloys has adverse effects on the human body. When preparing food, microparticles enter the gastrointestinal tract, and since they also contain lead, this metal accumulates in the body, intoxication expressed by neuroosteofibrosis (damaged changes in the tissue at the junction of tendons and muscles).
- Genetic factor.Everyone has an individual level of flexibility, which is directly correlated to the ratio of fibers in the connective tissue (collagen and elastin) and is genetically inherited. Despite all the above, there is a norm in the fiber ratio; deviation leads to faster wear on the spinal column.
- Biomechanical factors– non-physiological movement of the articular surface of the spine. This is due to muscle atrophy (clinical symptoms are pain that appears when bending and twisting).
- Aseptic-inflammatory factor– usually a rapid inflammatory process in the intervertebral disc. Micro defects are formed in the spine due to malnutrition of the spinal discs. 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 continuous or periodic, painful or acute, often it is intensified by sudden movements and physical activity.
Osteochondrosis is a common disease among athletes. It arises from a discrepancy between physiological ability and motor load, which contributes to microtrauma and wear of spinal tissue.
Localization of symptoms depends largely on the part of the spine where the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is localized in several parts, then this condition is called mixed osteochondrosis.
| Types of osteochondrosis | cervix | chest | Lumbosacral | mixed |
|---|---|---|---|---|
| Clinical picture |
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stable pain or spreading to all parts of the spine. |
| Complications |
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compressive myelopathy (spinal cord compression by various neoplasms). |
all possible complications with cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| level | First | Second | Third | Fourth |
|---|---|---|---|---|
| Changes in the spine |
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Breakage and displacement of the spinal disc with the immersion of other surrounding elements into its cavity, which provokes the development of local inflammatory symptoms. | Destruction of other elements of the intervertebral articulation, pathological arrangement of the articular surface, marginal bone growth. |
| Patient complaints | Absent or showing discomfort when 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 heart area and only from there radiates (spreads) to the neck, lower jaw, and arms. The disease begins for no reason or after physical activity with the appearance of compressive pain that is not associated with movement in the spine. After half an hour, the pain reaches its maximum, the person experiences shortness of breath and fear of death. Diagnosis is confirmed by electrocardiogram (ECG) and markers of myocardial necrosis.
- Subarachnoid hemorrhage(bleeding between the arachnoid and the pia mater of the brain). In some cases, due to the toxic effect of blood spilled on the spinal roots, severe pain in the spine may occur. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- Abnormalities of the spine.Minimal examination: radiography of the skull and cervical spine in frontal and lateral projections. The most common spinal anomalies are: fusion of the atlas (first cervical vertebra) with the occipital bone, indentation of the edge of the occipital foramen into the cranial cavity, fusion of the vertebrae, changes in the shape and size of the vertebrae.
- Cervical lymphadenitismay also be accompanied by neck pain, sometimes worsened by bending and twisting. Making a diagnosis is not difficult: enlarged and painful lymph nodes; a history of frequent sore throats.
- Multiple myeloma.Pain in the spine occurs gradually, against the background of progressive weight loss and periodic fever. The main laboratory sign is protein in the urine.
- Tumors or metastases in the spine.Evidence in favor of a malignant neoplasm is: progressive weight loss, laboratory changes, as well as ultrasound of the source of metastasis - kidney, lung, stomach, thyroid gland, prostate.
- Rheumatic polyarthritis and infectious allergiesdistinguished by medical history, moderately elevated body temperature, and major damage to large joints.
- Depression in a mask.Patients "impose" non-existent pathology (in this context, symptoms of osteochondrosis), attempts to explain to them the essence of what is happening run into a wall of misunderstanding. Signs of masked depression are: decreased mood, concentration, and performance; sleep and appetite disturbances; suicidal thoughts and actions.
- Peptic ulcer of the stomach and duodenum, pancreatitis and cholecystitisdiagnosed using the connection 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
- Often, the patient complains to a neurologist, who collects the anamnesis of the patient's life and illness and conducts a neurological examination. A neurologist examines the spine in three options (standing, sitting and lying down). When examining the back, pay particular attention to posture, the lower angle of the shoulder blade, the crest of the iliac bone, the position of the shoulder girdle, and the expression of the back muscles. During palpation, deformation, pain, and muscle tension are determined.
- When establishing the diagnosis of osteochondrosis, additional consultation with a specialist is required to exclude pathology with similar symptoms (cardiologist, therapist, rheumatologist).
- Carry out mandatory laboratory tests (general blood test, general urinalysis, biochemical blood test).
- Validating the study is important:
radiography of the spine in two projections – the easiest method to identify changes in the spinal column (narrowing the gap between the vertebrae);Depending on the level, various changes can be seen on radiographs:
Degree First Second Third Fourth X-ray sign No radiological signs. Changes in the height of the intervertebral disc. Protrusion (bulging into the spinal canal) of the intervertebral disc 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) – used not only to identify changes in the spine, but also to determine pathology in other organs;USDG MAG (Doppler Ultrasound of the main artery of the head) – ultrasound examination of the circulatory system of the head and neck, which allows you to diagnose the level of changes in blood vessels as early as possible.
What are the treatment methods available for osteochondrosis?
Drug therapyshould 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 done with the help of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Treatment with NSAIDs should be as short as possible; 5-7 days is enough to relieve the pain. If the pain is not well controlled and a constant dose of medication for pain relief is needed, you can take a selective COX-2 inhibitor.
- Antispasmodics reduce pain and relieve muscle spasms.
- Transcutaneous method relieves pain: ointment, the active ingredient is NSAID; anesthetic cream; application with anti-inflammatory and analgesic drugs; Corticosteroids are added for greater effect.
- Treatment aims to regenerate inflamed or compressed nerves, as well as improve 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 the formation of bone matrix and reducing the destruction of joints. The best composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.
Non-drug treatment methods:
Neuroorthopedic measures. An important point in the treatment of osteochondrosis is adherence to a rational regimen of physical activity. Staying in bed for a long time and the minimum amount of physical activity not only does not benefit the spine, but also leads to permanent symptoms - back pain.Therapeutic exercise (physical therapy) 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 muscle corset.To prevent falls, improve movement coordination and function vestibular devices (relevant for elderly patients), balancing discs, platforms, and pathways are used in exercise therapy.
Manual therapy with severe pain in the neck. 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 some contraindications for this type of treatment, which are relevant for osteochondrosis - massive osteophytes (pathological growths on the surface of bone tissue), which are formed at the 4th stage of the development of this pathology.Physiotherapy procedures in the acute period: - ultrasound;
- phonophoresis;
- ultraviolet irradiation;
- impulsive current;
- neuroelectric stimulation.
Physiotherapy procedures in the subacute period: - electrophoresis;
- magnetotherapy.
massage Of all types, a shallow, relaxing massage with rubbing elements is used. As soon as the symptoms of pain are relieved with the help of massage, they smoothly move to more intense rubbing elements. When mastering acupressure (local) massage techniques, preference is given to this type.The issue of surgical intervention is decided strictly individually, depending on the signs and condition of the patient.
Preventive measures
- Efficient selection of furniture (especially in the workplace). A work chair consists of a flat and compact back. Beds include mattresses with medium hardness, pillows with medium softness (if possible, orthopedic mattresses and pillows).
- Correction of vision, posture, bite.
- Rational selection of shoes (especially important for drivers). The maximum heel size is 5 cm.
- Wearing a belt, bandage or corset while working.
- Movement correction: avoid bending and twisting, lift weights with a straight back and legs bent at the knees.
- Change your body position more often: don't stand or sit for long.
- Proper nutrition: limit the amount of sweet, salty, fatty, spicy foods. The most dangerous food for bones is white sugar, because it dissolves calcium from bone tissue. The diet should include fruits, berries, vegetables, eggs, nuts, meat, kidney, liver, fish, legumes, and dairy products.
- Protect yourself from sudden changes in temperature; hot water in bathtubs, saunas, swimming pools, etc. very dangerous, because it relaxes the back muscles and even small injuries in this situation are not felt, but lead to tragic consequences for the spine, and also in general for the musculoskeletal system.
- Water procedures are not only preventive measures, but also therapeutic. Swimming combines stretching and muscle relaxation.
- Treatment of chronic diseases.
- Active and regular vacation.
Examples of effective exercises to prevent cervical osteochondrosis, which can be done at work:
- sitting on a chair, looking ahead. The brush covers and supports the lower jaw. Pressing your head forward and down through the resistance (tension phase); relax and stretch the neck muscles, slowly move your head back (relaxation phase);
- sitting on a chair, looking ahead. The right palm is on the right cheek. Slowly tilt our head to the left, try to touch our 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, to the right shoulder;
- sitting on a chair, looking ahead. Hands are on your knees. We tilt our head to the right, hold for 5-7 seconds, and slowly return to the starting position. Then we tilt our head to the left and, with that, do the same thing.
Conclusion
The high frequency and social importance of osteochondrosis determines the scientific interest in this problem. This disease not only affects older people, but is increasingly occurring among young people, which attracts the attention of neurologists, neurosurgeons, orthopedic traumatologists and other specialists. Timely diagnosis and adequate treatment of this pathology ensure social adjustment and future quality of life.