Osteochondrosis of the spine is a complex of dystrophic and degenerative changes in the intervertebral discs and adjacent surfaces of the vertebral bodies associated with the destruction of tissues and the disruption of their structure. Depending on the level of damage, cervical, thoracic and lumbar osteochondrosis can be distinguished.
Symptoms
The main signs by which the presence of osteochondrosis of the cervical spine can be assumed is a local change in the configuration of one of the segments of the spine (the development of lordosis, kyphosis or scoliosis) - a clear visual curvature of the spine in the longitudinal plane or transversal. The second most common symptom is pain syndrome, which can be localized not only in the region of the vertebra, but also in areas of the body innervated by the corresponding nerve root. Another complaint of these patients is a feeling of discomfort and a feeling of fatigue in the neck.
With cervical osteochondrosis, pain, as a rule, occurs in the neck area and can be administered to the shoulder and scapula, can be confused with pain in myocardial infarction, as it has similar symptoms. Also, cervical osteochondrosis can be accompanied by frequent headaches, dizziness. When the arteries that feed the brain are compressed (squeezed), there may be signs of brain malfunction (neurological symptoms): fainting, nausea, tinnitus, mood swings, anxiety, and others.
According to the severity of pain, they are divided into 3 degrees:
- Pain occurs only with pronounced movements in the spine;
- The pain is relieved by a certain position of the spine;
- The pain is permanent.
Shapes
Depending on the syndromes caused in osteochondrosis, there are:
- Compression syndromes - occur with compression (radiculopathy - compression of the nerve roots, myelopathy - muscle compression, neurovascular - compression of blood vessels and nerves);
- Reflex (muscular-tonic, neurodystrophic, neurovascular);
- Myadactive syndrome (overexertion of healthy muscles when they assume the functions of the affected muscles).
causes
The mechanism of development of the disease is damage to the intervertebral disc due to various reasons and its displacement with the loss of the depreciation functions (attenuating pressure) of the spine. The immediate cause of disc damage can be age-related degenerative changes associated with impaired blood supply to the intervertebral discs, mechanical damage from injury and severe physical strain on the spine, for example, with overweight.
An important role in the development of osteochondrosis is played by a sedentary lifestyle, in which a violation of the blood supply and the functioning of the intervertebral joints develops. The mechanism of development of the disease is as follows: if the fibrous ring connecting the vertebral bodies is damaged, the intervertebral disc is pushed back and forth - into the lumen of the spinal canal or laterally - with the formation of the median disc and lateral hernias. The disc can be pushed into the body of the vertebra itself with the formation of Schmorl's hernia - microscopic ruptures of the cartilage tissue of the intervertebral disc in the spongy tissue of the vertebral bone. In the case of a posterior displacement of the disc, compression of the spinal cord and the roots extending from it is possible, with the development of a typical pain syndrome.
Diagnostics
Diagnosis of osteochondrosis of the spine is made on the basis of complaints, anamnesis data, clinical examination and methods of instrumental examination. Diagnostic measures serve to find out the reasons that led to the development of neurological symptoms.
From the anamnesis, it is possible to find out the presence of an injury, the nature of the work - constant physical overload (weight lifting), poor posture, peculiarities of work and position of the spine at the table and while walking, the presence of infections.
General clinical studies (clinical blood test, general urinalysis), biochemical blood tests have no independent value. They are prescribed to assess the current state, diagnose the underlying disease and emerging complications.
Diagnosis is based on the clinical picture of the disease and is carried out by the method of sequential exclusion of similar diseases in clinical signs. Among the instrumental diagnostic methods, the most common and available is X-ray examination (spondylography is a study without contrast). It reflects the narrowing of the intervertebral joint spaces and makes it possible to identify osteophytes (bone growths) on the vertebral bodies, but provides only indirect information on the degree of damage to the intervertebral discs.
Accurate diagnosis can be made using CT and MRI (magnetic resonance and computerized resonance) imaging, even at an early stage of the disease. CT allows you to determine the slightest abnormalities in bone and cartilage tissues, MRI - to perform the details of soft tissue structures and determine the localization of the herniated disc.
Duplex ultrasound of the cerebral arteries is performed if a violation of the blood supply to the brain is suspected.
Differential diagnosis is carried out with diseases that have similar clinical manifestations: pathologies that proceed with pain that radiates to the shoulder and scapular region (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - an increase in cervical lymph nodes, rheumatoid arthritis; oncological diseases (tumors of the vertebrae, roots, spinal cord and membranes), tumors of the pharynx and pharyngeal space, pancost cancer (compression of the brachial plexus in cancer of the upper lobe of the lung), metastases in the cervical region; tuberculous spondylitis - an inflammatory disease of the spine caused by mycobacterium tuberculosis; arachnoid cysts; dura mater pseudocysts; spinal anomalies; fibromyalgia is a disease that causes pain in muscles, ligaments and tendons, chest outlet compression syndrome - a disorder caused by excessive pressure on the neurovascular bundle that passes between the anterior and middle scalene muscles, above the first rib and below the clavicle, myofascial muscle of the neck syndrome and shoulder girdle - a chronic pathological condition caused by the formation of local muscle spasms or seals, represented by sore spots.
The main laboratory tests used:
- clinical blood test;
- Blood chemistry.
The main instrumental studies used:
- X-ray of the spine (spondylography);
- Magnetic resonance imaging (MRI);
- computed tomography (CT);
- Duplex ultrasound scan of the arteries of the brain (if a violation of the blood supply to the brain is suspected).
Additional instrumental studies used:
- Densitometry - measurement of bone density (according to indications).
Treatment
Treatment of osteochondrosis of the spine depends entirely on the stage and degree of development of osteochondrosis. At the initial stage, preventive measures, physiotherapy exercises, exercises on simulators and fitness can be used. With severe pain syndrome, the patient needs physical rest. Anti-inflammatory and antispasmodic drugs are prescribed. It is possible to perform paravertebral blocks with anesthetics to open the pathological circulation, when pain causes muscle spasm, while the intervertebral disc is compressed more strongly, which, in turn, increases the pain itself.
Warming ointments are applied topically to the skin in the vertebral region to improve local blood supply and reduce tissue edema. These patients are shown wearing a corset. In patients with the initial stage of development of osteochondrosis, chondroprotectors are effective: drugs that improve the restoration of cartilage tissue, as well as drugs that improve local blood supply, venotonics, vitamins of group B. In cases where the syndrome of pain does not stop doctor for a long time and there is a spinal cord root compression clinic with intervertebral hernia, surgical removal of the damaged intervertebral disc is shown. In the case of total compression of the spinal cord by a disc, early surgery is indicated.
You shouldn't wait for a person to start urinating or defecating spontaneously - in this case, the damage to the spinal cord may already be irreversible. As physiotherapeutic procedures, magnetotherapy, ultrasound, massage, manual therapy, acupuncture and physiotherapy exercises are prescribed.
complications
Possible vegetative-vascular dystonia and disruption of the heart, cerebrovascular accident, hypotension and hypertension (decrease and increase in blood pressure), vestibular disturbances (impaired coordination of movements), vertebral artery syndrome (a disease caused by narrowing of the vertebral artery) , periarthrosis (a disease with reduced mobility) of the shoulder joint.
Prophylaxis
For the prevention of osteochondrosis, it is necessary to address the factors that cause it, namely: avoiding spinal injuries, stress on the spine (weight lifting) and fighting overweight. For people who already suffer from the initial stage of osteochondrosis, it is recommended to wear corsets at home and during physical exertion. In order for the spine to rest during sleep, it is recommended to sleep on orthopedic mattresses and pillows.
What questions should you ask your doctor?
Are there any exercises to relieve symptoms?
What drugs will help to cope with osteochondrosis of the cervical spine?
What will happen if you don't start treating the disease in time?
Advice for the patient
Exercise, weight loss in the presence of excess weight, the use of cold or hot compresses help relieve the symptoms of osteochondrosis of the thoracic spine. It is also important to eat right, monitor the spine, treat chronic conditions, and avoid injury.