Spinal osteochondrosis is a complex of dystrophic and degenerative changes in the intervertebral discs and adjacent surfaces of the vertebral bodies accompanied by tissue destruction and disruption of their structure. Depending on the degree of damage, cervical, thoracic and lumbar osteochondrosis can be distinguished.
Symptoms
The main signs by which the presence of cervical osteochondrosis can be assumed is a local change in the configuration of one of the segments of the spine (development of lordosis, kyphosis or scoliosis) - a clear visual curvature of the spine. in the longitudinal or transverse plane. The second most common symptom is pain syndrome, which can be localized not only in the vertebral region, but can also be given to areas of the body innervated by the corresponding nerve root. Another complaint of these patients is the feeling of restlessness and feeling of fatigue in the neck.
With osteochondrosis of the cervix, the pain, as a rule, manifests itself in the neck area and can be given to the shoulder and scapula, can be confused with pain in myocardial infarction, as there are similar symptoms. Also, cervical osteochondrosis can be accompanied by frequent headaches, dizziness. When the arteries that supply the brain are congested, there may be signs of a brain dysfunction (neurological symptoms): fainting, nausea, tinnitus, mood swings, anxiety, and more.
According to the severity of the pain, they are divided into 3 degrees:
- The pain appears only with pronounced movements in the spine;
- The pain is relieved by a certain position of the spine;
- The pain is permanent.
shape
Depending on the syndromes caused by osteochondrosis, there are:
- Compression syndromes - occur by compression (radiculopathy - compression of nerve roots, myelopathy - compression of muscles, neurovascular - compression of blood vessels and nerves);
- Reflex (muscular-tonic, neurodystrophic, neurovascular);
- Myoadaptive syndrome (excessive straining of healthy muscles when they take over the functions of the affected muscles).
Causes
The mechanism of disease development is damage to the intervertebral disc for various reasons and its displacement with the loss of cushioning (relaxing pressure) functions 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 strenuous physical exertion on the spine - for example, overweight.
An important role in the development of osteochondrosis plays a sedentary lifestyle, in which a violation of blood supply and functioning of the intervertebral joints develops. The mechanism of disease development is as follows: if the fibrous ring connecting the vertebral bodies is damaged, the intervertebral disc is pushed back and forth - in the lumen of the spinal canal, or sideways - with the formation of the middle and lateral disc. herniet. The disc can be pushed into the body of the vertebra itself with the formation of Schmorl's hernia - microscopic fracture of the cartilaginous tissue of the intervertebral disc into the spongy tissue of the vertebral bone. In the case of a posterior disc displacement, compression of the spinal cord and the roots extending from it is possible, with the development of a typical pain syndrome.
Diagnosing
The diagnosis of osteochondrosis of the spine is made on the basis of complaints, anamnesis data, clinical examination and instrumental examination methods. Diagnostic measures are to find the reasons that led to the development of neurological symptoms.
From the anamnesis, it is possible to detect the presence of an injury, the nature of the work - constant physical overload (lifting weights), poor posture, work characteristics and the position of the spine on the table and while walking; the presence of infections.
General clinical studies (clinical blood test, general urine analysis), biochemical blood analysis have no independent value. They are prescribed to assess the current condition, to diagnose the underlying disease and the complications that appear.
Diagnosis is based on the clinical picture of the disease and is performed by the method of sequential exclusion of similar diseases in clinical signs. Of the instrumental diagnostic methods, the most common and available is X-ray examination (spondylography is a non-contrast study). It reflects the narrowing of the intervertebral joint spaces and allows you to identify osteophytes (bone growth) in the vertebral bodies, but provides only indirect information about the degree of damage to the intervertebral discs.
An accurate diagnosis can be established by CT imaging and MRI (computerized imaging and magnetic resonance imaging), even at an early stage of the disease. CT allows you to determine the minimum abnormalities in bone and cartilage tissue, MRI - to perform detailing of soft tissue structures and to determine the location of the disc herniation.
Duplex ultrasound scan of the cerebral arteries is performed if there is a suspicion of a violation of the blood supply to the brain.
Differential diagnosis is made with diseases that have similar clinical manifestations: pathologies that continue with pain radiating to the shoulder and scapular region (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - an increase in the lymph nodes of the cervix, 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 region of the cervix; tuberculous spondylitis - an inflammatory disease of the spine caused by mycobacterium tuberculosis; arachnoid cyst; pseudocysts of dura mater; spinal abnormalities; Fibromyalgia is a disease that causes pain in the muscles, ligaments and tendons, thoracic compression syndrome - a disorder caused by excessive pressure on the neurovascular bundle that passes between the muscles of the anterior and middle scales, above the first rib, andbelow the clavicle, the myofascial muscle of the neck. shoulder syndrome and girdle - a chronic, pathological condition caused by the formation of local spasms of muscles or seals, represented by pain points.
Main laboratory tests used:
- Clinical blood test;
- Blood chemistry.
Main instrumental studies used:
- X-ray of the spine (spondylography);
- Magnetic resonance imaging (MRI);
- Computed tomography (CT);
- Duplex ultrasound scan of the cerebral arteries (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 spinal osteochondrosis depends entirely on the stage and degree of development of osteochondrosis. In the initial stage, it is possible to use preventive measures, physiotherapy exercises, exercises in simulators and fitness. With severe pain syndrome, the patient needs physical rest. Anti-inflammatory and antispasmodic drugs are prescribed. Paravertebral blockades can be performed with anesthetics to open the pathological circle, when the pain causes muscle spasm, while the intervertebral disc compresses more strongly, which, in turn, increases the pain itself.
Warming ointments are applied topically to the skin of the vertebral region to improve the local blood supply and reduce tissue edema. These patients are shown wearing corsets. In patients with early-stage osteochondrosis, chondroprotectors are effective - drugs that improve cartilage tissue restoration, as well as drugs that improve local blood supply, venotonics, B vitamins. In cases where pain syndrome is not medically stopped fora long time and there is a clinic of compression of the spinal cord root with intervertebral hernia, surgical removal of the damaged intervertebral disc is indicated. In cases of total compression of the spinal cord by a disc, an early operation is indicated.
You do not have to wait until a person starts urinating or defecating spontaneously - in this case, the spinal cord injury may already be irreversible. As physiotherapeutic procedures, magnetotherapy, ultrasound, massage, manual therapy, acupuncture and physiotherapy exercises are described.
Complications
Possible vegetative-vascular dystonia and heart disorder, cerebrovascular accident, hypotension and hypertension (decrease and increase in blood pressure), vestibular disorders (impaired coordination of movements), vertebral artery syndrome (disease caused by narrowing of the artery), periarthrosis (a disease with impaired mobility) shoulder joint.
Prophylaxis
To prevent osteochondrosis, it is necessary to deal with the factors that cause it, namely: avoiding spinal injuries, stress on the spine (lifting weights) 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 exercises to help relieve symptoms?
What medications will help to cope with osteochondrosis of the cervical spine?
What will happen if you do not start treatment on time?
Patient advice
Exercise, weight loss in the presence of excess weight, use of cold or warm compresses help to alleviate the symptoms of thoracic spine osteochondrosis. It is also important to eat properly, monitor your spine, treat chronic diseases and avoid injuries.