The spine is a unique biokinematic system; it is capable of bearing loads without damage, but, like any structure, it wears out over time. At a young age, a stable state is maintained thanks to rapid regenerative capabilities, but after 50 years, their supply gradually fades away, which leads to the formation of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spinal column, which, as it progresses, spreads to nearby structures of the spinal segment.
Development theories
The etiology of osteochondrosis is unknown. Currently existing theories of the development of this disease:
- Metabolic.Changes in the metabolism of the vertebral disc due to its 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 earlier development is possible due to injuries, metabolic disorders, infections).
These theories are sometimes combined into one - involution, which is based on a violation of trophism, especially in those tissues in which there are no vessels. In childhood, there is a vascular network in the intervertebral discs, but after the complete formation of the spine's architecture, this network is closed by connective tissue.
- Hormonal theorymore controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is inappropriate to refer only to hormone levels. This theory is most relevant for postmenopausal women.
- Mechanical theorytalks about the connection between the occurrence of osteochondrosis and overload of certain parts of the spine.
- Anomaly theory- an isolated case from mechanical theory. Anomalies of the vertebral bodies, fusion of the bodies, non-fusion of the arch due to improper biomechanism stimulate overload of the vertebral discs and cause destruction of bone tissue.
These theories have a right to exist, but none of them is universal. It is more correct to call osteochondrosis a multifactorial disease, which is characterized by genetic predisposition and provoking factors.
Factors contributing to the development of the disease
- Gravity factor:for the spine, any non-physiological displacement is nothing more than a trigger for many muscle reactions.
- Dynamic factor: the greater and longer the load on the spine, the more and longer it is subject to trauma (persons prone to forced long-term positions; constant lifting of heavy objects).
- Dysmetabolic factor:insufficient nutrition of the spinal column due to autoimmune disorders, toxic effects.
It is known that eating food from aluminum dishes leads to its accumulation in the bones, which will subsequently contribute to the formation of osteochondrosis. Eating food from dishes made of an alloy of aluminum and iron has an adverse effect 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 with which is expressed by neuroosteofibrosis (defective changes in tissue at the junction of the tendon and muscle).
- Genetic factor.Each person has an individual level of flexibility, which directly correlates with the ratio of fibers in the connective tissue (collagen and elastin) and is inherited genetically. Despite all of the above, there are norms in the ratio of fibers; deviations lead to faster wear of the spinal column.
- Biomechanical factor– non-physiological movements in the articular surface of the spine. This is caused by muscle atrophy (the clinical symptom is pain that appears when bending and turning).
- Aseptic-inflammatory factor– most often a rapid inflammatory process in the intervertebral discs. Microdefects form in the spine due to malnutrition of the spinal disc. In these microdefects, areas of dead tissue are formed.
Symptoms of osteochondrosis of the spinal column
The main symptom of osteochondrosis is back pain, which can be constant or periodic, aching or acute, most often it intensifies with sudden movements and physical activity.
Osteochondrosis is a common disease among athletes. It arises from a discrepancy between physiological capabilities and motor loads, which contribute to microtrauma and wear of spinal tissue.
The localization of symptoms depends largely on the part of the spine in which the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is localized in several parts, then this condition is called mixed osteochondrosis.
| Type of osteochondrosis | Cervical | Chest | Lumbosacral | Mixed |
|---|---|---|---|---|
| Clinical picture |
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the pain is stable or spreading to all parts of the spine. |
| Complications |
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compression myelopathy (compression of the spinal cord by various neoplasms). |
all complications that are possible with cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| Stages | First | Second | Third | Fourth |
|---|---|---|---|---|
| Changes in the spine |
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Rupture and displacement of the spinal disc with immersion of other surrounding elements into its cavity, which provokes the development of local symptoms of inflammation. | Destruction of other elements of the intervertebral articulation, pathological arrangement of articular surfaces, marginal bone growths. |
| Patient complaints | Absent or indicate discomfort when staying 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, depends on the location. | Constant pain throughout the spine. |
Differential diagnosis
- Acute myocardial infarction.The pain is concentrated in the area of the heart and only from there radiates (spreads) to the neck, lower jaw, and arm. The disease begins for no reason or after physical activity with the appearance of compressive pain not associated with movement in the spine. After half an hour, the pain reaches its maximum, the person develops shortness of breath and fear of death. The diagnosis is confirmed by an electrocardiogram (ECG) and markers of myocardial necrosis.
- Subarachnoid hemorrhage(hemorrhage between the arachnoid and pia mater of the brain). In some cases, due to the toxic effect of spilled blood on the spinal roots, severe pain in the spine may occur. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- Spinal abnormalities.Minimum examination: radiography of the skull and cervical spine in frontal and lateral projections. The most common anomalies of the spine are: fusion of the atlas (the first cervical vertebra) with the occipital bone, depression of the edges 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 aggravated by bending and turning. Making a diagnosis is not difficult: enlarged, painful lymph nodes; 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.
- Tumor or metastases in the spine.Evidence in favor of a malignant neoplasm is: progressive loss of body weight, laboratory changes, as well as ultrasound of the sources of metastasis - kidneys, lungs, stomach, thyroid gland, prostate.
- Rheumatic and infectious-allergic polyarthritisdifferentiated by medical history, moderately elevated body temperature, and predominant damage to large joints.
- Masked depression. Patients "impose" non-existent pathologies (in this context, symptoms of osteochondrosis), an attempt to explain to them the essence of what is happening runs 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 cholecystitisare diagnosed using the connection of pain with food intake, laboratory tests (FGDS, general blood test, biochemical blood test, activity of pancreatic enzymes, ultrasound examination of the abdominal organs).
Diagnosis of osteochondrosis
- Most often, a patient complains to a neurologist, who collects an 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). When examining the back, pay special attention to posture, the lower angles of the shoulder blades, the crests of the iliac bones, the position of the shoulder girdles, and the expression of the back muscles. During palpation, deformation, pain, and muscle tension are determined.
- When establishing a diagnosis of osteochondrosis, additional consultation with specialized specialists is necessary to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Conducting mandatory laboratory tests (general blood test, general urinalysis, biochemical blood test).
- Confirming studies are instrumental:
- radiography of the spine in two projections– the simplest method for identifying changes in the spinal column (narrowing of the gap between the vertebrae);
Depending on the degree, various changes are visible on radiographs:
Degree First Second Third Fourth X-ray signs No radiological signs. Changes in the height of intervertebral discs. Protrusion (bulging into the spinal canal) of intervertebral discs or even prolapse (loss). Formation of osteophytes (marginal bone growths) 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 pathologies in other organs;
- USDG MAG (Ultrasound Dopplerography of the main arteries of the head)– ultrasound examination of the circulatory system of the head and neck, which allows you to diagnose the degree of changes in the blood vessels as early as possible.
- radiography of the spine in two projections– the simplest method for identifying changes in the spinal column (narrowing of the gap between the vertebrae);
What treatment methods are there for osteochondrosis?
Drug therapyshould be strictly individual and differentiated, the prescription of drugs is carried out by a doctor after diagnosis.
The main drugs used in the treatment of osteochondrosis:
- Pain relief is carried out with the help of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). Treatment with NSAIDs should be as short as possible; 5-7 days are enough to relieve pain. If the pain is poorly controlled and a constant dose of drugs that relieve pain is needed, you can take selective COX-2 inhibitors.
- Antispasmodics reduce pain and relieve muscle spasms.
- Transcutaneous method of pain relief: ointment, the active ingredient of which is an NSAID; anesthetic cream; applications with anti-inflammatory and analgesic drugs; corticosteroids are added for greater effect.
- Treatment intended to regenerate an inflamed or compressed nerve, as well as to 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 cartilage tissue framework, thereby increasing the formation of bone matrix and reducing joint destruction. The most favorable 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 a minimal amount of physical activity not only does not benefit the spine, but also leads to a permanent symptom - back pain.
Therapeutic exercise (physical therapy)is prescribed when the patient is in satisfactory condition (especially during the period when signs of the disease are decreasing), the main goal is to strengthen the muscle corset.
To prevent falls, improve coordination of movements and the functioning of the vestibular apparatus (relevant for elderly patients), balancing discs, platforms, and paths are used in exercise therapy.
Manual therapywith 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 pathological tension of the paravertebral muscles. Do not forget about a number of contraindications for this type of treatment, which are relevant for osteochondrosis - massive osteophytes (pathological growths on the surface of bone tissue), which form at the 4th stage of development of this pathology.
Physiotherapeutic procedures in the acute period:
- ultrasound;
- phonophoresis;
- ultraviolet irradiation;
- impulsive currents;
- neuroelectric stimulation.
Physiotherapeutic procedures in the subacute period:
- electrophoresis;
- magnetotherapy.
Massage.Of all types, a superficial, relaxing massage with elements of rubbing is used. As soon as the pain symptom is relieved with the help of massage, they smoothly move on to more intense elements of rubbing. When mastering the technique of acupressure (local) massage, preference is given to this type.
The issue of surgical interventions is decided strictly individually, depending on the indications and the patient’s condition.
Preventive actions
- Competent selection of furniture (especially in the workplace). The work chair consists of a flat and solid back. The bed includes a mattress of moderate hardness, a pillow of medium softness (if possible, an orthopedic mattress and pillow).
- Correction of vision, posture, bite.
- Rational selection of shoes (especially important for drivers). The maximum heel size is 5 cm.
- Wearing a fixing belt, bandage or corset while working.
- Correction of movements: avoid bending and turning, lift weights with a straight back and legs bent at the knees.
- Change body positions more often: do not stand or sit for a long time.
- Proper nutrition: limit the amount of sweet, salty, fatty, spicy foods. The most dangerous food for bones is white sugar, as it leaches calcium from bone tissue. The diet should include fruits, berries, vegetables, eggs, nuts, meat, kidneys, liver, fish, legumes, and dairy products.
- Protect yourself from sudden changes in temperature; hot water in a bath, sauna, swimming pool, etc. is especially dangerous, since it relaxes the back muscles and even a small injury in this state is not felt, but leads to tragic consequences for the spinal column, and even inin general for the musculoskeletal system.
- Water procedures are not only a preventive measure, but also a therapeutic one. Swimming combines stretching and relaxation of muscles.
- Treatment of chronic diseases.
- Active and regular vacation.
Examples of effective exercises to prevent cervical osteochondrosis, which can be performed right at the workplace:
- sitting on a chair, looking ahead. The brush covers and supports the lower jaw. Pressing your head forward and down through resistance (tension phase); relaxing and stretching 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. 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 it for 5-7 seconds, and very slowly return to the starting position. Then we tilt our head to the left and, accordingly, do the same.
Conclusion
The high frequency and social significance of osteochondrosis determines scientific interest in this problem. The disease affects not only 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 ensures social adaptation and quality of future life.