The osteochondrosis of the spine is a chronic disease in which degenerative changes occur in the vertebrae and intervertebral discs located with each other.Depending on the place of the damage to the spine, they distinguish: osteochondosis of the cervical region, osteochondosis of the thoracic and osteochondous region of the lumbar region.To diagnose osteochondrosis of the spine, it is necessary to conduct the X -ray and, in the case of its complications (for example, hernia of the intervertebral disc) - magnetic resonance imaging of the spine.In the treatment of osteochondosis of the spine, together with pharmacological methods, it is widely used, reflexology, massage, manual therapy, physiotherapy and physiotherapy exercises.
Etiology and pathogenesis
In a certain degree or in the other, the osteochondosis of the spine develops in all aged people and is one of the body aging processes.Previous or subsequent, atrophic changes occur in the intervertebral disc, however, injuries, diseases and various overloads of the spine contribute to the previous occurrence of osteochondosis.The most common osteochondosis of the cervical region and the osteochondosis of the lumbar column.
About 10 osteocondrosis theories have been developed: vascular, hormonal, mechanical, hereditary, infectious allergic and others.But none of them provides a complete explanation of the changes that take place in the spine, rather are complementary to each other.
The main point is believed in the occurrence of the osteocondrosis is the constant overload of the vertebral motor segment consisting of two adjacent vertebrae.This overload can occur due to a stereotype of the engine: posture, an individual way of sitting and walking.The poster disorders, sitting in the wrong laying, walking with an irregular spine cause an additional load on discs, ligaments and muscles of the spine.The process can worsen due to the characteristics of the structure of the spine and the insufficiency of the trophism of its tissues due to hereditary factors.Very often, the defects in the structure are found in the cervical region and lead to vascular disorders and the early aspect of signs of osteochondrosis of the cervical column.
The presence of osteochondosis of the lumbar region is more often associated with its overload during inclinations and gravity systems.A healthy intervertebral disc can resist significant loads due to the hydrophilia of the octopus nucleus located in its center.The nucleus contains a large amount of water and the fluids, as you know, are little compressed.The rupture of a healthy intervertebral disc can occur with a compression of over 500 kg, while the disc has changed due to the osteocondrosis is torn with a compression of 200 kg.A load of 200 kg is experiencing a lumbar of the spine of a person weighing 70 kg, when it holds a load of 15 kilograms in the body's inclination position in view of 200. Support so large is due to the low size of the nucleus of the pulp.With an increase in inclination to 700, the load on the intervertebral discs will be 489 kg.Therefore, the first clinical manifestations of osteochondosis of the lumbar column during or after weight lifting, performing housework, deserted in the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, ligaments and capsules of the faceted joints causes the reaction of the immune system and the development of the aseptic inflammation with the swelling of the joints of the facet and the surrounding tissues.Due to the movement of the vertebral bodies, the capsules of the faceted joints are elongated and the altered intervertebral disc is not so firmly fixed by the bodies of the nearby vertebrae.The instability of the spinal segment is formed.Due to instability, the violation of the spinal nerve with the development of the root syndrome is possible.With osteochondrosis of the cervical column, this often occurs during the curves of the head, with osteochondosis of the lumbar region - during the inclination of the body.It is possible to form a functional block of the vertebral engine segment.It is due to the reduction in the compensation of the vertebral muscles.
The hernia of the intervertebral disc is formed when the disc moves back, the breakdown of the rear longitudinal ligament and the protrusion of the disc in the spinal canal occurs.If at the same time the core of the disc is crushed in the cerebrospinal channel, then this hernia is called to explode.The severity and duration of pain with such hernia are much larger than inexplicated.The hernia of the disc can cause root syndrome or compression of the spinal cord.
With osteochondrosis, the growth of bone tissue occurs with the formation of osteophytes: external for bones on the bodies and processes of the vertebrae.Osteophytes can also cause spinal cord compression or cause the development of root syndrome.
Symptoms of osteochondosis of the spine
The main symptom of osteochondosis of the spine is pain.The pain can be acute with high intensity, it intensifies with the slightest movement in the segment concerned and therefore causes the patient to take a forced position.So, with the osteochondrosis of the cervical column, the patient holds his head in the less painful pose and cannot turn it, with osteochondrosis of the thoracic region, the pain also increases with deep breathing and with the osteochondosis of the lumbar region is difficult to sit, get up and walk.This pain syndrome is characteristic of compressing the spinal spine.
In about 80% of cases, there is a boring pain of constant nature and moderate intensity.In such cases, after the examination, the doctor must differentiate the manifestations of the osteocondrosis of the spine from the myosite of the back muscles.The stupid pain in the osteocondrosis is due to excessive muscle tension, maintaining the vertebral motor segment concerned, inflammatory changes or significant stretching of the intervertebral disc.In patients with such pain, a forced position is absent, but the restriction of movements and physical activity is revealed.Patients with osteochondrosis of the cervical column avoid acute curves and inclinations with the head, with osteochondrosis of the lumbar region: they sit slowly and get up, avoid tilt the body.
Complications of the osteochondosis of the spine
The complications of the osteocondrosis are associated with the intervertebral disc.These include the compression of the spinal cord, which is characterized by numbness, the weakness of some muscle groups of the ends (depending on the level of compression), leading to the appearance of paresis, muscle atrophy, a change in the reflections of the tendon, in urination and defecation.The intervertebral hernia can cause compression of the artery that feeds the spinal cord with the formation of ischemic areas (spinal cord infarction) with the death of the nerve cells.This manifests itself from the appearance of a neurological deficit (compromised movements, sensitivity, trophic disorders) corresponding to the level and prevalence of ischemia.
Diagnosis of osteochondosis of the spine
The diagnosis of spinal osteochondrosis is carried out by a neurologist or vertebrologist.In the initial phase, the radiography of the spine is performed in 2 projections.If necessary, they can shoot a separate spinal segment and shoot in additional projections.For the diagnosis of intervertebral hernias, the evaluation of the state of the spinal cord is used and detect the complications of the osteochondrosis, magnetic and resonance tomography (magnetic resonance imaging of the spine).An important role is played by magnetic resonance imaging in the differential diagnosis of osteocondrosis and other diseases of the spine: spondylitis tuberculosis, osteomyelitis, tumors, spondel of ankilosante, rheumatism, infectious lesions.Sometimes in the event of complicated osteochondous of the cervical column, the exclusion of Siringomyelia is required.In some cases, if magnetic resonance imaging is impossible, myelography is shown.
A targeted study of the interested intervertebral disc is possible using discography.Electrophysiological studies are used to determine the degree and location of damage to nerve paths, to monitor the restoration process during therapy.
Treatment of the osteochondrosis of the spine
In the acute period, peace is shown in the interested vertebral motor segment.To this end, with the osteochondosis of the cervical column, the fixation is used using a chantz collar, with osteochondrosis of the lumbar region - bed rest.The fixation is also necessary for osteochondosis of the cervical region with instability of the vertebral segment.
In drug therapy of osteochondrosis, non -pounded anti -inflammatory drugs (NSAIDs) are used: Diclofenac, Nimesulide, Lornoxicam, Meloxicam.With intense pain syndrome, analgesics are shown, for example, a central analgesic action of fluorine.To alleviate muscle tension, muscle relaxant are used: Tolperisone, Tizanidina.In some cases, it is advisable to prescribe anticonvulsant drugs - carbamazepine, gabapentin;Antidepressants, including preference is given to inhibitors of the reverse capture of serotonin (CERSERINA, paroxetine).
In case of root syndrome, hospital treatment is indicated.Local introduction of glucocorticoids, treatment against edema, use of traction is possible.In the treatment of osteochondrosis, physiotherapy, reflexology, massage, physiotherapy exercises are widely used.The use of manual therapy requires clear compliance with the technique of its implementation and particular attention in the treatment of osteochondosis of the cervical column.
The operations of the spine are mainly indicated with a significant compression of the spinal cord.It consists in removing the hernia of the intervertebral disc and the decompression of the spinal canal.It is possible to perform microdisectomy, disk laser reconstruction, replacement of the disk concerned with a system, stabilization of the spinal segment.