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 tissue destruction and disruption of its 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 spinal segments (the 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 the pain syndrome, which may be located not only in the vertebrae region, 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 tiredness in the neck.
In cervical osteochondrosis, pain, as a rule, manifests itself in the neck region and can occur in the shoulder and scapula, and may be confused with pain in myocardial infarction, as it presents similar symptoms. In addition, cervical osteochondrosis can be accompanied by frequent headaches, dizziness. When the arteries supplying the brain are compressed (compressed), there may be signs of brain malfunction (neurological symptoms): fainting, nausea, tinnitus, mood swings, anxiety and others.
According to the intensity of pain, they are divided into 3 degrees:
- Pain only occurs with pronounced movements in the spine;
- Pain is relieved by a certain position of the spine;
- The pain is permanent.
Forms
Depending on the syndromes caused in osteochondrosis, there are:
- Compression syndromes - occur with compression (radiculopathy - compression of nerve roots, myelopathy - muscle compression, neurovascular - compression of blood vessels and nerves);
- Reflex (muscle tonic, neurodystrophic, neurovascular);
- Myoadaptive syndrome (overexertion of healthy muscles when they take over the functions of the affected muscles).
Causes
The disease development mechanism is intervertebral disc injury for various reasons and its displacement with the loss of depreciation functions (attenuating pressure) of the spine. The immediate cause of disc damage can be age-related degenerative changes associated with insufficient blood supply to the intervertebral discs, mechanical damage from injuries, and heavy physical strain on the spine - for example, being 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 - in the spinal canal lumen, or laterally - with the formation of the median and lateral disc hernias. The disc can be pushed into the body of the vertebra itself with the formation of a Schmorl hernia - microscopic ruptures of the cartilaginous tissue of the intervertebral disc in the cancellous tissue of the vertebral bone. In the case of posterior disc displacement, compression of the spinal cord and the roots that extend from it is possible, with the development of a typical pain syndrome.
Diagnosis
The diagnosis of spinal osteochondrosis is based on complaints, anamnesis data, clinical examination and instrumental examination methods. Diagnostic measures are to discover the reasons that led to the development of neurological symptoms.
Through anamnesis, it is possible to verify the presence of injury, the nature of the work - constant physical overload (weight lifting), inadequate posture, peculiarities of the work and the position of the spine at the table and when walking, the presence of infections.
General clinical studies (clinical blood tests, general urine tests) and biochemical blood tests have no independent value. They are prescribed to assess current status, diagnose underlying disease and emerging complications.
Diagnosis is based on the clinical picture of the disease and is performed by the sequential exclusion method of diseases with similar clinical signs. Of the instrumental diagnostic methods, the most common and available is X-ray examination (spondylogram is a non-contrast study). It reflects the narrowing of the spaces of the intervertebral joints and allows the identification of osteophytes (bone growths) in the vertebral bodies, but it provides only indirect information about the degree of damage to the intervertebral discs.
An accurate diagnosis can be made by CT scans and MRI scans (computed imaging and MRI), even at an early stage of the disease. The tomography allows to determine the minimal anomalies in the bony and cartilaginous tissues, magnetic resonance - to carry out the detailing of the structures of the soft tissues and to determine the location of the disc herniation.
Duplex ultrasound of the cerebral arteries is performed if a violation of the brain's blood supply is suspected.
Differential diagnosis is made with diseases that present similar clinical manifestations: pathologies that evolve with pain radiating to the shoulder and scapular region (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - an enlarged 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 abnormalities; Fibromyalgia is a disease that causes pain in muscles, ligaments and tendons, chest outflow compression syndrome - a disorder caused by excessive pressure on the neurovascular bundle passing between the anterior and middle scalene muscles, over the first rib and under the clavicle, muscle myofascial syndrome of the neck and shoulder girdle - a chronic pathological condition caused by the formation of local muscle spasms or seals, represented by pain points.
The main laboratory tests used:
- Clinical blood test;
- Blood chemistry.
The main instrumental studies used:
- Spine X-ray (spondylogram);
- 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 (as indicated).
Treatment
The treatment of spinal osteochondrosis depends entirely on the stage and degree of development of the osteochondrosis. In the initial phase, 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 medications are prescribed. It is possible to perform paravertebral blocks with anesthetics to open the pathological circle, when the pain causes muscle spasm while the intervertebral disc is compressed harder, which in turn increases the pain itself.
Warming ointments are applied locally to the skin in the vertebral region to improve local blood supply and reduce tissue swelling. These patients are shown wearing a corset. In patients with early-stage osteochondrosis development, chondroprotectors are effective - drugs that improve cartilage tissue restoration, as well as drugs that improve local blood supply, venotonics, group B vitamins. it ceases medically for a long time and there is a clinic of spinal cord root compression with intervertebral hernia, surgical removal of the damaged intervertebral disc is shown. In cases of total spinal cord compression by disc, early surgery is indicated.
You shouldn't wait until a person spontaneously starts urinating or defecating - in which case, the damage to the spinal cord may already be irreversible. As physiotherapeutic procedures, exercises such as magnetotherapy, ultrasound, massage, manual therapy, acupuncture and physiotherapy are prescribed.
complications
Possible vegetative-vascular dystonia and heart rupture, stroke, hypotension and hypertension (decrease and increase in blood pressure), vestibular disorders (impaired movement coordination), vertebral artery syndrome (a disease caused by narrowing of the vertebral artery), periarthrosis (a disease with limited mobility) shoulder joint.
Prophylaxis
For the prevention of osteochondrosis, it is necessary to deal with the factors that cause it, namely: avoiding spinal injuries, spinal stress (weight lifting) and fighting excess weight. For people already suffering from early stage osteochondrosis, wearing corsets at home and during physical exertion is recommended. In order for the spine to rest during sleep, sleeping on orthopedic mattresses and pillows is recommended.
What questions should you ask your doctor
Are there exercises to help relieve symptoms?
What medications will help deal with cervical spine osteochondrosis?
What will happen if you don't start treating the disease in time?
patient advice
Exercise, weight loss in the presence of excess weight, the use of cold or warm compresses help to alleviate the symptoms of osteochondrosis of the thoracic spine. It's also important to eat well, monitor your spine, treat chronic illnesses, and avoid injury.