The spine is a unique biokinematic system that can carry loads without damage, but like any structure, it wears out over time. At a young age, a stable condition is maintained due to rapid regenerative capabilities, but after 50 years, their supply gradually decreases, which leads to the appearance of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spine, as it progresses, it spreads to the adjacent structures of the spinal segment.
Theories of development
The etiology of osteochondrosis is unknown. Currently available theories of the development of this disease:
- Metabolic.Changes in metabolism due to dehydration of the spinal disc (water content is 88% at a young age, water content decreases to 60% with age).
- Vein.Changes in spinal circulation (occurs during adolescence, but earlier development is possible due to injuries, metabolic disorders, infections).
These theories are sometimes combined into one - involution is based on the violation of trophism, especially in tissues without vessels. In childhood, the intervertebral discs have a vascular network, but after the complete formation of the architecture of the spine, this network is connected by connective tissue.
- Hormonal theoryis more controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is inappropriate to refer only to the hormone level. This theory is most suitable for postmenopausal women.
- Mechanical theorytalks about the connection between the occurrence of osteochondrosis and overloading of certain parts of the spine.
- Anomaly theory- a case isolated from mechanical theory. Anomalies of the vertebral bodies, fusion of the bodies, non-union of the arch due to incorrect biomechanism stimulate the overload of the vertebral discs and cause the destruction of bone tissue.
These theories have the right to exist, but none of them are universal. It is more correct to call osteochondrosis a multifactorial disease characterized by genetic predisposition and provoking factors.
Factors contributing to the development of the disease
- Attraction factor:any non-physiological displacement of the spine 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 traumatized (people prone to forced long-term positions; constant lifting of heavy objects).
- Dysmetabolic factor:insufficient nutrition of the spine due to autoimmune disorders, toxic effects.
It is known that eating food from aluminum containers leads to its accumulation in the bones, which will later contribute to the formation of osteochondrosis. Eating food from aluminum and iron alloy dishes has a negative effect on the human body. When preparing food, microparticles enter the gastrointestinal tract, and since they contain lead, this metal accumulates in the body, intoxication is manifested by neuroosteofibrosis (defective changes in the tissue at the tendon and muscle junction).
- Genetic factor.Each person has an individual level of elasticity that is directly related to the ratio of fibers in the connective tissue (collagen and elastin) and is genetically inherited. Despite all of the above, there are norms in the ratio of fibers, deviations lead to faster wear of the spine.
- Biomechanical factor- non-physiological movements on the articular surface of the spine. This is caused by muscle atrophy (the clinical sign is pain when bending and turning).
- Aseptic-inflammatory factor- often a rapid inflammatory process in the intervertebral discs. As a result of malnutrition of the spinal disc, microdefects are formed in the spine. Dead tissue areas are formed in these microdefects.
Symptoms of osteochondrosis of the spine
The main symptom of osteochondrosis is back pain, which can be constant or periodic, painful or sharp, and in most cases it is aggravated by sudden movements and physical activity.
Osteochondrosis is a common disease among athletes. It arises from a mismatch between physiological capabilities and motor loads, which contribute to microtrauma and wear of the spinal tissue.
The localization of symptoms mainly depends on the part of the spine where the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is localized in several parts, this condition is called mixed osteochondrosis.
| Type of osteochondrosis | Cervical | Chest | Lumbosacral | Mixed |
|---|---|---|---|---|
| Clinical picture |
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the pain is constant or spreads to all parts of the spine. |
| Complications |
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compression myelopathy (spinal cord compression by various neoplasms). |
all possible complications with cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| Stages | First | Second | the third | Fourth |
|---|---|---|---|---|
| Changes in the spine |
|
|
Rupture and displacement of the vertebral disc, with the immersion of other surrounding elements into its cavity, leads to the development of local symptoms of inflammation. | Destruction of other elements of intervertebral articulation, pathological alignment of articular surfaces, marginal bone growth. |
| Patient complaints | Absence or sign of restlessness when staying in the same position for a long time. | Discomfort and pain with some types of exercise. | Pain in the back, neck, lower back, sacrum or coccyx depends on the location. | Constant pain along the spine. |
Differential diagnosis
- Acute myocardial infarction.The pain is concentrated in the region of the heart, and only from there it spreads (spreads) to the neck, lower jaw and arm. The disease begins with the appearance of a pressing pain in the spine that is not related to movement for no reason or after physical activity. After half an hour, the pain reaches its maximum, the person has shortness of breath and fear of death. The diagnosis is confirmed by electrocardiogram (ECG) and markers of myocardial necrosis.
- Subarachnoid hemorrhage(hemorrhage between the arachnoid and pia mater of the brain). In some cases, severe pain can occur in the spine due to the toxic effect of the spilled blood on the spinal roots. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- Spinal anomalies.Minimal examination: X-ray of the skull and cervical spine in frontal and lateral projections. The most common anomalies of the spine are: fusion of the atlas (first cervical vertebra) with the occipital bone, collapse of the edges of the occipital foramen into the cranial cavity, fusion of the vertebrae, changes in the shape and size of the spine. vertebrae.
- Cervical lymphadenitisit can also be accompanied by neck pain, sometimes aggravated by bending and turning. It is not difficult to make a diagnosis: enlarged, painful lymph nodes; frequent history of sore throat.
- 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: 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 polyarthritisit is characterized by a history of illness, a moderately elevated body temperature, and a predominant lesion of the large joints.
- Masked depression.Patients "put" non-existent pathologies (in this context, signs of osteochondrosis), an attempt to explain to them the essence of what is happening turns into a wall of misunderstanding. Symptoms of masked depression: decrease in mood, concentration and performance; sleep and appetite disturbances; suicidal thoughts and actions.
- Peptic ulcer of the stomach and duodenum, pancreatitis and cholecystitisThe relationship between pain and food intake is diagnosed by laboratory tests (FGDS, general blood test, biochemical blood test, activity of pancreatic enzymes, ultrasound examination of abdominal organs).
Diagnosis of osteochondrosis
- Often, the patient complains to a neurologist who collects an anamnesis about the patient's life and illness and conducts a neurological examination. A neurologist examines the spine in three positions (standing, sitting and lying down). When examining the back, pay special attention to the posture, the lower angles of the shoulder blades, the tips of the iliac bones, the position of the shoulder girdle and the expression of the back muscles. During palpation, deformation, pain, and muscle tension are determined.
- When diagnosing osteochondrosis, additional consultations with specialized specialists are necessary to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Conducting mandatory laboratory tests (general blood test, general urinalysis, biochemical blood test).
- Validation studies are instrumental in:
X-ray of the spine in two projections – the simplest way to determine changes in the spine (narrowing of the space between the vertebrae);Depending on the degree, various changes are visible on the X-ray:
Degree First Second the third Fourth X-ray signs No radiological signs. Changes in the height of the intervertebral discs. Intervertebral disc protrusion (bulging into the spinal canal) or even prolapse (loss). Formation of osteophytes (marginal bone growths) at the contact point of the vertebrae. computed tomography (CT) and nuclear magnetic resonance (MRI) – it is used not only to identify changes in the spine, but also to identify pathologies of other organs;USDG MAG (Doppler ultrasound of the main arteries of the head) - ultrasound examination of the circulatory system of the head and neck allows to diagnose the degree of changes in blood vessels as early as possible.
What are the treatment methods for osteochondrosis?
Drug therapymust be strictly individual and different, the prescription of drugs is carried out by the doctor after the 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 you need a constant dose of pain relievers, you can take selective COX-2 inhibitors.
- Antispasmodics reduce pain and relieve muscle spasms.
- Transcutaneous method of pain relief: ointment with active substance NSAID; anesthetic cream; applications with anti-inflammatory and analgesic drugs; corticosteroids are added for greater effect.
- Treatment designed to restore 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 incorporated into the framework of cartilage tissue, 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 to follow a rational regime of physical activity. Staying in bed for a long time and minimal physical activity does not only benefit the spine, but also causes a permanent symptom - back pain.Therapeutic exercise (physical therapy) it is prescribed when the patient's condition is satisfactory (especially when the symptoms of the disease are reduced), the main goal is to strengthen the muscle corset.To prevent falls, improve coordination of movements and work of the vestibular apparatus (suitable for elderly patients), balancing discs, platforms and paths are used in exercise therapy.
Manual therapy with violent pain in the neck. It is prescribed with special vigilance and according to strict instructions. 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 a number of contraindications for this type of treatment, which is relevant for osteochondrosis - massive osteophytes (pathological growths on the surface of bone tissue), which occur in the 4th stage of the development of this pathology.Physiotherapy procedures in the acute period: - ultrasound;
- phonophoresis;
- ultraviolet radiation;
- impulsive currents;
- neuroelectrical stimulation.
Physiotherapy procedures in the subacute period: - electrophoresis;
- magnetotherapy.
Massage. A superficial, relaxing massage with friction elements of all types is used. As soon as the pain symptom is eliminated with the help of massage, they move on to more intense elements of smooth friction. When mastering the acupressure (local) massage technique, this type is preferred.The question of surgical interventions is decided strictly individually, depending on the indications and the patient's condition.
Preventive measures
- Competent choice of furniture (especially in the workplace). The work chair consists of a straight and firm back. The bed includes a mattress of medium hardness, a pillow of medium softness (orthopedic mattress and pillow, if possible).
- Correction of vision, posture, bite.
- Rational selection of shoes (especially important for drivers). The maximum heel size is 5 cm.
- Wearing a fixation belt, bandage or corset during work.
- Correcting 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, because 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; in the bath, sauna, swimming pool, etc. hot water is especially dangerous, because it relaxes the back muscles, and in this case, even a small injury is not felt, but it leads to tragic consequences for the body. for the spine and even the musculoskeletal system in general.
- Water procedures are not only a preventive measure, but also curative. Swimming combines stretching and relaxation of muscles.
- Treatment of chronic diseases.
- Active and regular vacation.
Examples of effective exercises to prevent cervical osteochondrosis that can be done directly at work:
- sitting on a chair and looking ahead. The brush surrounds and supports the lower jaw. Pushing your head forward and down through resistance (tension phase); relax and stretch the neck muscles, slowly pull your head back (relaxation phase);
- sitting on a chair and looking ahead. The right palm is on the right cheek. Tilting our head slowly to the left, try to touch our left shoulder with our ear and stay in this position for 3-5 seconds. Do the left palm on the left cheek and the same on the right shoulder;
- sitting on a chair and looking ahead. Hands are on your knees. We bend our head to the right, hold for 5-7 seconds and very slowly return to the starting position. Then we bend our head to the left and do the same accordingly.
The result
The high frequency and social importance of osteochondrosis determines the scientific interest in this problem. The disease occurs not only among elderly people, but also 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.