Spinal osteochondrosis is a complex of dystrophic and degenerative changes in the intervertebral discs and the adjacent surfaces of the vertebral bodies associated with tissue destruction and alteration 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 segments of the spine (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 pain syndrome, which can be localized not only in the region of the vertebrae, but also in the areas of the body innervated by the corresponding nerve root. Another complaint from these patients is a feeling of discomfort and a feeling of fatigue in the neck.
With cervical osteochondrosis, pain, as a rule, manifests itself in the neck area and can be given to the shoulder and scapula, it can be confused with pain in myocardial infarction, since it has similar symptoms. Also, cervical osteochondrosis can be accompanied by frequent headaches, dizziness. When the arteries supplying the brain become compressed (squeezed), there may be signs of brain malfunction (neurological symptoms): fainting, nausea, tinnitus, mood swings, anxiety, and others.
According to the severity of the pain, they are divided into 3 degrees:
- Pain occurs only with pronounced movements in the spine;
- The pain is relieved with a certain position of the spine;
- The pain is permanent.
Forms
Depending on the syndromes provoked in osteochondrosis, there are:
- Compression syndromes - occur with compression (radiculopathy - nerve root compression, 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 mechanism of development of the disease is damage to the intervertebral disc due to various reasons and its displacement with the loss of depreciation (mitigating pressure) functions of the spine. The immediate cause of disc damage can be age-related degenerative changes associated with poor blood supply to the intervertebral discs, mechanical damage from injuries, and strong physical strain on the spine, for example, being overweight.
A sedentary lifestyle plays an important role in the development of osteochondrosis, in which a violation of the blood supply and functioning of the intervertebral joints develops. The mechanism of development of the disease is as follows: if the fibrous ring that connects the vertebral bodies is damaged, the intervertebral disc is pushed back and forth, towards the lumen of the spinal canal or laterally, with the formation of the median disc and side. herniasThe disc can be pushed into the body of the vertebra with the formation of Schmorl's hernia - microscopic ruptures of the cartilaginous tissue of the intervertebral disc in the spongy tissue of the vertebral bone. In the case of a posterior displacement of the disc, compression of the spinal cord and the roots extending from it is possible, with the development of a typical pain syndrome.
Diagnostics
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 discover the reasons that led to the development of neurological symptoms.
From the anamnesis, it is possible to find out the presence of an injury, the nature of work: constant physical overload (weight lifting), poor posture, peculiarities of work and the position of the spine on the table and when walking, the presence of infections.
General clinical studies (clinical blood tests, general urinalysis), biochemical blood tests have no independent value. They are prescribed to assess the current state, diagnose the underlying disease and emerging complications.
The diagnosis is based on the clinical picture of the disease and is carried out by the method of sequential exclusion of similar diseases in clinical signs. Of the instrumental diagnostic methods, the most common and available is the X-ray examination (spondylography is a study without contrast). It reflects the narrowing of the intervertebral joint spaces and allows you to identify osteophytes (bony growths) in the vertebral bodies, but only provides indirect information on the degree of damage to the intervertebral discs.
An accurate diagnosis can be made using CT and MRI (computerized and magnetic resonance imaging) diagnostics, even at an early stage of the disease. Computed tomography allows you to determine the minimal abnormalities in the bone and cartilaginous tissues, MRI - to perform the detail of the soft tissue structures and determine the location of the herniated disc.
A duplex ultrasound of the cerebral arteries is performed if there is a suspicion of a violation of the blood supply to the brain.
The differential diagnosis is carried out with diseases that have similar clinical manifestations: pathologies that present with pain that radiates to the shoulder and the scapular region (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - increased 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; pseudocysts of the dura mater; spinal abnormalities; fibromyalgia is a disease that causes pain in the muscles, ligaments and tendons, chest outlet compression syndrome: a disorder caused by excessive pressure on the neurovascular bundle that passes between the anterior and middle scalene muscles, over the first rib and below the clavicle, myofascial neck syndrome 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;
- Chemistry of the blood.
The main instrumental studies used:
- X-ray of the spine (spondylography);
- Magnetic resonance imaging (MRI);
- Computed tomography (CT);
- Duplex ultrasound 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 (according to indications).
Treatment
Treatment of osteochondrosis of the spine completely depends on the stage and degree of development of osteochondrosis. At the initial stage, it is possible to use preventive measures, physical therapy exercises, exercise in simulators and fitness. With severe pain syndrome, the patient needs physical rest. Anti-inflammatory and antispasmodic drugs are prescribed. Paravertebral blocks can be performed with anesthetics to open the pathological circle, when the pain causes muscle spasm, while the intervertebral disc is compressed more strongly, which, in turn, increases the pain itself.
Hot ointments are applied locally to the skin of the spinal region to improve local blood flow and reduce tissue edema. These patients are shown wearing a corset. In patients with the initial stage of development of osteochondrosis, chondroprotectors are effective: drugs that enhance the restoration of cartilage tissue, as well as drugs that improve the local blood supply, venotonics, vitamins of group B. In cases where the pain syndrome does not stop. medically for a long time and there is a spinal cord root compression clinic with intervertebral hernia, surgical removal of the damaged intervertebral disc is shown. In cases of total compression of the spinal cord by a disc, early surgery is indicated.
You should not wait until a person begins to urinate or defecate spontaneously; in this case, the damage to the spinal cord may already be irreversible. Magnetotherapy, ultrasound, massage, manual therapy, acupuncture, and physical therapy exercises are prescribed as physiotherapeutic procedures.
Complications
Possible vegetative-vascular dystonia and disturbance of the heart, stroke, hypotension and hypertension (decrease and increase in blood pressure), vestibular disorders (impaired coordination of movements), vertebral artery syndrome (a disease caused by narrowing vertebral artery), periarthrosis (a disease with reduced mobility) shoulder joint.
Prophylaxis
For the prevention of osteochondrosis, it is necessary to deal with the factors that cause it, namely: avoiding injury to the spine, stress on the spine (weight lifting) and combating overweight. For people who already suffer from the initial stage of osteochondrosis, it is recommended to wear corsets at home and during physical exertion. 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 that help relieve symptoms?
What drugs will help to cope with osteochondrosis of the cervical spine?
What will happen if you don't start treating the disease in time?
Counseling the patient
Exercise, weight loss in the presence of excess weight, the use of hot or cold compresses help to relieve the symptoms of osteochondrosis of the thoracic spine. It's also important to eat right, control your spine, treat chronic illnesses, and avoid injury.