The osteochondrosis of the spine is a chronic disease in which degenerative changes occur in the vertebrae and intervertebral discs located between them.Depending on the place of damage to the column, they distinguish: osteochondrosis of the cervical region, osteochondrosis of the thoracic region and osteochondrosis of the lumbar region.To diagnose the osteochondrosis of the spine, it is necessary to perform the radiography, and in the case of its complications (for example, hernia of the intervertebral disc) - Magnetic resonance of the spine.In the treatment of the vertebral spine osteochondrosis, together with the drug methods, it is widely used, reflexology, massage, manual therapy, physiotherapy and physiotherapy exercises.
Etiology and pathogenesis
In one degree or another, the osteochondrosis of the column develops in all aging people and is one of the body aging processes.Previously or posterior, atrophic changes occur in the intervertebral disc, however, injuries, diseases and the various overloads of the column contribute to the previous occurrence of osteochondrosis.The most common osteochondrosis of the cervical region and the osteochondrosis of the lumbar column.
About 10 osteochondrosis theories have been developed: vascular, hormonal, mechanical, hereditary, infectious-allergic and others.But none of them gives a complete explanation of the changes that take place in the spine, but are complementary to each other.
It is believed that the main point in the appearance of osteochondrosis is the constant overload of the vertebral motor segment consisting of two adjacent vertebrae.Such overload can happen as a result of a motor stereotype: posture, an individual way of sitting and walking.Poster disorders, sitting in the wrong bore, walking with an unequal spinal column cause an additional load on the discs, ligaments and muscles of the spine.The process can be aggravated due to the characteristics of the spine structure and the impairment of the trophism of its tissues due to the hereditary factors.Most of the time, the vices in the structure are found in the cervical region and lead to vascular disorders and the early appearance of signs of osteochondrosis of the cervical column.
The appearance of osteochondrosis of the lumbar region is more often associated with its overload during inclinations and gravity elevators.A healthy intervertebral disk can withstand significant loads due to the octopus core hydrophilia located in its center.The nucleus contains a lot of water, and fluids, as they know, are little compressed.The breakdown of a healthy intervertebral disk can occur with a compression of more than 500 kg, while the album changed as a result of osteochondrosis is divided with a 200 kg compression.A 200 kg load is experiencing a lumbar of the backbone of a person weighing 70 kg, when it contains a load of 15 kilograms in the body's inclination position ahead of 200. Such a large pressure is due to the low size of the pulp nucleus.With an increase in the inclination to 700, the load on the intervertebral discs will be 489 kg.Therefore, the first clinical manifestations of the lumbar spine are often produced during or after lifting weights, performing domestic tasks, weeding in the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, the ligaments and capsules of the facial joints causes the reaction of the immune system and the development of aseptic inflammation with the swelling of the facial joints and their surrounding tissues.Due to the displacement of the vertebral bodies, the capsules of the facial joints are stretched and the altered intervertebral disk is not so firmly fixed by the bodies of the neighboring rooms.The instability of the spinal segment is formed.Due to instability, spinal nerve violation is possible with the development of root syndrome.With the osteochondrosis of the cervical column, this often occurs during the turns of the head, with osteochondrosis of the lumbar region, during the inclinations of the body.It is possible to form a functional block of the vertebral engine segment.It is due to the reduction of vertebral muscles compensation.
The hernia of the intervertebral disc is formed when the disc changes backwards, the rear longitudinal ligament rupture occurs and the protuberance of the disc into the spinal channel occurs.If at the same time the disc nucleus is squeezed on the Cephalorraquido channel, then such hernia is called an explosion.The severity and duration of pain with such hernia is much greater than without exploiting.The hernia of the disc can cause root syndrome or compression of the spinal cord.
With osteochondrosis, bone tissue growth occurs with the formation of osteophytes - bone growth in the bodies and processes of vertebrae.Osteophytes can also cause spinal cord compression or cause the development of root syndrome.
Column osteochondrosis symptoms
The main symptom of the column osteochondrosis is pain.The pain can be acute with high intensity, intensifies with the slightest movement in the affected segment and, therefore, makes the patient take a forced position.Then, with the osteochondrosis of the cervical column, the patient keeps the head in the least painful possession and cannot turn it, with the osteochondrosis of the thoracic region, the pain increases even with deep breathing and with the osteochondrosis of the lumbar region it is difficult to sit, climb and walk.Such pain syndrome is characteristic of compressing the spinal nerve spine.
In approximately 80% of cases, there is an opaque pain of constant nature and moderate intensity.In such cases, when examining, the doctor must differentiate the manifestations of the osteochondrosis of the myositis column of the back muscles.The silly pain in osteochondrosis is due to excessive muscle tension, which maintains the affected vertebral motor segment, 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 sharp turns and inclinations with their heads, with osteochondrosis of the lumbar region, sit down slowly and get up, avoid the inclination of the body.
Complications of the spine osteochondrosis
The complications of osteochondrosis are associated with the hernia of the intervertebral disc.These include the compression of the spinal cord, which is characterized by the numbness, the weakness of certain muscle groups of the extremities (depending on the level of compression), which leads to the appearance of paresis, muscular atrophy, a change in the tendinal reflexes, urination and defecation.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 nerve cells.This is manifested by the appearance of a neurological deficit (deteriorated movements, sensitivity, trophic disorders) corresponding to the level and prevalence of ischemia.
Diagnosis of spine osteochondrosis
The diagnosis of spinal osteochondrosis is performed by a neurologist or vertebrologist.In the initial stage, the radiography of the column 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, evaluating the state of the spinal cord and detecting complications of osteochondrosis, magnetic and resonance tomography (MRI of the column).Important magnetic resonance is an important role in the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculosis spondylitis, osteomyelitis, tumors, spondel of ankylosing, rheumatism, infectious lesions.Sometimes, in cases of complicated osteochondrosis of the cervical column, the exclusion of Sirringomyelia is necessary.In some cases, if magnetic resonance is impossible, myelography is shown.
A directed study of the affected intervertebral disc is possible using discography.Electrophysiological studies are used to determine the degree and location of the damage to the nerve pathways, to monitor the process of restoration during the therapy.
Treatment of spine osteochondrosis
In the acute period, peace is shown in the affected vertebral engine segment.To this end, with the osteochondrosis of the cervical column, the fixation is used using a chantz necklace, with osteochondrosis of the lumbar region: bed rest.The fixation is also necessary for the osteochondrosis of the cervical region with instability of the vertebral segment.
In the pharmacological therapy of osteochondrosis, non -steroid anti -inflammatory drugs (NSAIDs) are used: diclofenaco, nimesulide, lornoxicam, meloxicam.With intense pain syndrome, analgesics are shown, for example, an analgesic central action of fluportin.To relieve muscle voltage, muscle relaxants are used: tolperisone, tizanidine.In some cases, it is advisable to prescribe anticonvulsive medications: carbamazepine, gabapentin;Antidepressants, among which preference is given to serotonin inverse capture inhibitors (cerseraline, paroxetine).
In the case of a root syndrome, treatment for hospitalized patients is indicated.The local introduction of glucocorticoids, treatment against edema, the use of traction is possible.In the treatment of osteochondrosis, physiotherapy, reflexology, massage, physiotherapy exercises are widely used.The use of manual therapy requires a clear observance of the technique of its implementation and special caution in the treatment of the osteochondrosis of the cervical column.
Column operations are mainly indicated with significant compression of the spinal cord.It consists of eliminating the hernia from the intervertebral disc and the decompression of the spinal channel.It is possible to carry out microdisectomy, laser reconstruction of the disc, replacement of the affected disk with an implant, stabilization of the spinal segment.