The term osteochondrosis itself is derived from two words: osteo - bone, and chondrue - cartilage. Simply put, it is cartilage ossification. Although this interpretation is fundamentally wrong. Some in their delusions go even further, and are confident that osteochondrosis is the deposition of salts in the joints. Moreover, it is table salt that is supposedly eaten in large quantities.
Pathogenesis
In reality, everything happens a little differently. And harder. And table salt, if it plays any role in the occurrence of osteochondrosis, is very indirect. Osteochondrosis is based on dystrophy and degeneration of the articular cartilage. This is not an independent disease, but a pathological process that can be noted almost anywhere where there is connective cartilage tissue.
Still, osteochondrosis in the overwhelming case affects the spine. Why is that? The fact is that between the vertebrae there are a kind of pads - intervertebral (intervertebral) discs. The physiological role of these discs is to cushion and protect the vertebral bodies from premature wear due to mechanical stress. The disc consists of an internal liquid nucleus pulposus surrounded by an annulus fibrosus and an upper and lower endplate.
The disc undergoes tremendous mechanical stress, leading to permanent damage to its structures at the cellular level. In humans, these processes are too pronounced - this is our payment for upright walking. To prevent the disk from being completely "erased", it must be constantly regenerated, that is, restored. It is the balance of damage-regeneration processes that determines the normal structure of the intervertebral disc. Another curious detail is that the supply of blood and nutrients to the intervertebral discs is carried out not through blood vessels, which are overgrown in childhood, but diffusely, from the bone tissue of the vertebral bodies. Again, the payment for the ability to move on two limbs, not four.
Because of this, the intervertebral discs are easily injured in the anatomical and physiological terms. Any negative process in the body leads to an imbalance in damage-regeneration, and to the development of dystrophy and degeneration in the discs. A structurally defective disc is no longer able to withstand the proper mechanical stress. Under excessive pressure from the overlying vertebrae, the discs are displaced in different directions, usually to the sides and posteriorly. This process is called disc herniation.
The bone tissue of the vertebrae, which has lost its cartilage lining, also undergoes mechanical wear. Due to constant trauma on the anterior edge surface of the vertebral bodies, pathological bone growths are formed - osteophytes. Spondylosis develops. Due to degeneration and displacement of the disc, the intervertebral spaces decrease, the spinal canal narrows, and the roots of the spinal nerves in the so-called foraminal foramina are infringed.
Causes
The causes, or etiological factors, of osteochondrosis are diverse. They can be both local, that is, due to the pathology of the spine itself, and general disorders at the organismal level. Any pathology leading to a violation of the structure of the spinal column or to metabolic disorders can be considered as the cause of osteochondrosis. In this regard, there are:
- Changes in the configuration of the spine (scoliosis, pathological lordosis or kyphosis).
- Other defects of the musculoskeletal system are flat feet, a narrow shoulder girdle, anomalies in the structure of the pelvis.
- Spine injury.
- Weak immunity.
- Metabolic disorders - osteoporosis, obesity, diabetes mellitus, thyroid disease.
- Diseases of the cardiovascular system - atherosclerosis, hypertension.
- Digestive disorders leading to insufficient absorption of nutrients from the gastrointestinal tract.
- Heredity.
It should be noted that the above pathological conditions do not necessarily lead to osteochondrosis. This requires constant exposure to certain predisposing factors - hypothermia, malnutrition, a sedentary lifestyle, or, on the contrary, excessive physical exertion.
Symptoms
Osteochondrosis itself is an asymptomatic process. And, at the same time, the signs of intervertebral disc degeneration are diverse. How so? The fact is that the clinical manifestations of osteochondrosis are based on its complications - disc hernias, spondylosis, sciatica, narrowing of the spinal canal.
Moreover, the clinic is very variable depending on the predominant localization of the process in the cervical, thoracic, or lumbosacral spine. The last section is most often affected, since it is the lower back that takes on the maximum physical activity. Signs of osteochondrosis of the lumbosacral region:
- Pain (lumbodynia, lumbago, sciatica).
- Restriction of movement in the lower back and lower extremities (intermittent claudication).
- Here, sensitivity disorders of the type of paresthesia - numbness, burning, crawling creeps.
- Pathological tension of the lumbar muscles.
- In the absence of treatment, disorders of the function of the pelvic organs.
Cervical osteochondrosis is observed somewhat less frequently than lumbosacral. However, this pathology is also quite common. In addition to the typical signs of pain (cervicalgia), decreased sensitivity and movements in the upper extremities, cervical osteochondrosis due to impaired blood supply to the brain has its own characteristics. These features are manifested:
- Insomnia.
- Headache, dizziness.
- Periodic nausea.
- General weakness, rapid fatigability.
- Fluctuations in blood pressure.
- Occasionally toothache.
- Behavioral reactions in the form of tearfulness, irritability.
The thoracic region with osteochondrosis is affected relatively rarely. Patients in this case are persons forced to sit in a fixed uncomfortable position by occupation - students, schoolchildren, programmers, office workers. The symptoms of osteochondrosis in this case will be as follows:
- Pain and paresthesia in the chest.
- Dyspnea.
- Feeling of heartbeat.
- Restriction of movement in the thoracic spine.
Diagnostics
It is clear from all this that osteochondrosis is a chameleon disease. Due to the similarity of signs, it is easy to confuse it with cerebrovascular accident, hypertension, myocardial infarction, angina pectoris, neurotic disorders. That is why, in order to make the correct diagnosis, a comprehensive complex diagnosis is necessary in order to correctly determine the symptoms and treatment of osteochondrosis.
This diagnosis, in addition to the traditional questioning and clarification of patient complaints, should include a medical examination and special research methods. These methods include X-ray of the spine, ultrasound of internal organs. Recently, computed and magnetic resonance imaging have been successfully used to diagnose osteochondrosis.
Treatment
Therapeutic tactics for osteochondrosis involves the use of:
- Medicines.
- Massage.
- Physiotherapy procedures.
- Physiotherapy (exercise therapy).
- Manual therapy.
- Acupuncture.
Medication for osteochondrosis is mainly aimed at pain relief and elimination of inflammatory processes in the nerve roots. In various combinations, these drugs are widely used in the form of ointments, injections, tablets for the treatment of osteochondrosis. It should not be forgotten that these drugs have a negative effect on the liver, stomach and intestines. By this, they can aggravate metabolic disorders in osteochondrosis. They relieve the pain of blockade well with local anesthetics. True, the effect of these funds is short-lived, and in no way affects the course of osteochondrosis as a whole.
It is possible to improve metabolic processes at the local and organism level with the help of drugs such as chondroprotectors, immunostimulants, and vitamins with minerals. Chondroprotectors are used in tablets, ointments, and ampoules. Among the fortifying agents, vitamins C, group B, in combination with minerals are used. In this regard, calcium preparations are most preferred. Indeed, contrary to some erroneous statements, the basis of osteochondrosis is not an excess, but just a deficiency of calcium.
After successfully relieving exacerbation, physiotherapy, massage, and exercise therapy are shown. As physical procedures, electrophoresis with calcium, phonophoresis with hydrocortisone, amplipulse, paraffin therapy are used. All these measures are aimed at eliminating pain and inflammation in the nerve roots, ligaments and muscles. Massage for osteochondrosis is carried out according to the generally accepted method. The massage zone is selected depending on the localization of osteochondrosis. The expansion of the range of motion is achieved with the help of exercise therapy. At the beginning, in the exacerbation phase, there are practically no dynamic loads. The patient is constantly in an optimal posture. At this time, it is desirable to wear immobilizing devices - a lumbar corset, Shants' neck collar. As the exacerbation subsides, the volume and duration of movements during exercise therapy increases.
Recently, in the treatment of osteochondrosis, non-traditional methods of treatment have been received - acupuncture, manual therapy, osteopathy. Acupuncture is an effect on special biologically active points located along the spine, on the ears, on the hands and on the feet. With manual therapy, the normal position of the vertebrae and intervertebral discs is restored through the manual action of the hands of a specialist. And in the course of osteopathy, the structural integrity of the musculoskeletal system is ensured using specific techniques. In the absence of the effect of conservative measures for the treatment of osteochondrosis, persistent pain, complications, surgery is indicated. The pathologically displaced disc is removed. Currently, for this purpose, microdiscectomy is performed - endoscopic removal of a displaced disc.