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 their structure. Depending on the level of damage, cervical, thoracic and lumbar osteochondrosis can be distinguished.
Symptoms
The main signs by which one can assume the presence of osteochondrosis of the cervical spine 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 vertebra region, but also be given to the areas of the body innervated by the corresponding nerve root. Another complaint of 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 are compressed (squeezed), there may be signs of a malfunction of the brain (neurological symptoms): fainting, nausea, tinnitus, mood changes, anxiety, and others.
According to the severity of pain, they are divided into 3 degrees:
- Pain occurs only with pronounced movements in the spine;
- The pain is relieved by a certain position of the spine;
- The pain is permanent.
Forms
Depending on the caused syndromes 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 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 impaired blood supply to the intervertebral discs, mechanical damage from trauma and severe physical exertion on the spinal column - for example, overweight.
An important role in the development of osteochondrosis is played by a sedentary lifestyle, in which a violation of 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 forward and backward - into the lumen of the spinal canal, or laterally - with the formation of median and lateral disc hernias. The disc can be pushed into the body of the vertebra itself with the formation of Schmorl's hernia - microscopic breaks of the cartilaginous tissue of the intervertebral disc into 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
Diagnosis of osteochondrosis of the spine is carried out on the basis of complaints, anamnesis data, clinical examination and instrumental examination methods. Diagnostic measures are to find out 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 the work - constant physical overload (lifting weights), poor posture, peculiarities of work and the position of the spinal column at the table and while walking, the presence of infections.
General clinical studies (clinical blood test, general urine analysis), biochemical blood test do not have an independent value. They are prescribed to assess the current state, diagnose the underlying disease and emerging complications.
Diagnosis is based on the clinical picture of the disease and is carried out by the method of sequential exclusion of diseases similar in clinical signs. Of the instrumental diagnostic methods, the most common and available is X-ray examination (spondylography is a non-contrast study). It reflects the narrowing of the intervertebral joint spaces and allows you to identify osteophytes (bone growths) on the vertebral bodies, but gives only indirect information about the degree of damage to the intervertebral discs.
An accurate diagnosis can be made by imaging CT and MRI (computed and magnetic resonance imaging) diagnostics, even at an early stage of the disease. CT allows you to determine the minimum anomalies in bone and cartilage tissues, MRI - to carry out the detailing of soft tissue structures and determine the localization of disc herniation.
Duplex ultrasound scanning of the cerebral arteries is performed if there is a suspicion of a violation of the blood supply to the brain.
Differential diagnosis is carried out with diseases that have similar clinical manifestations: pathologies proceeding with pain radiating to the shoulder and scapular region (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - an increase in cervical lymph nodes, rheumatoid arthritis; oncological diseases (tumors of the vertebrae, roots, spinal cord and membranes), tumors of the pharynx and pharyngeal space, Pancost's 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 anomalies; fibromyalgia is a disease that causes pain in muscles, ligaments and tendons, chest outlet 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 collarbone, myofascial neck muscle syndromeand 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:
- X-ray of the spine (spondylography);
- Magnetic resonance imaging (MRI);
- Computed tomography (CT);
- Ultrasound duplex scanning 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 entirely depends on the stage and degree of development of osteochondrosis. At the initial stage, it is possible to use preventive measures, physiotherapy exercises, exercise on simulators, and fitness. With severe pain syndrome, the patient needs physical rest. Anti-inflammatory and antispasmodic drugs are prescribed. It is possible to carry out paravertebral blockages with anesthetics in order 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.
Warming ointments are applied locally to the skin on the vertebral region to improve local blood supply and reduce tissue edema. These patients are shown wearing a corset. In patients with the initial stage of osteochondrosis, chondroprotectors are effective - drugs that improve the restoration of cartilage tissue, as well as drugs that improve 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 clinic of root compressionspinal cord 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. As physiotherapeutic procedures, magnetotherapy, ultrasound, massage, manual therapy, acupuncture and physiotherapy exercises are prescribed.
Complications
Possible vegetative dystonia and disruption of the heart, cerebrovascular accident, hypotension and hypertension (decrease and increase in blood pressure), vestibular disorders (impaired coordination of movements), vertebral artery syndrome (a disease caused by narrowing of the vertebral artery), periarthrosis (a disease with impaired mobility)shoulder joint.
Prophylaxis
For the prevention of osteochondrosis, it is necessary to deal with the factors that cause it, namely: avoid spinal injuries, stress on the spine (lifting weights), and fight overweight. For people who already suffer from the initial stage of osteochondrosis, it is recommended to wear corsets at home and during physical exertion. In order 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 to help relieve symptoms?
What medications will help to cope with osteochondrosis of the cervical spine?
What will happen if you do not start treating the disease in time?
Patient advice
Exercise, weight loss in the presence of excess weight, the use of cool or warm compresses help to alleviate the symptoms of osteochondrosis of the thoracic spine. It is also important to eat right, monitor your spine, treat chronic conditions, and avoid injury.