The spine is a unique biokinematic system, it can carry loads without damage, but like any structure, it wears out over time. At a young age, a steady state is maintained thanks to rapid regenerative abilities, but after 50 years, their supply gradually disappears, which leads to the formation of osteochondrosis.
Osteochondrosis is the most common degenerative-dystrophic pathology of the spinal column, which, as it progresses, spreads to the surrounding structures of the spinal segment.
Theories of development
The etiology of osteochondrosis is unknown. The existing theories of the development of this disease:
- metabolic.Changes in the metabolism of the vertebral disc due to its dehydration (the amount of water at a young age is 88%, with age the water content decreases to 60%).
- vascular.Changes in the circulation of the spine (occurs in adulthood, but early development is possible due to injuries, metabolic disorders, infections).
These theories are sometimes combined in one involution, which is based on the violation of trophism, especially in those tissues in which there are no vessels. In childhood, there is a vascular network in the intervertebral discs, but after the vertebral architecture is fully formed, this network is closed by connective tissue.
- Hormonal theorymore controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is not appropriate to indicate the level of hormones alone. This theory is most relevant for postmenopausal women.
- Mechanical theoryTalks about the connection between the occurrence of osteochondrosis and overloading of certain parts of the spine.
- Anomaly theory- An isolated case from mechanical theory. Anomalies of the vertebral bodies, fusion of the bodies, non-fusion of the arch due to incorrect biomechanics 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 that contribute to the development of the disease
- Gravity Factor:For the spine, any non-physiological movement is nothing more than triggering multiple muscle reactions.
- dynamic factor:The greater and longer the load on the spine, the longer and longer it is exposed to trauma (people tend to forced long-term positions; constant lifting of heavy objects).
- Dysmetabolic factor:Insufficient nutrition of the spinal column due to autoimmune disorders, toxic effects.
It is known that eating aluminum dishes leads to its accumulation in the bones, which will further contribute to the formation of osteochondrosis. Taking food from dishes made of aluminum and iron alloys has a negative effect on the human body. During food preparation, microparticles enter the gastrointestinal tract, and since they contain lead, this metal accumulates in the body, with which intoxication is manifested by neuroosteofibrosis (defective tissue changes at the junction of tendon and muscle).
- genetic factor.Each person has an individual level of flexibility that is directly related to the ratio of connective tissue fibers (collagen and elastin) and is genetically inherited. Despite all of the above, there are fiber ratio norms, deviations lead to rapid wear and tear of the spinal column.
- Biomechanical factor- Non-physiological movements on the articular surface of the spine. This is due to muscle atrophy (the clinical symptom is pain that occurs when bending and turning).
- Aseptic-inflammatory factor- most often a rapid inflammatory process in the intervertebral discs. Microdefects appear in the spine due to malnourishment of the spinal disc. During these microdefects, areas of dead tissue are formed.
Symptoms of osteochondrosis of the spinal column
The main symptom of osteochondrosis is back pain, which can be constant or periodic, painful or acute, most often 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 contributes to microtrauma and wear and tear of the spinal tissue.
The localization of symptoms largely depends on the part of the spine in which the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is localized in several parts, then this condition is called mixed osteochondrosis.
| Type of osteochondrosis | cervix | chest | Lumbosacral | mixed |
|---|---|---|---|---|
| Clinical picture |
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The pain is stable or spreads to all parts of the spine. |
| Complications |
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Compressive myelopathy (spinal cord compression by various neoplasms). |
All possible complications of cervical, thoracic, lumbosacral osteochondrosis. |
Stages of osteochondrosis
| stages | Პirveli | second | the third | fourth |
|---|---|---|---|---|
| Changes in the spine |
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Rupture and displacement of the spinal disc by sinking other adjacent elements into its cavity, which leads to the development of local symptoms of inflammation. | Destruction of other elements of the intervertebral articulation, pathological arrangement of articular surfaces, marginal bone formations. |
| patient complaints | Does not exist or indicates discomfort when staying in the same position for a long time. | Discomfort and pain during certain types of exercise. | Pain in the back, neck, lower back, pelvis or tailbone, depending on the location. | Constant pain throughout the spine. |
differential diagnosis
- Acute myocardial infarction.The pain is concentrated in the heart area and only radiates (spreads) to the neck, lower jaw and arm. The disease begins for no reason or after physical exertion with the manifestation of compressive pain, which is not related to the movement of the spine. After half an hour, the pain reaches its maximum, the person feels short of breath and fears death. The diagnosis is confirmed by electrocardiography (ECG) and markers of myocardial necrosis.
- Subarachnoid hemorrhage(Hemorrhage between the arachnoid and pia mater of the brain). In some cases, due to the toxic effect of the spilled blood on the roots of the spine, severe pain in the spine may occur. The main clinical sign is the presence of blood in the cerebrospinal fluid.
- disorders of the spine.Minimal examination: radiography 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, depression of the edges of the occipital foramen in the cranial cavity, fusion of the vertebrae, changes in shape and size. Vertebrates.
- Cervical lymphadenitisIt may also be accompanied by neck pain, sometimes aggravated by bending and turning. Making a diagnosis is not difficult: enlarged, painful lymph nodes; History of frequent sore throat.
- Multiple myeloma. Spinal pain develops gradually, with progressive weight loss and intermittent fever. The main laboratory sign is protein in the urine.
- Tumor or metastases in the spine.Evidence in favor of a malignant neoplasm is: progressive loss of body weight, laboratory changes, as well as ultrasound of the sources of metastases - kidneys, lungs, stomach, thyroid gland, prostate.
- Rheumatic and infectious-allergic polyarthritisDifferentiated by medical history, moderately elevated body temperature and predominant damage to large joints.
- Masked depression.Patients "impose" non-existent pathologies (in this context, symptoms of osteochondrosis), an attempt to explain the essence of what happened to them goes into the wall of misunderstanding. Signs of masked depression are: decreased mood, concentration and performance; sleep and appetite disturbances; suicidal thoughts and actions.
- Peptic ulcer of stomach and duodenum, pancreatitis and cholecystitisIt is diagnosed using the connection of pain with food intake, laboratory tests (FGDS, general blood test, biochemical blood test, activity of pancreatic enzymes, ultrasound examination of abdominal organs).
Diagnosis of osteochondrosis
- Most often, the patient complains to a neurologist, who collects the anamnesis of the patient's life and illness and conducts a neurological examination. The 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 tops of the hip bones, the position of the shoulder girdle and the expression of the back muscles. During palpation, deformation, pain and muscle tension are determined.
- When establishing the diagnosis of osteochondrosis, additional consultation with specialized specialists is required to rule out pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
- Conducting mandatory laboratory tests (general blood analysis, general urine analysis, biochemical blood test).
- Confirmatory studies are instrumental in:
X-ray of the spine in two projections – the simplest method of identifying changes in the vertebral column (narrowing of the gap between the vertebrae);Depending on the quality, various changes can be seen on the X-ray:
quality Პirveli second the third fourth X-ray signs No radiological signs. Changes in the height of intervertebral discs. Intervertebral disc protrusion (bulging in the spinal canal) or even prolapse (loss). Formation of osteophytes (marginal bone formations) at the point of contact of the vertebrae. Computed tomography (CT) and nuclear magnetic resonance (MRI) - used not only to determine changes in the spine, but also to determine pathologies in other organs;USDG MAG (ultrasound dopplerography of the main arteries of the head) - Ultrasound examination of the circulatory system of the head and neck, which allows you to determine the degree of changes in blood vessels as early as possible.
What methods are there for the treatment of osteochondrosis?
drug therapyIt should be strictly individual and differentiated, the doctor prescribes medicines after making a 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 non-steroidal anti-inflammatory drugs 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 drugs that relieve the pain, you can take selective COX-2 inhibitors.
- Antispasmodics reduce pain and relieve muscle spasm.
- Analgesic subcutaneous method: ointment, the active substance of which is a non-steroidal anti-inflammatory drug; anesthetic cream; Applications with anti-inflammatory and painkillers; Corticosteroids are added for greater effect.
- Treatment aimed at the regeneration of an inflamed or compressed nerve, as well as improving blood microcirculation: B vitamins, neuroprotective agents, nicotinic acid.
- Oral chondroprotectors - glucosamine, chondroitin sulfate. They help stop destructive changes in cartilage when taken regularly. Chondroprotectors are embedded in the framework of cartilage tissue, thereby increasing bone matrix formation and reducing joint destruction. The most favorable composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.
Non-narcotic treatment methods:
Neuro-orthopedic measures. An important point in the treatment of osteochondrosis is to observe a rational regime of physical activity. Staying in bed for a long time and minimal physical activity not only does not benefit the spine, but also causes a constant symptom - back pain.Therapeutic exercise (physical therapy) It is prescribed in a satisfactory condition of the patient (especially in the period when the signs of the disease decrease), the main goal is to strengthen the muscular corset.To prevent falls, improve coordination of movements and improve the functioning of the vestibular apparatus (suitable for elderly patients), exercise therapy uses balancing discs, platforms and paths.
manual therapy with severe pain in the neck. It is prescribed with special caution and according to strict indications. The main goal is to eliminate pathobiomechanical changes in the musculoskeletal system. The main reason for the appointment of manual therapy is the pathological tension of the paravertebral muscles. Do not forget about a number of contraindications of this type of treatment, which are relevant for osteochondrosis - massive osteophytes (pathological formations on the surface of bone tissue) that are formed at the 4th stage of the development of this pathology.Physiotherapy procedures in the acute period: - ultrasound;
- phonophoresis;
- ultraviolet radiation;
- from impulse currents;
- Neuroelectric stimulation.
Physiotherapy procedures in the subacute period: - electrophoresis;
- magnetotherapy.
Massage. All types use superficial, relaxing massage with scraping elements. As soon as the pain symptom is removed with the help of massage, they smoothly move on to more intense elements of rubbing. When mastering acupressure (local) massage techniques, preference is given to this type.The issue of surgical intervention is decided strictly individually, depending on the indication and the patient's condition.
preventive actions
- Competent selection of furniture (especially in the workplace). The work chair consists of a flat and solid back. The bed includes a mattress of moderate 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 size of the heel is 5 cm.
- Wearing a belt, bandage or corset while working.
- Correction of movements: avoid bending and turning, lift weights with a straight back and legs bent at the knees.
- Change body positions more often: don't stand or sit for a long time.
- Proper nutrition: limit the amount of sweet, salty, fatty, spicy food. The most dangerous food for bones is white sugar, because it removes 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; Hot water in the bath, sauna, pool, etc. is especially dangerous. Sh. , because it relaxes the muscles of the back and in this condition even a small injury is not felt, but it leads to tragic consequences. For the spine and the musculoskeletal system in general.
- Water procedures are not only a preventive, but also a therapeutic measure. Swimming combines muscle stretching and relaxation.
- Treatment of chronic diseases.
- Active and regular vacation.
Examples of effective exercises to prevent cervical osteochondrosis that can be performed directly at the workplace:
- He was sitting on a chair and looking ahead. The brush covers and supports the lower jaw. pressing the head forward and downward through resistance (tension phase); relax and stretch the neck muscles, slowly move the head back (relaxation phase);
- He was sitting on a chair and looking ahead. The right hand is on the right cheek. Slowly tilt your head to the left, try to touch your left shoulder with your ear and stay in this position for 3-5 seconds. the left hand on the left cheek and do the same, respectively, on the right shoulder;
- He was sitting on a chair and looking ahead. Your 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 tilt our head to the left and, accordingly, do the same.
conclusion
The high frequency and social importance of osteochondrosis determine the scientific interest in this problem. The disease affects not only the elderly, but is increasingly occurring in 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 future quality of life.