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 degree of damage, cervical, thoracic and lumbar osteochondrosis can be distinguished.
Symptoms
The main signs that can be assumed the presence of osteochondrosis of the cervical spine is a local change in the configuration of one of the segments of the spine (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 the pain syndrome, which can be localized not only in the area of the vertebrae, but also in 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.
In cervical osteochondrosis, the pain usually occurs in the neck and can be attributed to the shoulder and shoulder blade, it can be confused with pain in myocardial infarction, as there are similar symptoms. Also, cervical osteochondrosis may be accompanied by frequent headaches, dizziness. When the arteries that supply the brain are constricted (constricted), there may be signs of brain failure (neurological symptoms): fainting, nausea, tinnitus, mood swings, anxiety, and more.
According to the severity of the pain, they are divided into 3 degrees:
- The pain occurs only with pronounced movements in the spine;
- The pain is relieved by a certain position of the spine;
- The pain is constant.
Forms
Depending on the syndromes caused by osteochondrosis, there are:
- Compression syndromes - occur during compression (radiculopathy - compression of nerve roots, myelopathy - muscle compression, neurovascular - compression of blood vessels and nerves);
- Reflex (muscular-tonic, neurodystrophic, neurovascular);
- Myoadaptive syndrome (overexertion of healthy muscles when they take over the functions of the affected muscles).
Reasons
The mechanism of disease development is damage to the intervertebral disc for various reasons and its displacement with loss of cushioning (relieving 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 injuries and heavy physical exertion of the spine - for example, overweight.
An important role in the development of osteochondrosis plays a sedentary lifestyle, which develops a violation of blood supply and functioning of the intervertebral joints. 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 back and forth - in the lumen of the spinal canal or laterally - with the formation of middle and lateral disc herniation. The disc can be pushed into the body of the vertebra itself with the formation of Schmorl's hernia - microscopic fractures of the cartilaginous tissue of the intervertebral disc in the spongy tissue of the spine. In the case of posterior displacement of the disc, compression of the spinal cord and the roots protruding from it is possible, with the development of a typical pain syndrome.
Diagnosis
The diagnosis of osteochondrosis of the spine is made on the basis of complaints, history, clinical examination and instrumental methods of examination. Diagnostic measures are to identify the causes that led to the development of neurological symptoms.
From the anamnesis it is possible to determine the presence of injury, the nature of the work - constant physical overload (lifting weights), poor posture, peculiarities of work and the position of the spine on the table and when walking, the presence of infections.
General clinical tests (clinical blood test, general urine analysis), biochemical blood test have no independent value. They are prescribed to assess the current condition, diagnose the underlying disease and emerging complications.
The diagnosis is based on the clinical picture of the disease and is performed by the method of sequential exclusion of diseases similar in clinical features. Of the instrumental diagnostic methods, the most common and accessible is the X-ray examination (spondylography is a non-contrast examination). It reflects the narrowing of the intervertebral joints and allows you to identify osteophytes (bone growths) on the bodies of the vertebrae, but gives only indirect information about the degree of damage to the intervertebral discs.
Accurate diagnosis can be made by CT and MRI (computer and magnetic resonance imaging) diagnostics, even in the early stages of the disease. CT allows you to determine the minimal abnormalities in bone and cartilage tissue, MRI - to detail the soft tissue structures and to determine the location of the disc herniation.
Duplex ultrasound scan of the cerebral arteries is performed if there is a suspicion of impaired blood supply to the brain.
The differential diagnosis is made with diseases that have similar clinical manifestations: pathologies occurring with pain radiating to the shoulder and shoulder blade (diseases of the liver, gallbladder, pancreatitis - inflammation of the pancreas); cervical lymphadenitis - enlargement of the 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 muscles, ligaments and tendons, chest compression syndrome - a disorder caused by excessive pressure on the neurovascular bundle passing between the anterior and middle scapular muscle, above the first rib and below the clavicle, the myofascial muscleneck and shoulder girdle syndrome - 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 research 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 researches used:
- Densitometry - measurement of bone density (as indicated).
Treatment
The treatment of osteochondrosis of the spine depends entirely on the stage and degree of development of osteochondrosis. In the initial stage it is possible to use preventive measures, physiotherapy exercises, simulator exercises and fitness. With severe pain, the patient needs physical rest. Anti-inflammatory and antispasmodic drugs are prescribed. It is possible to perform paravertebral blockades with anesthetics to open the pathological circle, when the pain causes muscle spasm, while the intervertebral disc is compressed more, which in turn increases the pain itself.
Warming ointments are applied topically to the skin of the spine to improve local blood supply and reduce tissue swelling. These patients are indicated with a corset. In patients with the initial stage of osteochondrosis, chondroprotectors are effective - drugs that improve the recovery of cartilage tissue, as well as drugs that improve local blood supply, venotonics, B vitamins. In cases where the pain syndrome does not stop medically for a long timetime and there is a clinic of root compression of the spinal cord with an intervertebral hernia, surgical removal of the damaged intervertebral disc is indicated. In cases of total compression of the spinal cord by a disc, early surgery is indicated.
You do not have to 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 physiotherapy exercises are prescribed as physiotherapeutic procedures.
Complications
Possible vegetative-vascular dystonia and heart disorder, cerebrovascular accident, hypotension and hypertension (lowering and raising of blood pressure), vestibular disorders (impaired coordination of movements), vertebral artery syndrome (disease caused by narrowing of the spinal artery), periarthrosis (a disease of impaired mobility) of the shoulder joint.
Prevention
To prevent osteochondrosis, it is necessary to deal with the factors that cause it, namely: avoiding injuries to the spine, loading the spine (lifting weights) and combating overweight. For people who already suffer from the initial stage of osteochondrosis, it is recommended to wear corsets at home and during exercise. 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 any exercises to relieve the symptoms?
What medications will help deal 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 overweight, the use of cool or warm compresses help to relieve the symptoms of osteochondrosis of the chest. It is also important to eat right, monitor your spine, treat chronic diseases and avoid injuries.