As a result of human upright walking, the spine, as an axial structure, took the main load. That is why degenerative and dystrophic processes are quite common consequences of human life. One of the most common diseases of the musculoskeletal system is osteochondrosis, which brings severe discomfort and can lead to disability. This article will talk about the most severe form of this pathology - common osteochondrosis.
general characteristics
Osteochondrosis is a degenerative disease of the spine, which most often affects the thoracic, lumbar and cervical parts. This pathology has a direct correlation with age. The disease is much more common in people over 40 years of age, but recently there has been a trend towards rejuvenation. Common osteochondrosis differs in that it affects more than one department or several departments at once. Due to the progressive development of degenerative processes not only in the bone tissue, but also in the ligamentous apparatus of the spine, the vertebrae become mobile and put pressure on the nerves and blood vessels. Symptoms of common osteochondrosis are associated with it, but it is important to note that the disease can be asymptomatic for some time.
Important! Pathology requires multidisciplinary control, because it affects not only the musculoskeletal system, but also the nervous system, as well as internal organs. In addition to the spine itself, the pathological process can also affect other elements of the skeleton.
Etiology and pathogenesis
There are many reasons for widespread osteochondrosis. Some of them are associated with congenital skeletal defects, others with inadequate load during vigorous activity. Particularly common factors that contribute to the development of the clinical picture are:
- injuries;
- flat feet;
- wedge foot - deformation of the foot (equinovarus, varus, valgus, depending on the position of the heel);
- work related to heavy lifting;
- playing sports without warming up or warming up the muscles;
- work at low temperatures.
Low temperatures are considered provocative factors, because the cold temporarily changes the molecular structure of soft tissues, reduces the intensity of blood circulation, reduces the conductivity of nerve impulses and metabolism, and thus the functioning of the immune system. Other reasons disrupt the biomechanics of the spine and contribute to rapid wear of the intervertebral discs.
Pain in widespread osteochondrosis can be a consequence of osteophytes or disc deformation. The pain is usually radicular, ie. associated with compression of the posterior nerve roots.
Common osteochondrosis easily imitates other diseases. With damage in the thoracic region, pain appears in the region of the heart and is mistaken for ischemic processes, and with damage in the lumbar region - radiculitis.
Symptoms
Clinical manifestations will depend on which parts are affected and in which combination.
When the cervical spine is affected, the following are characteristic:
- unstable blood pressure;
- headache;
- lack of coordination;
- pain in hands;
- numbness in the upper body and arms.
For pathology in the thoracic region:
- intercostal neuralgia;
- stiffness in arms and neck;
- dysfunction of internal organs.
If the lumbar region is affected:
- burning;
- urination disorders;
- spasms;
- pain when walking.
Based on the above, it is easy to conclude that the pathology affects not only the spine and large joints, but also the autonomic nervous system. The latter is associated with interruptions in the work of internal organs. The usual polysegmental osteochondrosis can sometimes get worse. In such cases, the manifestations are much more intense. With a combination of disorders of several departments, the symptoms will be appropriate.
Complications
Osteochondrosis can conditionally be divided into moderate osteochondrosis, which is a natural process of wear and tear of the spine as a result of life activity, and severe osteochondrosis, which is most often characterized by complications.
Moderate osteochondrosis is easily treated with conservative treatment. And if it is impossible to completely stop the inevitable aging process, then it is quite possible to significantly slow it down. Complications that can lead to severe osteochondrosis are the following.
- Spondyloarthrosis.
- Degeneration of the intervertebral disc.
- Spinal stenosis.
Important! Intervertebral discs act as shock absorbers and reduce friction between the vertebrae. Degenerative processes in these structures can lead to protrusion of the nucleus pulposus of the disc and intervertebral hernia. Protrusion leads to root compression and pain.
Spondyloarthrosis is a degeneration of the facet joints that connect adjacent vertebrae. Otherwise, such joints are called facet joints. When the articular cartilage is damaged, there is painful contact between the vertebrae. With degeneration of the facet joints, bony growths occur most often, which leads to spondylosis.
Stenosis is a narrowing (in this case of the spinal canal). Usually, stenosis is the result of pathologies such as intervertebral hernia or spondylosis. Bony growths and hernial protrusions compress the nerve roots at their entry and exit points.
The clinical picture of severe osteochondrosis is the result of complications:
- chronic pain in the spine;
- friction of bone surfaces;
- stiffness;
- sudden muscle weakness;
- reduced reflexes;
- tingling in limbs;
- radiates pain;
- sciatica symptoms.
Sciatica is caused by compression of the sciatic nerve.
Classification
There are four degrees of osteochondrosis. Classification is done on the basis of the collected history and with the help of instrumental diagnostic methods. The main criteria in this classification are pain and neurological symptoms.
- I degree - the pain is easily alleviated with medication.
- II degree - characterized by prolonged pain and deformation of the spine with moderate neurological symptoms.
- III degree - pain is systematic, neurological symptoms are significant.
- IV degree - constant pain, multiple neurological deficits. Disorder in the conduction of nerve impulses. Paralysis and paresis.
In the case of widespread dysplastic osteochondrosis, the patient is assigned the status of disability. Depending on the general condition of the patient, the degree and intensity of the development of the clinical picture, disability can be divided into three groups.
Types of disability in osteochondrosis.
| Group | Description |
|---|---|
| The first group | Spinal functions are lost. The patient is unable to move independently and take care of himself. |
| The second group | The patient can move around and perform minor tasks, but periods of deterioration are frequent. Surgery is contraindicated or useless for some reason. Or the operation has already been performed but proved ineffective. |
| The third group | The patient is capable of self-care. There is pain and vestibular symptoms, but the frequency of exacerbations is moderate and periodic. |
The disability group is determined by the doctor on the basis of some studies to assess work ability.
Diagnostics
When visiting a doctor, the diagnosis will consist of several components. The first and most important is the collection of anamnesis based on subjective information provided by the patient. Attention is paid to the family history, because osteochondrosis has a genetic component. The specialist asks about the place of work, living conditions and the course of the disease itself, and the patient must describe what exactly is bothering him. The best results can be achieved with good feedback between the patient and the doctor.
The next method is an objective study, which is carried out by the specialist himself or using instrumental methods. The doctor checks the range of motion of the neck and limbs, which may be significantly reduced due to pain and stiffness. Using the palpation method, he notes how much the muscles are subjected to spasms and how much the spine is curved. Attention is drawn to the neurological examination, with the help of which weakened reflexes can be monitored. This symptom can be the result of compression or damage to the nerve.
Instrumental methods for diagnosing common osteochondrosis include:
- X-ray of the whole spine in two projections.
- MRI to assess ligaments and nerve tissue.
- An electrophysiological study to investigate the conduction of nerve impulses.
X-ray is effective for determining the presence of bone growths - osteophytes, narrowing of the spinal canal and the presence of other diseases that are a consequence of osteochondrosis, for example, scoliosis.
Computed tomography can also be used in conjunction with MRI. Using a CT scan, you can determine the degree of nerve compression by the spurs.
The diagnosis of widespread polysegmental osteochondrosis is made if other pathologies that cause destruction of the vertebrae (for example, tuberculosis) are excluded and if several segments of one or more departments are affected.
There are additional diagnostic methods. This includes:
- Bone scan.
- Discography.
- Myelogram.
A bone scan can detect conditions such as osteoarthritis, fractures or infections. This method is radionuclide and is suitable for differential diagnosis and for determining possible complications.
During discography, a contrast agent is injected into the nucleus pulposus of the intervertebral disc. This method is effective in determining the presence of a herniated disc.
Myelogram is also a method of contrast research. Contrast is injected into the spinal canal and an image is taken using X-rays or a CT scan. Using this method, you can determine the condition of the spinal cord, the presence of narrowing and compression.
Treatment
Treatment is based on the following mechanisms.
- It slows down the degenerative process by improving the supply of nutrients to the structures of the musculoskeletal system.
- Stabilization of the spine.
- Elimination of pinched nerve fibers.
- Symptom relief.
The following drugs are used for drug treatment:
- nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
- Anilides relieve pain in the initial stages;
- local analgesics in the form of ointments;
- muscle relaxants to reduce muscle spasm and increase range of motion;
- B vitamins to improve nerve tissue conductivity;
- chondroprotectors, which reduce the rate of progression of degenerative processes by integrating active substances (chondoitin sulfate and glucosamine) into cartilage cells. As a result, metabolism is normalized and clinical manifestations are reduced. The drug is used for a long time and requires special consultation during pregnancy, breastfeeding and the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
- antispasmodics alleviate spasms of smooth muscles and thus alleviate the manifestations of osteochondrosis in internal organs;
- antioxidants;
- antidepressants to remove the psychosomatic component of this disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. They promote the production of endorphins and help to solve the problem of chronic insomnia due to constant pain.
- neuropathic agents to remove damage to nerve endings.
- opiates for unbearable pain and ineffectiveness of other pain relievers.
The following are used as invasive medical procedures:
- injection of steroids into the epidural space. Steroids are powerful anti-inflammatory drugs. They relieve inflammation of the nerve roots, which helps relieve pain caused by radiculopathy. Complicated procedure. Requires a qualified professional;
- facet joint injections. Injected drugs lead to local numbness and pain relief.
It's important to know! Taking medicine is not aimed at getting rid of the disease - there are no medicines that would completely eliminate osteochondrosis, which is a chronic disease. Medicines are prescribed only to relieve symptoms.
Medicines are prescribed by the attending physician. The patient is informed about the possible side effects of each drug, and then decides for himself which treatment to choose.
For symptoms that give reason to suspect osteochondrosis, consult a vertebrologist, orthopedist and neurologist. High-quality medical care will consist of the close cooperation of these specialists with each other and with the patient.
Physiotherapy
Physiotherapy is used as a set of auxiliary therapeutic measures to improve circulation and metabolism in the affected tissue. The following methods are used for widespread osteochondrosis.
- Electrophoresis (based on the movement of colloidal particles under the influence of an external electric field).
- Phonophoresis (combination of ultrasound and drugs).
- Magnetotherapy (use of static magnetic field).
- UHF therapy (ultra high frequency therapy).
- Electromyostimulation (stimulation of nerves and muscles).
- Acupuncture (acupuncture).
- Laser exposure.
Along with physiotherapy, manual therapy and physical therapy are actively used. Professional massage can lead to long-term remission. Therapeutic exercises should not be performed during an exacerbation of the disease, as this can lead to complications. During the period of remission, moderate physical activity maintains the tone of the muscles, and thus the spine. The exercises are performed under the supervision of the instructor and are prescribed by the attending physician.
During an exacerbation, you cannot warm the spine, but you can wear a corset, but only for a few hours. In other cases, wearing a corset for more than a few hours is not optimal because it can lead to muscle atrophy.
Manual therapy can increase the clearance of pinched nerves and reduce neurological symptoms. Alternative methods are leeches and vacuum massage. These methods are aimed at improving blood circulation in the affected area. Sanitary spa treatment is beneficial. Particular preference is given to water procedures.
Operation
In the treatment of osteochondrosis, experts are more willing to resort to conservative therapy, however, the real effect requires a lot of time, patience and careful compliance with the patient's recommendations. If conservative treatment is ineffective, only then should resort to invasive methods. Usually the operation is palliative. This means that the operation will be performed only for the relief of symptoms and a comparative improvement of the quality of life, but not for a complete cure (it is fair to say that conservative treatment also does not lead to the complete elimination of the disease, but to the receptivity of the patient). to non-invasive therapy is a sign of a good prognosis).
There are two types of operations: decompression and stabilization. The first is aimed at relieving nerve compression, and the second at stabilizing the spinal column. The following operations are classified as decompression operations.
- Facetectomy – removal of the facet joints to relieve compression.
- Foraminotomy is the enlargement of the lumen of the spinal canal, which is narrowed due to osteophytes.
- Laminectomy is the removal of the back part of the vertebra, which can be deformed due to osteochondrosis.
- Laminotomy - removal of a fragment of the back part of a vertebra to widen the spinal canal.
These operations require a posterior approach, but in the case of an intervertebral hernia, the surgical approach will be anterior.
Anterior approach decompression operations are as follows.
- Discectomy – removal of the intervertebral disc.
- Corpectomy – removal of the entire vertebral body with adjacent discs.
Stabilization operations include:
- Spinal fusion is a method of fusion of vertebrae.
- Artificial intervertebral disc.
The need for stabilization operations occurs after discectomy.
Operations are rarely prescribed because there is a risk of developing serious complications.
Complications include:
- pain relapses;
- false union;
- infection;
- phlebitis on the limbs;
- violation of the act of urination;
- graft pain;
- failure of built-in fasteners.
The postoperative period lasts several months. Sutures heal 2 weeks after surgery. If complications are detected, consult a doctor immediately.
After the operation, a rehabilitation course is carried out in order to speed up the healing process and restore full working capacity.
General recommendations
Proper nutrition helps prevent recurrence of exacerbation of common osteochondrosis. Proper nutrition is first of all necessary for maintaining a stable body weight, because excess weight puts additional strain on the spine. In this case, the diet should be complete, enriched and rich in calcium, magnesium and potassium. It is necessary to limit the consumption of coffee because it removes calcium from the body. It is useful to visit the pool. You should avoid staying in one position all the time.
If there are frequent exacerbations and a lack of discipline to strictly follow the recommendations, it is best to undergo the entire course of treatment in a hospital under the supervision of a doctor.
You cannot take the medicine yourself.
Let's summarize
Often widespread osteochondrosis occurs after incompletely cured "one" osteochondrosis. This fact suggests that if any discomfort appears, you should immediately consult a doctor, without hoping that the pain will go away by itself. In this case, it will be much easier to prevent the development of other pathologies, and even more so to cure the main cause.