Osteochondrosis is a chronic disease in which degenerative changes occur in the vertebrae, and is situated between them intervertebral disks. Depending on the type of lesion in the spine: in the cervical osteochondrosis, osteochondrosis of the thoracic and osteochondrosis of the lumbar spine. For the diagnosis of osteochondrosis of the spine need radiography, and, in the case of complications (eg, herniated disc) - spinal MRI. In the treatment of osteoarthritis of the spine, along with the medical methods to be used, reflexology, massage, manual therapy, physiotherapy, and exercise therapy.
Etiology and pathogenesis
To varying degrees, osteochondrosis occurs at any of the ages of the people, and it is one of the aging process. Sooner or later, in the intervertebral discs occur that atrophic changes, however, the injuries, the diseases, and the various overloads of the spine may be contributing to an earlier onset of the disease. The most common osteochondrosis of the cervical and degenerative disc disease of the lumbar spine.
There are about 10 theories of degenerative disc disease: vascular, hormonal, mechanical, genetic, infectious-allergic, and others. But none of them provides a complete explanation of what is going on in the backbone of the change, and they are complementary.
It is believed that the main point in the case that the load is a constant overload on vertebral motor segments, which consists of two adjacent vertebrae. This overload can be the result of movement patterns — gait, an individual's way of sitting and walking. Incorrect posture, sitting in a wrong posture, walk with an uneven spinal column has caused an additional pressure on discs, ligaments, and muscles of the spine. The process can be made even worse, due to the nature of the structure of the spine, and failure of trophic its tissues due to hereditary factors. Most of the defects in the structure occur in the cervical spine and can lead to vascular disease, and early signs of degenerative disc disease of the cervical spine.
The occurrence of osteochondrosis in the lumbar often associated with his burden, when bending, and lifting weights. Healthy intervertebral discs are able to withstand considerable loads due to the hydrophilicity, is located in the center of the nucleus pulposus. The nucleus contains a large amount of water and fluids, such as, you know, just a little compressed. Rupture of the intact intervertebral disc can occur when the force of compression of more than 500 kg, while it changed as a result of degenerative disc disease, the disc is broken, when the force of compression to 200 bar. A load of 200 kg the experiences of the lumbar spine for a person weighing 70 kg, when he is 15 pounds and the load at the position of the torso ahead in the 200. As a pressure, because of the small size of the nucleus pulposus. When the inclination is increased to 700, the load on the intervertebral discs is 489 lbs. So often the first clinical manifestation of osteochondrosis of the lumbar spine occur during or after heavy lifting, working on the house, weeding the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, ligaments and the capsules of the facet joints causes a reaction of the immune system and the development of aseptic inflammation with swelling of the facet joints and the surrounding tissues. Due to the displacement of the vertebral body is the stretching of the capsule of the facet joints, and the change of intervertebral discs is not so firm as to not be locked to the main body of the adjacent vertebrae. Set up the instability of the spinal segment. Due to the instability of the potential injury to the nerve roots of the spinal nerves, with the development of the radicular syndrome. Osteochondrosis of the cervical spine, often occurs during a turn of the head, osteochondrosis of the lumbar spine during trunk bending. The establishment of the functional unit of the vertebral motor segment. This is due to the compensatory contraction of vertebrate muscles.
A Herniated disc occurs when a disc moves backward, there is a rupture of the posterior longitudinal ligament and bulging of the disc into the spinal canal. If the spinal canal is squeezed out the nucleus of the disc, this is called a ruptured hernia. The intensity and duration of pain associated with a hernia is a lot more of the unexploded. A Herniated disc may cause radicular syndrome, or compression of the spinal cord.
When osteochondrosis occurs, the expansion of the bone with formation of osteophytes — bony growths on the vertebrae. Osteophytes can also cause compression of the spinal cord or it may cause development of radicular syndrome.
The signs and symptoms of osteochondrosis
The main symptom of osteochondrosis is a pain. The pain can be sharp, of high intensity, and it is increased by the slightest movement of the affected segment and, therefore, forces the patient to take a forced position. In osteochondrosis of the cervical spine, the patient keeps the head in the least painful position, and cannot rotate, osteochondrosis of the thoracic pain is the worse, even in a deep breath, and osteochondrosis of the lumbar, the patient is difficult to sit, stand and walk. Such a pain syndrome is characteristic of compression of the nerve roots of the spinal nerves.
Approximately 80% of the cases, there is a dull pain is constant in nature and of moderate intensity. In such cases, during the examination the doctor needs to be different manifestations of osteochondrosis of the spine of the myositis of the back muscles. The dull ache in osteochondrosis is caused by an excessive tension of the muscles, which hold the affected vertebral motor segment, inflammatory changes, or a significant stretching of the intervertebral discs. Patients with this pain syndrome in a coercive position to be extinct, but found the restriction of movement and physical activity. Of the patients with osteochondrosis of the cervical spine, avoid sharp turns, and tilts his head, osteochondrosis of the lumbar - slow, sit-in and take-up, in order to avoid trunk bending.
Complications of spinal osteochondrosis
The complications of degenerative disc disease associated with disc hernias. These include compression of the spinal cord, which is characterized by numbness, weakness in certain muscle groups of the legs (depending on the level of compression, which gives rise to the appearance of the paresis, muscular atrophy, changes in tendon reflexes, disturbances of urination and defecation. Disc herniation may cause compression of the artery feeding the spinal cord, with the formation of ischemic areas (infarction of the spinal cord) is damage to the nerve cells. This is manifested by the appearance of a neurological deficit (violation of movements, loss of sensibility, trophic disorders), appropriate to the level and extent of the ischemia.
The diagnosis of osteochondrosis
The diagnosis of osteochondrosis is conducted by a neurologist or a spine. In the initial stage of the production of x-rays of the spine in 2 projections. If you need to, you can do the research on a particular vertebral segment, and to shoot additional photos. For the diagnosis of intervertebral hernia, the assessment of the spinal cord and to detect the complications of degenerative disc disease using magnetic resonance imaging (MRI of spine). A major role is played by MRI in the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculous spondylitis, osteomyelitis, tumors, ankylosing spondylitis, rheumatism, sclerosis. Sometimes, in complicated cases of degenerative disc disease of the cervical spine exclusion, it is necessary to syringomyelia. In some cases, where the lack of MRI myelography is presented.
Sighting of a study of the affected intervertebral disc is not possible with the discography. Electrophysiological studies were used to determine the extent and localization of lesions in the neural pathways, and the monitoring of their recovery during the course of the therapy.
The treatment of osteochondrosis
In the acute period, it is shown to the rest at the affected vertebral motor segment. With this goal in osteochondrosis of the cervical spine was used, performed with the aid of a powerful Trench, osteochondrosis of the lumbar in the bed. Fixation of a cervical osteochondrosis with instability of the spinal segment.
In the treatment of degenerative disc disease the use of nonsteroidal anti-inflammatory drugs (Nsaids): diclofenac, nimesulide, lornoxicam, meloxicam. With intense pain syndrome shows analgesics, for example, a Central analgesic action, flupirtine. To relieve the tension in the muscles and use of muscle relaxants — tolperisone, tizanidine. In some cases, the appropriate use of anticonvulsants - carbamazepine, gabapentin; antidepressants, among which priority has been given to inhibitors of serotonin reuptake (sertraline, paroxetine).
Upon the occurrence of radicular syndrome of the patient shown inpatient treatment. Perhaps a local injection of glucocorticoids, treatment of edema, the use of traction. In the treatment of osteoarthritis are used in physiotherapy, reflexology, massage, physiotherapy. The use of manual therapy and requires strict adherence to the techniques of performing and of any special precautions to be taken in the treatment of degenerative disc disease of the cervical spine.
Surgery is indicated primarily by a significant compression of the spinal cord. It consists of the removal of the herniated disc and decompression of the spinal canal. It is also possible to implement a microdiscectomy and laser disc reconstruction, replacement of the affected disc implant, and the stabilization of the spinal segment.