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Treatment of osteochondrosis

severe pain with osteochondrosis

Osteochondrosis - dystrophic changes in the spine associated with age-related tissue aging. The pathology is 80% related to genetic data, the rest is the influence of external factors.

Osteochondrosis- a disease mainly in humans, the development of which is facilitated by:

  • Increased lifespan. Over time, metabolism slows down, tissue nutrition is disrupted, destructive regulatory systems begin to prevail over constructive ones.
  • Walking upright. Standing on his feet, the person gained an uneven load on various parts of the spine, he was able to perform more movement - for twisting, extension. Abnormal lateral flexions - scoliosis - appeared with uneven load on the muscles and small joints of the spine. This increased the chance of the disease forming even in the part where low mobility and the rib cage protect the vertebrae - thoracic osteochondrosis
  • Acceleration. Rapid growth makes bones, muscles and cartilage more vulnerable. The number and prevalence of blood vessels is insufficient to supply them with oxygen and essential substances
  • Lack of adequate physical activity. There are two extremes - sedentary work and movement exclusively by car or excessive stress in the gym, when the discs and cartilage wear out at an accelerated rate.
  • Inadequate nutrition. The dominance of fast carbohydrates, the lack of protein, the use of carbonated beverages leads to the fact that the body does not have enough high quality building materials to maintain tissue health.
  • Smoking. Causes prolonged vasospasm - disturbance of tissue nutrition, acceleration of degenerative processes
  • Urbanization, a large number of traumatic objects around lead to spinal injuries, secondary osteochondrosis

Types of osteochondrosis

By localization

  • Osteochondrosis of the cervical spine
  • Injury to the thoracic spine
  • Lumbar osteochondrosis
  • Frequent osteochondrosis - cervical and lumbar, thoracic, lumbar and other combinations

The most common changes in the most mobile parts are the cervical and lumbar. The painful point is the transition of the mobile lumbar region to the fixed sanctuary.

By stage

  • Home - small changes in the center of the disc, compression of the nucleus, appearance of cartilage cracks
  • The progression of the disease - the cracks deepen, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs - due to violation of the ratio of vertebrae to each other, the cartilage on the surfaces of the small joints is erased unevenly, arthritis and arthritis develop
  • Complicated osteochondrosis - symptoms: further cartilage degeneration occurs - ruptures of the cartilage ring that connect the bodies of two adjacent vertebrae. Part of the nucleus protrudes through the free space and presses on the roots, the spinal cord - a disc herniation is formed. A more serious problem is the separation of the fallen part - a stuck hernia. Disturbed by severe pain, decreased sensitivity and movement in the area responsible for the compressed nerve
  • The body responds to increased load and excessive mobility with the development of bone tissue - osteophytes appear. They stabilize the spine but reduce the range of motion. Bone hooks irritate muscle receptors and press on nearby blood vessels. With cervical osteochondrosis, this causes symptoms of the "vertebral artery" - dizziness, tinnitus, flicker of dots in front of the eyes

Osteochondrosis of the cervical spine

With the advent of mobile phones and computerscervical osteochondrosiseven in adolescents: a prolonged abnormal position of the head with muscle tension overloads their vertebrae, discs and joints.

Cervical osteochondrosis - symptoms

  • Neck pain extending to the back of the head, upper back
  • Sometimes the headaches associated with cervical osteochondrosis mimic migraine - unilateral symptoms, intolerance to sounds and bright light, strong pulses in the temples, bright flashes in front of the eyes
  • Frequent headaches that do not respond well to conventional tablets
  • Antihypertensive drug resistant blood pressure drop
  • Dizziness and darkness in the eyes with sudden turns of the head
  • Numbness in the fingers, especially after sleep, a feeling of crawling on the skin
  • Restriction of movement in the neck, stinging while trying to move. Patients have to turn their whole body to see something behind them
  • Sweating on the upper body
  • The tense muscles of the neck and shoulder girdle can be detected by palpation.

If detectedcervical osteochondrosis, treatment in the early stages prevents serious complications - compression of the vertebral artery with oxygen starvation of the brain, compression of the spinal cord.

Manifestations of osteochondrosis of the thoracic spine

Changes in the chest area develop less frequently, causing factors - back injuries, scoliosis, previous diseases of the spine (tuberculous, non-specific spondylitis, body hemangiomas).

Symptoms of thoracic injury:

  • Back pain - pain, pulling, worse after prolonged standing or sitting in an uncomfortable position. But with persistent pain complaints, other possible causes must be ruled out - pneumonia, pleurisy, tumors, intercostal neuralgia of various natures, shingles before blisters appear
  • Difficulty breathing, shortness of breath, inability to take a deep breath
  • Thoracic osteochondrosis sometimes mimics angina attacks - a person is treated for a long time by a cardiologist and the problem lies in a diseased intervertebral disc

Lumbar and lumbar osteochondrosis

In the structure of all types of osteochondrosis, these departments are confident leaders, more than half of all diagnoses. The reason is that the greatest load falls on this area of the body, both standing and sitting. Body weight, load in case of improper weight lifting, for a long time in a bent position - the pulpal nucleus of the intervertebral discs is in a state of compression, is pressed on the vertebral bodies through the cartilaginous plates - Schmorl hernias are formed. Hypertension and muscle spasm disrupt the position of the small joints of the vertebrae in relation to each other - the articular cartilage is deleted, mobility is reduced.

Several vicious cycles develop simultaneously: muscle spasm causes pain - pain reflexively increases muscle fiber contraction, acute pain forces a person to restrict movement, to save the damaged area - the strength of the muscular framework and the support of the spinedecreases, this increases instability, lumbar osteochondrosis develops.

At the point of transition of the mobilelumbar spinein a stationary sacrum fused to a single monolith, there is a risk of the fifth lumbar vertebra slipping off the surface of the sacrum. This pinches the bundles of nerves, the root syndrome develops.

Symptoms of lumbar osteochondrosis

  • Low back pain, especially sitting and standing. After resting, the horizontal position improves. With a prolonged course, the pain is ordinary, pain, pulling
  • Sharp sudden lumbar spine when changing body position, weight lifting, heavy load. The patient sticks to the position where he was attacked, it is difficult to straighten, to start moving. Lumbar spine is usually associated with compression of the spinal nerve root, which has developed acutely
  • The passage of pain in the gluteal area, legs. The largest nerve in the body, the sciatic nerve, is a direct continuation of the spinal cord; therefore, patients with lumbar osteochondrosis are often concerned about sciatica.
  • Due to the fact that the nerve fibers control the tone of the muscles and blood vessels, regulate the nutrition of the tissues, there are changes in that part of the trunk for which the diseased nerve is responsible. The limb feels colder than the healthy one. With a prolonged course of the disease, muscle atrophy, dry skin and swelling are felt. Local immunity is reduced - any scratches, cuts, abrasions easily become a gateway for infection
  • The defeat of the sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may burn or catch a cold due to the fact that he did not feel a dangerous change in temperature.
  • Very frightening symptoms - numbness of the skin of the perineum, loss of control of the pelvic organs. The patient does not feel full bladder, does not feel the need to empty the intestines. Over time, urine and feces begin to be excreted on their own, it is not possible to maintain them. In this case, the treatment of osteochondrosis of the spine and its complications is done surgically, on an urgent basis.

Diagnosis of osteochondrosis

It is performed by a neurologist or orthopedist after the therapist has ruled out the pathology of the internal organs.

  • The specialist discovers the main complaints, their time of onset, their development, the effect of drugs on the intensity of pain, rest, changes in the rhythm of life
  • A mandatory external examination is performed when the patient undresses in underwear - it is necessary to compare the condition and color of the skin in symmetrical parts of the body, tissue tone, reaction to various stimuli: pain, touch, cold or heat. Symptoms of tension are identified, indicating muscle tension and irritation of the tendons and their membranes - fascia
  • The neurological hammer will reveal the uniformity and symmetry of the reflexes
  • The neurologist records the volume of active (independent) and passive (performed by the doctor) movements in the joints, the ability to turn the head, the upper part of the body without involving the lower parts of the spine

If necessary, send for additional examination

  • Thermal imaging diagnostics
  • ENMG (electroneuromyography): X-ray. In order to obtain the necessary information, it is performed in at least two views - direct and lateral. The image will tell about the condition of the bone tissue, the severity of osteoporosis, the size and safety of the vertebral bodies and will reveal the osteophytes. Damaged discs are determined by the width and uniformity of the intervertebral discs. The unevenness of the lower or upper body will make one suspect Schmorl's hernia. To clarify the nature of the changes in the bone structure of the spine, computed tomography is recommended. The versatile examination allows the three-dimensional modeling of the vertebrae. If necessary, to find out the condition of the soft tissues - muscles, ligaments, intervertebral disc, MRI is prescribed.

We must remember that the results of the research must be compared with the complaints and changes found during the examination. Detection of signs of osteochondrosis of the spine and even disc herniation without complaints does not require serious measures.

Treatment of osteochondrosis of the spine

Removal of acute manifestations of the disease

  • The intense pain and the intense muscle tension reinforce each other, without letting the exacerbation subside. Therefore, the first is pain relief.
  • Prescribe non-steroidal anti-inflammatory drugs injections, muscle relaxants - muscle relaxants
  • If these measures are not enough, they are blocked with painkillers and hormonal drugs

Radiofrequency ablation

It is recommended to rest in bed for several days

Once the symptoms subside, it is necessary to start moving, gradually increasing the range of motion and the load. At the moment, active kneading, massage is undesirable due to possible complications.

Osteochondrosis: treatment without exacerbation

When the patient's condition stabilizes, the usual lethargy remainsosteochondrosis, the treatment consists of several components:

  • Medication. All the same anti-inflammatory painkillers in tablets, capsules and ointments. A particular drug is selected by the doctor based on the patient's condition, lifestyle, co-morbidities, dominance of one or the other component of osteochondrosis. A series of B vitamins will improve the conduction of pulses along the nerve, will normalize the nutrition of tissues. While maintaining increased muscle tone, the use of muscle relaxants will continue. There is no magic pill, an injection that could restore the vertebrae and cartilage to their original state. Medications relieve symptoms, improve mobility and performance. But they are not able to completely stop the progression of the disease.
  • Physiotherapy. It is used to administer drugs directly to the irritated spot (electrophoresis), heating (paraffin, infrared radiation). Exposure to therapeutic currents relaxes the muscles, improves the function of nerve fibers. After several sessions, the pain decreases, mobility is restored. Not prescribed for active inflammation
  • Manual handling, massage, acupuncture, acupuncture. Relieve the spasm by stretching and relaxing the muscles. If during the massage only the upper layer of the muscles is affected, then the manual therapy penetrates deeper, therefore the requirements for specialists are higher. Be sure to have an MRI scan first to find out the anatomical features of a particular patient
  • Spinal traction. The vertebrae are removed from each other, the normal distance between them is restored, the sting of the nerves is reduced. The procedure has contraindications, so only a doctor can prescribe it
  • Physiotherapy. The most effective method of treatment. The only caveat is that it must be applied for life. Of the advantages - provides activity, improves mood, increases tissue tone. The best methods are a set of exercises suggested by the doctor, basic yoga asanas, pilates, swimming. Performed smoothly, without sudden and traumatic movements, stretching the tissue, gradually increasing the width
  • Proper nutrition and giving up bad habits
  • Adequate supply of nutrients to the tissues, good condition of the blood vessels and adequate supply of blood to the vertebrae and the structures around them are measures to prevent the development of osteochondrosis. Proper nutrition normalizes weight, reduces stress on the spine

Surgical treatment of osteochondrosis of the spine.Modern clinics have a large arsenal of minimally invasive interventions:

  • Treatment and diagnostic exclusion
  • Removal of faces with radio frequencies
  • Cold plasma and laser nucleoplasty
  • Endoscopic disc herniation removal
  • Microdiscectomy

Thermal radiofrequency ablation of the facial joints

Special needles are placed right next to the intervertebral joints where the medial branch of the Lyushka nerve passes. Electrodes are placed on the needles, the tip of which is heated to 80 degrees for 90 seconds. This leads to nerve coagulation. The pain goes away.

Cold plasma nucleoplasty

Through a needle inserted into the disc, a special cold plasma electrode is applied to the disc tissue. The intra-disc pressure decreases, the hernia (protrusion) is pulled inwards.

Microdiscectomy

With a disc herniation, the adjacent nerve roots and blood vessels are compressed, extremely painful sensations appear and various disorders of the nerve endings. If the effect of conservative treatment no longer exists, then disc herniation surgery is the only possible solution for many patients. The operation is performed under anesthesia through a 2-3 cm incision using microsurgical equipment and tools. The duration of the operation is 45-60 minutes. The pain syndrome is significantly reduced or disappears completely immediately after surgery in 95% of patients. The next day the patient is allowed to walk and soon leaves the clinic.

Endoscopic disc herniation:

A hernia or loose ligament is removed through the lateral intervertebral foramen. For the placement of the tube, a 5 mm incision is made in the skin. Muscles, fascia and ligaments are not destroyed, they are removed using a system of piping with a gradual increase in diameter. The operation is almost bloodless and lasts only 40-50 minutes. Patients can return to their normal shape after three weeks. The risk of complications is minimal.

Decompression and stabilization operations are performed when complications occur, large disc herniation, severe compression of the spinal nerve root and spinal cord. If there are signs of sudden loss of sensitivity, movement, pelvic dysfunction, the patient should be transported urgently to a neurosurgeon. The sooner the compression can be eliminated, the more complete the recovery will be, the person will quickly return to normal life. In this case, the surgical treatment aims at decompressing the compressed nerve structures and stabilizing the affected part. This is a semi or horseshoe. Fastening is performed by a bipod system, in combination with an in-body cage, which provides 360 degree fusion. Intermediate stabilization of the vertebrae is widely used. Today there are several intermediate implants. Microdiscectomy in combination with intermediate stabilization, especially in the elderly, can significantly increase the effectiveness of long-term outcomes and reduce the likelihood of recurrent disc herniation.