Because humans walked upright, the spine, as an axial structure, took on the main load. That is why degenerative and dystrophic processes are widespread consequences of human life. One of the most common diseases of the musculoskeletal system is osteochondrosis, which causes severe discomfort and can lead to disability. This article will discuss the most severe form of this pathology - common osteochondrosis.
general characteristics
Osteochondrosis is a degenerative disease of the spine that most commonly affects the thoracic, lumbar and cervical regions. This pathology is directly related to age. The disease is significantly more common in people over 40 years old, but recently there has been a trend towards rejuvenation. The difference from common osteochondrosis is that it affects more than one section of one department or several departments at once. As a result of 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. Associated with this are the symptoms of ordinary osteochondrosis, but it is noteworthy that the disease may be asymptomatic for some time.
Important! Pathology requires multidisciplinary control because it affects not only the musculoskeletal system, but also the nervous system and 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 insufficient loads during intense activity. Particularly common factors that contribute to the development of the disease are:
- injuries;
- Flat feet;
- Clubfoot – deformation of the foot (equinovarus, varus, valgus, depending on the position of the heel);
- work involving heavy lifting;
- playing sports without warming up or warming up the muscles;
- work at low temperatures.
Low temperatures are considered provoking factors, since cold temporarily changes the molecular structure of soft tissues, reduces the intensity of blood circulation, reduces the conductivity of nerve impulses and metabolism, and therefore 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 extensive osteochondrosis can be a consequence of osteophytes or disc deformation. The pain is usually radicular, i. e. H. associated with compression of the posterior nerve roots.
Common osteochondrosis easily mimics other complaints. With damage to the thoracic region, pain occurs in the cardiac region and is confused with ischemic processes, with damage to the lumbar region with radiculitis.
Symptoms
The clinical manifestations depend on which parts are affected and in what combination.
The following features are characteristic of an infection of the cervical spine:
- unstable blood pressure;
- Headache;
- lack of coordination;
- pain in hands;
- Numbness in the upper body and arms.
For pathology in the chest area:
- intercostal neuralgia;
- stiffness in arms and neck;
- Dysfunction of internal organs.
If the lumbar spine is affected:
- Combustion;
- urinary tract diseases;
- Cramps;
- Pain when walking.
From 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 dysfunction of internal organs. Common polysegmental osteochondrosis can sometimes worsen. In such cases, the manifestations are much more intense. If there is a combination of disorders in several departments, the symptoms are the same.
Complications
Osteochondrosis can be conditionally 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 slow it down significantly. The complications that severe osteochondrosis can lead to are as follows.
- 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 bulging of the disc nucleus and intervertebral herniation. Protrusion leads to root compression and pain.
Spondyloarthrosis is a degeneration of the facet joints that connect adjacent vertebrae. In other words, such joints are called facet joints. If the articular cartilage is damaged, painful contact occurs between the vertebrae. Degeneration of the facet joints most often results in bone overgrowth that leads to spondylosis.
A stenosis is a narrowing (in this case of the spinal canal). Typically, stenosis is the result of pathologies such as an intervertebral hernia or spondylosis. Bone growths and fracture 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;
- decreased reflexes;
- tingling in the limbs;
- radiating pain;
- Sciatica symptoms.
Sciatica is caused by compression of the sciatic nerve.
classification
There are four degrees of osteochondrosis. The classification is based on the anamnesis taken and with the help of instrumental diagnostic methods. The main criteria of this classification are pain and neurological symptoms.
- I degree – pain can be easily relieved with medication.
- II degree – characterized by persistent pain and deformation of the spine with moderate neurological symptoms.
- III. Degree – Pain is systematic, neurological symptoms are significant.
- Grade IV - constant pain, multiple neurological deficits. Disturbance in the transmission of nerve impulses. paralysis and paresis.
With extensive dysplastic osteochondrosis, the patient is assigned disability status. Depending on the general condition of the patient, the degree and intensity of development of the clinical picture, the disability can be divided into three groups.
Types of disability in osteochondrosis.
| group | Description |
|---|---|
| First group | The functions of the spine are lost. The patient is unable to move independently and care for himself. |
| Second group | The patient is able to move and perform minor tasks, but periods of exacerbation often occur. The operation is contraindicated or useless for some reason. Or an operation has already been performed but proved ineffective. |
| Third group | The patient is capable of self-care. Pain and vestibular symptoms occur, but the frequency of exacerbations is moderate and periodic. |
The classification of the disability group is carried out by the doctor based on a number of studies to assess the ability to work.
diagnosis
When visiting a doctor, the diagnosis consists of several components. The first and most important thing is to collect an anamnesis based on subjective information from the patient. Attention is paid to family history, as 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 has to describe exactly what is bothering him. The best results can be achieved with good feedback between patient and doctor.
The next method is an objective examination, carried out by a specialist himself or using instrumental methods. The doctor checks the mobility of the neck and limbs, which may be noticeably limited due to pain and stiffness. Using the palpation method, he records how severely the muscles are tense and how much the spine is curved. A neurological examination is recommended, which can be used to detect weakened reflexes. This symptom may be due to compression or damage to the nerve.
Instrumental methods for diagnosing common osteochondrosis include:
- X-ray of the entire spine in two projections.
- MRI to assess ligaments and nerve tissue.
- An electrophysiological study to test the conduction of nerve impulses.
X-rays are effective in 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 compression of the nerves by the spurs.
The diagnosis of extensive polysegmental osteochondrosis is made when other pathologies leading to the destruction of the vertebrae (for example, tuberculosis) have been excluded and several segments of one or more departments are affected.
There are additional diagnostic methods. These include:
- Bone scan.
- Discography.
- Myelogram.
A bone scan can detect conditions such as osteoarthritis, fractures or infections. This method is a radionuclide and is suitable for differential diagnosis and determination of 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 contrast research method. Contrast medium is injected into the spinal canal and the image is recorded using an X-ray or CT. This method allows you to determine the condition of the spinal cord, as well as the presence of narrowings and compressions.
Treatment
Treatment is based on the following mechanisms.
- Slowing down the degenerative process by improving the nutrient supply to the structures of the musculoskeletal system.
- Stabilization of the spine.
- Elimination of pinched nerve fibers.
- Relief of symptoms.
The following drugs are used for drug treatment:
- nonsteroidal anti-inflammatory drugs that reduce inflammation and pain;
- Anilides relieve pain in the initial stages;
- local analgesics in the form of ointments;
- muscle relaxants to reduce muscle spasms and increase range of motion;
- B vitamins to improve the conductivity of nervous tissue;
- Chondroprotectors that slow down the progression of degenerative processes by integrating active ingredients (chondoitin sulfate and glucosamine) into the cartilage cells. As a result, metabolism is normalized and clinical manifestations are reduced. The drug has been used for a long time and requires special consultation during pregnancy, breastfeeding and in the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
- antispasmodics relieve spasms of smooth muscles, thereby alleviating the manifestations of osteochondrosis in internal organs;
- antioxidants;
- Antidepressants to eliminate the psychosomatic component of this disease. They disrupt the transmission of nerve impulses from the central nervous system to the brain. Promote the production of endorphins and help solve the problem of chronic insomnia due to constant pain.
- neuropathic agents to eliminate damage to nerve endings.
- Opiates for unbearable pain and ineffectiveness of other painkillers.
The following invasive medical procedures are used:
- Injection of steroids into the epidural space. Steroids are powerful anti-inflammatory drugs. They relieve inflammation of the nerve roots, which helps relieve the pain caused by radiculopathy. Complicated procedure. Requires a qualified specialist;
- Injections into the facet joint. The injected drugs cause local numbness and pain relief.
It is important to know! Taking medication is not intended to get rid of the disease - there are no medications that could completely eliminate osteochondrosis, a chronic disease. Medications are only prescribed to relieve symptoms.
Medications are prescribed by the attending physician. The patient is informed about the possible side effects of each medication and then decides for himself which treatment method to choose.
If you have symptoms that give rise to suspicion of osteochondrosis, contact a vertebral doctor, orthopedist and neurologist. High-quality medical care requires these specialists to work closely with each other and with the patient.
physical therapy
Physiotherapy is used as a series of supportive therapeutic measures to improve blood circulation and metabolism in the affected tissue. With widespread osteochondrosis, the following methods are used.
- Electrophoresis (based on the movement of colloidal particles under the influence of an external electric field).
- Phonophoresis (a combination of ultrasound and medication).
- Magnetotherapy (use of a static magnetic field).
- UHF therapy (ultra high frequency therapy).
- Electromyostimulation (stimulation of nerves and muscles).
- Acupuncture (acupuncture).
- Laser exposure.
In addition to physiotherapy, manual therapy and physical therapy are also actively used. A professional massage can lead to long-term remission. During an exacerbation of the disease, therapeutic exercises should be avoided, as this can lead to complications. During the remission phase, moderate physical activity maintains muscle tone and therefore the spine. The exercises are carried out under the supervision of an instructor and prescribed by the attending physician.
During an exacerbation, you cannot warm up the spine, but you can wear a corset, but only for a few hours. In other cases, wearing a corset for several hours is not optimal as it can cause muscle loss.
Manual therapy can improve clearance of pinched nerves and relieve neurological symptoms. Alternative methods include leeching and vacuum massage. These methods are aimed at improving blood circulation in the affected area. A sanitary spa treatment makes sense. Water treatments are particularly preferred.
surgery
When treating osteochondrosis, specialists are more willing to resort to conservative therapy. However, for the correct effect to occur, a lot of time, patience and scrupulous adherence to the patient's recommendations are required. Invasive methods should only be resorted to if conservative treatment is ineffective. Usually the operation is palliative. This means that the operation is performed only to relieve symptoms and comparatively improve the quality of life, but not to achieve complete cure (it is fair to say that conservative treatment also does not lead to complete elimination of the disease, but to improvementthe patient's receptivity). 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, the second at stabilizing the spine. The following operations are classified as decompression operations.
- Facetectomy – Removal of the facet joints to relieve compression.
- Foraminotomy is an enlargement of the lumen of the spinal canal, which has become narrowed due to osteophytes.
- Laminectomy involves removing the posterior part of the vertebra, which may be deformed due to osteochondrosis.
- Laminotomy – removal of a fragment of the posterior part of the vertebra to widen the spinal canal.
These operations require a posterior approach, but in the case of an intervertebral hernia, the surgical approach is from the front.
Anterior approach decompression operations are as follows.
- Discectomy – Removal of an intervertebral disc.
- Corpectomy – removal of the entire vertebral body with adjacent intervertebral discs.
Stabilization operations include:
- Spinal fusion is a method of fusing vertebrae.
- Artificial intervertebral disc.
The need for stabilizing operations arises after a discectomy.
Surgery is rarely prescribed due to the risk of serious complications.
Complications include:
- relapses of pain;
- false union;
- Infection;
- phlebitis in the limbs;
- Violation of urination;
- pain due to transplantation;
- Failure of embedded fasteners.
The postoperative period lasts several months. The sutures heal 2 weeks after the operation. If complications are detected, you should immediately consult a doctor.
After the operation, a rehabilitation course is carried out to accelerate the healing process and restore full performance.
General recommendations
Proper nutrition helps prevent relapses or exacerbation of common osteochondrosis. Maintaining a stable body weight requires proper nutrition, as excess weight puts additional strain on the spine. In this case, the diet should be complete, fortified and rich in calcium, magnesium and potassium. It is necessary to limit coffee consumption as it deprives the body of calcium. It makes sense to visit the swimming pool. You should avoid staying in one position all the time.
With frequent exacerbations and lack of discipline to strictly follow the recommendations, it is best to undergo full treatment in a hospital under medical supervision.
You cannot take medication on your own.
Let's summarize it
Often, extensive osteochondrosis develops after an incompletely healed "single" osteochondrosis. This fact suggests that if any discomfort occurs, you should immediately consult a doctor, without hoping that the pain will go away on its own. In this case, it is much easier, to prevent the development of other pathologies and, above all, to cure the root cause.