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Common osteochondrosis

pain due to osteochondrosis

As a result of man's upright gait, the spine, as an axial structure, assumed 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 causes serious 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, most frequently affecting the thoracic, lumbar and cervical regions. 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 section of one department or several departments at the same time. 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. The symptoms of common osteochondrosis are associated with this, but it is worth noting that the disease can be asymptomatic for some time.

Important! The pathology requires multidisciplinary control, since 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 generalized osteochondrosis. Some of them are associated with congenital skeletal defects, others with inadequate loading during vigorous activity. Particularly common factors that contribute to the development of the clinical picture are:

  • injuries;
  • flatfoot;
  • clubfoot: deformation of the foot (equinovarus, varus, valgus, depending on the position of the heel);
  • work related to lifting heavy objects;
  • playing sports without warming up or warming up your 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 alter the biomechanics of the spine and contribute to the rapid wear of the intervertebral discs.

Pain in generalized osteochondrosis may be a consequence of osteophytes or disc deformation. The pain is usually radicular, that is. associated with compression of the posterior nerve roots.

Common osteochondrosis easily imitates other ailments. With damage to the thoracic region, pain appears in the heart area and is confused with ischemic processes, and with damage to the lumbar regions - with radiculitis.

Symptoms

The clinical manifestations will depend on which parts are affected and in what combination.

When the cervical spine is affected, the following are characteristic:

  • unstable blood pressure;
  • headache;
  • lack of coordination;
  • pain in the 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:

  • fire;
  • urinary 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 disruptions in the functioning of internal organs. Common polysegmental osteochondrosis can sometimes worsen. In such cases, the manifestations are much more intense. With a combination of multi-part disorders, the symptoms will be corresponding.

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 vital activity, and severe osteochondrosis, which is often characterized by complications.

Moderate osteochondrosis is easily treated with conservative treatment. And if it is impossible to completely stop the inevitable aging process, it is quite possible to slow it down significantly. The complications that severe osteochondrosis can cause are the following.

  1. Spondylarthrosis.
  2. Intervertebral disc degeneration.
  3. Spinal stenosis.

Important! The intervertebral discs act as shock absorbers and reduce friction between the vertebrae. Degenerative processes in these structures can cause a protrusion of the nucleus pulposus of the disc and an intervertebral hernia. The protrusion causes compression of the roots and pain.

Spondyloarthrosis is the degeneration of the facet joints that connect adjacent vertebrae. Otherwise, these joints are called facet joints. When the articular cartilage is damaged, painful contact occurs between the vertebrae. With degeneration of the facet joints, bone growths appear more often, which leads to spondylosis.

Stenosis is a narrowing (in this case, of the spinal canal). Normally, stenosis is the result of pathologies such as intervertebral hernia or spondylosis. Bony growths and hernial protrusions compress 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;
  • rigidity;
  • sudden muscle weakness;
  • decreased reflexes;
  • tingling in the extremities;
  • radiating pain;
  • sciatica symptoms.

Sciatica is caused by compression of the sciatic nerve.

Classification

There are four degrees of osteochondrosis. The classification occurs on the basis of the collected history and with the help of instrumental diagnostic methods. The main criteria for this classification are pain and neurological symptoms.

  1. Grade: Pain is easily relieved with medications.
  2. Grade II: characterized by prolonged pain and deformation of the spine with moderate neurological symptoms.
  3. III degree: the pain is systematic, the neurological symptoms are significant.
  4. Grade IV: constant pain, multiple neurological deficits. Alteration in the conduction of nerve impulses. Paralysis and paresis.

In case of generalized dysplastic osteochondrosis, the patient is assigned a disability status. Depending on the general condition of the patient, the degree and intensity of the development of the clinical picture, disability can be of three groups.

Types of disability in osteochondrosis.

Cluster Description
First group The functions of the column are lost. The patient is unable to move independently or take care of himself.
Second group The patient is able to move and perform small tasks, but periods of exacerbation are frequent. The operation is contraindicated or is useless for some reason. Or surgery has already been performed, but it was ineffective.
Third group The patient is able to take care of himself. There is pain and vestibular symptoms, but the frequency of exacerbations is moderate and periodic.

The disability group is assigned by the doctor based on some studies to evaluate the ability to work.

Diagnosis

When visiting a doctor, the diagnosis will consist of several components. The first and most important is the collection of a history based on subjective information provided by the patient. Attention is paid to family history, since osteochondrosis has a genetic component. The specialist asks about the place of work, living conditions and the course of the disease, and the patient must describe exactly what worries 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 extremities, which may be markedly reduced due to pain and stiffness. Using the palpation method, he records how many muscles spasm and how curved the spine is. Attention is drawn to a neurological examination, with the help of which weakened reflexes can be traced. This symptom may be the result of compression or damage to the nerve.

Instrumental methods for diagnosing common osteochondrosis include:

  1. X-ray of the entire spine in two projections.
  2. MRI to evaluate ligaments and nervous tissue.
  3. An electrophysiological study to test the conduction of nerve impulses.

X-ray is 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.

CT scan can also be used in conjunction with MRI. Using a CT scan, the degree of compression of the nerves by the spurs can be determined.

The diagnosis of generalized polysegmental osteochondrosis is made if other pathologies that cause destruction of the vertebrae are excluded (for example, tuberculosis) and if several segments of one or more sections are affected.

There are additional diagnostic methods. These include:

  1. Bone scan.
  2. Discography.
  3. 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 to determine 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 is injected into the spinal canal and the image is recorded using x-rays or a CT scan. Using this method, it is possible to determine the condition of the spinal cord, the presence of narrowing and compression.

Treatment

The treatment is based on the following mechanisms.

  1. Slow down the degenerative process by improving the supply of nutrients to the structures of the musculoskeletal system.
  2. Spinal stabilization.
  3. Removal of pinched nerve fibers.
  4. Relieve symptoms.

The following drugs are used for drug treatment:

  • non-steroidal 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 spasms and increase range of motion;
  • B vitamins to improve the conductivity of nervous tissue;
  • chondroprotectors, which reduce the rate of progression of degenerative processes by integrating active substances (condoitin sulfate and glucosamine) into 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, lactation and the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
  • antispasmodics relieve smooth muscle spasms and thereby alleviate the manifestations of osteochondrosis in internal organs;
  • antioxidants;
  • antidepressants to eliminate the psychosomatic component of this disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. It promotes the production of endorphins and helps solve the problem of chronic insomnia due to constant pain.
  • neuropathic agents to eliminate damage to nerve endings.
  • Opioids for unbearable pain and the ineffectiveness of other pain relievers.

The following are used as invasive medical procedures:

  • Steroid injection into the epidural space. Steroids are powerful anti-inflammatory medications. They relieve inflammation of the nerve roots, which helps relieve pain caused by radiculopathy. Complicated procedure. Requires a qualified specialist;
  • facet joint injections. The injected drugs cause local numbness and pain relief.

It's important to know! Taking medication is not intended to get rid of the disease; There are no medications that can completely eliminate osteochondrosis, which is a chronic disease. Medications are prescribed only to relieve symptoms.

Medications are prescribed by the treating doctor. The patient is informed about the possible side effects of each drug and then decides for himself which course of treatment to choose.

If you have symptoms that raise suspicion of osteochondrosis, contact a vertebrologist, orthopedist and neurologist. High-quality medical care will consist of close collaboration of these specialists with each other and with the patient.

Physiotherapy

Physiotherapy is used as a set of auxiliary therapeutic measures to improve blood circulation and metabolism in the affected tissue. For generalized osteochondrosis, the following methods are used.

  1. Electrophoresis (based on the movement of colloidal particles under the influence of an external electric field).
  2. Phonophoresis (a combination of ultrasound and medication).
  3. Magnetotherapy (use of a static magnetic field).
  4. UHF therapy (ultra high frequency therapy).
  5. Electromyostimulation (nerve and muscle stimulation).
  6. Acupuncture (acupuncture).
  7. Laser exposure.

In addition to physiotherapy, manual therapy and physiotherapy are actively used. Professional massage can lead to long-term remission. Therapeutic exercise should not be performed during an exacerbation of the disease, as this can lead to complications. During the remission period, moderate physical activity maintains muscle tone and, therefore, the spine. The exercises are performed under the supervision of an instructor and are prescribed by the treating doctor.

During an exacerbation, the spine cannot be warmed, but a corset can be worn, but only for a few hours. In other cases, wearing a corset for more than a few hours is not optimal because it can cause muscle atrophy.

Manual therapy can increase the clearance of pinched nerves and reduce neurological symptoms. Alternative methods are leeches and vacuum massage. These methods aim to improve blood circulation in the affected area. Health spa treatment is helpful. Special preference is given to water procedures.

Surgery

In the treatment of osteochondrosis, specialists are more willing to resort to conservative therapy, but to obtain the proper effect, a lot of time, patience and strict adherence to the patient's recommendations are required. If conservative treatment is ineffective, only then should invasive methods be resorted to. Generally the operation is palliative. This means that the operation will be performed only to relieve symptoms and comparatively improve the quality of life, but not for a complete cure (it is fair to say that conservative treatment also does not lead to complete elimination of the disease, but to the receptivity of the patient). to non-invasive therapy is a sign of good prognosis).

There are two types of surgery: decompression and stabilization. The first aims to relieve nerve compression and the second aims to stabilize the spine. The following operations are classified as decompression operations.

  1. Facetectomy: removal of the facet joints to relieve compression.
  2. Foraminotomy is an increase in the lumen of the spinal canal, which has been narrowed due to osteophytes.
  3. Laminectomy is the removal of the back part of the vertebra, which may be deformed due to osteochondrosis.
  4. Laminotomy: removal of a fragment of the back of the vertebra to widen the spinal canal.

These operations require a posterior approach, but in the case of intervertebral hernia the surgical approach will be anterior.

Decompression surgeries with an anterior approach are as follows.

  1. Discectomy: removal of an intervertebral disc.
  2. Corpectomy: removal of the entire vertebral body with adjacent discs.

Stabilization operations include:

  1. Spinal fusion is a method of fusing vertebrae.
  2. Artificial intervertebral disc.

The need for stabilization operations arises after discectomy.

Surgeries are rarely prescribed because there is a risk of developing serious complications.

Complications include:

  • pain relapses;
  • false union;
  • infection;
  • phlebitis in the extremities;
  • violation of the act of urination;
  • pain due to graft;
  • failure of embedded fasteners.

The postoperative period lasts several months. The sutures heal 2 weeks after surgery. 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 working capacity.

General recommendations

Proper nutrition helps prevent relapses of exacerbation of common osteochondrosis. Proper nutrition is necessary primarily to maintain a stable body weight, since excess weight puts additional pressure on the spine. In this case the diet must be complete, fortified and rich in calcium, magnesium and potassium. It is necessary to limit coffee consumption as it removes calcium from the body. It is useful to visit the pool. You should avoid staying in the same position all the time.

If there are frequent exacerbations and lack of discipline to strictly follow the recommendations, it is best to undergo full treatment in a hospital under the supervision of a doctor.

You cannot take medicine on your own.

let's summarize it

Often, generalized osteochondrosis develops after a "single" osteochondrosis that is not completely cured. This fact suggests that if any discomfort occurs, you should immediately go to the doctor, without waiting for the pain to go away on its own. In this case, it will be much easier to prevent the development of other pathologies, and even more so to cure the root cause.