Spinal osteochondrosis symptoms and treatment. Causes, symptoms and prevention of osteochondrosis

Dystrophic processes and dysfunction of the intervertebral discs of the cervical spine are called cervical osteochondrosis (COX).

What is cervical osteochondrosis?

- This is a disease in which the soft intervertebral pulp, which acts as a shock absorber between the vertebrae, degenerates into ossified tissue, while nerve roots and blood vessels are involved in the pathogenesis. This pathology masquerades as a variety of disorders. A distinctive feature of osteochondrosis of the cervical spine is pain in the head, neck and upper back. Also, patients go to the doctor with nausea, loss of consciousness, lack of air, numbness of the tongue, with suspicion of angina pectoris and other pathologies of the cardiovascular system.

This means that a person who feels pain in the back of the head, shoulders, arms, sternum and in the retrosternal region complains not only to a neurologist, but also to doctors of other medical specialties (cardiologist, therapist, orthopedist), which seriously complicates the initial diagnosis of the disease. .

Dystrophic changes in the tissues of the cervical spine are widespread among middle-aged and older people. This is due to the vertical arrangement of the human skeleton and the distribution of static and dynamic loads.

The wide distribution of cervical osteochondrosis is explained by the peculiarities of the exit of the roots of nerve endings in the upper part of the spinal column and the mobility of the neck joints, which bear the load of keeping the cranium in an upright position.

Approximately 60% of the adult population of European countries suffer to some extent from the clinical manifestations of osteochondrosis. It is noticed that this disease manifests itself earlier in men - at 45-50 years. Women usually get sick a little later, at about 50-55 years of age.

In modern society, rejuvenation of osteochondrosis of the neck is taking place. When examining representatives of different generations with a tendency to this disease, it was reliably established that today's young people begin to experience difficulties with the spine much earlier in comparison with the representatives of the older generation of the family, sometimes even in adolescence. People born 60-70 years ago first go to a medical institution for cervical osteochondrosis in adulthood or even in old age, but people born 20-40 years ago often get osteochondrosis at a young age. This indicates a significant deterioration in the health of the younger generation, which is associated with a sedentary lifestyle and a decrease in the quality of nutrition.

OsteochondrosisIt is customary to consider in two ways, always in the relationship of physiological (natural aging of the body) and pathological (dystrophic and inflammatory processes) factors:

Physiological process - the inevitable aging of the cartilage of the spinal column, regulated by the neuro-endocrine mechanisms of the body as a result of natural irreversible phenomena;

The pathological process is the destruction of the intervertebral structures and the nerve nodes and blood vessels surrounding the vertebrae - the less healthy the lifestyle, the faster the disease develops.

From the point of view of the localization of the pathological process:

Physiological changes are located in the center of the intervertebral disc, are accompanied by replacement of the pulp of the disc with fibrous tissue, are part of the aging process of the body, are not clinically manifested or appear only when the nerve endings are irritated;

Pathological changes spread outside the cartilage, always cause irritation of nerve endings and compression of blood vessels, which is manifested by local and reflected pain reactions (dyscalgia).

The pathological form of osteochondrosis is the replacement of physiological aging with a pathological process.

The disease can be eliminated on its own, compensated and manifest itself episodically. This feature is associated with the ability of the organism of higher mammals and humans to develop compensatory and protective mechanisms that level pathology. Meanwhile, it is inappropriate to test the body for strength.

The pathological form of the disease is always associated with the aging of the body, even in young people. Further destruction of the tissues of the annulus fibrosus without replacing the pulp with fibrous tissue leads to the formation of microcracks, impaired fixation of the vertebrae, and the development of symptoms of spinal instability.

The pathogenesis is accompanied by:

Impregnation of the nucleus pulposus with calcium salts;

By pressing the structures of a vertebra into the body of an adjacent vertebra (like a hernia);

Gradual wear of the vertebrae (spondylosis);

Ossification of ligaments (ossifying ligamentosis).

Diagnosis of the disease is difficult, pain is sometimes not manifested, and the symptoms are blurred, in addition, the uncontrolled use of strong analgesics masks the signs of the disease. A patient who does not feel pain considers himself healthy, and this continues until the development of irreversible processes in the tissues of the neck joints.

Important symptoms of cervical osteochondrosis are dizziness, jumps in blood pressure.

Dizziness with cervical osteochondrosis

This condition does not always clearly indicate osteochondrosis of the cervical spine.

Dizziness may be due to:

Inflammation in the middle or inner ear;

Spasms of cerebral vessels;

Violations of the transmission of nerve impulses;

Problems with the vestibular apparatus;

There are no clear criteria for dizziness in osteochondrosis. However, there are systemic and non-systemic dizziness, they have clear differences.

Systemic dizziness- this is a feeling of circular movement of surrounding objects or the body, which is a consequence of a disruption in the functioning of the vestibular apparatus, visual analyzers and receptors in the joints, muscles and epidermis (osteochondrosis of various etiologies);

Non-systemic dizziness- this is a feeling of dizziness, a feeling of stupor, an insecure state in an upright position. With non-systemic dizziness, there is no sensation of circular rotation, and this is an important difference between the compared signs.

A person who feels dizziness of one of these types should be examined by an experienced doctor, first of all, by a neuropathologist or (if there is a suspicion of an ear and nasopharyngeal disease) by an otolaryngologist.

The reason for emergency hospitalization, not associated with osteochondrosis of the cervical spine, is the identification in the patient (except for dizziness) of such signs as:

Paralysis of the facial muscles and numbness of part of the shoulder girdle;

Severe headache against the background of deterioration of health;

Disturbances in coordination of movements;

Loss or extinction of consciousness.

Headache with cervical osteochondrosis

This is one of the most common non-specific signs of many human diseases. Headaches are especially prevalent in the female population. It can be difficult to determine the cause of headaches, and, even more so, to associate it with spinal lesions. About 14 different causes of headache in humans have been identified.

The most common causes of headache in the pathology we describe are:

Spasms of cerebral vessels;

Pinched nerve roots;

Reflex increase in intracranial pressure.

Headache with cervical osteochondrosis may resemble sensations with arterial hypertension, or a stroke. Moreover, middle-aged and older people, as a rule, have risks of developing or.

The pain can feel like paroxysmal, constant, throbbing and dull.

With pathologies of the heart, patients complain of discomfort in the chest area, accompanied by a violation of the rhythm of cardiac activity. Only a qualified doctor can determine the cause. In the event of headaches, combined with nausea, dizziness and retrosternal pain, an ECG is mandatory.

Pain in osteochondrosis of the cervical region

Not always the pain is localized in the head and neck. Cases of other localization of pain are known.

Neck pain (cervicalgia) can radiate to the shoulder area and to various parts of the arms. A distinctive feature of such sensations is the suddenness of seizures after sleep, sudden movements, and tensions that are hardly noticeable to a person, for example, when laughing or sneezing. The pain associated with osteochondrosis, if the process has not become chronic, usually subsides after some short time and is combined with a crunch in the cervical vertebrae.

Without a preliminary examination, pain should not be relieved with manual therapy (massage). In some cases, inept manipulation can only aggravate the pathology, disrupt the innervation and lead to the patient's disability.

The intensity of the pain can be moderate or severe. By duration - both short and long.

Typical sensations described by patients:

Localization of pain in the depth of the neck;

Sensation of crunching and crackling when you try to turn your head;

Muscle weakness or decreased sensation in different parts of the body.

In the cervical region of all mammals, including humans, there are seven vertebrae and eight pairs of ganglions. MOC can also develop at the border of the cervical and thoracic vertebrae.

It is noted that osteochondrosis of the cervical region is most often associated with lesions of the sixth and seventh cervical vertebrae.

There are tests to determine the localization of the focus of the pain impulse. A lesion in the region of the sixth vertebra is accompanied by pain in the thumb, and a lesion in the region of the seventh vertebra is accompanied by pain in the middle finger.

Blood pressure in cervical osteochondrosis

The connection of cervical osteochondrosis with jumps in blood pressure has long been established. The cervical vertebrae have important nerve endings and blood vessels.

Characterized by pressure surges during the day. Hypertension for a long time is not characteristic of this disease. Reflex irritation of nerve endings and short-term spasms of blood vessels cause spasmodic daily dynamics of arterial hypertension.

A distinctive feature of high blood pressure in cervical osteochondrosis is a combination with the following symptoms:

Headache;

Pain in limbs and chest;

Decreased sensitivity in the area of ​​the collar zone;

The occurrence of pressure surges after stress, muscle tension, prolonged exposure to an uncomfortable position and other similar situations.

These signs should be taken into account in self-differentiation of hypertension of various origins.

Sharp jumps in blood pressure and a rapid deterioration in well-being are the basis for seeking emergency medical help.

The reasons are always associated with the aging of the body and the developed pathology of bone and cartilage tissue. However, not all people in old age suffer from various types of skeletal pathologies.

Numerous observations have established that cervical osteochondrosis has provoking factors, including:

Sedentary lifestyle;

Forced postures in the process of work;

Excessive nervous tension and prolonged;

Previous injuries in the back of the head and neck;

Local hypothermia;

Autoimmune diseases that lead to cartilage degeneration;

Congenital anomalies in the structure of the spine.

Moderate physical activity, a healthy diet and a proper lifestyle significantly reduce the risk of osteochondrosis, or minimize its impact on well-being in old age.

Why is cervical osteochondrosis dangerous?

Decreased flexibility in the joints, muscle elasticity and other signs of aging of the body - unconditional companions of the elderly - is a natural process.

Pain during movement and at rest begin to annoy a person much earlier than the natural aging period, sometimes it ends with disability or a significant decrease in the quality of life.

Inept treatment is just as dangerous as inaction, because in the first case, the pathology worsens without quality treatment, in the second, inept therapy can result in sudden disability or a persistent deterioration in well-being, because therapeutic manipulations affect the two most important body systems - nervous and vascular.

Syndromes of cervical osteochondrosis

Syndromes are a combination of several symptoms. There are several symptom complexes of cervical osteochondrosis, the main ones are:

Vertebral or vertebral;

vertebral artery;

Cardiac or cardiac;

Nerve endings (radicular).

The combination of different syndromes, like a mosaic, develops into a single picture of cervical osteochondrosis.

Vertebral syndrome

This syndrome means that pathological processes are associated with the body of bone and cartilage tissue.

In the case of clinical manifestation, the syndrome consists of three symptoms associated with damage to the bone or cartilage tissue of the vertebrae, namely:

Impaired mobility of the neck;

Pain when trying to turn the neck;

Morphological changes in the vertebral body or in the intervertebral space (the symptom is determined on the x-ray).

These symptoms must be combined with each other. In the absence of one of them, there is also no vertebral syndrome - this is a medical axiom. In the presence of pain during head rotation, morphological changes in the tissues of the bones and cartilage of the cervical skeleton can always be assumed, and by indirect signs (change in the place of sensitivity), it is possible to determine a specific vertebra or group of joints involved in the pathology.

The difficulty in diagnosing vertebral syndrome lies in the fact that a similar clinical picture (limitation of neck mobility) can also be detected with lesions of the neck muscles (myositis), and the main symptom of the syndrome - pain with an active change in the position of the neck - is often the result of other pathological processes in the human body.

vertebral artery syndrome

This syndrome means that pathological processes are associated with the vertebral arteries that supply the brain. The manifestation of symptoms should be considered in direct connection with a violation of the blood supply to the brain and tissues of the cervical region.

The syndrome consists of several symptoms. The main ones are related to:

Insufficient blood flow in one of the trunks due to arterial compression (, state of stunning, dizziness, pressure surges, nausea, and);

Irritation of the nerve endings of the artery (severe pain and vice versa, numbness, decreased sensitivity, temporary one-sided blindness or "flies" in the eyes);

Oxygen starvation (drowsiness, fainting, mild aching headache, decreased performance and concentration,).

This syndrome can develop not only with osteochondrosis, but also with other pathologies (deposition of atherosclerotic plaques on the inner wall of blood vessels, squeezing of the vessel by tumors, inflammatory infiltrate, and so on).

Cardiac syndrome

Signs of this syndrome resemble cardiac disorders, angina pectoris, and even a condition preceding a heart attack. The syndrome includes the following symptoms:

Pain and burning in the chest area;

Shortness of breath, weakness and fatigue;

Cardiopalmus.

The main methods of differential diagnosis of pathologies of the cardiovascular system and osteochondrosis are the ECG method and functional tests. On the ECG, a shortened ST segment is noted, with angiography - the absence of atherosclerosis. It can be difficult to exclude cardiac syndrome in osteochondrosis, and this requires a long study.

The clinical manifestation of this syndrome is associated with one of the eight pairs of spinal nerve roots that innervate the cervical part of the spinal column. Characterized by unilateral lesion of the body.

The syndrome is associated with a violation of nerve conduction: with pain, or, conversely, with semi-paralysis (paresis), paralysis and decreased sensitivity.

Conduction disturbance is characterized by the following symptoms:

The first or second roots - numbness or, conversely, pain in the occipital region;

The third pair of roots - numbness of the tongue and the area behind the ears, difficulty chewing food, a feeling of fullness of the tongue;

Fourth pair - pain in the collarbone, hiccups, difficulty swallowing as in the case of tonsillitis;

Fifth pair - violations are felt in the shoulder area in the form of difficulty in moving the arms;

Sixth pair - discomfort in the shoulder blades and forearm;

Seventh pair - numbness in the hands and, in particular, the index and middle fingers;

The eighth pair - leads to difficulties in owning the ring fingers and little fingers on the hands.

In practice, single vertebrae are very rarely affected, more often several pairs of nerve roots are involved in the pathogenesis, so the syndromes are mixed and confuse the clinical picture. It is desirable for the patient to independently listen to his own body.

Treatment of osteochondrosis of the cervical spine

Depending on the stage of the pathology (remission or exacerbation), the form of the disease (acute or chronic), the severity of clinical manifestations (the presence or absence of pain), various methods of therapy are selected.

It could be:

Conservative treatment (drug and non-drug);

Surgical intervention;

Combinations of conservative and operative techniques.

Let us dwell on the classical methods of therapy. Knowledge and competent use of simple techniques, including physiotherapy exercises, massage and self-massage, greatly facilitates the well-being of a person experiencing pain in the neck with osteochondrosis. In the case of long-term degenerative processes, it is better to undergo an examination in a hospital or outpatient setting, and only after that apply treatment procedures.

If it is not possible to undergo an examination, then it is recommended to use sparing methods, for example, to perform exercises aimed at hydration - saturation of the interarticular space with fluids by improving blood supply in the neck and neck.

Exercise therapy (physiotherapy exercises) for cervical osteochondrosis

Therapeutic gymnastics, when performed correctly, works wonders. Many methods have been proposed, but all of them are based on enhanced nutrition of cartilage and bone tissues. The principle of exercise therapy is to restore blood supply to the damaged area of ​​the body.

It is forbidden during exercise therapy to strongly rotate and bend your head, only imitation of such movements is allowed. This method has proven to be effective despite its apparent simplicity.

The correct use of exercise therapy is the use of physical exercises without:

Long loads on the joints of the neck (one set of exercises is performed no more than 2 minutes);

Turns, tilts and rotations of the neck (such exercises exacerbate pathological processes in the joints and intervertebral discs).

Small (shallow) tilts of the head are shown, which do not lead to movement of the joints, but increase blood flow to them. Such tilts in movement resemble a barely noticeable nod of the head, meaning the answer is “yes”. After a while, after about 30 minutes, the movement is repeated, reminiscent of the answer "no".

You can also perform exercises that imitate the movement of the head forward (limiting the frontal part of the head with the hand) and backward (limiting the movement of the head with the hands in the back of the head).

Massage for cervical osteochondrosis

Massage should be done carefully, without power loads. Inept, unprofessional massage can end badly. Movements should extend to the cervical region, collar zone and part of the back.

Massage is performed in the supine position, in extreme cases, in a sitting position.

The methods are based on the following techniques:

Stroking. Impact on the superficial layers of the skin. With the palms of the hands or fingertips from the head down to the upper third of the middle of the back. Stroking from the base of the neck can also be zigzag;

Squeezing. Impact on the deep layers of the skin in the upper third of the back. Fingers (thumb and forefinger) across the neck carry out movements to capture the skin, reminiscent of squeezing. This is done carefully, tissues close to the vertebrae are not involved;

Trituration. The purpose of the procedure is to warm up the skin and increase blood flow in the collar zone. It is done very carefully. Impact on the spinous processes of the vertebrae is not allowed. Rubbing can be replaced by movements resembling sawing, or circular strokes;

Kneading. It is of limited value, as it affects very deep-lying tissues, which can aggravate the pathology.

Self-massage for cervical osteochondrosis performed while sitting in a comfortable position. Use the methods of stroking, circular rubbing in the neck or shoulders. It is advisable to combine the self-massage method with rubbing in various ointments that increase blood flow and relieve pain in the kneaded area.

This is a simple plastic device that has spikes that act on areas of the skin. A person lies down on the spikes or applies them to the body, thereby causing irritation of the skin receptors responsible for the physiological processes in the body.

In some cases, the applicator helps and permanently reduces pain caused by cervical osteochondrosis. In addition, the device sometimes increases a person’s working capacity, has a beneficial effect on skin turgor, normalizes sleep and blood circulation, and restores joint mobility.

Contraindications to the use of the Kuznetsov applicator are infectious, tumor, skin and vascular diseases. Before using the device, the patient should consult with the attending physician or independently test this simple device on himself with the help of short-term applications of the applicator and monitoring how he feels.

Orthopedic pillows for cervical osteochondrosis

Orthopedic pillows for sleep are an effective means of prevention. In many cases, osteochondrosis is aggravated due to additional compression of the cervical artery and nerve roots while sleeping on an uncomfortable pillow. The orthopedic product provides a uniform horizontal position of a person during sleep and, thereby, guarantees a physiologically complete blood supply to the brain.

When choosing a pillow, one should take into account the individual anatomical features of a person and correlate them with the volume and characteristics of the filler. A properly selected pillow brings tangible benefits to a patient with osteochondrosis of the cervical spine.

Preparations and drugs for cervical osteochondrosis

The arsenal of medicines and preparations for the treatment of cervical osteochondrosis is very extensive:

(non-steroidal pain relievers). They are usually prescribed in the form of tablets or capsules. It should be remembered that most of these drugs cause irritation of the mucous membrane of the digestive tract. Among the modern drugs used to relieve pain in osteochondrosis are diclofenac, piroxicam;

Anti-inflammatory(steroid). These are hormonal drugs that relieve inflammation and, thereby, eliminate pain. Most often, for osteochondrosis of the cervical spine, tablets and ointments based on hydrocortisone, prednisolone or dexamethasone are used;

Muscle relaxants are drugs that relax muscle tone. They are used in surgery and orthopedics, as aids for pain relief. Such drugs are administered parenterally, and therefore always under medical supervision. For the treatment of osteochondrosis, drugs from two pharmacological groups are used: glycerin and benzimidazole. There is an extensive list of contraindications;

Vitamins. With osteochondrosis of the cervical region, vitamins are prescribed that have a beneficial effect on the peripheral nervous system and improve conductivity. Water-soluble vitamins: B 1 , B 6 , B 12 , fat-soluble vitamins: A, C, E. In recent years, combined preparations containing both painkillers and vitamin components have become more common. One of these medicines is Milgamma compositum. An effective drug consists of B vitamins based on pyridoxine and thiamine, and contains lidocaine as an anesthetic;

Ointments and gels for external use. This is the most accessible group of drugs for home use. They are divided into anti-inflammatory, warming and painkillers. Such funds are often advertised, the most popular are: voltaren emulgel, nurofen, fastum gel. With cervical osteochondrosis, not all ointments are effective, in addition, due to their availability, they are sometimes used unreasonably and without taking into account the peculiarities of pathogenesis. Before using any medication, you must be examined by a doctor.

Prevention of cervical osteochondrosis

The disease is better to prevent or minimize the factors contributing to the development of pathology. It is known that the basis of health is the right way of life. It includes moderate exercise, weight control, regular warm-ups during sedentary work, especially if it is performed in a static position. All of the above is independently controlled by a person and often depends on the habits laid down in childhood.

But throughout life, a person is exposed to risks that cannot be eliminated. These include congenital and acquired microtrauma of the spine, diseases of the musculoskeletal system.

If a person has a tendency to clinical manifestations of osteochondrosis, then it is advisable not to choose work associated with increased physical exertion, and also to avoid sudden movements in everyday life. Excess weight of more than 10 kg is considered critical for people with back problems.

If it is impossible to completely abandon intense physical activity, you should:

To carry weights alternately on one side of the body, then on the other;

Use a corset to protect the spine;

After doing the work, unload the spine, namely, lie down for a while, or hang on the horizontal bar.

Avoid sudden changes in weather and climate. The risks increase with increasing humidity and decreasing temperatures.

To protect yourself from exacerbation of cervical osteochondrosis will help:

Sleep on an orthopedic mattress and pillow in the correct position that does not interfere with the blood circulation of the spine;

Regular swimming;

Healthy food.

With osteochondrosis, sports that increase the load on the spine and contribute to its traumatization are contraindicated: running, jumping, weightlifting. During the period of exacerbation, you should refuse to visit the steam room in the bath.

The implementation of simple rules of prevention, exercise therapy and massage (in some cases) allows you to lead a comfortable life with osteochondrosis of the cervical spine, even in old age.

Education: Moscow Medical Institute. I. M. Sechenov, specialty - "Medicine" in 1991, in 1993 "Occupational diseases", in 1996 "Therapy".

This is a chronic disease in which degenerative changes occur in the vertebrae and the intervertebral discs located between them. Depending on the location of the lesion of the spine, there are: osteochondrosis of the cervical region, osteochondrosis of the thoracic region and osteochondrosis of the lumbar region. For the diagnosis of osteochondrosis of the spine, it is necessary to conduct x-rays, and in case of its complications (for example, a herniated disc) - MRI of the spine. In the treatment of osteochondrosis of the spine, along with medical methods, reflexology, massage, manual therapy, physiotherapy and physiotherapy exercises are widely used.

Etiology and pathogenesis

To some extent, osteochondrosis of the spine develops in all people of age and is one of the processes of aging of the body. Sooner or later, atrophic changes occur in the intervertebral disc, however, injuries, diseases and various overloads of the spine contribute to the earlier onset of osteochondrosis. The most common osteochondrosis of the cervical and osteochondrosis of the lumbar spine.

About 10 theories of osteochondrosis have been developed: vascular, hormonal, mechanical, hereditary, infectious-allergic, and others. But none of them gives a complete explanation of the changes occurring in the spine, rather they are complementary to each other.

It is believed that the main point in the occurrence of osteochondrosis is the constant overload of the spinal motion segment, which consists of two adjacent vertebrae with an intervertebral disc located between them. Such an overload can occur as a result of a motor stereotype - posture, an individual manner of sitting and walking. Posture disorders, sitting in the wrong position, walking with an uneven spinal column cause additional stress on the discs, ligaments and muscles of the spine. The process can be aggravated due to the peculiarities of the structure of the spine and the insufficiency of the trophism of its tissues, due to hereditary factors. Most often, defects in the structure are found in the cervical region (Kimerli anomaly, craniovertebral anomalies, Chiari anomaly) and lead to vascular disorders and early onset of signs of osteochondrosis of the cervical spine.

The occurrence of osteochondrosis of the lumbar spine is more often associated with its overload during bending and lifting weights. A healthy intervertebral disc can withstand significant loads due to the hydrophilicity of the nucleus pulposus located in its center. The core contains a large amount of water, and liquids are known to be poorly compressible. Rupture of a healthy intervertebral disc can occur with a compression force of more than 500 kg, while a disc changed as a result of osteochondrosis ruptures with a compression force of 200 kg. A load of 200 kg is experienced by the lumbar spine of a person weighing 70 kg, when he holds a 15-kilogram load in the position of tilting the body forward by 200. Such a large pressure is due to the small size of the nucleus pulposus. With an increase in inclination to 700, the load on the intervertebral discs will be 489 kg. Therefore, often the first clinical manifestations of osteochondrosis of the lumbar spine occur during or after lifting weights, doing housework, weeding in the garden, etc.

With osteochondrosis, the pulpous nucleus loses its hydrophilic properties. This is due to disturbances in its metabolism or insufficient intake of necessary substances. As a result, the intervertebral disc becomes flat and less elastic, and radial cracks appear in its fibrous ring under load. The distance between adjacent vertebrae decreases and they shift relative to each other, while displacement occurs in the facet (facet) joints connecting the vertebrae.

Destruction of the connective tissue of the fibrous ring of the disc, ligaments and 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 surrounding tissues. Due to the displacement of the vertebral bodies, the capsules of the facet joints are stretched, and the altered intervertebral disc no longer fixes the bodies of neighboring vertebrae so firmly. Instability of the spinal segment is formed. Due to instability, it is possible to pinch the spinal nerve root with the development of radicular syndrome. With osteochondrosis of the cervical spine, this often occurs during head turns, with osteochondrosis of the lumbar spine - during torso tilts. It is possible to form a functional block of the spinal motion segment. It is caused by compensatory contraction of the vertebral muscles.

A herniated disc is formed when the disc shifts backward, ruptures the posterior longitudinal ligament, and protrudes part of the disc into the spinal canal. If at the same time the nucleus pulposus of the disc is squeezed into the spinal canal, then such a hernia is called ruptured. The severity and duration of pain with such a hernia is much greater than with an unruptured one. A herniated disc can cause radicular syndrome or spinal cord compression.

With osteochondrosis, bone tissue grows with the formation of osteophytes - bone outgrowths on the bodies and processes of the vertebrae. Osteophytes can also cause compression of the spinal cord (compression myelopathy) or cause radicular syndrome.

Symptoms of osteochondrosis of the spine

The main symptom of osteochondrosis of the spine is pain. The pain can be acute with high intensity, it increases with the slightest movement in the affected segment and therefore forces the patient into a forced position. So, with osteochondrosis of the cervical spine, the patient holds his head in the least painful position and cannot turn it, with osteochondrosis of the thoracic region, the pain intensifies even with deep breathing, and with osteochondrosis of the lumbar spine, it is difficult for the patient to sit down, get up and walk. This pain syndrome is typical for compression of the spinal nerve root.

In about 80% of cases, there is a dull pain of a constant nature and moderate intensity. In such cases, when examining a doctor, it is necessary to differentiate the manifestations of osteochondrosis of the spine from myositis of the muscles of the back. Dull pain in osteochondrosis is caused by excessive compensatory tension of the muscles that hold the affected spinal motion segment, inflammatory changes, or significant stretching of the intervertebral disc. In patients with such a pain syndrome, there is no forced position, but limitation of movements and physical activity is revealed. Patients with osteochondrosis of the cervical spine avoid sharp turns and tilts of the head, with osteochondrosis of the lumbar spine - slowly sit down and stand up, avoid tilting the body.

All symptoms of osteochondrosis, manifesting only in the region of the spinal column, belong to the vertebral syndrome. All changes localized outside the spine form an extravertebral syndrome. It can be pain along the peripheral nerves when their roots are compressed at the exit from the spinal cord. For example, lumboischialgia - pain along the sciatic nerve with osteochondrosis of the lumbar spine. With osteochondrosis of the cervical spine, these are vascular disorders in the vertebrobasilar basin of the brain, caused by compression of the vertebral artery.

Complications of osteochondrosis of the spine

Complications of osteochondrosis are associated with a herniated disc. These include compression of the spinal cord (discogenic myelopathy), which is characterized by numbness, weakness of certain muscle groups of the limbs (depending on the level of compression), leading to the appearance of paresis, muscle atrophy, changes in tendon reflexes, impaired urination and defecation. An intervertebral hernia can cause compression of the artery that feeds the spinal cord, with the formation of ischemic areas (spinal cord infarction) with the death of nerve cells. This is manifested by the appearance of a neurological deficit (disturbance of movement, loss of sensitivity, trophic disorders), corresponding to the level and prevalence of ischemia.

Diagnosis of osteochondrosis of the spine

Diagnosis of osteochondrosis of the spine is carried out by a neurologist or vertebrologist. At the initial stage, an X-ray of the spine is performed in 2 projections. If necessary, they can make a survey of a separate vertebral segment and a survey in additional projections. Magnetic resonance imaging (MRI of the spine) is used to diagnose intervertebral hernia, assess the condition of the spinal cord and identify complications of osteochondrosis. MRI plays an important role in the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculous spondylitis, osteomyelitis, tumors, ankylosing spondylitis, rheumatism, infectious lesions. Sometimes in cases of complicated osteochondrosis of the cervical spine, it is necessary to exclude syringomyelia. In some cases, if MRI is not possible,

In the drug therapy of osteochondrosis, non-steroidal anti-inflammatory drugs (NSAIDs) are used: diclofenac, nimesulide, lornoxicam, meloxicam, ketoralac. With intense pain, analgesics are indicated, for example, the centrally acting analgesic flupirtine. To relieve muscle tension, muscle relaxants are used - tolperisone, tizanidine. In some cases, it is advisable to prescribe anticonvulsants - carbamazepine, gabapentin; antidepressants, among which preference is given to serotonin reuptake inhibitors (sertraline, paroxetine).

In the event of a radicular syndrome, the patient is shown inpatient treatment. Perhaps local administration of glucocorticoids, decongestant therapy, the use of traction. In the treatment of osteochondrosis, physiotherapy, reflexology,

Osteochondrosis I Osteochondrosis (osteochondrosis: Greek osteon + chondros cartilage + -ōsis)

The term "osteochondrosis" was previously used to refer to a large group of osteoarticular diseases. Subsequently, many of these diseases began to be attributed to osteochondropathy m, for example, dissecting osteochondrosis of the articular surfaces (Koenig's disease), dissecting osteochondrosis of the body of the talus (Diaz), etc. As a result, the term "osteochondrosis" has been preserved to refer to the degenerative-dystrophic disease Spine a, which is based on damage to the intervertebral discs, accompanied by their progressive deformation, decrease in height and stratification. Dystrophic changes in the intervertebral disc in osteoarthritis are called dyscarthrosis in order to emphasize the similarity between this pathological process and similar changes in other joints in osteoarthritis, for example, in polyosteoarthritis with lesions of many joints, incl. and spine. A special case of O. is - resulting from the introduction of the tissue of a pathologically altered intervertebral disc into the lumen of the spinal canal ( rice. 1 ). A special form of O. is primary juvenile osteochondrosis, a disease that develops in children on the basis of chondroosteosteonecrosis and is accompanied by the formation of osteophytes when the apophyses merge with the vertebral bodies.

The final stage of the degenerative-dystrophic process in O. is characterized by its spread to the yellow ligaments, interspinous ligaments, and other structures of the spine. At the same time or somewhat earlier, the gelatinous is replaced by fibrous cartilage or a disc occurs. Considering that various disks are simultaneously at different stages of degeneration, in the final stage of O., the clinical manifestations of the disease are very diverse. In an uncomplicated course of O., disc fibrosis means a stable clinical remission, which is accompanied by the restoration of the support ability of the spine and the elimination of its instability (see Spondylosis (Spondylosis)).

With involutive degeneration of the intervertebral discs, the process develops much more slowly and is clinically manifested only by a gradual decrease in the amplitude of movements of the spine; it is usually not accompanied by neurological disorders.

clinical picture. Among the clinical manifestations of O., the leading place is occupied by static and neurological disorders. Along with them, vascular and trophic changes of vertebral and extravertebral origin are noted.

O.'s main clinical symptoms occur when it extends to the posterior annulus fibrosus and the posterior longitudinal ligament. Depending on the stage of degeneration of the intervertebral discs, irritation, compression or impaired conduction of the roots of the spinal cord, vessels or spinal cord occurs. Various neurological syndromes develop - reflex and compression. The main cause of pain in O. is the so-called irritation of the nerve root. In this case, there is a violation of blood circulation, edema occurs, and in the future, a fibroma of the structures surrounding it may develop, which is accompanied by an increase in the sensitivity of the roots to various influences (in the affected segment of the spine, etc.). Vascular disorders in O. are more often associated with a violation of the vasomotor innervation and, less often, with mechanical compression of the vessels by osteophytes, for example, in the cervical spine.

During the course of the disease, periods of exacerbation and remission are distinguished. The period of exacerbation is divided into phases - progression, stationary and regression of clinical symptoms. It is characterized by the presence of spontaneous pain, often accompanied by a forced (antalgic) posture, pronounced muscular tonic reactions, a functional block of the affected spinal segment, and symptoms of severe root irritation. Often there are signs of loss of its functions. In the regression phase of exacerbation, only the so-called provoked pains, static-dynamic disturbances when walking and sitting, moderately pronounced muscular-tonic disorders remain, often the affected segment of the spine remains. Symptoms of root irritation are usually less pronounced. It remains the functions of the spine, which developed earlier.

During the period of remission, pain can appear only in uncomfortable postures (tilt, rotation of the body, head, etc.), when the position changes, they usually disappear. There are no symptoms of root irritation, but loss of its function may remain.

Neurological manifestations of O. depend on the level of damage and the prevalence of the degenerative process. So, at O. of a cervical department of a backbone neurological syndromes of both reflex, and compression genesis can develop. Among the reflex syndromes, spastic torticollis, humeroscapular periarthrosis syndrome (see Shoulder joint), Steinbrocker syndrome (-, or reflex neurovascular arm), epicondylitis and styloiditis syndromes (in the region of the external epicondyle of the humerus and styloid process), (paroxysmal pain in the occipital areas of the type of neuralgia, which may be accompanied by a violation of sensitivity, often on the one hand), pseudoangina and cardialgia. Less common are phrenicocholecystopathy syndromes (right-sided in combination with spastic pseudoesophagitis, hiccups, dyskinesia of the biliary tract and gallbladder), Putnam-Schultze brachialgia (nighttime brachialgia with paresthesias), pseudosyringomyelia syndrome (vaguely localized weak aching pain in the arm, shoulder girdle, side, combined with hypesthesia in the form of a "half-jacket"). Some syndromes at O. have the mixed origin. For example, scalenus syndrome is reflex-compression (pain in the neck and in the arm, combined with a feeling of numbness in the distal parts of the arm, which are aggravated by pressure on the stairs). Some of the neurological syndromes in O. of the cervical spine can be both reflex and compression. Among them, the syndrome of cervical backache and cervicalgia, vegetative-irritative syndrome, and other cervical and cervicobrachial sciatica, characterized by impaired function of a disc herniated by a herniated disc or osteophyte of the spinal cord root, can only be compression. Radicular syndromes at the upper cervical level develop rarely and are characterized by pain in the occipital region, submastoid zones, as well as a violation of sensitivity in the zone of innervation of roots C I-IV. In most cases, compression occurs at levels C VI and C VII.

The most severe (relatively rare) neurological disorders in O. of the cervical spine occur with compression of the spinal cord and ischemic myelopathy - spastic-subatrophic hands, syringomyelic syndrome, syndrome of partial unilateral ischemic radiculomyelopathy, etc.

In connection with the peculiarities of the formation of the posterior cerebral vascular pool (vertebrobasilar) and direct innervation connections of the autonomic ganglia of the neck with the vessels of the brain, O. of the cervical spine is often accompanied by a number of cerebral syndromes that are both reflex and compression in nature. This group includes posterior cervical sympathetic syndrome ( cervical), Unterharnsheidt's syncopal syndrome (paroxysms of a sudden fall with complete loss of consciousness) and drop syndrome (the same, but unconscious), cochlear-stem syndrome (, ringing in the ears, dizziness and unsteadiness when walking), pharyngeal-laryngeal syndrome (paresthesia of the mucous membrane of the pharynx, impaired phonation, swallowing), vegetative-emotional syndrome (more often diencephalic paroxysms in combination with vestibulopathy), visual impairment syndrome (complaints about the appearance of fog, veils before the eyes, less often on transient blindness or photopsia).

O.'s development in the thoracic spine, as a rule, is combined with arthrosis of the costovertebral and costotransverse joints. The resulting neurological disorders may be due to a dystrophic process both in the intervertebral discs and in these joints, since they come into contact with the spinal nerves. Neurological syndromes are also reflex and compression. Among reflex vegetative-visceral syndromes, laryngotracheitis syndrome is relatively often observed (the leading one is dry, less often phonation disturbance, sore throat and dryness in the larynx), it can contribute to the occurrence (or increase) of ischemic myelopathy. Less common reflex syndrome of peptic ulcer, which may accompany the degenerative process at the level of Th VII-IX. Clinically, it is manifested by hungry and night pains in the epigastric region with irradiation to the back, heartburn, vomiting, etc. In this case, exacerbations are associated with spinal overload, and not with the season (spring, autumn).

With O. of the thoracic spine, a vegetative-irritative syndrome is observed, which has reflex and compression. It is caused by prolonged irritation of the autonomic structures in the spine itself, the posterior roots of the spinal cord, the vascular autonomic plexuses, adjacent sympathetic trunks (usually on one side), herniated discs, osteophytes, altered joints and ligaments. Often, in addition to irritation of the autonomic structures, dysfunction of the intercostal nerves is noted. consists of sensitive and visceral-effector disorders. In the acute phase, a decrease in sensitivity is usually determined with signs of hyperpathy with a segmental-sympathetic distribution of zones - “half-jacket”, “wide half-belt” without clear boundaries. Patients complain of burning pains in the back, side, front of the chest, face and head, arm and leg, which are aggravated by weather changes, excitement, physical exertion, more often at night. With a left-sided process at the upper thoracic level, a violation of cardiac activity is possible, especially with concomitant cardiosclerosis. The described syndrome during the period of exacerbation may be accompanied by headache, chills, fluctuations in the pulse, vegetative-trophic edema.

As well as at defeats of other departments of a backbone, at O. of a lumbosacral department compression and reflex syndromes which can be combined are noted. In some cases, they are caused by impaired circulation of the spinal cord or its roots. The most common reflex neurological syndrome associated with O. is - gradually (rarely acute) pain in the lumbosacral region. They do not have a clear localization, are almost constant (in the exacerbation phase), increase with physical activity, bending and turning the body, after a long stay in an upright position. () - suddenly appeared very sharp pains (more often at the time of physical exertion), which have a clear localization in the lumbosacral region. in these cases cannot move. At the first manifestations of the pathological process, it can stop on its own in a few minutes. Sometimes lumbosacral pain without irradiation is mild and goes almost unnoticed. Characteristic clinical symptoms in lumbago and lumbalgia are the smoothness of the lumbar lordosis or the appearance of the so-called reflex kyphosis, the symptom of the triangle of the multifidus muscle (Lewingston's symptom), characterized by its tension, a feeling of tightness, turning into dull pain, as well as the symptom of the square muscle of the lower back (symptom of Sol and Williams ), reminiscent of Levingston's symptom, combined with an additional increase in pain and the inability to breathe deeply because of this. in the lumbar spine are limited (blocking of one or more motor segments between the vertebrae is noted). aggravated by pressure on the spinous processes of the vertebrae and at paravertebral points, usually at the level of the disc lesion. Other reflex syndromes are less common. So, with autonomic-irritative syndrome, pain is localized in the muscles, bones, and joints belonging to the corresponding sclero- and myotomes, in combination with impaired heat production, vasoconstriction, etc. and Bostrup syndrome (interspinous). In the latter case, the pain of a aching nature in the affected area becomes more intense when unbending and carrying weights, the lumbar often intensifies. Other clinical variants of the syndromes of this group are also possible, for example, the syndrome of sacroiliac periarthrosis, chronic perigonarthrosis (neuroosteofibrosis of the knee joint or its special case - popliteal fossa syndrome), pupart ligament syndrome (neuroosteofibrosis of its attachment sites), peroneal nerve canal syndrome (often accompanied by secondary non-rough paresis of the peroneal muscle group), the syndrome of neurotrophic periostosis of the tibial crest is characterized by sclerotomy pain in the tibia, aggravated at night. The spondylogenic (occurring in O.) reflex syndromes include a number of neurotrophic foot syndromes, such as Bradford-Sperling syndrome (pain in the ankle joint, aggravated by walking, in combination with swelling of the outer ankle and lower third of the leg, which increases towards the end of the day). This group also includes tarsal tunnel syndrome - neuroosteofibrosis of the structures that form it, accompanied by compression of the tibial nerve (mainly the lateral branch). Patients complain of dull dull pain under the inner ankle and in the medial part of the arch of the foot.

Sometimes with O. of the lumbar spine, repercussion pains in various parts of the body and dysfunction of internal organs are noted, for example, the syndrome of neurotrophic proctosigmoiditis (pain in the left iliac region, colon, and other symptoms) or dysfunction of the genitourinary organs (decrease, erection, impaired ejaculation - in men, lengthening of the menstrual cycle, mastopathy - in women, difficulty urinating, and in some cases).

Compression radicular syndromes (radiculopathy) in O. of the lumbosacral spine are most often observed when the root is damaged in the epidural zone of the spinal canal and in the medial zone of the intervertebral foramen, especially if the intervertebral foramen is narrowed. Along with posterolateral disc herniation, radiculopathy occurs with reflex ischemia (less often with hemorrhage) followed by swelling of one root, as well as with varicose veins located here as a result of aseptic inflammation.

Clinical manifestations of impaired function of the roots of the spinal cord depend on the level of their damage. So, rare compression L I. II. III roots is accompanied by pain and loss of sensitivity of the corresponding dermatomes (often the skin of the inner and anterior thighs). When the root of L IV (disc L III-IV) is damaged, pain occurs, radiating along the anterointernal surface of the thigh, sometimes to the knee and below. At the same time, mild weakness of the quadriceps femoris muscle and its intact (sometimes increased) knee reflex are noted. root L V (disc L IV-V) usually occurs after a long period of lumbar backache. In this case, the pain radiates from the lower back to the gluteal region, along the outer edge of the thigh, along the anterolateral edge of the lower leg to the inner edge of the foot and the first toes (usually up to the first finger). It is aggravated by coughing, and pressure at the level of the affected disc. Determine the decrease in the strength of the extensor muscle of the first toe. Compression of the root S I (disc L V -S I) is most often observed in O. of the spine. at this level, it can manifest immediately without previous lumbodynia. The pain radiates from the lumbar and gluteal regions along the posterior outer edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot, sometimes to the heel or to the fifth toe. It is aggravated by coughing and sneezing, pressure in the Mihazlis rhombus (at the level of the disc lesion). Often there is hypoesthesia in the distal part of the corresponding dermatome, a decrease in the strength of the triceps muscle of the lower leg and flexors of the fingers (especially the fifth), and hypotrophy of the gastrocnemius muscle. Patients hardly stand on their toes, their heel decreases or falls out. When S I is compressed, antalgic (torso tilt forward or to the side) occurs.

With many hernias compressing the roots or one large hernia that stretches neighboring roots, as well as with hypertrophy of the yellow ligament, reactive inflammation, dyscirculatory disorders, and under the influence of a number of other causes, several roots of the spinal cord are disturbed and bi- or polyradiculopathy develops. The clinical picture in this case is a complex combination of the described reflex and compression syndromes.

As a result of compression (disc herniation, osteophyte, etc.) or reflex spasm of the additional radicular-spinal artery accompanying the roots L V -S I, inferior ischemic myelopathy syndrome, or paralyzing, may develop - a subacute developing unilateral paresis of the muscles of the foot or peroneal group. Sometimes at O. of a lumbar department of a backbone function of a horse tail is broken (see. Spinal cord ).

Diagnosis. Recognition of O. and its syndromes and typical cases does not present any particular difficulties, but requires a complete neurological, orthopedic and radiological examination, during which the features of the patient's posture are revealed, in particular the presence of intalgic torso, back muscle tension, painful points on palpation, restriction of movements . For the diagnosis of disc herniation, spinal puncture is indicated, with compression of the vertebral artery and myelopathy, vertebral angiography (Angiography) and venography of the vertebral plexus are performed.

X-ray examination of the spine in O. makes it possible to establish the localization and extent of the pathological process. The degenerative and dystrophic process underlying O. in intervertebral disks is radiologically shown by decrease in height of intervertebral space; in this regard, as O. progresses, the adjacent surfaces of the vertebrae come closer together. Changes arising in the disc entail a restructuring of the adjacent surfaces of the vertebral bodies, they become denser and thicker. Bone growths are formed along the edges of the surfaces of the vertebral bodies, having the form of a fringe, beaks or bridges ( rice. 6 ). Bone growths also form on the posterior surface of the vertebral body, often protruding towards the spinal canal. Against the background of the altered end plate of the vertebral bodies, semicircular depressions are determined, resulting from the prolapse of fragments of the intervertebral disc - cartilaginous hernias (Schmorl's nodes - rice. 7 ). Around the impressions develops in the form of a rim of sclerosis. In severe cases, O. observed vertebrae, usually not exceeding 1 cm(on the roentgenogram in the direct projection, a shift to the side is visible, and on the roentgenogram in the lateral projection - in the anteroposterior direction; rice. 8 ). Unlike true spondylolisthesis, vertebral displacement in O. is called pseudospondylolisthesis.

To determine the degree of dysfunction of the intervertebral disc, the so-called functional (in the position of the maximum possible flexion, extension and in the middle position) is shown. At the same time, physiological displacement of 2-3 vertebrae in relation to each other up to 2-3 is normally observed. mm. In contrast, with O. pseudospondylolisthesis is detected within two vertebrae. Violation of the normal function of the intervertebral disc manifests itself in the form of instability (increased displacement - more than 3 mm) vertebrae or, conversely, a functional unit. ( rice. 9 ) and Myelography can detect protrusions of the discs towards the spinal canal, depression and displacement of the trunks or roots of the spinal nerves. Discography makes it possible to detect changes in the nucleus pulposus, to clarify the direction and degree of its displacement. With the help of computed tomography of the spine, it is also possible to establish the ratio of its structures, spinal cord and roots ( rice. 10 ), identify a herniated disc. Similar information can be obtained using nuclear magnetic resonance.

X-ray differential O. is carried out with those processes that lead to a decrease in the height of the intervertebral spaces - with tuberculous and nonspecific Spondylitis. When O., there is a thickening and thickening of the closing plates of the vertebral bodies, and not their destruction, as in inflammatory processes. Besides, O. needs to be differentiated with tumoral process, Calve's illness and consequences of damage of disks.

Treatment It is mainly aimed at eliminating the pain syndrome, dysfunction of the roots of the spinal cord and preventing the progression of the dystrophic process in the structures of the spine. In most cases, a set of conservative measures is used, selected in accordance with the phase and localization of the pathological process, the nature of neurological and static-dynamic disorders. As a rule, the course of treatment consists of several periods. Initially, its task is to eliminate pain and muscles, then eliminate the consequences of root damage, restore mobility of the affected motor segments of the spine, create the so-called muscle corset and form the physiological curves of the spine (see Posture).

Orthopedic methods of influencing the spine in O. include: position, the use of bandages, corsets, head holders, traction treatment (using various devices, self-traction, traction in water in combination with mud therapy), etc. They are often supplemented with vagosympathetic blockade, blockade of the stellate ganglion, the second lumbar sympathetic node, infiltration with novocaine solution of muscle trigger zones (for example, scalene, piriformis muscles), vertebral artery (blocking of the sympathetic plexus of this artery), epidural and epidural blockades.

To eliminate pain, swelling in the region of the spinal cord root and muscle relaxation, non-steroidal anti-inflammatory drugs (indomethacin, ortofen, etc.) are prescribed in combination with dehydration therapy. To influence the vertebral and extravertebral zones of neuroosteofibrosis, adenosine triphosphoric acid is used, which is administered intramuscularly daily, 2 times a day. ml 1% solution, only 30-40 injections. In order to improve metabolic processes in the intervertebral disc, many experts recommend rumalon, osteochondrin, thiol preparations and a number of biogenic stimulants, however, reliable data on their favorable effect have not been obtained.

During the period of subsiding of the pain syndrome, especially in the case of a chronic relapsing process, sanatorium treatment is recommended in order to eliminate residual effects and prevent exacerbations. Showing mud, ozocerite applications, brine, hydrogen sulfide, radon.

An important place in the complex treatment of O. of the spine is given to physiotherapy exercises. During the period of exacerbation of the disease, unloading of the affected spine is prescribed. For this purpose, various orthoses are used, for example, a Shants collar or a head holder made of foamed polyethylene for O. of the cervical region, a wide, lumbar or corset for O. of the lumbar region. It is recommended to avoid movements that cause pain, to be less upright or to stay in bed (on a semi-rigid bed, or a shield with a comfortable pillow). With compression syndromes, this regimen can be supplemented by constant bed traction, periodic manual traction or self-traction, which alternate with isometric muscle tension (post-isometric relaxation). As the pain subsides, they gradually expand, the set of exercises includes movements aimed at increasing the mobility of the spine ( rice. 11 ), tilts, turns of the head or torso, a group of stretching exercises (various mixed hangs, often with kyphosis of the spine; rice. 12 ). In parallel, they solve the problem of eliminating contractures in the joints of the extremities and increasing the extensibility of the periarticular muscles, for example, with humeroscapular periarthrosis (increased abduction and rotational movements in the shoulder joint), with piriformis syndrome (increased adduction and internal rotation of the thigh). At this stage, physical exercises in warm water are widely prescribed - in a large hydrokinesitherapy bath ( rice. 13 ) or in the pool. To consolidate the effect achieved during gymnastics, they are fixed for several minutes in the position of extreme muscle stretching, which does not cause pain. Subsequently, emphasis is placed on strengthening the ligamentous-muscular apparatus of the spine (increasing its stability), as well as on developing the correct posture. For this purpose, isometric tension of the neck muscles is used ( rice. 14 ), back and abdominal wall ( rice. 15 ) duration 5-7 With, alternating them with rest sinuses 3-4 With; movements in the joints of the limbs (including with additional weights - dumbbells,), which are performed in the prone and knee-hand positions (on all fours). With compression syndromes accompanied by paresis of the muscles of the extremities, the complex is supplemented with exercises aimed at restoring their function (see Paralysis).

The indication for surgical intervention in O. of the spine are some types of compression of the roots and spinal cord. So, in case of acute compression of the cauda equina or spinal cord, accompanied by a dysfunction of the sphincters, bilateral pain syndrome, especially against the background of instability of the intervertebral motor segment in combination with paresis, decompression is indicated (, removal of a herniated disc, etc.), which should end with stabilization of the affected motor segment(). After the first 6 h, and especially the first days, become relative to surgical treatment, firstly, because of the formation of irreversible changes in the roots of the cauda equina, and, secondly, because under the influence of drug therapy the process regresses in about the same 6 months. In addition to these reasons, an absolute indication for surgery is irreducible disc herniation with complete liquorodynamic and myelographic block. Relative indications for surgical intervention are pronounced and persistent (not amenable to conservative treatment) pain with no tendency to disappear within 3 months. Among the methods of treatment, a special place is occupied by the dissolution of the hernial cartilage by introducing papain into it (extracted from the melon tree, which causes necrobiotic processes in the intervertebral disc). After 4-5 days after the introduction of the preparation of the disk tissue, it is replaced by their reparation, and then fibrous cartilage is formed, which leads to a limitation of the disk mobility within 1 year (sometimes a little more).

In the postoperative period, all patients are prescribed to wear a corset to fix the affected spine, therapeutic exercises aimed at increasing its stability (limit or exclude tilts, turns, hanging, use mainly isometric muscle tension), recommend back muscle massage and spa treatment. For patients who have undergone surgery for O. of the spine, all types of traction and manual are contraindicated.

Forecast favorable with timely treatment.

Bibliography: Kaptelin A.F. Hydrokinesitherapy in orthopedics and traumatology, p. 69, 126, M., 1986; Kasvande Z.V. Therapeutic for cervical osteochondrosis. Riga, 1976; Clinical X-ray Radiology, ed. G.A. Zedgenidze, vol. 3, M., 1985; Kogan O.T. and Naidin V.L. Medical in neurology and neurosurgery, M., 1988. , ed. V.A. Epifanova, p. 394, M., 1987; Guide to kinesitherapy, ed. L. Boneva and others,. from Bulgarian, p. 241, Sofia, 1978; , ed. M. Veyes and A. Zembaty, trans. from Polish, p. 278, M., 1986.

Rice. 2. Schematic representation of herniated intervertebral disc: a - normal intervertebral disc (given for comparison); b - protrusion of the disc as a result of the displacement of part of the nucleus pulposus and the protrusion of the fibrous ring into the spinal canal; c - disc herniation with rupture of the posterior longitudinal ligament of the spine; d - a large disc herniation, squeezing the spinal cord and its roots.

X-ray of the spine with osteochondrosis (lateral projection): change in the end plates of the vertebral bodies and intradentate hernia - Schmorl's node (indicated by an arrow) "\u003e

Rice. 7. X-ray of the spine with osteochondrosis (lateral projection): change in the end plates of the vertebral bodies and intradentate hernia - Schmorl's node (indicated by an arrow).

Rice. 4b). Schematic representation of topographic variants of herniated intervertebral discs directed to the spinal canal in the lumbar spine in osteochondrosis: lateral.

Rice. 6. X-ray of the cervical spine with cervical osteochondrosis (lateral projection): 1 - a slight narrowing of the intervertebral disc between VI-VII vertebrae; 2 - sclerosis of the adjacent end plates of the vertebral bodies; 3 - anterior marginal osteophytes.

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Rice. 13b). Physical exercises in a hydrokinesitherapy bath for osteochondrosis: alternate bending of the legs.

Currently, in all countries of the world, specialists are struggling with osteochondrosis, as the number of patients who are diagnosed with this disease is increasing every year.

Most often, osteochondrosis is diagnosed in young people whose age ranges from 15 to 30 years. This is due to the fact that the development of this disease occurs at a socially active age (the male half of the population is more difficult to tolerate osteochondrosis).

- This is a lesion of the intervertebral discs and other tissues of the spine. Osteochondrosis is understood as a dystrophic process in the intervertebral discs. The spine is compressed, crushing the discs that are between the vertebrae. Over time, they lose their elasticity, and now the nerve endings of the spinal cord begin to pinch. Pain arises, appears.

In the advanced stage of osteochondrosis, people face serious complications, some of which cause disability.

An osteophyte is an abnormal bone growth along the edges of the surface of a bone or articular processes of the vertebrae. Osteophyte appears due to the prolonged existence of instability of the spinal motion segment against the background of osteochondrosis or spinal injury. In general, an osteophyte is a protective reaction of the body to heavy loads, therefore, if the growths are removed, they return again.

Symptoms of osteochondrosis

Osteochondrosis is accompanied by characteristic symptoms, which include the following:

severe pain syndrome (all, without exception, patients complain of unbearable cutting, sharp or shooting pains in the spine, which are stopped by special medications);

numbness of the lower and upper limbs;

spasm of the arteries of the feet;

lowering the temperature regime of the skin of the lower extremities, etc.

The cervical and lumbar spine are most often injured, as they are the most mobile. By the age of 45, the intervertebral discs stop accumulating water. And, as a result, they become not as elastic as before. Therefore, they are more prone to flattening, they can be squeezed out of the spine. This phenomenon is called. If the disk came forward or sideways, then there is no particular discomfort. But if back, then this is what is called sciatica.

Pain can occur due to a simple sneeze, or due to the efforts of the abdominal muscles. If the symptoms of osteochondrosis last more than two weeks, you need to seek help from doctors - either a neurologist or a neurosurgeon-traumatologist - and undergo an examination, preferably a comprehensive one, which necessarily includes fluoroscopy. It would be nice to have another magnetic resonance imaging.

The causes of osteochondrosis can be hypothermia of the body, sharp turns in which the vertebrae are displaced, and physical overload.

According to many experts who have studied this disease, the main cause of osteochondrosis is an improperly distributed load on the spinal column. As a result, in patients, directly in places on which excessive physical pressure is exerted, there is a change in the structure of cartilage tissues.

The provoking factors of osteochondrosis are:

slouch;

weak back muscles (no muscle corset);

rachiocampsis;

being in an uncomfortable position for a long period of time;

weight lifting;

dragging heavy objects;

passive lifestyle;

metabolic disorders (in the patient's body there is not enough phosphorus, calcium, magnesium, zinc and other useful vitamins and microelements);

bad heredity;

negative impact on the body caused by chemicals;

transferred infectious diseases;

general hypothermia of the body;

hormonal imbalance;

active and strength sports;

frequent and abrupt changes in the position of the body;

• 
  

Osteochondrosis should be taken seriously. Only the uninitiated think that this is a simple disease that is easy to deal with without the help of a specialist. For effective treatment, it is necessary to approach the problem comprehensively. Eliminate heavy loads, lead a measured lifestyle, eat right and perform special exercises. In the acute phase, medication support and constant medical supervision will be required.

Osteochondrosis - what is it?

Dystrophic processes leading to a partial or complete change in the intervertebral discs. The vertebrae, shrinking, crush the discs, which, under the influence of stress, infection, and malnutrition, lose their elasticity. Shrinking, the discs begin to put pressure on the nerve endings, which causes unbearable pain. The disease at an early stage does not cause serious problems, but the sooner the patient turns to a specialist, the more effective the treatment will be.
At the onset of the disease, minor changes occur in the spine. Osteochondrosis approaches imperceptibly. There are small pains in different parts of the spine, signaling degenerative-dystrophic processes in the discs.

If treatment is not started immediately, the process may become irreversible and will be transferred to the tissues of the vertebrae. Disc dystrophy leads to a gradual weakening of the outer fibrous rings. Patients with osteochondrosis often face complications such as protrusion and vertebral hernia.

Regularly conducted studies in this area provide disappointing statistics. People over thirty years of age often face a disease of the spine, 70% of patients suffer from various forms of osteochondrosis. This is a neurological disease that affects the ligaments of the intervertebral joints. It is accompanied by sharp pains, pressure surges and other symptoms, often preventing people from leading a normal life and working normally.

Osteochondrosis does not occur without reason, abruptly, with acute pain. The first symptoms are minor and imperceptible. With an unexpected deterioration in well-being, the appearance of unpleasant sensations in the spine, which quickly pass, do not neglect the signals of the body. It is required to immediately consult a doctor for advice and undergo a complete examination. Timely treatment will help to avoid serious complications.

Important. Neglecting the treatment and advice of doctors, you may encounter protrusion or bulging of part of the disc - a hernia, in which part of the nucleus pulposus hangs down into the spinal canal and can cause paralysis, infringement of nerve endings, resulting in unbearable pain.

There are several types of osteochondrosis, named after the location and position of pain in the spine.

• Cervical
• thoracic

Upon examination, the specialist will determine the degree of damage, the place of exposure and choose the method of complex treatment. The effectiveness of the treatment of osteochondrosis largely depends on the exact observance of all the prescriptions of the attending physician.

Causes

After numerous in-depth studies, specialists came to the conclusion that the main reason for the appearance of osteochondrosis is the uneven distribution of loads on different parts of the spinal column. The root cause may be intensive work in unusual conditions, long sitting in one position, heavy loads during sports training, shock. The result of an unexpected or prolonged load on a certain area of ​​the spine is a gradual change in the structure of the intervertebral discs.

Among the main reasons for the appearance and gradual development of the disease, there are several main ones:

• Hereditary changes in the development of the body, leading to the appearance of osteochondrosis.
• Diseases of the endocrine system, failure of metabolic processes.
• Improper development of the musculoskeletal system, leading to pathological changes in the body.
• Any injuries of the back, lower back, neck during a fall, training, sudden loads, impacts.
• Inactive lifestyle, burdened by malnutrition.
• Osteochondrosis is a constant companion of overweight people suffering from obesity.
• The abuse of alcohol and nicotine necessarily leads to the destruction of the intervertebral discs.
• Constant psychological and physical stress, stress and overwork become the root cause of intervertebral cartilage dystrophy.
• Women at different stages of pregnancy often experience manifestations of osteochondrosis.

People of certain professions are most susceptible to osteochondrosis, since the monotonous performance of their duties gradually leads to degenerative changes in the structure of the intervertebral cartilage. The main risk groups include:

• Accounting workers.
• Cashiers and managers.
• Drivers of any vehicles.
• People professionally involved in sports.

It should be borne in mind that women are most often affected by the disease due to a poorly developed muscular system.

I'm tired of repeating! If the joints of the arms and legs begin to hurt, immediately remove from the diet ...

The corset of the dorsal muscles that support the spine is more durable in the representatives of the strong half of humanity. Women with magnificent large breasts and little exercise will definitely encounter and.

Development of osteochondrosis

No disease occurs without a cause and does not begin immediately. The body always goes through changes step by step. The disease has four main stages, which you need to know about in order to promptly consult a doctor for help.

1. Gradually beginning dystrophic changes in the pulpous nuclei of the intervertebral cartilages usually go unnoticed. Dehydration of the disc becomes the root cause of the occurrence of microcracks, loss of elasticity and thinning of the cartilage. Often people at this stage feel a little discomfort when sitting in one position for a long time or unexpected backaches during intense exercise.
2. The second stage is already hard to miss. Degenerative tissue change leads to the appearance of protrusion. The fibrous capsule is destroyed, and the intervertebral space is reduced. The result will be a pinched nerve endings, the appearance of a sharp pain in certain parts of the back. The pain syndrome is actively expressed with any inclinations, sharp turns and running. Osteochondrosis is accompanied by a sharp loss of working capacity and the appearance of weakness in the body.
3. Complete or partial abrasion of the intervertebral cartilage lining due to osteochondrosis. The thinning of the tissue is clearly visible when X-rays are taken. Symptoms of the disease are pronounced and can lead to partial paralysis. It is impossible to relieve the pain, and one has to resort to injections and other medical effects on the focus of the disease. Only potent drugs and complete rest help.
4. This is the last stage, characterized by the complete destruction of the intervertebral cartilage. A complex violation of the neurological system, leading to the appearance of bone growths in place of cartilage tissue. Joint mobility is completely impaired. Osteophytes can injure the nerve endings of the vertebrae and bone segments. At this stage, the help of a surgeon may be needed for treatment.

The petrified appearance of the spine can lead to partial or complete immobilization of the patient. In this case, the pain may disappear.

Symptoms of osteochondrosis

Osteochondrosis is a pathological change in the cartilaginous tissues of the connective discs of the spine. Degenerative-dystrophic changes occur for various reasons and lead to the formation of diseases of the ligamentous intervertebral discs. During osteochondrosis, soft tissues and nerve endings are infringed. Vessels and nerve endings in the vicinity of the focus experience serious changes, which causes severe pain and disruption of the supply of nutrients.

The main symptoms indicating the development of osteochondrosis

You should be attentive to any, even minor changes in the body. The sooner you begin preventive measures to influence the emerging focus of the disease, the more effective the treatment will be.

• There are pains in the neck, chest, lower back and ribs.
• There is stiffness of movements when turning, tilting and fast walking, running. When lifting weights, short-term pain appears.
• Hands and feet lose sensitivity, become numb and swell.
• Chills appear even at high temperatures outside. Aches in the lower and upper limbs.
• Sudden and very painful spasms of the muscles of the legs and arms.
• There is a pronounced dysfunction in the work of the genital organs, which can cause serious psychological trauma.
• The appearance of dizziness and severe headaches.
• Sharp pains in the chest, strongly reminiscent of a pre-infarction condition.
• The sensitivity of the fingers is partially or completely lost.
• Unsystematic muscular hypotension.
• A sharp decrease in efficiency, high fatigue, loss of visual acuity.

Symptoms may appear unexpectedly, for no apparent reason. Most often, exacerbation is preceded by prolonged and unexpected physical exertion, overwork at work or in training, sudden hypothermia and prolonged exposure to vibration. Any injuries, even those that have passed without visible consequences, blows, bruises, can become a trigger for the development of osteochondrosis.

Symptoms characteristic of the development of the disease in different parts of the spine

Cervical. The disease can be signaled by sharp, quickly starting pains in the shoulders and arms, the appearance of nausea, dizziness and sudden migraine attacks. Unexplained pressure surges that are not related to the work of the cardiovascular system.

The appearance of constant noise in the ears, stars before the eyes speaks of problems of the cervical spine. Elderly people may suddenly lose consciousness while walking.

Thoracic. The appearance of sharp pains in the front of the chest, abdomen, between the ribs. Breathing becomes more frequent and difficult. Pressive heaviness in chest. Sharp pain in the region of the shoulder blades when turning, moving and bending. Disorder of the gastrointestinal tract. Attacks of pancreatitis, bloating, diarrhea. The limbs become suddenly numb and people may lose their balance when walking. Sharp bouts of weakness, there is a feeling of trembling under the skin.

Lumbar. The appearance of a dull growing pain in the lumbar region. It can give to the leg, leading to loss of balance when moving. Sharp backaches lead to partial or complete immobilization of the body. There are unpleasant tingling in the lower extremities, even when resting. When tilted, it becomes difficult to straighten up without assistance. Violation of the genitourinary system.

Possible Complications

Many do not pay much attention to the first manifestations of degenerative-dysfunctional processes in the connective tissues of the spine. Such an attitude towards one's own body can have a sharply negative impact on the work of all internal organs. The imbalance of functions will grow like an avalanche, and a person may suddenly end up in a hospital bed. A decrease in the mobility of the spine, a violation of the speed of the passage of signals and the difficulty in the supply of nutrients to certain parts of the body lead to the development of dysfunctions in the musculoskeletal system, the work of the joints and ligaments.

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Partial or complete destruction of intervertebral connections leads to the development of numerous chronic diseases. Even a slight pain in the spine, which suddenly appeared and disappeared just as quickly, should force a person to undergo a full examination. This will help to identify the foci of the onset of the disease and, with the help of preventive measures, to avoid the further development of the disease.

Ignoring the first signals, you may encounter more serious problems:

• The appearance of sharp, prolonged pain in the head, migraines and dizziness.
• Problems in the cervical spine can lead to sudden loss of vision.
• Hearing loss is often the result of a malfunction of the upper spine.
• The development of osteochondrosis can cause autonomic dysfunction.
• Problems in the lower back lead to a sharp exacerbation of diseases of the genitourinary system.
• Lack of proper treatment of osteochondrosis leads to chronic radiculitis and sciatica.
• Large loads and lack of systemic treatment cause intervertebral hernia.
• People stack up with such diseases as lumbago, spondylarthrosis, lumbalgia.
• Prolonged development of osteochondrosis without qualified treatment leads to stenosis of the spinal canals, spondylosis, osteophytosis.

It must be clearly understood that any violations in the functioning of the spine will necessarily lead to the development of more complex chronic diseases of the internal organs. Damage to the neurovascular bundles makes it difficult for the rhythm of the organs to work, disrupts the supply of the required amount of nutrition and the removal of toxins and toxins.

This negatively affects the entire body. Damaged cells and slags accumulating inside the tissues stimulate the development of malignant tumors. You may suddenly find out that excellent health has suffered serious damage from a small pain in the lower back, back or neck.

The phase of exacerbation of osteochondrosis

People face a sharp deterioration in well-being in the spring in the lower spine. This may be due to the lack of the required amount of minerals and vitamins. Sudden physical exertion and temperature changes in the street. In winter, the thoracic region suffers the most. Due to infectious diseases, hypothermia and poor nutrition. The cervical spine is most affected by a sedentary lifestyle or work in one sitting position. At the first symptoms, it is necessary to use warming ointments, try to get rid of spasms and swelling as soon as possible. Immediate contact with a specialist will help to effectively cope with osteochondrosis. When severe swelling occurs, using diuretics, do not forget to take preparations containing potassium and calcium.

Diagnostics

The doctor to whom the patient addresses with sharp pains in the spine must perform several steps in sequence.

1. Collection of anamnesis. Conducting a detailed conversation with the patient. The goal is to find out the root causes of the disease. At what time do the most striking attacks occur, which led to the onset of pain. Individual features of the course of the disease "Osteochondrosis".
2. Thorough personal examination by a specialist. The skin is examined for the presence of a rash and swelling. The flexibility of the joints and the sharpness of the reflexes are checked. Palpation of the painful area will help to localize pain points and find places of exacerbation. Percussion with fingers or special instruments helps to determine the irradiation of pain. With the help of tingling with needles, the degree of sensitivity in different parts of the body is determined.

To obtain the most complete picture of the state of the body and identify hidden foci, a hardware examination should be used, which necessarily includes:

• Diagnosis by X-ray. A snapshot of the affected area allows you to immediately notice the narrowing of the allowable gap between the spinous vertebrae. Drying of the intervertebral discs is clearly visible on the x-ray.
• MRI is a state-of-the-art technology that guarantees accurate diagnosis of spinal diseases. The use of magnetic resonance imaging helps to determine and localize the site of the formation of an intervertebral hernia.
• Computed tomography in its value and effectiveness is not much different from MRI. The only drawback is the increased radiation exposure, so CT is not recommended for children.

Treatment of osteochondrosis

No qualified specialist uses the same methods of treatment for all patients. If the doctor claims that everyone can be cured by one method, it is best to turn to another. The method of treatment is always based on the individual characteristics of the patient's body, the dynamics of the development of the disease and the body's response to medications.

A comprehensive path to healing includes:

1. Passive or active physiotherapy, which is always prescribed individually, taking into account the age, weight and condition of the patient.
2. The use of various massage techniques and special exercises for the affected parts of the spine.
3. A well-trained, experienced chiropractor can provide invaluable assistance.
4. The use of medical support in the acute phases of the development of osteochondrosis.
5. The use of hardware treatment with electrophoresis, heating, exposure to reflex zones.
6. The use of special stretching and relaxation techniques.

How can you help at home with osteochondrosis?

People who work a lot and do not have free time neglect going to the doctor. However, a progressive disease can be a serious cause for disability. To prevent negative consequences and reduce the risk of serious complications, treatment can be carried out at home.

For this you need:

1. Gradually give up bad habits. Smoking and excessive alcohol consumption often cause the development of the disease.
2. Compliance with the correct diet. You will need to avoid fatty, spicy and salty foods. It is best to consume more natural juices and fresh vegetables.
3. For those who can't work without a few cups of coffee a day, consider switching to green tea. There is no less caffeine in the drink, but more benefits.
4. Take care of the correct equipment of the bed. Orthopedic pillows and a mattress will help the body to fully relax and relieve pain.
5. Restoration of good blood flow. The ideal option is to use the services of a professional massage therapist. If there are no funds for this, learn the technique of self-massage.
6. Daily special gymnastics. At first, this may require some effort, but over time, a person gets used to it and can no longer do without it.

Preparations for the medical treatment of osteochondrosis

Do not rely on the opinion of friends and close relatives in this matter. It must be remembered that each person is individual. A drug that was able to help your brother or friend may have a completely different effect on you and cause serious health problems. Doctors prescribe medications that relieve swelling, reduce pain, stimulate the regeneration of damaged tissues and restore the musculoskeletal system as a whole. Only a qualified doctor can choose the right complex for the treatment of osteochondrosis. The effectiveness of treatment will depend on the collected history, visual examination and the use of hardware diagnostics.

Prescribed medications can be divided into several groups:

• NSAIDs. They act on areas of pain, localizing and eliminating the unpleasant consequences of the occurrence. These include diclofinac, ibuprofen, piroxicam. The dosage and method of application is always prescribed by the attending physician, based on the study of the patient's body.
• Antispasmodic. A group of drugs that helps to quickly relieve muscle spasm and relieve the patient from unbearable pain in the damaged area of ​​the body. Sirdalud, dratoverin, myolastan and other medicines on the pharmaceutical market with the same focus.
• Antioxidant. Mandatory preparation necessary for the rapid removal of accumulated toxins from the internal tissues. Vitamins of groups B and C. Mexidol and other drugs of this group.
• Restoration of microcirculation in the circulatory system. Trental, theonicol. Nicotinic acid, actovegin and other drugs offered in the pharmacy of this direction.
• Chondroprotector. It has a narrowly targeted action, designed for the rapid restoration of cartilage tissue. Stimulates metabolism and detoxification. Teraflex, chondroxide, structum.

The doctor may prescribe injections to relieve pain and speed up the healing process. In this case, it is necessary to visit a day hospital for daily injections. Dosages and drugs are always prescribed individually. If negative factors appear, you should immediately tell your doctor about them and change the drug or reduce the dose of the drug.

Ointments and gels are usually used for small local problems. They can be bought at a pharmacy without a prescription, after consulting with the seller. However, they allow only temporary relief from severe pain. After relief, you must immediately contact a specialist for a more detailed and complete treatment.

The choice of drugs and treatment method affects the development of osteochondrosis. Carefully monitor your well-being after starting treatment and talk to your doctor immediately about any changes. A specialist who observes you for a long time and is well aware of the various chronic diseases of the patient is able to cope with the disease as quickly as possible. Remember that osteochondrosis is an insidious disease and can manifest itself at the most unexpected moment under the influence of external factors. Be treated by a doctor who is trustworthy and has long confirmed his qualifications. Only the complex use of all existing means will help to quickly rid the patient of osteochondrosis.

Non-drug treatments

• Regular massage perfectly stimulates blood flow and helps keep muscles, cartilage and tendons in perfect condition.
• Manual therapy helps to quickly relieve pain, localize the focus of the disease and stimulate the restoration of cartilage tissues.
• Physiotherapy. A properly selected individual set of exercises guarantees the harmonious development of the musculoskeletal system.

Prevention of osteochondrosis

Taking care of your body will help you avoid serious problems in the future. Simple precautions will relieve the insidious disease:

1. Try not to carry heavy weights above 10 kg.
2. When carrying heavy bags, distribute the load evenly in both hands.
3. Proper nutrition will relieve obesity and relieve stress from the spine.
4. Regular visits to the pool and daily gymnastics are the key to health.
5. When working in one position, try to find time for a little warm-up.

Is it possible to cure osteochondrosis completely?

By contacting a specialist for help and having completed a full course of treatment for osteochondrosis in a hospital, you can guarantee a good result. Be sure to consult with your doctor after discharge from the hospital and learn an individual course of exercises to maintain the muscular system. At least once every three months it is required to visit a masseur or chiropractor. Adhere to an active lifestyle and proper nutrition so that the muscles are always in perfect condition. Preventive measures will help you stay in great physical shape.

Osteochondrosis is a difficult disease and only the uninitiated think that it is easy to deal with it. The support of a qualified doctor, compliance with milestones of prescriptions, patience and perseverance will help restore health.

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