Dorsopathy are a group of diseases of the spine and nearby tissues that cause pain in the trunk and extremities that are not associated with pathologies of internal organs. Pain syndrome can be acute or chronic, it increases with sudden movements, sneezing, coughing. It can be combined with limited mobility, muscle weakness, sensitivity disorders, vascular, trophic disorders. The diagnosis of dorsopathy is established on the basis of complaints, objective examination, radiography, CT, MRI, and other studies. Treatment – drug therapy, physiotherapy, massage, physical therapy. Operations are rarely required.
Dorsopathy are an extensive and heterogeneous group of diseases, including inflammatory, degenerative, post–traumatic, hereditary and other spinal pathologies accompanied by pain syndrome. They occupy the first place in terms of prevalence among diseases of the musculoskeletal system. They are the third most common cause of persistent disability after cardiovascular diseases, malignant tumors. They can be diagnosed in any age group, and are more often detected in middle-aged and elderly people.
According to experts, the leading reason for the widespread prevalence of dorsopathies is a change in lifestyle associated with automation, a decrease in the average level of physical activity, narrow specialization, which causes the presence of monotonous non-physiological loads on the musculoskeletal system. Factors contributing to the development of dorsopathies are:
- Features of training. Prolonged stay in a sitting position during school can cause changes in muscle tone, the formation of posture disorders, scoliosis, flat back, pathological kyphosis, lordosis.
- Lack of mobility. The widespread use of motor vehicles, the Internet, mobile phones, the widespread use of office professions entail a decrease in physical activity, detrenirovannost, against which injuries occur more often, degenerative diseases develop.
- Production factors. Long-term preservation of a static posture, excessive loads on certain muscle groups, vibration, work in conditions of low temperatures and high humidity have a negative impact on the musculoskeletal system, contribute to muscle overstrain, the formation of inflammatory, degenerative pathologies.
- Psychoemotional tension. Constant stress effects cause tension of individual muscle groups, changes in muscle tone, motor stereotypes. Managers, teachers, doctors, representatives of law enforcement and financial structures are particularly susceptible to chronic stress.
- Overweight. The load on the spine increases in proportion to the increase in body weight, so overweight people suffer from overload even in conditions of moderate activity. The situation is aggravated by a tendency to inactivity due to poor tolerance of physical exertion.
- Heredity. There is a hereditary predisposition to certain diseases of bones, muscles, joints and ligaments, as well as inherited weakness of connective tissue, which creates favorable conditions for the development of pathologies of the musculoskeletal system.
Other predisposing circumstances are flat feet, diseases of the lower extremities, accompanied by a violation of the physiological mechanisms of standing and walking. Pathology is often provoked by improper lifting of weights. Pregnancy plays a certain role in women. Researchers note the importance of smoking, poor nutrition, alcohol abuse.
Most often (90%) dorsopathy is caused by reflex syndrome, which develops when pain receptors are irritated against the background of inflammation, displacement, overstrain, and other effects. In response to irritation, muscle spasm occurs, which becomes a source of additional pain impulses. A vicious circle of “pain – spasm – increased pain” is formed.
In 10% of patients, the cause of dorsopathy is compression of the spinal cord, nerve roots or vertebral artery. Compression is provoked by inflammation, traumatic injury, bone growths, violation of normal anatomical relationships between various structures of the spinal column, the formation of hernial protrusion.
Irritation of pain receptors in reflex syndrome or compression of nerve structures leads to the development of aseptic inflammation. From the receptors, signals are transmitted to the brain, which activates the production of anti-inflammatory compounds in synapses. This stimulates neighboring neurons, thalamus nuclei, cytokine synthesis in nerve endings. Against the background of the inflammatory process, axons are replaced by collagen fibers, inflammation becomes chronic.
Taking into account the peculiarities of the course, there are three variants of dorsopathies: acute (pain disappears within 3 weeks), subacute (pain syndrome persists for 3-12 weeks), chronic (soreness worries for more than 4 months or there are more than 25 pain attacks per year). According to ICD-10, there are three main groups of dorsopathies:
- Deforming dorsopathies: spinal deformities, degeneration of discs without herniation, displacement of vertebrae, subluxations. Osteochondrosis, spondylolysis, spondylolisthesis, all types of spinal curvature (scoliosis, lordosis, kyphosis), including the consequences of neurological diseases, habitual subluxations C1.
- Spondylopathy: dystrophic changes of the spine with reduced mobility. Spondylitis of various genesis, traumatic and neuropathic spondylopathy, osteomyelitis, spinal stenosis, spondylosis, inflammation of the discs, fractures due to overexertion.
- Other dorsopathies: degenerative disc changes with the formation of protrusion or herniation. Intervertebral hernias of the cervical, thoracic and lumbar spine, including those with radiculopathy, myelopathy; Schmorl hernias.
In addition, the group of other dorsopathies includes dorsalgia – pain that occurs against the background of functional changes in soft tissues, intervertebral discs, and arched joints. A distinctive feature of dorsalgia is the absence of neurological disorders due to compression of nerve roots or spinal cord.
Taking into account the localization, features of the pain syndrome, the following variants of pain in dorsopathies are distinguished:
- local – in the affected area;
- projection (reflected) – spreading along the course of the nerve;
- radicular (radicular) – arising from compression of the root, accompanied by sensitivity disorders, muscle weakness, decreased reflexes;
- developing with muscle spasm.
The most common pain syndromes of mixed genesis. For example, when the nerve root is compressed, local back pain appears, muscle spasm occurs reflexively, soreness in the innervation zone is noted in combination with neurological disorders.
The cervical and lumbar sections are more often affected. Pain about dorsopathies can be aching, permanent or sudden, acute, intense, according to the type of lumbago. Accompanied by tension of the muscles of the back, neck, upper arms, limbs, soreness during palpation. The pain increases with movements, lifting weights, sneezing, coughing, forcing patients to limit physical activity.
Patients are concerned about muscle spasms, a decrease in the volume of movements of the spine and limbs. Possible paresthesia, decreased sensitivity, muscle weakness, impaired reflexes. With a significant duration of the disease, the presence of neurological symptoms, muscle hypotrophy is formed. Neurotrophic disorders may be detected.
Dorsopathy of the cervical spine
Pain in the cervical region is often combined with pain in the upper arms, upper extremities. Restrictions of movements in the shoulder joints are often noted, with a prolonged course of pathology, the likelihood of developing degenerative lesions of the joints, periarticular soft tissues increases. Due to the concomitant compression of the vertebral artery, patients may be disturbed by headache, dizziness, noise in the head, darkening in the eyes or flashing “flies”.
Along with pain in the thoracic region, patients often complain of pain in the heart or chest, which can complicate the diagnostic search. Intercostal neuralgia may develop, accompanied by short-term, but very intense attacks. With compression of the roots, the spinal cord, numbness, crawling of goosebumps, movement disorders are observed.
Dorsopathy of the lumbar spine
Acute pain attacks of a shooting nature often occur against the background of constant or periodic dull pain in the lower back, give in the buttock, lower limb, less often – the lower abdomen. The pain usually increases in the standing position, when bending, rotating the body. Sometimes it makes it difficult to straighten the trunk, causes lameness. Possible cramps in the calf muscles, numbness, weakness in the legs.
With a prolonged course, there is a progression of dystrophic processes with the formation of protrusions, hernias, and the occurrence of osteoporosis. A typical complication of dorsopathies are motor, sensory and mixed neurological disorders. It is possible to form functional scoliosis, the development of mental disorders (depression, neurosis, hypochondria) due to prolonged pain retention.
Primary diagnosis of dorsopathy is carried out by neurologists. If necessary, neurosurgeons, orthopedic traumatologists, and other specialists are involved in the examination. The diagnostic program includes:
- Collection of complaints and anamnesis. The doctor finds out the time and circumstances of the appearance of symptoms, the dynamics of their development, the connection with external circumstances. Determines the factors contributing to the appearance of the disease, the occurrence of exacerbations. Assesses the impact of pathology on the quality of life of the patient, the patient’s attitude to his disease.
- Neuro-orthopedic examination. It involves the study of posture using two electronic scales, curvimetry, determination of the volume of active and passive movements, study of muscle tone, identification of trigger pain points.
- Radiography. It includes survey images of the entire vertebral column, targeted radiographs of the affected area, often supplemented with functional tests. X-ray examination reveals traumatic injuries and their consequences, bone growths, changes in bone structure, congenital anomalies, stenosis.
- CT of the spine. It is used at the final stage of diagnostic search. Complements the results of radiography, allows you to clarify the location, size, configuration of the pathological focus, its relationship with neighboring structures, plan surgical intervention or clarify the tactics of conservative therapy.
- MRI of the spine. It displays well intervertebral discs, ligaments, cartilage, nerves, vessels, spinal cord and its membranes, surrounding muscles, fatty tissue. It makes it possible to assess in detail the condition of soft tissue structures, to identify injuries, inflammatory, degenerative diseases, developmental anomalies, tumors.
- Neurophysiological techniques. Electromyography, electroneurography, study of somatosensory evoked potentials are assigned to determine the level, topic, nature and prevalence of the lesion, assess the condition of muscles, pathways, differential diagnosis, detection of subclinical forms of the disease, tracking dynamics.
In the process of diagnosis, questionnaires, tests, special scales are used: a six-point assessment of muscle strength, an index of muscle syndrome, a scale for assessing vertebroneurological symptoms, a questionnaire for neuropathic pain, an Oswester questionnaire. Differential diagnosis is carried out between different dorsopathies.
Treatment of this group of pathologies is more often conservative, as a rule, carried out on an outpatient basis. The main principles of dorsopathy therapy are early onset, an integrated approach, measures aimed at eliminating pain syndrome, a combination of symptomatic and pathogenetic techniques. Conservative treatment of dorsopathies includes the following medicinal and non-medicinal methods:
- NSAIDs. They are prescribed in short courses orally, less often intramuscularly during the period of exacerbation to reduce the intensity of pain syndrome, reduce inflammation. If necessary, they can be used for a long time in the form of local funds.
- Muscle relaxants. They are recommended to reduce the intensity of muscle spasms, eliminate the reflexogenic component of the pain syndrome.
- Blockades with corticosteroids. They are indicated for severe pain that cannot be eliminated by other drugs. Betamethasone, dexamethasone, and other drugs are injected into the affected area together with a local anesthetic.
- Medications to stimulate recovery. To stimulate repair, activate biochemical processes in the nervous tissue, restore cartilage, B vitamins, chondroprotectors, anabolic, vascular drugs are used.
- Sedatives. Herbal preparations, mild tranquilizers, and antidepressants are used to prevent depressive disorders. Medications of these groups also reduce the severity of psychogenic muscle spasms.
- Traction therapy. Dry and underwater stretching helps to relax the muscles, increase the distance between the vertebrae. Eliminates compression of nerves and blood vessels, reduces the severity of pain, improves blood supply.
- Physical therapy. Patients are prescribed electrophoresis, magnetotherapy, laser therapy, diadynamic currents, UFO, mud applications, underwater shower.
- Other methods. Individual complexes of physical therapy are an obligatory part of rehabilitation. Massage is widely used. According to the indications, acupuncture, manual therapy, taping are used.
Orthoses are recommended to fix the affected area. With unbearable shooting pains, anticonvulsants are prescribed. Patients are under dispensary observation by a neurologist. To prevent exacerbations, treatment courses are regularly repeated. During the period of remission, patients are referred for sanatorium treatment.
The absolute indication for surgery is considered to be compression of the ponytail with impaired pelvic organ function, loss of sensitivity of the anogenital zone, paresis of the feet. The ineffectiveness of conservative therapy for 6 months is considered as a relative indication. Taking into account the nature of the pathology, the following interventions are performed:
- for intervertebral hernias: discectomy, microdiscectomy, nucleoplasty, radiofrequency denervation of facet joints;
- in scoliosis: correction using thoracic, dorsal or thoracophrenolumbotomic access;
- for stenosis: facetectomy, laminectomy, puncture decompression of the disc;
- in case of instability: interbody fusion, transpedicular fixation, fixation with cages and plates.
In the postoperative period, rehabilitation measures are prescribed, including drug therapy, physical therapy, physiotherapy. The volume and duration of the recovery period are determined by the type of surgery, the severity of neurological disorders, the age of the patient, and other factors.
In acute dorsopathies caused by functional disorders (for example, due to overload or hypothermia), complete recovery is possible. In chronic processes accompanied by organic changes in the vertebral column and adjacent anatomical structures, timely adequate treatment can eliminate or significantly reduce pain, ensure long-term preservation of working capacity, habitual activity.
Preventive measures involve the formation of a schedule of students taking into account official recommendations, the use of functional furniture, ensuring appropriate working conditions at work, minimizing stress, maintaining sufficient physical activity. Persons with diagnosed dorsopathy, a tendency to connective tissue diseases should be monitored by a neurologist or orthopedist.
- Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion. Willems P. Acta Orthop Suppl. 2013 Feb;84(349):1-35. link
- Low back pain: risk evaluation and preplacement screening. Himmelstein JS, Andersson GB. Occup Med. 1988 Apr-Jun;3(2):255-69. link
- [Unspecific back pain – basic principles and possibilities for intervention from a psychological point of view]. Flothow A, Zeh A, Nienhaus A. Gesundheitswesen. 2009 Dec;71(12):845-56. link
- [Social and professional effects of hip prosthetic replacment on people under 50 years of age]. Xenard J. Eur J Orthop Surg Traumatol. 1996 Dec;6(4):229-234. link
- Methodological and conceptual issues regarding occupational psychosocial coronary heart disease epidemiology. Burr H, Formazin M, Pohrt A. Scand J Work Environ Health. 2016 May 1;42(3):251-5. link