Spinal osteochondrosis is a chronic disease in which degenerative changes of the vertebrae and intervertebral discs located between them occur. Depending on the location of the lesion of the spine, there are: osteochondrosis of the cervical spine, osteochondrosis of the thoracic spine and osteochondrosis of the lumbar spine. To diagnose spinal osteochondrosis, radiography is necessary, and in case of its complications (for example, a herniated disc), an MRI of the spine. In the treatment of spinal osteochondrosis, along with medical methods, reflexotherapy, massage, manual therapy, physiotherapy and physical therapy are widely used.
ICD 10
M42 Spinal osteochondrosis
Etiology and pathogenesis
To one degree or another, spinal osteochondrosis develops in all aged people and is one of the aging processes of the body. Sooner or later, atrophic changes occur in the intervertebral disc, but injuries, diseases and various overloads of the spine contribute to the earlier occurrence of osteochondrosis. The most common osteochondrosis of the cervical spine 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 taking place 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 vertebral-motor segment, consisting of two adjacent vertebrae with an intervertebral disc located between them. Such overload can occur as a result of a motor stereotype — posture, individual manner of sitting and walking. Violations of posture, sitting in the wrong position, walking with an uneven vertebral 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 trophic tissues caused by hereditary factors. Most often, malformations in the structure occur in the cervical region (Kimberly anomaly, craniovertebral anomalies, Chiari anomaly) and lead to vascular disorders and the early appearance of signs of osteochondrosis of the cervical spine.
The occurrence of osteochondrosis of the lumbar region is more often associated with its overload during slopes and lifts of gravity. A healthy intervertebral disc can withstand significant loads due to the hydrophilicity of the pulpous nucleus located in its center. The core contains a large amount of water, and liquids are known to be little compressible. Rupture of a healthy intervertebral disc can occur with a compression force of more than 500 kg, while a disc modified as a result of osteochondrosis ruptures with a compression force of 200 kg. The 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 trunk forward by 200. Such a high pressure is due to the small size of the pulpous nucleus. With an increase in the slope 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, radial cracks appear in its fibrous ring under load. The distance between adjacent vertebrae decreases and they shift relative to each other, while displacement also occurs in the facet (arch-process) joints connecting the vertebrae.
The 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 modified intervertebral disc no longer so firmly fixes the bodies of neighboring vertebrae. Instability of the vertebral segment is formed. Due to instability, infringement of the spinal nerve root with the development of radiculopathy is possible. With osteochondrosis of the cervical spine, this often occurs during head turns, with osteochondrosis of the lumbar spine — during torso bends. It is possible to form a functional block of the vertebral-motor segment. It is caused by compensatory contraction of the vertebral muscles.
A herniated intervertebral disc is formed when the disc moves backwards, the posterior longitudinal ligament is torn and part of the disc protrudes into the spinal canal. If at the same time the pulpous nucleus of the disc is squeezed out 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 unexploded one. A herniated disc can cause radicular syndrome or compression of the spinal cord.
In 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 the development of radicular syndrome.
Symptoms
The main symptom of spinal osteochondrosis 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 to take a forced position. Thus, 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 increases even with deep breathing, and with osteochondrosis of the lumbar region, it is difficult for the patient to sit down, get up and walk. This pain syndrome is characteristic of compression of the spinal nerve root.
In about 80% of cases, dull pain of a permanent nature and moderate intensity is observed. In such cases, when examined by a doctor, it is necessary to differentiate the manifestations of spinal osteochondrosis from myositis of the back muscles. Dull pain in osteochondrosis is caused by excessive compensatory tension of the muscles holding the affected vertebral-motor segment, inflammatory changes or significant stretching of the intervertebral disc. In patients with such a pain syndrome, there is no forced position, but there is a restriction of movement and physical activity. Patients with osteochondrosis of the cervical spine avoid sharp turns and head tilts, with osteochondrosis of the lumbar spine – slowly sit down and stand up, avoid trunk tilts.
All the symptoms of osteochondrosis, manifested only in the area of the vertebral column, belong to the vertebral syndrome. All changes localized outside the spine form an extravertebral syndrome. These may be pains along the course of peripheral nerves when their roots are squeezed at the exit from the spinal cord. For example, lumboishialgia is pain along the sciatic nerve in osteochondrosis of the lumbar spine. In osteochondrosis of the cervical spine, these are vascular disorders in the vertebral-basilar basin of the brain caused by compression of the vertebral artery.
Complications
Complications of osteochondrosis are associated with a herniated intervertebral disc. These include compression of the spinal cord (discogenic myelopathy), which is characterized by numbness, weakness of certain muscle groups of the extremities (depending on the level of compression), leading to the appearance of paresis, muscle atrophy, changes in tendon reflexes, disorders of urination and defecation. An intervertebral hernia can cause compression of the artery feeding 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 neurological deficits (movement disorders, loss of sensitivity, trophic disorders) corresponding to the level and prevalence of ischemia.
Diagnostics
The diagnosis of spinal osteochondrosis is carried out by a neurologist or a vertebrologist. At the initial stage, radiography of the spine is performed in 2 projections. If necessary, they can take pictures of a separate vertebral segment and shoot 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. An important role is played by MRI 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, myelography is indicated.
A targeted examination of the affected intervertebral disc is possible with the help of a discography. Electrophysiological studies (evoked potentials, electroneurography, electromyography) are used to determine the degree and localization of damage to the nerve pathways, to monitor the process of their recovery during therapy.
Treatment
In the acute period, rest is shown in the affected vertebral-motor segment. For this purpose, with osteochondrosis of the cervical spine, fixation with the collar of the Trench is used, with osteochondrosis of the lumbar spine — bed rest. Fixation is also necessary for osteochondrosis of the cervical spine with instability of the vertebral segment.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the drug therapy of osteochondrosis: diclofenac, nimesulide, lornoxicam, meloxicam, ketoralac. With intense pain syndrome, analgesics are indicated, for example, the analgesic of central action flupirtin. To relieve muscle tension, muscle relaxants are used — tolperizone, tizanidine. In some cases, it is advisable to prescribe anticonvulsants – carbamazepine, gabapentin; antidepressants, among which preference is given to serotonin reuptake inhibitors (sertraline, paroxetine).
If a radicular syndrome occurs, the patient is shown inpatient treatment. Local administration of glucocorticoids, decongestant therapy, the use of traction is possible. In the treatment of osteochondrosis, physiotherapy, reflexotherapy, massage, physical therapy are widely used. The use of manual therapy requires strict adherence to the technique of its implementation and extreme caution in the treatment of osteochondrosis of the cervical spine.
Spinal surgery is indicated primarily with significant compression of the spinal cord. It consists in the removal of a herniated intervertebral disc and decompression of the spinal canal. Microdiscectomy, puncture valorization of the disc, laser reconstruction of the disc, replacement of the affected disc with an implant, stabilization of the vertebral segment is possible.
