What is spinal osteochondrosis in simple words?
Spinal osteochondrosis is a chronic disease based on degenerative-dystrophic changes in the intervertebral disc with the subsequent participation of adjacent vertebrae, intervertebral joints and spinal ligaments in the process.
The word "osteochondrosis" has two Greek roots: οστό - bone and χόνδρος - cartilage.
Vertebrae are formations made of spongy bone.They are connected to each other by cartilaginous discs.There are ligaments along the anterior and posterior surfaces of the vertebrae.The cartilaginous discs prevent the vertebrae from coming together and the ligaments from separating.Thanks to the coordinated work of discs and ligaments, the spine is elastic and this allows it to perform vital functions:
- ensure balance in an upright position,
- soften bumps and jolts when walking and jumping,
- Protect the skull and the brain located therein from blows due to excessive blows.
In osteochondrosis, protrusions of the intervertebral discs form beyond the vertebral bodies.Depending on the direction in which the lump occurs, as well as its size, pain, numbness, muscle disorders and other symptoms develop.
ICD-10 codes:
- M42 Osteochondrosis of the spine
- M42.0 Juvenile osteochondrosis of the spine
- M42.1 Osteochondrosis of the spine in adults
- M42.9 Osteochondrosis of the spine, unspecified
- M43.1 Spondylolisthesis
- M47 Spondylosis
- M47.0 Compression syndrome of anterior spinal or vertebral artery
- M47.1 Other spondyloses with myelopathy
- M47.2 Other spondylosis with radiculopathy
- M48.0 Spinal stenosis
- M50.0 Damage to the intervertebral disc of the cervical spine with myelopathy
- M50.1 Damage to the intervertebral disc of the cervical spine with radiculopathy
- M50.2 Displacement of intervertebral disc of cervical spine of other type
- M50.3 Other degenerations of the cervical intervertebral disc
- M51.0 Injuries to intervertebral discs of the lumbar region and other parts with myelopathy
- M51.1 Injuries to intervertebral discs of the lumbar region and other parts with radiculopathy
- M51.2 Other specified displacement of intervertebral disc
- M51.3 Other specified degenerations of intervertebral disc
- M53 Other dorsopathies, not elsewhere classified
Types of osteochondrosis
Depending on which part of the spine changes occur, there are several variants of the disease:
- cervical,
- chest,
- lumbar,
- sacrum,
- mixed variants (cervicothoracic, lumbosacral).
Depending on the duration of the symptoms, the disease can be:
- acute (up to 3 weeks),
- subacute (3-12 weeks),
- chronic (more than 12 weeks).
According to the predominant neurological manifestation:
- with myelopathy (damage to the spinal cord),
- with radiculopathy (pinched and inflamed nerve roots).
Causes of osteochondrosis
To date, there is no exact data on the causes of osteochondrosis.
The role of genetic predisposition, mechanical damage and inflammation in the onset of premature wear of intervertebral discs is recognized.
Intervertebral discs do not have their own blood or lymphatic vessels.The vessels of the vertebrae play a role in their nutrition and cleansing of harmful substances.With age and/or exposure to harmful influences, blood and lymph flow decreases, the discs receive less oxygen and nutrients and harmful substances can accumulate in them.All this leads to gradual wear.The degree and speed of disc wear increases when exposed to risk factors.
Risk factors:
- congenital anomalies of the vertebrae and spinal canal;
- flat feet;
- occupational risks (vibrations, lifting heavy objects, prolonged stay in an uncomfortable and forced position, exposure to toxic substances);
- sedentary lifestyle;
- obesity;
- a diet that is not balanced in terms of protein, fat, vitamin and mineral content;
- insufficient consumption of clean water;
- smoking;
- environmental pollution.
Symptoms of spinal osteochondrosis.
Listed by frequency of occurrence:
- pain;
- decreased range of motion;
- numbness, loss of sensation;
- decreased muscle strength;
- dysfunction of organs whose innervation is associated with the problem part of the spine.
Clinically significant manifestations of spinal osteochondrosis are observed in 51 people per 1000 inhabitants.
The location of the pain and other symptoms depends on the problem part of the spine.
Cervical osteochondrosis:
- pain in arms, shoulders, neck, aggravated by turning and tilting the head;
- headaches;
- decreased muscle strength in the arm;
- noises in the head, dizziness, flashes of “floaters”, colored spots before the eyes in combination with throbbing and burning headache (vertebral artery syndrome).
The health of the brain depends on the state of the cervical spine, since the arteries that go to the brain pass through the canal formed by the processes of the vertebrae.If due to osteochondrosis the lumen of the canal is narrowed, blood flow through the arteries is disrupted and the brain experiences a lack of oxygen and nutrients.
Thoracic osteochondrosis:
- pain in the chest, under the shoulder blade, in the heart area, which worsens when turning the body, coughing, sneezing;
- dysfunction of the gallbladder, stomach, esophagus.
Lumbar and/or sacral osteochondrosis:
- pain in the lower back, back and side of the thigh;
- numbness in the toes;
- increased frequency of urination (10 to 12 times a day, possibly more), involuntary loss of urine during physical activity;
- sexual disorders.
Due to frequent pain, half of people suffering from osteochondrosis show signs of constant emotional stress.
Stages of development and course of osteochondrosis.
The initial stage of osteochondrosis is manifested by dull pain in the back or lower back that occurs when standing for a long time, after walking or running;Pain in the neck, aggravated by turning and tilting the head.
As intervertebral disc pathology progresses, it can bulge (herniate) and, as a result, compress the nerve root (radiculopathy).This causes intense pain that radiates to the arm or leg, muscle weakness, changes in skin sensitivity, vascular tone and the function of the organs that receive innervation from the problematic part of the spine.In more severe cases, spinal cord compression may occur, causing paresis or paralysis.
Osteochondrosis is a chronic disease.After adequate treatment, remission occurs, that is, the symptoms decrease or disappear completely.If a new bulge of the intervertebral disc forms, aggravation occurs and pain and other symptoms reappear.
Diagnosis
Examination by a neurologist.
Basic instrumental research methods:
- magnetic resonance imaging (MRI),
- computed tomography (CT).
Additional:
- spondylography (in-depth radiological examination of the spine),
- electromyography (EMG),
- electroneuromyography (ENMG),
- bone densitometry (performed to detect osteopenia/osteoporosis).
Basic laboratory methods:
- general blood test,
- general urinalysis,
- biochemical blood test (glucose, creatinine, urea, electrolytes, bilirubin, liver and pancreatic enzymes; glycated hemoglobin, C-reactive protein),
- coagulogram.
Additional:Concentration of calcium and phosphates in the blood.
Osteochondrosis treatment
Conservative treatment
It is carried out if the patient does not present neurological symptoms of acute progression.
Goals:
- reduction or relief of pain,
- correction of muscle tone,
- reduction of inflammation and swelling,
- prevent the progress of dystrophic changes in the structures of the spine,
- correction of impaired function of internal organs,
- increase the patient's daily activity,
- Teach the patient to cope with pain.
Conservative treatment of osteochondrosis includes:
- compliance with a rational motor regime,
- use of medications,
- physiotherapy,
- massage,
- Exercise therapy (after pain relief and stabilization of the condition),
- acupuncture,
- manual therapy.
Pharmacological treatment
The main groups of drugs that can relieve or relieve pain and stabilize the condition of a patient with osteochondrosis are listed.Only a doctor can select an appropriate treatment regimen, taking into account the characteristics of the clinical picture of a particular patient.
Non-steroidal anti-inflammatory drugs(NSAID):
- for oral administration,
- for intramuscular injections,
- for intravenous administration,
- for insertion into the rectum (rectal suppositories),
- for external use (ointment, gel).
muscle relaxants(medicines that reduce muscle spasticity).
It is used for severe tension and painful muscle spasms.
Diuretics(to reduce local swelling).
Medicines that improve the condition of cartilage tissue.(chondroprotectors):
- sodium chondroitin sulfate,
- a combination of sodium chondroitin sulfate and glucosamine.
B vitamins:
- thiamine (B1),
- pyridoxine (B6),
- cyanocobalamin (B12),
- combination B1+B6+B12.
In the acute period, with severe pain, bed rest is possible for 1 to 2 days, which helps to relax the muscles and reduce pressure inside the cartilaginous disc.It is advisable to wear a stabilizing lumbar corset or a Shants collar.
As the intensity of pain decreases, treatment is supplemented by special therapeutic exercises aimed at stretching the spine and relaxing the muscles, with the gradual inclusion of exercises to form a muscle corset.Therapeutic manual massage is indicated.
With proper therapy, the pain gradually decreases and may disappear completely.There is also a regression of neurological symptoms.The improvement in condition is due to a decrease in the size of the herniated disc and associated inflammatory changes in the surrounding tissues.
Surgical treatment
Emergency neurosurgical intervention is indicated for pelvic disorders with numbness in the anogenital area and ascending paresis of the feet (caquina equina syndrome).
The need for surgery may also arise if conservative therapy stops being effective within 3 to 6 months.
Prevent back pain
Avoid excessive physical activity (lifting heavy objects, carrying a heavy bag in one hand, etc.).
Avoid prolonged static loads (sitting, staying in an uncomfortable position).
If your job involves so much stress, it is recommended to take 10-minute breaks every 45 minutes, during which you need to walk.
Avoid hypothermia.
Maintain an adequate level of physical activity through regular exercise, swimming and/or walking.
Sleep on a medium firm mattress.
Nutrition for osteochondrosis.
A balanced diet and adequate fluid intake guarantee a normal blood supply and nutrition of the vertebrae and, consequently, the cartilaginous discs.As a result, metabolism and energy are normalized and harmful products do not accumulate.
Basic principles:
Daily calorie content, calculated individually, taking into account height, age and sex.
For patients who are overweight or obese, caloric intake should be limited.
Drinking regimen– drink pure water, mineral water and infusions in a volume of at least 1 liter per day, ideally at a rate of 30 ml/kg of body weight.
Daily use:
- whole grain products (buckwheat, millet, oats);
- sufficient amount of protein (taking into account age and kidney function): animal: lean beef, chicken, turkey, rabbit, chicken egg (4-5 pieces per week);vegetables: beans, lentils, peas;
- healthy fats containing mono- and polyunsaturated fatty acids (fish, seafood, unrefined vegetable oils, unroasted and unsalted nuts, seeds);
- greens (both fresh and cooked), lettuce, herbs and leafy greens;
- Berries: blueberries, blackberries, raspberries, cherries.
Exclusion from diet:
- white bread and bakery products made with premium flour;
- sugar, industrial sweets: candies, cakes, cookies, gingerbread, waffles;
- industrial drinks with added sugar: carbonated water, packaged juices;
- processed meat products: sausages, sausages, preserves.