Osteochondrosis is a chronic disease in which there occurs the degenerative changes in the vertebrae and are located between them are the intervertebral discs. With regard to an injury of the spinal column are: cervical osteochondrosis, osteochondrosis of the thoracic and osteochondrosis of the lumbar spine. The diagnosis of osteochondrosis of the spine need radiography, and, in the case of problems (e.g., herniated disc) - spinal MRI. In the treatment of osteoarthritis of the spine, together with the medical methods are often used, reflexology, massage, manual therapy, physiotherapy, and exercise therapy.
Etiology and pathogenesis
To varying degrees, osteochondrosis can occur in any of the old people, and it is one of the aging process. Sooner or later, into the intervertebral disc comes to atrophic changes, but for the injury, illness, and the various overloads of the spine can contribute to the earlier emergence of osteoarthritis. The most common osteochondrosis of the cervical and degenerative disc disease of lumbar spine.
There are about 10 theories of degenerative disc disease: vascular, hormonal, mechanical, genetic, infectious, allergic, and so on. However, none of them gives a complete explanation of what is going on in the spinal cord of the change, rather than to complement each other.
It is believed to be the main point in the occurrence of osteoarthritis is a continual overloading of the vertebral motor segment, which is made up of two adjacent vertebrae. This overload may be due to the samples of motion — posture and individual way of sitting, and walking. Incorrect posture, sitting in an incorrect posture, walk with an uneven back caused an additional pressure on discs, ligaments, and muscles of the spine. The process can be aggravated due to peculiarities of the structure of the vertebral column, and failure of trophic its tissues due to hereditary factors. Most often, the defects in the structure occur in the cervical spine, and lead to vascular disease, and early signs of degenerative disc diseases of the cervical spine.
The occurrence of osteochondrosis of the lumbar often associated with his or her on overload, when bending, and lifting weights. A healthy intervertebral disc can withstand a considerable load due to the hydrophilicity are located in the center of the nucleus pulposus. The nucleus contains a large amount of water and fluids, such as, you know, a little compressed. Rupture of a healthy intervertebral disc can occur when the force of compression of no more than 500 kg, while it changes as a result of degenerative disc disease the disc is broken, when the force of compression of 200 kg. A load of 200 kg, the experiences of the lumbar area of the spine, a person weighing 70 kg, a 15-pound load in the position of the torso ahead on the 200. Thus, a large pressure due to the small size of the nucleus pulposus. When the inclination is increased to 700, the load on the intervertebral discs is 489 kg). As is often the rst clinical manifestation of osteochondrosis of the lumbar spine, which occur during or after heavy lifting, performing household chores, weeding the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, the ligaments and the capsules of the facet joints causes a reaction of the immune system and the development of an aseptic inflammation of the joint, with swelling of the facet joints and the surrounding tissues. Due to the displacement of the body of the vertebrae of the stretching of the capsule of the facet joints, and changed the intervertebral disc is not as solid a lock body of the adjacent vertebrae. Resulting instability of the spine segment. Due to the instability of a possible infringement of the nerve root of the spinal nerve to the development of the radicular syndrome. Osteochondrosis of the cervical spine, often occurs during a cornering of the head, osteochondrosis of the lumbar spine during trunk bending. The formation of the functional unit of the vertebral motor segment. It is due to the compensatory contraction of vertebrate muscles.
A herniated disc occurs when a disc moves backward, it is rupture of the posterior longitudinal ligaments, and bulging of the disc into the spinal canal. If the spinal canal is squeezed out of the core of the disk is called a ruptured hernia. The severity and duration of pain associated with a hernia there is a lot more than the unexploded. A herniated disc may result in radicular syndrome or spinal cord compression.
When osteochondrosis occurs, the expansion of the bone with formation of osteophytes — bony growths on the bodies and the vertebral joints. Osteophytes can also cause compression of the spinal cord, or caused by the development of the radicular syndrome.
The symptoms of osteochondrosis
The main symptom of osteochondrosis is a pain. The pain can be sharp with a high intensity, it increases with the slightest movement of the affected segment and, therefore, forces the patient to take a forced position. In osteochondrosis of the cervical spine, the patient keeps the head in the least painful position, and does not rotate, osteochondrosis of the thoracic pain is worse, and even to take a deep breath, and osteochondrosis of the lumbar, the patient is difficult to sit, stand and walk. This pain syndrome is characterized by compression of the nerve roots of the spinal nerve.
About 80% of the cases, there is dull pain is constant in nature and of moderate intensity. In such cases, during the examination the doctor needs to differentiate between the manifestations of osteochondrosis of the spine from the myositis of the back muscles. The dull ache in osteochondrosis is caused by excessive tension of the muscles, which hold the affected vertebral motor segment, the types of changes, or a significant stretching of the intervertebral disc. The patients with the pain syndrome, to the position of the missing, but found the restriction of movement, physical activity and health. Patients with osteochondrosis of the cervical spine, and avoid any sharp bends, and tilts his head, osteochondrosis of the lumbar slowly sat up, and up, to avoid trunk bending.
Complications of spinal osteochondrosis
The complications of degenerative disc disease associated with disc hernias. These include spinal cord compression, which is characterized by numbness, weakness in certain muscle groups of the limbs, depending on the compression level), which leads to the appearance of the paresis, muscular atrophy, changes in tendon reflexes, disturbances of urination and defecation. A disc herniation can lead to compression of arteries feeding the spinal cord, with the formation of ischemic areas (infarction of the spinal cord, with loss of the nerve cells. This is shown by the occurrence of neurological deficit (violation of movements, loss of sensitivity, trophic disorders), appropriate to the level and extent of the ischemia.
The diagnosis of osteochondrosis
The diagnosis of osteochondrosis implements a neurologist or a spine. In the early stages of producing the x-rays of the spine in 2 projections. If necessary, you may perform a review of each individual vertebral segment, and to shoot more images. To be diagnosed as a hernia, and the assessment of the spinal cord, and the detection of complications of degenerative disc disease using magnetic resonance imaging (MRI of spine). A lot of the role played by MRI in the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculous spondylitis, osteomyelitis, tumors, ankylosing spondylitis, rheumatism, infections of the. Sometimes, in complicated cases of degenerative disc diseases of the cervical spine exclusion, it is necessary to syringomyelia. In some cases, the inability of MRI myelography is indicated.
Up to study the influence of the intervertebral disc may be the discography. Electrophysiological studies are used to determine the extent and localization of damage to the nerve pathways, and the monitoring of their recovery during a course of treatment.
The treatment of osteochondrosis
In the acute period are as shown at rest in the affected vertebral motor segment. With this goal in osteochondrosis of the cervical spine is used, fixation by means of the collar of the Trench, osteochondrosis of the lumbar of the bed. Fixation of the cervical osteochondrosis with instability of the spinal segment.
The drug for the treatment of degenerative disc disease using the non-steroidal anti-inflammatory drugs (nsaids): diclofenac, nimesulide, lornoxicam, meloxicam. With intense pain syndrome shows analgesics, for example, the Central analgesic action of flupirtine. For the relief of muscle tension and the use of muscle relaxants — tolperisone, tizanidine. In some cases, the appropriate use of anticonvulsants - carbamazepine, gabapentin; antidepressants, including the advantage of the monoamine uptake inhibitor (sertraline, paroxetine).
Upon the occurrence of radicular syndrome, and the patient was shown to in-patient care. May be a local injection of glucocorticoids, in the treatment against edema, the use of traction. In the treatment of osteoarthritis are often used in physiotherapy, reflexology, massage, physiotherapy. How to use this guide this therapy requires strict adherence to the techniques of craftsmanship, and a particular care in the treatment of degenerative disc diseases of the cervical spine.
The operation is illustrated in particular by the importance of the spinal cord compression. It consists of removing the herniated disc, and the pressure in the spinal canal. It is possible to perform a microdiscectomy and laser disc reconstruction, replacement of the damaged disk of the implant, and the stabilization of the spinal segment.