Common osteochondrosis

As a result of human upright walking, the spine, as an axial structure, takes the main load. That is why degenerative and dystrophic processes are quite common consequences in human life. One of the most common diseases of the musculoskeletal system is osteochondrosis, which brings severe discomfort and can cause disability. This article will discuss the most severe form of this pathology - ordinary osteochondrosis.

general characteristics

Osteochondrosis is a degenerative disease of the spine, which most often affects the thoracic, lumbar and cervical regions. This pathology has a direct correlation with age. The disease is more common in people over the age of 40, but recently there has been a trend towards rejuvenation. Normal osteochondrosis differs because it affects more than one department or several departments at once. Due to the progressive development of the degenerative process not only in the bone tissue, but also in the ligamentous apparatus of the spine, the vertebrae become mobile and put pressure on the nerves and blood vessels. Symptoms of osteochondrosis are usually associated with this, but it should be noted that the disease can be asymptomatic for some time.

Important! Pathology requires multidisciplinary control, because it affects not only the musculoskeletal system, but also the nervous system, as well as internal organs. In addition to the spine itself, the pathological process can also affect other elements of the skeleton.

Etiology and pathogenesis

There are many reasons for widespread osteochondrosis. Some of them are associated with congenital skeletal defects, others with insufficient loads during vigorous activity. Common factors that contribute to the development of the clinical picture are:

• injury;
• Flat feet;
• clubfoot - deformation of the foot (equinovarus, varus, valgus, depending on the position of the heel);
• work related to heavy lifting;
• playing sports without warming up or warming up the muscles;
• work at low temperatures.

Low temperature is considered a provoking factor, because cold temporarily changes the molecular structure of soft tissue, reduces the intensity of blood circulation, reduces the conductivity of nerve impulses and metabolism, and therefore the functioning of the immune system. Other reasons disrupt the biomechanics of the spine and contribute to rapid wear of the intervertebral discs.

Pain in widespread osteochondrosis can be the result of osteophytes or disc deformation. The pain is usually radicular, i. e. associated with posterior nerve root compression.

Common osteochondrosis easily imitates other diseases. With damage in the thoracic region, pain appears in the heart area and is mistaken for an ischemic process, and with damage in the lumbar region - for radiculitis.

symptoms

Clinical manifestations will depend on which part is affected and in what combination.

When the cervical spine is affected, the following are the characteristics:

• unstable blood pressure;
• Headache;
• lack of coordination;
• pain in hand;
• numbness in the upper body and arms.

For pathology in the thoracic region:

• intercostal neuralgia;
• stiffness in arms and neck;
• internal organ dysfunction.

If the lumbar region is affected:

• combustion;
• urinary disorders;
• cramps;
• pain when walking

Based on the above, it is easy to conclude that the pathology affects not only the spine and large joints, but also the autonomic nervous system. The latter is associated with disturbances in the functioning of internal organs. Normal polysegmental osteochondrosis can sometimes be worse. In such cases, the manifestation is more intense. With a combination of disorders of several departments, the symptoms will match.

Complications

Osteochondrosis can be conditionally divided into moderate osteochondrosis, which is a natural process of wear and tear of the spine due to life activities, and severe osteochondrosis, which is most often characterized by complications.

Moderate osteochondrosis is easily treated with conservative treatment. And if it is impossible to completely stop the inevitable aging process, then it is very possible to significantly slow it down. Complications that can cause severe osteochondrosis are as follows.

1. Spondyloarthrosis.
2. Intervertebral disc degeneration.
3. Spinal stenosis.

Important! Intervertebral discs act as shock absorbers and reduce friction between the vertebrae. Degenerative processes in this structure can cause protrusion of the nucleus pulposus of the disc and intervertebral herniation. Protrusion leads to root compression and pain.

Spondyloarthrosis is a degeneration of the facet joints that connect adjacent vertebrae. In other words, the joint is called a facet joint. When the articular cartilage is damaged, painful contact occurs between the vertebrae. With degeneration of the facet joints, bone growth most often appears, leading to spondylosis.

Stenosis is a narrowing (in this case, the spinal canal). Usually, stenosis is the result of pathologies such as intervertebral hernia or spondylosis. Bony growth and hernial protrusion compress the nerve root at its entry and exit points.

The clinical picture of severe osteochondrosis is the result of complications:

• chronic pain in the spine;
• bone surface friction;
• stiffness;
• sudden muscle weakness;
• decreased reflexes;
• tingling in the limbs;
• radiating pain;
• sciatica symptoms.

Sciatica is caused by compression of the sciatic nerve.

Classification

There are four degrees of osteochondrosis. Classification occurs based on the collected history and with the help of instrumental diagnostic methods. The main criteria in this classification are pain and neurological symptoms.

1. I degree - pain easily relieved with medicine.
2. Degree II - characterized by prolonged pain and deformation of the spine with moderate neurological symptoms.
3. Stage III - pain is systemic, neurological symptoms are significant.
4. IV degree - constant pain, various neurological deficits. Disturbances in the conduction of nerve impulses. Paralysis and paresis.

In the case of widespread dysplastic osteochondrosis, the patient is given the status of disability. Depending on the general condition of the patient, the level and intensity of the development of the clinical picture, the defects can consist of three groups.

Types of disability in osteochondrosis.

Group	Description
The first group	Spinal function is lost. The patient is unable to move freely and take care of himself.
The second group	The patient is able to move around and carry out small tasks, but periods of exacerbation are frequent. The operation is contraindicated or useless for some reason. Or surgery has already been done, but it turned out to be ineffective.
The third group	Patients are able to take care of themselves. There is pain and vestibular symptoms, but the frequency of exacerbations is moderate and periodic.

Groups of disabled people are assigned by doctors based on several studies to assess the ability to work.

Diagnostics

When visiting a doctor, the diagnosis will consist of several components. The first and most important is the collection of anamnesis based on subjective information provided by the patient. Attention is paid to family history, because osteochondrosis has a genetic component. Specialists ask about the workplace, living conditions and the course of the disease itself, and the patient must explain exactly what is bothering him. The best results can be achieved with good feedback between the patient and the doctor.

The next method is objective research, which is carried out by experts themselves or using instrumental methods. The doctor checks the range of motion of the neck and limbs, which may be significantly reduced due to pain and stiffness. Using the palpation method, he records how many muscles are in spasm and how the spine is curved. Attention is drawn to the neurological examination, with the help of which weak reflexes can be detected. These symptoms may be caused by compression or damage to the nerve.

Instrumental methods for diagnosing common osteochondrosis include:

1. X-ray of the entire spine in two projections.
2. MRI to evaluate ligaments and nerve tissue.
3. An electrophysiological study to test the conduction of nerve impulses.

X-ray is effective for determining the presence of bone growth - osteophytes, narrowing of the spinal canal and the presence of other diseases that are the result of osteochondrosis, for example, scoliosis.

Computed tomography can also be used in conjunction with MRI. Using a CT scan, you can determine the degree of nerve compression by the spur.

The diagnosis of extensive polysegmental osteochondrosis is made if other pathologies that cause the destruction of the vertebrae (for example, tuberculosis) have been excluded and if several segments of one or more departments are affected.

There are additional diagnostic methods. This includes:

1. Bone scan.
2. Discography.
3. Myelogram.

A bone scan can detect conditions such as osteoarthritis, fractures or infections. This method is a radionuclide, and it is suitable for differential diagnosis and to determine possible complications.

During discography, a contrast agent is injected into the nucleus pulposus of the intervertebral disc. This method is effective in determining the presence of a herniated disc.

Myelogram is also a contrast research method. Contrast is injected into the spinal canal and images are recorded using X-ray or CT. Using this method, you can determine the condition of the spinal cord, the presence of narrowing and compression.

Treatment

Treatment is based on the following mechanisms.

1. Slows the degenerative process by increasing the supply of nutrients to the structure of the musculoskeletal system.
2. Spinal stabilization.
3. Removal of pinched nerve fibers.
4. Relieves symptoms.

The following drugs are used for drug treatment:

• nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
• Anilides relieve pain in the early stages;
• local analgesics in the form of ointments;
• muscle relaxants to reduce muscle spasms and increase range of motion;
• Vitamin B to increase the conductivity of nerve tissue;
• chondroprotectors, which reduce the rate of development of degenerative processes by integrating active substances (chondoitin sulfate and glucosamine) into cartilage cells. As a result, metabolism becomes normal and clinical manifestations decrease. This drug has been used for a long time and requires special consultation during pregnancy, breastfeeding, and the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
• antispasmodics relieve spasms of smooth muscles and thereby reduce the manifestation of osteochondrosis in internal organs;
• antioxidants;
• antidepressants to eliminate the psychosomatic component of the disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. Promotes the production of endorphins and helps solve chronic insomnia due to constant pain.
• neuropathic agents to eliminate damage to nerve endings.
• opiates for unbearable pain and ineffectiveness of other pain relievers.

The following are used as invasive medical procedures:

• steroid injection into the epidural space. Steroids are powerful anti-inflammatory drugs. They relieve inflammation of the nerve root, which helps relieve pain caused by radiculopathy. A complicated procedure. Requires a qualified specialist;
• injection into the facet joint. The injected drug leads to local numbness and pain relief.

It is important to know! Taking medicine is not intended to eliminate the disease - no medicine can completely eliminate osteochondrosis, which is a chronic disease. Drugs are prescribed only to relieve symptoms.

Medicines are prescribed by the attending physician. Patients are informed about the possible side effects of each drug and then decide for themselves which course of treatment to choose.

For symptoms that give reason to suspect osteochondrosis, contact a vertebrologist, orthopedist and neurologist. High quality medical care will consist of close collaboration between these specialists with each other and with the patient.

Physiotherapy

Physiotherapy is used as a set of additional therapeutic measures to improve blood circulation and metabolism in the affected tissue. For widespread osteochondrosis, the following methods are used.

1. Electrophoresis (based on the movement of colloidal particles under the influence of an external electric field).
2. Phonophoresis (a combination of ultrasound and medication).
3. Magnetotherapy (the use of static magnetic fields).
4. UHF therapy (ultra high frequency therapy).
5. Electromyostimulation (nerve and muscle stimulation).
6. Acupuncture (acupuncture).
7. Laser exposure.

In addition to physiotherapy, manual therapy and physical therapy are actively used. Professional massage can lead to long-term remission. Therapeutic exercises should not be performed during an exacerbation of the disease, as this can cause complications. During the remission period, moderate physical activity maintains muscle tone, and therefore the spine. Training is conducted under the supervision of an instructor and prescribed by the attending physician.

During an exacerbation, you can not warm the spine, but you can wear a corset, but only for a few hours. In other cases, wearing a corset for more than a few hours is not optimal because it can cause muscle atrophy.

Manual therapy can improve the clearance of pinched nerves and reduce neurological symptoms. Alternative methods are leech and vacuum massage. This method aims to increase blood circulation in the affected area. Hygienic spa treatments are useful. Special priority is given to water procedures.

Surgery

When treating osteochondrosis, experts are more willing to use conservative therapy, however, for the correct effect, a lot of time, patience and careful compliance with the patient's recommendations are required. If conservative treatment does not work, then you need to use invasive methods. Usually this operation is palliative. This means that the operation will be performed only to relieve symptoms and comparatively improve the quality of life, but not for a complete cure (it is fair to say that conservative treatment also does not lead to the complete elimination of the disease, but the patient's acceptance to non-invasive therapy is a sign of a favorable prognosisgood).

There are two types of surgery: decompression and stabilization. The first is aimed at relieving nerve pressure, and the second is aimed at stabilizing the spinal column. The following operations are classified as decompression operations.

1. Facetectomy - removal of the facet joint to relieve compression.
2. Foraminotomy is an increase in the lumen of the spinal canal, which has narrowed due to osteophytes.
3. Laminectomy is the removal of the back of the vertebrae, which may be deformed due to osteochondrosis.
4. Laminotomy - removal of fragments of the posterior part of the vertebrae to widen the spinal canal.

This operation requires a posterior approach, but in the case of an intervertebral hernia, the surgical approach will be anterior.

Decompression surgery with an anterior approach is as follows.

1. Discectomy - removal of the intervertebral disc.
2. Cortectomy - removal of the entire vertebral body with the adjacent disc.

Stabilization operations include:

1. Spinal fusion is a method of combining vertebrae.
2. Artificial intervertebral disc.

The need to stabilize the operation arises after discectomy.

Surgery is rarely prescribed because there is a risk of serious complications.

Complications include:

• recurrent pain;
• false union;
• infection;
• phlebitis in the limbs;
• violation of the act of urination;
• sick from corruption;
• embedded fastener failure.

The postoperative period lasts several months. Stitches healed 2 weeks after surgery. If complications are detected, you should immediately see a doctor.

After surgery, a rehabilitation course is carried out to speed up the healing process and restore full working capacity.

General recommendations

Proper nutrition helps prevent the recurrence of exacerbations of common osteochondrosis. Proper nutrition is especially necessary to maintain a stable body weight, as excess body weight puts additional pressure on the spine. In this case, the diet should be complete, enriched and rich in calcium, magnesium and potassium. It is necessary to limit your coffee consumption because it dissolves calcium from the body. It is useful for visiting ponds. You should avoid staying in one position all the time.

If there are frequent exacerbations and a lack of discipline to strictly follow the recommendations, it is best to undergo full treatment in a hospital under the supervision of a doctor.

You should not take the medicine yourself.

Let's summarize

Often extensive osteochondrosis develops after a "single" osteochondrosis that does not heal completely. This fact shows that if any discomfort occurs, you should immediately contact the doctor, without hoping that the pain will go away by itself. In this case, it is easier to prevent the development of other pathologies, and even more so to cure the cause.