Osteochondrosis is a chronic degenerative disease in which changes occur in the vertebrae and between them the intervertebral disks. Depending on the damage to the spine are: cervical osteochondrosis osteochondrosis osteochondrosis of the thoracic and lumbar spine. The diagnosis of osteoarthritis of the spine need radiography, and in the event that complications (eg, herniated disc) - spinal cord MRI. Osteoarthritis of the spine along with the medical methods are widely used, zone therapy, massage, manual therapy, physiotherapy and exercise therapy.
Etiology and pathogenesis
To varying degrees, osteochondrosis occurs in people of all ages and it is one of the aging process. Sooner or later the intervertebral disc occur atrophic changes, however, injuries, illness, and a different overload of the spine to promote the earlier emergence of osteoarthritis. The most common osteochondrosis of the cervical and degenerative disc disease of the lumbar spine.
There are about 10 theories of degenerative disc disease: vascular, hormonal, mechanical, genetic, infectious-allergic and other. But none of them gives a complete explanation of what happened to the spine of the changes, but they are complementary.
It is believed that the main point of the occurrence of osteoarthritis is the constant overload of the spine-motor segment, which consists of two adjacent vertebrae. This overload can be attributed to the business model you to position, individual way, sitting and walking. Incorrect posture, sitting in a wrong posture, walking on uneven spine causing extra strain on your discs, ligaments and muscles of the spine. The process may be exacerbated, due to the peculiarities of the structure of the spine and the failure of the food chain in its tissues, which is due to hereditary factors. Most often, defects in the structure occur in the cervical spine and lead to vascular dysfunction and early signs of degenerative disc disease of the cervical spine.
The occurrence of osteochondrosis of the lumbar spine is often associated with his overload, when bending and lifting weights. A healthy intervertebral disc can withstand high loads, because of the hydrophilicity located in the centre of the nucleus pulposus. The Kernel contains a large amount of water and fluid, as you know, a little compressed. Rupture of a healthy intervertebral disc can occur when the force of compression of more than 500 kg, while changed as a result of degenerative disc disease the disc is broken, when the force of compression of 200 kg. Load 200 kg the experiences of the lumbar spine for a person weighing 70 kg, when he holds a 15 kg load in the position of the upper body forward 200. So great pressure, because of the small size of the nucleus pulposus. When the slope increases to 700, the load on the intervertebral discs is 489 kg. So often the first clinical manifestation of osteochondrosis of the lumbar spine occur during or after heavy work, performing household chores, weeding the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, ligaments and capsules facet joints cause a reaction of the immune system and the development of aseptic inflammation, swelling of the facet joints and the surrounding tissues. Because the displacement of the vertebrae the body is stretching of the capsule of the facet joints, and changed the intervertebral disc is not so firmly locks the body to the adjacent vertebrae. Formed in instability of the spine segment. Because of the instability of possible infringement of the nerve roots of the spinal nerve with the development of radicular syndrome. Osteochondrosis of the cervical spine often occur in the curves of the head, osteochondrosis of the lumbar spine during trunk bending. The formation of the functional unit of the spine-motor segment. It is due to the fact that the compensatory contraction of vertebrate muscles.
A Herniated disc occurs when the disc moves backward, there is rupture of the posterior longitudinal ligament and bulging of the disc into the spinal canal. If the spinal canal is squeezed out of the core plate, this is called a ruptured hernia. The severity and duration of pain with a hernia is much more than unexploded. A Herniated disc may cause radicular syndrome or spinal cord compression.
When osteochondrosis occurs, the extension of bone formation of osteophytes — bony growths on the bodies and vertebrae. Osteophytes can also cause compression of the spinal cord or cause the development of radicular syndrome.
Symptoms of osteochondrosis
The main symptoms of osteochondrosis are pain. The pain can be sharp with high intensity, it adds the slightest movement of the affected segment, thereby forcing the patient takes a forced situation. So, osteochondrosis of the cervical spine, the patient keeps the head in the least painful position, and cannot rotate, osteochondrosis of the thoracic pain is worse with a deep breath, and osteochondrosis of the lumbar spine of the patient is difficult to sit, stand and walk. Such pain syndrome is characterized by compression of the nerve root in the spine the nerve.
About 80% of cases, there is dull pain constant in nature and moderate. In such cases, during the examination the doctor needs to distinguish the manifestations of osteochondrosis of the spine with myositis of the back muscles. Dull pain in osteochondrosis is caused by the excess voltage of the muscles, which keeps the affected spine-motor segment, the inflammatory changes or significant stretching of the intervertebral disc. Patients with this pain syndrome forced drive is missing, but it turned out, the limitation of movement and physical activity. In patients with osteochondrosis of the cervical spine, avoid sharp turns and tilting of the head, osteochondrosis of the lumbar spine - slowly sit down and stand up, to avoid frame bending.
Complications of spinal osteochondrosis
Complications of degenerative disc disease associated with disc hernia. These include spinal cord compression, which is characterized by numbness, weakness in certain muscle groups of the limbs (depending on compression level), which leads to the appearance of paresis, muscle atrophy, changes in tendon reflexes, disorders of urination and defecation. Herniation can cause compression of the artery feeding the spinal cord, the formation of ischemic areas (infarction of the spinal cord), where the loss of nerve cells. This is manifested in the appearance of neurological deficit (violation of movements, loss of sensitivity, trophic disorders), the appropriate level and extent of ischemia.
The diagnosis of osteochondrosis
The diagnosis of osteoarthritis is carried out to a neurologist or spine. The initial stage to produce x-rays of the spine in 2 projections. If necessary, you can do a survey of the individual vertebrae segments and shoot other images. A diagnosis of intervertebral hernia, the evaluation of the spinal cord and to identify the complications of degenerative disc disease using magnetic resonance imaging (MRI spine). The large role of MRI in the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculous spondylitis, osteomyelitis, tumors, ankylosing spondylitis, rheumatism, infections. Sometimes in complex cases of degenerative disc disease of the cervical spine exclusion is needed for syringomyelia. In some cases, it is impossible to MRI myelography is shown.
Sighting study the influence of the intervertebral disc it is possible to discography. Electrophysiological studies are used to determine the extent and localization of lesions of the nervous paths, and tracking their recovery during treatment.
Treatment of osteochondrosis
In the acute period are shown at rest, the affected spine-motor segment. This goal osteochondrosis of the cervical spine is used, the fixation, which allows the collar of the Trench, osteochondrosis of the lumbar spine in bed. Repair cervical osteochondrosis, instability of the spine segment.
Drug for treatment of degenerative disc disease the use of non-steroidal anti-inflammatory drugs (Nsaids): diclofenac, nimesulide, lornoxicam, meloxicam. Strong pain syndrome shows analgesics, for example, the Central analgesic effect of flupirtine. Relieve muscle tension and use muscle relaxants — tolperisone, tizanidine. In some cases, appropriate use of antiepileptic drugs - carbamazepine, gabapentin; antidepressants, of which preference is given to serotonin reuptake inhibitors (sertraline, paroxetine).
When the event radicular syndrome patient shown inpatient treatment. Maybe a local injection of glucocorticoids, treatment against swelling, the use of the grip. In the treatment of osteoarthritis are widely used in physiotherapy, reflexology, massage, physiotherapy. The use of manual therapy requires strict adherence to technology implementation and special care for the treatment of degenerative disc disease of the cervical spine.
Surgery appears primarily to significant spinal cord compression. It consists of removing the herniated disc and decompression of the spinal canal. It is possible to perform a microdiscectomy and laser disc reconstruction, replacement of the affected disc implant and stabilization of spinal segments.