Treatment of osteochondrosis

Osteochondrosis - dystrophic changes in the spine associated with aging of age-related tissues. Pathology is 80% related to genetic data, the rest is the influence of external factors.

Osteochondrosis- Mainly human diseases, the development of which is facilitated by:

• Increased longevity. Over time, metabolism slows down, tissue nutrition is disrupted, destructive regulatory systems begin to prevail over constructive ones.
• Walking straight. While standing, the person gained an uneven load on different parts of the spine, was able to perform a greater movement - for torsion, extension. Abnormal lateral curves - scoliosis - appeared with an uneven load on the muscles and small joints of the spine. This increased the likelihood of disease formation even in the department where low mobility and the thoracic cage protect the vertebrae - thoracic osteochondrosis
• Hurry. Rapid growth makes bones, muscles and cartilage more vulnerable. The number and prevalence of blood vessels is insufficient to supply them with oxygen and essential substances
• Lack of adequate physical activity. There are two extremes - sedentary work and movement exclusively by driving or excessive stress in the gym, when discs and cartilage are consumed at an accelerated rate.
• Improper nutrition. The predominance of fast carbohydrates, lack of protein, use of carbonated beverages leads to the fact that the body does not have enough high quality building materials to maintain tissue health.
• Smoking. Causes prolonged vasospasm - interruption of tissue nutrition, acceleration of degenerative processes
• Urbanization, a large number of surrounding traumatic objects lead to spinal cord injuries, secondary osteochondrosis

Types of osteochondrosis

By localization

• Osteochondrosis of the cervical spine
• Chest Injury
• Osteochondrosis of the lumbar region
• Common osteochondrosis - cervical and lumbar, thoracolumbar, lumbosacral and other combinations

The most common changes in the most mobile parts are those of the cervix and lumbar region. The injured point is the passage of the movable lumbar region to the fixed sacral one.

According to the stage

• Initial - small changes in the center of the disc, compression of the nucleus, the appearance of cartilage cracks
• Disease progression - cracks deepen, disc height decreases, intervertebral foramen diameter decreases. Compression of the spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs - due to violation of the ratio of vertebrae to each other, cartilage on the surfaces of small joints is unevenly rubbed, arthrosis and arthritis develop.
• Complicated osteochondrosis - symptoms: further cartilage degeneration occurs - ruptures of the cartilaginous ring appear that connect the bodies of two adjacent vertebrae. Part of the nucleus extends through the free space and squeezes the roots, the spinal cord - a disc herniation is formed. A more serious problem is the separation of the fallen part - a sequestered hernia. Concerned by severe pain, tenderness and impaired movement in the area responsible for the compressed nerve
• The body responds to increased load and excessive mobility with the growth of bone tissue - osteophytes appear. They stabilize the spine, but reduce the range of motion. Bone clumps irritate muscle receptors and suppress nearby vessels. With osteochondrosis of the cervix, it causes symptoms of "vertebral artery" - dizziness, tinnitus, tremors in front of the eyes.

Osteochondrosis of the cervical spine

With the advent of cell phones and computerscervical osteochondrosiseven in adolescents: an unnaturally prolonged position of the head with muscle tension overloads their vertebrae, discs, and joints.

Osteochondrosis of the cervix - symptoms

• Pain in the neck that extends to the back of the head, to the upper back
• Sometimes the headaches associated with cervical osteochondrosis mimic a migraine - bias of symptoms, intolerance to bright sounds and light, strong pulse in the temples, bright flashes in front of the eyes
• Frequent headaches that do not respond well to conventional tablets
• Pressure resistant to antihypertensive drugs
• Dizziness and darkening of the eyes with sudden curves of the head
• Numbness in the fingers, especially after sleep, a feeling of crawling on the skin
• Restriction of movement in the neck, crackling when trying to move. Patients have to turn their whole body to see something behind them
• Sweating in the upper body
• Tensed neck and shoulder girdle muscles can be detected by palpation.

If identifiedcervical osteochondrosis, treatment in the initial stages prevents serious complications - compression of the vertebral artery with oxygen oxygen to the brain, compression of the spinal cord.

Manifestations of thoracic spine osteochondrosis

Changes in the chest region develop less frequently, provoking factors - back injuries, scoliosis, previous spinal diseases (tuberculous spondylitis, nonspecific, body hemangioma).

Symptoms of a lesion of the chest region:

• Back pain - pain, traction, worse after prolonged standing or sitting in an uncomfortable position. But with persistent complaints of pain, other possible causes must be ruled out - pneumonia, pleurisy, tumors, intercostal neuralgia of a different nature, shingles before the appearance of blisters.
• Difficulty breathing, shortness of breath, inability to breathe deeply
• Thoracic osteochondrosis sometimes mimics angina pectoris attacks - a person is treated for a long time by a cardiologist and the problem is in a diseased intervertebral disc

Lumbar and lumbosacral osteochondrosis

In the structure of all types of osteochondrosis, these departments are safe leaders, more than half of all diagnosis cases. The reason is that most of the load falls on this area of the body, both standing and sitting. Body weight, load in case of improper weight lifting, for a long time in a bent position - the pulposus nucleus of the intervertebral discs is in a state of compression, pressed on the vertebral bodies through the cartilaginous plates - Schmorl hernias are formed. . Muscle overload and spasm disrupt the location of small vertebral joints in relation to each other - the articular cartilage is erased, mobility is reduced.

Some vicious circles develop immediately: muscle spasm gives pain - the pain reflexively increases the contraction of the muscle fibers, the acute pain forces a person to restrict movement, to spare the injured area - the strength of the muscle frame and the support of the spine decreases, this increases instability, lumbar osteochondrosis progresses.

At the mobile transition pointlumbar spinein a stationary sacrum fused to a single monolith, there is a risk of the fifth lumbar vertebra sliding off the surface of the sacrum. This tightens the nerve bundles, radicular syndrome develops.

Symptoms of lumbar osteochondrosis

• Low back pain, especially in the legs and sitting. After resting, the horizontal position improves. With a prolonged course, pain is common, aching, pulling
• Sudden sharp lumbago during change of body position, weight lifting, heavy load. The patient gets stuck in the position in which he was caught by the attack, it is difficult to steer, to start moving. Lumbago is usually accompanied by compression of the spinal nerve root, which developed acutely
• Passage of pain in the gluteal region, legs. The largest nerve in the body, the sciatic nerve, is a direct extension of the spinal root; therefore, patients with lumbar osteochondrosis are often concerned about sciatica.
• Due to the fact that nerve fibers control the tone of muscles and blood vessels, regulate tissue nutrition, changes are observed in that part of the trunk for which the diseased nerve is responsible. The limb feels colder than the healthy one. With a prolonged course of the disease, muscle atrophy, dry skin, and swelling are observed. Local immunity is reduced - any scratches, cuts, abrasions easily become a gateway for infection
• Loss of sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may burn or rise due to the fact that they do not feel a dangerous change in temperature.
• Very scary symptoms - numbness of the skin of the perineum, loss of control over the pelvic organs. The patient does not feel a full bladder, does not feel the need to empty the bowels. Over time, urine and feces begin to be excreted on their own, it is not possible to hold them. In this case, the treatment of osteochondrosis of the spine and its complications is performed surgically, on an urgent basis.

Diagnosis of osteochondrosis

It is performed by a neurologist or orthopedist after the therapist has ruled out visceral pathology.

• The specialist reveals the main complaints, the time of their appearance, development, the effect of drugs on the intensity of pain, rest, changes in the rhythm of life.
• A mandatory external examination is performed when the patient undresses internally - it is necessary to compare the condition and color of the skin in symmetrical parts of the body, tissue tone, reaction to various stimuli: pain, touch, cold. or heat. The symptoms of tension are defined, which show the tension of the muscles and the irritation of their tendons and integral membranes - fascia
• The neurological hammer will reveal the uniformity and symmetry of the reflexes
• The neurologist records the volume of active (independent) and passive movements (performed by the doctor) in the joints, the ability to turn the head, the upper body without including the lower parts of the spine.

If necessary, send for additional examination

• Thermal imaging diagnostics
• ENMG (electroneuromyography): Radiography. To get the necessary information, it is performed in at least two projections - direct and lateral. The photograph will tell about the condition of the bone tissue, the severity of the osteoporosis, the size and safety of the vertebral bodies and will reveal osteophytes. Damaged discs are determined by the width and uniformity of the intervertebral fissures. Inequality of the lower or upper body border will make one suspect a Schmorl hernia. To clarify the nature of the changes in the bone structure of the spine, computed tomography is recommended. Multispiral examination allows three-dimensional modeling of beads. If necessary, to detect the condition of soft tissues - muscles, ligaments, intervertebral disc, MRI is prescribed.

It should be remembered that the results of the research should be compared with the complaints and changes found during the examination. Detection of signs of spinal osteochondrosis and even disc herniation without complaints does not require any serious measures.

Treatment of spinal osteochondrosis

Elimination of acute manifestations of the disease

• Severe pain and sharp muscle tension reinforce each other, not allowing irritation to subside. Therefore, the first is to relieve the pain.
• Prescribe non-steroidal anti-inflammatory drugs in injections, muscle relaxants - muscle relaxants
• If these measures are not enough, blockade with painkillers and hormonal medications is done.

Radiofrequency denervation

It is recommended to rest in bed for a few days

Once the symptoms have subsided, it is necessary to start moving, gradually increasing the range of motion and load. At this time, active boiling, massage is undesirable due to possible complications.

Osteochondrosis: treatment without irritation

When the patient's condition stabilizes, the usual laziness remainsosteochondrosis, the treatment consists of several components:

• Treatment. All the same painkillers in tablets, capsules and ointments. A specific medication is chosen by the physician based on the patient's condition, lifestyle, concomitant diseases, the predominance of one or another component of osteochondrosis. A course of B vitamins will improve the conduction of impulses along the nerve, will normalize tissue nutrition. Maintaining increased muscle tone, the use of muscle relaxants will continue. There is no magic pill, an injection that can restore the vertebrae and cartilage to their original state. Medications relieve symptoms, improve mobility and performance. But they are not able to completely stop the progression of the disease.
• Physiotherapy. Used to send drugs directly to the injured site (electrophoresis), heating (paraffin, infrared radiation). Exposure to therapeutic currents relaxes muscles, improves the functioning of nerve fibers. After a few sessions, the pain decreases, mobility returns. It is not prescribed for active inflammation
• Manual manipulation, massage, acupuncture, acupressure. Relieve spasm by stretching and relaxing muscles. If during the massage only the upper layer of the muscles is affected, then the manual therapy penetrates deeper, therefore the requirements for specialists are higher. Be sure to do an MRI first to discover the anatomical features of a particular patient
• Spinal traction. The vertebrae move away from each other, the normal distance between them is restored, the nerve tightening is reduced. The procedure has contraindications, so only a doctor can prescribe it
• Physiotherapy. The most effective method of treatment. The only caveat is that it must be applied throughout life. Of the advantages - provides activity, improves mood, increases tissue tone. The best methods are a set of exercises recommended by a doctor, beginner yoga asana, Pilates, swimming. They are performed smoothly, without sudden and traumatic movements, stretching the tissue, gradually increasing the amplitudes.
• Proper nutrition and giving up bad habits
• Adequate supply of tissues with nutrients, a good condition of blood vessels and an adequate blood supply to the vertebrae and structures around them are measures to prevent the progression of osteochondrosis. Proper nutrition normalizes weight, reduces stress on the back

Surgical treatment of osteochondrosis of the spine.Modern clinics have a large arsenal of minimally invasive interventions:

• Treatment and diagnostic blockade
• Radiofrequency facial ablation
• Cold plasma and laser nucleoplasty
• Endoscopic removal of disc herniation
• Microdisectomy

Radiofrequency thermal ablation of the site joints

The special needles are placed exactly on the side of the intervertebral joints at the place where the middle branch of the Lyushka nerve passes. Electrodes are installed on the needles, the tip of which heats up to 80 degrees for 90 seconds. This leads to nerve coagulation. The pain goes away.

Cold plasma nucleoplasty

Through a needle inserted into the disc, a special cold plasma electrode is applied to the disc tissue. Intradiscal pressure decreases, hernia (protrusion) is retracted from the inside.

Microdisectomy

With a disc herniation, the adjacent nerve roots and blood vessels are compressed, extremely painful sensations and various limb innervation disorders appear. If the effect of conservative treatment is no longer there, then surgery to remove a disc herniation is the only possible solution for many patients. The operation is performed under anesthesia through a 2-3 cm incision using microsurgical equipment and instruments. The duration of the operation is 45-60 minutes. Pain syndrome is significantly reduced or completely disappears immediately after surgery in 95% of patients. The next day the patient is allowed to walk and is soon discharged from the clinic.

Endoscopic removal of disc herniation:

A free-lying hernia or sequestration is removed through the lateral intervertebral foramen. To place the tube, a 5 mm incision is made in the skin. Muscles, fascia and ligaments are not damaged, they are distributed using a tubular traction system with a gradual increase in diameter. The operation is almost bloodless and lasts only 40-50 minutes. Patients can return to their normal regimen after three weeks. The risk of complications is minimal.

Decompression and stabilization surgeries are performed when complications occur, a large disc herniation, severe compression of the nerve root of the spine and spinal cord. If there are signs of sudden loss of sensation, movement, pelvic dysfunction, the patient should be urgently referred to a neurosurgeon. The sooner the congestion is eliminated, the more complete the recovery will come, the person will quickly return to normal life. In this case, surgical treatment aims to decompress the compressed nerve structures and stabilize the affected segment. This is a hemi or laminectomy. Fixation is performed by a transpedicular system, in combination with an interbody cage, which provides a 360 degree fusion. Cross-vertebral stabilization is widely used. Today there are some interspinous implants. Microdisectomy in combination with interspin stabilization, especially in the elderly, can significantly increase the effectiveness of long-term outcomes and reduce the likelihood of recurrent disc herniation.