This material is intended for people without medical education who want to know more about osteochondrosis than has been written in popular publications and at private clinics. Patients ask physicians with different specialties such questions that characterize a complete lack of understanding of the topic of osteochondrosis. Examples of such questions can be considered: "why do I have pain in osteochondrosis", "congenital osteochondrosis was found, what should I do"? Perhaps apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have initial signs of chondrosis, how scary is it? " This article is intended to structure material on osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention and to answer the most frequently asked questions. Since we are all, without exception, patients with regard to osteochondrosis, this article will be useful for everyone.
How is the intervertebral disc arranged?
Each intervertebral disc consists of two different sections:
- outer ring fibers consisting of dense fibers surrounding the disc from the outside along the circumference;
- the inner elastic component is the gelatinous core.
The fibers of the annulus fibrosus are very dense and elastic. Over the years, elasticity is lost, and after 60 years, the fibrous ring becomes stiff. Between the surface of each overlying and underlying vertebra and the disc itself are the so-called end plates, i. e. the boundaries between the vertebra and the disc. Due to these endplates, the vertebrae grow in height and through them nucleus pulposus and intervertebral disc tissue are diffused by the diffusion method, as disc cartilage is not supplied with blood and is not innervated.
Healthy intervertebral discs in a young person are capable of a high metabolic rate. If contrast is introduced in a normal disk, it disappears after 20 minutes from it.
Studies have shown that the height of each intervertebral disc in an adult is approx.
- 25% of the height of the adjacent vertebrae in the cervix;
- 20% in the chest
- 33% in the lower back.
That is, in the lumbar region, the thickness of the discs is greatest due to the greatest load. Laboratory studies have shown that a single healthy disk from a young person can withstand a static compression load of up to 2. 5 tons. At the age of 70, this number drops to 110 kg! That is, the "old and dry disk" performs 22 times worse with the transfer of the load to the sides and with the retention of the increased pressure inside the ring.
Why did it happen? Over time, the annulus fibrosus also wears out gradually. It can no longer stretch, but only curves outwards, beyond the disc or breaks. The core stops transmitting and converting the vertical load to the radial. With age, tensions gradually accumulate inside the discs and their structure changes. If all these processes, taken in a separate disk, are transferred to the entire spine, we get a condition called osteochondrosis in the clinic. Now you can start defining.
What is osteochondrosis?
The name of the disease is scary when it is incomprehensible. Medical suffix "-oz" means growth or enlargement of any tissue: hyalinosis, fibrosis. An example would be liver cirrhosis as the connective tissue grows and the functional tissue, hepatocytes, decreases in volume. There may be an accumulation of abnormal protein or amyloid, which should not normally be present. Then this accumulative disease is called amyloidosis. There may be a significant increase in the liver due to fat degeneration, which is called fatty hepatosis.
Well it turns out that with intervertebral osteochondrosis, the volume of cartilage tissue from the intervertebral discs increases because "chondros, χόνδρο" in translation from Greek to Russian means "cartilage"? No, chondrosis or more precisely osteochondrosis is not an accumulative disease. In this case, no real growth of cartilage tissue occurs, we are only talking about a change in the configuration of the intervertebral cartilage plates under the influence of many years of physical exertion, and we examined above what happens in each disc. The term "osteochondrosis" was introduced into the clinical literature by A. Hilderbrandt in 1933.
Osteochondrosis refers to dystrophic-degenerative processes and is part of the usual normal aging of the intervertebral discs. None of us are surprised that a 20-year-old girl's face will be a little different than her face at age 70, but for some reason everyone thinks that the spine, its intervertebral discs, do not undergo the same pronounced temporarychanges. Dystrophy is a malnutrition and degeneration is a violation of the structure of the intervertebral discs after a long period of dystrophy.
Causes of osteochondrosis and its complications
The main cause of uncomplicated, physiological osteochondrosis can be considered as a method of movement for a person: this is vertical posture. Of all mammals, humans are the only biological species on earth that can walk on two legs, and this is the only way to move. Osteochondrosis became the plague of mankind, but we liberated our hands and created civilization. Thanks to upright posture (and osteochondrosis), we have not only created a wheel, an alphabet and mastered fire, but you can also sit at home in the heat and read this article on a computer screen.
The closest relatives of humans, the great apes, chimpanzees, and gorillas, sometimes climb on two legs, but this form of movement is helpful to them, and often they still move on four legs. In order for osteochondrosis to disappear, as an intense aging of the intervertebral discs, a person has to change the path of movement and remove the constant vertical load from the spine. Dolphins, orcas and whales do not have osteochondrosis; dogs, cows and tigers do not have osteochondrosis. Their spine does not take prolonged static and shock vertical loads as it is in a horizontal position. If humanity goes to sea and diving is a natural way to move, then osteochondrosis will be defeated.
Walking upright forced the human musculoskeletal system to evolve towards protecting the skull and brain from shock loads. But discs - elastic pads between the vertebrae - are not the only way to protect yourself. A person has a resilient arch of the foot, cartilage in the knee joint, physiological curves in the spine: two lordosis and two kyphosis. All of this allows you to not "shake" your brain off, even when you are running.
But doctors are interested in the risk factors that can change and avoid complications of osteochondrosis, which cause pain, discomfort, limitation of mobility and a decrease in quality of life. Consider these risk factors, which are so often ignored by physicians, especially private health centers. After all, it is much more profitable to constantly treat a person than to point out to him the cause of the problem, solve it and lose the patient. Here they are:
- the presence of longitudinal and transverse flat feet. Flat feet cause the arch of the foot to stop jumping and the blow is transferred upwards to the spine without softening. Intervertebral discs are under considerable strain and are rapidly destroyed;
- overweight and obesity - need no comments;
- improper lifting and transfer of weights with uneven pressure on the intervertebral discs. For example, if you lay and carry a bag of potatoes on one shoulder, then the intense load will fall on one edge of the slices and it may be too large;
- physical inactivity and a sedentary lifestyle. Above it was said that it is during the meeting that the maximum pressure on the discs occurs, as a person never sits vertically, but always "slightly" bends;
- chronic injuries, slipping on ice, intense weightlifting, contact martial arts, heavy hats, head bumps in low ceilings, heavy clothing, carrying heavy bags in your hands.
The symptoms, which will be described below, are found outside localization. These are common characters and can exist anywhere. These are pain, movement disorders and sensory disorders. There are also vegetative-trophic disorders or specific symptoms, such as urination disorders, but much less frequently. Let's take a closer look at these signs.
Pain: muscle and radicular
Pain can be of two types: radicular and muscle pain. Radicular pain is associated with compression or compression of the protrusion or herniation of the intervertebral disc of the corresponding root at this level. Each nerve root consists of two parts: sensory and motor.
Depending on exactly where the hernia is directed and which part of the root has undergone compression, there may be either sensory or movement disorders. Sometimes both these and other disorders exist at the same time, expressed in varying degrees. Pain also refers to sensory disorders, as pain is a special, specific emotion.
Radicular pain: compression radiculopathy
Radicular pain is known to many, it is called "neuralgia". The swollen nerve root reacts violently to any concussion, and the pain is very sharp, equivalent to an electric shock. She shoots either in the arm (from the neck) or in the leg (from the loins). Such a sharp, painful impulse is called lumbago: in the loins it is lumbago, in the neck it is the cervicago, a rarer expression. Such radicular pain requires a forced, analgesic or numerical posture. Radicular pain occurs immediately when coughing, sneezing, crying, laughing, exertion. Any concussion of the swollen nerve root causes increased pain.
Muscle pain: myofascial-tonic
However, an intervertebral hernia or disc defect may not press on the nerve root, and when you move, you injure close ligaments, fascia, and deep back muscles. In this case, the pain will be secondary, tender, permanent, there will be stiffness in the back, and this pain is called myofascial pain. The source of this pain will no longer be nerve tissue but muscles. A muscle can only respond to any stimulus in one way: by contraction. And if the stimulus is prolonged, the muscle contraction becomes a constant cramp, which will be very painful.
A characteristic symptom of such a secondary, myofascial pain will be increased stiffness in the neck, lower back or in the thoracic spine, the appearance of dense, painful muscle tubercles - "combs" next to the spine, ie. paravertebral. In such patients, back pain intensifies after several hours of "office" work with prolonged immobility, when the muscles practically lose their work and are in a state of convulsion.
If a protrusion or hernia or a spasmodic muscle presses on a sensitive part of the nerve root, a series of sensory disturbances occur. They may be accompanied by pain, or they may occur separately after the pain has already passed. There are also completely painless forms of sensory disorders, but rarely.
Many people experience numbness in the fingertips and toes (hypaesthesia or complete anesthesia), a decrease in skin sensitivity in the form of long streaks according to the radicular type. Sometimes there are paresthesias or formations, a feeling of "creep". Most often, sensory disturbances occur in the feet and tips of the fingers and toes. Sensory disorders are quite unpleasant, but sensitivity disorders do not yet make a person disabled, but movement disorders may very well lead to this.
Peripheral movement disorders
If a motor neuron is affected or axons that are part of the motor part of a nerve, either weakness in the muscle or its complete immobility occurs. In the second case we are talking about complete paralysis and in the first case about paresis. Paresis is a partial paralysis when a muscle is not working at full strength.
Often such disorders occur in the legs with protrusions and hernias in the lumbar spine. There are motor structures that innervate the muscles of the lower leg and foot. Therefore, with advanced, complicated lumbar osteochondrosis, the foot may slam. It faces inwards, a person is forced to lift the leg high to step with a paddle foot, this is called steppage, "cock walk".
But the whole danger of movement disorders is that they can be isolated and not accompanied by pain. And if a person "does not hurt", he may not be able to get to the doctor in a timely manner. That is why it is so important for patients with progressive protrusions and hernias, for example in the lumbar spine, that they regularly walk on toes and heels and monitor the work of their muscles.
Local symptoms: main signs
Let us now consider the specific symptoms and syndromes that are characteristic of cervical, thoracic, and lumbar osteochondrosis. Let's go "from top to bottom", from the cervix and down through the thorax to the lumbosacral.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis continues in the cervical and cervicothoracic spine as described above. Therefore, the main phase of the diagnosis was and remains the identification of the patient's complaints, the establishment of the presence of concomitant muscle spasm by simple palpation of the muscles along the spine. Is it possible to confirm the diagnosis of osteochondrosis using X-ray examination?
"X-ray" of cervical spine, and even with functional tests for bending - elongation does not show cartilage, as their tissue transmits X-rays. Despite this, based on the location of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general alignment of the physiological flexion of the neck - lordosis, and the presence of marginal growths on the vertebrae with prolonged irritation of their fragile anddehydrated intervertebral discs. Functional tests can confirm the diagnosis of instability in the cervix.
Since the discs themselves can only be seen by CT or MRI, magnetic resonance imaging and X-ray computed tomography are indicated to clarify the internal structure of cartilage and such formations as protrusions and hernias. Thus, the diagnosis is accurately made using these methods, and the result of the tomography is an indication and even a current guide to surgical treatment of a hernia in neurosurgical department.
Treatment of complications of osteochondrosis
We repeat once again that it is impossible to cure osteochondrosis, as planned aging and dehydration of the disc. You simply can not bring the matter to complications:
- if there are symptoms of a narrowing of the height of the intervertebral discs, move properly, do not gain weight and avoid the appearance of protrusions and muscle pain;
- if you already have a protrusion, then be careful not to bring it to the fracture of the annulus fibrosus, that is, not to transfer the protrusion to a hernia and to avoid the appearance of protrusions on several levels
- if you have a hernia, observe the dynamic, do MRI regularly, avoid increasing its size or perform modern minimally invasive surgical treatment, as all without exception conservative methods of treating an exacerbation of osteochondrosis leave the hernia in place and only eliminate temporarysymptoms: inflammation, pain, lumbago and muscle spasms.
But with the slightest violation of the regime, with heavy lifting, hypothermia, injury, weight gain (in case of lumbar), the symptoms return again and again. Let us describe how you can cope with discomfort, pain and limited mobility in the back on the background of exacerbation of osteochondrosis and existing protrusions or hernia, secondary flesh of the social tonic syndrome.
What should I do during an exacerbation?
As there has already been an attack of acute pain (for example in the lower back), the following appointments should be made at the pre-medical stage:
- eliminate physical activity completely
- sleep on a hard (orthopedic mattress or hard sofa) that prevents falling back
- it is advisable to wear a semi-rigid cross to prevent sudden movements and "distortions";
- on the lower back, place a massage pad with plastic needle applicators or use the Lyapko applicator. You need to hold it for 30-40 minutes, 2-3 times a day;
- then ointments containing NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- after rubbing in on the second day, you can wrap the lower back in dry heat, for example, a belt made of dog hair.
Heating on the first day is a common mistake. It can be a heating pad, bathing procedures. In this case, the swelling only intensifies and the pain follows. You can only warm up when the "highest point of pain" is over. Then the heat will intensify the "resorption" of the edema. This usually happens on days 2 to 3.
The basis of any treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (which affects the mechanisms of the disease). Symptomatic therapy is adjacent to it. With back pain (caused by problems in the spine) things are like this:
- to reduce muscle and root swelling, a salt-free diet is indicated and limits the amount of fluid consumed. You can even give a pill with a mild potassium-sparing diuretic.
- in the acute phase of osteochondrosis of the lumbar spine, short-term treatment with intramuscular "injections" of NSAIDs and muscle relaxants can be performed: daily. This will help stop the swelling in the nerve tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, "injections" should no longer be taken and attention should be paid to restorative drugs, for example modern drugs in group "B". They effectively restore decreased sensitivity, reduce numbness and paresthesia.
Physiotherapy continues, the time has come for exercise therapy for osteochondrosis. Its task is to normalize blood circulation and muscle tone when edema and inflammation have already receded and muscle spasms have not yet been fully resolved.
Kinesiotherapy (movement therapy) provides therapeutic exercises, swimming. Gymnastics with osteochondrosis of the cervix is not aimed at the discs at all, but at the surrounding muscles. Its job is to relieve tonic cramps, improve blood flow and also normalize venous outflow. This is what leads to a decrease in muscle tone, a decrease in the severity of pain and stiffness in the back.
Exercises for osteochondrosis should be performed after a light general warm-up on "warm muscles". The most important therapeutic factor is movement, not the degree of muscle contraction. Therefore, it is not allowed to use weights to avoid relapse, a gym mat and a gym stick are used. With their help, you can effectively restore the range of motion.
Rubbing in ointments continues Kuznetsov's applicator. Shown are swimming, underwater massage, Charcot shower. It is in the phase of dwindling aggravation that medicines for home magnetotherapy and physiotherapy are shown.
Usually the treatment does not take more than a week, but in some cases osteochondrosis can manifest itself with such dangerous symptoms that an operation may be necessary and an urgent one.
About Shant's collar
In the early stages, in the exacerbation phase, it is necessary to protect the neck from unnecessary movements. The Shants collar is great for this. Many people make two mistakes when buying this collar. They do not choose it because of the size, which is why it simply does not perform its function and causes a feeling of discomfort.
The other common mistake is to wear it as a preventative measure for a long time. This leads to weakness in the neck muscles and only causes more problems. There are only two indications that a collar can be worn:
- the appearance of sharp pain in the neck, stiffness and spread of pain in the head;
- if you have to do physical work in the middle of a complete state of health, where there is a risk of "pulling" in the neck and worsening. This repairs, for example, a car when you are lying under it, or washing windows when you need to reach out and take uncomfortable positions.
You should wear a collar no more than 2-3 days as prolonged use can cause venous overload in the muscles of the neck at a time when it is time to activate the patient. An analogue of Shants collar for lower back is a semi-rigid corset purchased in an orthopedic salon.
Surgical treatment or conservative measures?
It is desirable that each patient, after progression of symptoms in the presence of complications, perform an MRI scan and consult a neurosurgeon. Modern minimally invasive surgeries make it possible to safely remove rather large hernias without prolonged hospitalization, without forced condition or lying down for several days without compromising the quality of life, as they are performed using modern video endoscopic, radio frequency, laser technology or using cold plasma. You can evaporate part of the core and lower the pressure, reducing the risk of hernia. And you can eliminate the defect radically, that is, get rid of it completely.
There is no need to be afraid of operating on a hernia, these are no longer the previous types of open surgeries in the 80s-90s of the last century with muscle dissection, blood loss and a subsequent long recovery period. They look more like a small puncture under X-ray control followed by the use of modern technology.
Prevention of osteochondrosis and its complications
Osteochondrosis, including complicated osteochondrosis, whose symptoms and treatment we have discussed above, is mostly not a disease at all, but simply a manifestation of inevitable aging and premature "shrinkage" of intervertebral discs. Osteochondrosis needs a little to never irritate us:
- Avoid hypothermia, especially in autumn - spring, fall in winter
- do not lift weights, but only carry weights with a straight back in a backpack;
- drink more clean water
- do not get fat, your weight should match your height;
- take care of treatment with flat feet, if any
- do physical exercise regularly
- engages in such types of load that reduce the load on the back (swimming)
- rejection of bad habits
- alternating mental stress with physical. After every hour and a half of mental work, it is recommended to change the type of activity to physical work;
- regularly you can do at least one x-ray of the lumbar spine in two protrusions or an MRI to know if the hernia is progressing, if any;
By following these simple guidelines, you can keep your back healthy and flexible throughout your life.