This material is intended for people without medical education who want to know more about osteochondrosis than what is written in popular publications and on the websites of private clinics.Patients ask doctors of various specialties questions that characterize the complete misunderstanding of the topic of osteochondrosis.Examples of such questions are: "why does osteochondrosis hurt?", "congenital osteochondrosis was detected, what should I do?"Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have the initial signs of chondrosis, how terrible is it?"This article aims to structure the material about osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, and to answer the most frequently asked questions.Since all of us, without exception, are patients with osteochondrosis, this article will be useful to everyone.
How is the intervertebral disc structured?
Each intervertebral disc consists of two distinct parts:
- outer annulus fibrosus, which consists of dense fibers that cover the disc from the outside around the circumference;
- the internal elastic component is the nucleus pulposus.
The fibers of the annulus fibrosus are very dense and elastic.Over the years, the elasticity is lost, and by the age of 60 the fibrous ring becomes rigid.Between the surface of each upper and lower vertebra and the disc itself are the so-called end plates, i.e. the border zone between the vertebra and the disc.Because of these end plates, the vertebrae grow in height, and the nucleus pulposus and intervertebral disc tissues are fed diffusely through them, because the cartilage of the disc is not supplied with blood or innervated.
Healthy intervertebral discs in a young person are capable of a high metabolic rate.If you introduce contrast into a normal disk, then after 20 minutes it disappears from it.
Research has shown that in an adult, the height of each intervertebral disc is approximately:
- 25% of the height of the adjacent vertebrae in the cervical region;
- 20% in the chest;
- 33% in the lumbar region.
That is, in the lumbar region, the thickness of the discs is the greatest, due to the greatest load.Laboratory studies have shown that one healthy disc in a young person can withstand a static pressure load of up to 2.5 tons.At the age of 70, this figure decreases to 110 kg!That is, the "old and dried out disc" copes 22 times worse with transferring the load to the sides and maintaining the increased pressure inside the ring.
Why did this happen?Over time, the fiber ring gradually wears out.It can no longer stretch, but just protrudes outwards, outside the disc, or breaks.The core stops transmitting and transforms the vertical load into a radial one.Over the years, stress gradually builds up inside the discs, and their structure changes.If all these processes, taken in a separate disc, are transferred to the entire spinal column, then in the clinic we get a condition called osteochondrosis.Now we can start to define.
What is osteochondrosis?
The name of the disease is scary when it is not clear.The medical suffix "-oz" means the proliferation or increase of a tissue: hyalinosis, fibrosis.An example would be cirrhosis of the liver, when the connective tissue grows and the functional tissue, the hepatocytes, decreases in volume.There can be a build-up of a pathological protein, or amyloid, that should not otherwise be present.This storage disease will then be called amyloidosis.There may be significant enlargement of the liver due to fatty degeneration, called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilage tissue of the intervertebral discs increases in volume, because "chondros, χόνδρο" in translation from Greek to Russian means "cartilage"?No, chondrosis or, more precisely, osteochondrosis is not a storage disease.In this case, there is no true growth of cartilage tissue;we are only talking about the change in the configuration of the intervertebral cartilaginous discs under the influence of many years of physical activity, and above we examined what happens on each individual 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 normal, normal aging of the intervertebral discs.None of us are surprised that the face of a 20-year-old girl will be slightly different from the face of a 70-year-old, but for some reason, everyone believes that the spine, its intervertebral discs, are not subject to the same pronounced temporary changes.Dystrophy is a nutritional disorder, and degeneration is a disruption of the structure of the intervertebral discs that accompanies a long period of dystrophy.
Causes of osteochondrosis and its complications
The main cause of uncomplicated, physiological osteochondrosis can be considered the way a person moves: upright walking.Man is the only species on earth that walks on two legs among all mammals and this is the only way to move.Osteochondrosis has become a scourge of humanity, but we freed our hands and created civilization.Thanks to upright walking (and osteochondrosis), not only did we create the wheel, the alphabet, and conquer fire, but you can sit at home in the warmth of your home and read this article on your computer screen.
The closest relatives of humans, higher primates - chimpanzees and gorillas, sometimes get up on two legs, but this way of movement is auxiliary to them, and most often they still move on four legs.In order for osteochondrosis to disappear, like intensive aging of the intervertebral discs, a person needs to change the way of movement and remove constant vertical load from the spinal column.Dolphins, killer whales and cetaceans do not have osteochondrosis, and dogs, cows and tigers do not.Their spine cannot withstand long-term static and shock vertical loads, because it is in a horizontal state.If humanity goes to sea, and the natural mode of transportation is diving, then osteochondrosis will be defeated.
The upright posture forced the human musculoskeletal system to evolve in the direction of protecting the skull and brain from impact loads.But the discs - the elastic cushions between the vertebrae - are not the only means of protection.A person has an elastic arch of the foot, cartilage of the knee joints, physiological curves of the spine: two lordosis and two kyphosis.All this allows you not to "shake" your brain even while running.
Risk factors
But doctors are interested in those risk factors that can be modified and avoid the complications of osteochondrosis, which cause pain, discomfort, limited mobility and reduced quality of life.Let's consider these risk factors, which are so often overlooked by doctors, especially in private medical centers.After all, it is much more profitable to constantly treat a person than to point out 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 growing, and the impact is transferred up the spine without softening.Intervertebral discs experience significant stress and quickly collapse;
- overweight and obesity - no comment needed;
- improper lifting and carrying of heavy objects, with uneven pressure on the intervertebral discs.For example, if you lift and carry a sack of potatoes on one shoulder, then the intense load will fall on one edge of the discs and may be excessive;
- physical inactivity and sedentary lifestyle.It was said above that it is precisely during sitting that the maximum pressure on the discs occurs, because a person never sits straight, but always "slightly" bends;
- chronic injuries, ice skating, intense weight lifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags.
General symptoms
The symptoms that will be described below exist outside of localization.These are common symptoms and can exist anywhere.These are pain, movement disorders and sensory disorders.There are also vegetative-trophic disorders, i.e. specific symptoms, for example, urination disorders, but much less often.Let's take a closer look at these signs.
Pain: muscular and radicular
Pain can be of two types: radicular and muscular.Radicular pain is associated with compression, i.e. pressing the protrusion or herniation of the intervertebral disc of the corresponding root at this level.Each nerve root consists of two parts: sensitive and motor.
Depending on where exactly the hernia is directed and which part of the root is compressed, sensory or motor disturbances may occur.Sometimes both disorders appear at once, expressed in different degrees.Pain also belongs to sensory disorders, because pain is a special, specific feeling.
Radicular pain: compressive radiculopathy
Radicular pain is familiar to many;it is called "neuralgia".The swollen nerve root reacts violently to every shock, and the pain is very sharp, similar to an electric shock.She shoots either the arm (from the neck) or the leg (from the lower back).Such a sharp, painful impulse is called lumbago: in the lower back it is lumbago, in the neck it is cervicago, a less common term.Such radicular pain requires forced, analgesic or antalgic posture.Radicular pain occurs immediately when coughing, sneezing, crying, laughing or straining.Any impact on the swollen nerve root causes increased pain.
Muscle pain: myofascial-tonic
But an intervertebral hernia or disc defect may not compress the nerve root, but may injure the nearby ligaments, fascia and deep muscles of the back during movement.In that case, the pain will be secondary, painful, permanent, there will be stiffness in the back, and such pain is called myofascial.The source of this pain will no longer be the nervous tissue, but the muscles.A muscle can respond to any stimulus in only one way: by contracting.And if the stimulus is prolonged, the muscle contraction will turn into a constant spasm, which will be very painful.
A characteristic symptom of such secondary myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense, painful muscle lumps - "rollers" next to the spine, i.e. paravertebral.In such patients, back pain intensifies after several hours of "office" work, with prolonged immobility, when the muscles are practically unable to work and are in a state of spasms.
Sensory disorders
If a protrusion or hernia, or a spasmodic muscle presses on a sensitive part of the nerve root, then various sensory disturbances occur.They can be accompanied by pain, or they can occur separately, after the pain has already passed.There are also completely painless forms of sensory disorders, but rarely.
Numbness of the tips of the fingers and toes (hypeesthesia or complete anesthesia), reduced sensitivity of the skin in the form of long stripes, radicular type, is known to many.Sometimes there is paresthesia, or formation, a feeling of "creeping goosebumps".Most often, sensitivity disorders occur in the feet, and the tips of the fingers and toes.Sensory disorders are quite unpleasant, but sensory disorders do not make a person disabled, but motor disorders can.
Motor disorders in the periphery
If the motor neuron or axons that are part of the motor part of the nerve are affected, then muscle weakness or its complete immobility occurs.In the second case, we are talking about complete paralysis, and in the first case, paresis.Paresis is partial paralysis when the muscle does not work at full strength.
Most often, such disorders appear in the legs, with protrusions and hernias of the lumbar spine.There lie the motor structures that innervate the muscles of the lower leg and foot.Therefore, in advanced, complicated lumbar osteochondrosis, the foot may strike.It turns inward, the person is forced to raise the leg high in order to step with the kicking leg, this is called steppage.
But the whole danger of movement disorders is that they can be isolated and not accompanied by pain.And if a person "doesn't have pain", then he may not get to the doctor in time.Therefore, it is so important that patients with progressive protrusions and hernias, for example, of the lumbar region, periodically walk on their toes and heels and monitor the work of their muscles.
Local symptoms: main signs
Let us now consider the specific symptoms and syndromes characteristic of cervical, thoracic and lumbar osteochondrosis.We go from top to bottom, from the cervical region down, through the thoracic part, to the lumbosacral region.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis of the cervical and cervical-thoracic spine occurs as described above.Therefore, the main stage of diagnosis was and remains the identification of the patient's complaints, determining the presence of accompanying muscle spasm by simple palpation of the muscles along the spinal column.Is it possible to confirm the diagnosis of osteochondrosis with an X-ray examination?
An "X-ray" of the cervical spine, and even with functional tests for flexion and extension, does not show cartilage, because their tissue allows x-rays.Despite this, based on the position of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general correction of the physiological curvature of the neck - lordosis, as well as the presence of marginal growths on the vertebrae with prolonged irritation of their surfaces by fragile and dehydrated intervertebral discs.Functional tests can confirm the diagnosis of instability in the cervical spine.
Since discs can only be seen with CT or MRI, magnetic resonance and X-ray computed tomography are indicated to clarify the internal structure of the cartilage and formations such as protrusions and hernias.Thus, with the help of these methods, an accurate diagnosis is made, and the findings of tomography are an indication and even a topical guide for surgical treatment of hernia in the department of neurosurgery.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, like planned aging and dehydration of the disc.You just can't let things get complicated:
- if there are symptoms of narrowing of the height of the intervertebral discs, then you need to move properly, do not gain weight and avoid the appearance of protrusions and pain in the muscles;
- if you already have a protrusion, then you must be careful not to rupture the fibrous ring, that is, not to transform the protrusion into a hernia and to avoid the appearance of protrusions on several levels;
- if you have a hernia, you must monitor it dynamically, do regular magnetic resonance imaging, avoid increasing its size or carry out modern minimally invasive surgical treatment, because without exception, all conservative methods of treatment for exacerbation of osteochondrosis leave the hernia in place, and remove only temporary symptoms: inflammation, pain, tearing and muscle spasms.
But with the slightest violation of the regime, with heavy lifting, hypothermia, injury, weight gain (in the case of the lower back), the symptoms return again and again.We will describe how you can cope with unpleasant sensations, pains and limited mobility in the back against the background of worsening osteochondrosis, and the existing protrusion or hernia, secondary to social tonic syndrome.
What to do during an exacerbation?
Since an attack of acute pain has occurred (for example, in the lower back), it is necessary to adhere to the following instructions in the pre-medical phase:
- completely eliminate physical activity;
- sleep on a hard (orthopedic mattress or hard sofa), eliminating back relaxation;
- it is advisable to wear a semi-rigid corset to prevent sudden movements and "distortions";
- A massage pillow with plastic needle applicators or a Lyapko applicator should be placed on the lower back.Keep it for 30 - 40 minutes, 2 - 3 times a day;
- after that, ointments containing NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- after rubbing, on the second day you can wrap the lower back with dry heat, for example, with a dog hair belt.
A common mistake is warming up on the first day.This could be a heating pad, bathing procedures.At the same time, the swelling only increases, along with the pain.You can warm up only after the "highest point of pain" has passed.After that, the heat will enhance the "resorption" of the swelling.This usually happens in 2-3 days.
The basis of any treatment is etiotropic therapy (removal of the cause) and pathogenetic treatment (influence on disease mechanisms).It is followed by symptomatic therapy.For vertebrogenic pain (caused by problems in the spine), things are like this:
- In order to reduce muscle and spine swelling, a salt-free diet and limiting the amount of fluid intake is indicated.You can even give a mild potassium-sparing diuretic tablet;
- in the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injections" of NSAIDs and muscle relaxants: daily.This will help relieve swelling of nerve tissue, remove inflammation and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, you should no longer take "injections", and you should pay attention to restorative agents, for example, modern drugs of group "B".They effectively restore impaired sensitivity, reduce numbness and paresthesias.
Physiotherapy measures continue, the time has come for exercise therapy for osteochondrosis.Its task is to normalize circulation and muscle tone, when the swelling and inflammation have already subsided, but the muscle spasm has not yet been completely resolved.
Kinesiotherapy (movement treatment) includes performing therapeutic exercises and swimming.Gymnastics for osteochondrosis of the cervical spine is not aimed at the discs at all, but at the surrounding muscles.Its task is to relieve tonic spasm, improve blood flow, and also normalize venous outflow.This is what leads to a decrease in muscle tone, a decrease in pain and stiffness in the back.
Exercises for osteochondrosis must be performed after a light general warm-up, on "warmed-up muscles".The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, in order to avoid relapse, the use of weights is not allowed;a gymnastic mat and a gymnastic pole are used.With their help, you can effectively restore range of motion.
Rubbing the ointment and using the Kuznetsov applicator continues.Bathing, underwater massage, Charcot shower are shown.In the worsening phase, drugs for home magnetotherapy and physiotherapy are indicated.
Usually, the treatment does not last more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that an operation may be needed, and that urgently.
About Shant's collar
In the early stages, during the acute stage, it is necessary to protect the neck from unnecessary movements.Shants collar is great for this.Many people make two mistakes when buying this collar.They do not choose it according to their size, because of which it simply does not perform its function and causes a feeling of discomfort.
Another common mistake is long-term wearing for prophylactic purposes.This weakens the neck muscles and only causes more problems.For the necklace, there are only two indications under which it can be worn:
- the appearance of acute pain in the neck, stiffness and pain that spreads to the head;
- if you are going to do physical work while you are in full health, where there is a risk of "straining" the neck and making it worse.This is, for example, repairing a car, when you lie down under it, or washing windows, when you need to stretch out your hand and take awkward positions.
The collar should be worn for no longer than 2-3 days, because longer wear can cause venous congestion in the neck muscles, at a time when it is time to activate the patient.An analogue of the Shants collar for the lower back is a semi-rigid corset purchased in an orthopedic salon.
Surgical treatment or conservative measures?
It is recommended that every patient, after the progression of symptoms, in the presence of complications, undergo MRI and consult a neurosurgeon.Modern minimally invasive operations enable the safe removal of rather large hernias, without prolonged hospitalization, without forced lying down for several days, without endangering the quality of life, because they are performed with modern video endoscopic, radio frequency, laser technology or the use of cold plasma.You can vaporize part of the core and reduce the pressure, reducing the risk of developing a hernia.And you can radically eliminate the defect, that is, get rid of it completely.
There is no need to fear hernia surgery;these are no longer the previous types of open surgeries of the 80s and 90s of the last century with muscle dissection, blood loss and subsequent long recovery periods.They are more like a small puncture under X-ray control followed by the use of modern technology.
Prevention of osteochondrosis and its complications
Osteochondrosis, including the complicated ones, about the symptoms and treatment of which we discussed above, is mostly not a disease, but simply a manifestation of inevitable aging and premature "reduction" of the intervertebral discs.Osteochondrosis needs a little to never disturb us:
- avoid hypothermia, especially in autumn and spring, and autumn winter;
- do not lift weights and carry loads only with a straight back, in a backpack;
- drink more clean water;
- do not gain weight, your weight should correspond to your height;
- treat flat feet, if any;
- do physical exercises regularly;
- engaging in types of exercises that reduce the load on the back (swimming);
- giving up bad habits;
- alternating mental stress with physical activity.After every hour and a half of mental work, it is recommended to change the type of activity to physical work;
- You can regularly do at least a two-view lumbar spine X-ray, or an MRI, to know if the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and mobile for life.