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Common osteochondrosis

pain due to osteochondrosis

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

general characteristics

Osteochondrosis is a degenerative disease of the spine, most often affecting the thoracic, lumbar and cervical regions. This pathology has a direct correlation with age. The disease is much more common in people over 40 years of age, but recently a trend towards rejuvenation has been observed. Common osteochondrosis differs in that it affects more than one section of a department or several departments at once. Due to the progressive development of degenerative processes not only in the bone tissue, but also in the ligament system of the spine, the vertebrae become mobile and put pressure on the nerves and blood vessels. Symptoms of common osteochondrosis are associated with this, but it is noteworthy that the disease can be asymptomatic for some time.

Important! The pathology requires multidisciplinary control, as it affects not only the musculoskeletal system, but also the nervous system and 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 diffuse osteochondrosis. Some of them are associated with congenital skeletal defects, others with inadequate loading during vigorous activity. Particularly common factors that contribute to the development of the clinical picture are:

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

Low temperatures are considered provoking factors, since cold temporarily changes the molecular structure of soft tissues, 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 the rapid wear of the intervertebral discs.

Pain in diffuse osteochondrosis may be a consequence of osteophytes or disc deformation. The pain is usually radicular, that is, associated with compression of the posterior nerve roots.

Common osteochondrosis easily mimics other disorders. With damage to the thoracic region, pain appears in the heart area and is mistaken for ischemic processes, and with damage to the lumbar regions - for radiculitis.

Symptoms

The clinical manifestations will depend on which parts are affected and in what combination.

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

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

For pathology in the thoracic region:

  • intercostal neuralgia;
  • stiffness in the arms and neck;
  • dysfunction of internal organs.

If the lumbar region is affected:

  • burn;
  • urinary disorders;
  • spasms;
  • 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 disruptions in the functioning of internal organs. Common polysegmental osteochondrosis can sometimes get worse. In these cases, the demonstrations are much more intense. With a combination of disorders of different departments, the symptoms will be corresponding.

Complications

Osteochondrosis can be conditionally divided into moderate osteochondrosis, which is a natural process of wear and tear of the spine as a result of life activity, and severe osteochondrosis, which is often characterized by complications.

Moderate osteochondrosis can be easily treated with conservative treatment. And if it is impossible to completely stop the inevitable aging process, it is quite possible to significantly slow it down. The complications that severe osteochondrosis can lead to are as follows.

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

Important! The intervertebral discs act as shock absorbers and reduce friction between the vertebrae. Degenerative processes in these structures can lead to protrusion of the nucleus pulposus of the disc and intervertebral herniation. Protrusion leads to compression of the roots and pain.

Spondyloarthrosis is the degeneration of the facet joints that connect adjacent vertebrae. In another way, such joints are called facet joints. When the articular cartilage is damaged, painful contact occurs between the vertebrae. With the degeneration of the facet joints, bony growths more often appear, leading to spondylosis.

Stenosis is a narrowing (in this case of the spinal canal). Typically, stenosis is the result of pathologies such as intervertebral hernia or spondylosis. Bony growths and hernial bumps compress the nerve roots at their entry and exit points.

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

  • chronic spinal pain;
  • friction of bone surfaces;
  • rigidity;
  • sudden muscle weakness;
  • decreased reflexes;
  • tingling in the limbs;
  • radiating pain;
  • symptoms of sciatica.

Sciatica is caused by compression of the sciatic nerve.

Classification

There are four degrees of osteochondrosis. The classification occurs on the basis of the anamnesis collected and with the aid of instrumental diagnostic methods. The main criteria in this classification are pain and neurological symptoms.

  1. I degree: the pain is easily relieved with medications.
  2. II degree - characterized by prolonged pain and deformation of the spine with moderate neurological symptoms.
  3. III degree: the pain is systematic, the neurological symptoms are significant.
  4. IV degree: constant pain, multiple neurological deficits. Disorders in the conduction of nerve impulses. Paralysis and paresis.

In case of diffuse dysplastic osteochondrosis, the patient is assigned the status of disability. Depending on the general condition of the patient, the degree and intensity of the development of the clinical picture, disability can be of three groups.

Types of disabilities in osteochondrosis.

Group Description
First group The functions of the spine are lost. The patient is unable to move independently and take care of himself.
Second group The patient is able to move and perform small tasks, but periods of flare-ups are frequent. The operation is contraindicated or unnecessary for some reason. Or the operation has already been performed, but proved ineffective.
Third group The patient is capable of taking care of himself. Pain and vestibular symptoms are present, but the frequency of exacerbations is moderate and periodic.

The disability range is assigned by the doctor on the basis of some studies to evaluate work ability.

Diagnostics

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

The next method is an objective study, which is carried out by the specialist himself or using instrumental methods. The doctor checks the range of motion of the neck and limbs, which may be greatly reduced due to pain and stiffness. Using the palpation method, he records how much the muscles spasm and how curved the spine is. Attention is drawn to a neurological examination, with the help of which weakened reflexes can be traced. This symptom may be the result of 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 nervous tissue.
  3. An electrophysiological study to test the conduction of nerve impulses.

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

Computed tomography can also be used in combination with magnetic resonance imaging. Using a CT scan, it is possible to determine the degree of compression of the nerves by the spurs.

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

There are additional diagnostic methods. These include:

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

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

During discography, a contrast medium 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 research method with contrast. Contrast is injected into the spinal canal and the image is recorded using X-rays or CT. Using this method, it is possible to determine the condition of the spinal cord, the presence of narrowing and compression.

Treatment

The treatment is based on the following mechanisms.

  1. Slow down the degenerative process by improving the supply of nutrients to the structures of the musculoskeletal system.
  2. Spinal stabilization.
  3. Elimination of crushed nerve fibers.
  4. Relieve symptoms.

For pharmacological treatment the following drugs are used:

  • nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
  • Anilides relieve pain in the initial stages;
  • local analgesics in the form of ointments;
  • muscle relaxants to reduce muscle spasm and increase range of motion;
  • B vitamins to improve the conductivity of nervous tissue;
  • chondroprotectors, which reduce the speed of progression of degenerative processes by integrating active substances (condoitin sulphate and glucosamine) into the cartilage cells. As a result, metabolism is normalized and clinical manifestations are reduced. The drug has been used for a long time and requires special counseling during pregnancy, breastfeeding and the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
  • antispasmodics relieve spasms of smooth muscles and thus alleviate the manifestations of osteochondrosis in internal organs;
  • antioxidants;
  • antidepressants to eliminate the psychosomatic component of this disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. They promote the production of endorphins and help solve the problem of chronic insomnia due to constant pain.
  • neuropathic agents to eliminate damage to nerve endings.
  • opiates for unbearable pain and the ineffectiveness of other painkillers.

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 roots, which helps relieve pain caused by radiculopathy. Complicated procedure. Requires a qualified specialist;
  • injections into the facet joints. The injected drugs cause local numbness and pain relief.

This is important to know! Taking medications is not intended to eliminate the disease: there are no drugs that can completely eliminate osteochondrosis, which is a chronic disease. Medicines are prescribed only to relieve symptoms.

Medicines are prescribed by the attending physician. The patient is informed about the possible side effects of each drug and then decides independently 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 cooperation of these specialists with each other and with the patient.

Physiotherapy

Physiotherapy is used as a set of auxiliary therapeutic measures to improve blood circulation and metabolism in the affected tissue. For diffuse 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 drugs).
  3. Magnetotherapy (use of a static magnetic field).
  4. UHF therapy (very high frequency therapy).
  5. Electromyostimulation (stimulation of nerves and muscles).
  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 exercise should not be performed during an exacerbation of the disease, as this can lead to complications. During the remission period, moderate physical activity maintains muscle tone, and therefore the spine. The exercises are performed under the supervision of an instructor and are prescribed by the attending physician.

During a flare-up, you cannot warm your 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 lead to muscle atrophy.

Manual therapy can increase release of pinched nerves and reduce neurological symptoms. Alternative methods are leeches and vacuum massage. These methods are aimed at improving blood circulation in the affected area. Health spa treatment is helpful. Particular preference is given to water procedures.

Surgery

In the treatment of osteochondrosis, specialists are more willing to resort to conservative therapy, however, to achieve the desired effect, a lot of time, patience and scrupulous adherence to the patient's recommendations are required. If conservative treatment is ineffective, only then should you resort to invasive methods. The operation is usually palliative. This means that the operation will be performed only to alleviate symptoms and comparatively improve the quality of life, but not to complete recovery (it is fair to say that even conservative treatment does not lead to complete elimination of the disease, but to the patient's receptivity to non-invasive therapy is a sign of a good prognosis).

There are two types of surgery: decompression and stabilization. The first aims to relieve nerve compression, the second aims to stabilize the spine. The following operations are classified as decompression operations.

  1. Facetectomy: Removal of facet joints 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 part of the vertebra, which may be deformed due to osteochondrosis.
  4. Laminotomy: Removal of a fragment of the back of the vertebra to widen the spinal canal.

These operations require a posterior approach, but in the case of intervertebral hernia the surgical approach will be anterior.

Decompression interventions with an anterior approach are as follows.

  1. Discectomy – removal of an intervertebral disc.
  2. Corpectomy – removal of the entire vertebral body with adjacent discs.

Stabilization operations include:

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

The need for stabilization operations arises after discectomy.

Surgical interventions are rarely prescribed because there is a risk of developing serious complications.

Complications include:

  • pain relapses;
  • false union;
  • infection;
  • phlebitis in the limbs;
  • violation of the act of urination;
  • pain due to the graft;
  • failure of the embedded fasteners.

The postoperative period lasts several months. The sutures heal 2 weeks after surgery. If complications are detected, you should immediately consult a doctor.

After the operation, a rehabilitation program is carried out to accelerate the healing process and restore full working capacity.

General recommendations

Proper nutrition helps prevent relapses of exacerbation of common osteochondrosis. Proper nutrition is primarily necessary to maintain a stable body weight, as excess weight places additional stress on the spine. In this case the diet should be complete, enriched and rich in calcium, magnesium and potassium. You need to limit your coffee consumption as it takes calcium out of your body. It is useful to visit the swimming pool. You should avoid staying in the same position all the time.

If you experience frequent exacerbations and lack the discipline to strictly follow the recommendations, it is better to undergo a full course of treatment in the hospital under the supervision of a doctor.

You cannot take medications on your own.

Let's summarize

Often, diffuse osteochondrosis develops after an incompletely cured "single" osteochondrosis. This fact suggests that if any discomfort occurs, you should immediately contact a doctor, without hoping that the pain will disappear on its own. In this case it will be much easier to prevent the development of other pathologies, and even more so to treat the root cause.