This material is intended for people without a medical degree who want to know more about osteochondrosis than can be found in popular publications and on the websites of private clinics.Patients ask doctors of various specialties questions that characterize a complete misunderstanding of the topic of osteochondrosis.Examples of such questions: "why does my osteochondrosis hurt?", "congenital osteochondrosis was discovered, what should I do?"Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, you have the initial signs of chondrosis, how scary is it?"This article is about osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, as well as answers to the most frequently asked questions.Since we are all patients with osteochondrosis without exception, this article will be useful for everyone.
How is the intervertebral disc constructed?
Each intervertebral disc consists of two different parts:
- outer fibrous ring, consisting of dense fibers that cover the disc from the outside along the circumference;
- the internal elastic component is the nucleus pulposus.
The fibers of the annulus fibrosus are very dense and flexible.As the years go by, flexibility is lost, and by the age of 60, the annulus fibrosus becomes rigid.Between the surface of each overlying and underlying vertebrae and the disc itself, there are so-called end plates, i.e. the border zones between the vertebra and the disc.Thanks to these end plates, the vertebrae grow in height, through them the tissues of the nucleus pulposus and the intervertebral disc are diffusely nourished by the diffusion method, since the disc of the intervertebral disc is not supplied with blood and is not innervated.
Healthy intervertebral discs in a young person are capable of a high metabolic rate.If you introduce contrast into a normal plate, it will disappear after 20 minutes.
Studies have shown that the height of each intervertebral disc in adults is approximately:
- 25% of the height of the adjacent vertebrae in the neck region;
- 20% in the chest;
- 33% in the groin.
That is, the thickness of the discs is the greatest in the lumbar region, due to the greatest load.Laboratory studies have shown that a single healthy disc in a young person can withstand a static compressive load of up to 2.5 tons.At the age of 70, this number drops to 110 kg!That is, an "old and dried out disc" copes 22 times worse with transferring the load to the side and maintaining the increased pressure inside the annulus.
Why did this happen?Over time, the fibrous ring gradually wears out.It can no longer extend, it only extends outward, beyond the disc, or it breaks.The core does not transmit and convert the vertical load into radial load.As we age, stress gradually builds up inside the discs and their structure changes.If all these processes are transferred to the entire spinal column on a separate disc, then in the clinic we get a condition called osteochondrosis.Now we can start defining it.
What is osteochondrosis?
The name of the disease is scary if not clear.The medical suffix "-oz" means proliferation or enlargement of certain tissues: hyalinosis, fibrosis.An example of this is cirrhosis of the liver, when the connective tissue increases and the volume of the functional tissue, the hepatocytes, decreases.There may be accumulation of pathological protein or amyloid that should not normally be present.This storage disease is then called amyloidosis.Significant liver enlargement can occur due to fatty degeneration, known as fatty hepatosis.
Well, it turns out that in case of intervertebral osteochondrosis, the volume of the cartilage tissue of the intervertebral discs increases, because "chondros, χόνδρο" translated from Greek to Russian means "cartilage"?No, chondrosis, more specifically osteochondrosis, is not a storage disease.In this case, the real growth of cartilage tissue does not occur;we are only talking about the change in the configuration of the intervertebral discs as a result of many years of physical activity, and we have 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 normal, normal aging of the discs.None of us are surprised that the face of a 20-year-old girl will be a little different than at 70, but for some reason, everyone thinks that the spine and intervertebral discs do not go through the same marked temporary changes.Dystrophy is a nutritional disorder, and degeneration is a violation of the structure of the intervertebral discs, which follows a long dystrophy.
Causes and complications of osteochondrosis
The main cause of uncomplicated, physiological osteochondrosis is the way a person moves: straight walking.Humans are the only species on earth that walks on two legs among all mammals, and this is the only mode of locomotion.Osteochondrosis became a scourge of humanity, but we freed our hands and created civilization.Thanks to straight walking (and osteochondrosis), not only did we create the wheel, the alphabet and fire, but you can sit at home in the heat and read this article on your computer screen.
Man's closest relatives, the higher primates - chimpanzees and gorillas - sometimes rise on two legs, but this mode of movement is helpful for them, and they still move on all fours most of the time.In order for osteochondrosis to disappear, as an intensive aging of the intervertebral discs, the person must change his movements and remove the constant vertical load on the spinal column.Dolphins, killer whales and whales do not suffer from osteochondrosis, and dogs, cows and tigers do not.Their spine does not absorb long-term static and shock-like vertical loads, as it is in a horizontal state.If humanity goes to sea, and the natural way of transportation is diving, then osteochondrosis can be overcome.
The upright posture forced the human musculoskeletal system to protect the skull and brain from shock loads.But the discs — the flexible cushions between the vertebrae — aren't the only defense.Humans have elastic foot arches, cartilage in the knee joints, and physiological curves of the spine: two lordosis and two kyphosis.All this allows you not to "shake off" your brain while running.
Risk factors
However, doctors are interested in the risk factors that can be modified and avoid the complications of osteochondrosis, which cause pain, discomfort, limited mobility, and reduced quality of life.Consider these risk factors that are often overlooked by doctors, especially in private medical centers.After all, it is much more rewarding to treat a person continuously 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.Due to flat feet, the arch stops springing and the shock is transmitted upwards towards the spine without softening.Intervertebral discs experience significant stress and quickly collapse;
- overweight and obesity - no comment required;
- improper lifting and transportation of heavy objects, with uneven pressure on the intervertebral discs.For example, if you lift and carry a sack of potatoes on one shoulder, the intense load falls on one edge of the discs and can be excessive;
- physical inactivity and sedentary lifestyle.It was said above that the maximum pressure on the discs is reached while sitting, since a person never sits straight, but always bends "slightly";
- chronic injuries, slipping on ice, intense weight lifting, contact martial arts, heavy hats, hitting low ceilings, heavy clothing, carrying heavy bags.
General symptoms
The symptoms described below also exist outside of localization.These are common symptoms and can occur anywhere.These are pain, movement disorders and sensory disturbances.There are also vegetative-trophic disorders or specific symptoms, such as urinary 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 or pressure of the intervertebral disc protrusion or herniation of the corresponding root at this level.Each nerve root consists of two parts: sensory and motor.
Depending on where exactly the hernia is directed and which part of the root has been compressed, there may be sensory or motor abnormalities.Sometimes both disorders appear at the same time, expressed to different degrees.Pain also belongs to sensory disorders, since pain is a special, specific feeling.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many;it is called "neuralgia".The swollen nerve root reacts violently to any stroke and the pain is very sharp, similar to an electric shock.Shoots in the arm (from the neck) or the leg (from the lower back).Such a sharp, painful impulse is called lumbago: lumbago in the lower back, cervicago in the neck, a less common term.Such radicular pain requires a supportive, pain-relieving, or pain-relieving posture.When coughing, sneezing, crying, laughing or exerting yourself, radicular pain occurs immediately.Any shock to 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 during movement the nearby ligaments, fascia and deep back muscles are injured.In this case, the pain is secondary, aching, constant, back stiffness occurs, and this pain is called myofascial.The source of this pain is no longer the nerve tissue, but the muscles.A muscle can only respond to any stimulus in one way: by contracting.And if the stimulus lasts, the muscle contraction turns into a permanent spasm, which will be very painful.
A characteristic symptom of such secondary myofascial pain is increased stiffness of the neck, lower back or thoracic spine, the appearance of dense, painful muscle lumps - "rollers" near the spine, i.e. paravertebral.In such patients, the back pain worsens after several hours of "office" work, with prolonged immobility, when the muscles practically cannot work and are in a spasmodic state.
Sensory disturbances
If a protrusion or hernia, or a spasmodic muscle presses on the sensitive part of the nerve root, various sensory disturbances occur.They can be accompanied by pain, or they can occur separately after the pain has passed.Sensory disorders also have completely painless forms, but rarely.
Many people are familiar with the numbness of the tips of the fingers and toes (hypoesthesia or complete anesthesia), the sensitivity of the skin in the form of long strips, they are of the radicular type.Sometimes paresthesia or formification, a feeling of "creeping goosebumps" occurs.Sensitivity disorders most often occur in the soles of the feet and the tips of the fingers and toes.Sensory disorders are quite unpleasant, but sensory disorders do not make you disabled, but movement disorders can also lead to this.
Motor disorders in the periphery
If the motor neuron or axons of the nerve are affected, muscle weakness or complete immobility occurs.In the second case, we are talking about complete paralysis, and in the first case, paresis.Paresis is a partial paralysis where the muscle does not work at full strength.
Most often, such abnormalities appear in the legs, with protrusions and hernias of the lumbar spine.There are motor structures that innervate the muscles of the leg and foot.Therefore, in the case of advanced, complicated lumbar osteochondrosis, the foot can cause beating.He turns inward, the person is forced to raise his foot high so that he can step with the beating foot, this is called steppage, "rooster walk".
But the whole danger of movement disorders is that they can be isolated and do not involve pain.And if a person has "no pain", he may not get to the doctor in time.Therefore, it is very important for patients with progressive protrusions and hernias, for example in the lumbar region, to regularly 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.Let's go from top to bottom, from the neck region down, through the chest to the lumbosacral region.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis of the cervical and cervicothoracic spine occurs as described above.Therefore, the main stage of the diagnosis was and remains the identification of the patient's complaints, establishing the presence of simultaneous muscle spasm by simply palpating the muscles along the spinal column.Can the diagnosis of osteochondrosis be confirmed by X-ray examination?
"X-rays" of the cervical spine and even flexion and extension functional tests do not detect cartilage because their tissue transmits X-rays.Nevertheless, based on the location of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general straightening of the physiological curvature of the neck - lordosis, and the presence of marginal growths on the vertebrae, which cause long-term irritation of their surface by the fragile and dehydrated intervertebral discs.Functional tests can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen with CT or MRI, magnetic resonance and X-ray computed tomography are recommended to clarify the internal structure of the cartilage and formations such as protrusions and hernias.Thus, with the help of these methods, the diagnosis is accurately established, and the results of the tomography are an indication and even a current guideline for the surgical treatment of hernia occurring in the neurosurgery department.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, like planned aging and drying out of the disc.You just can't let things get complicated:
- if there are symptoms of a narrowing of the height of the intervertebral discs, you need to move correctly, do not gain weight and avoid the appearance of protrusions and muscle pain;
- if there is already a protrusion, then take care not to break the annulus fibrosus, that is, the protrusion does not turn into a hernia, and avoid the appearance of protrusions at several levels;
- if there is a hernia, it should be monitored dynamically, regular MRI should be performed, its size should be avoided, or modern, minimally invasive surgical treatment should be performed, since without exception, all conservative methods of treating exacerbation of osteochondrosis leave the hernia in place and only eliminate temporary symptoms: inflammation, pain, shooting and muscle spasms.
But with the slightest violation of the regime, heavy lifting, hypothermia, injury, weight gain (in the lower back), the symptoms return again and again.We describe how to cope with discomfort, pain and limited mobility in the back against the background of exacerbation of osteochondrosis and secondary protrusion or herniation of social tone syndrome.
What to do during an exacerbation?
Since acute pain has arisen (for example, in the lower back), in the pre-doctor phase, you should follow the following instructions:
- completely eliminate physical activity;
- sleep hard (on an orthopedic mattress or hard sofa), eliminating sagging of the back;
- it is advisable to wear a semi-rigid corset to prevent sudden movements and "distortions";
- Place a massage pad with plastic needle applicators on the lower back or use a Lyapko applicator.It should be used 2-3 times a day for 30-40 minutes;
- after that, ointments containing NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- on the second day after rubbing, you can wrap the lower part of the back in dry heat, for example with a belt made of dog hair.
A common mistake is warming up on the first day.It can be a heating pad, bath procedures.At the same time, the swelling only increases, and along with it, the pain.You can only warm up after the "highest point of pain" has passed.After that, the heat increases the "absorption" of the swelling.This usually happens within 2-3 days.
All treatment is based on etiotropic therapy (elimination of the cause) and pathogenetic (influencing the mechanisms of the disease) treatment.It is accompanied by symptomatic therapy.Vertebrogenic pain (caused by spinal problems) includes:
- In order to reduce the swelling of the muscles and spine, a salt-free diet and limiting the amount of liquid consumed is recommended.You can even give a tablet of a mild potassium-sparing diuretic;
- in the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injection" of NSAIDs and muscle relaxants: daily.This helps to relieve the swelling of nerve tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, you should no longer take "injections" and pay attention to restorative agents, for example, modern drugs of the "B" group.They effectively restore damaged sensitivity, reduce numbness and paresthesia.
Physiotherapy measures continue, it's time to practice osteochondrosis.Its task is to normalize blood circulation and muscle tone when the swelling and inflammation have passed, but the muscle spasm has not yet completely disappeared.
Kinesiotherapy (movement treatment) includes 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 normalize venous outflow.This 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 on "warmed muscles" after a mild general warm-up.The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, in order to avoid a relapse, the use of weights is not allowed;they use a gym mat and a gym stick.With their help, you can effectively restore range of motion.
The rubbing of ointments and the use of the Kuznetsov applicator continue.Swimming, underwater massage, Charcot shower can be seen.At the stage of worsening of the fading, home magnetic therapy and physiotherapy drugs are indicated.
Usually, the treatment does not last longer than a week, but in some cases, osteochondrosis can present with such dangerous symptoms that surgery may be required, and urgently.
From Shants collar
In the initial stage, the acute stage, the neck must be protected from unnecessary movements.The Shants collar is excellent for this.Many people make two mistakes when buying this collar.They are not selected according to their size, which is why it simply does not fulfill its function and causes discomfort.
The second common mistake is to wear it for a long time for prophylactic purposes.This leads to weak neck muscles and only causes more problems.In the case of the collar, it can only be worn based on two indications:
- the appearance of acute pain in the neck, stiffness and pain spreading to the head;
- if in full health you will be doing physical work during which there is a risk of "straining" and aggravating your neck.This is, for example, fixing a car when you lie down, or washing windows when you have to reach out and assume awkward positions.
The collar should be worn for no more than 2-3 days, as venous congestion may occur in the neck muscles when the patient has time to activate it.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 advisable that after the progression of the symptoms, in the event of complications, an MRI should be performed on all patients and they should be referred to a neurosurgeon.Modern, minimally invasive operations allow the safe removal of rather large hernias, without long-term hospitalization, without several days of bed rest, without deterioration of the quality of life, as they are performed using modern video endoscopy, radio frequency, laser technology or cold plasma.It can vaporize part of the core and reduce the pressure, reducing the risk of herniation.And you can eliminate the error radically, that is, by getting rid of it completely.
There is no need to fear hernia surgery;these are no longer the previous types of the 80s and 90s of the last century, with muscle dissection, blood loss and the subsequent long recovery period.They are more like a small puncture with an X-ray check followed by the application of modern technology.
Prevention of osteochondrosis and its complications
Osteochondrosis, including complex ones, the symptoms and treatment of which were discussed above, is mostly not a disease at all, but simply a manifestation of inevitable aging and premature "shrinkage" of the intervertebral discs.Osteochondrosis needs little to never bother us:
- avoid hypothermia, especially in autumn and spring, and fall in 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;
- treatment of flat feet, if present;
- do physical exercises regularly;
- practicing types of exercises that reduce the load on the back (swimming);
- giving up bad habits;
- alternation of mental stress and 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 take at least an x-ray of the lumbar spine in two projections or an MRI to see if the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and flexible for a lifetime.