Osteochondrosis Treatment

Osteochondrosis - dystrophic changes in the spine associated with age-related tissue aging. The pathology is 80% associated with genetic data, the rest is the impact of external factors.

osteochondrosis- predominantly human disease, whose development is facilitated by:

• Longer life expectancy. Over time, metabolism slows down, tissue nutrition is interrupted, destructive regulatory systems begin to prevail over constructive ones.
• Walking upright. Standing, the person acquired an irregular load in different parts of the spine, was able to perform a greater amount of movement - twisting, extending. There were pathological lateral curves - scoliosis - with unequal 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 rib cage protect the vertebrae - thoracic osteochondrosis
• Acceleration. Rapid growth makes bones, muscles and cartilage more vulnerable. The number and prevalence of blood vessels are insufficient to supply them with oxygen and essential substances
• Lack of adequate physical activity. There are two extremes - sedentary work and movement only in the car or excessive stress in the gym, when the discs and cartilage wear out at an accelerated rate.
• Inadequate nutrition. The predominance of fast carbohydrates, the lack of protein, the use of carbonated drinks 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 traumatic objects around lead to spinal injuries, secondary osteochondrosis

Types of osteochondrosis

By location

• Cervical spine osteochondrosis
• Thoracic spine injury
• lumbar osteochondrosis
• Common osteochondrosis - cervical and lumbar, thoracolumbar, lumbosacral and other combinations

The most common changes in the most mobile parts are cervical and lumbar. The sore point is the transition from the mobile lumbar region to the fixed sacral region.

By internship

• Initial - small changes in the center of the disc, compaction of the nucleus, appearance of cracks in the cartilage
• Disease progression - fissures increase, disc height decreases, intervertebral foramen diameter decreases. The compression of spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is not only manifested by changes in the discs - due to a violation of the ratio of the vertebrae to each other, the cartilage on the surfaces of small joints is unevenly effaced, osteoarthritis and arthritis develop
• Complicated osteochondrosis - symptoms: more cartilage degeneration occurs - tears appear in the cartilaginous ring connecting the bodies of two adjacent vertebrae. Part of the nucleus protrudes through the free space and compresses the roots, the spinal cord - a herniated disc is formed. A more serious problem is the separation of the fallen part - a kidnapped hernia. Disturbed by severe pain, decreased sensation and movement in the area for which the pinched nerve is responsible
• The organism responds to increased load and excess mobility by the growth of bone tissue - osteophytes appear. They stabilize the spine but reduce range of motion. Bone hooks irritate muscle receptors and put pressure on nearby vessels. With cervical osteochondrosis, this causes "vertebral artery" symptoms - dizziness, tinnitus, flickering spots in front of the eyes.

Cervical spine osteochondrosis

With the advent of cell phones and computerscervical osteochondrosiseven in teenagers: an unnaturally prolonged head position with muscle tension puts strain on the vertebrae, discs, and joints.

Cervical osteochondrosis - symptoms

• Neck pain extending to the back of the head, upper back
• Sometimes the headaches associated with cervical osteochondrosis simulate a migraine - one-sidedness of symptoms, intolerance to sounds and bright light, strong pulse in the temples, bright flashes in front of the eyes
• Frequent headaches that do not respond well to conventional pills
• Blood Pressure Drops Resistant to Antihypertensive Drugs
• Dizziness and darkening of the eyes with sudden turns of the head
• Numbness in fingers, especially after sleeping, tingling sensation in the skin
• Movement restriction in neck, crushing when trying to move. Patients need to turn their whole body to see something behind them
• upper body sweat
• Tight muscles in the neck and shoulder girdle can be detected by palpation.

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

Manifestations of osteochondrosis of the thoracic spine

Changes in the thoracic region develop less frequently, causing factors - back injuries, scoliosis, previous spinal diseases (tuberculosis, nonspecific spondylitis, body hemangiomas).

Symptoms of injury to the thoracic region:

• Back pain - pain, pulling, worse after standing for an extended period or sitting in an uncomfortable position. But with constant complaints of pain, other possible causes must be excluded - pneumonia, pleurisy, tumors, intercostal neuralgia of another nature, herpes zoster before the onset 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 framework of all types of osteochondrosis, these departments are confident leaders in more than half of all diagnosed cases. The reason is that the greatest burden falls on this area of the body, both standing and sitting. Body weight, load in case of improper lifting of weight, for a long time in a bent position - the nucleus pulposus of the intervertebral discs is in a state of compression, it is pressed into the vertebral bodies through the cartilaginous plates - Schmorl's hernias are formed. Excessive tension and muscle spasm disturb the location of the small joints of the vertebrae in relation to each other - the articular cartilage is effaced, mobility is reduced.

Several vicious circles develop at the same time: muscle spasm gives pain - the pain reflexively increases the contraction of muscle fibers, acute pain forces a person to restrict movement, spare the damaged area - the strength of the muscle structure and support the spine decrease, which increases its instability, lumbar osteochondrosis progresses.

At the cell's transition pointlumbar spinein an immobile sacrum fused into a single monolith, there is a danger of slipping from the fifth lumbar vertebra from the surface of the sacrum. This tightens the nerve bundles, the root syndrome develops.

Lumbar osteochondrosis symptoms

• Lower back pain, especially sitting and standing. After resting, the horizontal position improves. With a prolonged course, pain is usual, aching, pulling
• Sharp sudden lumbago when changing the state of the body, lifting weights, heavy load. The patient is stuck in the position in which he was caught by the attack, it is difficult to straighten out, to start moving. Lumbago is usually associated with spinal nerve root compression, which has developed acutely.
• The transition from pain to the gluteal region, legs. The largest nerve in the body, the sciatic nerve, is a direct continuation of the spinal root; therefore, patients with lumbar osteochondrosis often worry about sciatica
• Because nerve fibers control the tone of muscles and blood vessels, regulate tissue nutrition, changes are noted in the part of the trunk for which the diseased nerve is responsible. The member looks cooler than the healthy one. With a prolonged course of the disease, muscle atrophy, dry skin and edema are noticeable. Local immunity decreases - any scratch, cut or abrasion easily becomes a gateway to infection.
• The defeat of sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may burn or freeze due to not feeling a dangerous change in temperature.
• Very frightening 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 excrete on their own, and it is not possible to keep them. In this case, the treatment of spinal osteochondrosis and its complications is performed surgically, as a matter of urgency.

Osteochondrosis diagnosis

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

• The specialist discovers the main complaints, the time of onset, evolution, effect of medications on pain intensity, rest, changes in the rhythm of life
• A mandatory external examination is performed when the patient takes off their underwear - it is necessary to compare the condition and color of the skin in symmetrical parts of the body, the tone of the fabrics, the reaction to various stimuli: pain, touch, cold or heat. Symptoms of tension are determined, indicating muscle tension and irritation of your tendons and integumentary membranes - fascia
• The neurological hammer will reveal the uniformity and symmetry of the reflexes
• The neurologist records the volume of active (independent) and passive (doctor) movements in the joints, the ability to turn the head, the upper part of the body without involving the lower parts of the spine.

If necessary, submit for further examination.

• Thermal Imaging Diagnostics
• ENMG (electroneuromyography): Radiography. To obtain the necessary information, it is performed in at least two projections - direct and lateral. The image will tell about the state 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 cracks. The unevenness of the lower or upper edge of the body will make the person suspect a Schmorl's hernia. To clarify the nature of changes in the bone structure of the spine, computed tomography is recommended. The multi-spiral exam allows for three-dimensional modeling of the vertebrae. If necessary, to find out the condition of the soft tissues - muscles, ligaments, intervertebral disc, MRI is prescribed.

It should be remembered that the research results must be compared with the complaints and alterations found during the exam. The detection of signs of spinal osteochondrosis and even a herniated disc without complaints does not require serious measures.

Treatment of osteochondrosis of the spine

Removal of acute manifestations of the disease

• Severe pain and acute muscle tension reinforce each other, not allowing the exacerbation to subside. So the first is to relieve the pain.
• Prescribe non-steroidal anti-inflammatory drugs in injections, drugs to relax muscles - muscle relaxants
• If these measures were not enough, a blockade is performed with analgesics and hormonal drugs

Radiofrequency denervation

Bed rest is recommended for several days.

Once symptoms subside, you need to start moving, gradually increasing range of motion and load. At this time, active massage, massage is undesirable due to possible complications.

Osteochondrosis: treatment without exacerbation

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

• Medicine. All the same anti-inflammatory pain relievers in pills, capsules and ointments. A specific medication is selected by the physician based on the patient's condition, lifestyle, concomitant illnesses, predominance of one or another component of osteochondrosis. A course of B vitamins improves the conduction of impulses along the nerve and normalizes tissue nutrition. While maintaining increased muscle tone, the use of muscle relaxants will continue. There is no magic pill, an injection that can return vertebrae and cartilage to their original state. Medications alleviate symptoms, improve mobility and performance. But they are not able to completely stop the progression of the disease.
• Physiotherapy. It is used for delivering drugs directly to the painful site (electrophoresis), heating (paraffin, infrared irradiation). Exposure to therapeutic currents relaxes muscles, improves nerve fiber function. After several sessions the pain subsides and mobility is restored. Not prescribed for active inflammation
• Manual manipulation, massage, acupuncture, acupressure. Relieve spasm by stretching and relaxing your muscles. If during massage only the upper layer of the muscles is affected, manual therapy penetrates more deeply, as the requirements for specialists are greater. Be sure to first have an MRI scan to find out the anatomy features of a specific patient.
• Spinal traction. The vertebrae move away from each other, the normal distance between them is restored, the tightness of the nerves decreases. The procedure has contraindications, so only a doctor can prescribe it
• Physiotherapy. The most effective treatment method. The only caveat is that it must be applied for life. Of the advantages - provides activity, improves mood, increases tissue tone. The best methods are a set of exercises recommended by a doctor, beginning yoga asanas, Pilates, swimming. They are performed smoothly, without sudden and traumatic movements, stretching the tissue, gradually increasing the amplitude
• Adequate nutrition and giving up bad habits
• A sufficient supply of nutrients to the tissues, a good condition of the blood vessels, and an adequate supply of blood to the vertebrae and surrounding structures are measures to prevent the progression of osteochondrosis. Proper nutrition normalizes weight, reduces stress on the spine

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

• Treatment and diagnostic block
• Radiofrequency faceted ablation
• Cold plasma and laser nucleoplasty
• Endoscopic Herniated Disc Removal
• microdiscectomy

Radiofrequency thermal ablation of joints

Special needles are placed just beside the intervertebral joints, where the median branch of the Lyushka nerve passes. Electrodes are installed on the needles, whose tip heats up to 80 degrees for 90 seconds. This leads to nerve clotting. The pain goes away.

Cold plasma nucleoplasty

Through a needle inserted into the disk, a special cold plasma electrode is applied to the disk tissue. The intradiscal pressure decreases, the hernia (protrusion) is pulled inward.

microdiscectomy

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

Endoscopic Herniated Disc Removal:

A hernia or free sequestration is removed through the lateral intervertebral foramen. For tube placement, a 5 mm incision is made in the skin. Muscles, fascia and ligaments are not damaged, they are separated by means of a tube retractor system with a gradual increase in diameter. The operation is almost bloodless and only lasts 40-50 minutes. Patients can return to their usual regimen after three weeks. The risk of complications is minimal.

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