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Treatment of osteochondrosis

severe pain with osteochondrosis

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

Osteochondrosis- mainly human diseases, the development of which is facilitated by:

  • Increased life expectancy. Over time, metabolism slows down, tissue nutrition is disrupted, and destructive regulatory systems begin to prevail over constructive ones.
  • Walking upright. Standing on his feet, the man acquired an uneven load on different parts of the spine, managed to make a larger amount of movement - to twist, lengthen. Unusual lateral curves - scoliosis - appeared with uneven loading of the muscles and small joints of the spine. This increases the likelihood of developing the disease even in the ward where low mobility and the chest protect the vertebrae - thoracic osteochondrosis
  • Acceleration. Rapid growth makes bones, muscles and cartilage more vulnerable. The number and distribution 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 driving exclusively by car or excessive stress in the gym, when the discs and cartilage wear out at an accelerated rate
  • Improper nutrition. The predominance of fast carbohydrates, lack of protein, the use of carbonated beverages leads to the fact that the body does not have enough high quality building materials to maintain tissue health
  • Smoking. Causes prolonged vasospasm - disruption 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 localization

  • Osteochondrosis of the cervical spine
  • Chest 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 spot is the transition of the mobile lumbar region to the fixed sacral.

By stage

  • Initially - small changes in the center of the disc, compaction of the nucleus, the appearance of cartilage cracks
  • Progression of the disease - cracks deepen, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the roots of the spinal nerve leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs - due to a violation of the ratio of vertebrae to each other, the cartilage on the surfaces of small joints is erased unevenly, develop osteoarthritis and arthritis
  • Complicated osteochondrosis - symptoms: further degeneration of cartilage occurs - ruptures of the cartilage ring that connect the bodies of two adjacent vertebrae. Part of the nucleus exits through the free space and compresses the roots, the spinal cord - a disc herniation is formed. A more serious problem is the separation of the fallen part - sequestered hernia. Disturbed by severe pain, impaired sensitivity and movement in the area for which the compressed nerve is responsible
  • The body responds to the increased load and excess mobility with the growth of bone tissue - osteophytes appear. They stabilize the spine, but reduce the range of motion. Bone hooks irritate muscle receptors and compress nearby vessels. In cervical osteochondrosis, this causes symptoms of the "vertebral artery" - dizziness, tinnitus, flickering dots in front of the eyes.

Osteochondrosis of the cervical spine

With the advent of mobile phones and computerscervical osteochondrosiseven in adolescents: prolonged unnatural position of the head with muscle tension overloads the vertebrae, their discs and joints.

Cervical osteochondrosis - symptoms

  • Pain in the neck, covering the back of the head, upper back
  • Sometimes the headache associated with cervical osteochondrosis mimics migraine - one-sidedness of symptoms, intolerance to sounds and bright light, strong pulsation in the temples, bright flashes in front of the eyes
  • Frequent headaches that do not respond well to conventional tablets
  • Pressure drops resistant to antihypertensive drugs
  • Dizziness and darkening of the eyes with sudden rotation of the head
  • Numbness of the fingers, especially after sleep, a feeling of crawling on the skin
  • Restriction of movement in the neck, crunch when trying to move. Patients need to turn their whole body to see something behind them
  • Sweating of the upper body
  • Tight muscles in the neck and shoulder girdle can be identified by palpation.

If identifiedcervical osteochondrosis, treatment in the initial stages prevents severe complications - compression of the spinal artery with oxygen starvation of the brain, compression of the spinal cord.

Manifestations of osteochondrosis of the chest

Changes in the thoracic region develop less frequently, provoking factors - back injuries, scoliosis, previous diseases of the spine (tuberculous, nonspecific spondylitis, body hemangiomas).

Symptoms of a chest lesion:

  • Back pain - pain, pulling, worsening after prolonged standing or sitting in an awkward position. But in case of constant complaints of pain, other possible causes should be ruled out - pneumonia, pleurisy, tumors, intercostal neuralgia of various natures, shingles before the appearance of blisters.
  • Difficulty breathing, shortness of breath, inability to breathe deeply
  • Thoracic osteochondrosis sometimes mimics attacks of angina pectoris - 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 structure of all types of osteochondrosis, these departments are confident leaders, more than half of all cases of diagnosis. The reason is that the greatest load falls on this part of the body, both in an upright and sitting position. Body weight, load with improper weight lifting, long time in a bent position - the nucleus pulposis of the intervertebral discs is in a state of compression, pressed into the vertebral bodies through the cartilaginous plates - Schmorl's hernias are formed. Overexertion and muscle spasm disrupt the position of the small joints of the vertebrae relative to each other - articular cartilage is erased, mobility is reduced.

Several vicious circles develop at once: muscle spasm gives pain - pain reflexively increases the contraction of muscle fibers, acute pain forces a person to restrict movement, protects the injured area - the strength of the muscular frame and spinal support decreases, this increases its instability, lumbarosteochondrosis progresses.

At the transition point of the mobile phonelumbar spinein a stationary sacrum, fused into a single monolith, there is a danger of the fifth lumbar vertebra slipping off the surface of the sacrum. This compresses the nerve bundles, the radicular syndrome develops.

Symptoms of lumbar osteochondrosis

  • Low back pain, especially when sitting and standing. After a break, the horizontal position improves. With prolonged travel, the pain is normal, painful, pulling
  • Acute sudden lumbago when changing body condition, lifting weights, heavy load. The patient gets stuck in the position in which he was caught by the attack, finds it difficult to stand up, begins to move. Lumbago is usually associated with compression of the spinal nerve root, which develops acutely
  • The transition of pain to the gluteal area, legs. The largest nerve in the body, the sciatic nerve, is a direct extension of the spinal cord, which is why patients with lumbar osteochondrosis often worry about sciatica.
  • Due to the fact that nerve fibers control the tone of muscles and blood vessels, regulate tissue nutrition, changes are observed in this part of the trunk, for which the diseased nerve is responsible. The limb feels colder than healthy. In the long course of the disease, muscle atrophy, dry skin and swelling are observed. Local immunity decreases - any scratch, cut, abrasion easily becomes a gateway to infection
  • Defeat of sensory fibers leads to impaired sensitivity - superficial and deep. The patient may experience burns or frostbite due to the fact that he has not experienced a dangerous change in temperature.
  • Very frightening symptoms - tingling 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 bowel. Over time, urine and feces begin to pass on their own, it is impossible to retain. In this case, the treatment of osteochondrosis of the spine and its complications is performed surgically, as a matter of urgency.

Diagnosis of osteochondrosis

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

  • The specialist identifies the main complaints, the time of their appearance, development, the effect of drugs on the intensity of pain, rest, changes in rhythm of life
  • Mandatory external examination is performed when the patient undresses to underwear - it is necessary to compare the condition and color of the skin of symmetrical parts of the body, tissue tone, the reaction of various stimuli: pain, touch, cold or heat. Symptoms of tension are indicated, showing tension in the muscles and irritation of their 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 (performed by the doctor) movements in the joints, the ability to turn the head, upper body, not including the lower parts of the spine

If necessary, send for further review

  • Thermal imaging diagnostics
  • ENMG (electroneuromyography): Radiography. In order to obtain the necessary information, it is done in at least two projections - direct and side. The picture will tell about the condition of the bone tissue, the severity of 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 fissures. The unevenness of the lower or upper border of the body will make a person suspect Schmorl's hernia. To clarify the nature of the changes in the bone structure of the spine, computed tomography is recommended. Multislice examination allows three-dimensional modeling of the vertebrae. If necessary, to determine the condition of soft tissues - muscles, ligaments, intervertebral disc, MRI is prescribed.

It should be remembered that the results of the study should be compared with the complaints and changes found during the examination. Detection of signs of spinal osteochondrosis and even herniated discs without complaints does not require serious measures.

Treatment of osteochondrosis of the spine

Eliminate the acute manifestations of the disease

  • Severe pain and sharp muscle tension reinforce each other, preventing the exacerbation from subsiding. Therefore, the first is to relieve the pain.
  • Prescribe non-steroidal anti-inflammatory drugs in injections, muscle relaxants - muscle relaxants
  • If these measures are not sufficient, a blockade with painkillers and hormonal drugs is performed

Radio frequency denervation

It is recommended to rest in bed for a few days

After the symptoms subside, it is necessary to start moving, gradually increasing the range of motion and load. At this time, active kneading, 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 painkillers in tablets, capsules and ointments. A specific drug is selected by the doctor based on the patient's condition, lifestyle, comorbidities, the predominance of one or another component of osteochondrosis. The course of B vitamins will improve the conduction of impulses on the nerve, will normalize tissue nutrition. While maintaining increased muscle tone, the use of muscle relaxants will continue. There is no magic pill, an injection that can return the vertebrae and cartilage to their original state. Medications relieve symptoms, improve mobility and performance. But they are not able to completely stop the progression of the disease.
  • Physiotherapy. It is used to deliver drugs directly to the affected area (electrophoresis), warming (paraffin, infrared radiation). Exposure to therapeutic currents relaxes muscles, improves the functioning of nerve fibers. After a few sessions the pain decreases, mobility is restored. Not prescribed for active inflammation
  • Manual manipulation, massage, acupuncture, acupressure. Relieve spasms by stretching and relaxing muscles. If only the upper muscle layer is affected during the massage, then the manual therapy penetrates deeper, which is why the requirements for specialists are higher. Be sure to do an MRI first to understand the specifics of a particular patient's anatomy
  • Traction of the spine. The vertebrae move away from each other, the normal distance between them is restored, the pinching of the nerves decreases. The procedure has contraindications, so only a doctor can prescribe it
  • Physiotherapy. The most effective method of treatment. The only caveat is that it should 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, initial yoga asanas, Pilates, swimming. They are performed smoothly, without sudden and traumatic movements, stretching the tissue, gradually increasing the amplitude
  • Proper nutrition and avoidance of bad habits
  • Adequate supply of nutrients to tissues, good condition of blood vessels and adequate blood supply to vertebrae and surrounding structures are measures to prevent the progression of osteochondrosis. Proper nutrition normalizes weight, reduces the load on the spine

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

  • Therapeutic and diagnostic blockade
  • Radiofrequency facet ablation
  • Cold plasma and laser nucleoplasty
  • Endoscopic removal of disc herniation
  • Microdiscectomy

Radiofrequency thermal ablation of facet joints

Special needles are placed exactly on the side of the intervertebral joints at the point where the middle branch of the Lyushka nerve passes. Electrodes are mounted in the needles, the tip of which is heated to 80 degrees for 90 seconds. This leads to nerve coagulation. The pain disappears.

Cold plasma nucleoplasty

A special cold plasma electrode is applied to the disc tissue using a needle inserted into the disc. The intradiscal pressure decreases, the hernia (protrusion) is pulled inwards.

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 limbs occur. If the effect of conservative treatment is no longer present, then surgery to remove the herniated disc is the only possible solution for many patients. The operation is performed under anesthesia through an incision of 2-3 cm with the help of microsurgical equipment and instruments. The duration of the operation is 45-60 minutes. The pain syndrome is significantly reduced or completely disappears immediately after surgery in 95% of patients. The next day the patient was allowed to walk and was soon discharged from the clinic.

Endoscopic removal of disc herniation:

The hernia or free-lying sequestration is removed through the lateral intervertebral foramen. To place the tube, make a 5 mm incision on the skin. The muscles, fascia and ligaments are not damaged, they are pushed away with the help of a system of tubular retractors with a gradual increase in diameter. The operation is almost bloodless and lasts only 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 in case of complications, large disc herniation, severe compression of the spinal nerve root and spinal cord. If there are signs of sudden loss of sensitivity, movement, pelvic dysfunction, the patient should be taken urgently to a neurosurgeon. The sooner it is possible to remove the compression, the more complete the recovery will come, the person will quickly return to normal life. In this case, the surgical treatment is aimed at decompression of the compressed nerve structures and stabilization of the affected segment. This is a hemi or laminectomy. Fixation is performed through a transpedicular system, in combination with an interbody cell that provides a 360-degree fusion. Interspinal stabilization of the vertebrae is widely used. Today there are several intervertebral implants. Microdiscectomy in combination with interspin stabilization, especially in the elderly, can significantly increase the effectiveness of long-term outcomes and reduce the likelihood of recurrent disc herniation.