This material is intended for people without medical training 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 a complete misunderstanding on the topic of osteochondrosis.Examples of such questions include: "why does osteochondrosis hurt?", "congenital osteochondrosis was discovered, what should I do?"Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have the first signs of chondrosis, how scary is it?"This article is aimed at structuring the material on osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, and answering 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 is made up of two different sections:
- external fibrous ring, consisting of dense fibers covering the disc from the outside around the perimeter;
- the internal elastic component is the nucleus pulposus.
The fibers of the fibrous ring are very dense and elastic.As the years pass, elasticity is lost and around the age of 60 the fibrous ring becomes rigid.Between the surface of each vertebra above and below and the disc itself are the so-called endplates, i.e. the border areas between the vertebra and the disc.Thanks to these end plates, the vertebrae grow in height and through them the nucleus pulposus and the tissues of the intervertebral disc are nourished diffusely by the diffusion method, since the cartilage of the disc is neither supplied with blood nor innervated.
Healthy intervertebral discs in a young person are capable of high metabolic rates.If you introduce contrast into a normal disc, after 20 minutes it disappears from it.
Studies have shown that in an adult the height of each intervertebral disc is approximately:
- 25% of the height of adjacent vertebrae in the cervical region;
- 20% chest;
- 33% in the lumbar area.
That is, in the lumbar region the thickness of the discs is greater, due to the greater 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.By the age of 70, this figure drops to 110 kg!That is, an "old, dry disc" tolerates load transfer to the sides and maintaining increased pressure inside the ring 22 times worse.
Why did this happen?Over time, the fibrous ring gradually wears away.It can no longer stretch, but only protrudes outward, beyond the disk, or it breaks.The core stops transmitting and transforming the vertical load into radial load.With age, stress gradually accumulates inside the discs and their structure changes.If all these processes, taken into a separate disk, are transferred to the entire spine, then in the clinic we get a condition called osteochondrosis.Now we can start defining.
What is osteochondrosis?
The name of the disease is scary when it is not clear.The medical suffix “-oz” means proliferation or enlargement of some tissue: hyalinosis, fibrosis.An example could be liver cirrhosis, when the connective tissue grows and the functional tissue, the hepatocytes, decreases in volume.There may be an accumulation of pathological proteins, or amyloid, that would not normally be present.This storage disease will then be called amyloidosis.Significant enlargement of the liver may occur due to fatty degeneration, called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilaginous tissue of the intervertebral discs increases in volume, why does "chondros, χόνδρο" translated from Greek into Russian mean "cartilage"?No, chondrosis or, more precisely, osteochondrosis is not a storage disease.In this case no real growth of the cartilaginous tissue occurs;we are just talking about a change in the configuration of intervertebral cartilaginous discs under the influence of many years of physical activity, and we have examined above what happens in 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 normal, normal aging of intervertebral discs.None of us are surprised that the face of a 20-year-old girl will be slightly different from her 70-year-old face, but for some reason everyone believes that the spine, its intervertebral discs, do not undergo the same pronounced temporary changes.Dystrophy is a nutritional disorder, and degeneration is a violation of the structure of the intervertebral discs that follows a long period of dystrophy.
Causes of osteochondrosis and its complications
The main cause of simple physiological osteochondrosis can be considered the way a person moves: walking in an upright position.Man is the only species on earth among all mammals that walks on two legs, and this is the only mode of locomotion.Osteochondrosis has become the scourge of humanity, but we freed our hands and created civilization.Thanks to upright walking (and osteochondrosis), we have not only created the wheel, the alphabet and mastered fire, but you can also sit at home in the heat and read this article on your computer screen.
The closest relatives of man, higher primates - chimpanzees and gorillas, sometimes stand on two legs, but this method of movement is auxiliary for them and most often they still move on four legs.In order for osteochondrosis to disappear, as well as intensive aging of the intervertebral discs, a person must change the way he moves and remove the constant vertical load from the spine.Dolphins, killer whales and whales do not have osteochondrosis, while dogs, cows and tigers do not.Their spine does not take on long-term static and shock vertical loads, since it is in a horizontal state.If humanity went to sea and the natural means of transport was scuba diving, osteochondrosis would be defeated.
The upright posture forced the human musculoskeletal system to evolve in the direction of protecting the skull and brain from shock loads.But discs - elastic pads between the vertebrae - are not the only method of protection.A person has an elastic arch of the foot, cartilage of the knee joints, physiological curves of the spine: two lordoses and two kyphoses.All this allows you not to "shake off" 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, so often ignored by doctors, especially in private medical centers.After all, it is much more profitable to constantly cure a person than to indicate 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 lose elasticity and the shock is transmitted upward to the spine without softening.Intervertebral discs experience significant stress and collapse rapidly;
- overweight and obesity – needs no comments;
- 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, the intense load will fall on one edge of the discs and may be excessive;
- sedentary lifestyle and sedentary lifestyle.It was said above that it is during the session that the greatest pressure on the discs occurs, since a person never sits straight, but always bends over “slightly”;
- chronic injuries, slipping on ice, heavy weight lifting, contact martial arts, heavy hats, banging your head on low ceilings, heavy clothing, carrying heavy bags in your hands.
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 or specific symptoms, for example urinary disorders, but much less frequent.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 a protrusion or herniation of the intervertebral disc of the root corresponding to this level.Each nerve root is made up of two portions: sensitive and motor.
Depending on where exactly the hernia is headed and what portion of the root has been compressed, there may be sensory or motor disturbances.Sometimes both disorders occur simultaneously, expressed to varying degrees.Pain also belongs to sensory disorders, since pain is a special and specific sensation.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many;It's called "neuralgia".The swollen nerve root reacts violently to any shock, and the pain is very sharp, similar to an electric shock.Shoot in the arm (from the neck) or leg (from the lower back).Such a sharp and painful impulse is called lumbago: in the lower back it is lumbago, in the neck it is cervicagus, a rarer term.Such radicular pain requires forced, analgesic or antalgic posture.Radicular pain occurs immediately when coughing, sneezing, crying, laughing, or straining.Any shock to the swollen nerve root causes increased pain.
Muscle pain: myofascial-tonic
But a herniated spinal cord or disc defect may not compress the nerve root, but when it moves, it injures nearby ligaments, fascia, and deep muscles in the back.In this case, the pain will be secondary, aching, permanent, stiffness in the back will occur, 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: contraction.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 of the neck, lower back or thoracic spine, the appearance of dense, painful muscle protuberances - “rollers” near the spine, that is, 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 spasm.
Sensory disorders
If a protrusion, hernia or spasmodic muscle compresses the sensitive part of the nerve root, various sensory disturbances occur.They can be accompanied by pain or occur separately, after the pain has already passed.There are also completely painless forms of sensory disorders, but rarely.
Many people are familiar with numbness of the tips of the fingers and toes (hypoesthesia or complete anesthesia), decreased sensitivity of the skin in the form of long stripes, radicular type.Sometimes paresthesia or tingling, a sensation of "creeping goosebumps" occurs.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 lead to this.
Motor disorders in the periphery
If a motor neuron or the axons that are part of the motor portion of a nerve are affected, weakness or complete immobility occurs in the muscle.In the second case we are talking about complete paralysis and in the first case about paresis.Paresis is partial paralysis when the muscle does not function at full strength.
Very often these disorders appear in the legs, with protuberances and hernias of the lumbar spine.There are motor structures that innervate the muscles of the lower leg and foot.Therefore, with advanced and complicated lumbar osteochondrosis, the foot can spank.It turns inward, the person is forced to raise the leg high to walk with the spanked foot, this is called steppage, “rooster gait”.
But the danger of movement disorders is that they can be isolated and not accompanied by pain.And if a person "does not have pain", he may not seek medical attention in a timely manner.Therefore, it is so important that patients with progressive protrusions and hernias, for example in 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 region, 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 diagnosis was and remains the identification of the patient's complaints, establishing the presence of concomitant muscle spasm by simple palpation of the muscles along the spine.Is it possible to confirm the diagnosis of osteochondrosis by radiographic examination?
An “X-ray” of the cervical spine, and even with functional tests of flexion and extension, does not show cartilage, since its tissue transmitsFunctional testing can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen by CT or MRI, magnetic resonance imaging and X-ray computed tomography are indicated to clarify the internal structure of the cartilage and formations such as protrusions and hernias.Therefore, with the help of these methods, an accurate diagnosis is made, and the result of tomography constitutes an indication, and even a topical guide, for surgical treatment of hernia in the neurosurgery department.
Treatment of complications of osteochondrosis
We repeat once again that it is impossible to cure osteochondrosis, as well as programmed aging and dehydration of the disc.You can simply keep things from getting complicated:
- if there are symptoms of narrowing of the height of the intervertebral discs, then it is necessary to move correctly, not gain weight and avoid the appearance of protrusions and muscle pain;
- if you already have a protrusion, then you must be careful not to let the fibrous ring break, that is, not to transform the protrusion into a hernia, and to avoid the appearance of protrusions at multiple levels;
- if you have a hernia, then you need to dynamically monitor it, do regular MRI scans, avoid increasing its size or carry out modern minimally invasive surgical treatment, since without exception, all conservative methods of treating exacerbation of osteochondrosis leave the hernia in place and eliminate only temporary symptoms: inflammation, pain, shooting and muscle spasms.
But with the slightest violation of the regime, with heavy lifting, hypothermia, injuries, weight gain (in the case of the lower back), the symptoms return again and again.We will describe how to deal with unpleasant sensations, pain and limited mobility of the back in a context of exacerbation of osteochondrosis and an existing protrusion or hernia, secondary to social tonic syndrome.
What to do during a flare-up?
Since an attack of acute pain has occurred (for example, in the lower back), you should follow the following instructions in the pre-medical stage:
- completely eliminate physical activity;
- sleep on a hard mattress (orthopedic mattress or hard sofa), eliminating sagging of the back;
- it is advisable to wear a semi-rigid corset to avoid sudden movements and "sprains";
- You should place a massage pillow with plastic needle applicators on your lower back or use a Lyapko applicator.It is necessary to maintain it for 30 - 40 minutes, 2 -3 times a day;
- subsequently, ointments containing NSAIDs, ointments with bee or snake venom can be rubbed on 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, bath procedures.At the same time, the swelling intensifies, and with it the pain.You can only warm up after the “highest point of pain” has passed.Subsequently, the heat will improve the “reabsorption” of the swelling.This usually happens in 2-3 days.
The basis of any treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (affecting the mechanisms of the disease).It is accompanied by symptomatic therapy.For vertebrogenic pain (caused by spinal problems), things are like this:
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of liquids consumed are recommended.You can also 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 "injections" of NSAIDs and muscle relaxants: every day.This will help relieve swelling of nervous tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after passing the maximum pain, no more "injections" should be done and attention should be paid to restorative agents, for example, modern drugs of group "B".They effectively restore impaired sensitivity, reduce numbness and paresthesia.
Physiotherapeutic measures continue, the time has come for physical therapy for osteochondrosis.Its task is to normalize blood circulation and muscle tone, when swelling and inflammation have already subsided, but muscle spasm has not yet completely resolved.
Kinesiotherapy (movement treatment) involves 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 the severity of pain and stiffness of the back.
Exercises for osteochondrosis should 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, to avoid relapses, the use of weights is not permitted;a gymnastics mat and a gymnastics stick are used.With their help, you can effectively restore freedom of movement.
Rubbing of ointments and the use of the Kuznetsov applicator continues.Swimming, underwater massage and Charcot shower are shown.It is during the attenuation phase of the exacerbation that drugs for home magnetotherapy and physiotherapy are indicated.
Usually treatment lasts no more than a week, but in some cases osteochondrosis can manifest itself with such dangerous symptoms that surgery may be necessary, and urgently.
About the Shants collar
In the early stages, during the acute phase, it is necessary to protect the neck from unnecessary movements.The Shants collar is great for this.Many people make two mistakes when purchasing this collar.They do not choose it based on their size, which is why it simply does not perform its function and causes a feeling of discomfort.
The second common mistake is wearing it for a long time for prophylactic purposes.This leads to weak neck muscles and only causes more problems.For a collar there are only two indications under which it can be worn:
- the appearance of sharp pain in the neck, stiffness and pain spreading to the head;
- if you intend to undertake physical work while in full health, where there is a risk of "straining" the neck and having an aggravation.This is, for example, repairing a car, when you lie down under it, or washing windows, when you have to reach out and take awkward positions.
The collar should be worn for no more than 2-3 days, as prolonged use can cause venous congestion in the neck muscles, at the moment 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 advisable that every patient, after the progression of symptoms, in the presence of complications, undergoes an MRI and consults a neurosurgeon.Modern minimally invasive interventions allow you to safely remove fairly large hernias, without prolonged hospitalization, without being forced to lie down for several days, without compromising the quality of life, since they are performed using modern videoendoscopy, radiofrequency, laser technology or using cold plasma.You can evaporate some of the core and lower your blood pressure, reducing the risk of hernia.And you can eliminate the defect radically, that is, eliminating it completely.
There is no need to be afraid of operating on hernias;these are no longer the previous types of open operations of the 80-90s of the last century with muscle dissection, blood loss and subsequent long recovery period.They are more like a small prick under X-ray control followed by the use of modern technology.
Prevention of osteochondrosis and its complications
Osteochondrosis, including complicated ones, the symptoms and treatment of which we discussed above, for the most part is 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 falls in winter;
- do not lift weights and carry loads only with a straight back, in the backpack;
- drink more clean water;
- do not gain weight, your weight should correspond to your height;
- treat flat feet, if present;
- do physical exercises regularly;
- engage in types of exercises that reduce the load on the back (swimming);
- abandon 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 an x-ray of the lumbar spine in two projections, or an MRI, to find out if the hernia, if present, is progressing;
By following these simple tips you can keep your back healthy and mobile for life.