Treatment of osteochondrosis

Osteochondrosis - dystrophic changes in the spinal space associated with age -related tissue aging. Pathology is 80% associated with genetic data, the rest is the effect of external factors.

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

• Increased life expectancy. Over time, metabolism slows down, tissue nutrition is disrupted, the destructive regulatory system begins to overcome constructively
• Walk upright. Standing on his feet, the person acquires an uneven load on different parts of the spine, is able to perform more movements - to rotate, extension. Abnormal side bends - scoliosis - with uneven load on the muscles and small joints of the spine appear. This increases the likelihood of disease formation even in departments 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 not sufficient to supply them with oxygen and essential substances
• Lack of adequate physical activity. There are two extremes - sedentary work and movement exclusively with a car or excessive stress in the gym, when the discs and cartilage wear out at an accelerated rate
• Improper nutrition. Rapid carbohydrate dominance, lack of protein, consumption of carbonated beverages lead to the fact that the body does not have enough high -quality building materials to maintain tissue health
• Smoking. Causes prolonged vasospasm - disorders of tissue nutrition, acceleration of degenerative processes
• Urbanization, a large number of traumatic objects around leads to spinal cord injury, secondary osteochondrosis

Types of osteochondrosis

According to localization

• Osteochondrosis of the cervical spine
• Injury to the thoracic spine
• Lumbar osteochondrosis
• Common osteochondrosis - a combination of cervical and lumbar, thoracolumbar, lumbosacral and others

The most common changes in the most mobile parts are the cervix and lumbar. The pain site is the transition of the mobile lumbar region to the permanent sacrum.

According to the stage

• Early - small changes in the center of the disc, compaction of the nucleus, the appearance of cartilage cracks
• Disease progression - the crack deepens, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the disc - due to violation of the ratio of the vertebrae to each other, cartilage on the surface of small joints is not removed unevenly, arthrosis and arthritis develop
• Complicated osteochondrosis - symptoms: further degeneration of cartilage occurs - rupture of the cartilage ring connecting the body of two adjacent vertebrae appears. Part of the nucleus protrudes through the free space and squeezes the root, the spinal cord - a disc hernia is formed. A more serious problem is the separation of the fallen part - the isolated hernia. Disturbed by severe pain, impaired sensitivity and movement in the area causing the compressed nerve is responsible
• The organism responds to increased load and excessive mobility by the growth of bone tissue - osteophytes appear. They stabilize the spine but reduce the range of motion. Bone hooks irritate muscle receptors and press on nearby ducts. With cervical osteochondrosis, this causes symptoms of "vertebral arteries" - dizziness, tinnitus, blinking spots in front of the eyes

Osteochondrosis of the cervical spine

With the advent of cell phones and computerscervical osteochondrosiseven in adolescents: prolonged unusual position of the head with muscle tension burdens their vertebrae, discs and joints.

Cervical osteochondrosis - symptoms

• Neck pain spreads to the back of the head, upper back
• Sometimes headaches associated with cervical osteochondrosis mimic migraines - symptoms of bias, intolerance to sound and bright light, strong throbbing in the temples, bright flashes in front of the eyes
• Frequent headaches that do not respond well to conventional tablets
• Stress drops are resistant to antihypertensive drugs
• Dizziness and eyes darken with sudden dizziness
• Numbness in the fingers, especially after sleep, a feeling of crawling on the skin
• Restriction of movement in the neck, crackling when trying to move. Patients have to turn their whole body to see something behind them
• The upper body is sweaty
• Tensed neck muscles and shoulder girdle can be detected by palpation.

If identifiedcervical osteochondrosis, treatment at an early stage prevents severe complications - compression of the vertebral arteries with oxygen starvation of the brain, compression of the spinal cord.

Manifestations of osteochondrosis of the thoracic spine

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

Symptoms of thoracic lesions:

• Back pain - sore, pulling, worse after long standing or sitting in an uncomfortable position. But with complaints of persistent pain, other possible causes must be excluded-pneumonia, pleurisy, tumors, intercostal neuralgia of different nature, herpes zoster before the appearance of bubbles.
• Difficulty breathing, shortness of breath, inability to take deep breaths
• Thoracic osteochondrosis sometimes mimics an attack 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, this department is a confident leader, more than half of all cases of diagnosis. The reason is that the greatest load falls on this part of the body, both standing and sitting. Weight, load in case of improper weight lifting, for a long time in a bent position - the nucleus pulposus of the intervertebral disc is in a state of compression, pressed into the vertebral body through the cartilaginous plate - Schmorl's hernia is formed. Overstrain and muscle spasm interfere with the location of small joints of the vertebrae relative to each other - articular cartilage is extinguished, mobility is reduced.

Several vicious circles develop simultaneously: muscle spasms give pain - pain reflexively increases muscle fiber contraction, acute pain forces a person to restrict movement, saves damaged areas - skeletal muscle strength and spinal support decreases, this increases it. instability, lumbar osteochondrosis develops.

At the point of mobile transitionlumbar spineinto the immobile sacrum united into a single monolith, there is a danger of slipping the fifth lumbar vertebra from the surface of the sacrum. This pinches the nerve bundle, radicular syndrome develops.

Symptoms of lumbar osteochondrosis

• Low back pain, especially sitting and standing. After resting, the horizontal position improved. With a prolonged course, the pain is habitual, aching, exciting
• Lumbago sharply sharp when changing body condition, lifting weights, heavy loads. The patient is stuck in a position where he is caught by the attack, difficult to straighten, begins to move. Lumbago is usually associated with spinal nerve root compression, which develops acutely
• Transition of pain to gluteal area, legs. The largest nerve in the body, the sciatic, is a direct continuation of the spinal root; therefore, patients with lumbar osteochondrosis often worry about sciatica
• Due to the fact that nerve fibers regulate muscle tone and blood vessels, regulate tissue nutrition, changes are noted in the part of the trunk for which the diseased nerve is responsible. The limbs feel cooler than the healthy ones. With a prolonged course of the disease, muscle atrophy, dry skin, and swelling are noticeable. Local immunity is reduced - any scratches, cuts, abrasions easily become the gateway to infection
• The defeat of sensory fibers leads to a violation of sensitivity - shallow and deep. Patients may have burns or frostbite due to the fact that they do not feel the dangerous temperature changes.
• Very frightening symptoms - numbness of the perineum skin, 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 excrete on their own, making it impossible to store them. In this case, treatment of spinal osteochondrosis and its complications is performed surgically, in an emergency manner.

Diagnosis of osteochondrosis

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

• Specialists know the main complaints, the timing of their appearance, development, the effect of the drug on pain intensity, rest, changes in the rhythm of life
• Mandatory external examination is carried out when the patient takes off underwear - it is necessary to compare the condition and color of the skin on the symmetrical parts of the body, tissue tone, response to various stimuli: pain, touch, cold or heat. Symptoms of tension are determined, indicating muscle tension and irritation of the tendons and their integumental membranes - fascia
• The neurological hammer will reveal the uniformity and symmetry of the reflexes
• Neurologists record the amount of active (independent) and passive (performed by a doctor) movements in the joints, the ability to turn the head, the upper body without involving the lower part of the spine.

If necessary, send for additional inspection

• Thermal imaging diagnostics
• ENMG (electroneuromyography): Radiography. To obtain the required information, it is carried out in at least two projections - direct and lateral. The picture will tell about the condition of the bone tissue, the severity of the osteoporosis, the size and safety of the vertebral body, and will reveal osteophytes. The damaged disc is determined by the width and uniformity of the intervertebral fissure. The inequality of the lower or upper body border will make one suspect Schmorl’s hernia. To elucidate the nature of changes in the bone structure of the spinal column, computed tomography is recommended. Multispiral examination allows three -dimensional modeling of the vertebrae. If necessary, to find out the condition of soft tissues - muscles, ligaments, intervertebral discs, MRI is prescribed.

It should be noted that the results of the research must be compared with the complaints and changes found during the examination. Detection of signs of spinal osteochondrosis as well as disc herniation without complaints does not require any serious measures.

Treatment of spinal osteochondrosis

Removal of acute manifestations of the disease

• Severe pain and sharp muscle tension reinforce each other, not allowing the deterioration to subside. Therefore, the first is to relieve pain.
• Prescribe non -steroidal anti -inflammatory drugs in injections, drugs for muscle relaxants - muscle relaxants
• If these measures are not sufficient, restriction with painkillers and hormone medications is carried out

Decreased radio frequency

Bed rest is recommended for several days

After the symptoms have subsided, it is necessary to start moving, gradually increasing the range of motion and load. At this time, active kneading, massage is not desirable due to possible complications.

Osteochondrosis: treatment without exacerbation

When the patient's condition is stable, normal dampness remainsosteochondrosis, treatment consists of several components:

• Medicine. All the same anti-inflammatory painkillers in tablets, capsules and ointments. Certain medications are selected by the doctor based on the patient’s condition, lifestyle, concomitant illness, mastery of one or another component of osteochondrosis. A course of vitamin B will increase the conduction of impulses along the nerves, normalizing tissue nutrition. While maintaining increased muscle tone, the use of muscle relaxants will continue. There are no magic pills, injections that can restore vertebrae and cartilage to their original state. Medications relieve symptoms, improve mobility and performance. But they could not completely stop the progression of the disease.
• Physiotherapy. It is used for direct delivery of the drug to the sore spot (electrophoresis), heating (paraffin, infrared irradiation). Exposure to therapeutic currents relaxes muscles, improves nerve fiber function. After a few sessions, the pain subsided, mobility was restored. Not prescribed for active inflammation
• Manual manipulation, massage, acupuncture, acupressure. Relieves cramps by stretching and relaxing muscles. If during the massage only the upper layer of muscle is affected, then manual therapy penetrates deeper, therefore the need for a specialist is higher. Be sure to do an MRI first to find out the anatomical features of a particular patient
• Spinal traction. The spines move away from each other, the normal distance between them is restored, nerve pinching is reduced. This procedure has contraindications, so only a doctor can prescribe it
• Physiotherapy. The most effective method of treatment. The only caveat is that it must be used for life. Of the advantages - it provides activity, improves mood, improves tissue tone. The best method is a set of exercises recommended by a doctor, early yoga asanas, Pilates, swimming. They are carried out smoothly, without sudden and traumatic movements, stretching the tissue, gradually increasing the amplitude
• Proper nutrition and abandoning bad habits
• Adequate supply of nutrients to the tissues, good vascular condition and adequate blood supply to the vertebrae and surrounding structures are measures to prevent the development 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:

• Diagnostic treatment and restrictions
• Radio frequency facet ablation
• Cold plasma and laser nucleoplasty
• Endoscopic removal of a herniated disc
• Microdiscectomy

Radio frequency thermal ablation of facet joints

A special needle is placed right on the side of the intervertebral joint at the point where the median branch of the Lyushka nerve passes. The electrode is mounted inside the needle, the tip heating up to 80 degrees for 90 seconds. This leads to nerve clotting. The pain is gone.

Cold plasma nucleoplasty

Through a needle inserted into the disc, a special cold plasma electrode is applied to the disc tissue. Intradiscal pressure is reduced, the hernia (bulge) is pulled inwards.

Microdiscectomy

With a herniated disc, the nerve roots and adjacent blood vessels are compressed, a very painful sensation and various limb conservation disorders occur. If the effects of conservative treatment are no longer present, then surgery to remove the herniated disc is the only possible solution for many patients. Surgery is performed under anesthesia through a 2-3 cm incision using microsurgical equipment and instruments. The duration of the operation is 45-60 minutes. The pain syndrome is significantly reduced or disappears completely immediately after surgery in 95% of patients. The next day the patient was allowed to walk and was soon out of the clinic.

Endoscopic removal of a hernia disc:

Hernia or free -lying isolation is removed through the lateral intervertebral foramen. To place the tube, a 5 mm incision is made in the skin. Muscles, fascia and ligaments are not damaged, they are pushed using a tubular retractor system with a gradual increase in diameter. The surgery is almost bleeding and lasts only 40-50 minutes. Patients can return to their normal regimen after three weeks. The risk of complications is minimal.

Decompression and stabilization surgeries are performed when complications arise, large disc herniation, severe compression on the roots of the spinal cord and spinal cord. If there are signs of sudden loss of sensitivity, movement, pelvic dysfunction, the patient should be immediately taken 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, surgical treatment is aimed at decompression of the compressed nerve structure and stabilization of the affected segment. This is a hemi or laminectomy. Fixing is carried out by a transpedicular system, combined with an interbody cage, which provides a 360 -degree combination. 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 improve the effectiveness of long -term outcomes and reduce the likelihood of recurrent disc herniation.