Osteochondrosis is a chronic disease, in which degenerative changes occur in the vertebrae situated between them inter-vertebral discs. Depending on the lesion of the spine: the cervical osteochondrosis, osteochondrosis of the thoracic and osteochondrosis of the lumbar spine. The diagnosis of osteochondrosis of the spine to x-rays, in the case of complications (e.g., herniated disc) - spinal MRI. The treatment of osteoarthritis of the spine along with the medical methods are widely used, reflexology, massage, manual therapy, physiotherapy, and exercise therapy.
Etiology and pathogenesis
To a different extent, osteochondrosis occurs in all aged people, this is one of the aging process. Eventually, the intervertebral disc may occur, atrophic changes, however, the injury, disease, and the various overloads of the spine contribute to the earlier emergence of osteoarthritis. The most common osteochondrosis of the cervical and degenerative disc disease of the lumbar spine.
Approximately 10 theories for degenerative disc disease: circulatory, hormonal, mechanical, genetic, infectious -allergic or other. But none of them gives a full explanation of what is happening in the spine changes, complement each other.
It is believed that the essence of the event in osteoarthritis of the constant overload of the vertebral motor segment, which is two adjacent vertebrae. This is because of the overload of the moving habits — posture, unique way, to sit, to walk. Incorrect posture, sitting in a bad posture, walking on uneven spinal column, because it's extra strain on discs, ligaments, and muscles of the spine. The process can be exacerbated because of the peculiarities of the structure, the backbone, the failure of the trophic tissue due to hereditary factors. Most often, the defects in the structure occur in the cervical spine leads to vascular diseases, early signs of degenerative disc disease of the cervical spine.
The event of osteochondrosis in the lumbar often associated with the overload, if the bending and weight lifting. The healthy intervertebral disc can withstand a substantial load due to the hydrophilicity is located in the centre of the nucleus pulposus. The kernel contains a large amount of water or fluid, as you know, a little compressed. Rupture of the healthy intervertebral disc may occur when the force of the compression more than 500 kg, while the changed as a result of degenerative disc disease the disc is broken, when the force of the compression 200 kg. Load capacity 200 kg experiences a lumbar spine of a person weighing 70 kg, in the hands of a 15-pound load in the position of the torso forward, 200. Such a large pressure, due to the small size of the nucleus pulposus. When the inclination increases to 700, the load on the intervertebral discs of 489 kg. So often the first clinical manifestation of osteochondrosis of the lumbar spine may occur during or after hard work, performing the chores, weeding the garden, etc.
The destruction of the connective tissue of the fibrous ring of the disc, ligaments, and capsule of the facet joints cause reaction of the immune system and the development of sterile inflammation, swelling of the facet joints and the surrounding tissues. Since the displacement of the vertebral body, stretching the capsule of the facet joints and changes of the intervertebral disc is not so firmly attached to the body of the adjacent vertebrae. The formation of the instability of the spinal segment. Since the uncertainty in the possible infringement of the nerve root of the spinal nerve in the development of radiculáriszt syndrome. Osteochondrosis of the cervical spine often occurs in the cornering of the head, osteochondrosis of the lumbar spine during trunk flexion. The formation of the functional unit of the vertebral motor segment. This is due to the compensatory contraction of vertebrate muscles.
A herniated disc occurs when the disc moves backwards, there is a tear in the posterior longitudinal ligament and bulging of the disc into the spinal canal. If the spinal canal is squeezed out of the disc, this is called a ruptured hernia. The severity duration of pain associated with a hernia is much more than the unexploded. A herniated disc can cause radiculáriszt syndrome or spinal cord compression.
When osteochondrosis occurs, the expansion of the bone formation of joint — a bony process on the bodies and vertebrae. Joints can also cause compression of the spinal cord or the development of radiculáriszt syndrome.
The symptoms of osteochondrosis
The main symptom of osteochondrosis pain. The pain can be sharp, high intensity, increase the smallest movement of the affected segment and, therefore, forces the patient to a forced situation. So, the osteochondrosis of the cervical spine, the patient keeps the head in the least painful position, not rotate, osteochondrosis of the thoracic pain is worse, another deep breath, and osteochondrosis of the lumbar the patient find it difficult to sit, stand, walk. Such pain syndrome is characterized by compression of the nerve roots of the spinal nerves.
Approximately 80% of cases, there is dull pain, on a permanent basis at a moderate intensity. In such cases, during the examination the doctor must be distinguished manifestations of osteochondrosis of the spine, the myositis of the back muscles. Dull pain in osteochondrosis is caused by the excessive tension, the muscles that keep the affected vertebral motor segment, inflammatory lesions, or significant stretching of the intervertebral disc. The patients the pain syndrome in a forced situation, that is missing, but it turns out, restriction of movement, physical activity. Patients with osteochondrosis of the cervical spine, avoid sharp turns, and tilts his head, osteochondrosis of the lumbar - slowly sit up, get up, avoid the strain of bending.
Complications of spinal osteochondrosis
Complications of degenerative disc disease associated with disc herniation. These include spinal cord compression, which is characterized by numbness, weakness, some muscle groups of the limbs (depending on the compression level), which is the appearance of the paresis, muscle atrophy, changes in tendon reflexes, disturbances of urination, defecation and. A herniated disc can cause compression of the artery feeding the spinal cord, the formation of ischemic areas (infarction of the spinal cord) the loss of the nerve cells. This is manifested in the appearance of neurological deficit (violation of the movements, the sensitivity reduction, eating disorders), at an appropriate level the extent of ischemia.
Diagnosis of osteochondrosis
The diagnosis of osteochondrosis is carried out to a neurologist or spine. In the initial stages of producing x-rays of the spine in 2 projections. If necessary, you can make a survey of each vertebral segment to shoot more pictures. The diagnosis of inter-vertebral hernia, assessment of the spinal cord, and to recognize the complications of degenerative disc disease using magnetic resonance imaging (MRI spine). Played a big role in the MRI, the differential diagnosis of osteochondrosis and other diseases of the spine: tuberculous spondylitis, osteomyelitis, tumors, ankylosing spondylitis, rheumatism, infections. Sometimes complicated cases, the degenerative disc disease of the cervical spine exclusion is necessary syringomyelia. In some cases, the impossible MRI myelography can be seen.
Perception study of the affected cartilage discs possible discography. Electrophysiological tests used in the determination of extent of localization of lesions of the nervous path, as well as the monitoring of the structure during therapy.
Treatment of osteochondrosis
In the acute period, the rest of the affected vertebral motor segment. That's the goal, osteochondrosis of the cervical spine is used, the fixing through collar Trench, osteochondrosis of the lumbar in the bed. Fixation of the cervical osteochondrosis the instability of the spinal segment.
The drug therapy for degenerative disc disease the use of nonsteroidal anti-inflammatory drugs (Nsaids): diclofenac, nimesulide, lornoxicam, meloxicam. The intense pain syndrome shows analgesics, for example, the Central analgesic action of flupirtine. To relieve the muscle tension, use of muscle relaxants — tolperisone, tizanidine. In some cases, the appropriate use of anticonvulsants - carbamazepine, gabapentin; antidepressants, among which preference is given to a serotonin-reuptake inhibitors (sertraline, paroxetine).
Upon the occurrence of radiculáriszt syndrome patients seen in the inpatient settings. Maybe a local injection of glucocorticoids, treatment against edema, the use of traction. The treatment of osteoarthritis are widely used physiotherapy, reflexology, massage, physiotherapy. The use of the manual therapy requires strict adherence to techniques implementation, or the implementation of special caution in the treatment of degenerative disc disease of the cervical spine.
The surgery can be seen primarily in the significant spinal cord compression. It consists of removing the herniated disc and decompression of the spinal canal. It is possible to perform a micro-discectomy, laser disc, renovation, replacement of the affected disc implant, the stabilization of the spinal segment.