This material is intended for people without medical education who want to know more about osteochondrosis than is written in popular publications and on the websites of private clinics.Patients ask questions to doctors of various specialties that characterize a complete misunderstanding of the topic of osteochondrosis.Examples of such questions include: "why does osteochondrosis hurt?", "Congenital osteochondrosis was detected, what should I do?"Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have initial signs of chondrosis, how scary is it?"This article aims to structure the material about osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention and to answer the most frequently asked questions.Since all of us, without exception, are patients with osteochondrosis, this article will be useful for everyone.
How is the intervertebral disc structured?
Each intervertebral disc consists of two different sections:
- outer fibrous ring, consisting of dense fibers that cover the disc from the outside around the circumference;
- the internal elastic component is the nucleus pulposus.
The fibers of the anulus fibrosus are very dense and elastic.Over the years, elasticity is lost, and at the age of 60 the annulus fibrosus becomes rigid.Between the surface of each upper and lower vertebra and the disc itself there are so-called end plates, that is, the border areas between the vertebra and the disc.Due to these end plates, the vertebrae grow in height and through them, the nucleus pulposus and intervertebral disc tissues are diffusely nourished by the diffusion method, since the disc cartilage is not supplied with blood or innervated.
Healthy intervertebral discs in a young person are capable of high metabolic rates.If you insert contrast into a normal disk, then 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% in the chest;
- 33% in the middle.
That is, in the middle 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.At the age of 70, this figure decreases to 110 kg!That is, an "old and dry disc" copes 22 times worse with transferring the load to the sides and with maintaining the increased pressure inside the ring.
Why did this happen?Over time, the fibrous ring gradually wears out.It can no longer be stretched, but just goes out, beyond the disc or breaks.The core stops the transmission and transformation of vertical load into radial load.As we age, stress gradually builds up within the discs and their structure changes.If all these processes, taken in a separate disc, 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 the spread or enlargement of certain tissues: hyalinosis, fibrosis.An example would be cirrhosis of the liver, when the connective tissue increases and the functional tissue, hepatocytes, decreases in volume.There may be an accumulation of pathological proteins, or amyloid, which should not normally be present.This storage disease will then be called amyloidosis.There may be significant enlargement of the liver due to fatty degeneration, which is called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilage tissue of the intervertebral discs increases in volume, because "chondros, χόνδρο" translated from Greek to Russian means "cartilage"?No, chondrosis, or, more precisely, osteochondrosis is not a storage disease.In this case, no real growth of cartilage tissue occurs;we are only talking about a change in the configuration of intervertebral cartilage discs under the influence of many years of physical activity, and above we examined 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 the normal, normal aging of the intervertebral discs.None of us are surprised that the face of a 20-year-old girl will be slightly different from her face at the age of 70, 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 uncomplicated, physiological osteochondrosis can be considered the way a person moves: walking straight.Man is the only species on earth that walks on two legs among all mammals, and this is the only way of locomotion.Osteochondrosis became the scourge of humanity, but we freed our hands and created civilization.Thanks to walking straight (and osteochondrosis), we not only created the wheel, the alphabet and mastered fire, but you can also sit at home in warmth and read this article on your computer screen.
The closest relatives of humans, the highest primates - chimpanzees and gorillas, sometimes get up on two legs, but this method of movement is helpful for them, and more often they still move on four legs.In order for osteochondrosis to disappear, like intensive aging of the intervertebral discs, a person must change the way of movement and remove the constant vertical load from the spine.Dolphins, killer whales and whales do not have osteochondrosis, and dogs, cows and tigers do not have it.Their spine does not receive static and long-term shock vertical loads, as it is in a horizontal state.If humanity goes to sea and the natural mode of transportation is scuba diving, then osteochondrosis will be defeated.
Upright posture forced the human musculoskeletal system to evolve in the direction of protecting the skull and brain from shock loads.But the discs — the elastic cushions between the vertebrae — aren't the only method of protection.A person has a spring arch of the foot, cartilage of the knee joints, physiological curves of the spine: two lordosis and two kyphosis.All this allows you not to "shake" 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 movement and reduced quality of life.Let's examine these risk factors, which are often ignored by doctors, especially in private medical centers.After all, it is much more useful to constantly treat a person than to show 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 stop releasing and the impact is transmitted up the spine without being cushioned.Intervertebral discs experience significant stress and quickly collapse;
- overweight and obesity - no comment needed;
- improper lifting and holding of heavy objects, with uneven pressure on the intervertebral discs.For example, if you lift and carry a bag of potatoes on one shoulder, then the intense load will fall on one end of the discs and may be excessive;
- physical inactivity and a sedentary lifestyle.It was said above that it is during sitting that the maximum pressure on the discs occurs, since a person never sits straight, but always bends "a little";
- chronic injuries, ice skating, intense weightlifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags.
General symptoms
The symptoms that will be described below exist outside the localization.These are common symptoms and can exist anywhere.These are pain, movement disorders and sensory disturbances.There are also vegetative-trophic disorders, or specific symptoms, for example, urinary disorders, but much less often.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 compression of a protrusion or herniation of the intervertebral disc of the corresponding root at this level.Each nerve root consists of two parts: sensory and motor.
Depending on where exactly the hernia is directed and which part of the root is compressed, there may be sensory or motor disturbances.Sometimes both disorders occur at the same time, expressed in different degrees.Pain also belongs to sensory disorders, since pain is a special, specific feeling.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many people;it is called "neuralgia".The swollen nerve root reacts violently to any stroke and the pain is very sharp, similar to an electric shock.It shoots either in the arm (from the neck) or in the 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 cervicago, a rarer term.Such radicular pain requires a forced, analgesic or antalgic posture.Radicular pain occurs immediately when you cough, sneeze, cry, laugh or exert yourself.Any blow to the swollen nerve root causes increasing pain.
Muscular pain: myofascial-tonic
But an intervertebral hernia or disc defect may not compress the nerve root, but when it moves, damage nearby ligaments, fascia, and deep back muscles.In this case, the pain will be secondary, aching, permanent, stiffness will appear in the back and such pain is called myofascial.The source of this pain will no longer be the nerve 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 continuous spasm, which will be very painful.
A characteristic symptom of such secondary, myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense, painful lumps of muscles - "rolls" near the spine, that is, paravertebral.In such patients, the 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 spasms.
Sensory disorders
If a protrusion or hernia, or a spasmodic muscle presses on the sensitive part of the nerve root, then various sensory disorders occur.They can be accompanied by pain, or they can appear separately, after the pain has already passed.There are also completely painless forms of sensory disorders, but rarely.
Many people know the numbness of the tips of the fingers and toes (hypoesthesia or complete anesthesia), decreased skin sensitivity in the form of long, radicular-type lines.Sometimes paresthesia, or the formation, a sensation of "creeping groups" occurs.Most often, sensitivity disorders occur in the legs, on 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.
Peripheral motor disorders
If a motor neuron or the axons that are part of the motor part of a nerve are affected, then there is either weakness in the muscle or its complete immobility.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 work at full strength.
Most often, such disorders appear in the legs, with protrusions and hernias of the lumbar spine.There lie the motor structures that innervate the muscles of the lower leg and foot.Therefore, with advanced and complicated lumbar osteochondrosis, the leg can hit.It turns inside out, the person is forced to lift the leg up in order to step with the kicking leg, this is called steppage, "cock walk".
But the whole danger of movement disorders is that they can be isolated and not accompanied by pain.And if a person "has no pain", then he may not go to the doctor at the right time.Therefore, it is so important that patients with progressive protrusions and hernias, for example, in the lumbar region, periodically walk on the 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.Let's 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 cervical-thoracic spine occurs as described above.Therefore, the main stage of diagnosis was and remains the identification of the patient's complaints, determining the presence of accompanying muscle spasm using simple palpation of the muscles along the spine.Is it possible to confirm the diagnosis of osteochondrosis using x-ray examination?
An "X-ray" of the cervical spine, even with functional tests for flexion and extension, does not show cartilage, since their tissues transmit X-rays. Despite this, based on the location of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general direction of the physiological curvature of the neck - lordosis, as well as the presence of marginal growths in the vertebrae with prolonged irritation of their surfaces frombrittle and dehydrated discs.Functional tests can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen using CT or MRI, magnetic resonance imaging and computed tomography x-rays are indicated to clarify the internal structure of the cartilage and formations such as protrusions and hernias.Thus, with the help of these methods, the diagnosis is accurately established and the result of the tomography is an indication, even an actual guide for the surgical treatment of a hernia in the department of neurosurgery.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, like planned aging and dehydration of the disc.You just can't let things get complicated:
- if there are symptoms of narrowing of the height of the intervertebral discs, then you should move properly, do not gain weight and avoid the occurrence of muscle strains and pains;
- if you already have a protrusion, then you must be careful not to let the annulus fibrosus rupture, that is, not to turn the protrusion into a hernia and avoid the appearance of protrusions at several levels;
- if you have a hernia, then you need to monitor it dynamically, do regular MRIs, avoid increasing its size or perform modern minimally invasive surgical treatment, since without exception, all conservative methods of treating the deterioration 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, injury, weight gain (in the case of the lower back), the symptoms return again and again.We will describe how you can cope with unpleasant sensations, pain and limited mobility in the back against the background of worsening osteochondrosis and an existing protrusion or hernia, secondary to social tonic syndrome.
What to do during a tantrum?
Since there was an attack of acute pain (for example, in the lower back), then you should follow the following instructions in the pre-medical stage:
- completely eliminate physical activity;
- sleep on a firm one (orthopedic mattress or firm sofa), eliminating the sagging of the back;
- it is advisable to wear a semi-rigid corset to prevent sudden movements and "distortions";
- You should place a massage cushion with plastic needle applicators on your lower back or use a Lyapko applicator.You should keep it for 30-40 minutes, 2-3 times a day;
- After that, NSAID-containing oils, bee or snake venom oils can be rubbed into the lower back;
- after rubbing, on the second day you can wrap the lower back in dry heat, for example, a belt made of dog hair.
A common mistake is to warm up on the first day.This can be a heating pad, bath procedures.At the same time, the swelling only intensifies, and the pain along with it.You can warm up only after the "highest point of pain" has passed.After that, the heat will increase the "resorption" 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 problems in the spine), things go like this:
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluids consumed is indicated.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: daily.This will help relieve the swelling of nerve tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming the maximum pain, no more "injections" should be given and attention should be paid to restorative agents, for example, modern drugs of group "B".They effectively restore damaged sensitivity, reduce numbness and paresthesia.
Physiotherapy measures continue, the time has come for exercise therapy for osteochondrosis.Its task is to normalize blood circulation and muscle tone, when the swelling and inflammation have already decreased, but the muscle spasm has not yet been 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 the surrounding muscles.Its task is to relieve tonic spasm, improve blood flow and also normalize venous flow.This is what leads to a decrease in muscle tone, a decrease in the severity of pain and stiffness in 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 rate of muscle contraction.Therefore, to avoid relapse, the use of weights is not allowed;a gymnastic mat and a gymnastic stick are used.With their help, you can effectively restore the range of motion.
Rubbing with ointments and using the Kuznetsov applicator continues.Swimming, underwater massage, Charcot shower are indicated.It is during the worsening phase of fading that medications for home magnetic therapy and physiotherapy are indicated.
Usually the treatment lasts no more than a week, but in some cases, osteochondrosis can appear with such dangerous symptoms that surgery may be urgently needed.
Around 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 buying this collar.They do not choose it according to their size, therefore it simply does not perform its function and causes a feeling of discomfort.
The second common mistake is keeping it for prophylactic purposes for a long time.This leads to weakening of the neck muscles and only causes more problems.For a collar, there are only two indications under which it can be worn:
- the appearance of acute pain in the neck, stiffness and pain that spreads to the head;
- if you are going to engage in physical work in full health, in which there is a risk of "straining" the neck and becoming heavy.This is, for example, repairing a car, when you lie down under it, or washing windows, when you have to lie down and take awkward positions.
The collar should be worn for no more than 2-3 days, as wearing it longer can cause venous congestion in the neck muscles at a time 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 recommended that every patient, after the progression of symptoms, in the presence of complications, undergo an MRI and consult a neurosurgeon.Modern minimally invasive operations make it possible to safely remove rather large hernias, without prolonged hospitalization, without being forced to lie down for several days, without affecting the quality of life, as they are performed using modern endoscopic video technology, radio frequency, laser or using cold plasma.You can vaporize part of the core and reduce the pressure, reducing the risk of a hernia.And you can eliminate the defect radically, that is, by getting rid of it completely.
There is no need to be afraid to operate on hernias;these are no longer the previous types of open surgeries of the 80s-90s of the last century with muscle dissection, blood loss and a long subsequent recovery period.They are more like a small puncture 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 a backpack;
- drink more clean water;
- do not gain weight, your weight should correspond to your height;
- treat flat feet, if any;
- do physical exercises regularly;
- engaging in types of exercises that reduce the load on the back (swimming);
- giving up bad habits;
- alternation of 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 have at least an x-ray of the lumbar spine in two projections, or an MRI, to know if the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and mobile for life.