This material is intended for non-medical people 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 the lack of understanding of the topic of osteochondrosis.Examples of such questions are: "Why does my osteochondrosis hurt?", "Congenital osteochondrosis has been detected, what should I do?".Perhaps the apotheosis of such illiteracy can be considered a fairly general question: "Doctor, I have the initial signs of chondrosis, how scary is this?"This article is designed to structure the material about osteochondrosis, its causes, manifestations, diagnosis, treatment and prevention methods and to answer the most frequently asked questions.Since we all suffer from osteochondrosis without exception, this article will be useful for everyone.
How is the intervertebral disc formed?
Each intervertebral disc consists of two distinct parts:
- outer fibrous ring, which consists of dense fibers that cover the disc from the outside around the perimeter;
- the internal elastic component is the nucleus pulposus.
The fibers of the annulus fibrosus are very dense and elastic.Over the years, it loses elasticity, and by the age of 60, the fibrous ring hardens.Between the surface of each upper and lower vertebra and the disc itself, there are end plates, that is, border zones 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 diffusely nourished by the diffusion method, since the cartilages of the disc are not supplied with blood or innervated.
Healthy intervertebral discs in a young person are capable of high metabolic rates.If you introduce contrast into a normal disk, it disappears from it after 20 minutes.
Research shows that the height of each intervertebral disc in adults is approximately:
- 25% of the height of adjacent vertebrae in the cervical region;
- 20% in the chest;
- 33% in the waist area.
That is, the thickness of the discs in the lumbar region is the greatest due to the greatest 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, the "old and dried disk" copes 22 times worse by transferring the load to the sides and maintaining the increased pressure inside the rim.
Why did this happen?Over time, the fiber ring gradually wears out.It can no longer stretch, but protrudes from the disc or breaks.It stops the transfer and transformation of the main vertical load to radial load.With age, stress gradually accumulates inside the discs and their structure changes.If all these processes taken in a separate disk are transferred to the entire spine, then we get a condition called osteochondrosis in the clinic.Now we can start defining.
What is osteochondrosis?
It is scary when the name of the disease is not clear.The medical suffix "-oz" means proliferation or growth of some tissues: hyalinosis, fibrosis.For example, cirrhosis of the liver can occur when the connective tissue increases and the functional tissue, hepatocytes, decreases in volume.There may be accumulation of pathological protein or amyloid that should not normally be present.This storage disease will later be called amyloidosis.There may be significant enlargement of the liver due to fatty degeneration called fatty hepatosis.
Well, it turned 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, more precisely, osteochondrosis is not a storage disease.In this case, the actual growth of cartilage tissue does not occur;we are only talking about the changes in the configuration of the intervertebral cartilage discs under the influence of many years of physical activity, and we have examined above what happens to each individual disc.The term "osteochondrosis" was introduced into the clinical literature in 1933 by A. Hilderbrandt.
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 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 breakdown of the structure of the intervertebral discs after prolonged dystrophy.
Causes of osteochondrosis and its complications
The main cause of uncomplicated, physiological osteochondrosis can be considered the way of movement of a person: upright walking.Man is the only species among all mammals on earth that walks on two legs, and this is the only way of locomotion.Osteochondrosis became a scourge of mankind, but we freed our hands and created civilization.Thanks to upright walking (and osteochondrosis) we created the wheel, the alphabet and mastered fire, and you can sit at home in the heat and read this article on your computer screen.
Humans' closest relatives, the higher primates - chimpanzees and gorillas - sometimes get up on two legs, but this method of locomotion is helpful for them, and most of the time they still move on all fours.In order for osteochondrosis to disappear, such as intensive aging of the intervertebral discs, it is necessary to change the way a person moves and remove a constant vertical load from the spine.Dolphins, killer whales and whales do not have osteochondrosis, but dogs, cows and tigers do not.Since their spine is in a horizontal position, it does not accept long-term static and shock vertical loads.If humanity goes to the sea and the natural way of transportation is scuba diving, osteochondrosis will be defeated.
The upright posture forced the human musculoskeletal system to evolve to protect the skull and brain from shock loads.But the discs - the elastic cushions between the vertebrae - are not the only method of protection.A person has a springy 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 risk factors that can be modified and prevent the complications of osteochondrosis, which cause pain, discomfort, limited mobility and reduced quality of life.Consider these risk factors, which are often overlooked by doctors, especially in private medical centers.After all, it is more profitable 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 straight legs.Flat feet cause the arch of the foot to stop springing, and the shock is transmitted upward into the spine without softening.Intervertebral discs experience significant stress and collapse quickly;
- overweight and obesity - no need to comment;
- improper lifting and carrying of heavy objects, uneven pressure on the intervertebral discs.For example, if you carry a bag of potatoes on one shoulder, then the dense load will fall to one side of the discs and may be excessive;
- physical inactivity and sedentary lifestyle.It was said above that the maximum pressure on the discs occurs precisely when sitting, because a person never sits straight, but always bends "slightly";
- chronic injuries, skating, intense weightlifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags.
General symptoms
The symptoms to be described below are present outside the localization.These are common symptoms and can be present anywhere.These are pain, movement disorders and sensory disorders.There are also vegetative-trophic disorders or specific symptoms, such as urinary disorders, but 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 exactly where the tear is directed and what part of the root is compressed, there can be either sensory or motor disturbances.Sometimes both disorders occur at the same time, expressed in different degrees.Pain also belongs to sensory disorders, because pain is a special, specific feeling.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many;this is called "neuralgia".The swollen nerve root reacts violently to any blow, and the pain is very sharp, similar to an electric shock.He shoots either from the arm (neck) or from the leg (from behind).Such a sharp, painful impulse is called lumbago: lumbago in the lower back, cervicago in the neck, a rarer term.Such radicular pain requires forced, analgesic or antalgic posture.Radicular pain occurs immediately when coughing, sneezing, crying, laughing or straining.Any blow to the swollen nerve root causes increased pain.
Muscle pain: myofascial-tonic
However, an intervertebral hernia or disc defect may not compress the nerve root, but instead injure nearby ligaments, fascia, and deep back muscles as it moves.At this time, the pains will be secondary, painful, permanent, stiffness will appear in the back, and such pains are 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 lasts for a long time, the muscle contraction will turn into a permanent spasm, which will be very painful.
A characteristic sign of such secondary, myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense, painful muscle bubbles - "rollers" near the spine, that is, paravertebral.In such patients, back pain is aggravated by prolonged immobility after several hours of "office" work, when the muscles are practically unable to work and are in a state of spasm.
Sensory disorders
If a protrusion or hernia or a spasmodic muscle compresses the sensitive part of the nerve root, then various sensory disturbances occur.They may be accompanied by pain or may occur separately after the pain has already passed.There are also completely painless forms of sensory disturbances, but rarely.
Many people know the numbness of the tips of the fingers and toes (hypoesthesia or complete anesthesia), decreased sensitivity of the skin in the form of long strips, radicular type.Sometimes paresthesia or formation, the feeling of "creeping goose bumps" occurs.Most often, sensitivity disorders occur in the feet, the tips of the fingers and toes.Sensory disorders are quite unpleasant, but sensory disorders do not disable a person, but motor disorders can.
Motor disorders in the periphery
If the motor neuron or axons, which are part of the motor part of the nerve, are affected, then either muscle weakness or complete immobility occurs.In the second case, we are talking about complete paralysis, and in the first case, 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 tears of the lumbar spine.There are motor structures that innervate the muscles of the lower leg and foot.Therefore, a foot can beat with advanced, complex lumbar osteochondrosis.It is turned inward, the person is forced to raise the foot high to step with the slap foot, this is called steppage, "cock walk".
But the whole danger of movement disorders is that they can be isolated and not accompanied by pain.If a person "does not have pain", then he cannot consult a doctor in time.Therefore, for patients with progressive protrusions and tears, for example, in the lumbar region, it is very important to periodically walk on the toes and heels and monitor the work of their muscles.
Local symptoms: main signs
Now let's 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, as described above, osteochondrosis of the cervical and cervical-thoracic spine occurs.Therefore, the main stage of diagnosis was and remains the determination of the patient's complaints, the presence of muscle spasm accompanied by simple palpation of the muscles along the spine.Is it possible to confirm the diagnosis of osteochondrosis using X-ray examination?
Although there are "x-rays" of the cervical spine and even functional tests for flexion and extension, the cartilage is not visible because their tissue transmits X-rays.Nevertheless, based on the location of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general correction of the physiological curvature of the neck - lordosis, as well as the presence of marginal growths in the vertebrae with long-term irritation of fragile and dehydrated intervertebral surfaces.Functional tests can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen using CT or MRI, magnetic resonance and X-ray computed tomography are indicated to clarify the internal structure of cartilage and formations such as protrusions and tears.Thus, with the help of these methods, an accurate diagnosis is made, and the result of the tomography becomes an indication and even an actual guide for the surgical treatment of hernias in the neurosurgery department.
Treatment of complications of osteochondrosis
Let's repeat once again that it is impossible to cure osteochondrosis, for example, planned aging and dehydration of the disc.You simply cannot let things get complicated:
- if there are signs of narrowing of the height of the intervertebral discs, then you should move correctly, do not lift weights and avoid the appearance of protrusions and muscle pain;
- if you already have a protrusion, then you need to be careful that it does not tear the fibrous ring, that is, it does not turn the protrusion into a tear, and the protrusions are not visible at several levels;
- If you have a hernia, you should monitor it dynamically, conduct regular MRI, do not increase its size or perform modern minimally invasive surgical treatment, because without exception, all conservative methods of treatment of exacerbation of osteochondrosis leave the hernia in place and only relieve temporary symptoms: inflammation, pain, drawing and muscle spasm.
But with the slightest violation of the regime, the symptoms of heavy lifting, hypothermia, injury, weight gain (in the case of the brain) return again and again.We will describe how you can cope with unpleasant sensations, pain and limited mobility against the background of an exacerbation of osteochondrosis, and a protrusion or hernia that exists after social tonic syndrome.
What to do during an exacerbation?
Since there is an acute pain attack (for example, in the lumbar region), you should follow the following instructions at the stage before the doctor:
- completely eliminate physical activity;
- to sleep on a hard one (orthopedic mattress or hard 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 pad with plastic needle applicators on your back or use a Lyapko applicator.2-3 times a day for 30-40 minutes;
- after that, ointments with NSAIDs, ointments with bee or snake venom can be applied to the lower back;
- after rubbing, on the second day you can tie your waist in dry heat, for example, with a belt made of dog fur.
A common mistake is warming up on the first day.This can be a heating pad, bath procedures.At the same time, swelling only intensifies, and with it pain.You can warm up only after the "highest point of pain" has passed.After that, the heat will enhance 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 (effect on the mechanisms of the disease).It is accompanied by symptomatic therapy.Things to do for vertebrogenic pain (caused by problems in the spine) are:
- A salt-free diet and limiting the amount of fluid consumed is indicated to reduce swelling of the muscles and spine.You can even give a mild potassium-sparing diuretic tablet;
- In the acute stage of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular "injections" of NSAIDs and muscle relaxants: daily.It will help to remove swelling of nerve tissue, remove inflammation and normalize muscle tone;
- in the subacute period, after maximum pain relief, "needles" should no longer be taken and attention should be paid to restorative substances, for example, modern drugs of group "B".They effectively restore impaired sensitivity, reduce numbness and paresthesia.
Physiotherapy measures continue, it's time for exercise therapy for osteochondrosis.Its task is to normalize blood circulation and muscle tone, when swelling and inflammation have already decreased, but muscle spasm has not yet been completely resolved.
Kinesiotherapy (movement treatment) consists of therapeutic exercises and swimming.Gymnastics for osteochondrosis of the cervical spine is usually not focused on the discs, but on the surrounding muscles.Its task is to eliminate tonic spasm, improve blood flow, and also normalize venous flow.This leads to a decrease in muscle tone, a decrease in the intensity of pain and stiffness in the back.
Exercises for osteochondrosis should be performed on "warmed muscles" after a light general warm-up.The main therapeutic factor is the movement, not the degree of muscle contraction.Therefore, the use of weights to prevent relapse is not allowed;a gymnastic mat and a gymnastic bar are used.With their help, you can effectively restore the range of motion.
Applying ointments and using the Kuznetsov applicator continues.Swimming, underwater massage, Charcot shower are indicated.It is at the stage of exacerbation of extinction that drugs for magnetic therapy and physiotherapy are indicated at home.
Usually, the treatment does not take more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that surgery may be necessary and urgent.
About the collar of the shunt
In the early stages, in the acute stage, it is necessary to protect the neck from unnecessary movements.Shants collar is great for this.Many people make two mistakes when buying this collar.They do not choose it for its size, so it simply does not perform its function and creates a feeling of discomfort.
The second common mistake is to wear it for long-term preventive purposes.This weakens the neck muscles and only causes more problems.For the collar, there are only two signs that it can be worn:
- the appearance of sharp pain in the neck, stiffness and pain radiating to the head;
- if you are going to do physical work in full health with the risk of "stretching" your neck and aggravation.This includes, for example, repairing a car, lying under it or washing windows, reaching out and taking awkward positions.
The collar should not be worn for more than 2-3 days, as wearing it for longer may cause venous congestion in the neck muscles when it is time to activate the patient.An analogue of the Shants collar for the lower back is a semi-rigid corset purchased at an orthopedic salon.
Surgical treatment or conservative measures?
It is recommended that every patient undergo an MRI and consult a neurosurgeon after the progression of symptoms, in case of complications.Modern minimally invasive operations make it possible to safely remove fairly large hernias without long-term hospitalization, without having to lie down for several days, without harming the quality of life, because they are performed using modern videoendoscopic, radiofrequency, laser technology or cold plasma.You can vaporize part of the core and reduce the pressure, reducing the risk of rupture.And you can eliminate the defect from the root, that is, by removing it completely.
There is no need to be afraid to operate on hernias;these are no longer the previous types of open operations of the 80s and 90s of the last century with muscle dissection, blood loss and the subsequent long recovery period.They are more like a small puncture under X-ray control and then use modern technology.
Prevention of osteochondrosis and its complications
Osteochondrosis, the symptoms and treatment of which we discussed above, including complex ones, is not a disease in most cases, but simply a manifestation of the inevitable aging and premature "shrinking" of the intervertebral discs.Osteochondrosis needs very little to never worry 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 be in accordance with your height;
- treat flat feet if present;
- do physical exercises regularly;
- engaging in sports that reduce the back load (swimming);
- giving up bad habits;
- replaces 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 take an x-ray or MRI of the spine in two projections to know if the hernia has developed;
By following these simple tips, you can keep your back healthy and mobile for life.