What is spinal osteochondrosis in simple words?
Osteochondrosis of the spine is a chronic disease that is based on degenerative-dystrophic changes in the intervertebral disc with subsequent involvement in the process of adjacent vertebrae, intervertebral joints and spinal ligaments.
The word "osteochondrosis" has two Greek roots: οστό - bone and χόνδρος - cartilage.
Vertebrae are formations consisting of cancellous bone.They are connected to each other by cartilaginous discs.There are ligaments on the front and back surfaces of the vertebrae.Cartilaginous discs prevent the vertebrae from coming together and the ligaments from moving apart.Thanks to the coordinated work of the discs and ligaments, the spine is elastic and this allows it to perform vital functions:
- provides balance in a vertical position,
- cushion shocks and impacts when walking and jumping,
- protecting the skull and the brain within it from impact due to excessive blows.
In osteochondrosis, protrusions of the intervertebral discs outside the vertebral bodies are formed.Depending on the direction of the protrusion, as well as its size, pain, numbness, muscle disorders and other symptoms develop.
ICD-10 codes:
- M42 Osteochondrosis of spine
- M42.0 Juvenile osteochondrosis of spine
- M42.1 Osteochondrosis of spine in adult
- M42.9 Osteochondrosis of spine, unspecified
- M43.1 Spondylolisthesis
- M47 Spondylosis
- M47.0 Anterior spinal or vertebral artery compression syndrome
- M47.1 Other spondylosis with myelopathy
- M47.2 Other spondylosis with radiculopathy
- M48.0 Spinal stenosis
- M50.0 Injury of intervertebral disc of cervical spine with myelopathy
- M50.1 Injury of intervertebral disc of cervical spine with radiculopathy
- M50.2 Displacement of intervertebral disc of cervical spine of other type
- M50.3 Other degeneration of cervical intervertebral disc
- M51.0 Lesions of intervertebral discs of lumbar and other parts with myelopathy
- M51.1 Lesions of intervertebral discs of lumbar and other parts with radiculopathy
- M51.2 Other specified displacement of intervertebral disc
- M51.3 Other specified degeneration of intervertebral disc
- M53 Other dorsopathies, not elsewhere classified
Types of osteochondrosis
Depending on which part of the spine there are changes, there are several variants of the disease:
- cervical,
- chest,
- lumbar,
- sacred,
- mixed variants (cervico-thoracic, lumbosacral).
Depending on the duration of the symptoms, the disease can be:
- acute (up to 3 weeks),
- subacute (3-12 weeks),
- chronic (more than 12 weeks).
According to the predominant neurological manifestation:
- with myelopathy (damage to the spinal cord),
- with radiculopathy (pinched and inflamed nerve roots).
Causes of osteochondrosis
To date, there is no exact data on the causes of osteochondrosis.
The role of genetic predisposition, mechanical damage and inflammation in the occurrence of premature wear of the intervertebral discs is considered.
Intervertebral discs do not have their own blood or lymph vessels.The vessels of the vertebrae play a role in their nutrition and cleansing of harmful substances.With age and/or exposure to harmful influences, blood and lymph flow decrease, the discs receive less oxygen and nutrients, and harmful substances can accumulate in them.All this leads to gradual wear and tear.The rate and speed of disc wear increases with exposure to risk factors.
Risk factors:
- congenital anomalies of the vertebrae and spinal canal;
- flat feet;
- occupational risks (vibration, heavy lifting, prolonged stay in a forced uncomfortable position, exposure to toxic substances);
- sedentary lifestyle;
- obesity;
- a diet that is not balanced in the content of proteins, fats, vitamins and minerals;
- insufficient consumption of clean water;
- smoking;
- environmental pollution.
Symptoms of osteochondrosis of the spine
Listed by frequency of occurrence:
- pain;
- reduced range of motion;
- numbness, loss of sensitivity;
- decreased muscle strength;
- dysfunction of organs whose innervation is related to the problematic part of the spine.
Clinically significant manifestations of spinal osteochondrosis are observed in 51 people per 1000 population.
The localization of pain and other symptoms depends on the problem part of the spine.
Cervical osteochondrosis:
- pain in the arms, shoulders, neck, increasing when turning and tilting the head;
- headache;
- decreased muscle strength in the arm;
- noise in the head, vertigo, flashing "fins", colored spots before the eyes in combination with a burning, throbbing headache (vertebral artery syndrome).
The health of the brain depends on the condition of the cervical spine, since the arteries to the brain pass through the channel formed by the processes of the vertebrae.If, due to osteochondrosis, the lumen of the channel narrows, the blood flow through the arteries is disturbed and the brain experiences a lack of oxygen and nutrients.
thoracic osteochondrosis:
- pain in the chest, under the scapula, in the region of the heart, increasing when turning the body, coughing, sneezing;
- dysfunction of the gallbladder, stomach, esophagus.
Lumbar and/or sacral osteochondrosis:
- pain in the lower back, back and side of the thigh;
- tingling in the toes;
- increased frequency of urination (10-12 times a day, maybe more), involuntary loss of urine during physical activity;
- sexual disorders.
Due to frequent pain, half of people suffering from osteochondrosis show signs of constant emotional stress.
Stages of development and course of osteochondrosis
The initial stage of osteochondrosis is manifested by dull pain in the back or lower back, which occurs during prolonged standing, after walking or running;pain in the neck, aggravated by turning and tilting the head.
As the pathology of the intervertebral disc(s) progresses, it can bulge (herniate) and as a result compress the nerve root (radiculopathy).This leads to severe pain radiating to the arm or leg, muscle weakness, disturbances in skin sensitivity, vascular tone and the function of the organs receiving innervation from the problematic part of the spine.In the most severe cases, compression of the spinal cord can occur, leading to paresis or paralysis.
Osteochondrosis is a chronic disease.After adequate treatment, remission occurs, that is, symptoms decrease or completely disappear.If a new protrusion of the intervertebral disc is formed, deterioration occurs, pain and other symptoms return again.
Diagnosis
Examination by a neurologist.
Main instrumental research methods:
- magnetic resonance imaging (MRI),
- computed tomography (CT).
Additionally:
- spondylography (in-depth X-ray examination of the spine),
- electromyography (EMG),
- electroneuromyography (ENMG),
- bone densitometry (performed to detect osteopenia/osteoporosis).
Basic laboratory methods:
- general blood test,
- general urinalysis,
- biochemical blood test (glucose, creatinine, urea, electrolytes, bilirubin, liver and pancreatic enzymes; glycated hemoglobin, C-reactive protein),
- coagulogram.
Additionally:the concentration of calcium and phosphates in the blood.
Treatment of osteochondrosis
Conservative treatment
It is carried out if the patient does not have acutely progressive neurological symptoms.
Objectives:
- reduce or relieve pain,
- correction of muscle tone,
- reduce inflammation and swelling,
- preventing the development of dystrophic changes in the structures of the spine,
- correction of the impaired function of internal organs,
- increasing the patient's daily activity,
- teaching the patient to manage pain.
Conservative treatment of osteochondrosis includes:
- compliance with a rational driving regime,
- drug use,
- physical therapy,
- massage,
- Exercise therapy (after pain relief and stabilization of the condition),
- acupuncture,
- manual therapy.
Drug treatment
The main groups of drugs that can alleviate or relieve pain and stabilize the condition of a patient with osteochondrosis are listed.Only a doctor can choose an appropriate treatment regimen, taking into account the characteristics of the clinical picture of a particular patient.
Nonsteroidal anti-inflammatory drugs(NSAIDs):
- for oral use,
- for intramuscular injections,
- for intravenous use,
- for insertion into the rectum (rectal suppositories),
- for external use (ointment, gel).
Muscle relaxants(medicines that reduce muscle spasticity).
It is used for severe tension and painful muscle spasms.
Diuretics(to reduce local swelling).
Medicines that improve the condition of cartilage tissue(chondroprotectors):
- sodium chondroitin sulfate,
- a combination of sodium chondroitin sulfate and glucosamine.
B vitamins:
- thiamine (B1),
- pyridoxine (B6),
- cyanocobalamin (B12),
- combination B1+B6+B12.
In the acute period with severe pain, bed rest for 1-2 days is possible, which helps to relax the muscles and reduce the pressure inside the cartilage disc.It is recommended that you wear a stabilizing lumbar corset or Shants collar.
As the intensity of pain decreases, the treatment is supplemented with special therapeutic exercises aimed at stretching the spine and relaxing the muscles, with the gradual inclusion of exercises for the formation of a muscle corset.Therapeutic manual massage is indicated.
With adequate therapy, the pain gradually decreases and may disappear completely.There is also regression of neurological symptoms.The improvement of the condition is due to a reduction in the size of the disc herniation and the associated inflammatory changes in the surrounding tissues.
Surgical treatment
Urgent neurosurgical intervention is indicated for pelvic disorders with numbness in the anogenital area and ascending paresis of the feet (cauda equina syndrome).
The need for surgery may also arise if conservative therapy is ineffective within 3-6 months.
Prevention of back pain
Avoid excessive physical activity (lifting heavy objects, carrying a heavy bag in one hand, etc.).
Avoid prolonged static loads (sitting, staying in an uncomfortable position).
If your job involves such stress, it is recommended that you take 10-minute breaks every 45 minutes you have to walk.
Avoid hypothermia.
Maintain an adequate level of physical activity through regular exercise, swimming and/or walking.
Sleep on a medium firm mattress.
Nutrition in osteochondrosis
A balanced diet and proper fluid intake ensure normal blood supply and nutrition to the vertebrae, and hence to the cartilage discs.As a result, metabolism and energy are normalized and harmful products do not accumulate.
Basic principles:
Daily calorie content, is calculated individually, taking into account height, age, gender.
In overweight or obese patients, caloric intake should be limited.
Drinking mode– drink pure water, mineral water and herbal teas in a volume of at least 1 liter per day, ideally in the amount of 30 ml/kg of body weight.
Daily use:
- whole grain products (buckwheat, millet, oatmeal);
- sufficient amount of protein (taking into account age and kidney function): animal - lean beef, chicken, turkey, rabbit, chicken egg (4-5 pieces per week);vegetables - beans, lentils, peas;
- healthy fats containing mono- and polyunsaturated fatty acids (fish, seafood, unrefined vegetable oils, unroasted and unsalted nuts, seeds);
- vegetables (both fresh and cooked), lettuce, herbs and leafy greens;
- berries - blueberries, blackberries, raspberries, cherries.
Exclusion from the diet:
- white bread and bakery products from premium flour;
- sugar, industrial sweets - candies, cakes, biscuits, gingerbread, wafers;
- industrial drinks with added sugar - carbonated water, packaged juices;
- processed meat products - sausages, sausages, canned goods.