This material is intended for people without medical training who want to know more about osteochondrosis than is written in popular publications and on the websites of private clinics.Patients ask doctors of various specialties questions that characterize a complete lack of understanding of the topic of osteochondrosis.Examples of this type of question include: "why does osteochondrosis hurt?", "Congenital osteochondrosis was discovered, what should I do?"Perhaps the apotheosis of such illiteracy can be considered a fairly common question: "Doctor, I have the first signs of chondrosis, how scary is it?"This article aims to structure the material on osteochondrosis, its causes, manifestations, methods of diagnosis, treatment and prevention, and answer the most frequently asked questions.Since all of us, without exception, are patients with osteochondrosis, this article will be useful to everyone.
How is the intervertebral disc structured?
Each intervertebral disc consists of two different sections:
- outer fibrous ring, formed by 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.As the years go by, elasticity is lost and around the age of 60 the annulus fibrosus becomes rigid.Between the surface of each overlying and underlying vertebra and the disc itself are the so-called end plates, that is, the border areas 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 cartilage of the disc does not receive blood or is innervated.
Healthy intervertebral discs in a young person are capable of achieving high metabolic rates.If you insert contrast into a normal disc, it disappears after 20 minutes.
Studies have shown that in an adult, the height of each intervertebral disc is approximately:
- 25% of the height of the adjacent vertebrae in the cervical region;
- 20% in the chest;
- 33% in the lumbar.
That is, in the lumbar 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 compression load of up to 2.5 tons.By the age of 70, this figure decreases to 110 kg!That is, an "old, dry disc" adapts 22 times worse to transferring load to the sides and maintaining higher pressure inside the ring.
Why did this happen?Over time, the annulus fibrosus gradually wears away.It can no longer stretch, it only protrudes outwards, beyond the disc, or breaks.The core stops transmitting and transforms the vertical load into radial load.With age, stress gradually builds up within the discs and their structure changes.If all these processes, taken on 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 proliferation or enlargement of some tissue: hyalinosis, fibrosis.An example would be cirrhosis of the liver, when the connective tissue grows and the functional tissue, the hepatocytes, decreases in volume.There may be a buildup of pathological protein 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, called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilaginous tissue of the intervertebral discs increases in volume, because "chondros, χόνδρο" translated from Greek into Russian means "cartilage."No, chondrosis or, more precisely, osteochondrosis is not a storage disease.In this case, true growth of cartilage tissue does not occur;We are talking only about a change in the configuration of intervertebral cartilaginous discs under the influence of many years of physical activity, and we have already 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 and normal aging of intervertebral discs.None of us are surprised that the face of a 20-year-old girl is slightly different from that of a 70-year-old girl, but for some reason everyone believes that the spine, its intervertebral discs, do not undergo the same pronounced temporal 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 upright.Man is the only species on earth that walks on two legs among all mammals, and this is the only form of locomotion.Osteochondrosis became the scourge of humanity, but we freed our hands and created civilization.Thanks to upright walking (and osteochondrosis), we not only created the wheel, the alphabet and mastered the fire, but you can also sit at home, in the heat, and read this article on your computer screen.
The closest relatives of a person, higher primates, chimpanzees and gorillas, sometimes stand on two legs, but this method of movement is auxiliary for them, and in most cases they still move on four legs.In order for osteochondrosis, as well as intensive aging of the intervertebral discs, to disappear, a person needs to change the way he moves and eliminate the constant vertical load from the spine.Dolphins, orcas and whales do not suffer from osteochondrosis, and dogs, cows and tigers do not suffer from it.Its column does not withstand long-term static and shock vertical loads, since it is in a horizontal state.If humanity goes to sea and the natural means of transportation is diving, then osteochondrosis will be defeated.
Upright posture forced the human musculoskeletal system to evolve to protect the skull and brain from shock loads.But discs (elastic pads between the vertebrae) are not the only method of protection.A person has an elastic 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 "rattle" 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 mobility and reduced quality of life.Let's consider these risk factors, which are often ignored by doctors, especially in private medical centers.After all, it is much more profitable to constantly treat a person than to point out the cause of the problem, fix 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 jumping and the impact is transmitted up to the spine without softening.The intervertebral discs experience significant stress and collapse quickly;
- overweight and obesity: no comments needed;
- Improper lifting and carrying of heavy objects, with uneven pressure on the intervertebral discs.For example, if you lift and carry a bag of potatoes on one shoulder, the intense load will fall on one edge of the discs and may be excessive;
- physical inactivity and sedentary lifestyle.It was said above that it is when sitting that the maximum pressure on the discs occurs, since a person never sits straight, but always leans "slightly";
- chronic injuries, slipping on ice, intense weight lifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags in your hands.
General symptoms
The symptoms that will be described below exist outside of the location.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 frequently.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 pressure from a protrusion or herniation of the intervertebral disc of the root corresponding to this level.Each nerve root consists of two portions: sensory and motor.
Depending on where exactly the hernia is going and what part of the root has been compressed, there may be sensory or motor disorders.Sometimes both disorders occur at the same time, expressed to varying degrees.Pain also belongs to sensory disorders, since pain is a special and specific feeling.
Radicular pain: compression radiculopathy.
Radicular pain is familiar to many;It's called "neuralgia."The inflamed nerve root reacts violently to any shock and the pain is very sharp, similar to an electric shock.Shoot the arm (from the neck) or the leg (from the lower back).Such a sharp and painful impulse is called lumbago: in the lumbar area it is lumbago, in the neck it is cervicago, a rarer term.This radicular pain requires a forced, analgesic or antalgic posture.Radicular pain appears immediately when coughing, sneezing, crying, laughing or straining.Any impact on the inflamed nerve root causes increased pain.
Muscle pain: myofascial tonic
But an intervertebral hernia or disc defect may not compress the nerve root, but when moving, injure nearby ligaments, fascia, and deep back muscles.In this case, the pain will be secondary, painful, permanent, stiffness will occur in the back and this pain is called myofascial.The source of this pain will no longer be the nervous 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 constant spasm, which will be very painful.
A characteristic symptom of this type of secondary myofascial pain will be increased stiffness in the neck, lumbar or thoracic spine, the appearance of dense and painful muscle protrusions, "rollers" next to the spine, that is, paravertebral.In these patients, back pain intensifies after several hours of “office” work, with prolonged immobility, when the muscles practically cannot work and are in a state of spasm.
Sensory disorders
If a bulge, hernia, or spasmodic muscle presses on the sensitive part of the nerve root, various sensory disorders occur.They may be accompanied by pain or may appear separately, once the pain has passed.There are also completely painless forms of sensory disorders, but in rare cases.
Many people are familiar with numbness of the tips of the fingers and toes (hypoesthesia or complete anesthesia), decreased sensitivity of the skin in the form of long, root-type stripes.Sometimes paresthesia or tingling, a sensation of “goosebumps” occurs.Most often, sensitivity disorders occur in the feet and the tips of the fingers and toes.Sensory disorders are quite unpleasant, but sensory disorders do not invalidate a person, but motor disorders may well cause it.
Motor disorders in the periphery.
If a motor neuron or axons that are part of the motor portion of a nerve are affected, muscle weakness or complete immobility occurs.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, these disorders appear in the legs, with protrusions and hernias of the lumbar spine.There are motor structures that innervate the muscles of the lower leg and foot.Therefore, with advanced and complicated lumbar osteochondrosis, the foot may whip.Turning inward, the person is forced to raise the leg high in order to take a step with the whipping foot, this is called steppage, “rooster march.”
But the whole danger of movement disorders is that they can occur isolated and not accompanied by pain.And if a person "does not feel pain", he may not get to the doctor in a timely manner.Therefore, it is very important for patients with progressive bulges and hernias, for example, of the lumbar region, to periodically walk on their toes and heels and monitor the work of their muscles.
Local symptoms: main signs.
Let us now consider specific symptoms and syndromes characteristic of cervical, thoracic and lumbar osteochondrosis.Let's go from top to bottom, from the cervical region down, passing through the thoracic region, until we reach 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, establishing the presence of concomitant muscle spasm by simple palpation of the muscles along the spine.Is it possible to confirm the diagnosis of osteochondrosis by X-ray examination?
An “X-ray” of the cervical spine, and even with functional tests of flexion and extension, does not show cartilage, since its tissue transmitsand dehydrated.Functional testing can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be seen using CT or MRI, MRI and X-ray CT are indicated to clarify the internal structure of the cartilage and formations such as bulges and hernias.Thus, with the help of these methods, an accurate diagnosis is made and the result of the tomography is an indication, and even a topical guide, for the surgical treatment of a hernia in the neurosurgery department.
Treatment of complications of osteochondrosis.
Let us 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 it is necessary to move correctly, not gain weight and avoid the appearance of bulges and muscle pain;
- If you already have a bulge, you must be careful not to break the annulus fibrosus, that is, not to transform the bulge into a hernia and avoid the appearance of bulges at various levels;
- if you have a hernia, then you should dynamically monitor it, perform regular MRI scans, avoid increasing its size or carry out modern minimally invasive surgical treatment, since, without exception, all conservative methods of treating exacerbation of osteochondrosis leave the hernia in place and only eliminate temporary symptoms: inflammation, pain, stitches and muscle spasms.
But with the slightest violation of the regime, with heavy lifting, hypothermia, injuries, weight gain (in the case of the lower back), the symptoms return again and again.We will describe how to cope with unpleasant sensations, pain and limited mobility in the back against the background of an exacerbation of osteochondrosis and an existing protrusion or hernia, secondary to social tonic syndrome.
What to do during an exacerbation?
Since there has been an attack of acute pain (for example, in the lower back), you should follow the following instructions at the premedical stage:
- completely eliminate physical activity;
- sleep on a hard one (orthopedic mattress or hard sofa), eliminating sagging back;
- It is advisable to wear a semi-rigid corset to avoid sudden movements and “distortions”;
- You should place a massage pillow with plastic needle applicators on your lower back or use a Lyapko applicator.It should be kept for 30 to 40 minutes, 2 to 3 times a day;
- after this, ointments containing NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- After rubbing, on the second day you can wrap your lower back with dry heat, for example, with a belt made of dog hair.
A common mistake is to warm up on the first day.It could be a heating pad, bath procedures.At the same time, the swelling only intensifies and with it the pain.It can be warmed only after the "peak pain point" has passed.After this, the heat will improve the "resorption" of the swelling.This usually happens within 2 or 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 spinal problems), things go like this:
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluid consumed are indicated.You can even give him 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 swelling of the nervous tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming maximum pain, "injections" should no longer be taken and attention should be paid to restorative agents, for example, modern drugs of group "B".They effectively restore altered sensitivity, reduce numbness and paresthesia.
Physiotherapeutic 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 subsided, but the muscle spasm has not yet 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 at the surrounding muscles.Its task is to relieve tonic spasm, improve blood flow, and also normalize venous flow.This is what causes a decrease in muscle tone, a decrease in pain intensity and stiffness in the back.
Exercises for osteochondrosis should be performed after a light general warm-up, on the “warmed up muscles.”The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, to avoid relapses, the use of weights is not allowed;A gymnastics mat and a gymnastics stick are used.With its help, you can effectively restore the range of motion.
Continue rubbing ointments and using the Kuznetsov applicator.Swimming, underwater massage and Charcot shower are shown.It is during the exacerbation stage that medications for magnetic therapy and home physiotherapy are indicated.
Usually, treatment lasts no more than a week, but in some cases osteochondrosis can manifest itself with such dangerous symptoms that urgent surgical intervention may be necessary.
About Shants necklace
In the early stages, during the acute stage, it is necessary to protect the neck from unnecessary movements.The Shants necklace is ideal for this.Many people make two mistakes when purchasing this necklace.They do not choose it according to its size, so it simply does not fulfill its function and causes a feeling of discomfort.
The second common mistake is to use it for prophylactic purposes for a long time.This causes weakness in the neck muscles and only causes more problems.For a necklace, there are only two indications under which it can be worn:
- the appearance of acute pain in the neck, stiffness and pain spreading to the head;
- if you are going to carry out physical work while in full health, in which there is a risk of "straining" the neck and suffering aggravation.This is, for example, repairing a car, when you lie under it, or washing windows, when you need to reach out and take awkward positions.
The collar should not be worn for more than 2 to 3 days, as prolonged use 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 advisable that each 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 quite large hernias, without long hospital stays, without being forced to lie down for several days, without compromising the quality of life, since they are performed using modern videoendoscopic technology, radiofrequency, laser or cold plasma.It can evaporate part of the grain and lower the pressure, reducing the risk of suffering a hernia.And it is possible to eliminate the defect radically, that is, by getting rid of it completely.
There is no need to be afraid of operating on hernias;These are no longer the previous types of open operations of the 80-90s of the last century with muscle dissection, blood loss and a long recovery period afterwards.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 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;
- perform types of exercise that reduce the load on the back (swimming);
- abandon bad habits;
- Alternate 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;
- At least an X-ray of the lumbar spine in two projections, or an MRI, can be performed periodically to find out if the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and mobile for life.