Osteochondrosis of the spine — it is a chronic disease in which degenerative changes occur to the vertebrae and stays between them are the intervertebral discs. Depending on the location of the lesion of the spine, we distinguish: osteochondrosis of the cervical, osteochondrosis of the thoracic department and osteochondrosis of the lumbar. For the diagnosis of degenerative disc disease of the spine is necessary to perform an x-ray, and in the case of its complications (eg, herniated intervertebral disc) - MRI of the spine. In the treatment of degenerative disc disease of the spine along with the cure methods are widely applied, reflexology, massage, manual therapy, physiotherapy and therapeutic physical training.
The etiology and pathological
In one degree or another osteochondrosis of the spine develops in all people over the age and is one of the processes of aging of the organism. Sooner or later in the intervertebral disc are formed atrophic changes, however, injury, disease and different overload of the spine contribute to the earlier occurrence of degenerative disc disease. Most often it occurs osteochondrosis of the neck and osteochondrosis of the lumbar spine.
Developed around 10 the theory of degenerative disc disease: vascular, hormonal, mechanical, genetic, infectious-allergic and other. But neither one of them does not provide a full explanation, occurring at the spine, changes, rather, they are complementing each other.
It is believed that the main point in the occurrence of degenerative disc disease is a constant congestion of the spinal motion segment, which consists of two adjacent vertebrae. Such overload may occur due to musculoskeletal stereotype — posture, an individual way to sit and walk. Disorders of posture, sitting in an incorrect posture, walk with an uneven spinal plague cause additional burden on the discs, ligaments and muscles of the spine. The process can be recovered from the functions of the structures of the spine and the kidneys trophic its tissues, caused by hereditary factors. Most malformations in the house occur in the cervical region and lead to vascular disorders and the early emergence of symptoms of degenerative disc disease of the cervical spine.
The incidence of degenerative disc disease of the lumbar often associated with its congestion in the slopes and the outputs of the severity. A healthy intervertebral disc can withstand heavy loads thanks to the hydrophilicity which is located in the center of nucleus pulposus. The core contains a large amount of water and fluids, as it is known a little smaller. Gap healthy intervertebral disc may occur when the strength of the compression more than 500 kg, while altered due to degenerative disease of the disc, the disc will burst when the strength of the compression of 200 units of Load of 200 kg is experiencing a lumbar department of the spine of a man weighing 70 kg, when you are holding 15 minutes pound load in the tilt position of the torso ahead on the 200. It's a lot of pressure is caused by the low value of the nucleus pulposus. When increasing the inclination up to 700 load on the intervertebral discs makes the 489 units Therefore often the first clinical manifestations of degenerative disc disease of the lumbar spine occur during or after lifting weights, perform household chores, weeding the garden, etc.
The destruction of the connective tissue of the fibrous rings of the disc, the ligaments and capsule of the facet joints provokes a reaction of the immune system and the development of aseptic inflammation with swelling of the facet joints and the surrounding tissues. Because of the displacement of the body of the vertebra's going on stretching the capsule of the facet joints and changed the intervertebral cd is no longer so firmly captures the bodies of adjacent vertebrae. It is formed by instability of the spinal segment. Because of the instability of possible pinched root of spinal nerves with the development of radicular syndrome. In osteochondrosis of the cervical spine is often occurs during the rotation of the head, in osteochondrosis of the lumbar — during předklonů hull. The possible creation of a functional block of the spinal motion segment. This is due to the compensatory reduction in vertebrate muscles.
Herniated disc occurs when the disc moves back, there will be a gap in the rear of the longitudinal ligaments and the swelling of the disc into the spinal canal. If during this into the spinal canal squeezes the core of the disc, then this hernia is called such. The severity and duration of pain, when such a hernia significantly more than when unexploded. A Herniated disc may cause radicular syndrome or spinal cord compression of the brain.
When osteochondrosis is happening overgrowth of bone tissue with the formation of osteophytes — bony growths on the body and processes of the vertebrae. Osteophytes can also cause compression of the spinal cord or to become a cause of the development of radicular syndrome.
Symptoms of degenerative disc disease of the spine
The main symptom of degenerative disc disease of the spine is pain. The pain can be acute with high intensity, it is better at the slightest movement of the affected segment, and therefore causes the patient to take a forced situation. So in osteochondrosis of the cervical spine, the patient holds the head in the least painful position and can't turn it in osteochondrosis of the breast department pain gets worse even with deep breathing and in osteochondrosis of the lumbar the patient to severe subsidence, standing up and walking. Such a painful typical for the compression of the root of the spinal nerve.
Approximately in 80% of cases there was the dull pain of a permanent nature and of medium intensity. In similar cases in the control of the doctor it is necessary to distinguish the manifestations of degenerative disc disease of the spine from myositis of the back muscles. Dull pain in osteochondrosis caused by excessive muscle tension, restriction of the affected spinal motion segment, inflammatory changes or significant stretching of the intervertebral disc. Patients with this pain syndrome, the forced position is missing, but draw attention to the restrictions in movement and physical activity. Patients with osteochondrosis of the cervical spine avoid sharp bends and předklonů head, with osteochondrosis of the lumbar - slowly sit down and rises, avoid předklonů hull.
Complications of degenerative disc disease of the spine
Complications of degenerative disc disease are associated with hernia of the intervertebral disc. These include compression of the spinal cord, which is characterized by numbness, weakness of certain muscle groups of the limbs (depending on the level of compression), leading to the formation of paresis, muscle atrophy, changes in tendon reflexes, disturbances of urination and bowel movements. Intervertebral hernia can be a cause of compression of the artery, the power supply of the spinal cord, with the formation of ischemic land (attack of the spinal cord) with the loss of nerve cells in the brain. It is manifested by the emergence of neurological deficit (violation of movements, loss of sensation, trophic disorders), the corresponding level and the occurrence of ischemia.
The diagnosis of degenerative disc disease of the spine
The diagnosis of degenerative disc disease of the spine performed by a neurologist or spine. Initially produce chest x-rays of the spine in 2 planes. In case of need can make shooting the individual spinal segment and shooting at other planes. For the diagnosis of intervertebral hernia, assessment of the condition of the spinal cord and to identify the complications of degenerative disc disease applying magnetic resonance tomography (MRI spine). A great role is played by MRI in the differential diagnosis of degenerative disc disease and other diseases of the spine: tuberculous spondylitis, osteomyelitis, tumor, disease Bechterew, rheumatism, infectious lesions. Sometimes in cases of complicated degenerative disc disease of the cervical spine should be an exception to syringomyelia. In some cases, when the impossibility of performing MRI shows myelography.
Observation studies of the affected intervertebral disc is possible using the discography. Electrophysiological study is used to determine the extent and localization of lesions of neural pathways, monitor the process of their recovery during therapy.
Treatment of degenerative disc disease of the spine
In the acute period is indicated by the serenity of the affected spinal motor segment. With this goal in osteochondrosis of the cervical spine applying fit using the collar Trench in osteochondrosis of the lumbar — bed rest. Fixation is necessary and in osteochondrosis of the cervical with the instability of the spinal segment.
In retroviral the treatment of degenerative disc disease applied a non-steroidal anti-inflammatory drugs (NSAIDS): diclofenac, nimesulide, lornoxicam, meloxicam. During intense pain syndrome shows analgesics, for example, an analgesic central action of flupirtine. For the release of muscle tension used muscle relaxants — tolperison, tizanidine. In some cases, it is appropriate to the appointment of anticonvulsants - carbamazepine, gabapentin; antidepressants, among which preference is given to selective serotonin reuptake inhibitors (escitalopram, paroxetine).
Upon the occurrence of radicular syndrome of the patient is indicated constitutional treatment. Maybe it's the local the introduction of glucocorticoid therapy against the swelling, the application of traction. In the treatment of degenerative disc disease is widely used physiotherapy, reflexology, massage, therapeutic exercise. The application of manual therapy requires a clear compliance with the technology of its design and take special care in the treatment of degenerative disc disease of the cervical spine.
Surgery on the spine shows mainly in a significant compression of the spinal cord. It consists in the removal of a herniated intervertebral disc and decompression of the spinal canal. Maybe holding a microdiscectomy, laser reconstruction of the disk, replacement of the affected disk implant, stabilize the spinal segment.