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Treatment of osteochondrosis

severe pain with osteochondrosis

Osteochondrosis - dystrophic changes in the spine associated with age-related tissue aging. 80% of the pathology is associated with genetic data, the rest is the impact of external factors.

Osteochondrosis- predominantly human disease, the development of which is facilitated by:

  • Longer life. Over time, the metabolism slows down, tissue nutrition is disturbed, destructive regulatory systems begin to prevail over constructive ones
  • Walk upright. Standing on his feet, the person acquired an uneven load on different parts of the spine, was able to perform a greater amount of movement - for twisting, extension. Abnormal lateral curvatures - scoliosis - with an uneven load on the muscles and small joints of the spine appeared. This increased the likelihood of disease formation even in the department where poor mobility and the rib cage protect the vertebrae - thoracic osteochondrosis
  • Acceleration. Rapid growth makes bones, muscles, and cartilage more vulnerable. Insufficient number and prevalence of blood vessels to supply them with oxygen and essential substances
  • Lack of adequate physical activity. There are two extremes - sedentary work and movement exclusively in the car or excessive stress in the gym, when discs and cartilage are wearing down at an accelerated rate.
  • Bad nutrition. The predominance of fast carbohydrates, a lack of protein, the use of carbonated drinks lead to the fact that the body does not have enough high-quality building materials to maintain tissue health
  • Smoking. Causes prolonged vasospasm - disruption of tissue nutrition, acceleration of degenerative processes
  • Urbanization, a large number of traumatic objects around lead to damage to the spine, secondary osteochondrosis

Types of osteochondrosis

By location

  • Osteochondrosis of the cervical spine
  • Thoracic spine injury
  • Lumbar osteochondrosis
  • Common osteochondrosis - cervical and lumbar, thoraco-lumbar, lumbosacral and other combinations

The most common changes in the more mobile parts are the cervical and lower back. The sore point is the transition from the mobile lumbar region to the fixed sacral region.

By step

  • Initial - small changes in the center of the disc, compaction of the nucleus, the appearance of cartilage cracks
  • The progression of the disease - the cracks widen, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the nerve roots of the spine leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs - due to a violation of the ratio of the vertebrae, the cartilage on the surface of small joints is unevenly erased, osteoarthritis and arthritisAre growing
  • Complicated osteochondrosis - symptoms: further degeneration of the cartilage occurs - ruptures of the cartilage ring that connect the bodies of two adjacent vertebrae appear. Part of the nucleus protrudes from the free space and squeezes the roots, the spinal cord - a herniated disc is formed. A more serious problem is the separation of the fallen part - a sequestered hernia. Disturbed by severe pain, altered sensation and movement in the area for which the compressed nerve is responsible
  • The body responds to the increased load and excessive mobility with the growth of bone tissue - osteophytes appear. They stabilize the spine but reduce the range of motion. Bone hooks irritate muscle receptors and press on nearby vessels. With cervical osteochondrosis, it causes "vertebral artery" symptoms - dizziness, tinnitus, flickering of the points in front of the eyes.

Osteochondrosis of the cervical spine

With the advent of cell phones and computerscervical osteochondrosiseven in adolescents: prolonged unnatural position of the head with muscle tension overloads the vertebrae, their discs and joints.

Cervical osteochondrosis - symptoms

  • Neck pain extending to back of head, upper back
  • Sometimes the headaches associated with cervical osteochondrosis mimic a migraine - one-sided symptoms, intolerance to sounds and bright light, strong pulsation in the temples, flashes of light in front of the eyes
  • Frequent headaches that do not respond well to conventional tablets
  • Pressure drops resistant to antihypertensive drugs
  • Dizziness and darkening of the eyes with sharp turns of the head
  • Numbness in the fingers, especially after sleep, a feeling of crawling on the skin
  • Restriction of movement in the neck, crunch when trying to move. Patients have to turn their whole body to see something behind them
  • Upper body sweating
  • Tense muscles of the neck and shoulder girdle can be detected on palpation.

If identifiedcervical osteochondrosis, treatment in the early stages prevents serious complications - compression of the vertebral artery with lack of oxygen to the brain, compression of the spinal cord.

Manifestations of osteochondrosis of the thoracic spine

Changes in the thoracic region develop less often, causing factors - back injuries, scoliosis, previous diseases of the spine (tuberculous, nonspecific spondylitis, bodily hemangiomas).

Symptoms of the lesion of the thoracic region:

  • Back pain - stiffness, tightness, worse after prolonged standing or sitting in an uncomfortable position. But with constant complaints of pain, other possible causes should be excluded - pneumonia, pleurisy, tumors, intercostal neuralgia of a different nature, shingles before the appearance of bubbles
  • Difficulty breathing, shortness of breath, inability to breathe deeply
  • Thoracic osteochondrosis sometimes mimics angina attacks - a person is treated for a long time by a cardiologist, and the problem is with a diseased intervertebral disc

Lumbar and lumbosacral osteochondrosis

In the structure of all types of osteochondrosis, these services are confident leaders, more than half of all cases of diagnosis. The reason is that the greatest load falls on this area of the body, both standing and sitting. Body weight, load in case of incorrect weight lifting, for a long time in a bent position - the pulpy nucleus of the intervertebral discs is in a state of compression, is pressed into the vertebral bodies through the cartilage plates - Schmorl's hernias are formed. Surge and muscle spasms disrupt the location of the small joints of the vertebrae in relation to each other - the articular cartilage is erased, mobility decreases.

Several vicious circles develop at once: muscle spasms give pain - the pain reflexively increases the contraction of muscle fibers, sharp pain forces a person to restrict movement, spare the damaged area - the strength of the framemuscle and spine support decrease, this increases its instability, lumbar osteochondrosis progresses.

At the mobile transition pointLumbar spinein an immobile sacrum fused into a single monolith, there is a risk of the fifth lumbar vertebra sliding off the surface of the sacrum. This pinches the nerve bundles, radicular syndrome develops.

Symptoms of lumbar osteochondrosis

  • Low back pain, especially when sitting and standing. After rest, the horizontal position improves. With a prolonged course, the pain is habitual, aching, pulling
  • Sudden and sharp lumbago when changing the state of the body, lifting weights, heavy load. The patient remains stuck in the position in which he was caught by the attack, it is difficult to get up, to get into motion. Lumbago is usually associated with compression of the nerve root in the spine, which has developed acutely
  • The passage of pain in the gluteal region, in the legs. The largest nerve in the body, sciatica, is a direct extension of the spinal root; therefore, patients with lumbar osteochondrosis often worry about sciatica.
  • Due to the fact that nerve fibers control the tone of muscles and blood vessels, regulate tissue nutrition, changes are noted in the part of the trunk for which the diseased nerve is responsible. The limb is colder than the healthy limb. With a prolonged course of the disease, muscle atrophy, dry skin and swelling are noticeable. Local immunity wanes - any scrapes, cuts, abrasions easily become a gateway for infection
  • The defeat of sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may burn himself or have frostbite because he did not feel a dangerous temperature change.
  • Very frightening symptoms - numbness of the skin of the perineum, loss of control of the pelvic organs. The patient does not feel a full bladder, does not feel the need to empty the intestines. Over time, urine and stool begin to excrete on their own, it is not possible to keep them. In this case, the treatment of osteochondrosis of the spine and its complications is performed urgently.

Diagnosis of osteochondrosis

It is performed by a neurologist or orthopedist after the therapist has excluded the pathology of internal organs.

  • The specialist finds out the main complaints, the time of their onset, their development, the effect of drugs on the intensity of pain, rest, changes in the rhythm of life
  • A mandatory external examination is carried out when the patient undresses in his underwear - it is necessary to compare the condition and color of the skin on symmetrical parts of the body, the tone of the tissues, the reaction to various stimuli: pain, touch, cold or heat. Tension symptoms are determined, indicating muscle tension and irritation of their tendons and integumentary membranes - fascia
  • Neurological hammer will reveal uniformity and symmetry of reflexes
  • The neurologist records the volume of active (independent) and passive (performed by the doctor) movements in the joints, the ability to turn the head, the upper part of the body without involving the lower parts of the spine

If necessary, send for further examination

  • Thermal imaging diagnostics
  • ENMG (electroneuromyography): Radiography. To obtain the necessary information, it is carried out in at least two projections - direct and lateral. The picture will talk about the condition of the bone tissue, the severity of osteoporosis, the size and safety of the vertebral bodies, and reveal the osteophytes. Damaged discs are determined by the width and uniformity of the intervertebral cracks. An irregularity of the lower or upper border of the body will raise suspicion of Schmorl's hernia. To clarify the nature of the changes in the bone structure of the spine, computed tomography is recommended. The multispiral examination allows a three-dimensional modeling of the vertebrae. If necessary, to find out the condition of soft tissues - muscles, ligaments, intervertebral disc, MRI is prescribed.

It should be remembered that the results of the research should be compared to the complaints and changes noted during the examination. Detecting signs of spinal osteochondrosis and even a herniated disc without a complaint does not require serious action.

Treatment of osteochondrosis of the spine

Elimination of acute manifestations of the disease

  • Severe pain and sharp muscle tension reinforce each other, not allowing the exacerbation to subside. Therefore, the first is to relieve pain.
  • Prescribe non-steroidal anti-inflammatory drugs in injections, drugs to relax muscles - muscle relaxants
  • If these measures are not enough, a blockage with pain relievers and hormonal drugs is carried out

Radiofrequency denervation

Bed rest is recommended for several days

After the symptoms disappear, it is necessary to start moving, gradually increasing the range of motion and the load. At this stage, active kneading, massage is undesirable due to possible complications.

Osteochondrosis: treatment without exacerbation

When the patient's condition stabilizes, the usual gloom remainsosteochondrosis, the treatment includes several components:

  • Medication. All the same anti-inflammatory pain relievers in tablets, capsules and ointments. A specific drug is selected by the doctor depending on the patient's condition, lifestyle, concomitant diseases, the predominance of one or another of the components of osteochondrosis. A course of B vitamins will improve the conduction of impulses along the nerve, normalize the nutrition of the tissues. While maintaining the increase in muscle tone, the use of muscle relaxants will continue. There is no magic pill, an injection that could return the vertebrae and cartilage to its original state. The drugs relieve symptoms, improve mobility and improve performance. But they are not able to completely stop the progression of the disease.
  • Physiotherapy. It is used for the administration of drugs directly to the sore spot (electrophoresis), warming (paraffin, infrared irradiation). Exposure to therapeutic currents relaxes muscles, improves the functioning of nerve fibers. After several sessions, the pain decreases, mobility is restored. Not prescribed for active inflammation
  • Manual manipulation, massage, acupuncture, acupressure. Relieve spasms by stretching and relaxing the muscles. If during the massage only the upper layer of the muscles is affected, the manual therapy penetrates deeper, therefore the requirements for specialists are higher. Be sure to do an MRI first to learn about the characteristics of a particular patient's anatomy
  • Spinal traction. The vertebrae move away from each other, the normal distance between them is restored, the pinching of the nerves decreases. The procedure has contraindications, so only a doctor can prescribe it
  • Physiotherapy. The most effective method of treatment. The only downside is that it has to be applied for life. Of the benefits - it provides activity, improves mood, increases tissue tone. The best methods are a set of doctor recommended exercises, initial yoga asanas, Pilates, swimming. They are performed smoothly, without sudden and traumatic movements, stretching the tissues, gradually increasing the amplitude
  • Good nutrition and the abandonment of bad habits
  • Adequate supply of nutrients to tissues, good condition of blood vessels, and adequate blood supply to vertebrae and surrounding structures are measures to prevent the progression of osteochondrosis. Good nutrition normalizes weight, reduces stress on the spine

Surgical treatment of osteochondrosis of the spine.Modern clinics have a large arsenal of minimally invasive interventions:

  • Blockage of treatment and diagnosis
  • Radiofrequency facet ablation
  • Cold plasma and laser nucleoplasty
  • Endoscopic removal of a herniated disc
  • Microdiscectomy

Radiofrequency thermal ablation of facet joints

Special needles are placed exactly on the side of the intervertebral joints where the middle branch of the Lyushka nerve passes. Electrodes are installed in the needles, the tip of which heats up to 80 degrees for 90 seconds. This leads to the coagulation of the nerve. The pain goes away.

Cold plasma nucleoplasty

Through a needle inserted into the disc, a special cold plasma electrode is applied to the disc tissue. The intradiscal pressure decreases, the hernia (protrusion) is pulled inward.

Microdiscectomy

With a herniated disc, the nerve roots and adjacent blood vessels are compressed, extremely painful sensations, and various disorders of the innervation of the extremities occur. If the effect of conservative treatment is no longer there, then surgery to remove a herniated disc is the only possible solution for many patients. The operation is performed under anesthesia through a 2-3 cm incision using microsurgical equipment and instruments. The duration of the operation is 45 to 60 minutes. The pain syndrome significantly decreases or disappears completely immediately after surgery in 95% of patients. The next day, the patient is allowed to walk and quickly leaves the clinic.

Endoscopic removal of herniated discs:

A hernia or free sequestration is removed by the lateral intervertebral foramen. To place the tube, a 5mm incision is made on the skin. The muscles, fasciae and ligaments are not damaged, they are separated using a system of tubular spacers whose diameter gradually increases. The operation is almost bloodless and lasts only 40 to 50 minutes. Patients can resume their usual regimen after three weeks. The risk of complications is minimal.

Decompression and stabilization operations are performed when complications arise, a large herniated disc, severe compression of the spinal nerve root and spinal cord. If there are signs of sudden loss of feeling, movement, pelvic dysfunction, the patient should be taken urgently to a neurosurgeon. The sooner it is possible to eliminate the compression, the more complete the recovery will be, the person will quickly return to normal life. In this case, surgical treatment is aimed at decompressing the compressed nerve structures and stabilizing the affected segment. It is a hemi or laminectomy. Fixation is achieved by a transpedicular system, in combination with an interbody fusion cage, which allows 360-degree fusion. Interspinous stabilization of the vertebrae is widely used. Today there are several interspinous implants. Microdiscectomy combined with interspinous stabilization, especially in the elderly, can greatly increase the effectiveness of long-term results and reduce the risk of recurrent herniated discs.