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Treatment of osteochondrosis

severe pain with osteochondrosis

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

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

  • Increased lifespan. Over time, metabolism slows down, tissue nutrition is disrupted, destructive regulatory systems begin to prevail over constructive ones
  • Walk upright. Standing, the person acquired an uneven load on different parts of the spine, he was able to perform a greater amount of movement - to twist, to extend. Abnormal lateral folds appeared - scoliosis - with an uneven load on the muscles and small joints of the spine. This increased the likelihood of disease formation even in the ward where low mobility and rib cage protect the vertebrae - thoracic osteochondrosis
  • Acceleration. Rapid growth makes bones, muscles and cartilage more vulnerable. The number and prevalence of blood vessels is insufficient to supply them with oxygen and essential substances
  • Lack of adequate physical activity. There are two extremes: sedentary work and car-only movement or excessive stress in the gym, when discs and cartilage wear out at an accelerated rate
  • Incorrect feeding. The predominance of fast carbohydrates, lack of protein, the use of carbonated drinks leads to the fact that the body does not have enough high-quality building materials to maintain tissue health
  • To smoke. It causes prolonged vasospasm - disruption of tissue nutrition, acceleration of degenerative processes
  • Urbanization, a large number of traumatic objects around lead to spinal injuries, secondary osteochondrosis

Types of osteochondrosis

By location

  • Osteochondrosis of the cervical spine
  • Injury to the thoracic spine
  • Lumbar osteochondrosis
  • Common osteochondrosis - cervical and lumbar, thoracolumbar, lumbosacral and other combinations

The most common changes in the most mobile parts are cervical and lumbar. The sore point is the passage of the mobile lumbar region to the fixed sacral one.

per phase

  • Initial: small changes in the center of the disc, compaction of the core, the appearance of cartilage cracks
  • The progression of the disease: the cracks deepen, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs - due to a violation of the relationship between the vertebrae, the cartilage on the surfaces of small joints is erased unevenly, osteoarthritis and arthritis develop
  • Complicated osteochondrosis - symptoms: further degeneration of cartilage occurs - breaks in the cartilaginous ring appear that connect the bodies of two adjacent vertebrae. Part of the nucleus protrudes through 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. Disturbance from severe pain, impaired sensation and movement in the area for which the compressed nerve is responsible
  • The organism responds to increased load and excess mobility through 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, this causes "vertebral artery" symptoms - dizziness, tinnitus, flickering of spots in front of the eyes

Osteochondrosis of the cervical spine

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

Cervical osteochondrosis - symptoms

  • Pain in the neck that extends to the back of the head, upper back
  • Sometimes the headache associated with cervical osteochondrosis mimics migraine: one-sidedness of symptoms, intolerance to sounds and bright light, strong throbbing in the temples, bright flashes in front of the eyes
  • Frequent headaches that do not respond well to conventional tablets
  • Pressure losses resistant to antihypertensive drugs
  • Vertigo and darkening of the eyes with sudden dizziness of the head
  • Numbness in the fingers, especially after sleep, burning sensation on the skin
  • Neck movement restriction, crunch when trying to move. Patients have to turn their entire body to see something behind them
  • Sweating of the upper body
  • Tense muscles of the neck and shoulder girdle can be detected by palpation.

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

Manifestations of osteochondrosis of the thoracic spine

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

Symptoms of injury to the thoracic region:

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

Lumbar and lumbosacral osteochondrosis

In the structure of all types of osteochondrosis, these wards are confident leaders, more than half of all diagnosed cases. The reason is that the greatest load falls on this area of the body, whether standing or sitting. Body weight, load in case of improper weight lifting, for a long time in a bent position - the pulpy nucleus of the intervertebral discs is in a state of compression, it is pressed into the vertebral bodies through the cartilaginous plates - Schmorl's hernias are formed. Overloading and muscle spasm disrupt the position of the small joints of the vertebrae relative to each other: the articular cartilage is erased, mobility decreases.

Several vicious circles develop simultaneously: muscle spasm gives pain - pain reflexively increases the contraction of muscle fibers, acute pain forces a person to limit movement, spares the damaged area - the strength of the muscle frame and the support of the spine decrease, this increases its instability, lumbar osteochondrosis progresses.

At the point of cell phone transitionlumbarin a sacred immovable fused into a single monolith, there is the danger of slipping of the fifth lumbar vertebra from the surface of the sacrum. This pinches the nerve bundles, radicular syndrome develops.

Lumbar Osteochondrosis Symptoms

  • 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 acute low back pain when changing the state of the body, lifting weights, loading heavy. The patient remains stuck in the position in which he was caught by the attack, it is difficult to straighten up, to start moving. Low back pain is usually associated with compression of the spinal nerve root, which has developed acutely
  • The transition of pain to the gluteal region, legs. The largest nerve in the body, the sciatic, is a direct continuation of the spinal root; therefore, patients with lumbar osteochondrosis are often concerned about sciatica
  • Due to the fact that nerve fibers control the tone of muscles and blood vessels, regulate the nutrition of tissues, changes are noted in that part of the trunk for which the diseased nerve is responsible. The limb looks colder than the healthy one. With a prolonged course of the disease, muscle atrophy, dry skin and swelling are noted. Local immunity decreases: any scratches, cuts, abrasions easily become an entrance gate for infection
  • The defeat of sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may be burned or frozen due to the fact that he did not feel a dangerous change in temperature.
  • Very frightening symptoms: numbness of the skin of the perineum, loss of control over the pelvic organs. The patient does not feel a full bladder, does not feel the need to empty the intestine. Over time, urine and feces begin to be excreted on their own, it is not possible to hold them. In this case, the treatment of osteochondrosis of the spine and its complications is performed surgically, in an emergency.

Osteochondrosis Diagnosis

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

  • The specialist finds out the main complaints, the time of their appearance, development, the effect of drugs on the intensity of pain, rest, changes in the rhythm of life
  • An obligatory external examination is performed when the patient undresses in 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. Symptoms of tension are determined, indicating muscle tension and irritation of their tendons and integumentary membranes - fascia
  • The neurological hammer will reveal the uniformity and symmetry of the reflexes
  • The neurologist records the volume of active (autonomous) and passive (performed by the doctor) movements in the joints, the ability to turn the head, the upper 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 performed in at least two projections: direct and lateral. The image will tell the state of the bone tissue, the severity of osteoporosis, the size and safety of the vertebral bodies, and reveal osteophytes. Damaged discs are determined by the width and evenness of the intervertebral fissures. Irregularity of the lower or upper edge of the body will make one suspect a Schmorl hernia. To clarify the nature of changes in the bone structure of the spine, computed tomography is recommended. The multispiral examination allows for 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 search results must be compared with the complaints and changes found during the examination. Detecting signs of spinal osteochondrosis and even herniated disc without complaints does not require serious measures.

Treatment of osteochondrosis of the spine

Removal of acute manifestations of the disease

  • Severe pain and strong 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, blockade with painkillers and hormonal drugs is carried out

Radio frequency denervation

Bed rest is recommended for several days

After the symptoms subside, you need to start moving, gradually increasing the range of motion and load. At this time, the active dough, massage is undesirable due to possible complications.

Osteochondrosis: treatment without exacerbations

When the patient's condition stabilizes, the usual slowness remainsosteochondrosis, the treatment consists of several components:

  • Drug. All the same anti-inflammatory pain relievers in tablets, capsules and ointments. A specific drug is selected by the doctor based on the patient's condition, lifestyle, concomitant diseases, the predominance of one or another component of osteochondrosis. A course of vitamins of group B will improve the conduction of impulses along the nerve, normalize the nutrition of tissues. While maintaining the increase in muscle tone, the use of muscle relaxants will continue. There is no magic pill, no injection that can restore the vertebrae and cartilage to their original state. Medicines relieve symptoms, improve mobility and performance. But they are unable to completely stop the progression of the disease.
  • Physiotherapy. It is used for administering drugs directly to the sore spot (electrophoresis), heating (paraffin, infrared irradiation). Exposure to therapeutic currents relaxes the muscles, improves the functioning of nerve fibers. After several sessions, the pain subsides, mobility is restored. Not prescribed for active inflammation
  • Manual manipulation, massage, acupuncture, acupressure. Relieves spasm by stretching and relaxing the muscles. If during the massage only the upper layer of the muscles is affected, then manual therapy penetrates deeper, so the requirements for specialists are higher. Be sure to do an MRI scan first to find out 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 caveat is that it must be applied throughout life. Of the advantages: it provides activity, improves mood, increases the tone of tissues. The best methods are a series of exercises recommended by a doctor, initial yoga asanas, pilates, swimming. They are performed smoothly, without sudden and traumatic movements, stretching the fabric, gradually increasing the amplitude
  • Proper nutrition and giving up bad habits
  • A sufficient supply of nutrients to the tissues, a good condition of the blood vessels and an adequate supply of blood to the vertebrae and surrounding structures are measures to prevent the progression of osteochondrosis. Proper 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:

  • Treatment and diagnostic block
  • Ablation of the veneers with radiofrequency
  • 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 in the place where the median 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 nerve clotting. 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 inwards.

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 present, 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 45-60 minutes. Pain syndrome significantly decreases or disappears completely soon after surgery in 95% of patients. The next day the patient can walk and is soon discharged from the clinic.

Endoscopic removal of herniated discs:

A loose hernia or seizure is removed through the lateral intervertebral foramen. To position the tube, a 5 mm incision is made in the skin. Muscles, fascia and ligaments are not damaged, they are removed by means of a system of tube retractors with a gradual increase in diameter. The operation is almost bloodless and takes only 40-50 minutes. Patients can return to 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 sensation, movement, pelvic dysfunction, the patient should be urgently referred to a neurosurgeon. The sooner the compression can be eliminated, the more complete the recovery will be, the person will quickly return to normal life. In this case, surgical treatment is aimed at decompression of compressed neural structures and stabilization of the affected segment. This is a hemi or laminectomy. Fixation is done by a transpedicular system, in combination with an interbody fusion cage, which provides 360 degree fusion. Interspinous stabilization of the vertebrae is widely used. There are several interspinous implants today. Microdiscectomy in combination with interspinous stabilization, especially in the elderly, can significantly increase the efficacy of long-term outcomes and reduce the likelihood of recurrent disc herniation.