Osteochondrosis of the spine - Causes, symptoms and treatment. MF.

Osteochondrosis is a chronic remitting degenerative-dystrophic disease of the intervertebral disc, vertebral bodies, intervertebral joints, ligamentous apparatus, roots, veins, arteries, sympathetic nervous system, fascia and muscular corset.

Basis of spine pathology - the entire vertebral motor segment( PDS) - two vertebral bodies, a disc, adjacent neuromuscular structures. The main character of the pain syndrome is the muscular structure.

For the development of pathology of the PDS,

is important - the pathology of the bony structures of the vertebrae - arthrosis, arthritis, osteoporosis;
- vascular pathology,
- muscular imbalance,
- pathology of the ligamentous apparatus( atrophy of ligaments with subsequent calcification contributes to infringement of nerves and vessels),
- pathology of discs: pathology of hyaline plates, pathology of fibrous ring - anterior hernia( clinically insignificant), lateral(with compression of rootlets and vessels - radiculopathy and radiculo-ischemia), posterior( compression of membranes, vessels, spinal cord), pathology of pulpous nucleus.

Chondrosis of the nucleus is a loss of fluid, osteochondrosis - degenerative-dystrophic changes are formed around the altered nucleus.

Osteochondrosis develops under the influence of basic factors that can not change a person - strabismus, sitting, imperfection of the spinal blood supply, leading to early hypoxia and physiological aging, autoimmune reactions, hypothalamic-pituitary-adrenal disorders. Deforming spondylosis is a protective reaction of the body."Thorns, hooks" on X-rays are a defense against spondylolisthesis. Risk factors for

include:

- muscular dysfunction
- microtraumas, forced postures
- infections and intoxications
- pathology of internal organs( according to the sclerotomy localization, the internal organs can cause pain in the spine, the sick spine can aggravate the existing pathologyinternal organs, but not cause it)
- "bad" legs, leading to dysfunction of the spinal column - flat feet, varus and valgus deformities. .. disrupting gait, inbinding muscle imbalances( with walking involved muscles that should not go), hypertonicity and pain
syndrome - psychogenic factors( vyvzyvaet degenerated muscle hypertonicity and pain).

Pain is always a shortage of endorphins. Their quantity is regulated by the limbic-reticular formation and the cortex of the brain. During stress, regulation is disturbed and endorphins are not enough. As a consequence, any pathology is aggravated, including muscle. Psychogenic pains are muscular. Symptoms of osteochondrosis at the cervical level.

The cervical region is characterized by a small muscle mass, a large number of vital organs - the vertebral artery supplies the cervical and limbic-reticular complex, posterior cervical sympathetic plexus, sympaticus trunk, thyroid gland, ENT organs. This determines the clinical picture of pathology.

Cervicalgia - pain in the cervical spine. This is an undifferentiated muscular reaction to any pathology in the cervical region. There are values ​​of angina, acute respiratory disease, retropharyngeal abscess, pathology of the apex of the lungs, mediastinum, teeth, coronary spasm and even myocardial infarction. The pains can be sharp and blunt, worse with head inclinations, coughing, can be irradiated to the head( cervicocranium).When examined, the positive symptom of Neri, Dejerine, the movements are limited in volume, painful.

Cervical-brachialgia - pain in the neck with irradiation of pain in the arm, possibly a sensitivity disorder in the hand, numbness, paresthesia.

Syndrome of anterior staircase - pain in the neck, numbness, paresthesia, tingling, hyperhidrosis, then plexalgia passes into plexitis. At the base of the spasm of the anterior staircase muscle, only 25 to 28% of the cases are caused by the osteochondrosis of the spine, the remaining% are traumas, pathology of the lungs, mediastinum, calculous cholecystitis.

Shoulder-scapular periarthritis and periarthritis - pains in the shoulder joint, clavicle, scapula, restriction of arm movements upwards and establishment behind.

Epicondylosis - pain in the elbow joint, local, in the nasier or internal condyle, restriction of movements. They are more common for injuries, for sportsmen, when working on a conveyor belt, a garden. ..

Shoulder-brush syndrome - pain in the neck, then in the shoulder, then in the brush, brush swelling, hyperhidrosis, pain syndrome disappears and atrophy, necrosis develops.

Cardialgia .There are no true vertebral cardialgias. A "bad" backbone can be a risk factor for compromised cardiac muscles.

Syndrome of the vertebral artery -

- functional - cervical posterior sympathetic syndrome( s / m Bare-Lieu, cervical migraine) - half headache and neck pain, "like a removed helmet", nausea, vomiting, vestibulopathy - staggering,dizziness, photopsy, ear noise,
- organic - vertebrob basilar insufficiency - develops in the presence of atherosclerotic manifestations in the vessels.

Radicular syndromes - are rare( 18%) - caused by compression or irradiation of the spine or vessel( radiculohemia):

C2C3 - pain in the neck, sensation of swelling of the tongue, glossodynia;
С3С4 - pain in shoulder and forearm, heart, increased diaphragm tone;
С4С5 - pain in the neck, shoulder, forearm, hypotension in the C5 zone, weakness of the deltoid muscle;
С5С6 - pain from the shoulder shoulder over the outer surface of the shoulder in the thumb and index fingers, sensitivity in the root zone is reduced, the reflex from the biceps muscle has dropped, the force in 1 and 2 fingers is decreased;
С6С7 - pains on the posterolateral surface of the forearm with irradiation in the middle finger, sensitivity in the root zone decreased, the reflex from the triceps muscle fell out, the weakness of the triceps muscle decreased;
С7С8 - pain in the foreleg, on the inner surface of the shoulder and forearm, 4 - 5 fingers, hypoalgesia in the root zone, muscle weakness. Symptoms of osteochondrosis at the thoracic level.

The thoracic region is characterized by a small amount of muscles, the presence of a bone( costal-chest) carcass for internal organs, low mobility of the thoracic spine. Degenerative - dystrophic pathology develops faster and earlier in the thoracic department.

The thoracic area is often prone to kypho-scoliotic deformities.

Thoracalgia - pain in the thorax - muscular-vegetative complex, undifferentiated muscular reaction to any pathology. Pains are associated with immobility - a prolonged standing, sitting, night pains, intensifying with inclines, deep inspiration, coughing. More often thoracalgia is caused by diseases of internal organs - lungs, heart, stomach, gall bladder, herpetic infection. ARI, bronchitis, pneumonia, pleurisy, pneumothorax, lung tumor, pulmonary tuberculosis, angina pectoris, myocarditis, myocarditis, peptic ulcer, cholecystitis, pancreatitis, esophagitis - all will give thoracology. More often there is an intercostal myalgia or a neuralgia.

Cardial syndrome .

Syndrome of anterior staircase .

anterior thoracic wall syndrome - pains on the anterior thoracic surface, parasternally, depending on the position.

posterior thoracic wall syndrome - pain in the region of the scapula, interscapular area, presence of myosteofibrosis foci( as a result of chronic muscle hypoxia and degeneration).

Trunkalgic syndrome - pains in half of the chest.

Radicular syndromes at the thoracic level - a rare phenomenon. Symptoms of osteochondrosis at the lumbar level.

The lumbar spine has the largest load, the largest muscles, many joints. The sacral plexus "floats" in the small pelvis and any pathology of the pelvic organs will cause spasm of the pear-shaped muscle and compression of the sacral plexus. The sciatic nerve passes in the thickness of the gluteus muscle. Long sitting, injections can cause pain along the nerve. The pathology of the knee joints affects the bifurcation of the nerve in the popliteal region. The lower extremities often affect the vessels - arteries and veins, which contributes to the pain syndrome.

Lumbalgia - back pain( in the lower back) - an undifferentiated muscular reaction in response to any pathology in the region. Possible with kidney and urinary tract diseases, genital organs, gastrointestinal tract disease. When vertebrogenic lumbalgia pains acute, shooting, intensifying during movements, slopes, coughing, head inclinations, raising legs. It is difficult for the patient to lie down, sit down, stand up. On examination, positive symptoms of perspiration - Lassega, Neri, Dezherin, Wasserman.

Lumbosciagii - back and leg pains, pulling, aching, twisting, shooting, associated with movement, coughing, accompanied by numbness of the foot, paresthesias, decreased tendon reflexes, neuromuscular, neurodystrophic, neurovascular syndromes - muscle spasms, cramps, tunnel syndromes,foci of myofibrosis, joint pain, pseudoarteritis

Radicular symptoms :

L4 - pains in the anterior parts of the thigh, along the inner surface of the knee and lower leg, hypoesthesia, weaknessgibateley shin, knee-jerk dropped, Achilles alive;
L5 - pain along the sciatic nerve to 1 toe of the foot, hypoesthesia in the root zone, weakness of the dorsal flexor of the foot;
S1 - pain along the sciatic nerve to 3 - 5 toes of the foot, hypoesthesia, weakness of the foot, knee reflex is saved, achilles dropped out.

Vascular syndromes - radiculo-ischemia - develop with vascular compression - no pain, muscle weakness. The cone syndrome is weakness of both feet, dysfunction of the pelvic organs, hypoalgesia of the sacral area.

Diagnosis of osteochondrosis

The described syndromes require a careful examination of a neurologist at once, rather than campaigns to "straighten" the fallen discs and knock out the salts from the spine."Hiding" under the mask of osteochondrosis can be a serious illness and it is unacceptable to do manual therapy with myocardial infarction, and physiotherapy procedures with metastasized tumors in the spine and so on.

Required tests - blood and urine tests( first general, and then individually depending on the clinical picture), ECG( with cervicotoracology) and cardiologist consultation, lung fluorography or chest X-ray with therapist's consultation, x-ray of the spine, computed tomography, magnetic resonance imaging. In connection with the variety of possible options and combinations, consultations and additional examinations in urologist, gastroenterologist, gynecologist, traumatologist, orthopedist, neurosurgeon, angiosurgeon, phthisiatrist, oncologist, otolaryngologist may be necessary.

Treatment of osteochondrosis

Treatment is prescribed individually, according to the established diagnosis, stage( exacerbation, subacute, remission), severity of pain syndrome( severe, moderate, remission) and concomitant somatic pathology.

Treatment in the acute period of pain syndrome: rest, non-steroidal anti-inflammatory drugs( diclobber, voltaren. .., coxibs - arkoxia. ..), spasmolytic mixtures intravenously, blockade with drugs, muscle relaxants, tranquilizers, B vitamins, gabapentines( gabantine, tebanthine, gatonin),cortsetting, locally - rubbing( fastum gel, diprilif, apizartron, lively. ..).

In cases of severe uncontrollable pain syndrome and the presence of compression of the root of the herniated disc, surgical treatment is indicated.

Used in the complex treatment of chondroprotectors - Dona( injections, and then powders courses), calcium preparations( calcium D3), drugs for improving blood circulation and venotonics, with muscle weakness anticholinesterase drugs( proserine, neuromidine), lipoic acid, nucleosome CMP.

Rehabilitation measures: physiotherapy( diadynamic currents, magnetotherapy, darsonvalization, ultrasound, electrophoresis, stimulus, myotone), massage, manual therapy, traction, post-isometric relaxation, acupuncture, hydro massage baths, physiotherapy, spa treatment( balneotherapy, radon, ozocerite, mud, underwater traction. ..).

Prevention of osteochondrosis

Prophylaxis is an influence on risk factors - fighting with sedentary lifestyle, obesity, exercise therapy, swimming, exercising, fitness, massage. .. - improving the muscular corset. With spondylolisthesis in the lumbar department, use corsets for physical exertion. For a good night's rest, use orthopedic mattresses and pillows. Follow the correct posture when walking and sitting. Avoid hypothermia. The better the muscles and the better mobility in the spine - the less likely will be pain.

The doctor neurologist Kobzeva S.V.