Cervical osteochondrosis symptoms and treatment
Mar 06, 2018
Osteochondrosis of the spine is the most severe form of degenerative-dystrophic spine injury. This process is based on the degeneration of the intervertebral disc with the subsequent involvement of bodies of adjacent vertebrae, intervertebral joints, ligamentous apparatus, spinal cord, its roots and neural-reflex mechanisms, and often blood supply structures.
Osteochondrosis is a complex word consisting of two Latin roots: "osteo" is bone, and "chondros" is cartilage, ie, it is the process of degeneration, aging, degradation of the cartilaginous tissue and its transformation into bone-like. How to use folk remedies for this disease look here.
The osteochondrosis of the spine does not have a single cause. Among the factors that cause it, the most important are the following:
The smallest and most mobile( with maximum dynamic load) are the cervical vertebrae.
The cervical vertebrae of number 7, with the exception of the first two, are characterized by small, low bodies, gradually widening towards the last, VII, vertebra.
I-atlant differ from general type of cervical vertebra, II - axial vertebra( axis) and VII - protruding vertebra.
The first cervical vertebra is a ring formed from two arcs( anterior and posterior) connected by two more developed parts - the lateral masses.
On the upper surface of the posterior arch is a groove of the vertebral artery, which sometimes turns into a canal.
The second cervical vertebra, the axial vertebra, is characterized by the presence of a guide up from the body of the tooth, around which, as around the axis, the atlas rotates along with the skull.
The seventh cervical vertebra is distinguished by a long and undiluted spinous process, which is easily probed through the skin, in connection with which this vertebra is called the speaker.
The neck muscles, covering one after another, form two layers: superficial and deep. In this case, both these and others according to their location can be divided: superficial - in the anterolateral and median groups, deep - on the lateral and pre-invertebrate( the groups of muscles that are of practical importance for the reader - the author's comment) are considered.
Superficial neck muscles:
a) Anterolateral group.
♦ The subcutaneous muscle of the neck. Action: pulls the skin of the neck and partly the chest, lowers the lower jaw, pulls the corner of the mouth outwards and downwards;
♦ sternocleidomastoid muscle. Action: with a strengthened thorax, a one-sided contraction of the muscle tilts the head in its direction, and the face turns in the opposite direction: with a bilateral contraction of the muscle, the head tilts back and a little extends anteriorly: when the head is strengthened, the muscle pulls up the collarbone and sternum.
b) Middle group of the neck muscles:
♦ Nadal muscles;
♦ sublingual muscles.
Deep neck muscles:
a) lateral group:
♦ anterior staircase. Action: with a strengthened spine, I pull the rib upward;with a strengthened thorax with one-sided cutting, it tilts the cervical spine to its side, and with a bilateral one, it tilts it forward;
♦ middle staircase. Action: with a strengthened spinal column, I lifts the rib;with a strengthened thorax, he tilts the cervical spine forward;
♦ posterior staircase. Action: with a strengthened spinal column, the second rib rises;with a strengthened thorax, a bilateral contraction of the muscle tilts the cervical spine forward.
b) prevertebral group:
♦ long muscle of the head. Action: inclines the head and cervical spine forward;
♦ Long neck muscle. Muscular fascicles in it have different lengths, so it distinguishes three parts: the medial-vertical part, the upper oblique part, the lower oblique part. Action: inclines the cervical spine forward and to its side;
♦ anterior rectus of the head. Action: tilts his head to his side, with bilateral cuts, he tilts his head forward;
♦ The lateral rectus muscle of the head. Action: tilts the head in his direction, with bilateral cuts, tilts his head forward.
The cervical nerves( C, -C8) are 8 pairs and are divided into dorsal( dorsal) and ventral( ventral) branches of the cervical nerves.
Among the cervical spinal nerves, the branches of the first, second and third cervical nerves are distinguished.
1. The dorsal branch of the first cervical nerve, or the suboccipital nerve( C,), passes between the occipital bone and the first cervical vertebra, lying under the vertebral artery in the sulcus of the vertebral artery of the atlas;
2. The back branch of the second cervical nerve 2 is the largest, passes first between the I and II cervical
vertebrae, then is divided into a series of short and one long branch;
3. The dorsal branch of the third cervical nerve( C3) or the third occipital nerve, unstable and branched in the skin of the occipital region.
The ventral branches of the cervical nerves are connected together by means of loops in the cervical and brachial plexus.
The cervical plexus is formed by the abdominal branches of the four upper cervical spinal nerves( C, -C4).
The brachial plexus is formed by the joining of the abdominal branches of the fifth, sixth, seventh and eighth spinal nerves( C5-C8), which come out from the intervertebral foramen at the level of the fourth cervical to the I( II) thoracic vertebrae.
Clinic of cervical osteochondrosis is largely due to anatomical and physiological features of the cervical spine.
Normally, when the neck is bent and unbent, the posterior edges of the body form the right arch. When osteochondrosis, accompanied by a decrease in the height of the disc, the appearance of marginal bony growths, such movements lead to subluxation in the intervertebral joints, which creates additional conditions for deformation and compression of the vertebral artery.
Cervical vertebrogenic pathology debuts almost always with pain or a sense of discomfort in the neck. Pain is more often of a paroxysmal nature in the form of cervical lumbago. Lumbago - this is an acute pain.
Podystro arising pains lasting longer in time, and they are called cervical spasms. Active activity of cervical muscles during periods of exacerbation of osteochondrosis intensifies painful sensations.
Severity of pain is three degrees: the first - the pain occurs only with the maximum in volume and strength movements in the spine, the second degree - the pain calms only in a certain position of the spine, the third degree - the pain is constant.
With the compression( compression) of each root, certain motor, sensory and reflex disorders are associated.
C1 root lies in the groove of the vertebral artery. Traumatized very rarely when obyazystvlenii last, subluxation of the Atlanta, or anomalies of the arch of the Atlanta( Kimerli anomaly).
The spine C2 is very rarely involved. When the lesion appears, pain, a violation of sensitivity in the parietal-occipital region.
The spine of C3 is rarely affected and manifests itself with pain in the corresponding half of the neck and a sensation of swelling of the tongue on this side, language is difficult to master( speech and movement of food in the mouth worsen), a violation of the sensitivity of the skin in the neck.
Counterfoil C4 - is not affected often. Pain in the forearm, collarbone, weakness, decreased neck muscle tone, there may be a violation of respiratory function, pain in the heart and liver. There may be dystrophy and hiccups, sensitive disorders in the forearm.
The spine of C5 - is rarely affected. The pain radiates from the neck to the shoulder and outer surface of the shoulder. Weakness and hypotrophy of the deltoid muscle, a violation of sensitivity along the outer surface of the shoulder.
Spine C6 - frequent localization. The pain spreads from the neck to the scapula, the foreleg along the outer surface of the shoulder to the radial edge of the forearm and to the large finger, accompanied by paresthesia( numbness) of the distal zone of the dermatome. Weakness and hypotrophy of biceps, decrease or absence of reflex, a violation of sensitivity from the lower third of the forearm along the radial margin, along the anterolateral surface of the thumb.
Spine C7 - pain radiates from the neck under the scapula along the outer-posterior surface of the shoulder and the posterior surface of the forearm to the II-III fingers, there may be paresthesia( numbness) in the distal part of this zone. Weakness and hypotrophy of the triceps muscle, decrease or disappearance of the reflex from it. Violation of the sensitivity of the skin along the outer surface of the forearm on the wrist to the rear surface of the 2nd and 3rd fingers.
One of the most important features of the structure of the cervical spine is the presence of holes in the transverse processes of III-V cervical vertebrae. These openings form a channel through which the main branch of the subclavian artery passes - the vertebral artery with the same sympathetic nerve( Frank's nerve).The vertebral artery vascularizes a vast territory: the segments of the spinal cord from C, to D3 inclusive.
In the clinical picture, the functional and organic stages are distinguished:
The functional stage of the vertebral artery syndrome is characterized by three groups of symptoms:
1) headache( pulsating or cerebral, aching, burning, persistent and intensifying paroxysmally, especially with head movements, extending from occiput forward tooften scalp skin, even with a light touch, combing the hair;
2) cochleovestibular disorders( sensation of instability, wiggle, systemic dizzinessNiya, tinnitus, mild hearing loss);
3) visual disorders are limited to darkening of eyes, sensation of sand, sparks, "flies", slight changes in the tone of the vessels of the fundus.
The organic stage of the vertebral artery syndrome is manifested by transient and persistent circulatory disorders in the brain and spinal cord.
Postisometric automobilization is carried out in the patient's position sitting on the couch. The patient grasps the back of the head so that the thumbs are on the zygomatic arches, and the rest on the occipital bone. The index fingers grasp the occipital bone at the level of the suboccipital opening. Then the patient with a slight muscular effort produces a tilt of the head back, raises the eyeballs upward, inhales for 3 seconds. Preserving the muscle tension for 7 seconds, holds his breath. Within 3 s produces an exhalation, drawing the eyeballs down. The exercise is repeated three times.
Repeated autoimmobilization is carried out in the same position. The patient performs in the anteroposterior direction 7-10 increasing passive movements in amplitude, after which the muscle relaxes.
Postisometric automobilization of the atlanto-occipital articulation is performed by the patient towards the restriction of motion, lying on the back with a slightly raised head or an upright position. If autoimmobilization of the left atlanto-occipital articulation is performed, the patient makes the maximum rotation of the head to the right to the shoulder. This position creates the inclusion of movements in the underlying joints of the head, and it becomes possible to carry out the automobilization of only the left atlanto-occipital junction. Then, supporting the head, the patient flexes the right arm in the elbow joint, the palm surface of the hand fixes the chin. To create a fixation in the frontal plane with the head rotated to the right, the patient puts the left palm on the parietal mounds, both elbows pointing forward. Gradually, with increasing strength within 3 s, the patient begins to exert pressure on the head in the frontal plane. Simultaneously produces an inhalation of the chest-abdominal type( involving consecutively the muscles of the abdomen, diaphragm, thorax).Together with the act of inspiration, keeps the head in its original position and simultaneously makes eyeballs move upward. At the next stage of autoimmobilization, the patient with the same strength for 7-10 s retains muscle tension and holds his breath. Within 3-4 seconds on an exhalation the patient reduces gradually force of pressure, and eyeballs deduces downwards.
Automobilization is carried out three times towards the limit of movement with a gradual increase in the amplitude of motion in the frontal plane. The force with which pressure is applied to the head must be selected individually by each patient. The degree of development of the muscular corset of the neck, the age, the degree of the initial osteochondrosis, the severity of the neurological disorders, the concomitant diseases, the possibilities of compensation are also important.
Postisometric automobilization of articular joints between C1 and C2 is performed by the patient sitting. Since the rotation of the atlas relative to the axis is possible with the maximum bending of the head and cervical spine, the patient, tilting the maximum head forward and turning it, creates a lever. The head becomes a lever by means of which it is possible to carry out some rotation between the atlas and the axis. Automobilization is slow: with increasing strength for 3 s, the patient exerts pressure with rotation around the axis of the spine. At this time, he inhales a chest-abdominal type( with a sequential movement of abdominal muscles, diaphragm and chest).Synchronously with the act of inspiration, the patient makes eyeballs move upward. At the second stage, the patient, without increasing muscle tension, keeps the load on the muscles of the neck for 7 seconds and holds his breath. The patient reduces the force of pressure with resistance on exhalation, taking the eyeballs down. Automobilization is carried out three times towards the limitation of motion with a gradual increase in the amplitude of the atlant movement with respect to the axis around the axis of the tooth-like process. The strength with which rotation and flexion is performed must be selected individually by each patient. It is necessary to take into account individual characteristics and concomitant diseases.
Postisometric autoimmobilization in the mid-cervical spine is performed by the patient towards the limitation of the sitting slope. At the beginning of auto-mobilization of the mid-cervical spine, the patient tilts his head toward the restriction of movement. Then one palm puts the palm of the blocked segment on the lower vertebra of the blocked segment, and the other palm on the parietal hillock from the opposite side, thereby forming the fixation zones and the lever for the movement.
Automobilization is carried out in the following position: slowly with increasing force within 3 s the patient begins to exert pressure on the parietal hillock on the right or from left to right depending on the side of the movement restriction. Then, within 3 seconds, the patient makes inhalation of the medulla type( with a consistent movement of abdominal muscles, diaphragm, chest).Together with the act of inspiration, the increasing pressure on the parietal hillock with the inclination of the head and cervical spine in the direction of restriction of movement with simultaneous counterpressure of the other palm to the underlying vertebrae, the patient synchronously makes eyeballs move upward. Further, without increasing muscle tension, it keeps the load on the muscles of the neck for 7 seconds and holds the breath. The patient reduces the force of pressure with resistance on exhalation, drawing the eyeballs down. Automobilization is carried out three times towards the limit of movement with a gradual increase in traffic volume.
Automobilization in the lower spinal segments of the spine is carried out in an upright position. The patient puts his hands on the lower cervical spine behind his neck where the movement in the sagittal plane is restricted. Then, slowly, without rotation, with a fixed lower segment, begins with an increasing muscle thrust within 3 seconds to shift forward the overlying part of the spine, inhaling the coarse-bellied type, synchronously, making eyeballs upward. In the second stage, the patient holds his breath for 3 seconds and keeps the muscle tension at the same level. On exhalation, the patient gradually reduces the strength of the muscle resistance and pulls the eyeballs down. The patient's head and cervical spine slowly return to the outgoing position.
Automobilization is repeated three times with an increase in volume towards the restriction of movement.
Complaints of patients for deep, aching, hardening, gnawing pain localized in the cervical-occipital region, radiating to the head, intensifying with loads on the cervical spine, the inability to raise the head and turn it, more often in the morning, the pain intensifies after coughing and sneezing.
Automobilization of deep neck flexors with reflex contracture of the neck muscles. Postisometric autoimmobilization of the deep neck muscles is performed by the patient sitting on the couch. The head is strictly in an upright position. The patient palms the right and left hands, placing them on the nape of the neck, with minimal muscular force exerts pressure in the sagittal plane with resistance. The procedure lasts 13-14 s. Repeated three times.
Repeated autoimmobilization is carried out in the same position. The patient makes 7-10 moves forward.
Antigravity autoimmobilization is performed in the position of the patient on the back. The head hangs from the edge of the couch, for 20 seconds. The procedure is repeated three times. Rest between procedures 15-20 sec. In the elderly, this procedure is contraindicated.
This muscle is attached to the transverse process of body C1 and to the spinous process of body C2.
Clinical picture described by J.Yu. Popelyansky in 1961: constant lomyaschaya pain in the cervico-occipital region, paresthesia in the nape, numbness in the zone of innervation of the large occipital nerve, painful palpation of points of attachment of the lower oblique muscle of the head, increased pain in the cervical-occipital region with rotation( turning) of the head into a healthyside.
Postisometric autoimmobilization of the lower oblique muscle is performed sitting on the couch. The patient's head is tilted forward as much as possible. The patient makes a slow rotation around the axis of the spine in the direction of limiting movement. Then the fingers pressurizes the resistance to the chin in the other direction. After each procedure during relaxation on exhalation the patient increases the amount of passive movements. Automobilization is repeated three times. The duration of each procedure is 13-14 s.
Repeated autoimmobilization is carried out in the same position. The patient makes 7-10 increasing in amplitude movements, without exerting pressure on the chin.
Postisometric autoimmobilization is performed in the position of the patient on the back. To relax this muscle, the patient should hang his head from the edge of the plane of the couch and turn it in the opposite direction. At the same time, the muscle tenses. Then the patient with his fingers minimally exerts pressure with resistance to the chin. The procedure for autobilization continues for 13-14 s. Repeated three times.
Repeated autoimmobilization is carried out in the same position. The patient commits 7-10 rotational, increasing in amplitude movements towards the limit, after which the muscle relaxes.
Antigravity autoimmobilization is carried out in the same position. The head hangs from the edge of the couch, rotates towards the restriction of movement and is held by the patient for 21 seconds. The procedure is repeated three times. Rest time between procedures is 15 seconds. For elderly patients, it is contraindicated to carry out such an autoimmobilization.
Treatment includes a number of local activities and drug therapy. The more pronounced joint and motor conflict, the greater the importance of local treatment. It should be aimed at eliminating the incorrect relationships in the joint-ligament apparatus of the cervical region, relaxing the reflexively stressed muscles and strengthening the "muscular corset" in the cervical spine.
For acute pain, it is preferable to first ensure the maximum rest of the cervical region. This is achieved with a removable collar, which effectively limits movement. If the risk of impaired stability in the cervical region during work is great, the patient is ordered to wear a collar during the day, and at night the collar is removed. If the exacerbation of pain occurs at night, when the patient can not find a comfortable position and suffers from lack of sleep due to pain, then the collar is recommended to be worn for the night. In the case of acute pain, bed rest is prescribed, and the rest and fixed position of the head is achieved with a dense cushion and sandbags.
Resting treatment is prescribed not only when the mobility in the cervical region is limited. Pain in the neck, as a rule, limits the mobility of the cervical spine in the elderly, while in young people, movements can persist in full. Nevertheless, immobilization is shown to young people, especially in the acute period. Its duration depends on severity. Usually recommend to use a removable collar at least one or two months.
According to Ya. Yu. Popelyansky, expediently cautious traction of the cervical region, either with hands or with the help of the "Glisson loop".Initially, the duration of the traction is limited to three minutes with a load of about five kilograms;gradually the duration of the procedure and the load is increased, but by the end of each stretching session the weight is reduced. Some patients experience significant improvement after the first extension. But if the patients do not tolerate the traction( mostly young people with reflex vascular syndromes), then the choice of the duration of the traction and the magnitude of the load should be approached with great care.
In addition to stretching, for the management of acute pain, novocain blockades can be used: 5-10 ml of a 0.5-2% solution of novocaine is injected into the affected muscle, and also into the region of the exit of the large occipital nerve. If it is possible to determine individual compaction areas in the stressed muscle, it is recommended to administer a solution of novocaine with hydrocortisone to these areas. In the case of persistent neuralgia of the occipital nerve, when the Novocaine blockade completely relieves pain for a short time, it is possible to introduce alcohol or phenol into this area.
After decreasing acute pain, prescribe cautious massage and physiotherapy exercises, physical factors: electrophoresis with novocaine, sinusoidal currents, mud applications( 35-37 ° C), diadynamic currents, radon baths.
Surgical treatment( separation of adhesions, surrounding roots or vertebral artery, introduction of a cocktail with alcohol into the disc, stabilization with the help of bone graft) is used only in those cases where combined conservative treatment does not have an effect and the disease progresses.
For patients in whom the main factor of suffering is the pain from the reflex tension of the neck muscles, the crucial importance is acquired by massage, exercise therapy, physiotherapy procedures, and also medicinal treatment.
This treatment includes the use of analgesics, as well as tranquilizers. In addition to protecting from emotional stress( supporting muscle tension), they facilitate muscle relaxation. It should be noted that with long-term use of analgesics, habituation develops and the effect decreases to 30%.In these cases, it is advisable to cancel with the appointment of amitriptyline;this increases the effectiveness of treatment in 76% of cases. With the prevalence of muscle reflex in the clinical picture, psychotherapy and muscle relaxation, achieved by the method of auto-training and biofeedback, are effective. With mixed muscular-vascular pain, vascular drugs are additionally prescribed, which are selected depending on the type of reflex vascular reaction.
Significant difficulties arise in the treatment of the posterior cervical sympathetic syndrome, where the object of the therapeutic effect is not only the plexus of the artery itself, but also the emerging secondary vascular disorders involving higher brain structures.
Local treatment is physiotherapeutic treatment of ultraviolet, ultrasound, sinusoidal and diadynamic currents, mud applications( 35-37 ° C) in the cervical region. If local procedures cause exacerbation, then it is advisable to postpone them until the time when drug treatment will reduce the severity of painful clinical manifestations.
Less commonly used such a method as a course of X-ray therapy with small doses on the cervical spine according to the following scheme: single dose of 25-30 rad;the interval between sessions is 1-2 days;The total dose is 150-300 rad for 6-9 sessions.
Drug treatment of should first of all be aimed at eliminating the neurotic component with the help of tranquilizers or eliminating the depressive state by antidepressants. Since crises develop with the predominant participation of adrenergic systems, alpha and beta blockers are shown in combination with other vascular active agents selected individually.
Due to the presence of a certain similarity of clinical manifestations in the posterior cervical sympathetic syndrome and typical migraine, the drugs normalizing the metabolism of serotonin are often used: pizotifen( sandomed igran) 1 tablet( 0.5 mg) 3 times a day, cinnarizine 1 tablet( 25mg) 3 times a day, dihydroergotoxin( redergin) 1 tablet( 1.5 mg) 3 times a day. Experience shows that all these remedies are useful when vascular disorders caused by osteochondrosis develop in patients with migraine, and when these disorders are provoked during migraines by specific specific factors( menstrual cycle disorders, menopause).The effectiveness of these agents does not prove the complete identity of central vascular disorders in typical migraine and vertebral artery syndrome.
Surgical treatment of with decompression of the vertebral artery is indicated when progression of the disease can cause disability - while conservative treatment methods do not have a positive effect.
The prognosis for recovery in osteochondrosis is doubtful, but the manifestations of the disease can practically be reduced to nothing if daily exercise, do not allow neck hypothermia, especially in the off-season, in the wind or draft.