Fatty degeneration of the vertebrae and methods of its treatment

Pain in the back is the most common complaint of patients on admission from a traumatologist and orthopedist. Without the necessary treatment, acute diseases of the spine turn into a chronic form and can significantly reduce the quality of life of the patient.

The intervertebral disc is located between the vertebral bodies and consists of three structures - the fibrous ring surrounding the intervertebral joint, the gelatinous nucleus and two hyaline plates that close the disc and adjacent to adjacent vertebrae. A fibrinous ring is needed to hold the nucleus in the correct position, because it is a kind of shock absorber of the spinal column when walking, jumping, bending, bending, turning.

Intervertebral discs make up almost a third of the entire vertebral column. The gelatinous nuclei contained inside it are very hydrophilic( like water), they need it for elasticity and elasticity, due to which they can serve as a shock absorber.

How degeneration of the vertebrae develops

When the spinal column nutrition is disturbed, various degenerative diseases develop, they lead to a decrease in the height of the intervertebral disc and impair movement in the spine. Gradually, the surrounding structures are involved in the process - joints, muscles, ligaments. A major role in the pathological process is played by fatty degeneration of the vertebrae, or rather of the yellow ligaments that hold the spine. As a result, the narrowing of the vertebral canal passing inside the vertebrae begins. It is this stenosis( constriction) that is the cause of back pain.

Due to the fact that vertebrae do not have their own system of innervation and blood supply( it is present only in the outer plates of the fibrous ring), and also because during life the vertebral column is under the greatest pressure, the degenerative processes in it begin muchearlier than in other large joints.

This fact is also associated with a fairly young age of the main number of patients, this process is gradually increasing and leads to the fact that by the age of 60-70 more than half of the population has degeneration of vertebrae to varying degrees. Gradual erosion of the border between the fibrous ring and the nucleus leads to a decrease in the height of the spine and infringement of the inner part of the intervertebral disc - the gelatinous nucleus.

In addition, age-related changes occur in the blood vessels, because of which the delivery of the necessary substances( protein-ligans) to the internal structures of the ligamentous apparatus of the spine worsens. Complex factors - deterioration of the trophic and compression of the vertebrae, leads to the formation of cracks in the gelatinous nucleus, it loses moisture and decreases its elastic properties. In addition, prolapse( protrusion) of the disc into the spinal canal occurs. This is how degeneration of intervertebral discs develops, and now the vertebrae are not sufficiently amortized, any careless, and abrupt movements can bring pain.

However, the process of degeneration of the spinal discs is not limited. Decreasing the height of the spinal column contributes to the involvement in the process of neighboring formations - ligaments, facet joints, which leads to their overstrain and increased excretion of calcium and the development of osteoporosis. Naturally, the yellow ligaments, which fill the spaces between the vertebrae and are attached to the arcs of the vertebrae, weaken, because the spine is shorter. Yellow ligaments or as they are called - fat, lose their elasticity, thicken and wrinkle. Due to the fact that there are serious pathological changes in the yellow( fatty) ligaments, the disease is called fatty degeneration of the spine.

As a result of long-term studies it has been proved that protrusion of the disc into the intervertebral canal is not always the only cause of pain. In the spinal canal passes the spinal cord, which is represented by the roots of the spinal cord nerves. With protrusion at any level of the intervertebral disc, the rootlet is compressed and the appearance of pain is quite logical. However, the scientists found that the pain sensations also appear due to a "sterile" autoimmune inflammation of the rootlet. The source of inflammation is a crushed vertebral disc that contacts the spine.

The main cause of degeneration of the intervertebral discs is a deterioration in the nutrition of their cells - they are more sensitive to reducing the amount of oxygen, glucose and changes in acid-base balance in the blood. This in turn initializes the degenerate processes in the disk.

What causes a power failure? There are a lot of reasons, this includes, in addition to exchange changes, various blood diseases, for example, anemia, as well as atherosclerotic changes, insufficient or excessive stress on the spine, malnutrition.

Classification of degenerative-dystrophic changes of the spine

Degenerative-dystrophic changes in vertebrae occur in several stages.

So, in the 0 stage of disturbances in the disk is not yet registered, but in the first stage it is already possible during the study to see small gaps in the inner layers of the fibrous ring.

In the transition to the second stage, the outer layers of the fibrous ring are still preserved( which for the time being keeps the bulging of the disc in the intervertebral canal), however, there are back pains that can irradiate into the lower limb and the knee joint.

The third stage is characterized by extensive ruptures of the fibrous ring around the perimeter, as a result of which the disk prolapses into the vertebral canal, the lumbar pains intensify. The rupture of the longitudinal ligament is visible.

Treatment of pain caused by degeneration of the vertebrae

Surgical and conservative methods are used to relieve pain. They are aimed at alleviating the patient's condition, and therefore they can only be considered as palliative.

1. Bed rest for the period of the most intense pain. Later, getting up aggravates the situation and leads to a lesser recovery of the spine;
2. Non-steroidal anti-inflammatory drugs - ibuprofen, diclofenac, piroxicam, indomethacin, naproxen, ibuprol, nimesulide, patch with diclofenac;
3. Muscle relaxants - baclofen, tizanidine, cyclobenzaprine, tolperisone, metocarbamol;
4. Local anesthesia - most often Novocain blockades;
5. Chondroprotectors - chondroitin sulfate, glycosamine sulfate and diacerein.
6. Physical therapy - dosed load on the spine, special power exercises, warming up, electrostimulation. Often the complex of these effects has a more significant result than long-term pharmacological treatment.
7. Specially selected set of exercises, therapeutic massage, in some cases manual therapy.

As for the surgical treatment of this pathology, the attitude towards it in most leading countries of the world is rather restrained, it is applied only to a small percentage of patients.

Among the surgical methods of treatment can be used:

• Discectomy with arthrodesis;
• Intradiscal injection of steroids;
• Internal disk decompression;
• Laser Therapy.

In recent years, minimally invasive methods of treatment have become widespread: electrothermal plasty of the fibrous ring, laser decompression of discs, percutaneous endoscopic disc removal. Methods of replacing the pulpous core with restoring the integrity of the fibrous disc have also been used.