This material is intended for people without medical education who want to know more about osteochondrosis than is written in popular publications and on private clinic websites.Patients ask questions to doctors from different specialties that characterize a total misunderstanding of the topic of osteochondrosis.Examples of such questions include: “why does my osteochondrosis hurt?”, “congenital osteochondrosis was discovered, what should I do?”Perhaps the apotheosis of this illiteracy can be considered a very common question: “Doctor, I have early signs of chondrosis, how scary is that?”This article aims to structure the material on osteochondrosis, its causes, manifestations, diagnostic methods, treatment and prevention, and answer the most frequently asked questions.Since all of us, without exception, are patients with osteochondrosis, this article will be useful for everyone.
How is the intervertebral disc structured?
Each intervertebral disc consists of two different sections:
- external fibrous ring, consisting of dense fibers that cover the disc from the outside around the entire perimeter;
- the internal elastic component is the nucleus pulposus.
The fibers of the fibrous ring are very dense and elastic.Over the years, elasticity is lost and, at age 60, the fibrous ring becomes rigid.Between the surface of each overlying and underlying vertebra and the disc itself there are so-called endplates, that is, the border areas between the vertebra and the disc.Due to these endplates, the vertebrae grow in height and through them, the nucleus pulposus and intervertebral disc tissues are diffusely nourished by the diffusion method, since the disc cartilage is neither supplied with blood nor innervated.
Healthy intervertebral discs in a young person are capable of high metabolic rates.If you introduce contrast to a normal disk, after 20 minutes it will disappear.
Studies have shown that in an adult the height of each intervertebral disc is approximately:
- 25% of the height of adjacent vertebrae in the cervical region;
- 20% in the chest;
- 33% in the lumbar region.
In other words, in the lumbar region the thickness of the discs is greater, due to the greater load.Laboratory studies have shown that a single healthy disc in a young person can withstand a static compressive load of up to 2.5 tons.At age 70, this number drops to 110 kg!In other words, an “old, dry disc” copes 22 times worse with transferring load to the sides and maintaining increased pressure inside the ring.
Why did this happen?Over time, the fibrous ring gradually wears away.It can no longer stretch, it just protrudes outward beyond the disc or breaks.The core stops transmitting and transforming vertical load into radial load.With age, stress gradually builds up inside the discs and their structure changes.If all these processes, taken in a separate disc, are transferred to the entire spine, we will have a condition called osteochondrosis in the clinic.Now we can start defining.
What is osteochondrosis?
The name of the disease is scary when it is not clear.The medical suffix “-oz” means proliferation or increase in some tissue: hyalinosis, fibrosis.An example would be liver cirrhosis, when the connective tissue grows and the functional tissue, the hepatocytes, decreases in volume.There may be a buildup of pathological protein, or amyloid, that normally should not be present.This storage disease will then be called amyloidosis.There may be significant enlargement of the liver due to fatty degeneration, which is called fatty hepatosis.
Well, it turns out that with intervertebral osteochondrosis, the cartilaginous tissue of the intervertebral discs increases in volume, because “chondros, χόνδρο” translated from Greek into Russian means “cartilage”?No, chondrosis, or, more precisely, osteochondrosis is not a storage disease.No true growth of cartilaginous tissue occurs in this case;we are just talking about a change in the configuration of the intervertebral cartilaginous discs under the influence of many years of physical activity, and we looked above at what happens in each individual disc.The term “osteochondrosis” was introduced into clinical literature by A. Hilderbrandt in 1933.
Osteochondrosis refers to dystrophic-degenerative processes and is part of the normal and normal aging of intervertebral discs.None of us are surprised that the face of a 20-year-old girl is slightly different from her face at 70, but for some reason everyone believes that the spine, its intervertebral discs, do not undergo the same pronounced temporary changes.Dystrophy is a nutritional disorder and degeneration is a violation of the structure of the intervertebral discs that follows a long period of dystrophy.
Causes of osteochondrosis and its complications
The main cause of uncomplicated physiological osteochondrosis can be considered the way the person moves: walking upright.Man is the only species on Earth that walks on two legs among all mammals, and this is the only form of locomotion.Osteochondrosis has become the scourge of humanity, but we freed our hands and created civilization.Thanks to upright walking (and osteochondrosis), not only have we created the wheel, the alphabet, and mastered fire, but you can also sit at home in the heat and read this article on your computer screen.
The closest relatives of humans, higher primates - chimpanzees and gorillas, sometimes stand on two legs, but this method of movement is auxiliary for them, and most often they still move on four legs.In order for osteochondrosis to disappear, as well as intensive aging of intervertebral discs, a person needs to change the way he moves and remove the constant vertical load from the spine.Dolphins, orcas and whales do not have osteochondrosis, and dogs, cows and tigers do not.Your spine cannot withstand long-term vertical static and shock loads since it is in a horizontal state.If humanity goes to sea and the natural means of transport is diving, osteochondrosis will be defeated.
Upright posture forced the human musculoskeletal system to evolve towards protecting the skull and brain from shock loads.But discs – elastic cushions between the vertebrae – are not the only method of protection.A person has an elastic arch of the foot, cartilage of the knee joints, physiological curves of the spine: two lordoses and two kyphosis.All this allows you not to “shake” your brain even while running.
Risk factors
But doctors are interested in risk factors that can be modified and avoid complications of osteochondrosis, which cause pain, discomfort, limited mobility and reduced quality of life.Let us consider these risk factors, so often ignored by doctors, especially in private medical centers.After all, it is much more profitable to constantly treat a person than to identify the cause of the problem, solve it and lose the patient.Here they are:
- the presence of longitudinal and transverse flat feet.Flat feet cause the arch of the foot to stop bouncing and the shock is transmitted upwards to the spine without softening.Intervertebral discs experience significant stress and collapse quickly;
- overweight and obesity – no comment required;
- inadequate lifting and transport of heavy objects, with unequal pressure on the intervertebral discs.For example, if you lift and carry a sack of potatoes on one shoulder, the intense load will fall on one edge of the discs and may be excessive;
- physical inactivity and sedentary lifestyle.It was said above that it is during the session that the maximum pressure on the discs occurs, as the person never sits straight, but always bends “slightly”;
- chronic injuries, slipping on ice, intense weight lifting, contact martial arts, heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags in your hands.
General symptoms
The symptoms that will be described below exist outside the location.These are common symptoms and can exist anywhere.These are pain, motor disorders and sensory disorders.There are also vegetative-trophic disorders, or specific symptoms, for example, urinary disorders, but much less frequently.Let's take a look at these signs.
Pain: muscular and radicular
Pain can be of two types: radicular and muscular.Radicular pain is associated with compression or pressure from a protrusion or herniation of the corresponding root intervertebral disc at this level.Each nerve root consists of two portions: sensory and motor.
Depending on where exactly the hernia is directed and which part of the root has been compressed, there may be sensory or motor disturbances.Sometimes both disorders occur at the same time, expressed in varying degrees.Pain also belongs to sensory disorders, as pain is a special and specific sensation.
Radicular pain: compression radiculopathy
Radicular pain is familiar to many;It’s called “neuralgia.”The swollen nerve root reacts violently to any shock and the pain is very sharp, similar to an electric shock.She shoots him in the arm (in the neck) or in the leg (in the lower back).Such a sharp and painful impulse is called lumbago: in the lower back it is lumbago, in the neck it is cervicago, a rarer term.This radicular pain requires a forced, analgesic or antalgic posture.Radicular pain occurs immediately when coughing, sneezing, crying, laughing or straining.Any shock to the swollen nerve root causes increased pain.
Muscle pain: myofascial tonic
But an intervertebral hernia or disc defect may not compress the nerve root, but, when moving, injure nearby ligaments, fascia and deep back muscles.In this case, the pain will be secondary, aching, permanent, stiffness in the back will occur, and this pain is called myofascial.The source of this pain will no longer be the nervous tissue, but the muscles.A muscle can respond to any stimulus in only one way: contraction.And if the stimulus is prolonged, the muscle contraction will turn into a constant spasm, which will be very painful.
A characteristic symptom of this secondary myofascial pain will be increased stiffness in the neck, lower back or thoracic spine, the appearance of dense and painful muscular protrusions - “rolls” near the spine, that is, paravertebral.In these patients, back pain intensifies after several hours of “office” work, with prolonged immobility, when the muscles are practically unable to work and are in a state of spasm.
Sensory disorders
If a protrusion or hernia, or a spasmodic muscle presses on the sensitive portion of the nerve root, various sensory disturbances will occur.They may be accompanied by pain or may occur separately, after the pain has passed.There are also completely painless forms of sensory disorders, but rarely.
Many people know about numbness in the tips of their fingers and toes (hypoesthesia or complete anesthesia), decreased skin sensitivity in the form of long stripes, of the radicular type.Sometimes paresthesia or tingling, a “goosebumps” sensation, occurs.Most often, sensitivity disorders occur in the feet and fingertips and toes.Sensory disorders are quite unpleasant, but sensory disorders do not make a person disabled, but motor disorders can lead to that.
Motor disorders in the periphery
If a motor neuron or axons that are part of the motor portion of a nerve are affected, weakness in the muscle or complete immobility occurs.In the second case we are talking about complete paralysis, and in the first case - about paresis.Paresis is partial paralysis when the muscle does not work at full strength.
Most often, these disorders appear in the legs, with protrusions and hernias of the lumbar spine.There are motor structures that innervate the muscles of the leg and foot.Therefore, with advanced and complicated lumbar osteochondrosis, the foot may knock.Turning inwards, the person is forced to raise their leg high to be able to step with the foot that strikes, this is called steppage, “cock walk”.
But the whole danger of movement disorders is that they can be isolated and not accompanied by pain.And if a person “doesn’t feel pain,” they may not get to the doctor in a timely manner.Therefore, it is very important for patients with progressive protrusions and hernias, for example, of the lower back, to periodically walk on toes and heels and monitor the work of the muscles.
Local symptoms: main signs
Let us now consider specific symptoms and syndromes characteristic of cervical, thoracic and lumbar osteochondrosis.We go from top to bottom, from the cervical region down, through the thoracic region, to the lumbosacral region.
Diagnosis of osteochondrosis
In typical cases, osteochondrosis of the cervical and cervico-thoracic spine occurs as described above.Therefore, the main stage of diagnosis was and continues to be the identification of the patient's complaints, establishing the presence of concomitant muscle spasm through simple palpation of the muscles along the spine.Is it possible to confirm the diagnosis of osteochondrosis through radiographic examination?
"X-ray" of the cervical spine, and even with functional flexion and extension tests, does not show cartilage, since its tissue transmits X-rays. Despite this, based on the location of the vertebrae, general conclusions can be drawn about the height of the intervertebral discs, the general straightening of the physiological curvature of the neck - lordosis, as well as the presence of marginal growths on the vertebrae with prolonged irritation of their surfaces by fragile and dehydrated intervertebral discs.Functional tests can confirm the diagnosis of cervical spine instability.
Since the discs themselves can only be visualized using CT or MRI, MRI and X-ray CT are indicated to clarify the internal structure of the cartilage and formations such as protrusions and hernias.Thus, with the help of these methods, the diagnosis is made accurately, and the tomography result is an indication, and even a topical guide, for the surgical treatment of a hernia in the neurosurgery sector.
Treatment of complications of osteochondrosis
We repeat once again that it is impossible to cure osteochondrosis, as well as planned aging and dehydration of the disc.You just can't let things get complicated:
- if there are symptoms of narrowing in the height of the intervertebral discs, it is necessary to move correctly, not gain weight and avoid the appearance of bulges and muscle pain;
- if you already have a protrusion, you need to be careful not to let it break the fibrous ring, that is, not to transform the protrusion into a hernia, and avoid the appearance of protrusions at various levels;
- if you have a hernia, you need to monitor it dynamically, do regular MRIs, avoid increasing its size or carry out modern minimally invasive surgical treatment, since, without exception, all conservative methods of treating exacerbation of osteochondrosis leave the hernia in place and only eliminate temporary symptoms: inflammation, pain, shooting and muscle spasms.
But with the slightest violation of the regime, with heavy lifting, hypothermia, injuries, weight gain (in the case of the lower back), the symptoms return again and again.We will describe how you can deal with unpleasant sensations, pain and limited mobility in the back against the background of exacerbation of osteochondrosis and an existing protrusion or hernia, secondary to social tonic syndrome.
What to do during an exacerbation?
Since there has been an attack of acute pain (e.g. in the lower back), you need to follow the following instructions in the pre-medical phase:
- completely eliminate physical activity;
- sleep on a hard mattress (orthopedic mattress or hard sofa), eliminating sagging of the back;
- it is advisable to use a semi-rigid corset to avoid sudden movements and “distortions”;
- You should place a massage cushion with plastic needle applicators on your lower back or use a Lyapko applicator.You need to keep it for 30 to 40 minutes 2 to 3 times a day;
- after that, ointments containing NSAIDs, ointments with bee or snake venom can be rubbed into the lower back;
- after rubbing, on the second day you can wrap your lower back in dry heat, for example, a belt made of dog hair.
A common mistake is to warm up on the first day.It can be a heating pad, bath procedures.At the same time, the swelling only intensifies, and the pain along with it.You can only warm up after the “highest point of pain” has passed.After that, the heat will increase the “resorption” of the swelling.This usually happens within 2–3 days.
The basis of any treatment is etiotropic therapy (elimination of the cause) and pathogenetic treatment (affecting the mechanisms of the disease).It is accompanied by symptomatic therapy.For vertebrogenic pain (caused by spinal problems), things are like this:
- To reduce swelling of the muscles and spine, a salt-free diet and limiting the amount of fluid consumed are recommended.You can even give a tablet of a mild, potassium-sparing diuretic;
- In the acute phase of lumbar osteochondrosis, short-term treatment can be carried out with intramuscular “injections” of NSAIDs and muscle relaxants: daily.This will help relieve swelling of nervous tissue, eliminate inflammation and normalize muscle tone;
- in the subacute period, after overcoming maximum pain, “injections” should no longer be taken, and attention should be paid to restorative agents, for example, modern group “B” drugs.They effectively restore impaired sensitivity, reduce numbness and paresthesia.
Physiotherapeutic measures continue, the time has come for exercise therapy for osteochondrosis.Its task is to normalize blood circulation and muscle tone, when the swelling and inflammation have already subsided, but the muscle spasm has not yet completely resolved.
Kinesiotherapy (movement treatment) involves performing therapeutic exercises and swimming.Gymnastics for osteochondrosis of the cervical spine is not aimed at the discs, but at the surrounding muscles.Its task is to relieve tonic spasm, improve blood flow, and also normalize venous outflow.This is what leads to decreased muscle tone, reduced pain intensity and stiffness in the back.
Exercises for osteochondrosis should be performed after a slight general warm-up, on “warmed muscles”.The main therapeutic factor is movement, not the degree of muscle contraction.Therefore, to avoid relapses, the use of weights is not permitted;a gym mat and a gym stick are used.With their help, you can effectively restore range of motion.
Rubbing ointments and using the Kuznetsov applicator continues.Swimming, underwater massage, Charcot shower are shown.It is in the exacerbation mitigation phase that medications for home magnetic therapy and physiotherapy are indicated.
Typically, treatment takes no more than a week, but in some cases, osteochondrosis can manifest itself with such dangerous symptoms that surgery may be necessary and urgently.
About Shants collar
In the early stages, during the acute phase, it is necessary to protect the neck from unnecessary movements.The Shants collar is great for this.Many people make two mistakes when purchasing this collar.They don't choose it according to its size, so it simply doesn't fulfill its function and causes a feeling of discomfort.
The second common mistake is using it for prophylactic purposes for too long.This leads to weak neck muscles and only causes more problems.For a collar, there are only two indications under which it can be used:
- the appearance of sharp pain in the neck, stiffness and pain that spreads to the head;
- if you are going to perform physical work in full health, in which there is a risk of “straining” your neck and getting worse.This is, for example, repairing a car when you lie down under it, or washing windows when you have to reach out and assume awkward positions.
The collar should not be used for more than 2 to 3 days, as longer use can cause venous congestion in the neck muscles when it is time to activate the patient.An analogue of the Shants collar for the lower back is a semi-rigid corset purchased in an orthopedic salon.
Surgical treatment or conservative measures?
It is advisable for each patient, after progression of symptoms, in the presence of complications, to undergo an MRI and consult a neurosurgeon.Modern minimally invasive operations allow the safe removal of quite large hernias, without prolonged hospitalization, without being forced to lie down for several days, without compromising quality of life, as they are performed with modern videoendoscopic, radiofrequency, laser technology or cold plasma.You can evaporate some of the grain and reduce the pressure, reducing the risk of getting a hernia.And you can eliminate the defect radically, that is, getting rid of it completely.
There is no need to be afraid of operating on hernias;these are no longer the previous types of open operations of the 80s-90s of the last century with muscle dissection, blood loss and a subsequent long recovery period.They are more like a small hole under X-ray control followed by the use of modern technology.
Prevention of osteochondrosis and its complications
Osteochondrosis, including complicated ones, the symptoms and treatment of which we discussed above, is, for the most part, not a disease, but simply a manifestation of inevitable aging and premature “shrinkage” of intervertebral discs.Osteochondrosis needs little to never bother us:
- avoid hypothermia, especially in autumn and spring, and autumn in winter;
- do not lift weights and carry loads only with your back straight, in your backpack;
- drink more clean water;
- do not gain weight, your weight must correspond to your height;
- treat flat feet, if any;
- do physical exercise regularly;
- practice types of exercises that reduce the load on the back (swimming);
- abandon bad habits;
- alternating mental stress with physical activity.After every hour and a half of mental work, it is recommended to change the type of activity to physical work;
- You can regularly have at least an x-ray of the lumbar spine in two projections, or an MRI, to know whether the hernia, if any, is progressing;
By following these simple recommendations, you can keep your back healthy and mobile for life.