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Treatment of osteochondrosis

severe pain with osteochondrosis

Osteochondrosis - dystrophic changes of the spine associated with tissue aging. Pathology is 80% related to genetic data, the rest is influenced by external factors.

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

  • Extended lifespan. Over time, the metabolism slows down, tissue nutrition is disrupted, and destructive regulatory systems begin to prevail over constructive ones.
  • Walking upright. Standing on his feet, the person gained an uneven load on different parts of the spine, he was able to perform a larger amount of movement - for twisting, extension. Abnormal lateral curves — scoliosis — appeared with uneven loading of the muscles and small joints of the spine. This has increased the likelihood of developing the disease even in a ward where low mobility and the chest protect the vertebrae - thoracic osteochondrosis
  • Acceleration. Rapid growth makes bones, muscles and cartilage more vulnerable. The number and distribution 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 moving exclusively by car or excessive stress in the gym, when discs and cartilage are consumed at an accelerated pace
  • Improper diet. The predominance of fast carbohydrates, lack of protein, and the use of carbonated beverages lead to the fact that the body does not have enough quality building materials to maintain tissue health.
  • Smoking. It causes prolonged vasospasm - a disorder of tissue nutrition, acceleration of degenerative processes
  • Urbanization, a large number of traumatic objects around leads to spinal injuries, secondary osteochondrosis

Types of osteochondrosis

By localization

  • Osteochondrosis of the cervical spine
  • Thoracic spine injury
  • 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 spot is the transition of the mobile lumbar region to the fixed sacral.

By phase

  • Initial - small changes in the center of the disc, compaction of the nucleus, the appearance of cartilage cracks
  • Disease progression - cracks deepen, disc height decreases, diameter of intervertebral foramen decreases. Compression of the spinal nerve root leads to pain, muscle cramps. Osteochondrosis of the spine is manifested not only by changes in the discs - due to the violation of the relationship of the vertebrae to each other, the cartilage on the surfaces of small joints is unevenly erased, arthrosis and arthritis develop
  • Complicated osteochondrosis - symptoms: further degeneration of cartilage occurs - ruptures of the cartilaginous ring that connect the bodies of two adjacent vertebrae occur. Part of the nucleus protrudes through the free space and compresses the roots, the spinal cord - a herniated disc is formed. A more serious problem is the separation of the fallen part - sequestered hernia. Disturbed by severe pain, impaired sensitivity and movement in the area responsible for the compressed nerve
  • The organism reacts to the increased load and excess mobility by growing bone tissue - osteophytes appear. They stabilize the spine, but reduce the range of motion. Bone hooks irritate muscle receptors and press on nearby blood vessels. In cervical osteochondrosis, it causes symptoms of the "vertebral artery" - dizziness, tinnitus, flickering spots in front of the eyes.

Osteochondrosis of the cervical spine

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

Cervical osteochondrosis - symptoms

  • Pain in the neck spreading to the nape of the neck, upper back
  • Sometimes headaches associated with cervical osteochondrosis mimic migraine - one-sidedness of symptoms, intolerance to sounds and strong light, strong pulsation in the temples, bright flashes in front of the eyes
  • Frequent headaches that do not respond well to conventional pills
  • Pressure drops resistant to antihypertensives
  • Dizziness and darkness in the eyes with a sudden turn of the head
  • Numbness of the fingers, especially after sleep, a feeling of crawling on the skin
  • Restriction of movement in the neck, creaking when trying to move. Patients have to turn their whole body to see something behind them
  • Upper body sweating
  • Tense muscles of the neck and shoulder girdle can be detected by palpation.

If identifiedcervical osteochondrosis, treatment in the initial stages prevents severe complications - compression of the vertebral artery with oxygen starvation of the brain, compression of the spinal cord.

Manifestations of osteochondrosis of the thoracic spine

Changes in the thoracic region develop less frequently, provoking factors - back injuries, scoliosis, previous spinal diseases (tuberculous, nonspecific spondylitis, body hemangiomas).

Symptoms of a thoracic region lesion:

  • Back pain - pain, withdrawal, worsening after standing or sitting in an awkward position for a long time. But with constant complaints of pain, other possible causes must be ruled out - pneumonia, pleurisy, tumors, intercostal neuralgia of various natures, herpes zoster before the appearance of blisters
  • Shortness of breath, shortness of breath, inability to breathe deeply
  • Thoracic osteochondrosis sometimes mimics attacks of angina pectoris - a person is treated for a long time by a cardiologist, and the problem is in the diseased intervertebral disc

Lumbar and lumbosacral osteochondrosis

In the structure of all types of osteochondrosis, these departments are reliable leaders, more than half of all cases of diagnosis. The reason is that the greatest load falls on this part of the body, both standing and sitting. Body weight, load in case of incorrect lifting of the load, in a bent position for a long time - the nucleus pulposus 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. Overload and muscle spasm disrupt the position of the small vertebral joints relative to each other - articular cartilage is erased, mobility is reduced.

Several vicious circles develop at once: muscle spasm gives pain - pain reflexively increases muscle fiber contraction, acute pain forces a person to restrict movement, spares damaged area - decreases muscle frame strength and spinal support, increases its instability, lumbar osteochondrosis progresses.

At the mobile transition pointlumbar spinein a fixed sacrum joined into a single monolith, there is a danger of the fifth lumbar vertebra slipping off the surface of the sacrum. It pinches the nerve bundles, radicular syndrome develops.

Symptoms of lumbar osteochondrosis

  • Pain in the lower back, especially sitting and standing. After resting, the horizontal position improves. With a prolonged course, the pain is normal, painful, withdrawing
  • Sharp sudden lumbago when changing body condition, lifting weights, heavy load. The patient is stuck in the position in which he was attacked, he finds it difficult to stand up, he starts to move. Lumbago is usually associated with acute compression of the spinal nerve root
  • The transition of pain to the gluteal region, legs. The largest nerve in the body, sciatica, is a direct extension of the spinal root, so 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 tissue nutrition, changes are noticed in that part of the trunk for which the diseased nerve is responsible. The limb is colder than healthy. In the prolonged course of the disease, muscle atrophy, dry skin and swelling are noticeable. Local immunity is reduced - every scratch, cut, abrasion easily becomes the gateway to infection
  • Defeat of sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may get burns or frostbite due to the fact that he did not feel a dangerous change in temperature.
  • Very frightening symptoms - numbness of the perineal skin, loss of control over the pelvic organs. The patient does not feel a full bladder, he does not feel the need to empty his intestines. Over time, urine and feces begin to be excreted on their own, it is not possible to retain them. In this case, the treatment of osteochondrosis of the spine and its complications is performed surgically, in emergencies.

Diagnosis of osteochondrosis

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

  • The specialist reveals 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
  • Mandatory external examination is performed when the patient takes off his underwear - it is necessary to compare the condition and color of the skin on symmetrical parts of the body, tissue tone, reaction to various stimuli: pain, touch, cold. or heat. Symptoms of tension are determined, which indicates muscle tension and irritation of their tendons and integumentary membranes - fascia
  • A neurological hammer will reveal the uniformity and symmetry of the reflex
  • The neurologist records the scope of active (independent) and passive (performed by the doctor) movements in the joints, the ability to turn the head, the upper part of the body without involving the lower parts of the spine.

Send for additional inspection if necessary

  • Thermal imaging diagnostics
  • ENMG (electroneuromyography): Radiography. In order to obtain the necessary information, it is carried out in at least two projections - direct and lateral. The image will talk about the condition of the bone tissue, the severity of the osteoporosis, the size and safety of the vertebral body, and will reveal osteophytes. Damaged discs are determined by the width and uniformity of intervertebral fissures. The unevenness of the lower or upper border of the body will lead to the suspicion of Schmorl's hernia. To clarify the nature of the changes in the bone structure of the spine, computed tomography is recommended. Multispiral examination enables three-dimensional modeling of vertebrae. If necessary, MRI is prescribed to determine the condition of soft tissues - muscles, ligaments, intervertebral disc.

It must be borne in mind that the results of the research must be compared with the complaints and changes found during the examination. Detection of signs of osteochondrosis of the spine, and even herniated disc without complaints, does not require serious measures.

Treatment of osteochondrosis of the spine

Elimination of acute manifestations of the disease

  • Severe pain and sharp muscle tension amplify each other, not allowing the deterioration to subside. Therefore, the first is pain relief.
  • Prescribe nonsteroidal anti-inflammatory drugs in injections, muscle relaxants - muscle relaxants
  • If these measures are not sufficient, blockade is carried out with painkillers and hormonal drugs

Radiofrequency denervation

It is recommended to rest in bed for a few days

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

Osteochondrosis: treatment without exacerbation

When the patient's condition stabilizes, he remains usually sluggishosteochondrosis, the treatment consists of several components:

  • Medications. All the same anti-inflammatory painkillers in tablets, capsules and ointments. A particular drug is selected by the physician based on the patient's condition, lifestyle, comorbidities, the predominance of one or another component of osteochondrosis. The course of vitamin B will improve the conduction of impulses along the nerve, normalize tissue nutrition. While maintaining increased muscle tone, the use of muscle relaxants will continue. There is no magic pill, no injection that would restore the vertebrae and cartilage to their original state. Medications relieve symptoms, improve mobility and performance. But they are not able to completely stop the progression of the disease.
  • Physiotherapy. It is used to deliver drugs directly to the sore spot (electrophoresis), heating (paraffin, infrared radiation). Exposure to therapeutic currents relaxes muscles, improves the work of nerve fibers. After a few sessions the pain decreases, mobility returns. Not prescribed for active inflammation
  • Manual manipulation, massage, acupuncture, acupressure. Relieve spasm by stretching and relaxing muscles. If only the upper layer of muscles is affected during the massage, then manual therapy penetrates deeper, so the requirements for specialists are higher. Be sure to do an MRI 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 returns, the pinching of the nerves decreases. The procedure has contraindications, so it can only be prescribed by a doctor
  • Physiotherapy. The most effective method of treatment. The only caveat is that it must be applied for life. Of the advantages - provides activity, improves mood, increases tissue tone. The best methods are a set of exercises recommended by a doctor, beginner yoga asanas, Pilates, swimming. They are performed smoothly, without sudden and traumatic movements, by stretching the tissue, gradually increasing the amplitude
  • Proper nutrition and giving up bad habits
  • Adequate supply of tissues with nutrients, good condition of blood vessels and adequate blood supply to the vertebrae and the structure around them 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 blockade
  • Radiofrequency ablation of veneers
  • Cold plasma and laser nucleoplasty
  • Endoscopic disc herniation removal
  • Microdiscectomy

Radiofrequency thermal ablation of facet joints

Special needles are placed exactly on the side of the intervertebral joints at the place where the middle branch of the Lyushka nerve passes. Electrodes are built into the needles, the tip of which is heated to 80 degrees for 90 seconds. This leads to nerve coagulation. The pain disappears.

Cold plasma nucleoplasty

A special cold plasma electrode is applied to the disc tissue through a needle inserted into the disc. Intradiscal pressure decreases, hernia (protrusion) recedes inwards.

Microdiscectomy

In herniated discs, the adjacent nerve roots and blood vessels are compressed, there is an extremely painful feeling and various disorders of the innervation of the extremities. If the effect of conservative treatment no longer exists, then disc herniation surgery is the only possible solution for many patients. The operation is performed under anesthesia through an incision of 2-3 cm with the help of microsurgical equipment and instruments. The duration of the operation is 45-60 minutes. The pain syndrome is significantly reduced or completely disappears immediately after the operation in 95% of patients. The next day, the patient was allowed to walk and was soon discharged from the clinic.

Endoscopic disc herniation removal:

Hernia or free-lying sequestration is removed through the lateral intervertebral foramen. To place the tube, a 5 mm incision is made in the skin. Muscles, fascia and ligaments are not damaged, they are separated by a tube retractor system with a gradual increase in diameter. The operation is almost bloodless and lasts 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 occur, large disc herniation, severe compression of the spinal nerve root and spinal cord. If there are signs of sudden loss of sensitivity, movement, pelvic dysfunction, the patient should be taken urgently to a neurosurgeon. The sooner the compression is removed, the more complete the recovery will be, the person will quickly return to normal life. In this case, surgical treatment is aimed at decompressing the compressed neural structures and stabilizing the affected segment. This is a hemi or laminectomy. Fixation is performed by the transpedicular system, in combination with an interbody body cage, which provides 360-degree fusion. Interspinous vertebral stabilization is widely used. There are several interspinous implants today. Microdiscectomy combined with interspinous stabilization, especially in the elderly, can significantly increase the effectiveness of long-term outcomes and reduce the likelihood of recurrent disc herniation.