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Treatment of osteochondrosis

severe pain with osteochondrosis

Osteochondrosis - dystrophic changes in the spine related to the age-related aging of tissues. 80% of pathology is related to genetic data, the rest is the influence of external factors.

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

  • Increased service life. Over time, the metabolism slows down, tissue nutrition is disturbed, and destructive regulatory systems begin to prevail over constructive ones
  • Walk upright. Standing on their feet, the person was exposed to uneven loads on different parts of the spine and was able to perform more movement - to twist, stretch. There were pathological side curvatures - scoliosis - with uneven loads on the muscles and small joints of the spine. This increased the likelihood of the development of the disease even in the department where low mobility and the rib cage protect the vertebrae - thoracic osteochondrosis
  • Acceleration. Rapid growth makes bones, muscles, and cartilage more vulnerable. The number and prevalence of blood vessels are insufficient to supply them with oxygen and vital substances
  • Lack of adequate physical activity. There are two extremes - sedentary work and driving only, or excessive exercise in the gym when intervertebral discs and cartilage wear out at an accelerated rate
  • Wrong diet. The predominance of fast carbohydrates, a lack of proteins, the use of carbonated beverages lead to the fact that the body does not have enough high-quality building materials available to maintain tissue health
  • Smoking. Causes prolonged vasospasm - disruption of tissue nutrition, acceleration of degenerative processes
  • Urbanization, many traumatic objects in the area lead to spinal injuries, secondary osteochondrosis

Types of osteochondrosis

After localization

  • Osteochondrosis of the cervical spine
  • Injury to the thoracic spine
  • Lumbar osteochondrosis
  • Common osteochondrosis - cervical and lumbar, thoracolumbar, lumbosacral and other combinations

The most common changes in the most moving parts are the cervical and lumbar spine. The sore point is the transition from the movable lumbar region to the fixed sacral region.

According to stage

  • Initial - small changes in the center of the intervertebral disc, compaction of the nucleus, the appearance of cartilage tears
  • The progression of the disease - the cracks deepen, the height of the intervertebral disc decreases, the diameter of the intervertebral foramen decreases. The compression of the spinal nerve roots leads to pain, muscle spasms. Osteochondrosis of the spine is manifested not only in changes in the intervertebral discs - due to a violation of the ratio of the vertebrae to each other, cartilage on the surfaces of small joints is unevenly erased, osteoarthritis and arthritis develop
  • Complicated osteochondrosis - symptoms: There is further degeneration of the cartilage - cracks appear in the ring of cartilage that connects the bodies of two adjacent vertebrae. Part of the nucleus protrudes through the free space and presses the roots, the spinal cord, in - a herniated disc occurs. A more serious problem is the separation of the fallen out part - a sequestered hernia. Disturbed by severe pain, sensitivity and movement disorders in the area for which the compressed nerve is responsible
  • The organism reacts to the increased stress and excess mobility with the growth of bone tissue - osteophytes appear. They stabilize the spine, but reduce freedom of movement. Bone hooks stimulate muscle receptors and press on neighboring vessels. With cervical osteochondrosis, this leads to symptoms of the "vertebral artery" - dizziness, tinnitus, flickering of points in front of the eyes

Osteochondrosis of the cervical spine

With the advent of cell phones and computerscervical osteochondrosisalso in adolescents: a longer, unnatural head posture with muscle tension overloads the vertebrae, their intervertebral discs and joints.

Cervical osteochondrosis - symptoms

  • Neck pain up to the back of the head, upper back
  • Sometimes headaches associated with cervical osteochondrosis mimick a migraine - one-sidedness of symptoms, intolerance to sounds and bright light, strong pulsation in the temples, bright flashes in front of the eyes
  • Frequent headaches that do not respond well to traditional tablets
  • Pressure drop resistant to antihypertensive drugs
  • Dizziness and darkening of the eyes with sudden turning of the head
  • Numbness of the fingers, especially after sleeping, a crawling sensation on the skin
  • Restriction of movement in the neck, crunching when trying to move. Patients have to turn their whole body to see something behind them
  • Sweating on the upper body
  • Tense muscles of the neck and shoulder girdle can be detected by palpation.

If identifiedcervical osteochondrosis, Treatment at the initial stage prevents serious 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 chest area develop less often and provoke factors - back injuries, scoliosis, previous diseases of the spine (tubercular, nonspecific spondylitis, body hemangiomas).

Symptoms of the lesion of the chest region:

  • Back pain - pain, pulling, worse after standing for a long time or sitting in an uncomfortable position. However, with constant pain complaints, it is necessary to exclude other possible causes - pneumonia, pleurisy, tumors, intercostal neuralgia of another type, herpes zoster before the appearance of blisters
  • Difficulty breathing, shortness of breath, inability to breathe deeply
  • Thoracic osteochondrosis sometimes mimics attacks of angina pectoris - a person is treated by a cardiologist for a long time, and the problem lies in a diseased intervertebral disc

Lumbar and lumbosacral osteochondrosis

In the structure of all types of osteochondrosis, these departments are self-confident leaders, more than half of all diagnosed cases. The reason for this is that this part of the body receives the greatest strain both when standing and when sitting. Body weight, stress when lifting weights improperly, prolonged time in a bent position - the nucleus pulposus of the intervertebral discs is in a state of compression, is pressed into the vertebral bodies by the cartilage plates - Schmorl hernias develop. Overexertion and muscle spasms disturb the position of the small joints of the vertebrae to one another - articular cartilage is erased and mobility is reduced.

Several vicious circles develop at the same time: muscle spasms cause pain - pain reflexively intensifies the contraction of muscle fibers, acute pain forces you to restrict movement, protect the damaged area - the strength of the muscular framework and the support of the spine decrease, this increases instability, lumbar osteochondrosis progresses.

At the mobile phone's transition pointLumbar spinein an immovable sacrum fused into a single monolith, there is a risk of the fifth lumbar vertebra slipping off the surface of the sacrum. As a result, the nerve bundles are pinched, the radicular syndrome develops.

Symptoms of lumbar osteochondrosis

  • Lower back pain, especially when sitting and standing. After rest, the horizontal position improves. With a prolonged course, the pains are habitual, sore, pulling
  • Sharp sudden lumbago when changing body condition, lifting weights, heavy load. The patient remains stuck in the position caught by the attack, it is difficult to straighten up, move. Lumbago is usually associated with compression of the spinal nerve root that has developed acutely
  • The transition from pain to the buttock region, legs. The body's largest nerve, the sciatic nerve, is a direct continuation of the spinal root, so patients with lumbar osteochondrosis are often afraid of sciatica
  • Due to the fact that nerve fibers control the tone of muscles and blood vessels, regulate the nutrition of tissues, changes are noted in the part of the trunk that the diseased nerve is responsible for. The extremity feels colder than the healthy one. If the disease progresses for a long time, muscle wasting, dry skin and swelling become noticeable. Local immunity decreases - any scratch, cut, abrasion easily becomes a gateway for infection
  • The defeat of the sensory fibers leads to a violation of sensitivity - superficial and deep. The patient may suffer burns or frostbite as he has not felt a dangerous change in temperature.
  • Very frightening symptoms - numbness of the skin of the perineum, loss of control over the pelvic organs. The patient does not have a full bladder, no need to empty the bowel. Over time, urine and feces will pass on their own, it will not be possible to hold them. In this case, treatment of osteochondrosis of the spine and its complications in an emergency is carried out surgically.

Diagnosis of osteochondrosis

It is carried out by a neurologist or orthopedic surgeon, after the therapist excludes the pathology of the internal organs.

  • The specialist learns about the main ailments, the time of their appearance, their development, the effect of drugs on the intensity of pain, rest, changes in the rhythm of life
  • A mandatory external examination is carried out when the patient undresses for underwear - it is necessary to compare the condition and color of the skin on symmetrical parts of the body, the tone of the tissues, the response to various stimuli: pain, touch, cold or heat. Tension symptoms are noted, indicating muscle tension and irritation of their tendons and skin membranes - fasciae
  • The neurological hammer shows the evenness and symmetry of the reflexes
  • The neurologist records the volume of active (independent) and passive (performed by the doctor) movements in the joints, the ability to turn the head, the upper body, without involving the lower parts of the spine

If necessary, send in for re-examination

  • Thermal imaging
  • ENMG (electroneuromyography): radiography. In order to get the necessary information, this is done in at least two projections - direct and lateral. The picture provides information about the condition of the bone tissue, the severity of the osteoporosis, the size and security of the vertebral bodies and shows osteophytes. Damaged intervertebral discs are determined by the width and evenness of the intervertebral fissures. Bumps on the lower or upper edge of the body suggest a Schmorl hernia. To clarify the nature of the changes in the bone structure of the spine, computed tomography is recommended. The multispiral examination enables three-dimensional modeling of the vertebrae. To determine the condition of the soft tissues - muscles, ligaments, intervertebral discs - an MRI is prescribed if necessary.

It should be noted that research results must be compared with the complaints and changes identified during the examination. Recognizing signs of spinal osteochondrosis and even a herniated disc without discomfort does not require any serious action.

Treatment of osteochondrosis of the spine

Removal of acute manifestations of the disease

  • Severe pain and severe muscle tension mutually reinforce each other and do not allow the exacerbation to subside. Hence, the first is to relieve pain.
  • Prescribe nonsteroidal anti-inflammatory drugs in injections, drugs for muscle relaxation - muscle relaxants
  • If these measures are not sufficient, pain relievers and hormone preparations are used to block the problem

Radio frequency denervation

Bed rest is recommended for several days

After the symptoms have subsided, it is necessary to move around, gradually increasing the range of motion and the load. At this time, active kneading and massage is undesirable due to possible complications.

Osteochondrosis: treatment without exacerbation

When the patient's condition stabilizes, the usual indolence persistsOsteochondrosis, Treatment consists of several components:

  • Drug. After all, anti-inflammatory pain relievers in tablets, capsules and ointments. A specific drug is selected by the doctor based on the patient's condition, lifestyle, concomitant diseases, and the prevalence of one or another component of osteochondrosis. A cure with B vitamins improves the conduction of stimuli along the nerve and normalizes tissue nutrition. While maintaining the increased muscle tone, the use of muscle relaxants is continued. There is no magic pill, an injection that can restore the vertebrae and cartilage to their original state. Medicines relieve symptoms, improve mobility and performance. However, they are unable to completely stop the disease's progression.
  • Physical therapy. It is used for delivering drugs directly to the sore point (electrophoresis), heating (paraffin, infrared radiation). The action of therapeutic currents relaxes the muscles and improves the functioning of the nerve fibers. After several sessions, the pain subsides and mobility is restored. Not prescribed for active inflammation
  • Manual manipulation, massage, acupuncture, acupressure. Help relieve cramps by stretching and relaxing muscles. If the massage only affects the upper muscle layer, manual therapy penetrates deeper, so the demands on specialists are higher. Make sure to do an MRI first to find out the features of a particular patient's anatomy
  • Spinal traction. The vertebrae move away from each other, the normal distance between them is restored, the pinching of the nerves decreases. The procedure has contraindications, so only a doctor can prescribe it
  • Physical therapy. The most effective method of treatment. The only limitation is that it must be used for life. Of the advantages - it provides activity, improves mood, increases tissue tone. The best methods are a series of exercises recommended by a doctor, first yoga asanas, pilates, swimming. They are performed smoothly, without sudden and traumatic movements, stretching the tissues and gradually increasing the amplitude
  • Proper nutrition and giving up bad habits
  • An adequate supply of nutrients to the tissue, a good condition of the blood vessels and an adequate blood flow to the vertebrae and the structures surrounding them are measures to prevent the progression of osteochondrosis. Proper nutrition normalizes weight, reduces the load on the spine

Surgical treatment of osteochondrosis of the spine.Modern clinics have a large arsenal of minimally invasive interventions:

  • Treatment and diagnostic block
  • Radiofrequency facet ablation
  • Cold plasma and laser nucleoplasty
  • Endoscopic removal of a herniated disc
  • Microdiscectomy

Radiofrequency thermal ablation of the facet joints

Special needles are placed exactly on the side of the intervertebral joints at the point where the median branch of the Lyushka nerve runs. Electrodes are built into the needles, the tips of which heat up to 80 degrees for 90 seconds. This leads to coagulation of the nerve. The pain goes away.

Cold plasma nucleoplasty

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

Microdiscectomy

With a herniated disc, the adjacent nerve roots and blood vessels are compressed, extremely painful sensations and various disorders of the innervation of the extremities occur. If the effect of conservative treatment no longer exists, surgery to remove a herniated disc is the only possible solution for many patients. The operation is performed under anesthesia through a 2-3 cm incision using microsurgical equipment and instruments. The duration of the operation is 45-60 minutes. The pain syndrome significantly decreases or disappears completely in 95% of patients immediately after surgery. The next day the patient is allowed to walk and will soon be discharged from the clinic.

Endoscopic removal of herniated discs:

A hernia or exposed sequestering is removed through the lateral intervertebral foramen. A 5 mm incision is made on the skin to place the tube. Muscles, fasciae and ligaments are not damaged, they are pushed apart by a system of tube retractors with a gradual increase in diameter. The operation is almost bloodless and only takes 40-50 minutes. Patients can return to their usual treatment after three weeks. The risk of complications is minimal.

Decompression and stabilization operations are performed when complications arise, a large herniated disc, severe compression of the spinal nerve root and spinal cord. If there are signs of sudden loss of sensitivity, movement or pelvic dysfunction, the patient should be taken to a neurosurgeon urgently. The sooner it is possible to get rid of the compression, the more complete the recovery will be and 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. The fixation is carried out by a transpedicular system in combination with an intercorporeal cage, which enables a 360-degree fusion. The interspinous stabilization of the vertebrae is widespread. There are several interspinous implants available today. Microdisectomy in combination with interspinous stabilization, especially in the elderly, can significantly increase the effectiveness of long-term results and reduce the likelihood of another herniated disc.