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Frequent osteochondrosis

pain due to osteochondrosis

As a result of upright human walking, the spine, as an axial structure, takes the main load. That is why degenerative and dystrophic processes are quite common consequences of human life. One of the most common diseases of the musculoskeletal system is osteochondrosis, which causes severe discomfort and can lead to disability. This article will discuss the most severe form of this pathology - ordinary osteochondrosis.

Main characteristics

Osteochondrosis is a degenerative disease of the spine that most often affects the thoracic, lumbar and cervical regions. This pathology is directly related to age. The disease is much more common in people over 40 years of age, but recently there has been a trend towards rejuvenation. General osteochondrosis differs in that it affects more than one section of a department or several departments at once. Due to the progressive development of degenerative processes not only in the bone tissue, but also in the ligament apparatus of the spine, the vertebrae become mobile and put pressure on the nerves and blood vessels. Symptoms of ordinary osteochondrosis are related to this, but it should be noted that the disease can be asymptomatic for some time.

important! The pathology requires multidisciplinary control, as it affects not only the musculoskeletal system, but also the nervous system and internal organs. In addition to the spine itself, the pathological process can also affect other elements of the skeleton.

Etiology and pathogenesis

There are many reasons for widespread osteochondrosis. Some of them are related to congenital skeletal defects, others to inadequate load during intense activity. Particularly frequent factors contributing to the development of the clinical picture are:

  • injuries;
  • flat feet;
  • flat feet - deformation of the foot (equinovarus, varus, valgus, depending on the position of the heel);
  • work related to lifting weights;
  • playing sports without warming up or warming up the muscles;
  • operation at low temperatures.

Low temperatures are considered provoking factors, because cold temporarily changes the molecular structure of soft tissues, reduces the intensity of blood circulation, reduces the conductivity of nerve impulses and metabolism, and hence the functioning of the immune system. Other reasons disrupt the biomechanics of the spine and contribute to the rapid wear of the intervertebral discs.

Pain in widespread osteochondrosis can be a consequence of osteophytes or disc deformation. The pain is usually radicular, i. e. associated with compression of the posterior nerve roots.

Simple osteochondrosis easily imitates other diseases. With damage to the chest, pain appears in the heart area and is confused with ischemic processes, and with damage to the lumbar areas - for sciatica.

Symptoms

Clinical manifestations will depend on which parts are affected and in what combination.

When the cervical spine is affected, the following are characteristic:

  • unstable blood pressure;
  • headache;
  • lack of coordination;
  • pain in hands;
  • numbness in the upper body and arms.

For pathology in the chest area:

  • intercostal neuralgia;
  • stiffness of arms and neck;
  • dysfunction of internal organs.

If the lumbar region is affected:

  • burning;
  • urination disorders;
  • spasms;
  • pain when walking.

Based on the above, it is easy to conclude that the pathology affects not only the spine and large joints, but also the autonomic nervous system. The latter is associated with interruptions in the functioning of internal organs. Simple polysegmental osteochondrosis can sometimes worsen. In such cases, the manifestations are much more intense. With a combination of disorders of several departments, the symptoms will be relevant.

Complications

Osteochondrosis can be conditionally divided into moderate osteochondrosis, which is a natural process of wear and tear of the spine as a result of life activity, and severe osteochondrosis, which is most often characterized by complications.

Moderate osteochondrosis is easily treated with conservative treatment. And if it is impossible to completely stop the inevitable aging process, it is quite possible to significantly slow it down. The complications that severe osteochondrosis can lead to are the following.

  1. Spondyloarthrosis.
  2. Degeneration of the intervertebral discs.
  3. Spinal stenosis.

important! The intervertebral discs act as shock absorbers and reduce friction between the vertebrae. Degenerative processes in these structures can lead to protrusion of the nucleus pulposus of the disc and intervertebral herniation. Protrusion leads to compression of the roots and pain.

Spondyloarthrosis is a degeneration of the facet joints connecting adjacent vertebrae. Otherwise, such joints are called facet joints. When the articular cartilage is damaged, there is a painful contact between the vertebrae. With degeneration of the facet joints, bony growths most often appear, leading to spondylosis.

Stenosis is a narrowing (in the case of the spinal canal). Usually, stenosis is the result of pathologies such as intervertebral hernia or spondylosis. Bony growths and herniated protrusions compress the nerve roots at their entry and exit points.

The clinical picture of severe osteochondrosis is the result of complications:

  • chronic pain in the spine;
  • friction of bone surfaces;
  • stiffness;
  • sudden muscle weakness;
  • decreased reflexes;
  • numbness of the limbs;
  • radiating pain;
  • symptoms of sciatica.

Sciatica is caused by compression of the sciatic nerve.

Classification

There are four degrees of osteochondrosis. Classification is carried out on the basis of the collected history and with the help of instrumental diagnostic methods. The main criteria in this classification are pain and neurological symptoms.

  1. Grade I - pain is easily relieved with medication.
  2. II degree - characterized by long-lasting pain and deformation of the spine with moderate neurological symptoms.
  3. III degree - the pain is systemic, the neurological symptoms are pronounced.
  4. IV degree - constant pain, multiple neurological deficits. Violation of the conduction of nerve impulses. Paralysis and paresis.

In the case of widespread dysplastic osteochondrosis, the patient receives a disability status. Depending on the general condition of the patient, the degree and intensity of the development of the clinical picture, the damage can be divided into three groups.

Types of damage in osteochondrosis.

Group Description
First group The functions of the spine are lost. The patient cannot move independently and take care of himself.
Second group The patient can move about and perform small tasks, but periods of exacerbation are frequent. The operation is contraindicated or useless for some reason. Or the operation has already been performed but proved ineffective.
Third group The patient is capable of self-care. There is pain and vestibular symptoms, but the frequency of exacerbations is moderate and intermittent.

The disability group is determined by a doctor based on certain studies to assess the ability to work.

Diagnosis

When visiting a doctor, the diagnosis will consist of several components. The first and most important is the collection of anamnesis based on subjective information given by the patient. Attention is paid to family history, as osteochondrosis has a genetic component. The specialist asks about the workplace, living conditions and the course of the disease itself, and the patient must describe what exactly bothers him. Best results can be achieved with good feedback between patient and doctor.

The next method is objective research, which is carried out by the specialist himself or with the help of instrumental methods. The doctor checks the range of motion of the neck and limbs, which may be significantly reduced due to pain and stiffness. Using the palpation method, he records how many muscles are under spasm and how much the spine is curved. Attention is paid to a neurological examination, with the help of which weakened reflexes can be traced. This symptom may be the result of compression or damage to the nerve.

Instrumental methods for diagnosing general osteochondrosis include:

  1. X-ray of the entire spine in two views.
  2. MRI to evaluate ligaments and nerve tissue.
  3. An electrophysiological study to study the conduction of nerve impulses.

Radiography is effective for determining the presence of bone growths - osteophytes, narrowing of the spinal canal and the presence of other diseases that are a consequence of osteochondrosis, for example, scoliosis.

Computed tomography can also be used in combination with MRI. With the help of computer tomography, you can determine the degree of compression of the nerves by the spurs.

The diagnosis of widespread polysegmental osteochondrosis is made if other pathologies that cause destruction of the vertebrae (for example, tuberculosis) are excluded, and if several segments of one or more departments are affected.

There are additional diagnostic methods. They include:

  1. Bone scan.
  2. Discography.
  3. Myelogram.

Bone scans can detect conditions such as osteoarthritis, fractures or infections. This method is radionuclide and is suitable for differential diagnosis and for determining possible complications.

During discography, a contrast agent is injected into the nucleus pulposus of the intervertebral disc. This method is effective in determining the presence of a herniated disc.

Myelogram is also a contrast method of research. Contrast is injected into the spinal canal and the picture is recorded using X-rays or a CT scan. Using this method, you can determine the condition of the spinal cord, the presence of narrowings and compressions.

Treatment

Treatment is based on the following mechanisms.

  1. Slowing down the degenerative process by improving the supply of nutrients to the structures of the musculoskeletal system.
  2. Stabilizing the spine.
  3. Elimination of pinched nerve fibers.
  4. Symptom relief.

The following drugs are used for drug treatment:

  • nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
  • Anilides relieve pain in the initial stages;
  • local analgesics in the form of ointments;
  • muscle relaxants to reduce muscle spasm and increase range of motion;
  • vitamins of group B to improve the conductivity of nerve tissue;
  • chondroprotectors that reduce the rate of progression of degenerative processes by integrating active substances (chondoitin sulfate and glucosamine) into cartilage cells. As a result, the metabolism normalizes and clinical manifestations decrease. The drug has been used for a long time and requires special consultation during pregnancy, breastfeeding and the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
  • antispasmodics relieve spasms of smooth muscles and thus alleviate the manifestations of osteochondrosis in the internal organs;
  • antioxidants;
  • antidepressants to eliminate the psychosomatic component of this disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. They promote the production of endorphins and help solve the problem of chronic insomnia due to constant pain.
  • neuropathic agents to eliminate damage to nerve endings.
  • opiates for unbearable pain and ineffectiveness of other pain relievers.

The following are used as invasive medical procedures:

  • injection of steroids into the epidural space. Steroids are powerful anti-inflammatory drugs. They relieve inflammation of the nerve roots, which helps relieve pain caused by radiculopathy. A complex procedure. Requires a qualified specialist;
  • facet joint injections. Injected drugs cause local numbness and pain relief.

It is important to know! Taking drugs is not aimed at getting rid of the disease - there are no drugs that could completely eliminate osteochondrosis, which is a chronic disease. Medicines are prescribed only to relieve symptoms.

Medicines are prescribed by the attending physician. The patient is informed about the possible side effects of each drug and then decides for himself which course of treatment to choose.

For symptoms that give reason to suspect osteochondrosis, contact a vertebrologist, orthopedist and neurologist. High-quality medical care will consist of close cooperation between these specialists with each other and with the patient.

Physiotherapy

Physiotherapy is used as a set of auxiliary therapeutic measures to improve blood circulation and metabolism in the affected tissue. In widespread osteochondrosis, the following methods are used.

  1. Electrophoresis (based on the movement of colloidal particles under the influence of an external electric field).
  2. Phonophoresis (combination of ultrasound and drugs).
  3. Magnetotherapy (using a static magnetic field).
  4. UHF therapy (ultra high frequency therapy).
  5. Electromyostimulation (stimulation of nerves and muscles).
  6. Acupuncture (acupuncture).
  7. Laser exposure.

In addition to physiotherapy, manual therapy and physiotherapy are actively used. Professional massage can lead to long-term remission. Physical therapy should not be performed during an exacerbation of the disease, as this can lead to complications. During the period of remission, moderate physical activity maintains muscle tone and therefore the spine. The exercises are performed under the supervision of an instructor and are prescribed by the attending physician.

During an exacerbation, you cannot warm the spine, but you can wear a corset, but only for a few hours. In other cases, wearing a corset for more than a few hours is not optimal because it can lead to muscle atrophy.

Manual therapy can increase clearance of pinched nerves and reduce neurological symptoms. Alternative methods are leeches and vacuum massage. These methods are aimed at improving blood circulation in the affected area. Sanitary balneotherapy is useful. Particular preference is given to water treatments.

surgery

In the treatment of osteochondrosis, specialists are more likely to resort to conservative therapy, but the correct effect requires a lot of time, patience and strict adherence to the patient's recommendations. If conservative treatment is ineffective, only then should you resort to invasive methods. Usually the operation is palliative. This means that the operation will be performed only to relieve the symptoms and relatively improve the quality of life, but not for a complete cure (it is fair to say that conservative treatment also does not lead to the complete elimination of the disease, but the patient's susceptibilityto non-invasive therapy is a sign of a good prognosis).

There are two types of surgery: decompression and stabilization. The first is aimed at relieving nerve compression, and the second is aimed at stabilizing the spine. The following operations are classified as decompression operations.

  1. Facetectomy – removal of the facet joints to relieve compression.
  2. Foraminotomy is an increase in the lumen of the spinal canal, which is narrowed due to osteophytes.
  3. Laminectomy is the removal of the back part of a vertebra, which can be deformed due to osteochondrosis.
  4. Laminotomy - removal of a fragment from the back of a vertebra to widen the spinal canal.

These operations require a posterior approach, but in the case of an intervertebral hernia, the surgical approach will be anterior.

Anterior access decompression operations are as follows.

  1. Discectomy - removal of the intervertebral disc.
  2. Corpectomy - removal of the entire body of a vertebra with the adjacent discs.

Stabilizing operations include:

  1. Spinal fusion is a method of fusing vertebrae.
  2. Artificial intervertebral disc.

The need for stabilization operations arises after a discectomy.

Operations are rarely prescribed, as there is a risk of developing serious complications.

Complications include:

  • pain relapses;
  • false union;
  • infection;
  • phlebitis of the extremities;
  • violation of the act of urination;
  • pain due to grafting;
  • damage to the built-in fasteners.

The postoperative period lasts several months. Sutures heal 2 weeks after surgery. If complications are found, you should immediately consult a doctor.

After the operation, a rehabilitation course is conducted to speed up the healing process and restore full working capacity.

General recommendations

Proper nutrition helps to prevent relapses of exacerbation of simple osteochondrosis. Proper nutrition is necessary above all to maintain a stable body weight, as excess weight puts additional strain on the spine. In this case, the diet should be complete, enriched and rich in calcium, magnesium and potassium. It is necessary to limit the consumption of coffee, as it extracts calcium from the body. It is useful to visit the pool. You should avoid standing in one position all the time.

If there are frequent exacerbations and a lack of discipline to strictly follow the recommendations, it is best to undergo a full course of treatment in a hospital under the supervision of a doctor.

You cannot take medicine alone.

Let's summarize

Often widespread osteochondrosis develops after incompletely healed "single" osteochondrosis. This fact suggests that if any discomfort occurs, you should immediately contact a doctor without hoping that the pain will disappear on its own. In this case, it will be much easier to prevent the development of other pathologies and even more so to cure the root cause.