Frequent osteochondrosis

As a result of a person walking straight, the spine, as an axial structure, took 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 discusses the most severe form of this pathology - common osteochondrosis.

General 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 occurs much more often in people over 40 years of age, but recently a tendency towards rejuvenation has been observed. Common osteochondrosis differs in that it affects several sections of one department or several departments at the same time. Due to the progressive development of degenerative processes, not only in the bone tissue, but also in the ligamentous apparatus of the spine, the vertebrae become mobile and put pressure on the nerves and blood vessels. Symptoms of frequent osteochondrosis are related to this, but it is noteworthy that the disease can be asymptomatic for some time.

Important! The pathology requires multidisciplinary control, as it affects not only the locomotor system, but also the nervous system and internal organs. The pathological process can affect other elements of the skeleton besides the spine.

Etiology and pathogenesis

Widespread osteochondrosis has many causes. Some of them have congenital skeletal disorders, others are associated with inappropriate load during intensive activity. Particularly common factors that contribute to the development of the clinical picture are:

• injuries;
• goose feet;
• clubfoot - deformation of the foot (equinovarus, varus, valgus, depending on the position of the heel);
• work involving heavy lifting;
• sports without warming up or warming up the muscles;
• work at low temperatures.

Low temperature is considered a provoking factor, as the cold temporarily changes the molecular structure of soft tissues, reduces the intensity of blood circulation, reduces the conductivity of nerve impulses and metabolism, thereby the functioning of the immune system. Other causes disrupt the biomechanics of the spine and contribute to rapid wear of the intervertebral discs.

Pain in widespread osteochondrosis may be the result of osteophytes or disc deformation. The pain is usually radicular, e. g. associated with compression of the posterior nerve roots.

Frequent osteochondrosis easily imitates other diseases. With damage to the thoracic region, pain appears in the area of the heart and is confused with ischemic processes, and with damage to the lumbar regions - radiculitis.

Symptoms

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

In the case of involvement of the cervical spine, the following are typical:

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

In case of pathology of the chest region:

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

If the lumbar region is affected:

• burning;
• urinary tract disorders;
• convulsions;
• pain when walking.

Based on the above, it can be easily established that the pathology affects not only the spine and large joints, but also the vegetative nervous system. The latter is associated with interruption of the functioning of internal organs. Frequent polysegmental osteochondrosis can sometimes worsen. In such cases, the manifestations are much more intense. In the case of a combination of disorders of several departments, the symptoms will be appropriate.

Complications

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

Moderate osteochondrosis can be easily treated with conservative treatment. And if it is impossible to completely stop the inevitable aging process, it is possible to slow it down completely. Complications caused by severe osteochondrosis are as follows.

1. Spondyloarthrosis.
2. Intervertebral disc degeneration.
3. Scoliosis.

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 root compression and pain.

Spondyloarthrosis is the degeneration of the facet joints connecting adjacent vertebrae. Otherwise, such joints are called facet joints. If the articular cartilage is damaged, painful contact occurs between the vertebrae. With the degeneration of the facet joints, bone growth most often appears, which leads to spondylosis.

A stenosis is a narrowing (in this case, the spinal canal). The narrowing is typically 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;
• tingling in the limbs;
• radiating pain;
• sciatica symptoms.

Sciatica is caused by compression of the sciatic nerve.

Classification

Osteochondrosis has four degrees. The classification is based on the collected anamnesis and with the help of instrumental diagnostic methods. In this classification, the main criteria are pain and neurological symptoms.

1. Grade I - the pain can be easily relieved with medication.
2. Grade II - long-lasting pain and deformation of the spine, with moderate neurological symptoms.
3. Grade III - the pain is systematic, the neurological symptoms are significant.
4. Grade IV - constant pain, multiple neurological deficits. Disturbance in the conduction of nerve impulses. Paralysis and paresis.

In the case of widespread dysplastic osteochondrosis, the patient becomes disabled. Depending on the general condition of the patient, the extent and intensity of the development of the clinical picture, the disability can be classified into three groups.

Types of disability 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 is able to move and perform small tasks, but periods of exacerbation are common. The operation is contraindicated or useless for some reason. Or the surgery has already been done, but it 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 assigned by the doctor to assess work capacity based on certain studies.

Diagnostics

During a visit to the doctor, the diagnosis consists of several components. The first and most important thing is to collect the anamnesis based on the subjective information given by the patient. Attention should be paid to family history, as osteochondrosis has a genetic component. The specialist asks about the place of work, living conditions and the course of the disease itself, and the patient must describe exactly what is bothering him. The best results can be achieved with good feedback between the patient and the doctor.

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

The instrumental methods of diagnosing common osteochondrosis are as follows:

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

X-ray is effective in determining the presence of bone growth - osteophytes, narrowing of the spinal canal and other diseases that are the consequences of osteochondrosis, such as scoliosis.

Computed tomography can also be used in conjunction with MRI. With the help of a CT scan, you can determine the degree of compression of the nerves by the spur.

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

There are additional diagnostic methods. These include:

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

A bone scan can detect conditions such as osteoarthritis, fractures or infections. This radionuclide method is suitable for differential diagnosis and determination of possible complications.

During discography, contrast material 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 research method. Contrast is injected into the spinal canal and the image is recorded using X-ray or CT. With 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 degenerative processes by improving the supply of nutrients to the structures of the locomotor system.
2. Stabilizing the spine.
3. Elimination of pinched nerve fibers.
4. Alleviation of symptoms.

The following drugs are used for drug treatment:

• nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
• Anilides relieve pain in the initial stage;
• local pain relievers in the form of ointments;
• muscle relaxants to reduce muscle spasms and increase range of motion;
• B vitamins to improve the conductivity of nerve tissue;
• chondroprotectors, which reduce the rate of progression of degenerative processes by integrating active substances (condoitin sulfate and glucosamine) into cartilage cells. As a result, metabolism is normalized and clinical manifestations are reduced. The drug has been used for a long time and requires special consultation in case of pregnancy, lactation and gastrointestinal diseases. Phenylketonuria is an absolute contraindication;
• antispasmodics relieve the spasm of smooth muscles and thereby relieve the manifestations of osteochondrosis in the internal organs;
• antioxidants;
• antidepressants to eliminate the psychosomatic components of the disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. It promotes the production of endorphins and helps to solve the problem of chronic insomnia caused by constant pain.
• neuropathic drugs to eliminate damage to nerve endings.
• opiates for excruciating 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 reduce the inflammation of the nerve roots, which helps relieve the pain caused by radiculopathy. A complicated procedure. It requires a trained professional;
• injections into the facet joint. Injected drugs lead to local numbness and pain relief.

It's important to know! The purpose of taking drugs is not to get rid of the disease - there are no drugs that can completely eliminate osteochondrosis, which is a chronic disease. Medicines are prescribed only to relieve symptoms.

Medicines are prescribed by the attending physician. The patient receives information about the possible side effects of each medication, and then decides which treatment method to choose.

In case of symptoms that suggest osteochondrosis, consult a vertebrologist, orthopedist and neurologist. High-quality medical care will consist of the close cooperation of specialists with each other and with the patient.

Physiotherapy

Physiotherapy is used as a series of additional therapeutic measures to improve blood circulation and metabolism in the affected tissue. For 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 (a combination of ultrasound and medication).
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 physical therapy are actively used. Professional massage can lead to long-term remission. During the exacerbation of the disease, therapeutic exercises should not be performed, as this may lead to complications. During the period of remission, moderate physical activity maintains muscle tone, including the spine. The exercises are performed under the supervision of an instructor and are prescribed by the attending physician.

During an exacerbation, you can not heat 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. An alternative method is leech and vacuum massage. These methods are aimed at improving blood circulation in the affected area. The spa treatment is useful. Water procedures are particularly advantageous.

Surgery

During the treatment of osteochondrosis, specialists are willing to resort to conservative therapy, however, in order to have an adequate effect, a lot of time, patience and strict adherence to the patient's recommendations are required. If conservative treatment is ineffective, only then should invasive methods be used. Surgery is usually palliative. This means that the operation is performed only to alleviate the symptoms and to relatively improve the quality of life, but not for complete recovery (it is fair to say that conservative treatment does not lead to the complete elimination of the disease, but to the patient's susceptibility to non-invasive therapya sign of good prognosis).

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

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

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

Anterior approach decompression surgeries are as follows.

1. Discectomy – removal of an intervertebral disc.
2. Corpectomy - removal of the entire vertebral body with 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.

Surgery is rarely prescribed because there is a risk of developing serious complications.

Complications include:

• relapses of pain;
• false union;
• infection;
• phlebitis on the limbs;
• violation of the act of urination;
• pain due to graft;
• failure of embedded fasteners.

The postoperative period lasts several months. The stitches heal 2 weeks after the operation. If you experience any complications, see your doctor immediately.

After the operation, we carry out a rehabilitation course in order to speed up the healing process and restore full working capacity.

General recommendations

Adequate nutrition helps to prevent the recurrence of frequent exacerbations of osteochondrosis. Adequate nutrition is primarily necessary to maintain a stable body weight, as excess weight places an additional burden on the spine. In this case, the diet should be complete, enriched and rich in calcium, magnesium and potassium. Coffee consumption should be limited as it leaches calcium from the body. It is useful to visit the pool. Staying in one position all the time should be avoided.

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

You cannot take medicines on your own.

Let's summarize

Often, widespread osteochondrosis develops after a "single" osteochondrosis that is not completely healed. This fact suggests that if any discomfort occurs, you should immediately consult a doctor, without hoping that the pain will go away by itself. In this case, muchit will be easier to prevent the development of other pathologies and even more to cure the root cause.