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Treatment of osteochondrosis.

severe pain with osteochondrosis

Osteochondrosis - Dystrophic changes in the spine associated with age-related tissue aging. The pathology is associated in 80% to genetic data, the rest is the impact of external factors.

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

  • Longer shelf life. Over time, metabolism slows down, tissue nutrition is disrupted, destructive regulatory systems begin to prevail over constructive ones.
  • Walking upright. Standing, the person acquired an uneven load on different parts of the spine, he was able to perform a greater amount of movement, to turn, to extend. Abnormal lateral curves (scoliosis) appeared with an uneven load on the muscles and small joints of the spine. This increased the probability of the formation 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 is insufficient to supply them with oxygen and essential substances.
  • Lack of adequate physical activity. There are two extremes: sedentary work and movement exclusively by car or excessive stress in the gym, when the discs and cartilage wear out at an accelerated rate.
  • Inadequate nutrition. The predominance of fast carbohydrates, the lack of protein, the use of carbonated drinks leads to the fact that the body does not have enough high-quality building materials to maintain the health of tissues.
  • Of smoking. It causes prolonged vasospasm: alteration of the nutrition of the tissues, acceleration of degenerative processes
  • Urbanization, a large number of traumatic objects around lead to spinal injuries, secondary osteochondrosis

Types of osteochondrosis

By location

  • 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 painful point is the transition from the mobile lumbar region to the fixed sacral region.

By stage

  • Initial: small changes in the center of the disc, compaction of the nucleus, the appearance of cracks in the cartilage
  • The progression of the disease: cracks deepen, the height of the disc decreases, the diameter of the intervertebral foramen decreases. Compression of the spinal nerve roots causes pain, muscle spasms. Osteochondrosis of the spine is manifested not only by changes in the discs; due to a violation of the ratio of the vertebrae to each other, the cartilage on the surfaces of small joints is unevenly erased, osteoarthritis and arthritis develop
  • Complicated osteochondrosis - symptoms: further degeneration of cartilage occurs - ruptures of the cartilaginous ring that connects the bodies of two adjacent vertebrae appear. Part of the nucleus protrudes through the free space and squeezes the roots, the spinal cord - a herniated disc is formed. A more serious problem is the separation of the fallen part: a sequestered hernia. Altered by severe pain, sensation, and impaired movement in the area for which the compressed nerve is responsible
  • The body responds to increased load and excess mobility through the growth of bone tissue: osteophytes appear. They stabilize the spine but reduce the range of motion. Bone hooks irritate muscle receptors and put pressure on nearby vessels. With cervical osteochondrosis, this causes "vertebral artery" symptoms: dizziness, tinnitus, blinking of points in front of the eyes.

Osteochondrosis of the cervical spine.

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

Cervical osteochondrosis - symptoms

  • Neck pain spreading to the back of the head, upper back
  • Sometimes headaches associated with cervical osteochondrosis mimic a migraine: one-sided symptoms, intolerance of sounds and bright light, strong pulsations at the temples, bright flashes before the eyes
  • Frequent headaches that do not respond well to conventional tablets.
  • Pressure drops resistant to antihypertensive drugs
  • Dizziness and darkening of the eyes with sudden turning of the head.
  • Numbness in the fingers, especially after sleeping, tingling sensation on the skin.
  • Restriction of movement in the neck, cracking when trying to move. Patients have to turn their entire body to see something behind them.
  • Upper body sweating
  • Tight muscles of the neck and shoulder girdle can be detected by palpation.

If you are identifiedcervical osteochondrosis, treatment in the initial stages prevents serious complications: compression of the vertebral artery with oxygen deprivation 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 diseases of the spine (tuberculosis, nonspecific spondylitis, body hemangiomas).

Symptoms of injury to the thoracic region:

  • Back pain: pain, pulling, worse after prolonged standing or sitting in an uncomfortable position. But with constant complaints of pain, other possible causes should be excluded: pneumonia, pleurisy, tumors, intercostal neuralgia of a different nature, shingles before the appearance of bubbles.
  • Difficulty breathing, shortness of breath, inability to breathe deeply.
  • Thoracic osteochondrosis sometimes mimics attacks of angina pectoris - a cardiologist treats a person for a long time, and the problem is in a diseased intervertebral disc

Lumbar and lumbosacral osteochondrosis

In the structure of all types of osteochondrosis, these departments are unsuspecting leaders, more than half of all diagnostic cases. The reason is that the greatest load falls on this area of the body, both standing and sitting. Body weight, load in case of improper lifting of weight, for a long time in a bent position: the nucleus pulposus of the intervertebral discs is in a state of compression, it is pressed into the vertebral bodies through the cartilaginous plates - the Schmorl's hernias. Overexertion and muscle spasm disrupt the location of the small joints of the vertebrae to each other: the articular cartilage is erased, mobility decreases.

Several vicious circles develop at the same time: muscle spasm causes pain; pain increases in a reflex way to the contraction of muscle fibers, acute pain forces the person to restrict movement, to protect the damaged area; the strength of the muscular structure and the support of the spine decrease, this increases its instability, lumbar osteochondrosis progresses.

At the mobile transition pointlumbar spineIn an immobile sacrum fused into a single monolith, there is a danger of the fifth lumbar vertebra slipping off the surface of the sacrum. This pinches the nerve bundles, radicular syndrome develops.

Lumbar osteochondrosis symptoms

  • Low back pain, especially sitting and standing. After the break, the horizontal position improves. With a long course, the pain is usual, aching, pulling
  • Acute sudden lumbago when changing the state of the body, lifting weights, heavy load. The patient gets stuck in the position in which he was caught by the attack, it is difficult to straighten up, start to move. Low back pain is usually associated with compression of the spinal nerve root, which developed acutely
  • The transition of pain to the gluteal region, legs. The largest nerve in the body, the sciatic nerve, is a direct continuation of the spinal root; therefore, 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 the nutrition of tissues, changes are noted in that part of the trunk for which the diseased nerve is responsible. The limb feels colder than the healthy one. With a prolonged course of the disease, muscle atrophy, dry skin and swelling are noted. Local immunity is lowered - any scratch, cut, or abrasion easily becomes a gateway for infection.
  • The defeat of the sensory fibers leads to a violation of sensitivity, superficial and deep. The patient can be burned or frozen due to the fact that he did not feel a dangerous change in temperature.
  • Very scary symptoms: numbness of the skin of the perineum, loss of control of the pelvic organs. The patient does not feel a full bladder, does not feel the need to empty the intestines. Over time, urine and feces begin to excrete on their own, it is not possible to keep them. In this case, the treatment of osteochondrosis of the spine and its complications is carried out surgically, urgently.

Diagnosis of osteochondrosis.

It is carried out by a neurologist or orthopedist after the pathology of the internal organs has been excluded by the therapist.

  • The specialist discovers the main complaints, the time of their appearance, the 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 and puts on underwear; it is necessary to compare the state and color of the skin in symmetrical parts of the body, the tone of the tissues, the reaction to various stimuli: pain, touch, cold. or heat. Symptoms of tension are determined, indicating muscle tension and irritation of your tendons and integumentary membranes - fascia
  • The neurological hammer will reveal the uniformity 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 needed, submit for additional review

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

It should be remembered that the results of the investigation should be compared with the complaints and changes found during the examination. Detection of signs of spinal osteochondrosis 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 acute muscle tension are mutually reinforcing, which does not allow the exacerbation to subside. Therefore, the first thing is to relieve pain.
  • Prescribe non-steroidal anti-inflammatory drugs in injections, drugs to relax muscles: muscle relaxants
  • If these measures are not enough, a blockade with painkillers and hormonal drugs is carried out.

Radiofrequency denervation

Bed rest for several days is recommended.

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

Osteochondrosis: treatment without exacerbation.

When the patient's condition stabilizes, the usual slowness remainsosteochondrosis, the treatment consists of several components:

  • Medicine. The same anti-inflammatory pain relievers in tablets, capsules, and ointments. The doctor selects a specific drug based on the patient's condition, lifestyle, concomitant diseases, the predominance of one or another component of osteochondrosis. A course of B vitamins will improve the conduction of impulses along the nerve and normalize the nutrition of the tissues. While maintaining increased muscle tone, use of muscle relaxants will continue. There is no magic pill, an injection that could return the vertebrae and cartilage to their original state. Medications relieve symptoms, improve mobility and performance. But they cannot completely stop the progression of the disease.
  • Physiotherapy. It is used for the administration of drugs directly to the painful point (electrophoresis), heating (paraffin, infrared irradiation). Exposure to therapeutic currents relaxes muscles, improves the functioning of nerve fibers. After several sessions, the pain subsides, mobility is restored. Not prescribed for active inflammation
  • Manual manipulation, massage, acupuncture, acupressure. Relieve spasms by stretching and relaxing your muscles. If only the upper layer of muscles is affected during the massage, manual therapy penetrates more deeply, therefore the requirements for specialists are higher. Be sure to do an MRI first to find out the characteristics of the anatomy of a particular patient.
  • 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.
  • Physiotherapy. The most effective treatment method. The only caveat is that it must be applied for life. Of the advantages: provides activity, improves mood, increases the tone of tissues. The best methods are a set of exercises recommended by a doctor, initial yoga asanas, Pilates, swimming. They are performed gently, without sudden and traumatic movements, stretching the tissue, gradually increasing the amplitude.
  • Proper nutrition and abandoning bad habits.
  • A sufficient supply of nutrients to the tissues, a good condition of the blood vessels and an adequate blood supply to the vertebrae and surrounding structures are measures to prevent the progression of osteochondrosis. Proper nutrition normalizes weight and 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 block.
  • Radiofrequency facet ablation
  • Cold plasma and laser nucleoplasty
  • Endoscopic Herniated Disc Removal
  • Microdiscectomy

Radiofrequency thermal ablation of the facet joints

Special needles are placed exactly next to the intervertebral joints where the median branch of the Lyushka nerve passes. The electrodes are installed on the needles, the tip of which is heated up to 80 degrees for 90 seconds. This leads to clotting of the nerve. The pain goes away.

Cold plasma nucleoplasty

Through a needle inserted into the record, a special cold plasma electrode is applied to the tissue of the record. The intradiscal pressure decreases, the hernia (bulge) is pulled inward.

Microdiscectomy

With a herniated disc, the nerve roots and adjacent 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 to 60 minutes. The pain syndrome decreases significantly or disappears completely immediately after surgery in 95% of patients. The next day, the patient can walk and is soon discharged from the clinic.

Endoscopic removal of herniated discs:

A hernia or resting abduction is removed through the lateral intervertebral foramen. To place the tube, a 5 mm incision is made in the skin. The muscles, fascia and ligaments are not damaged, they are separated by a system of tube retractors 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 arise, a large herniated disc, severe compression of the spinal nerve root and spinal cord. If there are signs of a sudden loss of sensation, movement, pelvic dysfunction, the patient should be urgently taken to a neurosurgeon. The sooner it is possible to remove compression, the more complete the recovery, 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 carried out using a transpedicular system, in combination with an interbody cage, which provides a 360-degree fusion. Interspinous stabilization of the vertebrae is widely used. Today there are several interspinous implants. Microdiscectomy in combination with interspinous stabilization, especially in the elderly, can significantly increase the effectiveness of long-term results and reduce the likelihood of recurrent disc herniation.