Spinal osteochondrosis: what it is, treatment of cervical, thoracic and lumbar areas

This material is intended for individuals without medical education who would like to learn more about osteochondrosis and is not intended to be found in popular publications and private practice websites. Patients ask doctors of various specialties questions that are characterized by a complete misunderstanding of the topic of osteochondrosis. Examples of such questions include: "Why does my osteochondrosis hurt? ", "Congenital osteochondrosis is discovered, what should I do? " Perhaps this paradigm of illiteracy can be considered a fairly common problem: "Doctor, I have the first signs of osteochondrosis, how scary is this? " This article aims to build material about osteochondrosis, its causes, manifestations, diagnosis, treatment and prevention methods and to answer the most frequently asked questions. Since all of us without exception are osteochondrosis sufferers, this article is useful for everyone.

What is osteochondrosis?

It’s scary when the name of this disease is unclear. The medical suffix "-oz" indicates the proliferation or enlargement of certain tissues: hyaline degeneration, fibrosis. One example is cirrhosis, when connective tissue grows and functional tissue (liver cells) decreases in size. There may be an accumulation of pathological proteins or amyloid that should not be present under normal circumstances. This storage disease would be called amyloidosis. Due to steatosis, the liver may become significantly enlarged, called fatty liver disease.Well, it turns out that intervertebral osteochondrosis causes the cartilage tissue of the intervertebral disc to increase in size, because "chondros, χόνδρο" translated from Greek to Russian means "cartilage"? No, rickets, or more accurately, osteochondrosis, is not a storage disease. In this case, no real growth of cartilage tissue occurs; we're just talking about changes in the disc structure under the influence of years of physical activity, and we examined above what happens in each individual disc. The term "osteochondrosis" was introduced into the clinical literature by A. Hilderbrandt in 1933.How do the biomechanics of a dehydrated disc change its shape? Due to excessive loading, their outer edges swell, rupture, and form herniations, which then form intervertebral hernias, or cartilage nodes that protrude beyond the normal contours of the disc. This is why rickets are called rickets, because cartilage nodules (hernias) appear where cartilage shouldn't be, behind the outer contour of a healthy disc.The edges of the vertebrae adjacent to the disc are also enlarged, forming coracoids or osteophytes. Therefore, this mutual destruction of cartilage and bone tissue structure is collectively called osteochondrosis.Osteochondrosis refers to a dystrophic-degenerative process that is part of the normal aging of the intervertebral discs. None of us would be surprised that a 20-year-old girl's face looks slightly different than her 70-year-old face, but for some reason everyone assumes that the spine and its discs don't undergo the same dramatic temporary changes. change. Malnutrition is a nutritional disorder, and degeneration is the destruction of the intervertebral disc structure after long-term malnutrition.

Causes of osteochondrosis and its complications

The main cause of uncomplicated physiological osteochondrosis can be considered the way a person moves: upright walking. Humans are the only species of all mammals on Earth that walk on two legs, and the only mode of locomotion. Osteochondrosis has become a scourge to mankind, but we have liberated our hands and created civilization. Not only did we create the wheel, the alphabet, and master fire thanks to upright walking (and osteochondrosis), but you can read this on your computer screen sitting in the warmth of your home.Humans' closest relatives, the higher primates - chimpanzees and gorillas - sometimes stand on two legs, but this mode of locomotion is supplementary to them, and most of the time they still walk on four legs. In order for osteochondrosis to go away, as does severe aging of the intervertebral discs, a person needs to change the way they move and eliminate the constant vertical load on the spine. Dolphins, killer whales, and whales do not have osteochondrosis, nor do dogs, cows, and tigers. Their spine is not subject to long-term static and impact vertical loads because it is in a horizontal position. If humans took to the sea like fish and the natural mode of locomotion was scuba diving, osteochondrosis would be defeated.The upright posture forces the human musculoskeletal system to evolve toward protecting the skull and brain from impact loads. But discs (the elastic pads between vertebrae) aren't the only method of protection. Humans have elastic arches, knee cartilage, and physiological curves of the spine: two lordosis and two kyphosis. All this allows you to not "dump" your brain even while running.

risk factors

But doctors are interested in risk factors that can be modified and avoided to prevent the complications of osteochondrosis, which can cause pain, discomfort, limited mobility and reduced quality of life. Let’s consider these risk factors that are often overlooked by doctors, especially in private medical centers. After all, it is much more beneficial to continually treat a person than to point out the cause of the problem, fix the problem, and lose the patient. Here they are:

• Longitudinal and transverse flat feet are present. Flat feet cause the arch of the foot to stop bouncing and impact forces are transmitted up the spine without softening. The intervertebral discs are under tremendous pressure and collapse rapidly;
• Overweight and obesity – no comment needed;
• Improper lifting and carrying of heavy objects causes uneven stress on the intervertebral discs. For example, if you carry a bag of potatoes on your shoulders, the powerful load will rest on one edge of the disc and may be too large;
• Lack of physical activity and a sedentary lifestyle. As mentioned above, the greatest pressure on the intervertebral disc is when sitting, because people never sit upright, but always "slightly" curved;
• Chronic injuries, slipping on ice, strenuous lifting, exposure to martial arts, wearing heavy hats, hitting your head on low ceilings, heavy clothing, carrying heavy bags in your hands.

Listed above are risk factors that can affect everyone. We deliberately do not list diseases here - connective tissue dysplasia, scoliotic deformations (which alter the biomechanics of movement), Pethe's disease, and other diseases that aggravate and worsen the physiological osteochondrosis process and lead to complications. These patients are treated by orthopedic surgeons. What are the common symptoms of complex osteochondrosis that patients turn to their doctors for help?

General symptoms

The symptoms described below exist outside of localization. These are common symptoms and can occur anywhere. These are pain, movement impairment, and sensory impairment. There are also phytotrophic diseases or specific symptoms, such as urinary tract disorders, but much less frequently. Let's take a closer look at these signs.

Pain: Muscle and nerve root pain

Pain can be of two types: radicular pain and muscle pain. Radicular pain is associated with compression or herniation or herniation of the disc at the corresponding root at that level. Each nerve root consists of two parts: a sensitive part and a motor part.  Depending on the exact location of the hernia and which part of the root is compressed, sensory or motor impairment may occur. Sometimes two diseases occur at the same time, but to different degrees. Pain is also a sensory disorder because pain is a special feeling.  

Radicular pain: compressive radiculopathy

Radicular pain is familiar to many people; it is known as "neuralgia. "The swollen nerve roots react violently to any electrical shock, with pain that is severe and similar to an electric shock. She either shoots in the arms (from the neck) or in the legs (from the lower back). This sharp, painful urge is called low back pain: in the lower back, it's lumbago, and in the neck, it's nuchal pain, a rarer term. This radicular pain requires coercive, analgesic, or analgesic postures. Root pain occurs immediately when coughing, sneezing, crying, laughing, or exerting force. Any impact to the swollen nerve root can cause increased pain.

Muscle pain: myofascial ankylosis

But an intervertebral hernia or disc defect may not compress the nerve root, but can damage nearby ligaments, fascia, and deep back muscles when moved. In this case, the pain will be secondary, sore, permanent, stiff back, and this pain is called myofascial pain. The source of this pain will no longer be nerve tissue, but muscles. Muscles can only respond to any stimulus in one way: to contract. And if stimulated for a long time, the muscle contraction will turn into continuous spasm, which will be very painful.This creates a vicious cycle: the spastic muscle does not receive a good blood supply, it becomes hypoxic, and it has difficulty clearing lactic acid (i. e. , a product of its own vital activity) into the venous capillaries. The buildup of lactic acid again leads to increased pain. It is this chronic muscle pain that significantly worsens the quality of life and forces the patient to undergo long-term treatment for osteochondrosis, although this does not prevent him from moving and does not force him to stay in bed.A classic symptom of this secondary myofascial pain is increased stiffness in the neck, lower back, or thoracic spine, and the development of dense, painful muscle masses—the "rollers" next to the spine, known as the paravertebral spine. In these patients, back pain worsens after working for several hours in the "office" and after long periods of immobility, when the muscles can barely work and are in a state of spasticity.  

Diagnosis of osteochondrosis

In typical cases, osteochondrosis of the cervical and cervicothoracic spine occurs as described above. Therefore, the main stage of diagnosis was, and still is, to identify the patient's presenting complaint and determine whether there is an accompanying muscle spasm by simply palpating the muscles along the spine. Can osteochondrosis be diagnosed through X-ray examination?An "X-ray" of the cervical spine, even with flexion and extension functional tests, will not show the cartilage because the cartilage tissue transmits the X-rays. Nonetheless, based on the position of the vertebrae, we can draw general conclusions about disc height, overall straightening of the physiological curvature of the neck (lordosis), and long-term spinal edge growth. Weak and dehydrated discs irritate their surfaces. Functional testing can confirm the diagnosis of cervical spine instability.Because the disc itself can only be seen with CT or MRI, magnetic resonance and X-ray computed tomography are used to elucidate the internal structure of the cartilage as well as structures such as protrusions and hernias. Therefore, diagnosis can be made accurately with the help of these methods, and tomography results can be used as an indication or even local guidance for neurosurgical hernia surgical treatment. It should be added that there are no other research methods that can show hernias other than MRI or CT. So if you undergo the popular full-body "computer diagnosis, " if a chiropractor diagnoses you with a hernia by running a finger down your back, if the hernia is detected based on acupuncture, a special extrasensory technique, or ifHave a honey thai massage and you can immediately think that this level of diagnosis is total illiteracy. Complications of osteochondrosis caused by herniation or hernia, compression, muscular, neurovascular, can only be treated by observing the condition of the disc at the appropriate level.

Treatment of complications of osteochondrosis

Let us reiterate that there is no cure for osteochondrosis, just like the planned aging and dehydration of the intervertebral discs. You can't make things complicated:

• If you have symptoms of narrowing of the intervertebral disc height, you need to exercise correctly, do not gain weight, and avoid protrusions and muscle pain;
• If there is already a herniation, care needs to be taken not to let it rupture the annulus fibrosus, that is, not to convert the herniation into a hernia, and to avoid the occurrence of multi-level herniations;
• If you have a hernia, then you need to monitor it dynamically, undergo regular MRI scans, avoid increasing its size, or undergo modern minimally invasive surgical treatment, since all conservative methods of treating the exacerbation of osteochondrosis without exceptionThe hernia remains in place and eliminates only temporary symptoms: inflammation, pain, shooting and muscle spasms.

But with just the slightest violation of this regime, weight lifting, hypothermia, injury, weight gain (in the case of the lower back), the symptoms will appear again and again. We will describe how you can deal with unpleasant sensations, pain, and limited mobility in your back in the context of worsening osteochondrosis and an existing herniation or hernia secondary to social ankylosis syndrome.

What should I do when my condition worsens?

In case of acute pain (such as lower back pain), you will need to follow the following instructions in the pre-medical period:

• Complete elimination of physical activity;
• Sleep on a firm mattress (orthopedic mattress or firm sofa) to eliminate back sagging;
• It is recommended to wear a semi-rigid corset to prevent sudden movements and "twisting";
• You should place a massage pillow with plastic needles on your lower back, or use a Lyapko massager. It needs to be maintained for 30-40 minutes, 2-3 times a day;
• Afterward, an ointment containing NSAIDs, bee venom, or snake venom can be rubbed into the lower back;
• After wiping, the next day you can wrap your waist with a dry heat wrap, such as a band made of dog hair.

A common mistake is warming up on the first day. This could be a heating pad, a bath routine. Meanwhile, the swelling only increases, and so does the pain. Warming can only be done after the "peak of pain" has passed. Thereafter, the heat will enhance the "absorption" of the swelling. This usually occurs within 2-3 days.The basis of any treatment is symptomatic treatment (eliminating the cause) and etiological treatment (affecting the disease mechanism). It is accompanied by symptomatic treatment. For vertebral pain (caused by spinal problems), here's what happens:

• To reduce muscle and spinal swelling, a salt-free diet and limited fluid intake are recommended. You can even take a mild potassium-sparing diuretic;
• In the acute stage of lumbar osteochondrosis, short-term treatment can be carried out through intramuscular "injection" of NSAIDs and muscle relaxants: 1. 5ml intramuscular injection daily for 3 consecutive days, or 1ml intramuscular injection for 5 consecutive days. This will help relieve nerve tissue swelling, eliminate inflammation, and normalize muscle tone;
• In the subacute phase, after the maximum pain has been overcome, no more "injections" should be given, attention should be paid to restorative drugs, such as modern drugs of the "B" group. They can effectively restore damaged sensitivity and reduce numbness and paresthesia.

Physiotherapy measures continue, and the time has come for exercise therapy in osteochondrosis. Its job is to normalize blood circulation and muscle tone when swelling and inflammation have subsided but muscle spasms have not yet completely resolved.Exercise therapy (exercise therapy) involves performing therapeutic exercises and swimming. Gymnastics for cervical osteochondrosis do not target the intervertebral disc at all, but the surrounding muscles. Its task is to relieve tonic spasms, improve blood flow, and normalize venous outflow. This is what leads to decreased muscle tone, back pain, and stiffness.In addition to massage, swimming and acupuncture treatments, it is recommended to purchase orthopedic mattresses and special pillows. Pillows for treating cervical osteochondrosis should use special materials with "shape memory" function. Its task is to relax the muscles of the neck and suboccipital area and prevent interruption of blood flow in the area of the vertebrobasilar artery at night.Autumn is an important period for prevention and treatment with home physiotherapy products and devices - from infrared and magnetic devices, to the most common needle applicators and hard rubber discs, which are the source of weak electric currents during massage and have beneficial effects on the body. patient. Exercises for the treatment of osteochondrosis must be performed on "warm-up muscles" after a slight general warm-up. The primary therapeutic factor is movement, not the degree of muscle contraction. Therefore, to avoid recurrence, the use of heavy objects is not allowed; gymnastic mats and gymnastic sticks are used. With their help, you can effectively regain your range of motion.Continue to apply the ointment and use the Kuznetsov applicator. Swimming, underwater massage, and Charcot showers are all on display. In the advanced stages of fading, home magnet therapy and physical therapy medications are required.Treatment usually takes no more than a week, but in some cases, osteochondrosis can exhibit dangerous symptoms that may require emergency surgery.

About Shants collar

In the early, acute phase, it is necessary to protect the neck from unnecessary movements. Shant collars are perfect for this. Many people make two mistakes when purchasing this collar. They do not choose it based on their size, which is why it simply fails to perform its function and causes uncomfortable feelings.The second common mistake is wearing them for extended periods of time for precautionary purposes. This can lead to weak neck muscles, which will only lead to more problems. For collars, there are only two situations where they can be worn:

• Acute pain and stiffness in the neck that spreads to the head;
• If you do physical work while you are healthy, there is a risk of "straining" your neck and aggravating the condition. For example, when you're lying under a car to work on your car, or when you need to reach out and assume an awkward position to wash your windows.

The collar should not be worn for more than 2-3 days, as wearing it for too long can cause venous congestion in the neck muscles, at which point the patient needs to be activated. An analogue of a Shants collar for the lower back is a semi-rigid corset purchased at a plastic surgery salon.

Surgical treatment or conservative treatment?

It is recommended that every patient undergo an MRI after symptom progression, when complications arise, and consult a neurosurgeon. Modern minimally invasive surgeries can safely remove sizable hernias without lengthy hospitalization, without forcing or lying down for days, and without affecting quality of life, as they are performed using modern videoendoscopy, radiofrequency, laser technology or using coldplasma. You can vaporize some of the kernels and reduce the pressure, thereby reducing the risk of hernias. And you can essentially eliminate the defect, that is, get rid of it completely.There is no need to be afraid of hernia surgery. It is no longer the open surgery of the 1980s and 1990s that was accompanied by muscle dissection, blood loss and long recovery period. They're more like doing a small puncture under X-ray control and then using modern technology.If you prefer a conservative approach without surgery, know that there is no way you can reduce or eliminate your hernia, no matter what they promise you! Hernias cannot be treated with hormone injections, papain electrophoresis, electrical stimulation, massage, leeches or acupuncture. Creams and balms, exercise therapy, and even the introduction of platelet-rich plasma don't help. Even traction therapy or traction, for all its benefits, only relieves symptoms.Therefore, the motto of conservative treatment of disc herniation is "no turning back for minced meat". Hernias can only be eliminated in time. The price of modern operations is not that high as they require a lump sum payment. But annual treatment in a nursing home can end up costing 10 to 20 times more than radically removing the hernia and relieving the pain and restoring quality of life.

Prevention of osteochondrosis and its complications

Osteochondrosis, including complex osteochondrosis, the symptoms and treatments we discussed above, are for the most part not a disease at all, but simply manifestations of the inevitable aging and premature "shrinkage" of the intervertebral discs. Osteochondrosis hardly bothers us:

• Avoid hypothermia, especially in fall and spring, and in winter and fall;
• Do not lift heavy objects, only carry heavy objects in the backpack with your back straight;
• Drink plenty of clean water;
• Don’t get fat, your weight should correspond to your height;
• Treat flat feet (if you have them);
• engage in regular physical exercise;
• Engage in exercise that relieves stress on the back (swimming);
• Quit bad habits;
• Alternate mental stress with physical activity. After every hour and a half of mental work, it is recommended to change the type of activity to physical work;
• You can regularly have at least one lumbar X-ray (two projections) or MRI to see if the hernia, if any, is progressing;

By following these simple tips, you can keep your back healthy and mobile throughout your life.