Cervical – degenerate and dystrophic process in small joints of cervical department of a backbone. Usually strikes aged people of 50-55 years and is more senior. After injuries, at some diseases and pathological states signs of a spondiloartroz can come to light at persons of young and middle age. The disease is shown by night pains, pains at the movements and after static loading, morning constraint and restriction of movements. At a sdavleniye of nervous backs there are neurologic violations. The diagnosis is specified by means of a X-ray analysis, by MRT, radio isotope scanning, ultrasonography of vessels and other researches. Treatment is conservative.
Cervical – a kind of arthrosis, the disease affecting small joints of cervical department of a backbone. Usually arises at the age of 50 years and is more senior, however at traumatic defeats, anomalies of development and some other states can develop at young patients. Seldom happens isolated, as a rule, it is combined with other diseases of a backbone – osteochondrosis and spondilezy. The pathological changes caused by a combination of the listed diseases can provoke a number of various symptoms among which neurologic frustration, signs of deterioration in blood supply of a brain etc. Therefore each case of a cervical spondiloartroz needs to be considered in a complex, taking into account other damages of a backbone. Treatment of a cervical spondiloartroz is performed by orthopedists, neurologists and vertebrolog.
The cervical department consists of 7 vertebras, at the same time two top vertebras have the non-standard form and differ from all others. The I cervical vertebra (Atlas) reminds a ring which on the one hand connects to an occipital bone, and with another "is got" on a toothlike shoot of the II cervical vertebra. Such connection allows to carry out free rotary motions (the Atlas together with the head "turns" around tooth). Besides, I and II cervical vertebras connect among themselves several small joints located on the side surfaces of vertebras. The intervertebral disk between I and II vertebras is absent.
Other vertebras of cervical department have a typical structure. They have a body, the top and lower articulate shoots. The lower articulate shoots of an overlying vertebra connect to the top articulate shoots underlying by means of facet joints. Between bodies of vertebras intervertebral disks – the elastic educations which are carrying out a role of shock-absorbers settle down. The backbone is strengthened by ligaments and deep tonic muscles which do not submit to conscious control and work reflex, providing preservation of balance and the correct position of a backbone at the movements and static loading.
Pathogenesis of development of a cervical spondiloartroz
In facet joints there are changes: the amount of articulate liquid decreases, cartilages become thinner, become less smooth. Quite often articulate surfaces are excessively displaced relatively each other that is caused both by changes of properties of the articulate capsule, and excess or not physiological load of articulate shoots which reason change of ratios between various structures at anomalies of development of a backbone is, redistribution of loading at violations of a bearing or increase in vertical loading at decrease in height of intervertebral disks.
Because of the shift of articulate surfaces the capsule of a facet joint stretches. The nervous receptors located in the thickness of the capsule send to a brain a signal of excessive stretching. The surrounding muscles which received "command" to eliminate the arisen violation strain excessively and spazmirutsya. At the same time, as normal ratios between elements of a backbone are broken, joints are fixed in vicious situation that aggravates cervical even more and leads to further progressing of degenerate and dystrophic changes.
The volume of movements in joints decreases, ankiloza can develop over time. The complex of pathological changes at simultaneous damage of facet joints and disks leads to infringement of nervous backs. There are neurologic frustration. The direct sdavleniye of vessels and the pain causing a spasm of vertebral arteries negatively influence blood supply of a brain that is shown by dizzinesses, headaches and flashing of front sights before eyes. The violations of venous outflow leading to increase in intra cranial pressure are possible owing to what arises weight in the head, an incoordination of movements and noise in ears.
Reasons of a cervical spondiloartroz
Along with age involutional changes, development of a cervical spondiloartroz can be connected with anomalies of development (insufficiently created arches of vertebras, asymmetry of shoots etc.) and spine injuries. Not physiologic load of cervical department of a backbone at athletes, people of hard physical work and persons forced to be a long time in the same situation (keyboarders, typists, laboratory doctors) is of great importance. A part is played by hereditary predisposition, existence of autoimmune diseases, hormonal and exchange violations.
Taking into account expressiveness of patomorfologichesky and clinical manifestations allocate 4 stages of a cervical spondiloartroz:
- 1 stage – proceeds asymptomatically. In joints there are initial changes.
- 2 stage – the first signs of a spondiloartroz appear: discomfort, pains, insignificant decrease in mobility.
- 3 stage – changes become well noticeable on roentgenograms: facet joints are deformed, at the edges of articulate surfaces bone growths appear.
- 4 stage – there are expressed violations of mobility of the struck department, ankiloza, violations of blood supply of a brain and neurologic symptoms can be observed.
Symptoms of a cervical spondiloartroz
The main manifestations of a cervical spondiloartroz at the initial stages are the pain syndrome and unpleasant feelings in a neck. The pains, as a rule, aching the constants amplifying at the movements. At long stay in an uncomfortable position or one-stage intensive loading pain can become sharper, sometimes – burning. In the mornings patients quite often feel constraint in a neck, usually disappearing within 30-40 minutes. Irradiation in a shoulder and a hand is uncharacteristic, neurologic violations are absent.
During the progressing of a cervical spondiloartroz and accession of osteochondrosis symptoms become brighter and various. Pains periodically amplify, begin to irradiate in and an upper back. There are dizzinesses, headaches, feeling of fog and weight in the head. There are paresteziya and a sleep of separate parts of the body, sensitivity violations are possible. At damage of joints of the I-II vertebras (an unkovertebralny spondiloartroz) balance violations, cervical and humeral neuritis, a hyporeflection are noted.
For confirmation of the diagnosis appoint a X-ray analysis, MPT and KT. The X-ray analysis of cervical department of a backbone is informative in the presence of the expressed changes in facet joints. KT of a spine column is more sensitive and allows to diagnose at initial stages. On MRT the accompanying changes of soft fabrics are visible. For assessment of a condition of brain blood circulation and an exception of a syndrome of a vertebral artery appoint doppler sonography (UZDG of vessels of the head and a neck). In the presence of neurologic violations of patients direct to consultation to the neurologist.
Treatment of a cervical spondiloartroz
Treatment of a cervical spondiloartroz is most effective at initial stages when in joints ankiloza did not manage to develop yet. Apply resolvents, hondroprotektor and vitamins of group B, carry out blockade of facet joints. The patient is directed to acupuncture, trained in the special exercises directed to strengthening of muscles of cervical department of a backbone and elaboration of the correct breath (because of a pain syndrome duration of a breath and exhalation can change).
According to indications appoint massage and manual therapy. It is necessary to treat these types of treatment with care, to apply strictly on doctor's orders and only for lack of signs of an acute inflammation. The unreasoned, at the wrong time appointed therapy, and, especially, self-treatment can be led to an aggravation of a spondiloartroz, sharp strengthening of a pain syndrome and even emergence of neurologic symptomatology. It is better to apply techniques short courses and only under cover of anti-inflammatory medicines.
Surgical treatment at a cervical spondiloartroz is carried out extremely seldom. At the dynamic violations caused by the shift of shoots and a sdavleniye of nervous structures of an osteofitama the stabilizing backbone operations are shown. At the stable violations caused by excessive bone growths in combination with rough degenerate changes of an intervertebral disk and a stenosis of the vertebral channel the surgical decompression is necessary (in some cases – in combination with the subsequent stabilization of the struck department). At the expressed reflex component (a constant strong spasm of muscles) low-invasive interventions – a denervation of facet joints with use of radio surgical techniques are effective.