Osteochondrosis of a backbone is a chronic disease at which there are degenerate changes of vertebras and the intervertebral disks which are between them. Depending on the place of damage of a backbone distinguish: osteochondrosis of cervical department, osteochondrosis of chest department and osteochondrosis of lumbar department. Diagnosis of osteochondrosis of a backbone requires carrying out a X-ray analysis, and in case of its complications (for example, hernias of an intervertebral disk) - backbone MRT. In treatment of osteochondrosis of a backbone along with medicamentous methods widely apply, reflexotherapy, massage, manual therapy, physiotherapy and physiotherapy exercises.
Osteochondrosis of a backbone is a chronic disease at which there are degenerate changes of vertebras and the intervertebral disks which are between them. Depending on the place of damage of a backbone distinguish: osteochondrosis of cervical department, osteochondrosis of chest department and osteochondrosis of lumbar department.
Etiology and pathogenesis
In a varying degree osteochondrosis of a backbone develops at all aged people and is one of processes of aging of an organism. Sooner or later in an intervertebral disk there are atrophic changes, however injuries, diseases and various overloads of a backbone promote earlier developing of osteochondrosis. Most often osteochondrosis of cervical department and osteochondrosis of lumbar department of a backbone meets.
About 10 theories of osteochondrosis are developed: vascular, hormonal, mechanical, hereditary, infectious and allergic and others. But any of them does not offer a full explanation of the changes happening in a backbone, rather they are supplementing each other.
It is considered that a main issue in developing of osteochondrosis is the constant overload of the vertebral and motive segment consisting of two next vertebras with the intervertebral disk located between them. Such overload can result from a motive stereotype — a bearing, an individual manner to sit and go. Violations of a bearing, sitting in the wrong pose, walking with an uneven spine column cause additional load of disks, sheaves and muscles of a backbone. Process can be aggravated because of features of a structure of a backbone and insufficiency traffic of its fabrics caused by hereditary factors. Most often defects in a structure meet in cervical department (Kimerli's anomaly, kraniovertebralny anomalies, Kiari's anomaly) and lead to vascular disorders and early emergence of symptoms of osteochondrosis of cervical department of a backbone.
Developing of osteochondrosis of lumbar department is more often connected with its overload at inclinations and rises in weight. The healthy intervertebral disk can maintain considerable loadings thanks to hydrophily of the pulpozny kernel which is in its center. The kernel contains a large amount of water, and liquids, as we know, are a little compressed. The rupture of a healthy intervertebral disk can occur with the force of sdavleniye more than 500 kg while the disk changed as a result of osteochondrosis is broken off with the force of sdavleniye of 200 kg. Strain in 200 kg is experienced by lumbar department of a backbone of the person weighing 70 kg when it holds 15 kilogram freight in the provision of an inclination of a trunk on 200 forward. Such big pressure is caused by the small size of a pulpozny kernel. At increase in an inclination up to the 700th load of intervertebral disks will make 489 kg. Therefore often the first clinical displays of osteochondrosis of lumbar department of a backbone arise in time or after heavy lifting, performance of housework, weeding on a kitchen garden, etc.
At osteochondrosis the pulpozny kernel loses the hydrophilic properties. It happens because of violations in his metabolism or insufficient intake of necessary substances. As a result the intervertebral disk becomes flat and less elastic, in its fibrous ring at loading radial cracks appear. The distance between the next vertebras decreases and they are displaced on the relation to each other, at the same time there is a shift and in the facet (dugootrostchaty) joints connecting vertebras.
Destruction of connecting fabric of a fibrous ring of a disk, sheaves and capsules of facet joints causes reaction of immune system and development of an aseptic inflammation with puffiness of facet joints and the fabrics surrounding them. Because of the shift of bodies of vertebras there is stretching of capsules of facet joints, and the changed intervertebral disk already not so strongly fixes bodies of the next vertebras. Instability of a vertebral segment is formed. Because of instability infringement of a back of a spinal nerve with development of a radicular syndrome is possible. At osteochondrosis of cervical department of a backbone it often arises during turns by the head, at osteochondrosis of lumbar department — during trunk inclinations. Formation of the functional block of a vertebral and motive segment is possible. It is caused by compensatory reduction of vertebral muscles.
Hernia of an intervertebral disk is formed when the disk is displaced back, there is a rupture of a back longitudinal sheaf and protrusion of a part of a disk to the spinal canal. If at the same time to the spinal canal the pulpozny kernel of a disk is squeezed out, then such hernia is called become torn. Expressiveness and duration of pains at such hernia much more, than at unexploded. Hernia of a disk can become the reason of a radicular syndrome or a sdavleniye of a spinal cord.
At osteochondrosis there is a growth of a bone tissue to formation of osteofit — bone outgrowths on bodies and shoots of vertebras. Osteofita can also cause a sdavleniye of a spinal cord (a compression miyelopatiya) or to become the reason of development of a radicular syndrome.
Backbone osteochondrosis symptoms
The main symptom of osteochondrosis of a backbone is pain. Pain can be sharp with high intensity, it amplifies at the slightest movement in the struck segment and therefore forces the patient to adopt the compelled provision. So at osteochondrosis of cervical department of a backbone the patient keeps the head in the least painful pose and cannot turn it, at osteochondrosis of chest department pain amplifies even at deep breath, and at osteochondrosis of lumbar department it is difficult to patient to sit down, to rise and go. Such pain syndrome is characteristic of a sdavleniye of a back of a spinal nerve.
Approximately in 80% of cases dull ache of constant character and moderate intensity is observed. In similar cases at survey the doctor needs to differentiate displays of osteochondrosis of a backbone from a miozit of muscles of a back. Dull ache at osteochondrosis is caused by the excess compensatory tension of the muscles holding the struck vertebral and motive segment, inflammatory changes or considerable stretching of an intervertebral disk. At patients with such pain syndrome the compelled situation is absent, but restriction of movements and physical activity comes to light. Patients with osteochondrosis of cervical department of a backbone avoid sharp turns and inclinations the head, with osteochondrosis of lumbar department - slowly sit down and get up, avoid trunk inclinations.
All symptoms of osteochondrosis which are shown only around a spine column belong to a vertebralny syndrome. All changes which are localized out of a backbone form an ekstravertebralny syndrome. It can be pains on the course of peripheral nerves at a sdavleniye of their backs at the exit from a spinal cord. For example, a lyumboishialgiya — pains on the course of a sciatic nerve at osteochondrosis of lumbar department of a backbone. At osteochondrosis of cervical department of a backbone it is the vascular disorders in the vertebro-bazilyarny pool of a brain caused by a sdavleniye of a vertebral artery.
Backbone osteochondrosis complications
Complications of osteochondrosis are connected with hernia of an intervertebral disk. Carry a sdavleniye of a spinal cord (a diskogenny miyelopatiya) of which the sleep, the weakness of certain muscular groups of extremities (depending on sdavleniye level) leading to emergence of paresis, muscular atrophies, change of tendinous reflexes, violations of an urination and defecation is characteristic to them. The hernia nuclei pulposi can become the reason of a sdavleniye of the artery feeding a spinal cord with formation of ischemic sites (a heart attack of a spinal cord) with death of nervous cages. It is shown by emergence of the neurologic deficiency (violation of movements, sensitivity loss, trophic frustration) corresponding to the level and prevalence of ischemia.
Diagnosis of osteochondrosis of a backbone
Diagnosis of osteochondrosis of a backbone is carried out by the neurologist or . At the initial stage make a backbone X-ray analysis in 2 projections. If necessary can make shooting of a separate vertebral segment and shooting in additional projections. Apply to diagnosis of intervertebral hernia, assessment of a condition of a spinal cord and identification of complications of osteochondrosis magnitno - a resonant tomography (backbone MRT). The large role is played by MRT in differential diagnosis of osteochondrosis and other diseases of a backbone: tubercular spondilit, osteomyelitis, tumors, Bekhterev's disease, rheumatism, infectious defeats. Sometimes in cases of the complicated osteochondrosis of cervical department of a backbone the siringomiyeliya exception is necessary. In certain cases at impossibility of carrying out MRT the miyelografiya is shown.
The aim research of the struck intervertebral disk is possible by means of a discography. Electrophysiological researches (the caused potentials, an elektroneyrografiya, an electromyography) apply to definition of degree and localization of defeat of nervous ways, observation of process of their restoration during therapy.
Treatment of osteochondrosis of a backbone
In the sharp period rest in the struck vertebral and motive segment is shown. For this purpose at osteochondrosis of cervical department of a backbone apply fixing by means of Shants's collar, at osteochondrosis of lumbar department — a bed rest. Fixing is necessary also at osteochondrosis of cervical department with instability of a vertebral segment.
In medicamentous therapy of osteochondrosis apply nonsteroid anti-inflammatory medicines (NPVP): diclofenac, , to lornoksika, meloksika, . At an intensive pain syndrome analgetics, for example, an analgetic of the central action are shown. For removal of muscular tension miorelaksant — , use. Purpose of anticonvulsive medicines - carbamazepine, is in certain cases expedient; antidepressants among which preference is given to inhibitors of the return capture of serotonin (, ).
At emergence of a radicular syndrome hospitalization is shown to the patient. Perhaps local introduction of glucocorticoids, antiedematous therapy, extension application. In treatment of osteochondrosis the physical therapy, reflexotherapy, massage, physiotherapy exercises is widely used. Application of manual therapy demands accurate observance of the technology of its performance and extra care at treatment of osteochondrosis of cervical department of a backbone.
Backbone operations are shown first of all at a considerable sdavleniye of a spinal cord. It consists hernias of an intervertebral disk and a decompression of the spinal channel at a distance. Carrying out a mikrodiskektomiya, punktsionny valorization of a disk, laser reconstruction of a disk, replacement of the struck disk with an implant, stabilization of a vertebral segment is possible.