Spondilez – the chronic degenerate and dystrophic process developing owing to aging, overloads or spine injuries. Is followed by dystrophic changes of forward departments of intervertebral disks, calcification of a forward longitudinal sheaf and formation of osteofit in forward and side departments of a backbone. Often proceeds asymptomatically, it can be shown by changeable pains, mobility restriction, bystry fatigue at loading and the movements. The diagnosis is exposed on the basis of results of a X-ray analysis, MPT and KT. Treatment is usually conservative.
Spondilez – a chronic disease of a backbone of degenerate and dystrophic character. Is followed by local changes in forward departments of intervertebral disks and a forward longitudinal sheaf. In the isolated option (with damage of 1-2 vertebras and lack of other pathological changes of a backbone) usually arises at young or middle age, is a consequence of constant statiko-dynamic overloads, spine injuries or infectious diseases and proceeds asymptomatically or with poorly expressed symptomatology.
In combination with other diseases of a backbone (osteochondrosis, spondiloartrozy) often comes to light at people of advanced and senile age, at the same time the brightest clinical manifestations are caused not spondilezy, and other degenerate and dystrophic processes. Pathological changes, characteristic of a spondilez, can arise at any level, however the lumbar and cervical department of a backbone is surprised more often. Treatment of a spondilez is performed by vertebrolog, orthopedists and traumatologists. In the presence of neurologic manifestations participation of the neurologist is required.
Reasons of development and pathological anatomy
Now there are two points of view on . One experts consider this process as option of primary degenerate and dystrophic damage of a backbone. Others consider that the single trauma or repeated microinjuries of a forward longitudinal ligament at protrusion of a fibrous ring of an intervertebral disk becomes the main reason for development of a spondilez. From this point of view is a disease with the mixed etiology combining influence of both traumatic, and degenerate processes.
Most of researchers recognizes communication between development of a spondilez and injuries of a forward longitudinal ligament. They describe the mechanism of development of pathological changes as follows: for some reason (injuries, overloads, infectious diseases) in forward departments of an intervertebral disk there are degenerate changes and the fibrous ring becomes incapable to keep pressure of a pulpy kernel. At considerable loading the fibrous ring is stuck out and tears off a longitudinal sheaf from the place of its attachment to the forward surface of a body of a vertebra.
In the field of a separation the small hematoma is formed, and at some distance from a hematoma under the exfoliated sheaf it begins to be formed osteofit. At the repeated injuries which are followed by new partial separations of a sheaf there are new osteofita. At the same time unlike osteochondrosis or a hernia nuclei pulposi, there is no change of height or the expressed malfunction of an intervertebral disk therefore long time proceeds asymptomatically.
Osteofita irritate a forward longitudinal sheaf, and at growth at the edges of vertebras limit mobility of a backbone. At a long current of a spondilez bone outgrowths can reach the big sizes and connect among themselves that leads to an union of bodies of the next vertebras. Over time growths of osteofit sometimes become the reason of narrowing of intervertebral openings and the vertebral channel. It becomes the cause of a pain syndrome and development of neurologic violations.
Researchers connect not only with injuries, but also with a metabolic disorder, natural aging and wear of anatomical structures of a backbone, and also the wrong distribution of load of a backbone owing to scoliosis or a kifoz. Experts specify constant static overloads, hard physical work, injuries and microspine injuries, some infectious and noninfectious diseases as the major contributing factors of developing of these disease. Also constitutional predisposition is noted.
Symptoms of a spondilez
In some cases proceeds asymptomatically and becomes a casual find when carrying out a X-ray analysis of a backbone concerning other injuries or diseases. Perhaps some restriction of mobility of the struck department of a backbone which is not followed by other symptoms. Typical manifestations of a spondilez are weight in a backbone and the dull aching local aches amplifying by the end of day. Pains can give trouble at night, arise not only at the movements, but also at rest.
Patients spondilezy long cannot find comfortable position of the head (at a cervical spondilez) or trunks (at a chest and lumbar spondilez). Tension of long muscles of a back and constraint of movements is noted. Even if pains at the moment are absent, patients are inclined to make the movements by the head or a trunk slowly and with some effort. At a sdavleniye of nervous backs there can be neurologic frustration. The pain syndrome and neurologic violations are provoked by considerable physical activity, the sharp movements or overcooling.
It is necessary to consider that at a spondileza there is no accurate correlation between expressiveness of pathological changes in area of the affected vertebras and clinical displays of a disease. At rough changes on roentgenograms only insignificant symptoms which are not giving to the patient special trouble and not breaking its working capacity can come to light. Very slow progressing is characteristic of a spondilez, in the absence of other diseases of a backbone clinical manifestations can not be aggravated within decades.
- Spondilez of cervical department is found more often in people of 40-50 years taken with intellectual work and thereof forced to stay long in the compelled pose – sitting at a table with the trunk inclined forward. Usually V and VI cervical vertebras are surprised. At a cervical spondilez cervical migraine and the neck pains sometimes irradiating in a hand or in a shovel can be observed. Restriction of movements at turn of the head, more noticeable in a standing position is noted. In a prone position constraint, as a rule, decreases. Also sight violations, a ring or noise in ears and differences of arterial pressure are possible. At a palpation of vertebras tension of muscles is defined, there can be pain amplifying when tilting the head back.
- Spondilez of chest department of a backbone meets rather seldom. Mainly lower and average chest vertebras are surprised. Pain in the struck department, sometimes unilateral can disturb the patients suffering from a chest spondilez. At a sdavleniye of spinal nerves pain irradiates in a thorax and a breast. At a palpation tension of long muscles of a back and local sites of morbidity along a backbone comes to light.
- Spondilez of lumbar department of a backbone comes to light more often than defeats of chest department. Can suffer both people of physical work, and the experts occupied with sedentary work. IV and V lumbar vertebras are characteristic defeat. At growth of osteofit not the sdavleniye, but irritation of nervous backs with development of the corresponding radicular symptomatology is usually observed. At patients with a lumbar spondilez the symptom of the false alternating lameness which is followed by feeling of "wadded legs", "odereveneniye" or "okocheneniye" of legs at long walking or static loading can come to light. Unlike the true alternating lameness caused obliterating endarteriity at a spondileza symptoms disappear during an inclination of a trunk of a kpereda.
The main method of tool diagnostics of a spondilez is the backbone X-ray analysis. On roentgenograms osteofita in the form of beak-shaped ledges or points come to light. Insignificant is followed by formation of the regional osteofit which are settling down within the plane of the platform of a body of a vertebra on its lobby, a perednebokovy or side surface. At the expressed spondilez of an osteofita platforms go beyond and can bend around an intervertebral disk. With a counter growth of two osteofit located on the next vertebras formation of neoarthroses is possible. Sharply expressed is followed by formation of a bone bracket which connects among themselves bodies of the next vertebras and completely blocks the movements in the struck segment.
The differential diagnosis is carried out on the basis of a kliniko-radiological picture. At osteochondrosis, unlike a spondilez, morbidity at a palpation of awned shoots of vertebras is noted. On roentgenograms the osteofita located perpendicularly to an axis of a backbone are visible, unions of osteofit are absent. At Forestye's disease, as well as at a spondileza, the ossifikation in a forward longitudinal ligament, but process extensive, widespread, with involvement of three or more vertebras is observed. Communication with gender and age (usually develops at men of 20-40 years) is characteristic of Bekhterev's disease, increase in SOE comes to light, subfebrilitt also an early ankilozirovaniye sacral joints.
In favor of a spondilez defeat no more than 1-2 motive segments (in lumbar department 3 segments sometimes suffer), absence or insignificant expressiveness of a pain syndrome testifies at considerable ossification of a forward longitudinal sheaf, and also preservation of height of intervertebral disks. Asymmetrically located osteofita of irregular shape directed down and up and which are bending around an intervertebral disk are characteristic of a spondilez. "Counter" ossification (a symptom of "a beak of a parrot") can come to light.
Treatment of a spondilez
Treatment of a spondilez is usually performed in out-patient conditions. The purpose of therapy is prevention of progressing of a disease, elimination of an inflammation and pain syndrome and strengthening of a muscular corset. Recommend to the patient the reasonable motive mode with restriction of physical activity and an exception of long stay in the compelled situation. During the sedentary work it is necessary to watch constantly a bearing and to regularly change a pose, leaning back on a chair back, relaxing hands and raising the head.
At the expressed inflammation and pains use NPVP (to meloksika, ketoprofen, diclofenac, indometacin, an ibuprofen), appoint physiotherapeutic procedures (ultrasound, diadynamic currents, an electrophoresis with novocaine). In some cases carry out paravertebralny blockade and appoint analgetics intramuscularly. It is necessary to consider that the listed medicines and physiotherapy eliminate symptoms, but do not stop progressing of a disease.
The fixed treatment-and-prophylactic assets at a spondileza are LFK and massage. Occupations begin with physiotherapy exercises after elimination of pains. Regular performance of exercises allows to improve blood circulation of muscles and a backbone, to lower load of a backbone by formation of a muscular corset and to develop the correct motive stereotypes allowing to avoid overloads of the struck segment. It is necessary to consider that at a spondileza intensive massage, extension of a backbone, manual therapy and exercises directed to mobilization of a backbone is contraindicated. The forecast is favorable.