Common osteochondrosis

As a result of upright human walking, the spine, as an axial structure, assumed the main load. That is why degenerative and dystrophic processes are quite common consequences of human life. Osteochondrosis is one of the most common diseases of the musculoskeletal system, which causes serious discomfort and can lead to disability. This article will discuss the most serious form of this pathology - common osteochondrosis.

Main Features

Osteochondrosis is a degenerative disease of the spine, which most often affects the thoracic, lumbar and cervical regions. This pathology has a direct correlation with age. The disease is much more common in people over 40, but there has recently been a trend toward younger people. Common osteochondrosis differs in that it affects more than one section of a department or several departments at once. Due to the gradual development of degenerative processes not only in bone tissue, but also in the ligamentous apparatus of the spine, the vertebrae become mobile and put pressure on nerves and blood vessels. Symptoms of common osteochondrosis are associated with it, but it should be noted that the disease can remain asymptomatic for some time.

Important! Pathology requires multidisciplinary control, since it affects not only the musculoskeletal system, but also the nervous system, as well as internal organs. In addition to the spine itself, the pathological process can also affect other elements of the skeleton.

Etiology and pathogenesis

There are many reasons for generalized osteochondrosis. Some of them are associated with congenital skeletal malformations, others with insufficient load during vigorous activity. Particularly common factors contributing to the evolution of the clinical picture are:

• injuries;
• flat foot;
• club foot - deformity of the foot (equinovarus, varus, valgus, depending on the position of the heel);
• work related to heavy lifting;
• play sports without warming up or warming up the muscles;
• work at low temperature.

Low temperatures are considered provoking factors, since cold temporarily changes the molecular structure of soft tissues, reduces the intensity of blood circulation, reduces the conductivity of nerve impulses and metabolism, and therefore the functioning of the immune system. Other reasons disrupt the biomechanics of the spine and contribute to rapid wear of the intervertebral discs.

Pain in generalized osteochondrosis can be a consequence of osteophytes or disc deformation. The pain is generally radicular, that is, associated with compression of the posterior nerve roots.

Common osteochondrosis easily imitates other diseases. In case of lesions in the thoracic region, pain appears in the heart region and is confused with ischemic processes, and in case of lesions of the lumbar regions - with radiculitis.

Symptoms

The clinical manifestations will depend on the affected parts and their combination.

When the cervical spine is affected, the following are characteristic:

• unstable blood pressure;
• headache;
• lack of coordination;
• pain in the hands;
• numbness of the upper body and arms.

For pathologies of the thoracic region:

• intercostal neuralgia;
• stiffness in the arms and neck;
• dysfunction of internal organs.

If the lumbar region is affected:

• burning;
• urinary disorders;
• spasms;
• pain when walking.

Based on the above, it is easy to conclude that the pathology affects not only the spine and large joints, but also the autonomic nervous system. The latter is associated with interruptions in the functioning of internal organs. Common polysegmental osteochondrosis can sometimes get worse. In such cases, the protests are much more intense. With a combination of disorders of several departments, the symptoms will be corresponding.

Complications

Osteochondrosis can be conditionally divided into moderate osteochondrosis, which is a natural process of wear of the spine as a result of vital activity, and severe osteochondrosis, which is most often characterized by complications.

Moderate osteochondrosis is easily treated with conservative treatment. And if it is impossible to completely stop the inevitable process of aging, then it is quite possible to significantly slow it down. The complications that severe osteochondrosis can cause are as follows.

1. Spondyloarthrosis.
2. Degeneration of the intervertebral disc.
3. Spinal stenosis.

Important! The intervertebral discs act as a shock absorber and reduce friction between the vertebrae. Degenerative processes in these structures can lead to protrusion of the nucleus pulposus of the disc and intervertebral herniation. The protrusion causes compression of the roots and pain.

Spondyloarthrosis is a degeneration of the facet joints connecting adjacent vertebrae. In another way, these joints are called facet joints. When articular cartilage is damaged, painful contact occurs between the vertebrae. With degeneration of the facet joints, bone growths most often appear, which lead to spondylosis.

Stenosis is a narrowing (in this case, of the spinal canal). Generally, stenosis is the result of pathologies such as intervertebral hernia or spondylosis. Bony growths and hernial protrusions compress nerve roots at their entry and exit points.

The clinical picture of severe osteochondrosis is the result of complications:

• chronic pain in the spine;
• friction of bone surfaces;
• stiffness;
• sudden muscle weakness;
• decreased reflexes;
• tingling in the limbs;
• radiating pain;
• sciatica symptoms.

Sciatica is caused by compression of the sciatic nerve.

Classification

There are four degrees of osteochondrosis. Classification is carried out on the basis of the collected history and using instrumental diagnostic methods. The main criteria for this classification are pain and neurological symptoms.

1. I degree - pain is easily relieved with medication.
2. Grade II - characterized by prolonged pain and spinal deformity with moderate neurological symptoms.
3. Grade III - the pain is systematic, neurological symptoms are significant.
4. Grade IV - constant pain, multiple neurological deficits. Disturbance of the conduction of nerve impulses. Paralysis and paresis.

In case of generalized dysplastic osteochondrosis, the patient is assigned disability status. Depending on the general condition of the patient, the degree and intensity of the development of the clinical picture, disability can be of three groups.

Types of disability in osteochondrosis.

Band	Description
First group	Spinal functions are lost. The patient is unable to move independently and take care of himself.
Second group	The patient is able to move around and perform small tasks, but periods of exacerbation are common. The operation is contraindicated or unnecessary for any reason. Or a surgical intervention has already been performed, but proved ineffective.
Third group	The patient is able to take care of himself. There is pain and vestibular symptoms, but the frequency of exacerbations is moderate and periodic.

The disability group is assigned by the doctor on the basis of certain studies aimed at assessing work capacity.

Diagnostic

During a visit to the doctor, the diagnosis will include several elements. The first and most important is the collection of history based on subjective information provided by the patient. Particular attention is paid to family history, since osteochondrosis has a genetic component. The specialist asks about the place of work, living conditions and the course of the disease itself, and the patient must describe exactly what is bothering him. The best results can be achieved with good feedback between the patient and the doctor.

The next method is an objective study carried out by a specialist himself or using instrumental methods. The doctor checks the range of motion of the neck and limbs, which may be noticeably reduced due to pain and stiffness. Using the palpation method, it records the extent of muscle spasms and curvature of the spine. Attention is drawn to a neurological examination, with the help of which weakened reflexes can be traced. This symptom may be the result of compression or damage to the nerve.

Instrumental methods for diagnosing common osteochondrosis include:

1. X-ray of the entire spine in two projections.
2. MRI to evaluate ligaments and nerve tissue.
3. An electrophysiological study to test the conduction of nerve impulses.

X-rays are effective in determining the presence of bone growths - osteophytes, narrowing of the spinal canal and the presence of other diseases resulting from osteochondrosis, for example, scoliosis.

CT scanning can also be used in conjunction with MRI. Using a CT scan, you can determine the degree of compression of the nerves by the spurs.

The diagnosis of generalized polysegmental osteochondrosis is made if other pathologies leading to destruction of the vertebrae (for example, tuberculosis) have been excluded and if several segments of one or more departments are affected.

There are additional diagnostic methods. These include:

1. Bone scan.
2. Discography.
3. Myelogram.

A bone scan can detect conditions such as osteoarthritis, fractures or infections. This method is radionuclide and is suitable for differential diagnosis and determination of possible complications.

During discography, a contrast agent is injected into the nucleus pulposus of the intervertebral disc. This method is effective in determining the presence of a herniated disc.

The myelogram is also a contrast research method. Contrast is injected into the spinal canal and the image is recorded using X-rays or CT scan. Using this method, you can determine the condition of the spinal cord, the presence of strictures and compressions.

Treatment

The treatment is based on the following mechanisms.

1. Slow down the degenerative process by improving the supply of nutrients to the structures of the musculoskeletal system.
2. Spinal stabilization.
3. Elimination of pinched nerve fibers.
4. Relieve symptoms.

The following drugs are used for drug treatment:

• nonsteroidal anti-inflammatory drugs that relieve inflammation and pain;
• Anilides relieve pain in the early stages;
• local analgesics in the form of ointments;
• muscle relaxants to reduce muscle spasms and increase range of motion;
• B vitamins to improve the conductivity of nervous tissues;
• chondroprotectors, which reduce the rate of progression of degenerative processes by integrating active substances (chondoitin sulfate and glucosamine) into cartilage cells. As a result, metabolism is normalized and clinical manifestations are reduced. The drug has been used for a long time and requires special consultation during pregnancy, breastfeeding and the presence of gastrointestinal diseases. An absolute contraindication is phenylketonuria;
• antispasmodics relieve smooth muscle spasms and thereby alleviate the manifestations of osteochondrosis in internal organs;
• antioxidants;
• antidepressants to eliminate the psychosomatic component of this disease. They interfere with the transmission of nerve impulses from the central nervous system to the brain. Promotes the production of endorphins and helps solve the problem of chronic insomnia due to constant pain.
• neuropathic agents to eliminate damage to nerve endings.
• opiates for unbearable pain and the ineffectiveness of other analgesics.

The following are used as invasive medical procedures:

• injection of steroids into the epidural space. Steroids are powerful anti-inflammatories. They relieve inflammation of the nerve roots, which helps relieve pain caused by radiculopathy. Complicated procedure. Requires a qualified specialist;
• injections into the facet joint. Injected medications cause local numbness and pain relief.

It is important to know this! Taking medication is not intended to get rid of the disease - there is no medication that can completely eliminate osteochondrosis, which is a chronic disease. Medications are prescribed only to relieve symptoms.

Medications are prescribed by the attending physician. The patient is informed of the possible side effects of each medication and then decides for himself which treatment to choose.

For symptoms suggesting osteochondrosis, contact a vertebrologist, orthopedist and neurologist. High-quality medical care will consist of close cooperation between these specialists and with the patient.

Physiotherapy

Physiotherapy is used as a set of auxiliary therapeutic measures to improve blood circulation and metabolism in affected tissues. For generalized osteochondrosis, the following methods are used.

1. Electrophoresis (based on the movement of colloidal particles under the influence of an external electric field).
2. Phonophoresis (a combination of ultrasound and medication).
3. Magnetotherapy (use of a static magnetic field).
4. UHF therapy (ultra high frequency therapy).
5. Electromyostimulation (nerve and muscle stimulation).
6. Acupuncture (acupuncture).
7. Laser exposure.

In addition to physiotherapy, manual therapy and physiotherapy are actively used. Professional massage can lead to long-term remission. Therapeutic exercises should not be performed during an exacerbation of the disease, as this may lead to complications. During the remission period, moderate physical activity maintains muscle tone, and therefore the spine. The exercises are performed under the supervision of an instructor and are prescribed by the attending physician.

During an exacerbation, you cannot warm the spine, but you can wear a corset, but only for a few hours. In other cases, wearing a corset for more than a few hours is not optimal because it can lead to muscle atrophy.

Manual therapy can increase the clearance of pinched nerves and reduce neurological symptoms. Alternative methods are leeches and vacuum massage. These methods aim to improve blood circulation in the affected area. A health spa treatment is useful. Particular preference is given to water procedures.

Surgery

When treating osteochondrosis, specialists are more willing to resort to conservative therapy. However, to achieve the desired effect, it takes a lot of time, patience and careful adherence to the patient's recommendations. If conservative treatment turns out to be ineffective, only then will you have to resort to invasive methods. The operation is generally palliative. This means that the operation will be carried out only to relieve symptoms and comparatively improve the quality of life, but not for complete cure (it is fair to say that conservative treatment also does not lead to complete elimination of thedisease, but to the receptivity of the patient (non-invasive treatment is a sign of good prognosis).

There are two types of surgery: decompression and stabilization. The first aims to relieve nerve compression and the second to stabilize the spine. The following operations are classified as decompression operations.

1. Facetectomy – removal of facet joints to relieve compression.
2. Foraminotomy is an increase in the lumen of the spinal canal, which has narrowed due to osteophytes.
3. Laminectomy is the removal of the back part of the vertebra, which may be deformed due to osteochondrosis.
4. Laminotomy - removal of a fragment of the posterior part of the vertebra to widen the spinal canal.

These operations require a posterior approach, but in cases of intervertebral hernia, the surgical approach will be anterior.

Decompression surgeries with anterior approach are as follows.

1. Discectomy – removal of an intervertebral disc.
2. Corpectomy – removal of the entire vertebral body along with adjacent discs.

Stabilization operations include:

1. Spinal fusion is a method of fusing the vertebrae.
2. Artificial intervertebral disc.

The need for stabilization operations appears after a discectomy.

Surgical interventions are rarely prescribed because there is a risk of serious complications.

Complications include:

• pain relapses;
• false union;
• infection;
• phlebitis on the limbs;
• violation of the act of urination;
• pain from the transplant;
• failure of recessed fixings.

The postoperative period lasts several months. The sutures heal 2 weeks after surgery. If complications are detected, you should immediately consult a doctor.

After the operation, a rehabilitation course is carried out to accelerate the healing process and restore full working capacity.

General recommendations

Proper nutrition helps prevent relapses of exacerbation of common osteochondrosis. Proper nutrition is necessary, first of all, to maintain a stable body weight, because excess weight puts additional pressure on the spine. In this case, the diet must be complete, enriched and rich in calcium, magnesium and potassium. It is necessary to limit your coffee intake as it removes calcium from the body. It is useful to visit the swimming pool. You should avoid staying in the same position all the time.

If there are frequent exacerbations and lack of discipline to strictly follow the recommendations, it is better to undergo comprehensive treatment in a hospital under the supervision of a doctor.

You cannot take medicine yourself.

Let's summarize it

Often generalized osteochondrosis develops after an incompletely cured "single" osteochondrosis. This fact suggests that in case of discomfort, you should immediately contact a doctor, without hoping that the pain will go away by itself. In this case, it will be much easier to prevent the development of other pathologies, and even easier to cure the root cause.