Osteochondrosis

What is spinal osteochondrosis in simple words?

Spinal osteochondrosis is a chronic disease based on degenerative-dystrophic changes in the intervertebral disc with subsequent involvement of adjacent vertebrae, intervertebral joints and spinal ligaments in the process.

The word "osteochondrosis" has two Greek roots: οστό - bone and χόνδρος - cartilage.

Vertebrae are formations composed of spongy bone.They are connected to each other with cartilage discs.There are ligaments along the front and back surfaces of the vertebrae.Cartilaginous discs prevent the vertebrae from joining and the ligaments from moving away.Thanks to the coordinated work of discs and ligaments, the spine is elastic and this allows it to perform vital functions:

• ensure balance in a vertical position,
• softens bumps and shocks while walking and jumping,
• protect the skull and the brain located in it from impact due to excessive blows.

With osteochondrosis, protrusions of the intervertebral discs are formed beyond the vertebral bodies.Depending on the direction of occurrence of the extension, as well as its size, pain, numbness, muscle disorders and other symptoms develop.

ICD-10 codes:

• M42 Osteochondrosis of spine
• M42.0 Juvenile osteochondrosis of spine
• M42.1 Osteochondrosis of spine in adults
• M42.9 Osteochondrosis of spine, unspecified
• M43.1 Spondylolisthesis
• M47 Spondylosis
• M47.0 Anterior spinal or vertebral artery compression syndrome
• M47.1 Other spondylosis with myelopathy
• M47.2 Other spondylosis with radiculopathy
• M48.0 Spinal stenosis
• M50.0 Injury of intervertebral disc of cervical spine with myelopathy
• M50.1 Injury of intervertebral disc of cervical spine with radiculopathy
• M50.2 Displacement of intervertebral disc of cervical spine of other kind
• M50.3 Other degeneration of cervical intervertebral disc
• M51.0 Lesions of lumbar intervertebral discs and other parts with myelopathy
• M51.1 Lesions of lumbar intervertebral discs and other parts with radiculopathy
• M51.2 Other specified displacement of intervertebral disc
• M51.3 Other specified degenerations of intervertebral disc
• M53 Other dorsopathies, not elsewhere classified

Types of osteochondrosis

Depending on which part of the spine there are changes, there are several variants of the disease:

• cervix,
• chest,
• middle,
• sacral,
• mixed variants (cervicothoracic, lumbosacral).

Depending on the duration of the symptoms, the disease can be:

• acute (up to 3 weeks),
• subacute (3-12 weeks),
• chronic (more than 12 weeks).

According to the predominant neurological manifestations:

• with myelopathy (damage to the spinal cord),
• with radiculopathy (pressed and inflamed nerve roots).

Causes of osteochondrosis

To date, there is no exact data on the causes of osteochondrosis.

The role of genetic predisposition, mechanical damage and inflammation is recognized in the occurrence of premature wear of the intervertebral discs.

Intervertebral discs do not have their own blood or lymphatic vessels.The vessels of the vertebrae play a role in their nutrition and purification of harmful substances.With age and/or exposure to harmful influences, the flow of blood and lymph decreases, the discs receive less oxygen and nutrients, and harmful substances can accumulate in them.All this leads to gradual wear.The rate and speed of disc wear increases when exposed to risk factors.

Risk factors:

• congenital anomalies of vertebrae and spinal canal;
• flat feet;
• risks at work (vibration, heavy lifting, prolonged stay in an uncomfortable forced position, exposure to toxic substances);
• sedentary lifestyle;
• obesity;
• a diet that is not balanced in the content of proteins, fats, vitamins and minerals;
• insufficient consumption of clean water;
• smoking;
• environmental pollution.

Symptoms of spinal osteochondrosis

Sorted by frequency of occurrence:

• pain;
• reduced range of motion;
• numbness, loss of sensation;
• decreased muscle strength;
• dysfunction of the organs whose innervation is associated with the problematic part of the spine.

Clinically significant manifestations of spinal osteochondrosis were observed in 51 people per 1000 population.

The location of the pain and other symptoms depends on the problematic part of the spine.

Cervical osteochondrosis:

• pain in the arms, shoulders, neck, aggravated by turning and tilting the head;
• headache;
• decrease in arm muscle strength;
• noise in the head, dizziness, flashing "floaters", colored spots before the eyes in combination with a burning, throbbing headache (vertebral artery syndrome).

The health of the brain depends on the condition of the cervical spine, since the arteries in the brain pass through the channel formed by the processes of the vertebrae.If, due to osteochondrosis, the lumen of the canal is narrowed, the blood flow through the arteries is disrupted and the brain experiences a lack of oxygen and nutrients.

Thoracic osteochondrosis:

• pain in the chest, under the shoulder blade, in the area of the heart, aggravated by turning the body, coughing, sneezing;
• dysfunction of the gall bladder, stomach, esophagus.

Lumbar and/or sacral osteochondrosis:

• pain in the lower back, back and side of the thigh;
• numbness of fingers;
• increased frequency of urination (10-12 times a day, maybe more), involuntary loss of urine during physical activity;
• sexual disorders.

Due to frequent pain, half of people suffering from osteochondrosis show signs of constant emotional stress.

Stages of development and course of osteochondrosis

The initial stage of osteochondrosis is manifested by dull pain in the back or lower back that occurs during prolonged standing, after walking or running;pain in the neck, aggravated by turning and tilting the head.

As the pathology of the intervertebral discs progresses, it can bulge (hernia) and, as a result, press on the nerve root (radiculopathy).This leads to severe pain that radiates to the arm or leg, muscle weakness, disturbances in the sensitivity of the skin, vascular tone and the function of the organs that receive innervation from the problematic part of the spine.In more severe cases, spinal cord compression can occur, leading to paresis or paralysis.

Osteochondrosis is a chronic disease.After adequate treatment, remission occurs, that is, symptoms decrease or disappear completely.If a new protrusion of the intervertebral disc forms, a deterioration occurs and the pain and other symptoms return.

Diagnosing

1. Examination by a neurologist.

2. Basic methods of instrumental research:

   • magnetic resonance imaging (MRI),
   • computed tomography (CT).

3. Additional:

   • spondylography (deep x-ray examination of the spine),
   • electromyography (EMG),
   • electroneuromyography (ENMG),
   • bone densitometry (performed to detect osteopenia/osteoporosis).

4. Basic laboratory methods:

   • general blood analysis,
   • general analysis of urine,
   • Biochemical blood test (glucose, creatinine, urea, electrolytes, bilirubin, liver and pancreatic enzymes; glycated hemoglobin, C-reactive protein),
   • coagulogram.

5. Additional:the concentration of calcium and phosphates in the blood.

Treatment of osteochondrosis

Conservative treatment

It is performed if the patient does not have acute progressive neurological symptoms.

Goals:

• reduction or relief of pain,
• correction of muscle tone,
• reducing inflammation and swelling,
• preventing the progression of dystrophic changes in the structures of the spine,
• correction of damaged function of internal organs,
• increasing the patient's daily activity,
• teaching the patient to cope with pain.

Conservative treatment of osteochondrosis includes:

• compliance with a rational motor regime,
• use of medications,
• physiotherapy,
• massage,
• Exercise therapy (after pain relief and condition stabilization),
• acupuncture,
• manual therapy.

Drug treatment

The main groups of drugs that can alleviate or relieve pain and stabilize the condition of a patient with osteochondrosis are listed.Only a doctor can choose an adequate treatment regimen, taking into account the characteristics of the clinical picture of a particular patient.

1. Nonsteroidal anti-inflammatory drugs(NSAIDs):

   • for oral administration,
   • for intramuscular injections,
   • for intravenous administration,
   • for insertion into the rectum (rectal suppositories),
   • for external use (ointment, gel).

2. Muscle relaxants(drugs that reduce muscle spasticity).

   It is used for severe tension and painful muscle spasms.

3. Diuretics(to reduce local swelling).

4. Drugs that improve the condition of cartilage tissue(chondroprotectors):

   • chondroitin sulfate sodium,
   • a combination of chondroitin sulfate sodium and glucosamine.

5. B vitamins:

   • thiamine (B1),
   • pyridoxine (B6),
   • cyanocobalamin (B12),
   • combination B1+B6+B12.

In the acute period, with severe pain, it is possible to rest in bed for 1-2 days, which helps to relax the muscles and reduce the pressure inside the cartilage disc.It is advisable to wear a stabilizing lumbar corset or a Shants collar.

As the intensity of the pain decreases, the treatment is supplemented with special therapeutic exercises aimed at stretching the spine and relaxing the muscles, with the gradual inclusion of exercises to form a muscular corset.Therapeutic manual massage is indicated.

With adequate therapy, the pain gradually decreases and can disappear completely.There is also a regression of neurological symptoms.The improvement of the condition is caused by a decrease in the size of the disc herniation and the accompanying inflammatory changes in the surrounding tissues.

Surgical treatment

Urgent neurosurgical intervention is indicated for pelvic disorders with numbness in the anogenital area and ascending paresis of the legs (cauda equina syndrome).

The need for surgery may arise even if conservative therapy is ineffective within 3-6 months.

Back pain prevention

• Avoid excessive physical activity (lifting heavy objects, carrying a heavy bag in one hand, etc.).

• Avoid prolonged static loads (sitting, standing in an uncomfortable position).

  If your work involves such stress, it is recommended to take 10-minute breaks every 45 minutes, during which you have to walk.

• Avoid hypothermia.

• Maintain an adequate level of physical activity through regular exercise, swimming and/or walking.

• Sleep on a mattress of medium firmness.

Nutrition for osteochondrosis

A balanced diet and adequate fluid intake ensure normal blood supply and nutrition to the vertebrae and, therefore, the cartilage discs.As a result, metabolism and energy are normalized, and harmful products do not accumulate.

Basic principles:

1. Daily calorie content, calculated individually, taking into account height, age, gender.

   For patients who are overweight or obese, caloric intake should be limited.

2. Drinking regime- drink pure water, mineral water and herbal teas in a volume of at least 1 liter per day, ideally at the rate of 30 ml/kg of body weight.

3. Daily use:

   • whole grain products (buckwheat, millet, oats);
   • sufficient amount of protein (taking into account age and kidney function): animals - lean beef, chicken, turkey, rabbit, chicken eggs (4-5 pieces per week);vegetables - beans, lentils, peas;
   • healthy fats containing mono and polyunsaturated fatty acids (fish, seafood, unrefined vegetable oils, raw and unsalted nuts, seeds);
   • vegetables (fresh and cooked), lettuce, herbs and leafy greens;
   • berries - blueberries, blackberries, raspberries, cherries.

4. Exemption from the diet:

   • white bread and bakery products made from premium flour;
   • sugar, industrial sweets - candies, cakes, cookies, gingerbread, waffles;
   • industrial drinks with added sugar - carbonated water, packaged juices;
   • processed meat products - sausages, sausages, canned food.