Osteochondrosis

What is osteochondrosis of the spine in simple words?

Osteochondrosis of the spine 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 made up of spongy bones.They are connected to each other by cartilaginous discs.There are ligaments along the anterior and posterior surfaces of the vertebrae.Cartilaginous discs prevent the vertebrae from coming together and the ligaments from moving apart.Thanks to the coordinated work of discs and ligaments, the spine is elastic, and this allows it to perform important functions:

• ensure balance in a vertical position,
• softens shocks and bumps when walking and jumping,
• protects the skull and the brain inside it from shock due to excessive shock.

With osteochondrosis, a protrusion of the intervertebral disc is formed outside the vertebral body.Depending on the direction in which the protrusion occurs, as well as its size, pain, numbness, muscle disturbances and other symptoms develop.

ICD-10 codes:

• M42 Osteochondrosis of spine
• M42.0 Osteochondrosis of juvenile spine
• M42.1 Osteochondrosis of spine in adult
• M42.9 Osteochondrosis of spine, unspecified
• M43.1 Spondylolisthesis
• M47 Spondylosis
• M47.0 Compression syndrome of anterior spinal cord or vertebral artery
• M47.1 Other spondylosis with myelopathy
• M47.2 Other spondylosis with radiculopathy
• M48.0 Spinal stenosis
• M50.0 Damage to intervertebral disc of cervical spine with myelopathy
• M50.1 Damage to intervertebral disc of cervical spine with radiculopathy
• M50.2 Displacement of intervertebral disc of cervical spine of other types
• M50.3 Degeneration of other cervical intervertebral discs
• M51.0 Lesions of lumbar intervertebral discs and other parts with myelopathy
• M51.1 Lesions of lumbar intervertebral disc and other parts with radiculopathy
• M51.2 Displacement of other specified intervertebral discs
• M51.3 Degeneration of other specified intervertebral discs
• 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,
• waist,
• holy,
• mixed variant (cervicothoracic, lumbosacral).

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

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

According to the main neurological manifestations:

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

Causes of osteochondrosis

Until now, there is no accurate data on the cause of osteochondrosis.

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

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

Risk factors:

• congenital anomalies of vertebrae and spinal canal;
• flat feet;
• occupational hazards (vibration, heavy lifting, forced long stays in uncomfortable positions, exposure to toxic substances);
• sedentary lifestyle;
• obesity;
• a diet that is not balanced in the content of protein, fat, vitamins, and minerals;
• insufficient use of clean water;
• smoking;
• environmental pollution.

Symptoms of osteochondrosis of the spine

Listed by frequency of occurrence:

• sick;
• reduced range of motion;
• numbness, loss of sensitivity;
• decreased muscle strength;
• dysfunction of organs whose retirement is associated with problematic parts of the spine.

Significant clinical manifestations of osteochondrosis of the spine are observed in 51 people per 1000 inhabitants.

The location of pain and other symptoms depends on the part of the spine that is affected.

Cervical osteochondrosis:

• pain in the arms, shoulders, neck, aggravated by turning and tilting the head;
• headache;
• decreased muscle strength in the arms;
• noise in the head, dizziness, flashing "floaters", colored spots in front of 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, because the arteries to the brain pass through channels formed by the vertebral processes.If, due to osteochondrosis, the lumen of the channel narrows, blood flow through the arteries is interrupted and the brain suffers from a lack of oxygen and nutrients.

Thoracic osteochondrosis:

• pain in the chest, under the shoulder blades, in the region of the heart, aggravated by turning the body, coughing, sneezing;
• gallbladder, stomach, esophagus dysfunction.

Lumbar and/or sacral osteochondrosis:

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

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 indicated by a dull pain in the back or lower back that occurs when standing for a long time, after walking or running;pain in the neck, worse by turning and tilting the head.

When the pathology of the intervertebral disc develops, it may bulge (hernia) and, as a result, compress the nerve root (radiculopathy).This leads to severe pain that radiates to the arms or legs, muscle weakness, impaired skin sensitivity, vascular tone and the function of organs that receive conservation from the problematic part of the spine.In the worst cases, compression of the spinal cord 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 is formed, exacerbation occurs, and pain and other symptoms return.

Diagnostics

1. Examination by a neurologist.

2. Basic instrumental research methods:

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

3. Additional:

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

4. Basic laboratory methods:

   • general blood test,
   • general urinalysis,
   • biochemical blood tests (glucose, creatinine, urea, electrolytes, bilirubin, liver and pancreatic enzymes; glycated hemoglobin, C-reactive protein),
   • coagulogram.

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

Treatment of osteochondrosis

Conservative treatment

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

Goals:

• reduce or relieve pain,
• correction of muscle tone,
• reduce inflammation and swelling,
• prevent the progression of dystrophic changes in the structure of the spine,
• correction of impaired function of internal organs,
• improve the patient's daily activities,
• teach patients to cope with pain.

Conservative treatment of osteochondrosis includes:

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

Drug treatment

The main group of drugs that can relieve or relieve pain and stabilize the condition of patients 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 injection,
   • for intravenous administration,
   • to be inserted into the rectum (rectal suppositories),
   • for external use (ointment, gel).

2. Relax the muscles(medicine that reduces muscle spasms).

   Used for severe tension and painful muscle spasms.

3. Diuretic(to reduce local swelling).

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

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

5. B vitamins:

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

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

When the intensity of the pain decreases, 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 muscle corset.A therapeutic manual sequence is indicated.

With adequate therapy, the pain gradually decreases and may disappear completely.There is also regression of neurological symptoms.The condition improves due to a reduction in the size of the disc herniation and associated inflammatory changes in the surrounding tissue.

Surgical treatment

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

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

Prevent back pain

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

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

  If your work involves such pressure, it is recommended to take a 10-minute break every 45 minutes, during which you need to walk.

• Avoid hypothermia.

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

• Sleep on a medium hard mattress.

Nutrition for osteochondrosis

A balanced diet and proper fluid intake ensure normal blood supply and nutrition to the vertebrae and, consequently, the cartilage discs.As a result, metabolism and energy become normal, 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, calorie intake should be limited.

2. Drinking regime- drink pure water, mineral water and herbal tea in the amount of at least 1 liter a day, ideally at a 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, unroasted and unsalted nuts, seeds);
   • vegetables (fresh and cooked), salads, herbs and leafy greens;
   • berries - blueberries, blackberries, raspberries, cherries.

4. Exceptions to the diet:

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