What is spinal osteochondrosis in simple terms?
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.
The word “osteochondrosis” has two Greek roots: οστό – bone and χόνδρος – cartilage.
Vertebrae are formations made up of spongy bones.They are connected together 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 the discs and ligaments, the spine is elastic, which allows it to perform vital functions:
- ensure balance in a vertical position,
- soften bumps and shocks when walking and jumping,
- protect the skull and brain located there from shocks due to excessive shock.
With osteochondrosis, protrusions of intervertebral discs are formed beyond the vertebral bodies.Depending on the direction in which the protrusion occurs, as well as its size, pain, numbness, muscle disorders and other symptoms develop.
ICD-10 codes:
- M42 Osteochondrosis of the spine
- M42.0 Juvenile osteochondrosis of the spine
- M42.1 Osteochondrosis of the spine in adults
- M42.9 Osteochondrosis of the spine, unspecified
- M43.1 Spondylolisthesis
- M47 Spondylosis
- M47.0 Anterior spinal or vertebral artery compression syndrome
- M47.1 Other spondyloses with myelopathy
- M47.2 Other spondylosis with radiculopathy
- M48.0 Spinal stenosis
- M50.0 Intervertebral disc injury of the cervical spine with myelopathy
- M50.1 Intervertebral disc injury of the cervical spine with radiculopathy
- M50.2 Displacement of the intervertebral disc of the cervical spine of another type
- M50.3 Other degeneration of the cervical intervertebral discs
- M51.0 Lesions of the intervertebral discs of the lumbar region and other parts with myelopathy
- M51.1 Lesions of the intervertebral discs of the lumbar region and other parts with radiculopathy
- M51.2 Other specified displacement of the intervertebral disc
- M51.3 Other specified degeneration of the intervertebral disc
- M53 Other dorsopathies, not elsewhere classified
Types of osteochondrosis
Depending on which part of the spine the changes occur, there are several variants of the disease:
- cervical,
- chest,
- lumbar,
- sacred,
- mixed variants (cervicothoracic, lumbosacral).
Depending on the duration of symptoms, the disease can be:
- acute (up to 3 weeks),
- subacute (3-12 weeks),
- chronic (more than 12 weeks).
According to the predominant neurological manifestation:
- with myelopathy (spinal cord damage),
- with radiculopathy (pinched 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 cleansing of harmful substances.With age and/or exposure to harmful influences, blood and lymph flow decreases, the discs receive less oxygen and nutrients, and harmful substances can accumulate there.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 the vertebrae and spinal canal;
- flat feet;
- occupational risks (vibrations, lifting heavy loads, prolonged stay in a forced uncomfortable position, exposure to toxic substances);
- sedentary lifestyle;
- obesity;
- a diet that is not balanced in terms of protein, fat, vitamin and mineral content;
- insufficient consumption of clean water;
- smoking;
- environmental pollution.
Symptoms of spinal osteochondrosis
Classified by frequency of occurrence:
- pain;
- decreased range of motion;
- numbness, loss of sensitivity;
- decreased muscle strength;
- dysfunction of organs whose innervation is associated with the problem part of the spine.
Clinically significant manifestations of osteochondrosis of the spine are observed in 51 people per 1000 population.
The location of the pain and other symptoms depends on the problem part of the spine.
Cervical osteochondrosis:
- pain in arms, shoulders, neck, aggravated by turning and tilting the head;
- headaches;
- decreased 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).
Brain health depends on the condition of the cervical spine, since the arteries leading to the brain pass through the canal formed by the processes of the vertebrae.If, due to osteochondrosis, the lumen of the canal narrows, blood flow in the arteries is disrupted and the brain lacks oxygen and nutrients.
Thoracic osteochondrosis:
- pain in the chest, under the shoulder blade, in the region of the heart, aggravated by turning the body, coughing, sneezing;
- dysfunction of the gallbladder, stomach, esophagus.
Lumbar and/or sacral osteochondrosis:
- pain in the lower back, back and side of the thigh;
- numbness of the toes;
- increased frequency of urination (10-12 times a day, possibly 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, aching pain in the back or lower back that occurs during prolonged standing, after walking or running;pain in the neck, worsened by turning and tilting the head.
As the pathology progresses, the intervertebral disc(s) may bulge (herniated) and, therefore, compress the nerve root (radiculopathy).This leads to severe pain radiating to the arm or leg, muscle weakness, disturbances in skin sensitivity, vascular tone and the functioning of the organs receiving innervation from the problem part of the spine.In more severe cases, compression of the spinal cord may occur, leading to paresis or paralysis.
Osteochondrosis is a chronic disease.After adequate treatment, remission occurs, that is, symptoms decrease or completely disappear.If a new protrusion of the intervertebral disc forms, worsening occurs and pain and other symptoms return.
Diagnosis
Examination by a neurologist.
Basic instrumental research methods:
- magnetic resonance imaging (MRI),
- computed tomography (CT).
Additional :
- spondylography (thorough radiological examination of the spine),
- electromyography (EMG),
- electroneuromyography (ENMG),
- bone densitometry (performed to detect osteopenia/osteoporosis).
Basic laboratory methods:
- general blood test,
- general urine analysis,
- biochemical blood test (glucose, creatinine, urea, electrolytes, bilirubin, liver and pancreatic enzymes; glycated hemoglobin, C-reactive protein),
- coagulogram.
Additional :concentration of calcium and phosphates in the blood.
Treatment of osteochondrosis
Conservative treatment
It is carried out if the patient does not present extremely progressive neurological symptoms.
Goals :
- reduction or relief of pain,
- correction of muscle tone,
- reduction of inflammation and swelling,
- prevent the progression of dystrophic changes in the structures of the spine,
- correction of dysfunction of internal organs,
- increase the patient's daily activity,
- teach the patient to cope with pain.
Conservative treatment of osteochondrosis includes:
- respecting a rational engine speed,
- use of medications,
- physiotherapy,
- massages,
- Exercise therapy (after pain relief and stabilization of the condition),
- acupuncture,
- manual therapy.
Drug treatment
The main groups of drugs capable of relieving or relieving pain and stabilizing the condition of a patient with osteochondrosis are listed.Only a doctor can select an adequate treatment regimen, taking into account the characteristics of the clinical picture of a particular patient.
Non-steroidal anti-inflammatories(NSAIDs):
- for oral administration,
- for intramuscular injections,
- for intravenous administration,
- for insertion into the rectum (rectal suppositories),
- for external use (ointment, gel).
Muscle relaxers(medications that reduce muscle spasticity).
Used in cases of severe tension and painful muscle spasms.
Diuretics(to reduce local swelling).
Medicines that improve the condition of cartilage tissue(chondroprotectors):
- sodium chondroitin sulfate,
- a combination of sodium chondroitin sulfate and glucosamine.
B vitamins:
- thiamine (B1),
- pyridoxine (B6),
- cyanocobalamin (B12),
- combination 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 pressure inside the cartilaginous disc.It is recommended to wear a lumbar stabilizing corset or a Shants collar.
As the intensity of 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 muscular corset.A therapeutic manual massage is indicated.
With proper treatment, the pain gradually decreases and may disappear completely.There is also a regression of neurological symptoms.Improvement in the condition is caused by a decrease in the size of the herniated disc and associated inflammatory changes in the surrounding tissues.
Surgical treatment
Emergency neurosurgical intervention is indicated in cases of pelvic disorders with numbness of the anogenital region and ascending paresis of the feet (cauda equina syndrome).
The need for surgery may also arise if conservative treatment proves ineffective within 3 to 6 months.
Preventing back pain
Avoid excessive physical activities (lifting heavy objects, carrying a heavy bag in one hand, etc.).
Avoid prolonged static loads (sitting, remaining in an uncomfortable position).
If your job involves such stress, it is recommended to take 10-minute breaks every 45 minutes, during which you should walk.
Avoid hypothermia.
Maintain an adequate level of physical activity by regularly exercising, swimming and/or walking.
Sleep on a medium-firm mattress.
Nutrition for osteochondrosis
A balanced diet and adequate fluid intake ensure normal blood supply and nutrition to the vertebrae and, therefore, the cartilaginous discs.As a result, metabolism and energy are normalized and harmful products do not accumulate.
Basic principles:
Daily calorie content, calculated individually, taking into account height, age and gender.
For overweight or obese patients, calorie intake should be limited.
Drinking regime– drink pure water, mineral water and herbal teas in a volume of at least 1 liter per day, ideally at a rate of 30 ml/kg of body weight.
Daily use:
- whole grain products (buckwheat, millet, oats);
- sufficient amount of protein (taking into account age and kidney function): animal - lean beef, chicken, turkey, rabbit, chicken egg (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), lettuce, herbs and leafy greens;
- berries - blueberries, blackberries, raspberries, cherries.
Exclusion from the plan:
- white bread and bakery products made from premium flour;
- sugar, industrial confectionery - candies, cakes, biscuits, gingerbread, waffles;
- industrial drinks with added sugar - sparkling water, packaged juices;
- processed meat products - sausages, sausages, canned foods.