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 neighboring vertebrae, intervertebral joints and spinal ligaments.

The word “osteochondrosis” has two Greek roots: οστό – bone and χόνδρος – cartilage.

Vertebrae are structures made of spongy bone.They are connected to each other by cartilage discs.There are bands along the front and back of the vertebrae.Cartilaginous discs prevent the vertebrae from coming together and the ligaments from moving away.Thanks to the coordinated work of intervertebral discs and ligaments, the spine is elastic and can therefore perform vital functions:

• ensure balance in a vertical position,
• Mitigate shocks and vibrations when walking and jumping,
• Protect the skull and the brain within from impacts caused by excessive impact.

In osteochondrosis, intervertebral disc protrusions form beyond the vertebral bodies.Depending on the direction and size of the protrusion, pain, numbness, muscle discomfort and other symptoms occur.

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 spondylosis with myelopathy
• M47.2 Other spondylosis with radiculopathy
• M48.0 Spinal stenosis
• M50.0 Damage to the intervertebral disc of the cervical spine with myelopathy
• M50.1 Damage to the intervertebral disc 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 disc
• M51.0 Lesions of the intervertebral discs of the lumbar spine and other parts with myelopathy
• M51.1 Lesions of the intervertebral discs of the lumbar spine and other parts with radiculopathy
• M51.2 Other specified disc displacement
• M51.3 Other specified intervertebral disc degeneration
• M53 Other dorsopathies, not otherwise classified

Types of osteochondrosis

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

• cervical,
• Breast,
• lumbar spine,
• 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 (damage to the spinal cord),
• 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 disc wear.

Intervertebral discs have no blood or lymph vessels of their own.The vessels of the vertebrae play a role in feeding them and cleaning them from pollutants.With increasing age and/or exposure to harmful influences, blood and lymph flow decreases, the intervertebral discs receive less oxygen and nutrients and harmful substances can accumulate in them.All this leads to gradual wear and tear.The degree and rate of disc wear increases with exposure to risk factors.

Risk factors:

• congenital anomalies of the vertebrae and spinal canal;
• flat feet;
• Occupational risks (vibration, heavy lifting, prolonged stay in a forced uncomfortable position, exposure to toxic substances);
• sedentary lifestyle;
• Obesity;
• a diet whose content of proteins, fats, vitamins and minerals is not balanced;
• insufficient consumption of clean water;
• Smoke;
• Pollution.

Symptoms of spinal osteochondrosis

Listed by frequency of occurrence:

• Pain;
• reduced range of motion;
• numbness, loss of sensitivity;
• decreased muscle strength;
• Dysfunction of organs whose innervation is connected to the problematic part of the spine.

Clinically significant manifestations of spinal osteochondrosis are observed in 51 people per 1000 inhabitants.

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

Cervical osteochondrosis:

• Pain in arms, shoulders and neck, aggravated by turning and tilting the head;
• Headache;
• decreased muscle strength in the arm;
• Noises in the head, dizziness, flashes of “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, since the arteries 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 through the arteries is disrupted and there is a lack of oxygen and nutrients in the brain.

Breast osteochondrosis:

• Pain in the chest, under the shoulder blade, in the heart area, 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 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 pain in the back or lower back that occurs when standing for a long time, after walking or running;Pain in the neck that is worsened by turning and tilting the head.

As the pathology of the intervertebral disc(s) progresses, a bulge (hernia) can occur, resulting in compression of 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 organs innervated by the problematic part of the spine.In the most severe cases, compression of the spinal cord can occur, leading to paresis or paralysis.

Osteochondrosis is a chronic disease.After adequate treatment, remission occurs, which means that the symptoms decrease or disappear completely.If the intervertebral disc bulges again, it will worsen and pain and other symptoms will reoccur.

diagnosis

1. Examination by a neurologist.

2. Basic instrumental research methods:

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

3. Additionally:

   • spondylography (deep x-ray examination of the spine),
   • electromyography (EMG),
   • Electroneuromyography (ENMG),
   • Bone density measurement (performed to detect osteopenia/osteoporosis).

4. Basic laboratory methods:

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

5. Additionally:Concentration of calcium and phosphates in the blood.

Treatment of osteochondrosis

Conservative treatment

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

Goals:

• relief or relief from pain,
• correction of muscle tone,
• reducing inflammation and swelling,
• Prevention of progression of dystrophic changes in the structures of the spine,
• correction of dysfunctions of internal organs,
• increasing the patient's daily activity,
• teach the patient to deal with pain.

Conservative treatment of osteochondrosis includes:

• Compliance with a rational motor regime,
• taking medication,
• physiotherapy,
• Massage,
• Exercise therapy (after pain relief and condition stabilization),
• Acupuncture,
• manual therapy.

Drug treatment

The main groups of drugs that can relieve or relieve pain and stabilize the condition of a patient with osteochondrosis are listed.Only a doctor can select an appropriate 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 suppository),
   • for external use (ointment, gel).

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

   Used for severe tension and painful muscle cramps.

3. Diuretics(to reduce local swelling).

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

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

5. B vitamins:

   • Thiamine (B1),
   • pyridoxine (B6),
   • cyanocobalamin (B12),
   • Combination B1+B6+B12.

In the acute phase with severe pain, bed rest is possible for 1-2 days, which helps to relax the muscles and reduce the pressure inside the cartilaginous intervertebral disc.It is recommended to wear a stabilizing lumbar corset or shants collar.

As the pain intensity decreases, the treatment is supplemented with special therapeutic exercises to stretch the spine and relax the muscles, gradually incorporating exercises to build a muscle corset.Therapeutic manual massage is indicated.

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

Surgical treatment

Emergency neurosurgical intervention is indicated for diseases of the pelvis with numbness in the anogenital area and ascending paresis of the feet (cauda equina syndrome).

The need for surgery may arise even if conservative therapy remains 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 is such a stress, it is recommended to take 10-minute breaks every 45 minutes during which you have to walk.

• Avoid hypothermia.

• Maintain adequate levels of physical activity through regular exercise, 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 thus 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 size, age and gender.

   In overweight or obese patients, calorie intake should be limited.

2. Drinking regime– Drink pure water, mineral water and herbal teas in an amount of at least 1 liter per day, ideally 30 ml/kg body weight.

3. 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 with monounsaturated and polyunsaturated fatty acids (fish, seafood, unrefined vegetable oils, unroasted and unsalted nuts, seeds);
   • Vegetables (both fresh and cooked), salad, herbs and leafy greens;
   • Berries - blueberries, blackberries, raspberries, cherries.

4. Exclusion from the diet:

   • White bread and baked goods made from high-quality 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.