Osteochondrosis

What is spinal osteochondrosis in simple words?

Osteochondrosis of the spine is a chronic disease based on degenerative-dystrophic changes in the intervertebral disc, which subsequently involves the adjacent vertebrae, intervertebral joints, and spinal ligaments.

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

Vertebrae are spongy formations.They are connected to each other by cartilaginous discs.There are ligaments along the front and back surfaces of the vertebrae.Cartilage 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 flexible, which allows you to perform vital functions:

• balance in a vertical position,
• to soften shocks and impacts during walking and jumping,
• protecting the skull and the brain inside from shock due to excessive blows.

With osteochondrosis, protrusions of the intervertebral discs occur outside the vertebral bodies.It develops depending on the direction in which the discharge occurs, as well as its size, pain, numbness, muscle disturbances and other symptoms.

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 cord 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 cervical intervertebral disc with radiculopathy
• M50.2 Displacement of intervertebral disc of cervical spine of another kind
• M50.3 Other cervical intervertebral disc degeneration
• M51.0 Injury of intervertebral discs of lumbar and other parts with myelopathy
• M51.1 Injury of intervertebral discs of lumbar and other parts with radiculopathy
• M51.2 Other specified displacement of intervertebral disc
• M51.3 Other specified degeneration 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:

• neck,
• chest,
• waist,
• sacred
• mixed options (cervicothoracic, lumbosacral).

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

• 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 (compressed and inflamed nerve roots).

Causes of osteochondrosis

To date, there is no exact information about the causes of osteochondrosis.

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

Intervertebral discs do not have their own blood or lymphatic vessels.The veins of the spines play a role in their nutrition and removal of harmful substances.With age and/or damage, blood and lymph flow 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 degeneration increases with exposure to risk factors.

Risk factors:

• congenital anomalies of vertebrae and spinal canal;
• straight legs;
• occupational hazards (vibration, lifting heavy loads, staying in a forced uncomfortable position for a long time, exposure to toxic substances);
• sedentary lifestyle;
• obesity;
• a diet that is not balanced in the content of protein, fats, vitamins and minerals;
• insufficient consumption of clean water;
• smoking;
• environmental pollution.

Symptoms of spinal osteochondrosis

Listed by frequency of occurrence:

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

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

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

Cervical osteochondrosis:

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

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

Thoracic osteochondrosis:

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

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, maybe more), forced loss of urine during physical activity;
• sexual disorders.

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

Developmental stages and course of osteochondrosis

The initial stage of osteochondrosis is manifested by a dull aching pain in the back or lumbar region that occurs during prolonged standing, walking or running;pain in the neck, aggravated by turning and bending the head.

As the pathology of the intervertebral disc(s) progresses, it can bulge (herniate) and eventually compress the nerve root (radiculopathy).This leads to severe pain radiating to the arm or leg, muscle weakness, impaired skin sensitivity, vascular tone, and dysfunction of the organs innervated by the problematic part of the spine.In the most severe cases, compression of the spinal cord can occur, causing 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, complications occur, pain and other symptoms return.

Diagnostics

1. Examination by a neurologist.

2. Main instrumental research methods:

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

3. Addendum:

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

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

Treatment of osteochondrosis

Conservative treatment

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

Objectives:

• reduction or elimination of pain,
• correction of muscle tone,
• reducing inflammation and swelling,
• prevent the development of dystrophic changes in the structures of the spine,
• correction of impaired function of internal organs,
• increase the patient's daily activities,
• teaching the patient to cope with pain.

Conservative treatment of osteochondrosis includes:

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

Drug treatment

The main groups of drugs that can stabilize the condition of a patient with osteochondrosis or relieve pain are given.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(NSIP):

   • for oral administration,
   • for intramuscular injection,
   • for intravenous administration,
   • to insert 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. Medicines 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),
   • B1+B6+B12 combination.

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

As the intensity of pain decreases, special therapeutic exercises aimed at stretching the spine and relaxing the muscles are added to the treatment with the gradual introduction of exercises for the formation of a muscle corset.Therapeutic hand massage is indicated.

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

Surgical treatment

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

If conservative therapy fails within 3-6 months, surgery may be required.

Prevention of back pain

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

• Avoid long-term static loads (sitting, staying in an uncomfortable position).

  If you have such a stressful job, it is recommended to take 10-minute breaks every 45 minutes, during which time you need to walk.

• Avoid hypothermia.

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

• Sleep on a medium firm mattress.

Nutrition for osteochondrosis

A balanced diet and proper fluid intake ensure normal blood supply and nutrition to the spine and, consequently, to the cartilage discs.As a result, metabolism and energy are normalized, harmful products are not accumulated.

Basic principles:

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

   Caloric intake should be limited for overweight or obese patients.

2. Drinking mode- drink at least 1 liter per day, ideally 30 ml/kg body weight of pure water, mineral water and herbal teas.

3. Daily use:

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

4. Exclusions from the diet:

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