About the most modern methods of treatment of osteochondrosis of the spine

The spine is a unique biokinetic system, it is able to carry loads without damage, but, like any structure, it wears out over time. At a young age, a steady state is maintained thanks to rapid regenerative abilities, but after 50 years, their supply gradually weakens, which leads to the formation of osteochondrosis.

Osteochondrosis is the most common degenerative-dystrophic pathology of the spine, which as it progresses spreads to nearby structures of the vertebral segment.

Developmental theories

The etiology of osteochondrosis is unknown. Currently existing theories about the development of this disease:

1. Metabolic.Changes in the metabolism of the vertebral disc due to its dehydration (the amount of water at a young age is 88%, with age the water content decreases to 60%).
2. Vascular.Changes in spinal circulation (occurs in adulthood, but early development is possible due to injuries, metabolic disorders, infections).

   These theories are sometimes combined into one - involution, which is based on a violation of trophism, especially in those tissues in which there are no vessels. In childhood, there is a vascular network in the intervertebral discs, but after the vertebral architecture is fully formed, this network is closed by connective tissue.

3. Hormonal theorymore controversial. Hormonal status plays a specific role in the development of osteochondrosis, but it is not correct to refer only to hormone levels. This theory is more relevant for postmenopausal women.
4. Mechanical theorytalks about the connection between the occurrence of osteochondrosis and overloading of certain parts of the spine.
5. Anomaly theory- a single case from mechanical theory. Abnormalities of the vertebral bodies, fusion of the bodies, non-fusion of the arch due to inappropriate biomechanical mechanism stimulate the overload of the vertebral discs and cause destruction of the bone tissue.

These theories have a right to exist, but none of them are universal. It is more correct to call osteochondrosis a multifactorial disease, which is characterized by genetic predisposition and causative factors.

Factors that contribute to the development of the disease

1. Gravity factor:for the spine, any abnormal displacement is nothing more than a trigger for many muscle reactions.
2. Dynamic factor:The greater and greater the load on the spine, the more and more it is subject to trauma (people prone to forced long-term postures, constant lifting of heavy objects).
3. Dysmetabolic factor:insufficient nutrition of the spine due to autoimmune disorders, toxic effects.

   It is known that eating food from aluminum plates leads to its accumulation in the bones, which will then contribute to the formation of osteochondrosis. Eating food from dishes made of aluminum and iron alloy has adverse effects on the human body. During food preparation, microparticles enter the gastrointestinal tract and because they also contain lead, this metal accumulates in the body, the poisoning of which is expressed by neuroosteofibrosis (defective changes in the tissue at the junction of tendon and muscle).

4. Genetic factor.Each person has an individual level of flexibility, which is directly related to the ratio of connective tissue fibers (collagen and elastin) and is genetically inherited. Despite all the above, there are rules in the ratio of fibers; deviations lead to faster wear and tear of the spine.
5. Biomechanical factor– abnormal movements in the articular surface of the spine. This is caused by muscle atrophy (the clinical symptom is pain when bending and turning).
6. Aseptic-inflammatory agent– more often a rapid inflammatory process in the intervertebral discs. Microdefects form in the spine due to malnutrition of the spinal disc. Areas of dead tissue form in these microdefects.

Symptoms of osteochondrosis of the spine

The main symptom of osteochondrosis is back pain, which can be continuous or periodic, aching or sharp, most often intensifies with sudden movements and physical activity.

Osteochondrosis is a common disease among athletes. It results from a mismatch between physiological capabilities and motor loads, which contribute to microtrauma and wear and tear of the spinal tissue.

The localization of symptoms largely depends on the part of the spine in which the pathological process occurs (cervical, thoracic, lumbosacral). If the pathological process is located in several places, then this condition is called mixed osteochondrosis.

Type of osteochondrosis	Cervical	Bosom	Lumbar	Mixed
Clinical picture	pain in the neck, back of the head, shoulders and arms, numbness of the fingers, muscle weakness. sometimes headaches, dizziness, spots before the eyes or reduced visual acuity.	more often night pain in the back, heart, chest, abdomen. numbness and weakness in the extremities. sometimes difficulty breathing.	periodic pain in the lower back, radiating to the sacrum, legs (depending on movements). tingling in the legs.	the pain is constant or spreads to all parts of the spine.
Complications	migraine; vegetative-vascular dystonia; Arterial hypertension.	pathologies of internal organs. intercostal neuralgia.	compressive myelopathy (compression of the spinal cord by various neoplasms);	all complications that are possible with cervical, thoracic, lumbosacral osteochondrosis.

Stages of osteochondrosis

Stages	First	Second	Third	Fourth
Changes in the spine	Intervertebral discs lose elasticity and flexibility. Rectifying normal lordosis.	Pathological mobility and subluxations of the vertebrae. Reduced intervertebral disc height.	Rupture and displacement of the spinal disc with immersion of other surrounding elements in its cavity, which causes the development of local symptoms of inflammation.	Destruction of other elements of the intervertebral joint, pathological arrangement of articular surfaces, marginal bone growths.
Patient complaints	Absence or sign of discomfort when staying in the same position for a long time.	Discomfort and pain with certain types of exercise.	Pain in the back, neck, lower back, sacrum or coccyx depends on the location.	Constant pain throughout the spine.

Differential diagnosis

1. Acute myocardial infarction.The pain is concentrated in the region of the heart and only from there it radiates (spreads) to the neck, lower jaw and arm. The disease begins without reason or after physical activity with the appearance of compressive pain not associated with movement in the spine. After half an hour, the pain reaches its maximum, the person experiences shortness of breath and fear of death. The diagnosis is confirmed by electrocardiogram (ECG) and markers of myocardial necrosis.
2. Subarachnoid hemorrhage(bleeding between the arachnoid and the pia mater of the brain). In some cases, due to the toxic effect of spilled blood on the roots of the spine, severe pain may occur in the spine. The main clinical sign is the presence of blood in the cerebrospinal fluid.
3. Abnormalities of the spine.Minimal examination: X-ray of the skull and cervical spine in frontal and lateral views. The most common abnormalities of the spine are: fusion of the atlas (the first cervical vertebra) with the occipital bone, depression of the edges of the occipital foramen in the cranial cavity, fusion of the vertebrae, changes in the shape and size of the vertebrae.
4. Cervical lymphadenitisit may also be accompanied by neck pain, sometimes worsened by bending and turning. The diagnosis is not difficult: enlarged, painful lymph nodes. history of frequent sore throat.
5. Multiple myeloma.Spinal pain appears gradually, in the context of progressive weight loss and periodic fever. The main laboratory sign is protein in the urine.
6. Tumor or metastases in the spine.Evidence for a malignant neoplasm is: progressive weight loss, laboratory changes, as well as ultrasound of the sources of metastasis - kidneys, lungs, stomach, thyroid gland, prostate.
7. Rheumatic and infectious-allergic polyarthritisdifferentiated by medical history, moderately elevated body temperature, and predominant damage to large joints.
8. Disguised depression.Patients "impose" non-existent pathologies (in this context, symptoms of osteochondrosis), an attempt to explain to them the essence of what is happening ends up in a wall of misunderstanding. The signs of masked depression are: decreased mood, concentration and performance. sleep and appetite disorders. suicidal thoughts and actions.
9. Peptic ulcer of stomach and duodenum, pancreatitis and cholecystitisthey are diagnosed using the connection of pain with food intake, laboratory tests (FGDS, general blood test, biochemical blood test, pancreatic enzyme activity, ultrasound examination of abdominal organs).

Diagnosis of osteochondrosis

1. Most often, a patient complains to a neurologist, who collects a history of the patient's life and illness and conducts a neurological examination. A neurologist examines the spine in three options (standing, sitting and lying down). When examining the back, pay particular attention to posture, the lower angles of the shoulder blades, the tops of the iliac bones, the position of the shoulder girdle, and the expression of the back muscles. During palpation, deformity, pain and muscle tension are determined.
2. When diagnosing osteochondrosis, additional consultation with specialized specialists is required to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
3. Carrying out mandatory laboratory tests (general blood test, general urinalysis, biochemical blood test).
4. Confirmatory studies are crucial:
   • X-ray of the spine in two views– the simplest method for detecting changes in the spine (narrowing of the gap between the vertebrae).

     Depending on the degree, various changes are visible on X-rays:

     Degree	First	Second	Third	Fourth
     x-ray marks	No radiological signs.	Changes in the height of the intervertebral discs.	Protrusion (bulging in the spinal canal) of intervertebral discs or even prolapse (loss).	Formation of osteophytes (marginal bone growths) at the point of contact of the vertebrae.

   • computed tomography (CT) and nuclear magnetic resonance (MRI)- it is used not only to detect changes in the spine, but also to determine pathologies in other organs.
   • USDG MAG (Ultrasound Dopplerography of the Major Arteries of the Head)– ultrasound examination of the circulatory system of the head and neck, which allows you to diagnose the degree of changes in blood vessels as early as possible.

What treatment methods are there for osteochondrosis?

Pharmacotherapyit should be strictly individual and differentiated, the prescription of drugs is carried out by a doctor after diagnosis.

The main drugs used in the treatment of osteochondrosis:

1. Pain relief is carried out with the help of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs). NSAID treatment should be as short as possible; 5-7 days is sufficient for pain relief. If the pain is poorly controlled and a constant dose of pain-relieving drugs is required, you can take selective COX-2 inhibitors.
2. Antispasmodics reduce pain and relieve muscle spasms.
3. Transdermal method of pain relief: ointment, the active ingredient of which is an NSAID. anesthetic cream; applications with anti-inflammatory and analgesic drugs; corticosteroids are added for greater effect.
4. Treatment aimed at regenerating an inflamed or compressed nerve, as well as improving blood microcirculation: B vitamins, neuroprotective drugs, nicotinic acid.
5. Oral chondroprotectants - glucosamine, chondroitin sulfate. They help stop destructive changes in cartilage when taken regularly. Chondroprotectants are incorporated into the framework of cartilage tissue, thereby increasing bone matrix formation and reducing joint destruction. The most favorable composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + non-steroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.

Treatment methods without drugs:

1. Neuro-orthopedic measures.An important point in the treatment of osteochondrosis is the observance of a rational scheme of physical activity. Staying in bed for a long time and minimal physical activity not only does not benefit the spine, but also leads to a permanent symptom - back pain.

2. Therapeutic exercise (physical therapy)prescribed when the patient is in a satisfactory condition (especially during the period when the signs of the disease decrease), the main goal is to strengthen the muscular corset.

   To prevent falls, improve coordination of movements and function of the vestibular apparatus (relevant for elderly patients), balancing discs, platforms and paths are used in exercise therapy.

3. Manual therapywith severe pain in the neck. It is prescribed with special care and according to strict indications. The main goal is to eliminate pathomechanical changes in the musculoskeletal system. The main reason for prescribing manual therapy is the pathological tension of the paraspinal muscles. Do not forget a number of contraindications for this type of treatment, which are related to osteochondrosis - massive osteophytes (pathological growths on the surface of bone tissue), formed in the 4th stage of development of this pathology.



4. Physiotherapy procedures in the acute period:

   • ultrasound;
   • phonophoresis?
   • ultraviolet radiation?
   • impulse currents;
   • neuroelectric stimulation.

   Physiotherapy procedures in the subacute period:

   • electrophoresis?
   • magnetotherapy.

5. Massage.Of all types, a superficial, relaxing massage with rubbing elements is used. Once the pain symptom is relieved with the help of massage, they smoothly proceed to more intense elements of friction. When testing the technique of acupuncture (local) massage, this type is preferred.

   The issue of surgical interventions is decided strictly individually, depending on the indications and the patient's condition.

Preventive actions

1. Competent selection of furniture (especially in the workplace). The work chair consists of a flat and solid back. The bed includes a mattress of medium hardness, a pillow of medium softness (if possible, an orthopedic mattress and pillow).
2. Vision correction, posture, bite.
3. Rational selection of shoes (especially important for drivers). The maximum heel size is 5 cm.
4. Wearing a restraint belt, bandage or corset while working.
5. Movement correction: avoid bending and twisting, lift weights with a straight back and legs bent at the knees.
6. Change body positions more often: don't stand or sit for a long time.
7. Proper nutrition: limit the amount of sweet, salty, fatty, spicy foods. The most dangerous food for bones is white sugar, as it leaches calcium from bone tissue. The diet should include fruits, berries, vegetables, eggs, nuts, meat, kidneys, liver, fish, legumes and dairy products.
8. Protect yourself from sudden temperature changes; the hot water in a bath, sauna, swimming pool, etc. it is particularly dangerous, as it relaxes the muscles of the back and even a small injury in this situation is not felt, but leads to tragic consequences for the spine and even for the musculoskeletal system in general.
9. Water procedures are not only a preventive measure, but also a therapeutic one. Swimming combines stretching and muscle relaxation.
10. Treatment of chronic diseases.
11. Active and regular holidays.

Examples of effective exercises for the prevention of cervical osteochondrosis, which can be performed directly in the workplace:

• sitting in a chair, looking ahead. The brush covers and supports the lower jaw. Pushing your head forward and down through resistance (tension phase). relaxing and stretching the neck muscles, slowly move your head back (relaxation phase).
• sitting in a chair, looking ahead. The right palm is on the right cheek. Slowly tilt our head to the left, try to touch our left shoulder with our ear and stay in this position for 3-5 seconds. Left palm on the left cheek and do the same, respectively, on the right shoulder.
• sitting in a chair, looking ahead. Hands are on knees. We tilt our head to the right, hold it for 5-7 seconds and very slowly return to the starting position. Then we tilt our head to the left and, accordingly, do the same.

conclusion

The high frequency and social importance of osteochondrosis determines the scientific interest in this problem. The disease affects not only the elderly, but is increasingly appearing in young people, which attracts the attention of neurologists, neurosurgeons, orthopedic traumatologists and other specialists. Early diagnosis and adequate treatment of this pathology ensures social adaptation and quality of future life.