General characteristics of spinal osteochondrosis
Osteochondrosis is a degenerative-dystrophic disease of the spine. With osteochondrosis of the spine, intervertebral discs are the first to suffer. Intervertebral discs with osteochondrosis of the spine are deformed, decrease in height, stratified.
Osteochondrosis of the spine is not a disease in itself, it is caused by age-related changes in the connective tissue. It is known that in people aged 40 and older, in most cases, signs of osteochondrosis are detected on radiographs of the spine. Does this mean that they are all sick? If you are guided by the modern definition of disease, then of course not. The disease is only clinically manifested osteochondrosis. If osteochondrosis of the spine is detected by chance during a special examination, then it should not be attributed to the disease.
Osteochondrosis of the spine is mainly a pathological process that can become a disease in the presence of appropriate clinical manifestations. Modern research methods, primarily computed tomography (CT of the spine) and magnetic resonance imaging (MRI of the spine), can reveal in most cases some changes (pathological processes) in the body of a healthy person.
Osteochondrosis of the spine is a dystrophic pathological process that begins with intervertebral discs with subsequent damage to other parts of the spine, primarily the cervical and lumbar, in some cases clinically manifested by various neurological disorders. The neck and lower back suffer from their regular and high mobility, while the thoracic spine is reliably fixed by the ribs.
At the same time, it should be noted that in 60-75% of cases of osteochondrosis of the spine, even "prolapse" of the lumbar discs proceeds clinically without pain or other symptoms. There is also no strict relationship between the degree of intervertebral disc dystrophy and the severity of neurological disorders. Moreover, in elderly and senile people, in whom the frequency and prevalence of osteochondrosis of the spine reach the maximum degree, lumbosacral radiculitis occurs 1.5-2 times less often than in middle-aged people.
Various aspects of spinal osteochondrosis and its neurological manifestations in adults are described in detail in dozens of monographs, reference books, manuals, and innumerable journal articles. Only a few monographs are devoted to the clinical manifestations of lumbar osteochondrosis in children and adolescents, and in general, this problem in childhood and adolescence remains largely unexplored. Therefore, there is no need to describe in detail the causes and mechanisms of the development of osteochondrosis. They are well known to neurologists and orthopedists, although much remains unexplored, and some aspects are controversial.
Osteochondrosis of the spine is a multifactorial disease with the participation of both hereditary, congenital traits, and several acquired factors: static-dynamic, autoimmune, metabolic, etc. changes leading to the development of osteochondrosis of the spine.
Based on clinical, pathomorphological, and experimental studies, the position was put forward that the initial triggering mechanism of spinal osteochondrosis is the vascular (ischemic) factor. This is confirmed by the following pathomorphological data obtained in the study of the blood supply to the spine. Clear parallelism was established between a decrease in the total area of the orifices of the lumbar and median sacral arteries and an increase in osteochondrosis in the entire lumbar spine.
A high frequency of anomalies in the development of vessels in this area feeding the lumbar segments was also revealed: abnormal discharge, multiple bends, narrowing, which leads to the insufficient blood supply to the lumbar vertebrae, the imbalance between the synthesis and destruction of the most important functional components of the intervertebral disc.
In the pathogenesis of neurological manifestations of osteochondrosis of the lumbar spine, an important role is played by the violation of venous outflow with partial or complete block of epidural veins at the level of protrusion or herniated disc. The detection of venous disorders was based mainly on the results of special paraclinical studies - rheocaudospondylography, rheovasography, radiculography, venospondylography. These data require the development of new methods of differentiated therapy with an effect on regional venous hemodynamics, exclusion of widely used thermal procedures.
With a variety of etiological factors of spinal osteochondrosis and its neurological manifestations, autoimmune disorders play a leading role in the pathogenesis of the disease. They arise after the appearance of biochemical changes in the intervertebral discs due to an imbalance between the processes of biosynthesis and the destruction of the most important functional components of connective tissue.
The autoimmune concept of the pathogenesis of spinal osteochondrosis and its clinical manifestations was further developed. It was found that with neurological manifestations of lumbar osteochondrosis, the function of the T- and B-systems of the immune system is impaired, which manifests itself in the increased production of antibodies to various structures of the intervertebral discs as a result of a deficiency of T-suppressor cells. These and other data made it possible to explain many mechanisms of the development of osteochondrosis of the spine, including the staging of morphological changes in the intervertebral discs, the alternation of remissions and relapses, as well as reactive changes in the nerve roots and surrounding tissues.
When assessing the role of autoimmune disorders in osteochondrosis of the spine, it should also be borne in mind that they are a universal response of the body to damage to any organ and any tissue.
Neurological syndromes of spinal osteochondrosis
Neurological syndromes of spinal osteochondrosis are clinically divided into:
- cervical spine osteochondrosis syndromes
- thoracic osteochondrosis syndromes
- lumbar spine osteochondrosis syndromes
Stages and degrees of osteochondrosis of the spine
The stages of osteochondrosis of the spine are also distinguished:
- the initial stage of spinal osteochondrosis
- the stage of rupture of the fibrous ring of the intervertebral disc
- stage of outcome and residual effects of spinal osteochondrosis
The severity of osteochondrosis of the spine during its X-ray examination:
- straightening of the lumbar lordosis, slight flattening of the intervertebral disc, small exostoses, proliferation of uncinate processes
- a slight narrowing of the intervertebral foramen and the spinal canal, a decrease in the height of the discs, instability of the spine
- significant narrowing of the intervertebral foramen and the spinal canal
The course of spinal osteochondrosis
The course of osteochondrosis of the spine:
- recurrent course of osteochondrosis of the spine
- chronically recurrent course of osteochondrosis of the spine
- chronic course of osteochondrosis of the spine
By the type of course of osteochondrosis of the spine:
- regredient type of the course of osteochondrosis of the spine
- non-progressive course of osteochondrosis of the spine
- progressive course of osteochondrosis of the spine
The periods of the course of osteochondrosis of the spine:
- debut of osteochondrosis of the spine
- exacerbation of osteochondrosis of the spine
- remission (complete, incomplete) of osteochondrosis of the spine
- period of relative stabilization, residual period of osteochondrosis of the spine
Osteochondrosis of the spine in children and adolescents
For a long time, there was an opinion that osteochondrosis of the spine develops only in adulthood and old age. Even in special manuals on nervous diseases, the possibility of vertebrogenic lesions of the nervous system in childhood and adolescence was not mentioned at all or was discussed very briefly.
The first mention of the possibility of herniated lumbar intervertebral discs in adolescents belongs to F. Jelsma (1944), in whom among 150 patients operated on, for this reason, there was a 17-year-old boy. In 1946, N. Wahren gave a detailed description of the clinic of prolapse of the lumbosacral disc in a 12-year-old girl. Similar data were presented later by other authors. In 1954 J.H. Webb, H.J. Svien, R.L.J. Kennedy reported the results of surgical treatment for prolapse of the lumbar intervertebral discs in 3 children and 57 adolescents. During 1946-1981. the literature describes 71 cases of such operations in patients under 15 years of age; the total number of operations in children and adolescents before 1974 was 158 (S.E. Borgesen, P.S. Vang, 1974).
There are different points of view about the reasons for the development of osteochondrosis of the spine in childhood and adolescence. In its occurrence, the peculiarity of the blood supply to the discs can play a role to some extent. It is known that the intervertebral disc is fed by diffusion since all vessels after 4 years of life undergo a reverse development. However, this age-related tissue rearrangement does not mean pathology. Great importance is attached to increased muscle load, overwork (micro- and macrotraumatization), especially during sports competitions. However, it is unlikely that trauma alone can result in a previously healthy disc "prolapsing". Based on research by J. A. Key (1950), S.E. Borgessen, P.S. Vang (1974), D. Jaster (1974) the frequency of trauma in history in children and adolescents does not differ from that in adults. In this case, disc dystrophy is primary, and the injury only accelerates its prolapse. The role of congenital inferiority of intervertebral disc tissues is also indicated (P. Rottgen, 1951).
According to I.E. O'Connell (1960), the rapid growth of the skeleton in childhood and adolescence is stress that contributes to the degeneration of the intervertebral discs. The author considers the second etiological factor to be muscle inadequacy, which occurred in 10% of the examined patients. This was manifested in the fact that some patients with osteochondrosis of the spine were very tall or, conversely, had an adipose physique, the muscles in some cases were weakened after prolonged bed rest for various diseases.
With the study of osteochondrosis of the spine and the resulting neurological disorders, more and more importance is given to hereditary factors. Khodosovskaya and Okuyeva (1980) conducted a genealogical study in 68 children and adolescents aged 8 to 18 years with various clinical manifestations of osteochondrosis. At the same time, 69.1% of the probands had family cases of the disease: parents, grandmothers, grandfathers, uncles, aunts suffered from similar diseases. Hereditary burden in adults took place in 53.3%, which is significantly lower than in childhood and adolescence. It was shown that in the case of illness of both parents, lumbosacral pain in the proband occurred at a younger age.
Various dysplastic signs were also identified in 75% of pediatric and adolescent patients with reflex and radicular syndromes of vertebral lesions of the lumbosacral localization, which is significantly higher than in adults (49%). These developmental anomalies manifested themselves in the form of mild facial dysmorphias (28%), deviations in the structure of the hands and feet (47%), anomalies in the development of the muscular system (8.8%), asymmetry of the body structure (63%), skin and vascular anomalies (23,five%). In addition, 40.9% of the examined had anomalies in the development of the lumbosacral spine:
- splitting of the vertebral arch (19.7%)
- transitional lumbosacral vertebra (14.6%)
- violation of the tropism of the articular processes (5.7%)
- spondylolisthesis (0.8%)
In most cases (60%), there was a combination of two or more different dysplastic signs, which is significantly higher than in adults (10%).
When examining the relatives of the probands, anomalies were also quite common: deformity of the feet, birthmarks, dilatation of the saphenous veins, irregular body structure, face dysmorphia, and the presence of bone anomalies of the lumbosacral spine in the family was also traced. It should be noted that the role of the latter in the occurrence of lumbar osteochondrosis and its clinical manifestations has not been finally established.
There is an opinion that congenital changes under the influence of various exogenous factors cause static inferiority of the spine and thereby contribute to the development of a dystrophic process in the discs. Osteochondrosis develops in the disc adjacent to the anomaly. These data indicate the role of hereditary predisposition with neurological manifestations of lumbar osteochondrosis. It can be transmitted both in an autosomal dominant and autosomal recessive manner.
The presence of familial cases of vertebrogenic diseases of the lumbosacral part of the peripheral nervous system, a high frequency of dysplastic signs in probands and their relatives (primarily from the lumbosacral spine), determine the possibility of developing osteochondrosis of the lumbar spine and its clinical manifestations in childhood.
Diagnosis of symptoms of spinal osteochondrosis
Diagnosis of symptoms of spinal osteochondrosis begins with a neurological and orthopedic examination by a doctor. During this examination, the patient's neurological status is assessed, as well as possible violations in the biomechanics of the spine are identified with a mandatory assessment of the state of the muscles of the back and gluteal region. Already at this stage of the study, a patient with osteochondrosis of the spine and pain in the back and lower back can be diagnosed and treated.
According to the results of a neurological and orthopedic examination of a patient with a pain symptom against the background of osteochondrosis of the spine, the following additional diagnostic procedures can be prescribed:
- radiography of the lumbosacral spine with functional tests
- CT scan of the lumbosacral spine
- MRI of the lumbosacral spine.
Treatment of symptoms of spinal osteochondrosis
Depending on the severity of the manifestations and causes of pain in the back and lower back against the background of osteochondrosis in the patient, the following therapeutic actions are possible:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic injections — injections of drugs into the cavity of the intervertebral joint, the spinal canal, in the trigger points in the muscles
- manual therapy (muscle, joint and root techniques)
- physical therapy (UHF, SMT, TENS, etc.)
- therapeutic gymnastics
- surgical treatment
In the intervertebral joints of the lumbar, thoracic or cervical spine (facet joints) therapeutic injections can also be performed. Therapeutic injections with local anesthetic and hormonal drugs are made to accelerate the relief of pain and inflammation and to obtain a positive clinical effect as soon as possible.
Usually, for therapeutic injections, low doses of an anesthetic (novocaine, lidocaine) and cortisone injected into the lumen of the affected joint are sufficient.
When combined with a well-chosen physiotherapy regimen, these therapeutic blockages can provide a good and long-term effect for lumbar and sacral pain in patients with spinal osteochondrosis.
Wearing a semi-rigid lumbosacral brace in the treatment of back and lower back pain against the background of spinal osteochondrosis with a herniated disc or a protrusion of the intervertebral disc helps to limit the amount of movement in the lumbar spine. This primarily helps to reduce pain in the area of inflammation of the intervertebral joints and relieve excessive protective tension and spasm of the back muscles.
In such brace, a patient with osteochondrosis of the spine can move independently at home and on the street, and even sit in the car and at the workplace. The need to wear an brace in the patient disappears with osteochondrosis, as soon as the back pain passes.
But you need to remember that during the period of exacerbation of back and lower back pain against the background of osteochondrosis of the spine, you should avoid workloads and observe rest. This is a temporary restriction, but it significantly shortens the recovery time and, against the background of the ongoing treatment, does not allow the disease of the spine to develop further.
There are several types of semi-rigid lumbosacral braces. All of them are selected individually in size and can be used repeatedly in case of recurrence of pain in the back and lower back against the background of osteochondrosis of the spine, as well as for the prevention of possible exacerbations of the pain symptom.