Statistical data for the disease of osteochondrosis for the year. Why does osteochondrosis occur and how is it treated? Development of osteochondrosis in obesity

“Traumatology and Orthopedics”, volume 4. Volume editors: corresponding member of the Russian Academy of Medical Sciences, honored. activities Science of the Russian Federation Professor N.V. Kornilov and Professor E.G. Gryaznukhin, St. Petersburg, ed. “Hippocrates”, 2006. Author of the article - B.M. Rachkov. The article very bizarrely mixes the practical experience of the authors with obvious, virginal, anti-scientific nonsense.

Based on a comprehensive survey of 341,600 adult residents of seven Russian cities, it was found that per 1,000 residents there were 22.5 visits for osteochondrosis (For how long? - H.B.) , while 3.3 of them are diagnosed for the first time [Shapiro K.I., 1993]. As a result, the accumulated incidence reaches 49.8 per 1000 inhabitants, and taking into account medical examinations, revealing another 1.4 cases per 1000 inhabitants, this figure is 51.2 per 1000 people. However, clinics register only 44% of the true incidence of osteochondrosis. It turned out that the incidence of osteochondrosis among women reaches 52.2%, and among men only 46.6%, which is apparently associated with the amount of physical activity and the uneven distribution of it among women and men.

Statistical data of K.I. Shapiro indicate that osteochondrosis begins to be diagnosed at the age of 15-19 years (2.6 cases per 1000 inhabitants), and by the age of 30-39 years of life the frequency of osteochondrosis reaches 30.7%. This figure increases 2.5 times among people 40-49 years old; at the age of 50-59 years, osteochondrosis is detected in 82.5% of residents. The highest incidence of osteochondrosis is observed among people aged 60-69 years and is 89.4% (That is, despite the treatment, the number of patients is growing. The question is: does this treatment help at all? - H.B.) . Among the causes of primary disability due to diseases musculoskeletal system Osteochondrosis ranks first and accounts for 41.1% of those examined. At the same time, 2.2% of patients become disabled on average 7.6 years after the onset of the disease, and 47.4% of them completely lose their ability to work (group I is established in 3.8%; II - in 43.6%. III - in 52.6 % of patients). It is characteristic that 50.4% of those suffering from osteochondrosis were diagnosed with glenohumeral periarthritis, flat feet and arthrosis, which indicates a systematic lesion of the musculoskeletal system (The entire spine is NEVER affected evenly, there are always more and less affected areas, there are always more and less affected joints. This indicates that factors other than just metabolism influence the development of the disease - H.B.)

State medical care in osteochondrosis, it is characterized by pronounced polarity and extreme trends associated with both personnel difficulties and weak material resources and equipment of medical institutions. In general, about 98% of all applicants are treated on an outpatient basis and only 2% of patients are hospitalized in various hospitals. In clinics, 51.3% of patients with osteochondrosis are treated by neurologists; 32.7% - from therapists and physiotherapists; 13.7% - among surgeons; 2.3% - from physical therapy doctors. Only 2.1% of patients are consulted by orthopedic specialists (Cool! - H.B.)

It is regrettable that after the disability group is established, only 10% of these patients are treated in hospitals, and re-hospitalization occurs on average after 4 years (There is absolutely nothing to regret. Hospitals are breeding grounds for infections (Robert S. Mendelsohn. “Confessions of a Medical Heretic”), expensive compared to outpatient treatment, and the quality of psychological comfort for patients there leaves much to be desired. People usually seek access to hospitals from prison , and healthy people go on vacation to relax - H.B.) . However, before transferring patients to disability, only 15.4% of them used outpatient, inpatient or sanatorium treatment; 75.1% of patients were treated only on an outpatient basis and in a hospital; 2.6% - exclusively on an outpatient basis and in a sanatorium; 6.9% - only outpatient. Among hospitalized patients, 51.7% were treated in therapeutic and neurological hospitals of various hospitals and medical units.

At the same time, the average length of stay of the patient in bed was 31.2 days (from 7 to 14 days - in 14.3%; from 15 to 30 days - in 42.9%; up to 2 months - in 37.7%; up to 3 months - in 4.1%; over 3 months - in 10% of hospitalized patients).

Such a wide range of inpatient treatment periods is apparently associated with a certain level of diagnostics in therapeutic hospitals, poor equipment and training of specialists, as well as the lack of a single coordinating center (It is also connected with the severity of each specific case - H.B.)

The essence of osteochondrosis

Osteochondrosis is a progressive decrepitude (Lord, where and what did these people study? Write also “withering” and “shrinking” - H.B.) segments of the spine, which is based on degenerative-dystrophic changes in the vertebral bodies and intervertebral joints (discs), caused by decreased muscle function, monotony of posture, low general physical activity and poor nutrition (I don't see ANY research to support this bullshit. In animals, osteochondrosis is often found in young, active horses http://www.vetpathology.org/cgi/content/full/44/4/429 - H.B.) . Each vertebra has an upper and lower articular surface, consisting of hyaline (cartilaginous) plates, between which there is a nucleus pulposus (pulpous), which acts as a shock absorber, muffler of the force of shocks and impacts when walking, jumping and complex physical exercises that require great muscle effort. The nucleus pulposus is immured in the intervertebral joint with the help of a fibrous ring, which has many fusions with the surface of the vertebral body itself and hyaline plates lying above and below the nucleus pulposus. The fibrous ring acts as a protective cover, or sleeve, within which the nucleus pulposus operates, like a bearing, providing mobility and shock absorption in the intervertebral joint. In the center of the nucleus pulposus there is a cavity filled with a specific fluid, reminiscent of the synovial fluid of ordinary joints. The nucleus pulposus, like a sponge, absorbs or loses fluid depending on certain conditions and physical activity. Thus, with physical overload and fatigue, the core reduces the volume of this fluid and shrinks, which leads to the convergence of the surfaces of the vertebrae, a decrease in the height of the spine as a whole and a decrease in human height by 2-4 cm or an increase in it after rest.
Such significant fluctuations in growth are due to the fact that in the first years of a person’s life, the nucleus pulposus contains about 90% of fluid, in adolescence - up to 80%, and in old age - no more than 60%. This explains the decrease in height of each person as they mature and age.

From the above it follows that the nucleus pulposus carries out intensive and polyvalent work to maintain the intervertebral joint in a state of physical and shock-absorbing activity. As the core matures, it loses its ability to become elastic, quickly absorb and release moisture, which leads to its flattening, rupture and loss of strong bonds with the hyaline plates and the fibrous ring. This is largely facilitated by immobility, monotony of posture, deterioration of blood supply and poor nutrition, which contribute to a decrease in the content of microelements, enzymes and vitamins in tissues (See comment above - H.B.) . The nucleus pulposus, which has lost its elasticity, is unable to resist the forces compressing it from above and below, which ends in a stable convergence of the upper and lower surfaces of the entire intervertebral joint and a decrease in its physiological height. This, in turn, creates conditions for detachment or rupture of the fibrous ring under the influence of muscle forces and a decrease in the elasticity of the anterior and posterior longitudinal ligaments that hold the vertebrae in a vertical position. The latter (especially the posterior ligament) are subject to increased mechanical stress and detachment from the bone structures of the vertebra due to abnormal mobility and bulging of the nucleus pulposus, which begins to dismember and, under the influence of pressure, breaks through these ligaments, forming a hernial bulge, often in the posterior or posterolateral directions.

A decrease in the height of the intervertebral joint (disc) leads to the fact that when flexion and extension of the spine, the vertebral bodies begin to come together so close that they touch each other, creating the phenomenon of edge-to-edge friction. This friction, in turn, forms bone spikes called traction spurs. The presence of a traction spur is an absolute sign of osteochondrosis, even in the absence of other signs and symptoms of this disease.

New data on the classification of vertebral osteochondrosis.

Based on the pathophysiological and anatomical processes of aging and decrepitude of the spinal structures, its intervertebral joints and ligaments, as well as on the basis of a comprehensive analysis of about 40 thousand outpatient and inpatient patients, it seems advisable to us to make some adjustments to the existing classifications of spinal osteochondrosis. This is also due to the fact that a decrease in the height of the intervertebral disc is not just a stage of osteochondrosis, but an absolute sign of decrepitude and aging of the spine due to the age of the patient (The author has obvious problems with logic, see the statistical data of K.I. Shapiro above - H.B.) . Therefore, segmental instability, segmental hyperextension, loss of disc height, disc protrusion, according to our data, are signs of one pathophysiological process, which can be combined under one heading called “segmental and polysegmental instability.” Even in boys and young adults, the first signs of osteochondrosis are manifested by pain of varying intensity, and x-rays reveal loss of the height of the intervertebral disc with elements of its protrusion (Thus, I do not see a connection between osteochondrosis and age - H.B.) . Therefore, against the background of loss of disc height and its protrusion, conditions arise for detachment of the posterior longitudinal ligament, which leads to pathological mobility of the vertebral bodies and the creation of conditions for rupture of the structures of the fibrous ring, most often in the zone of detachment of the posterior longitudinal ligament in the outer parts of the vertebra.

This situation can be characterized as stage II of osteochondrosis and referred to as the stage of rupture of the fibrous ring with fragmentation and loss of part of the nucleus pulposus. This interpretation is confirmed by widespread cases where, after sudden and inappropriate movements or lifting heavy objects, patients experience severe pain associated with rupture of the fibrous ring and prolapse of a fragment of the nucleus pulposus into the cavity of the spinal canal, which causes compression of the nerve roots or structures of the intervertebral nerve ganglion, followed by abundance and diversity pain, symptoms of irritation and loss, which create a picture of spinal osteochondrosis. (You can read the discussion about hernias here: http://community.livejournal.com/healthy_spine/50400.html - H.B.) This situation is the most common in the pathogenesis of spinal osteochondrosis in young and middle-aged people and is often regarded by doctors as “lumbago”, “sciatica”, “lumbodynia”, which does not correspond to the essence of pathological changes in the area of ​​the intervertebral articulation and the ligamentous apparatus of this segment of the spine.

In mature and elderly people, the acute appearance of pain is more often associated with hypothermia, which leads to a pronounced decrease in the volume of the nucleus pulposus to 40% of its initial parameters, which causes a sharp convergence of the surfaces of the vertebral bodies and stretching of the capsules of true synovial joints, leading to acute pain in this segment, which are mistakenly regarded as a manifestation of “sciatica” (Again, I do not see ANY evidence of a “reduction in the volume of the nucleus pulposus to 40% of its original parameters.” Liquids generally do not respond well to changes in volume. Cold causes muscle spasms - that’s what is reliably known. See Injuries - H.B.) .

The stage of rupture of the fibrous ring with loss of a fragment of the nucleus pulposus can cause the development of reflex acute scoliotic deformity, which requires emergency treatment in a hospital setting, or the development of spondylolisthesis, which also requires complex hospital treatment. The second outcome of rupture of the fibrous ring may be persistent chronic pain syndrome, against which the picture of ackylosing hyperostosis develops as a protective reaction of the body aimed at strengthening the stabilizing mechanisms in this segment of the spine. This process often leads to the creation of a spontaneous protective hip joint due to the creation of bone blocks in the anterolateral parts of the intervertebral joint.

In the absence of a therapeutic effect, conditions are created for a fibrotic process in the area of ​​the dissected nucleus pulposus with its replacement by a cicatricial process, which leads to a pronounced loss of the height of the intervertebral disc with the loss of the functional properties of this segment. This situation can be assessed as a stage of osteochondrosis in the form of mono- or polysegmental fibrosis of the intervertebral disc. Fibrosis of the intervertebral disc is followed by the development of akylosing hyperostosis, which can be mono- or polysegmental and appears as an adaptive protective reaction aimed at enhancing stabilization in these segments of the spinal column, which eliminates the need for surgical interventions in such patients to install stabilizing structures or spinal fusion.

According to our data, ankylosing hyperostosis often develops with traumatic fractures of the vertebral bodies, especially in women of reproductive age, and this is important in the mechanisms of stabilization of the damaged spinal segment. Against the background of ankylosing hyperostosis, reflex antalgic scoliosis can occur, more often in the lumbar and thoracic spine, which significantly aggravates the clinical course of osteochondrosis and requires surgical intervention to correct posture. Ankylosing hyperostosis leads to spinal canal stenosis of varying severity and varying intensity of clinical manifestations. Often such patients clearly require surgical treatment.

In general, the following sequence of progression of the pathological condition can be imagined:
- Stage I - mono- and polysegmental instability (includes segmental instability, hyperextension, loss of disc height, disc protrusion); at this stage, periodic pain attacks predominate with the possibility of their relief using traditional non-operative treatment; performance is maintained;
- Stage II - rupture of the fibrous ring with loss of a fragment of the nucleus pulposus or other components of the intervertebral disc; characterized by acute and severe long-term pain, focal neurological loss, paresis or paralysis of muscle groups, dysfunction of the pelvic organs; reflex aitalgic scoliosis may form; Often such patients are transferred to disability or undergo surgery;
- Stage III - fibrosis of the intervertebral disc; characterized by moderate pain, obvious neurological loss; however, pain can be periodic and not always pronounced, which still leads to decreased ability to work;
- Stage IV - ankylosing hyperostoe mono- and polysegmental (the presence of fibrosis of the intervertebral discs is required, up to the formation of a bone block); the pain is regular with pronounced neurological loss and decreased ability to work; Antalgic scoliosis may develop with their transition to fixed scoliosis; performance is limited;
- Stage V - spinal canal stenosis due to ankylosing hyperostea, deformation of the vertebral bodies, fibrosis of the intervertebral discs.

Gross disturbances of sensitivity and movement, up to paresis and paralysis, dominate; complete or partial disability. This stage is typical for mature and elderly people.

Osteochondrosis cervical spine spine.

Holding the head in the desired position is associated with constant dynamic and static work of the muscles of the neck and the back of the neck and back. The large range of movements of the head is due to the fact that in the cervical spine 40% of its height falls on the cartilaginous intervertebral joints (hyaline plates, nucleus pulposus, fibrous ring, etc.), which impart special flexibility and expand the amplitude of flexion and extension of the neck, which leads to increased fatigue of the muscles in this area and accelerated “wear and tear” of the intervertebral discs.

One of the first signs of osteochondrosis of the cervical spine is a feeling of heaviness and pain in the neck when moving and even at rest, sometimes a crunching sound or sharp painful “shoots” radiating to the back of the head. Most often, the pain intensifies in a horizontal position at night. In this case, numbness of the III-V fingers occurs with a decrease in strength in the flexor muscles of the fingers. As the disease progresses, the duration and severity of pain become stronger, a frightening decrease in strength in the flexors and extensors of the fingers and hand appears, and restriction of movements in the shoulder and elbow joints occurs. All this, against the background of pain, creates anxiety and fear in the sick person.

Sometimes swelling of the fingers, the entire hand and joints, and pale or bluish skin may appear. More often, pain and decreased muscle strength occur in the 5th and 4th fingers, combined with their numbness.

In such patients, radiographs show objective signs of osteochondrosis. There is a decrease in pain and tactile sensitivity in the area of ​​​​innervation of the cutaneous branch, ulnar nerve or in other skin areas of the hand, forearm and shoulder.

These sensory disturbances are a consequence of compression of the nerve roots of the cervical spinal cord, either by a “settled” vertebra and its edges, or by a bulging fragment of the intervertebral disc, or by swollen and enlarged vessels lying next to the nerve roots. In this case, a complete disruption of nerve conduction with paralysis of a certain muscle group is possible. The most diagnostic errors are made at this stage.

Manifestations of true osteochondrosis should be distinguished from the so-called anterior scalene muscle syndrome, in which the patient complains of severe pain in the anterolateral part of the neck when light pressure is applied with a finger at the junction of the lower and middle thirds of the neck height. This disease requires a different and more specific therapy in the form of local novocannon blockades of the anterior scalene muscle. (I don’t see ANY scientific evidence for the effectiveness of novocaine blockades in the long term. The very concept of treating CHRONIC diseases through a COURSE of any therapy without eliminating the causes contradicts common sense-H.B.) .

True osteochondrosis of the cervical spine, confirmed by x-ray, can only as an exception be accompanied by inflammation of the nerve root - radiculitis. The latter is observed after severe hypothermia or due to influenza infection and is accompanied by acute paralysis of a certain group of muscles or a pronounced limitation of their motor function and severe pain. The latter is most often characteristic of cervical osteochondrosis.

There is no doubt that there are exceptions in which pain recedes into the background and motor disorders predominate, leading the patient to the doctor.

Osteochondrosis of the thoracic spine According to F. Geist (1958), in the thoracic spine, only 20% of its height is accounted for by the cartilaginous formations of the intervertebral joints. This is due to the sufficient limitation of movements in this department. The thoracic spine forms a backward bend - thoracic kyphosis, which plays an important role in regulating balance.

It is no coincidence that osteochondrosis of the thoracic spine, which brings the patient to the doctor, is not a common occurrence. Moreover, there are often cases in which radiographs (see Fig.) reveal gross changes in the intervertebral joints, but the patient does not present any subjective complaints. However, most often with osteochondrosis of the thoracic region, pain occurs in the upper thoracic region at the border with the cervical segment. These pains can be in the interscapular region or in the lower thoracic region with irradiation along the intercostal spaces or long back muscles. The pain can radiate to the sternum along the intercostal nerves, have a girdling nature, and intensify with a deep breath, coughing or straining. In this regard, with osteochondrosis of the thoracic spine in old and senile age, breathing disorders occur as a result of a decrease or shutdown of nerve conduction in the intercostal nerves, which leads to a decrease in the activity of the intercostal muscles!

In differential diagnosis, one should distinguish between girdle pain in the lower thoracic region due to diseases of the pancreas (inflammation, cysts, tumors). These pains are often bilateral and are accompanied by changes in either blood sugar or urinary amylase activity, indicating damage to the pancreas.

Intractable pain in the upper thoracic region, which is unilateral in nature with irradiation to the shoulder and scapula, should prompt an urgent x-ray examination to exclude a tumor of the apex of the lung (Pancoast syndrome), which requires specific methods of examination and treatment. Pain due to osteochondrosis of the thoracic spine can cause the development of scoliosis (curvature of the spine) of varying severity, especially in adolescence and young adulthood. It should always be remembered that these pains are predominantly unilateral and are often combined with impaired nerve conduction in the roots of the spinal cord. On the contrary, with ordinary osteochondrosis of the thoracic region, irritation of the nerve roots of the spinal cord prevails in combination with irritation of the paravertebral nerve ganglia, which increases the severity of pain and is accompanied by the loss of superficial abdominal reflexes or their decrease. The latter can be useful in neurological diagnosis in combination with pain at the Zitto and Lapinsky points on the side of irritation of the paravertebral nerve ganglia (paravertebral sympathetic nodes).

Osteochondrosis of the lumbosacral spine. In the lumbar spine, the proportion of cartilaginous intervertebral joints is about 33% of the height of this entire section, which indicates sufficient mobility and significant functional and static loads on this part of the spine. This part of the spine is the support of the entire body, has lordosis and is most often affected by osteochondrosis due to the increased influence of many factors on it. It is no coincidence that most often manifestations of osteochondrosis begin in the lumbosacral region in the form of a feeling of heaviness, increased fatigue, which are complemented by the appearance of pain. The pain can be dull and pressing only in the lumbar region or in the form of an acute episode (“hit like an electric shock”, “pain shot through the entire lower back and thigh”, etc.). More often, acute pain occurs on one side and less often on both sides of the midline of the lumbar region. Dull pain without irradiation is characteristic of the initial stage of osteochondrosis. Pain radiating to the outer parts of the leg and foot, knee-joint, are more often associated with prolapse of part of the nucleus pulposus through a ruptured fibrous ring onto the posterior longitudinal ligament. Less commonly, a fragment of the nucleus pulposus rushes anteriorly.

Based on the nature and location of pain projection, one can quite accurately determine the level of prolapse of part of the intervertebral disc. Practice shows that ruptures of the fibrous ring and ligamentous apparatus are most often observed between the IV and V lumbar vertebrae, compressing the nerve roots of this segment at the time of lifting weights or strong and uncoordinated movements, as well as during falls.

Acute pain on one side generates protective tension in the muscles of the lumbar region, leading to flattening of lordosis or scoliotic deformity, aggravating the painful manifestations of osteochondrosis and prolonging treatment time. Therefore, it is advisable to consult a doctor as early as possible to prevent the development of further more dangerous symptoms of osteochondrosis (switching off individual muscles or paralysis of one limb, reducing muscle strength to the point of paresis!).

Prolapse of a fragment of the intervertebral disc at the level of the first lumbar vertebra may be accompanied by symptoms of dysfunction Bladder and rectal type incontinence or urinary retention. The same symptoms can also occur when a disc fragment roughly compresses the underlying nerve roots of the spinal cord. Often, osteochondrosis of the lumbosacral region is accompanied by a decrease in sexual function of varying severity. This should be remembered by everyone who takes part in the diagnosis and treatment of such patients.

The appearance of bone spines on the bodies of the lumbar vertebrae causes constant irritation of the sympathetic nerve ganglia in the paravertebral space, leading to severe spasms of the large arteries (femoral artery, arteries of the leg and foot) supplying the lower extremities. This, in turn, significantly reduces blood flow and increases pain. Therefore, you should always check the pulsation of these arteries and, if necessary, examine them using special equipment. Underestimation of the condition of blood vessels can neutralize all the most powerful therapeutic measures aimed at eliminating the signs of osteochondrosis. Therefore, the diagnosis of osteochondrosis of the lumbosacral region should be based on a comprehensive examination (neurological, radiological, orthopedic and anthological).

The most serious mistake in diagnosing osteochondrosis is underestimating the symptoms of spinal cord tumors, which have much in common with the initial signs of osteochondrosis, which leads to too late diagnosis and poor or tragic outcomes.

We must remember that most spinal cord tumors in the first stages cause constant and local pain in a certain area of ​​the spine. The intensity of these pains increases, they are almost not eliminated by known drugs and do not radiate anywhere. Only in the later stages of the disease can projection pain appear (directed to the leg, abdomen, perineum), intensifying with compression of the veins of the neck, severe coughing and at night as a result of venous stagnation in the supine position due to impaired outflow of venous blood. The painful stage of spinal cord tumors can last up to 8-10 months, followed by a decrease in muscle strength in one of the limbs with the subsequent development of paralysis. Therefore, persistent and prolonged pain should alert the doctor and he must do everything to exclude a spinal cord tumor, which most often can be completely removed surgically, restoring the victim’s ability to work.

Unfortunately, underestimation of the specific pain stage in spinal osteochondrosis is still common, and the patient pays for this with deep disability or life itself (undiagnosed tuberculosis, tumor, osteomyelitis of the vertebral bodies, vascular anomalies).

Pain that cannot be relieved with medication for 2-3 weeks should be the basis for referring the patient to a neurological or neurosurgical hospital for a more thorough examination with the involvement of a neurosurgeon.

Osteochondrosis of the lumbosacral region can be combined with arthrosis or arthrosis of other intervertebral joints, or the so-called true joints. These joints are located in the back of the vertebrae and can cause lower back pain of varying intensity. These pains often occur only during movements associated with flexion, extension, or lateral bending of the body and subside with rest. This is why expert evaluation of spinal x-rays can provide true insight into the cause of pain. Therefore, treatment should not be started without prior x-ray examination.

One of the most severe manifestations of osteochondrosis in this area is spondylolisthea - displacement, most often of the IV, V lumbar vertebrae as a result of rupture of ligaments or their atrophy and stretching under the influence of injury or a prolapsed fragment of the intervertebral disc. In such patients, pain may radiate to both legs and to the perineum against the background of severe limitation of flexion and extension. Patients suffering from spondylolistheoma (see Fig.) require surgical intervention, which should be preceded by comprehensive and comprehensive non-surgical treatment.

Often osteochondrosis is combined with the so-called hormonal spondylopathy - rarefaction and loss of strength of the vertebral bodies due to hormonal changes. Such patients develop a variety of spinal deformities, requiring the wearing of corsets and great caution when walking and doing work. Rare lesions of the spine are also no less dangerous (see figure).

Hormonal spondylopathy. Hormonal spocdylopathy occupies a special place among diseases of the spine and has many similarities in its manifestations with osteochondrosis, and is also manifested by the occurrence of pain, which is often regarded as the onset of osteochondrosis.

It should be understood that hormonal spondylopathy occurs in middle-aged and elderly people due to a decrease in the content of hormones that promote the absorption of calcium and phosphorus, which leads to disruption of metabolic processes and a decrease in the strength of the bone structures of the vertebrae and their processes. In general, in patients, the absorption of all microelements is impaired, rarefaction of bone tissue occurs with a violation of its strength (osteoporosis of varying severity), deformation of the vertebral bodies, their processes, curvature of the spinal axis and the appearance of pain.

Osteoporosis of the vertebral bodies leads to a decrease in their height, disrupting the anatomical relationships between the nerve roots and bone formations, which under normal conditions protect them from the pressure of surrounding tissues. In this case, excessive and excessive mobility (instability) of the vertebrae appears relative to each other along the horizontal and vertical axes due to the weakness of the ligamentous apparatus and a decrease in the volume of the vertebral body. This, in turn, causes changes in posture and curvature of the spinal axis of varying severity, up to the formation of deformities in different parts (usually in the thoracic region). These deformations are accompanied by displacement and compression of the spinal cord roots or the spinal cord itself in the cavity of the spinal canal, resulting in pain. These pains can migrate and often change localization, which is a distinctive sign of hormonal spondylopathy from spinal osteochondrosis. The appearance of pain leads to tension in muscle groups, increasing spinal deformation and further disrupting posture.

Some patients experience pain when changing position, turning, bending or lifting something heavy. Often, physical stress causes a characteristic crunch in a certain part of the spine, followed by pain of varying intensity, which is caused by a fracture of the osteoporotic vertebral body or its processes. Such patients themselves come to doctors, unaware of the fracture that has occurred and without resorting to any therapeutic measures. Unfortunately, the mechanisms of hormonal spondylopathy are almost unstudied, the severity of the disease progresses and so far there are no radical means for its prevention and successful treatment, and patients have been treated for “radiculitis” for many years without the desired effect. The main concern of the patient and the doctor should be to prevent fractures of the vertebral bodies and their processes, because fractures not only aggravate the condition of patients, but also complicate the use of traditional physical therapy, massage and exercise therapy, which play an important role in the treatment of the disease. We must remember that poor posture, the occurrence of migrating pain in the spine, and their intensification when changing position are the initial manifestations of hormonal spondylopathy, requiring competent assessment and proper preventive measures. You should not refrain for a long time from conducting an X-ray examination or CT scan, which will indicate destructive changes in certain vertebrae and will allow you to exclude more tumor nature, requiring urgent surgical treatment or radiation exposure. Unfortunately, there are facts of too late diagnosis of tumors of the spinal cord and vertebrae occurring against the background of existing osteochondrosis or hormonal spondylopathy.

It is necessary to pay attention to the inadmissibility of carrying out all types of FTL without prior consultation of the patient with a neuropathologist or neurosurgeon who is well aware of the problems of diseases of the spine and spinal cord. It should also be noted the importance of X-ray and contrast contrast studies carried out to clarify the diagnosis in a neurosurgical hospital. All this is a complex of diagnostic measures, without which it is unacceptable to carry out manual therapy, different types electrotherapy, laser and magnetic therapy, as well as thermal procedures, which can accelerate tumor growth, making movement and sensitivity disorders irreversible. At the same time, every specialist should know that against the background of existing pronounced signs of spinal osteochondrosis, other diseases can arise, such as tumors of the vertebrae themselves, surrounding tissues of the spinal cord and its roots, which is so clearly demonstrated in our daily practice.

Naturally, one can challenge any diagnosis, lean towards only one-sided ideas about diseases of the spine and spinal cord, and give preference to one classification and certain treatment methods. Osteochondrosis is only a small fragment of systemic damage to bone tissue and not only in the structures of the spine. We have many observations where the signs of osteochondrosis were in second place after the severity of the manifestations of the disease of the joints of the extremities, and these two processes in the same patient can coexist for a long time (see Fig.).

There is no doubt that the leading mechanism in the development of pain is disturbances in the roots of the spinal cord and the spinal cord itself, as evidenced by the facts of rapid regression of all pain after analgesic blockades using the Rachkov-Kustov method.

These observations, associated with the rapid switching off of pain reactions, indicate the decisive role not of the deformed bone structures of the spine, but of the nervous structures located in the paravertebral space and surrounding tissues, which are primarily affected by analgesic blockades.

Osteochondrosis is a disease in which degenerative-dystrophic changes in the cartilaginous tissues of the spine are diagnosed, also accompanied by disturbances in the structure and functionality of the intervertebral discs. Depending on the location of the damaged tissue, osteochondrosis of the cervical, thoracic and lumbar regions is distinguished.

According to medical statistics, symptoms of osteochondrosis are observed in 50-90% of the population. The average age of onset of osteochondrosis is 30-35 years. Under unfavorable conditions, signs of osteochondrosis may appear in more early period, especially with prolonged uneven loads on the back, legs and the consequences of injuries.

What is osteochondrosis?

Osteochondrosis is a disease of the spinal column in which degenerative and dystrophic lesions of the intervertebral discs occur. With the development of osteochondrosis, degenerative-dystrophic lesions spread to the tissues of the vertebrae.
The main sign indicating the development of the disease osteochondrosis is pain in the neck, back, lumbar region; as it progresses, the pain “radiates” to the arms, chest, shoulders, upper thighs, etc. With negative dynamics of osteochondrosis, atrophy of muscle tissue begins, sensory disturbances and dysfunction internal organs, provoked by their compression and displacement. In the absence of timely treatment, osteochondrosis develops to an incurable condition.

Causes of osteochondrosis

The main factor in the development of osteochondrosis is uneven load on the spine. A common cause of improper load distribution is the habit of carrying a bag on one shoulder or in one hand, incorrect sitting position, on an overly soft mattress, high pillow, and wearing anatomically incorrect types of shoes.

Additional risk factors include physical inactivity, a sedentary lifestyle, excess weight, injuries to the back, lower extremities, flat feet and other disorders of the musculoskeletal system, as well as age-related degenerative processes due to age-related changes in the blood supply to the spinal column.

The following factors may also play a role in the etiology of osteochondrosis:

• physical overstrain of the body;
• neuro-emotional exhaustion;
• metabolic disorders, poisoning, diseases gastrointestinal tract, preventing the full absorption of nutrients;
• occupational risks, in particular, working on vibration platforms;
• genetic predisposition;
• poor posture during the period of active growth, scoliosis;
• wearing uncomfortable shoes (tight, heels);
• prolonged and/or regular dehydration;
• poor diet, hypovitaminosis;
• smoking;
• pregnancy, especially multiple pregnancy, in combination with an undeveloped muscular-ligamentous apparatus (due to a shift in the center of gravity of the body).

Stages of development of osteochondrosis

Photo: Marcelo Ricardo Daros/Shutterstock.com

Osteochondrosis in the dynamics of the disease goes through four stages:

• Stage 1 (degree) osteochondrosis is characterized by the initial stage of pathology in the nucleus pulposus of the intervertebral disc. Due to excessive load, the process of dehydration (dehydration) of the nucleus begins, which leads to a decrease in the height of the disc and the appearance of cracks in the fibrous ring. Symptoms at this stage, as a rule, are absent; minor discomfort may occur during prolonged stay in an uncomfortable static position, active movement, etc.;
• at stage 2, a decrease in the height of the discs leads to a decrease in the distance between the vertebrae and sagging of the spinal muscles and ligaments. This causes increased mobility of the vertebrae with affected discs, which is dangerous due to their displacement or slipping. During the second stage of the disease, discomfort and pain occur, especially with certain types of load, movements, positions;
• Osteochondrosis stage 3 (degree) is characterized by the formation of prolapses and protrusions of the intervertebral discs, and may be accompanied by subluxations and/or the development of arthrosis of the intervertebral joints. With some types of movement, patients feel stiffness, lack of mobility, and a feeling of tingling and numbness may occur in the limbs. At this stage of osteochondrosis, pain is clearly felt in the back, neck, lumbosacral region or coccyx area, depending on the location of the affected discs;
• at stage 4 of osteochondrosis, the body tries to correct the consequences of vertebral hypermobility and adapt to impaired functionality of the spinal column. Osteophytes, new bone formations, improve the fixation of the vertebrae, form at the points of contact between the vertebrae. However, in some cases, osteophytes can cause pinched nerves and injure the vertebrae. Fibrous ankylosis begins in the intervertebral discs and joints. In the absence of microtraumas and pinched nerve roots, the symptoms of the disease subside.

Symptoms of osteochondrosis

The main symptoms of osteochondrosis are a feeling of discomfort and/or pain in the neck and back. The severity of sensations and the presence of additional symptoms depend on the stage of the disease. When examining the patient and collecting anamnesis, the specialist conducts a primary diagnosis, suggesting the presence of osteochondrosis by a visually detectable curvature of the spine observed in the transverse or longitudinal plane of the spinal column. Pathologies of the intervertebral discs of the cervical and lumbar spine are much more common than degenerative and dystrophic changes in the sternum.

Signs of osteochondrosis felt by the patient include a periodic or permanent feeling of back fatigue, mild or severe pain, depending on the stage of the disease. The pain can be localized in the neck, back, chest, shoulder girdle, making it difficult and constraining the movements of the upper extremities.

The clinical picture of osteochondrosis largely depends on the localization of the pathology, the degree of development of the process, and the individual characteristics of the patients. Pathology of intervertebral discs, displacements, protrusions, hernias and the growth of osteophytes lead to various consequences. Among the most common are disturbances of normal blood circulation in tissues, pinched nerve endings, dysfunction of the spinal canal, edema, fibrosis of tissues and structures.
Such consequences can be accompanied by many different symptoms, leading to misdiagnosis of diseases.
The most common and characteristic symptoms of osteochondrosis include the following:

• pain in the back, neck, lower back, shoulder girdle, rib area;
• discomfort, stiffness in body movements that occurs in certain body positions, bending, turning, increased muscle tension;
• feeling of numbness in the upper and lower extremities;
• muscle and joint discomfort, muscle spasms;
• headaches, dizziness, increased fatigue;
• pain in the heart area;
• impaired hand sensitivity;
• muscle hypotonia.

Symptoms of osteochondrosis vary depending on the location of the pathology:

• with osteochondrosis of the cervical spine, pain in the neck, arms, and shoulder girdle predominates, radiating to the area of ​​the scapula and shoulder; headaches, dizziness, flashing “spots” or spots before the eyes, tinnitus are noted;
• if the thoracic spine is affected, the pain is localized in the chest, heart, inner surface of the shoulder, armpit area, respiratory discomfort is also noted, shortness of breath is possible;
• Osteochondrosis of the lumbosacral spine is manifested by lower back pain radiating to the legs, upper thighs or pelvic organs, often accompanied by sexual dysfunction.

Superficial symptoms - back fatigue, pain - may indicate not only the presence of osteochondrosis, but also the addition of other diseases or the development of other pathological processes and disorders not related to degeneration of the intervertebral discs. The diagnosis of “osteochondrosis” can only be made by a specialist, and self-medication for such symptoms is unacceptable.

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Types of osteochondrosis are distinguished according to several principles. Depending on the location of the pathology, osteochondrosis of the cervical, thoracic, lumbar, sacral or mixed, combined types of disease are distinguished. According to clinical manifestations, osteochondrosis of various localizations is divided into subtypes depending on the identified symptoms and the clinical picture as a whole.
Osteochondrosis of the cervical spine:

• depending on the type of reflex syndrome, cervicalgia, cervicocranialgia, cervicobrachialgia with various manifestations (vegetative-vascular, neurodystrophic, muscle-tonal) are identified;
• if the test result for radicular syndrome is positive, discogenic damage to the roots of the cervical spine is diagnosed.

For pathology of the thoracic level there are:

• for reflex syndromes - thoracalgia with vegetative-visceral, neurodystrophic or muscle-tonal manifestations;
• by radicular – discogenic lesion of the roots of the thoracic region.

For osteochondrosis of the lumbosacral level, the following is diagnosed:

• depending on the type of reflex syndrome - lumbago (lumbago), lumbodynia, lumboischialgia with vegetative-vascular, neurodystrophic or muscle-tonal manifestations;
• radicular syndrome indicates discogenic damage to the roots of the lumbosacral region;
• radicular vascular syndrome indicates radiculoischemia.

Diagnosis of osteochondrosis

Used to make a diagnosis instrumental methods examinations:

• X-ray examination of the spine;
• myelography;
• neurological examination of sensitivity and reflexes.

Additional methods prescribed to differentiate and clarify the diagnosis and stage of pathology include:

• computed tomography of the spine (CT);
• nuclear magnetic resonance (NMR);
• magnetic resonance imaging (MRI).

Directions of therapy for osteochondrosis

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Treatment is based on an integrated approach and, depending on the stage, lasts from 1 to 3 months of intensive therapy and 1 year of supportive measures to consolidate the result and prevent relapses.

Therapy for the disease osteochondrosis is carried out in two directions, depending on the degree of osteochondrosis and the patient’s health condition. Conservative treatment of the disease consists of taking medications and performing a set of exercises. Surgical treatment in almost any situation cannot be the method of first choice and is prescribed in the absence of positive dynamics or progression of the disease against the background of long-term conservative therapy.
In addition to medical methods of therapy, it is necessary to follow general recommendations for osteochondrosis: follow a diet, take measures necessary for rehabilitation.

Conservative treatment of osteochondrosis

Conservative therapy is aimed at relieving pain, normalizing the functionality of the spinal column and preventing negative changes
Conservative treatment of osteochondrosis includes the following types of therapy:

• drug therapy. Medicines for osteochondrosis they are used to relieve pain syndromes, inflammatory processes in tissues and normalization of metabolic processes in the body. In case of severe pain syndrome, it is recommended to use drug blockades of nerve endings, which also help to reduce the severity of muscular-tonic syndrome. The following types of blockades are distinguished: trigger point blockade, intraosseous, facet, paravertebral, epidural;
• physiotherapy methods. Physiotherapeutic procedures help reduce pain, increase the effect of medications, and are also used during the rehabilitation period. The most common use is ultrasonic waves, magnetic fields, low frequency currents, laser beams, etc.;
• methods of physical therapy (physical therapy) and kinesitherapy. A set of special exercises, when performed regularly and correctly, helps to correct posture, strengthen the muscle corset, ligamentous apparatus, normalize muscle function, reduce compression of nerve fibers and help prevent complications of osteochondrosis. Methods of exercise therapy and kinesitherapy procedures are aimed at normalizing metabolic processes, restoring adequate nutrition of the intervertebral discs, restoring the location of the vertebrae and discs between them, and uniformly distributing the load in the musculoskeletal system;
• massage. Manual massage techniques are used to improve blood supply to tissues, relieve muscle spasms and tension, and generally improve blood circulation. Hydromassage as a direction of therapeutic activity, in addition to the listed effects, helps to normalize work nervous system body;
• manual therapy. Manual therapy methods are selected on an individual basis. A targeted effect on the musculoskeletal system of the body helps improve blood circulation, lymph circulation, improves metabolism, helps correct the mobility of the musculoskeletal system, strengthens the immune system, and serves as a means of preventing complications of osteochondrosis;
• therapy using the method of traction (extension) of the spine using special equipment. The purpose of the manipulations is to increase the intervertebral space to normal parameters and correct structural disorders of the spinal column.

Osteochondrosis: drug therapy

In the treatment of osteochondrosis, medications are aimed at reducing the severity of symptoms, improving the processes of blood supply to tissues and their regeneration. Osteochondrosis cannot be cured by taking medications alone; therapy must be combined, including a set of exercises, diet, and preventive measures.
In the absence of pronounced dystrophic changes and pain, taking medications without the prescription of a specialist can be considered unjustified.
Medicines used to relieve pain and treat osteochondrosis:

• anti-inflammatory group: ibuprofen-containing medications (Ibuprofen, Nurofen), Karipazim, Pantohematogen, Reoprin and so on;
• antispasmodic drugs: Baclofen, drotaverine (Drotaverine, No-Shpa), Milastan, Sirdalud, etc.;
• antioxidant preparations: vitamins C (in the form of ascorbic acid), E (tocopherol acetate), N (thioctic acid);
• means for improving blood supply to tissues: Actovegin, Teonicol, Trental, B vitamins (mainly B3);
• preparations for regeneration and/or prevention of degeneration of cartilage tissue: Aflutop, Diacerin, Piaskledin, hyaluronic acid.

Drugs can be prescribed both in the form of ointments, creams for local use for pain, and for oral administration and injections.
In case of acute complications, medications are used to block the nerve endings.

Osteochondrosis: dietary nutrition of the patient

The principles of the diet are based on the need to improve metabolic processes, saturate the body with essential nutrients, vitamins, minerals, and include foods high in antioxidants and polyunsaturated fatty acids, compounds that promote the regeneration of cartilage tissue. The drinking regimen recommended for osteochondrosis is aimed at preventing dehydration of the body, which can negatively affect the affected tissues.
You need to eat in small portions, 5-6 times a day.

The basis of the diet is dairy and fermented milk products, lean meats, poultry, fish, fresh vegetables, fruits, nuts and seeds, cereals, and mushrooms. It is especially recommended to include meat and fish jellies, jellied meats, jellied dishes in the diet, and use olive oil first pressing without heat treatment (for dressing salads, etc.).

Preferred food processing methods: steaming, baking, boiling.
Limit intake of flour and confectionery, fatty foods, spicy, salty foods and seasonings, canned and smoked foods, strong meat broths, legumes, sugar and fruits high in sugar (grapes).
During the day, you must drink at least 1.5 liters of liquid, giving preference to clean and mineral water, dried fruit compotes, unsweetened fruit drinks, and herbal teas. You should limit the amount of strong black tea, coffee, sweet carbonated drinks, and alcohol.

Complications of osteochondrosis

Failure to comply with prescribed treatment, prolonged avoidance of the doctor and lack of treatment for osteochondrosis contributes to the progression of the disease and provokes the development of complications, pathologies and new diseases, such as:

• herniated intervertebral discs (spinal herniation);
• protrusion;
• kyphosis;
• radiculitis;
• salt deposits in the intervertebral space;
• spinal cord strokes;
• decrease muscle mass limbs, muscle atrophy due to blood supply disorders;
• paralysis of the lower limbs.

Despite the fact that grade 4 osteochondrosis can occur without severe symptoms and pain, advanced osteochondrosis is the most dangerous for the development of serious complications and can lead to disability of the patient.

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The causes of osteochondrosis are mainly related to lack of attention to the body's requirements, poor nutrition, and excessive stress on the body. To prevent the onset of pathological changes in the spine and curb the dynamics of existing osteochondrosis, it is recommended to adhere to general principles healthy image life:

• eliminating the possibility of physical inactivity: moderate sports: exercise, running, swimming, cycling, skiing, gymnastics, non-contact wrestling, etc.;
• When working or other activities that involve staying in a static position for a long time, you must take breaks to warm up every 45 minutes to restore blood circulation. If you need to sit for a long time, you should choose the right chairs, chairs that provide support for the spine, ensure compliance with the standards for the position of your hands on the table, feet on the floor or a special stand, learn to maintain your posture (straight back, relaxed shoulders);
• for night sleep, you need to select an elastic, preferably orthopedic, mattress with a flat surface, avoid high or too flat pillows;
• if necessary, lift and/or carry heavy objects, avoid jerking when lifting weights from a semi-squat position, use special belts that support the lower back;
• choosing orthopedic correct shoes: with the appropriate width for the foot, without high heels and their timely replacement will help reduce the load on the spine, this is especially important for women during the period of bearing a child. IN summer period do not neglect the opportunity to walk barefoot on uneven surfaces, this strengthens the muscles of the foot and relieves tension from the musculoskeletal system;
• A proper diet and drinking regimen contribute to overall health and help maintain normal metabolism;
• If you are prone to increased emotionality, anxiety with a muscle spasmodic reaction to stress, it is worth learning relaxation methods, as well as regularly taking courses in restorative massage.