About the most modern methods of treating osteochondrosis of the spine

The spine is a unique biokinematic system; it is capable of supporting loads without damage, but, like any structure, it wears out over time. From an early age, a stable state is maintained thanks to rapid regenerative abilities, but after 50 years, their supply gradually fades, which leads to the formation of osteochondrosis.

Osteochondrosis is the most common degenerative-dystrophic pathology of the spine, which, as it progresses, spreads to neighboring structures of the spinal 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 (occur in adulthood, but earlier 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 tissues in which there are no vessels. In childhood, there is a vascular network in the intervertebral discs, but after the architecture of the spine is fully formed, this network is closed by connective tissue.

3. Hormonal theorymore controversial. Hormonal status plays a certain role in the development of osteochondrosis, but it is inappropriate to refer only to hormonal levels. This theory is particularly relevant for postmenopausal women.
4. Mechanical theorytalks about the connection between the appearance of osteochondrosis and overloading certain parts of the spine.
5. Anomaly theory- an isolated case of mechanical theory. Anomalies of the vertebral bodies, fusion of the bodies, non-fusion of the arch due to inappropriate biomechanism stimulate overloading of the vertebral discs and cause destruction of 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, characterized by genetic predisposition and provoking factors.

Factors contributing to the development of the disease

1. Severity factor:for the spine, any non-physiological movement is only the trigger for numerous muscular reactions.
2. Dynamic factor:the greater and longer the load on the spine, the more it is subjected to increasingly prolonged trauma (people prone to long-term forced positions; constant lifting of heavy objects).
3. Dysmetabolic factor:insufficient nutrition of the spine due to autoimmune diseases, toxic effects.

   It is known that eating food from aluminum dishes leads to their accumulation in the bones, which will subsequently contribute to the formation of osteochondrosis. Eating food made from aluminum and iron alloy dishes has a detrimental effect on the human body. When preparing food, microparticles enter the gastrointestinal tract and, since they also contain lead, this metal accumulates in the body, the intoxication of which results in neuroosteofibrosis (defective changes in tissues atthe junction of the tendon and the muscle).

4. Genetic factor.Each person has an individual level of flexibility, which is directly correlated to the ratio of fibers in the connective tissue (collagen and elastin) and is inherited genetically. Despite all of the above, there are norms in the ratio of fibers, deviations lead to faster wear of the spine.
5. Biomechanical factor– non-physiological movements of the articular surface of the spine. This is due to muscle atrophy (the clinical symptom is pain that occurs when bending and rotating).
6. Aseptic-inflammatory factor– most often a rapid inflammatory process in the intervertebral discs. Microdefects form in the spine due to malnutrition of the intervertebral disc. In these microdefects, areas of dead tissue form.

Symptoms of osteochondrosis of the spine

The main symptom of osteochondrosis is back pain, which can be constant or periodic, painful or acute, most often it intensifies with sudden movements and physical activity.

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

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

Type of osteochondrosis	Cervical	Chest	Lumbosacral	Mixed
Clinical image	aching pain in the neck, back of the head, shoulders and arms, numbness of the fingers, muscle weakness; sometimes headaches, dizziness, spots in front of the eyes or decreased visual acuity.	more often night pains in the back, heart, chest, abdomen; numbness and weakness of the limbs; sometimes difficulty breathing.	periodic, aching pain in the lower back, radiating to the sacrum, legs (depending on movements); tingling in the legs.	the pain is stable or extends to all parts of the spine.
Complications	migraine; vegetative-vascular dystonia; high blood pressure.	pathologies of internal organs; intercostal neuralgia.	compression myelopathy (compression of the spinal cord by various neoplasms).	all possible complications with cervical, thoracic and lumbosacral osteochondrosis.

Stages of osteochondrosis

Steps	First of all	Second	Third	Fourth
Spinal changes	The intervertebral discs lose their elasticity and flexibility. Straightening of physiological lordosis.	Pathological mobility and subluxations of the vertebrae. Reduced height of the intervertebral discs.	Rupture and displacement of the intervertebral disc with immersion of other surrounding elements into its cavity, which causes the development of local symptoms of inflammation.	Destruction of other elements of the intervertebral joint, pathological arrangement of the articular surfaces, marginal bone growths.
Patient complaints	Absent or indicates discomfort when remaining in the same position for a long time.	Discomfort and pain related to certain types of exercises.	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 radiates (spreads) to the neck, lower jaw and arm. The disease begins for no reason or after physical activity with the appearance of compressive pain not associated with movement of the spine. After half an hour, the pain reaches its maximum, the person develops shortness of breath and fear of death. The diagnosis is confirmed by an electrocardiogram (ECG) and markers of myocardial necrosis.
2. Subarachnoid hemorrhage(hemorrhage 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 in the spine may occur. The main clinical sign is the presence of blood in the cerebrospinal fluid.
3. Spinal abnormalities.Minimum examination: x-ray of the skull and cervical spine in frontal and lateral projections. The most common spinal abnormalities are: fusion of the atlas (the first cervical vertebra) with the occipital bone, depression of the edges of the foramen occipitalis into the cranial cavity, fusion of the vertebrae, changes inthe shape and size of the vertebrae.
4. Cervical lymphadenitismay also be accompanied by neck pain, sometimes worsened by bending and turning. Making a diagnosis is not difficult: enlarged and painful lymph nodes; history of frequent sore throats.
5. Multiple myeloma.Pain in the spine appears gradually, against the background of gradual weight loss and periodic fever. The main laboratory sign is the presence of protein in the urine.
6. Tumor or metastases in the spine.Evidence in favor of a malignant tumor is: gradual loss of body weight, laboratory changes, as well as ultrasound of sources of metastases - kidneys, lungs, stomach, thyroid gland, prostate.
7. Rheumatic and infectious-allergic arthritisdifferentiated by medical history, moderately elevated body temperature and predominant damage to large joints.
8. Masked depression. Patients "impose" non-existent pathologies (in this context, symptoms of osteochondrosis), trying to explain to them the essence of what is happening is met with a wall of incomprehension. Signs of masked depression include: decreased mood, concentration, and performance; sleep and appetite disturbances; suicidal thoughts and actions.
9. Peptic ulcer of the stomach and duodenum, pancreatitis and cholecystitisare diagnosed using the connection between pain and 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 an anamnesis 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 crests of the hip bones, the position of the shoulder girdles, and the expression of the back muscles. During palpation, deformation, pain and muscle tension are determined.
2. When establishing a diagnosis of osteochondrosis, additional consultation with specialized specialists is necessary to exclude pathologies with similar symptoms (cardiologist, therapist, rheumatologist).
3. Carrying out mandatory laboratory analyzes (general blood analysis, general urine analysis, biochemical blood analysis).
4. Confirmatory studies are decisive:
   • x-ray of the spine in two projections– the simplest method for identifying changes in the spine (narrowing of the space between the vertebrae);

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

     Degree	First of all	Second	Third	Fourth
     Radiological signs	No radiological signs.	Changes in the height of the intervertebral discs.	Protrusion (bulge into the spinal canal) of the intervertebral discs or even prolapse (loss).	Formation of osteophytes (marginal bony growths) at the point of contact of the vertebrae.

   • computed tomography (CT) and nuclear magnetic resonance (MRI)– used not only to identify changes in the spine, but also to determine pathologies in other organs;
   • USDG MAG (Doppler ultrasound of the main arteries of the head)– ultrasound examination of the circulatory system of the head and neck, which allows you to diagnose the extent of changes in blood vessels as early as possible.

What are the methods of treating osteochondrosis?

Drug therapymust be strictly individual and differentiated, the prescription of medications is carried out by a doctor after diagnosis.

The main drugs used in the treatment of osteochondrosis:

1. Pain relief is achieved using analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs). Treatment with NSAIDs should be as short as possible: 5 to 7 days are enough to relieve the pain. If the pain is poorly controlled and a constant dose of pain-relieving medication is needed, you can take selective COX-2 inhibitors.
2. Antispasmodics reduce pain and relieve muscle spasms.
3. Transcutaneous method of pain relief: ointment whose active ingredient is an NSAID; numbing cream; applications with anti-inflammatory and analgesic drugs; corticosteroids are added for greater effect.
4. Treatment intended to regenerate an inflamed or compressed nerve, as well as to improve blood microcirculation: B vitamins, neuroprotective drugs, nicotinic acid.
5. Oral chondroprotectants – glucosamine, chondroitin sulfate. They help stop destructive changes to cartilage when taken regularly. Chondroprotectors are integrated into the structure of cartilage tissue, thereby increasing the formation of bone matrix and reducing joint destruction. The most favorable composition: chondroitin sulfate + glucosamine sulfate + glucosamine hydrochloride + nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are called combined chondroprotectors.

Non-drug treatment methods:

1. Neuroorthopedic measures.An important point in the treatment of osteochondrosis is compliance with a rational regime of physical activity. Staying in bed for a long time and engaging in minimal physical activity not only benefits the spine, but also leads to a permanent symptom: back pain.

2. Therapeutic exercise (physiotherapy)is 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 the functioning of the vestibular apparatus (relevant for elderly patients), balancing discs, platforms and paths are used in exercise therapy.

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



4. Physiotherapeutic procedures in the acute period:

   • ultrasound;
   • phonophoresis;
   • ultraviolet irradiation;
   • impulsive currents;
   • neuroelectric stimulation.

   Physiotherapeutic procedures in the subacute period:

   • electrophoresis;
   • magnetotherapy.

5. Massage.Of all types, a superficial and relaxing massage with rubbing elements is used. As soon as the painful symptom is relieved with the help of massage, they smoothly move on to more intense rubbing elements. When mastering the technique of acupressure massage (local), preference is given to this type.

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

Preventive actions

1. Competent selection of furniture (especially in the workplace). The task chair consists of a flat and solid backrest. The bed includes a mattress of moderate hardness, a pillow of medium softness (if possible, an orthopedic mattress and pillow).
2. Correction of vision, posture, bite.
3. Rational selection of shoes (especially important for drivers). The maximum heel size is 5 cm.
4. Wear a fixation belt, bandage or corset during work.
5. Correction of movements: avoid bending and twisting, lift weights with your back straight and your legs bent at the knees.
6. Change your body position more often: do not stand or sit for long periods of time.
7. A good diet: limit the amount of sweet, salty, fatty and spicy foods. The most dangerous food for bones is white sugar because it removes 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 changes in temperature: hot water in a bath, sauna, swimming pool, etc. is especially dangerous, because it relaxes the back muscles and even a small injury in this state is not felt, but leads to tragic consequences for the spine, and even in general for the musculoskeletal system.
9. Water procedures are not only a preventive, but also therapeutic measure. Swimming combines stretching and muscle relaxation.
10. Treatment of chronic diseases.
11. Active and regular vacations.

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

• sitting in a chair, looking ahead. The brush covers and supports the lower jaw. Press the head forward and down with resistance (tension phase); while 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. The hands are on the 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 heads to the left and, accordingly, do the same.

Conclusion

The high frequency and social significance of osteochondrosis determine the scientific interest in this problem. The disease affects not only older people, but is increasingly affecting young people, which attracts the attention of neurologists, neurosurgeons, orthopedic traumatologists and other specialists. Prompt diagnosis and adequate treatment of this pathology guarantee social adaptation and quality of future life.