The spine includes the cervical, thoracic, lumbosacral sections and consists of 33-34 vertebrae placed on top of each other and connected in a single chain.To evenly distribute the load on the spine during daily physical activity and when the body is in an upright position, the spine has physiological (normal) curves.Two convex curves forward in the cervical and lumbar regions (lordosis) and two convex backwards in the thoracic and sacral regions (kyphosis).Between the vertebrae there are intervertebral discs - cartilage, which perform a shock-absorbing function and consist of the nucleus pulposus and the fibrous ring that surrounds it.
Spinal osteochondrosis is a chronic disease characterized by the development of degenerative-dystrophic changes in the intervertebral discs with the subsequent involvement of adjacent vertebrae and surrounding tissues in the process.
Currently, doctors more often use the broader term "dorsopathy" to refer to pain in the back and neck, sometimes replacing the concept "osteochondrosis" with it.Dorsopathy includes pain in the neck (cervicalgia), neck and head (cervicocranialgia), neck and shoulder (cervicobrachialgia), chest pain (thoracalgia), lower back pain (lumbodynia), lower back pain radiating to the legs (lumboischialgia).
Causes of spinal osteochondrosis
To date, there are no exact data on the causes of degenerative changes in the spine.There are a number of theories that take into account different factors: involution (involution - reverse development, backward movement), mechanical, immune, hormonal, dysmetabolic (metabolic), vascular, infectious, functional and hereditary.The most common is the involutive theory, according to which premature local (local) aging of cartilage and bones occurs as a result of previous mechanical or inflammatory damage.According to this theory, the development of degenerative changes in the spine is genetically predetermined, and the appearance of the disease with the corresponding clinical manifestations is due to the influence of various endogenous (internal) and exogenous (external) factors.
The possibility of osteochondrosis increases with age, in the presence of excess weight, a sedentary lifestyle and poor physical skills, on the one hand, and heavy physical work and exposure to vibration, on the other.
The load on the spine increases in proportion to the increase in body weight, so overweight people suffer from overload even under conditions of moderate activity;The situation is aggravated by a tendency to physical inactivity due to poor tolerance to physical activity.
Psycho-emotional stress, associated with a sedentary lifestyle, causes tension in individual muscle groups, changes in muscle tone and movement patterns - posture, walking.The development of scoliosis - lateral curvature of the spine, pathological kyphosis and lordosis (worsening of physiological curves) also contribute to the deformation of the intervertebral discs.
Classification of the disease
By location:
- osteochondrosis of the cervical spine;
- osteochondrosis of the thoracic spine;
- osteochondrosis of the lumbar and sacral spine.
According to the stage of the disease:
- irritation (maximum number of clinical manifestations);
- remission (absence of clinical manifestations).
Depending on the pathologically affected formations, the affected structures of the spine are distinguished:
- Reflex syndromes - reflex tension of innervated muscles, or muscle-tonic disorders (muscle spasm), vascular, vegetative, dystrophic - develop when pain receptors are irritated.
- Compression syndromes often develop against the background of protrusion (bulging, protrusion of the intervertebral disc beyond the spinal column without compromising the integrity of the annulus fibrosus) or disc herniation due to compression of a nerve root, spinal cord or vessel (radiculopathy, neuropathy, myelopathy syndrome distinguished by radiculosemia).
Depending on the stage of development of the process, the following are distinguished:
- Stage of intradiscal pathological process (chondrosis).During this period, the intradiscal movement of the nucleus pulposus occurs.The nucleus pulposus penetrates its outer fibers through fissures in the annulus fibrosus.As a result, nerve endings are irritated and pain develops.
- The phase of instability, or loss of fixation ability of the affected disc, when the upper vertebra is displaced relative to the lower one.During this period, instability syndrome, reflex syndrome and even compression can form.
- The stage of the formation of herniated intervertebral discs due to the violation of the integrity of the fibrous ring, which can compress the adjacent neurovascular formations, including the spinal nerve root.
- The stage of fibrosis of the intervertebral discs and the formation of marginal osteochondral growths of the vertebral bodies, resulting in immobility of the vertebrae and a compensatory increase in the area of their support on the defective discs.In some cases, these bony growths, such as disc herniations, can compress adjacent neurovascular formations.
Symptoms of osteochondrosis
Symptoms of osteochondrosis depend on the area of damage to the spine and the degree of changes that occur in it, and the function of internal organs may be impaired.
Osteochondrosis of the cervical spine is characterized by pain in the neck, which intensifies during movement, radiates to the arm and is accompanied by numbness of the fingers.
Complaints of headache in the occipital region, dizziness, tinnitus, darkening of the eyes or flickering of the spots before the eyes are possible.
When the thoracic spine is affected, patients may experience pain in the area of the heart, in the interscapular region, which lasts for a long time, aching or pressing, quite often sharp, stabbing, sharp.
They can appear or intensify with deep breathing, when bending and turning the body, when raising the arms, sneezing, coughing.There may be a feeling of numbness in the skin on the chest, abdomen and back.
With osteochondrosis of the lumbosacral region, patients notice stiffness of movement, pain in the lower back, which can radiate to one or both legs, intensifies when bending, turning the body, walking, lifting heavy objects.
Possible vegetative disorders: cooling of the feet to a comfortable temperature for the rest of the body, paleness of the skin of the feet.There is a feeling of numbness, paresthesia (pins and needles) of the skin of the legs and buttocks.
Diagnosis of the disease
Instrumental diagnosis includes radiography of the spine to exclude traumatic injuries, congenital structural abnormalities and identification of bone growths.The study is also carried out with functional tests - photographs during flexion and extension in the cervical and lumbar regions to exclude pathological displacement of the vertebrae in relation to each other.