The spine includes the cervical, thoracic and lumbosacral sections and consists of 33-34 vertebrae located on top of each other and connected into 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 forward curves 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 absorption function and are formed by the nucleus pulposus and the annulus fibrosus 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.
Today, doctors more often use the broader term "dorsopathy" to refer to back and neck pain, sometimes replacing the concept of "osteochondrosis."Dorsopathy includes pain in the neck (cervicalgia), neck and head (cervicocranialgia), neck and shoulders (cervicobrachialgia), pain in the chest (thoracalgia), low back pain (lumbodynia), low back pain that radiates to the leg (lumboischialgia).
Causes of spinal osteochondrosis.
To date, there is no exact data on the causes of degenerative changes in the spine.There are a number of theories that consider various factors: involution (involution - reverse development, regression), mechanical, immunological, hormonal, dysmetabolic (metabolic), vascular, infectious, functional and hereditary.The most common is the involutional theory, according to which local (local) premature aging of cartilage and bone 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 likelihood of osteochondrosis increases with age, in the presence of excess weight, a sedentary lifestyle and poor physical fitness, on the one hand, and intense physical work and exposure to vibrations, 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 towards physical inactivity due to poor tolerance for physical activity.
Psychoemotional stress, along with a sedentary lifestyle, causes tension in individual muscle groups, changes in muscle tone and movement patterns: posture, gait.The development of scoliosis (lateral curvature of the spine, pathological kyphosis and lordosis (exacerbation of physiological curves) also contributes 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.
Depending on the phase of the disease:
- exacerbation (maximum number of clinical manifestations);
- remission (absence of clinical manifestations).
Depending on which formations are pathologically affected, the affected structures of the spine are distinguished:
- Reflex syndromes (reflex tension of innervated muscles or muscle tonic disorders (muscle spasms), vascular, vegetative, dystrophic) develop when pain receptors are irritated.
- Compression syndromes often develop against the background of a 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 (accordingly, radiculopathy, neuropathy, myelopathy, radiculoischemic syndrome are distinguished).
Depending on the stage of development of the process, there are:
- Stage of the intradiscal pathological process (chondrosis).During this period, intradiscal movement of the nucleus pulposus occurs.The nucleus pulposus penetrates its outer fibers through cracks in the annulus fibrosus.As a result, the nerve endings become irritated and pain develops.
- The stage of instability or loss of fixation capacity of the affected disc, when the overlying vertebra moves relative to the underlying one.During this period, instability syndromes, reflexes and even compression syndromes can form.
- The stage of formation of intervertebral disc herniations is due to a violation of the integrity of the annulus fibrosus, which can compress 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, as a result of which the immobility of the vertebrae and a compensatory increase in the area of their support on the defective discs occurs.In some cases, these bony growths, such as herniated discs, can compress adjacent neurovascular formations.
Symptoms of osteochondrosis
The 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 affected.
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 spots before the eyes are possible.
When the thoracic spine is affected, patients may experience pain in the heart area, in the interscapular region, which lasts a long time, is painful or oppressive, often sharp, stabbing, sharp.
They can occur or intensify with deep breathing, bending and twisting the body, raising the arms, sneezing, coughing.There may be a feeling of numbness in the skin of the chest, abdomen and back.
With osteochondrosis of the lumbosacral region, patients note stiffness of movement, pain in the lower back, which can radiate to one or both legs, intensifies when bending, turning the body, walking or lifting heavy objects.
Possible vegetative disorders: chills in the legs at a comfortable temperature for the rest of the body, pallor of the skin on the legs.There is a feeling of numbness, paresthesia (tingling sensation) in the skin of the legs and buttocks.
Diagnosis of the disease.
Instrumental diagnosis involves an x-ray of the spine to exclude traumatic injuries, congenital structural anomalies, and identify bone growths.The study is also carried out with functional tests: taking photographs during flexion and extension in the cervical and lumbar regions to exclude pathological displacement of the vertebrae relative to each other.