The spinal column includes the cervical, thoracic and lumbosacral sections and is made up of 33-34 vertebrae placed one above the 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 curves convex forward in the cervical and lumbar regions (lordosis) and two convex backwards in the thoracic and sacral regions (kyphosis).Between the vertebrae are intervertebral discs - cartilage, which perform a shock-absorbing function and consist of the nucleus pulposus and the fibrous ring surrounding it.
Spinal osteochondrosis is a chronic disease characterized by the development of degenerative-dystrophic changes in the intervertebral discs with subsequent involvement of adjacent vertebrae and surrounding tissues in the process.
Currently, doctors more often use the broader term “dorsopathy” to refer to back and neck pain, sometimes replacing the concept of “osteochondrosis” with it.Dorsopathy includes neck pain (cervicalgia), neck and head pain (cervicocranialgia), neck and shoulder pain (cervicobrachialgia), chest pain (thoracalgia), lower back pain (lumbago), lower back pain radiating 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 numerous theories that consider various factors: involution (involution - reverse development, backward movement), mechanical, immune, 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 due to previous mechanical or inflammatory damage.According to this theory, the development of degenerative changes in the spine is genetically predetermined, and the onset of the disease with corresponding clinical manifestations is due to the influence of various endogenous (internal) and exogenous (external) factors.
The probability of osteochondrosis increases with age, in the presence of excess weight, sedentary lifestyle and poor physical fitness, on the one hand, and heavy 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 the tendency towards physical inactivity due to poor tolerance to physical activity.
Psycho-emotional stress, combined 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.
According to the stage 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 musculo-tonic disorders (muscle spasms), 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 fibrous ring) or herniated disc due to compression of a nerve root, spinal cord or vessel (accordingly, radiculopathy, neuropathy, myelopathy, radiculoischemic syndrome are distinguished).
Depending on the development stage 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 are irritated and pain develops.
- The stage of instability, or loss of fixation capacity of the affected disc, when the vertebra above is displaced relative to the one below.During this period, instability syndromes, reflex syndromes and even compression syndromes can form.
- The stage of formation of intervertebral disc herniation is due to a violation of the integrity of the fibrous ring, 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 outgrowths 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 herniated discs, can compress adjacent neurovascular formations.
Symptoms of osteochondrosis
The symptoms of osteochondrosis depend on the damaged area of 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, radiating to the arm and 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 feel pain in the heart area, in the interscapular region, lasting for a long time, aching or pressing, most often sharp, stabbing, sharp.
They can manifest themselves or intensify with deep breathing, during bending and turning the body, when raising arms, sneezing, coughing.You may experience a feeling of numbness in the skin of your chest, abdomen, and back.
With osteochondrosis of the lumbosacral region, patients note stiffness of movements, 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: cold legs at a temperature comfortable for the rest of the body, paleness of the skin of the legs.You feel a sensation of numbness, paresthesia (tingling sensation) of the skin of the legs and buttocks.
Diagnosis of the disease
Instrumental diagnostics include x-rays of the spine to exclude traumatic injuries, congenital structural anomalies and identify bone growths.The study is also carried out with functional tests: taking photos during flexion and extension in the cervical and lumbar regions to exclude pathological displacement of the vertebrae relative to each other.