The spine includes the cervical, thoracic, lumbosacral sections and consists of 33-34 vertebrae located one above the other and connected into a single chain.To evenly distribute the load on the spinal column during everyday 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 backward 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 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 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 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, backward movement), mechanical, immune, hormonal, dysmetabolic (metabolic), vascular, infectious, functional and hereditary.The most common is the involutive 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 occurrence of the disease with 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 heavy physical labor and vibration exposure, on the other.
The load on the spine increases in proportion to the increase in body weight, so overweight people suffer from overload even in conditions of moderate activity;the situation is aggravated by a tendency to physical inactivity due to poor tolerance to physical activity.
Psycho-emotional stress, coupled 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 deformation of the intervertebral discs.
Classification of the disease
By localization:
- osteochondrosis of the cervical spine;
- osteochondrosis of the thoracic spine;
- osteochondrosis of the lumbar and sacral spine.
According to 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 protrusion (bulging, protrusion of the intervertebral disc beyond the spinal column without compromising the integrity of the fibrous ring) or disc herniation due to compression of a nerve root, spinal cord or vessel (radiculopathy, neuropathy, myelopathy, radiculoischemic syndrome are distinguished accordingly).
Depending on the stage of development of the process, there are:
- Stage of intradiscal pathological process (chondrosis).During this period, intradiscal movement of the nucleus pulposus occurs. The nucleus pulposus penetrates into its outer fibers through cracks in the fibrous ring.As a result, nerve endings are irritated and pain develops.
- The stage of instability, or loss of fixation ability of the affected disc, when the overlying vertebra is displaced in relation to the underlying one.During this period, instability syndrome, reflex and even compression syndromes can form.
- The stage of formation of herniated intervertebral discs due to a 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 defective discs.In some cases, these bone growths, like disc herniations, 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 occurring 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 into 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 experience pain in the heart area, in the interscapular region, lasting for a long time, aching or pressing, quite often sharp, stabbing, sharp.
They can occur or intensify with deep breathing, during bending and turning of the body, when raising arms, sneezing, coughing.There may be a feeling of numbness in the skin in 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, lifting heavy objects.
Possible vegetative disorders: chilliness of the legs at a comfortable temperature for the rest of the body, paleness of the skin of the legs.There is a feeling of numbness, paresthesia (pins and needles sensation) of the skin of the legs and buttocks.
Diagnosis of the disease
Instrumental diagnostics involves radiography of the spine to exclude traumatic injuries, congenital structural anomalies, and identify bone growths.The study is also carried out with functional tests - taking pictures during flexion and extension in the cervical and lumbar regions to exclude pathological displacement of the vertebrae relative to each other.