The spine includes the cervical, thoracic and lumbosacral sections and consists of 33 to 34 vertebrae located 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 forward convex curves in the cervical and lumbar regions (lordosis) and two backward convex curves 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.
Osteochondrosis of the spine 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 pain in the neck (cervicalgia), neck and head (cervicocranialgia), neck and shoulders (cervicobrachialgia), chest pain (thoracalgia), lower back pain (lumbodynia), lower back pain radiating towards 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 take into account 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 results from 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 risk 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 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 in conditions of moderate activity;the situation is aggravated by a tendency towards 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, gait.The development of scoliosis - lateral curvature of the spine, pathological kyphosis and lordosis (exacerbation of physiological curvatures) also contributes to the deformation of the intervertebral discs.
Disease classification
By location:
- osteochondrosis of the cervical spine;
- osteochondrosis of the thoracic spine;
- osteochondrosis of the lumbar and sacral spine.
Depending on the stage of the disease:
- exacerbation (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 tensions 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 spine 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, radiculo-ischemic syndrome are distinguished).
Depending on the stage of development of the process, we distinguish:
- 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 the fissures of the annulus fibrosus.As a result, the nerve endings are irritated and pain appears.
- The stage of instability, or loss of attachment capacity of the affected disc, when the overlying vertebra is displaced relative to the underlying vertebra.During this period, instability syndromes, reflex syndromes or even compression syndromes can form.
- The stage of formation of an intervertebral disc herniation 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 outgrowths of the vertebral bodies, leading to immobility of the vertebrae and a compensatory increase in the surface 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
Symptoms of osteochondrosis depend on the damaged area of the spine and the degree of changes occurring there, and the functioning of internal organs may be impaired.
Osteochondrosis of the cervical spine is characterized by pain in the neck, which intensifies during movements, radiates into 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 spots in front of the eyes are possible.
When the thoracic spine is affected, patients may experience pain in the heart region, in the interscapular region, which lasts for a long time, aching or pressing, quite often sharp, stabbing, sharp.
They can occur or intensify during deep breathing, when bending and rotating the body, raising your arms, sneezing, coughing.There may be a feeling of numbness of the skin in the 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, intensify when bending, turning the body, walking, lifting heavy objects.
Possible vegetative disorders: shivering of the legs at a comfortable temperature for the rest of the body, pallor of the skin of the legs.There is a feeling of numbness, paresthesia (tingling sensation) of 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 bony growths.The study is also carried out with functional tests - taking photos in flexion and extension in the cervical and lumbar regions to exclude pathological displacement of the vertebrae relative to each other.