The first signs of osteochondrosis

Osteochondrosis is an outdated name for degenerative disease of the spine. The old term is often used in our country, but it does not reflect the essence of the disease, which is based on age-related degeneration - destruction of the tissue structure. In this article we will consider the first signs of osteochondrosis, the patterns of its development and treatment options.

What is osteochondrosis?

To understand the processes that occur during osteochondrosis, it is necessary to understand the anatomy of the spine. Includes the following structures:

• Vertebrae formed by bodies, arches, processes. Between the arches of adjacent vertebrae there are joints called facets.
• Intervertebral discs located between the bodies of adjacent vertebrae.
• spinal ligaments
• The posterior and anterior longitudinals pass along the bodies of all the vertebrae in front and behind.
• Ligamentum flavum: connects the arches of adjacent vertebrae.
• Supraspinous ligaments and interspinous ligaments: connect the spinous processes
• The spinal cord, which is located in the spinal canal, along with the nerve roots that extend from it. They are nerve cell processes. Through these processes, the brain receives information about the state of the tissues and, in response, sends signals that regulate their functioning: muscle contractions, changes in the diameter of blood vessels and much more.

Degeneration begins with the intervertebral discs and, as the changes progress, all previous structures become involved in the process. This is partly due to the fact that the discs do not have blood vessels. Nutrients and oxygen enter them from the vertebrae and other surrounding structures by diffusion.

Intervertebral discs make up one third of the length of the spine and serve as shock absorbers, protecting the vertebrae from overload when lifting heavy objects, prolonged standing or sitting, bending and twisting. Each disc consists of:

• The nucleus pulposus, which is located inside, in the center, contains a lot of hyaluronic acid, type II collagen, which retains water. This gives the normal core a gelatinous consistency for effective cushioning. As degeneration progresses, the composition of the inner part of the disc changes, its water content decreases, the nucleus "drys out" and the height of the intervertebral disc decreases.
• The annulus fibrosus, which is located outside the nucleus and consists of 15 to 25 layers of collagen fibers. The collagen in the annulus fibrosus is type I. It is denser than the nucleus and is necessary to support the inside of the disc and protect it from damage. The ring fibers are intertwined along the periphery with the posterior longitudinal ligament of the spine. This ensures the immobility of the spinal structures in a healthy person; Doctors call this condition spinal stability. In people with degenerative diseases, the annulus fibrosus cracks, so instability can develop: adjacent vertebrae can move forward or backward relative to each other. This is dangerous because of the pinching of the nerve root between them.

It is also important to mention the end plates. They are thin cartilage located between the vertebral bodies and the discs. They contain blood vessels that supply the disc. In degenerative diseases, calcium is deposited in the end plates, resulting in impaired blood supply.

Stages of development of osteochondrosis.

The development of spinal osteochondrosis occurs gradually:

• Initial degeneration. The intervertebral disc does not receive enough nutrition, it wears out, its height decreases and it cracks. The nucleus pulposus protrudes through microdamage to the annulus fibrosus, irritating the posterior longitudinal ligament and causing pain and reflex spasms of the back muscles.
• Bulging of the intervertebral disc. The fibers of the annulus fibrosus are destroyed, the nucleus pulposus protrudes more strongly, forming a hernia. It can compress the roots of the spinal nerves, causing the development of paresis or paralysis of the muscles of the limb and a decrease in skin sensitivity. One of the complications of a hernia is its sequestration: the separation of the bulge of the disc from its main part.
• Progression of degeneration of protrusion and other spinal structures. The disc becomes even more compact, and the body tries to compensate for the excessive mobility of the spine by forming pathological bone growths of the vertebral bodies - osteophytes. They, like the hernia itself, can affect nerves and ligaments, altering their function and causing pain. Unlike a hernia, bone spurs do not dissolve.

Complications of osteochondrosis, In addition to compression of herniated spinal nerve roots:

• spondyloarthrosis. The decreased height of the intervertebral disc places greater stress on the facet joints. They can develop inflammation and malnutrition, causing them to "dry out" and cause pain.
• spondylolisthesis 一 displacement of the vertebral bodies relative to each other due to ligament damage
• Degenerative processes in the area of the yellow ligament cause its thickening.  This is dangerous because the ligamentum flavum is adjacent to the spinal canal and can narrow it, compressing the spinal cord.
• At the level of the 1st and 2nd lumbar vertebra, it extends downward from the spinal cord "horsetail" - a bundle of nerve roots responsible for the innervation of the lower extremities and pelvic organs: bladder, rectum, external genitalia. Cauda equina syndrome is one of the most dangerous complications of osteochondrosis, which is manifested by severe pain, muscle weakness in the legs, numbness of the perineum, urinary and fecal incontinence.

Causes of osteochondrosis of the back

There is still no consensus on what degree of degenerative changes in the spine should be considered normal. Sooner or later, spinal aging begins in everyone.

In most people, these changes are minor and do not cause symptoms: they are sometimes discovered incidentally during an MRI of the spine. The progression of degeneration leads to significant changes in the structure of the spine. The intervertebral discs can be destroyed so much that they no longer perform a shock-absorbing function, bulge and put pressure on the spinal nerves and even the spinal cord itself.

It is impossible to accurately predict how severe the degenerative changes will be in a particular person and whether they will lead to complications. There is a genetic predisposition to osteochondrosis, but the specific genetic mutations responsible for the course of the disease have not been identified. Therefore, there is no precise genetic test that shows personal risk. There are certain factors that increase the risk of developing osteochondrosis. It is they who are targeted by measures to prevent osteochondrosis.

Risk factors for osteochondrosis include:

• Excessive load on the spine.: professional sports, heavy lifting, regular hard physical work
• Staying in a static and incorrect position for a long time:  sitting, slouched, cross-legged, in a chair without lumbar support, working in an upright position with an inclination
• Sedentary lifestyleleading to weakness of the trunk muscles that cannot effectively support the spine
• Overweight 一 Obesity places additional stress on the back and joints
• Smoking - nicotine and other components of cigarettes alter the diffusion of nutrients from blood vessels to tissues, including intervertebral discs
• alcohol intake - Regular consumption causes calcium to be poorly absorbed from food. Lack of calcium causes the vertebrae to lose density
• back injuries with damage to the structure of the vertebrae or discs, so the recovery process occurs much more slowly than the degeneration process

Osteochondrosis of the spine in adults: symptoms

In the early stages of a degenerative disease, a person usually does not experience any symptoms. They occur suddenly or gradually as the disease progresses. The main manifestations are back pain and reflex spasms of the back muscles. The location of the symptoms depends on where in the spine the problem occurs:

• Degeneration of the cervical spine causes muscle stiffness and neck pain that radiates to the shoulder and arm or the back of the head and worsens with head movements.
• Changes in the thoracic spine appear very rarely, since it is the most static. If a hernia occurs, pain appears between the shoulder blades.
• Hernias in the lumbar region occur more frequently than others and are manifested by pain in the lower back or sacrum, which radiates to the gluteal region and leg. There is also stiffness in the lumbar area. The pain worsens when sitting, standing for long periods of time, and bending over.

If the pain radiates from the back to the limb, we speak of radiculopathy, damage to the nerve root. This is compression by a herniated spinal nerve. Radiculopathy, in addition to pain, is also accompanied by other symptoms that are located in a specific area innervated by the damaged nerve. Such manifestations may include:

• weakness of the muscles of the extremities, up to paralysis
• alterations in the sensitivity of the skin of the extremity
• bladder and rectal dysfunction with lumbar radiculopathy

Signs of spinal osteochondrosis in women and men usually do not differ, but in women symptomatic degeneration develops more rapidly after menopause, when bone density decreases. In men, degenerative processes are usually caused by physical work and develop from an earlier age, but gradually.

Not all back pain is caused by spinal osteochondrosis. Our specialists can perform a complete examination and decide if you need an MRI.

Osteochondrosis of the spine at a young age.

It is generally accepted that osteochondrosis is a disease of older people. In fact, degenerative spinal disease is common among patients over age 60, but is becoming increasingly common in people in their 30s and even 20s. Generally the cause is a genetic predisposition, excess weight, a sedentary lifestyle or back injuries. Both serious one-off injuries, for example, from a fall, and common minor injuries, for example, when playing professional sports, are important. The disease occurs most frequently in the lumbar region as the most mobile. Intervertebral hernias can form here, including Schmorl's nodes. The main mechanism of its appearance is damage to the end plates, which cannot withstand intradiscal pressure. This is how protrusions form on the body of the upper or lower vertebra, called Schmorl's hernias. They do not cause compression of the nerve roots and are generally not dangerous. In rare cases, they can grow and cause back pain, but most often they are discovered by chance during an MRI. Intervertebral hernias that protrude backward are often accompanied by pain and may require treatment.

Osteochondrosis of the spine: treatment.

Up to 90% of cases of degenerative diseases can be treated with conservative methods.

Surgery is only indicated if serious complications threaten, such as progressive loss of bladder control or weakness in the lower extremities. Surgical treatment makes it possible to save a person from paralysis, but by itself it does not relieve pain and further progression of the disease, therefore, a special rehabilitation program is prescribed after the operation.
Uncomplicated hernias in many cases resolve on their own. The resorption process may be accompanied by the formation of excess connective tissue and calcifications in the spine, which increases the likelihood of relapse of the disease in the future. Existing physiotherapy techniques and special exercises help:

• accelerate hernia resorption
• improve disc power
• normalize the biomechanics of movements and load distribution.
• avoid the need for surgery in the future

For pain, drugs from the group of non-steroidal anti-inflammatory drugs, glucocorticoids and muscle relaxants are also used, but the use of drugs is limited to the acute period of the disease and does not improve the long-term condition of the spine. . You can reduce the intensity of degeneration by:

• MLS laser therapy: The laser radiation used has an anti-inflammatory effect, dilates lymphatic vessels and improves lymphatic drainage.
• Acupuncture - This method relieves pain, swelling and inflammation due to the body's reflex response to the stimulation of biologically active points on the body with special needles.
• The magnetotherapy method stimulates blood flow, normalizes the diffusion of nutrients and eliminates toxins from the thickness of the intervertebral discs, accelerating recovery processes.
• Therapeutic physical education - special sets of exercises help to strengthen the muscles of the torso, learn to correctly distribute the load on the back, maintain correct posture and relieve muscle spasms. To monitor performance, it is better to start working with an instructor, and then continue the exercises yourself according to the recommendations.

Depending on the manifestations of the disease and the characteristics of the patient, different combinations of the above methods can be used.

Both conservative treatment of spinal hernias and rehabilitation after surgery can be performed on an outpatient basis in the clinic. It has all the necessary equipment and a team of professionals specialized in the non-surgical treatment of hernias. It is not recommended to go to hospitals where methods without a scientific basis and not approved by the world medical community are used; This can be dangerous to your health. In a modern clinic you can receive advice at an affordable price and choose further measures together with your doctor.