The osteochondrosis of the spine — degenerative change affecting intervertebral discs m? s, joints, ligaments and other tissues that form the vertebral-motor segment (asr). In this disorder is primary involvement of the spinal discs and secondarily to other departments of the spine and the musculo-skeletal system. It is considered that the higher prevalence of this disease is found on young and middle-aged people, with a tendency to decrease in old age and senility.
In the composition of the spinal skeletal segment includes two located near the vertebrae, the height and the niinamesai. Among them is intervertebral disc, joints, and articular guided spinous stems. Neighbors of the vertebrae between the joints with guided spindles form joint guidance of the connection (bootnote, or facet joints). Spinous and transverse of the shank of the nearby, the vertebrae are fixed by ligaments. This design, along with the discs, provides the backbone of the mobility and the stability.
The causes of osteochondrosis of the spinal column up to the moment have not been defined. However, the fact that it is often found to certain professional categories of adults, suggests that the main cause of the onset of the disease is a sedentary lifestyle. As a result of the shortage of loads muscle, reduce physical effort and muscle to replace your static on parts of the body that by nature must be mobile (neck, waist), there is a weakening of the spring stabilizer and muscle function.
Degenerative changes of the spine occur as a result of:
- excessive static or dynamic loading of the spine (for example, weight lifting);
- hereditary predisposition;
- confirmed the injuries of the spine in the past.
When it is caught-like symptoms check with the doctor. Not to self-this is dangerous for your health!
The symptoms of degenerative disc disease
The main symptom of degenerative disc disease — myofascial pain syndrome, that is to say, a painful spasm of the muscles, with the result that it becomes muscle dysfunction.
Talking about the causes of the syndrome of pain, distinguish the pain that is caused by a pathology is one of the structures of the spinal column (or vertebral pain syndromes), or the pain of other origin (nevertebralnah the pain). What type of pain is revealed, it influences the choice of method of treatment.
Types of back pain:
1. Notsitseptivnaya — derives from the fact that in the receptors painful influence different triggers (injury or inflammation) when untouchable of all the divisions of the nervous system. For this type of pain characterized by the appearance of zones of constant pain and increased pain sensitivity at the sites of tissue damage.
2. Neuropathic — arising as a result of the irritation of neurons in the peripheral or central nervous system, responsible for the response to the damage a physical body. Often a common feature of neuropathic pains is the decrease of the muscle force and the violation of the sensitivity, which is manifested, in particular, the fact that the patient experiences pain in response to nabolese stimuli.
3. Dysfunctional (psychogenic) — is produced by changes in the functional state of the nervous system or of alteration of human perception. Often it is observed the gain in peace after a stressful activity.
4. Mixed — is manifested by a combination of several varieties of pain, as described above.
Usually, the back pain is related to irritation of the receptors for painful muscles, joints, and ligaments, and it is a pain of a nociceptive nature. The patient feels in the place of the local event (pain) or distance (referred pain). Neuropathic back pain is usually associated with the fact that in the process involved Karasek of a nerve or spinnomozgovogo ganglion. This type of pain is chronic.
Have pain in the back can cause diseases of the internal organs (in other words, viceregency of the pain).
Taking into account the causes of the degenerative disc disease, the clinical manifestations of the disease may be related to intervertebral disk herniation or degenerative (pathological) changes in the spine (for example, osteoarthritis, intervertebral joints, or the education of osteophytes).
4 the main clinical syndrome, may lead to each one of these options:
- local the local pain;
- mirror (involuntary reflex pain), injury-related osteo-muscular (fascial) structures;
- radicular syndromes (radiculopathy), caused by the irritation or compression Spino-cerebral roots;
- myelopathy – pain resulting from sdavleniya of the spinal cord or its vessels.
The pathogenesis of degenerative disc disease
On the basis of the development of osteochondrosis is based on a series of pathophysiological mechanisms. The disease develops as a result of calcification of the processes that originate at an early age, as well as aseptic inflammation, dystonia, spasm.
When there is a change in your spine's intervertebral disc, in principle, the damages occur in the sheath around the nerve fibers (demyelination), then the observed damage in the appendages of the nerve cells (axonopathy), the reduction of the circulation of the blood (ischemia), and, in addition, venous stasis. The set of these processes exacerbates the situation, and if there is no timely treatment, this leads to peripheral or central sensitization.
Often signaled the defeat of nucleus-like and annulus fibrosus of the intervertebral disc. The mechanical loads cause the elastic fibrous ring of the disc loses elasticity and the protrusion. Then, through the cracks in fibrous rings the fall of the plots gelatinous core of the vertebral column, that is to say, the protrusion of the unit is replaced by the herniated disc.
Hernia entrevertebralth disk is called a solid formation, which sohranyaet relationship with the body of the intervertebral disc, but sometimes results in the loss of their fragments in the spinal canal (the kidnapping of the unit).
The classification and the stage of development of the degenerative disc disease
From the point of view of the location are distinguished the following varieties of the disease:
- low back pain — pain in the lumbar spine (lumbar-sacral) the department back;
- sciatica — pain in the back, the irradiation of the feet;
- low back pain — lumbar of a shot, that is to say, sharp, intense pain in the lower back;
- torakalgiya — pain in the chest;
- cervicalgia, cervicobrachialgia — pain in the neck and upper limbs.
Classification of the stages of development of degenerative disc disease:
1 stage: it reduces the amount of moisture, intervertebral disc loses its elastic and elastic of the property and the loading are the same. As a result, the disc decreases in height, flattened, there is a protrusion.
2 stage: if the disease is continues to be developed, in a fibrous ring is observed the appearance of cracks, and since the height flattened disk already reduced, the result becomes in the unstable state of the entire segment vertebral.
3 stage: the formation of the gap in the cartilage tissue of fibrous ring. Through it infiltrates into the most liquid of the nucleus and results in the formation of a hernia of the intervertebral disc. These changes often can be found in the lumbar spine and cervical.
For the first time the pain of the existence of a herniated intervertebral disk appears when there is irritation of the receptors painful outer layers of the fibrous ring and the posterior part of the longitudinal ligaments.
The complications of degenerative disc disease
- The symptom of low back pain. In the early stages we observe the appearance of the newspapers of the pain as a response to some action, for example, as a result of a sudden movement, lifting weights, heavy load (long walk, a long stay in the obezbijede position. This type of pain is familiar to many and is described as "collected." It is distinguished from unlikely appearance, motion activation and practically does not manifest itself in static in its position. This type of pain, no serious consequences, and independently, and it is celebrated during the week.
- Low back pain. This type of pain tends to be worse when the hypothermia, with intense demonstrations during the movement. It is not a reaction to the load on the spine, when it still does not stop, but disappears, leaving nagging feeling.
- Sciatica. The pain is triggered in the neighboring countries of departments. The Lumbar osteochondrosis is characterized by the irrational pain in the leg, chest — in the area of the hand or of the heart; the neck is manifested by migraines.
- The cramps. Often undergoes triceps muscle of the leg. Among other things, it points to the emergence of pain is very severe at the time of play in the back or the legs.
- Coccygodynia. Irradiiruet in the area of the coccyx or in the groin. The pain whining, burning, sterledeva of nature, that can sharply limit the physical activity of the patient
Diagnosis of degenerative disc disease
Diagnosis of degenerative disc disease includes several steps:
1. The collection of the clinical history. In this stage we study the patient's complaints and history of disease. In the conversation with the patient makes it clear, where they are based mainly unpleasant sensations, their intensity, duration, triggers the amplification of painful sensations and help alleviate the pain. In addition, for the diagnosis of important is to determine the history of the disease: the emergence of unpleasant sensations and stiffness; the identification of the causes likely to occur; information is collected about a study prior treatment and its effectiveness; information is collected about the last of the exacerbation and the character of its course. For the diagnosis it is also important to know under what conditions the patient lives and works, what leads to a style of life, what habits, what he suffered from illness and injury, for the is, and the count of the genetic factors.
2. At the time the physiological inspection of the evaluation of the patient's body position, gait, and movements; of the skin (for redness, rash, desquamation), the comparison is made symmetrical parts of the body healthy side and painful; makes the determination of the amount of movement (bending, circular movement of the trunk, the amount of rotation of the movements in the different departments of the spine); detectable painful plot to determine the temperature of the skin, the presence of muscle spasms, swelling, painful the joints; the palpacin of deep and superficial layers of the muscles allows to evaluate the state of the musculo-skeletal system (muscles, increase or decrease in their volume); with the touch special of a hammer or with the finger defines the area of the irradiation of pain; with the help of a tingling sensation of a needle is defined painful sensation; finally, we perform a series of special moves, in order to find out the symptoms of the root of the tension.
3. The x-ray. For better reference, is a study of each department of the spine separately. This is done in two oblique projections and in two planes mutually perpendicular (direct and lateral). In some cases, you can assign function key x-rays when the patient is in a position of flexion, extension or side slopes. Special indications for more quality results the study was carried out with the introduction of contrast material into the spinal canal, in disease of the dream or vertebral artery, in an intervertebral disc or the vertebral column: angiography, discography, myelography, pneumola myelography.
The main x-ray signs of degenerative disc disease include:
- patalgico painful mobility of the vertebrae;
- the displacement of their bodies;
- the calcification disk of the deposition of salts);
- uniform narrowing of the intervertebral slit in the lumbar spine and cervical departments, and the division of narrowing of the connection with a wedge;
- the education of osteophytes (provincial growths);
- education on the border with surprised end plate (territorial, multiple sclerosis).
5. Magnetic resonance imaging (mri) is based on the fact that it applies the electromagnetic waves to generate the signal, characteristic for each tissue. Is processed in the computer and translates into a graphical image. By using this method, we can clearly consider the vessels, nerves, rods and discs of the spine, without the harmful effects of ionizing radiation on the organism.
Prognosis. The prevention of the
As practice shows, the majority of the manifestations of the degenerative disc disease when it is well-made therapy resolution occurs within 6 weeks.
However, ill-fitting or treatment of the medication can cause the pain syndrome will pass to a chronic form and will contribute to aggravating changes in the vertebral column in the future.
When you see the pain in the back or limbs, you should first consult a qualified professional for the correct diagnosis and the target treatment.
The most efficient and effective for the treatment of most of the manifestations of back pain is a medical treatment and injection of the therapy, as well as iglorefleksoterapija. Physiotherapy, including lazeroterapiya, massage, spinal manipulation provided little unstable and effect, and in some cases they may be are not contraindicated.
The current methods of treatment of osteochondrosis is based on the principle of the continuity of treatment: that is to say, quickly and safely by the defiance of an episode of acute pain, and the incorporation of the preventive methods. For the prevention of the emergence and development of osteochondrosis can be recommended, above all, the decrease of the mass of the body (in the case of obesity) and physical activity on a regular basis.
The most important regular classes with the technique of dynamic muscular stabilization (yoga, pilates, in the framework of aerobic load) is the basis of the rehabilitation and prevention of back pain, contributes to increase the strength and endurance of the muscles of the spine.