The spine includes the cervical, thoracic and 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 spine during daily physical activity and when the body is in an upright position, the spine exhibits physiological (normal) curves.Two convex forward curves in the cervical and lumbar regions (lordosis) and two backward 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.
Spinal osteochondrosis is a chronic disease characterized by the development of degenerative-dystrophic changes in 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 shoulder (cervicobrachialgia), chest pain (thoracalgia), low back pain (lumbodynia), low 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 several theories that consider various factors: involution (involution - reverse development, backward movement), mechanical, immunological, hormonal, dysmetabolic (metabolic), vascular, infectious, functional and hereditary.The most common is the involutionary 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 probability of osteochondrosis increases with age, in the presence of excess weight, sedentary lifestyle and low physical fitness, on the one hand, and heavy physical work and vibration exposure, on the other.
The load on the spine increases in proportion to the increase in body weight, which is why overweight people experience overload even in conditions of moderate activity;the situation is aggravated by the tendency towards physical inactivity due to low 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 intervertebral discs.
Disease classification
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 spinal structures 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 usually develop against the background of protrusion (bulging, protrusion of the intervertebral disc beyond the spine without compromising the integrity of the fibrous ring) or herniated disc due to compression of a nerve root, spinal cord or vessel (radiculopathy, neuropathy, myelopathy, radiculoischemic syndrome are differentiated accordingly).
Depending on the stage of process development, 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 fissures in the fibrous ring.As a result, the nerve endings become irritated and pain occurs.
- Stage of instability, or loss of fixation capacity of the affected disc, when the overlying vertebra is displaced in relation to the underlying one.During this period, instability syndromes, reflex syndromes and even compression syndromes can form.
- Stage of formation of intervertebral disc herniation due to violation of the integrity of the fibrous ring, which can compress adjacent neurovascular formations, including the spinal nerve root.
- The phase 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 the defective discs.In some cases, these bony growths, such as herniated discs, can compress adjacent neurovascular formations.
Osteochondrosis symptoms
The symptoms of osteochondrosis depend on the affected area of 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 to the arm and accompanied by numbness in 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 long-lasting, aching or pressing pain in the region of the heart, in the interscapular region, often sharp, stabbing, sharp.
They can occur or intensify with deep breathing, when bending and turning the body, when raising the arms, sneezing, coughing.There may be a feeling of numbness in the skin of the chest, abdomen and back.
With osteochondrosis of the lumbosacral region, patients notice 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: coldness in the legs at a comfortable temperature for the rest of the body, pallor of the skin on the legs.There is a feeling of numbness, paresthesia (pins and needles sensation) in the skin of the legs and buttocks.
Diagnosis of the disease
Instrumental diagnosis 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.