Osteochondrosis of the spine — degenerative changes affecting the intervertebral discs, muscles, joints, ligaments and other tissues that form the spinal-skeletal segment (PDS). In this disease primary affects the intervertebral disks, and secondly to other departments of the spine and musculoskeletal system. It is believed that the prevalence of this disease is common in relatively young and middle-aged people, who have a tendency to decrease in the elderly, and the elderly.
In the composition vertebral bone segment comprises two nearby are the vertebrae, the long and niinamesai. Between them lies the intervertebral disc, joints, and articular spinous processes. The adjacent vertebrae between the cartilage peaks form joint connection (bootnote, or facet joints). Spinous and transverse processes in the vicinity of the vertebrae are held together by ropes. This design, along with the discs, provides the backbone of mobility and stability.
The causes of degenerative disc disease of the spine has not yet been identified. However, the fact that he is often found in certain professional categories of adults, leads one to think that the main cause of the appearance of this disease is a sedentary life-style. As a consequence of a deficit of muscular load, reduced physical muscular efforts and their replacement static in the parts of the body that, by nature, should be mobile (neck, back) is results in a decline in the spring and the stabilisation of muscle function.
Degenerative alterations of the spine occur due to:
- excessive static or dynamic load on the spine (for example, lifting weights);
- hereditary predisposition;
- confirmed spinal injury in the past.
When it is detected symptoms, consult your doctor. Do not self-medication is dangerous for your health!
The symptoms of degenerative disc disease
The main symptom of degenerative disc disease — myofascial pain syndrome, namely painful spasm of muscle, which is a consequence of muscle dysfunction.
Talking about the causes of the onset of pain, showing the pain that is caused by a malocclusion 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 identified, depends on the choice of treatment methods.
The types of back pain:
1. Nociceptive — is due to the fact that the peripheral pain receptors influence various factors (injury or inflammation) when integrity all departments of the nervous system. For this pain is characterized by the appearance of zones of constant pain, and improve the sensitivity to pain in places of damage to the tissues.
2. Neuropathic — occurs as a result of pathological irritation of neurons in the peripheral or central nervous system, responsible for response to physical damage of the body. Often, a characteristic symptom neuropathic pain is the reduction of muscular strength and disturbances of sensitivity, manifested, in particular, the fact that the patient feels pain in response to nabolese stimuli.
3. Dysfunctional (depression, psychogenic) — occurs due to changes of the functional state of the nervous system or altered perception of the man. Often there is a gain in peace after strenuous activity.
4. Mixed — manifests a combination of different types of pain, as described above.
Usually the back pain associated with irritation of pain receptors of muscles, joints and ligaments, and this is the pain nociceptive character. The patient feels his place of occurrence (local pain) or distance (the pain). Neuropathic back pain usually associated with the fact that in the process involved Karasek nerve or spinal ganglion. Such pain is chronic.
Reflected back pain caused the disease of the internal organs (in other words, viceregency pain).
Considering the causes of degenerative disc disease, the clinical manifestations of the disease may be associated with the hernia of the intervertebral disc or degenerative (pathological) changes in the position of the spinal column (for example, osteoarthritis of the intervertebral or formation, osteophytes).
4 main clinics of the syndrome, which can bring in any of the above options:
- local pain local;
- reflex (reflex pain), associated with lesions of osteo-muscular (fascial) structures;
- syndrome radicular (radiculopathy), caused by irritation or compression spino-cerebral waves roots;
- myelopathy – pain, which is the result of the compression of the spinal cord or blood vessels.
The pathogenesis of degenerative disc disease
The basis for the development of degenerative disc disease is a series of pathophysiological mechanisms. The disease develops as a result of processes underweight, which take the beginning of quite an early age, and also aseptic inflammation, dystonia, spasm.
In case of changes In the spine the intervertebral disc at the beginning occurs the damage to the sheath around nerve fibres (demyelination), were then observed damage processes of the nerve cells (axonopathy), the local decline of the circulation of the blood (ischemia), and via the venous stasis. The set of these processes exacerbates the situation, and if there is no timely treatment, this leads to the appearance of peripheral or central sensitization.
Often it celebrates the defeat pulposus of the kernel and ring of the fibrous intervertebral disc. Mechanical loads lead to the fact that the elastic ring, the fibrous of the disc loses its elasticity and the diverticulum. Then through the cracks in the fibrous ring widths occurs, the loss of land type of gelatine the kernel of the vertebral column, that is, the protrusion of the disc replaced by a disc herniation.
The hernia of the intervertebral disk is called solid formation, which sohranyaet bond with the body of an intervertebral disc, but sometimes occurs in the loss of fragments into the spinal canal (the seizure of the disk).
Classification and the stage of development of degenerative disc disease
From the point of view of localization, the following types of diseases:
- low back pain — low back pain (lumbosacral) department of the back;
- sciatica — back pain, pain that radiates to the legs;
- low back pain, back pain lumbar, that is, acute, intense back pain;
- torakalgiya — pain in the chest;
- cervicalgia, cervicobrachialgia — pain in the neck and upper limbs.
Classification stages of the development of degenerative disc disease:
Phase 1: is reduces the amount of moisture, the intervertebral disc loses its elastic band and the elastic properties and load remain the same. Accordingly, the disc shrinks in height, flattened, happens the diverticulum.
Phase 2: if the malocclusion continues to develop in the fibrous ring observes the occurrence of cracks, and since the height of the flattened disk is already reduced, the result was the instability of the whole segment of the spine.
Step 3: formation of cartilage breakdown in the tissues ring the fibrous. Through it filters out the most liquid part of the nucleus, and occurs in the formation of hernia of the intervertebral disc. Similar changes, it is often possible to meet the lumbar and cervical spine.
For the first time the pain in the presence of hernia of the intervertebral disc is displayed when you experience irritation of the pain receptors external layer fibrous ring widths and the posterior longitudinal ligament.
Complications of degenerative disc disease
- Symptom of back pain. In the early stages celebrates the event pain the appellant as a reaction to an action, for example, as a result of a strong movement, weight lifting, strong load (long walk), a long stay in the obezbijede position. This type of pain is familiar to many and is described as "blocked". Enjoys a rare occurence, the activation of movement and almost does not manifest itself in a static position. This type of pain there are serious consequences, and he alone, takes place in the span of a week.
- Low back pain. This type of pain has the property to get worse with hypothermia, having intense events during the movement. It is not a reaction to stress on the spine, and when it stops it stops, even if it disappears, leaving the small, nagging sense.
- Sciatica. The pain makes the neighbouring departments. Lumbar, low back pain characterized by irrationalism pain in the leg, the chest area of the hand or of the heart; the cervical is manifested headaches.
- Cramps. Often exposed triceps muscle of the calf. Among other things, points to the emergence of a strong pain when touched in the area of the back or the legs.
- Kokcigodiniâ. Irradiiruet in the region of the coccyx or in the groin. The pain aching, burning, sterledeva of character, which can limit drastically the physical activity of the patient
The diagnosis of degenerative disc disease
The diagnosis of degenerative disc disease includes several stages:
1. History. In this phase, you study the complaints of the patient and the history of the disease. In an interview with the patient it turns out, where most of the localized discomfort, their intensity, duration, factors that trigger the amplification of the pain and promote relief of pain. In addition, when the diagnosis is important to understand if the history of the disease: the emergence of unpleasant sensations and stiffness; the identification of possible reasons for their presence; it collects information on the conducted previously, the treatment and its effectiveness; collects information about the latest deterioration and the character of its flow. For the diagnosis it is also important to understand whether the conditions in which the patient lives and works, leading a style of life, what are the bad habits that has suffered from the disease and the accident, it will be important, and accounting for genetic factors.
2. During the physiological inspection is carried out the evaluation of the position of the patient, his gait and movements; the skin, any redness, rashes, flaking), a comparison is made symmetrical parts of the body healthy side and painful; it is defined as a volume of movements (slopes, circular movements, the trunk, the volume of movements of rotation in different departments of vertebral column); reportable to the painful area to determine the temperature of the skin, the presence of muscle spasms, swelling of the gaskets; palpation of the deep and superficial layers of muscle allows you to assess the state of the muscular system (muscle tone, the increase or decrease of their volume), and with the help of special touch the hammer or with the finger given area of irradiation of the pain; with the help of tingling to choose a needle determined the sensitivity to pain; in the end he made a series of special moves, in order to understand if the symptoms of create tension.
3. The x-ray. For the best information search is performed of each department of the vertebral column individually. Is performed step-by-step in two oblique and two surfaces perpendicular to each other (front and side). In some cases, they can assign functional an x-ray, when the patient is in a position of flexion, extension, or slopes to the side. For special reasons to get the best result of a study carried out with the introduction of the contrast medium into the spinal canal, a sleepy or artery in the spine, the intervertebral disc or in the backbone: angiography, discography, myelography, pneumonologia.
The main radiographic signs degenerative disc disease believe:
- pathological mobility of the vertebrae;
- the movement of their bodies.
- calcification of the disc (the deposition of salts).
- uniform contraction in a slot in the lumbar and cervical departments, and within department contraction wedge;
- education osteophytes (regional growths);
- education on the border with the direction of disk seal (regional multiple sclerosis).
5. Magnetic resonance imaging (MRI) is based on the fact that you apply the electromagnetic waves that generate a signal, characteristic for each tissue. It is processed to the computer and translates into a graphical image. With this method, one can consider clearly blood, the processes and the intervertebral discs without the harmful effects of ionizing radiation on the organism.
Prognosis. Prevention
As practice shows, the majority of the manifestations of degenerative disc disease, if properly conducted therapy, the resolution occurs for 6 weeks.
However, combined in the wrong way or treatment or self-medication can lead to the fact that the pain will pass in the chronic form, and will promote the aggravating changes in the spine and in the future.
When the pain in the back or in the limbs, first of all, you need to contact a qualified technician for a proper diagnosis and assignment to appropriate treatment.
The most effective and efficient for the treatment of most of the manifestations of back pain is to drug and injection therapy, as well as acupuncture. Physiotherapy, including laser therapy, massage, spinal manipulations have a slight and unstable effect, and in some cases can be, and are not contraindicated.
The modern methods of treatment of degenerative disc disease are based on the principle of continuity of treatment: that is, secure, quick, and severe-episodes of acute pain followed by turn on of the methods of prevention. In order to prevent the emergence and development of degenerative disc disease can be recommended, first of all, reduce the body weight (obesity) and regular physical activity.
Regular classes with the technique of dynamic muscular stabilization (yoga, pilates within the aerobic load) is the basis of the rehabilitation and prevention of back pain, it helps to increase the strength and endurance of the muscles of the spine.