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The first signs of osteochondrosis

Osteochondrosis is an outdated name for a degenerative disease of the spine.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

how the spine works

To understand the processes occurring in osteochondrosis, you need to understand the anatomy of the spine. It includes the following structures:

  • Vertebrae consisting of bodies, arches, processes. Between the arches of adjacent vertebrae are joints called facets
  • The intervertebral discs located between the bodies of adjacent vertebrae
  • Spinal ligaments
  • Posterior and anterior longitudinal 一 pass along the bodies of all 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, together with the nerve roots emerging from it. They are outgrowths of nerve cells. 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 many others.

Degeneration begins in the intervertebral discs, and as the changes progress, all the structures listed above are involved. This is partly because discs have no blood vessels. Nutrients and oxygen enter them from the vertebrae and other surrounding structures by diffusion.

The intervertebral discs make up one-third of the length of the spine and serve as shock absorbers, protecting the vertebrae from overload during heavy lifting, 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, collagen type II, which holds water. This gives the normal core a jelly-like consistency for effective softening. As degeneration progresses, the composition of the inner part of the disc changes, the water content in it decreases, the nucleus "dries out" and the height of the intervertebral disc decreases
  • The annulus fibrosus, which is located outside the nucleus and consists of 15-25 layers of collagen fibers. The collagen in the annulus fibrosus is type I. It is denser than in the core and is needed to hold the inside of the disc together and protect it from damage. The fibers of the annulus are entwined peripherally with the posterior longitudinal ligament of the spine. This ensures immobility of the spinal structures in a healthy person - doctors call this condition spinal stability. In people with degenerative disease, the annulus fibrosus cracks, so instability can develop: adjacent vertebrae can move anteriorly or posteriorly relative to each other. This is dangerous due to pinching of the nerve root between them

It is also important to mention the end plates. These are thin cartilages located between the vertebral bodies and discs. They contain blood vessels that supply the disc. In a degenerative disease, calcium is deposited in the endplates, which leads to disruption of the blood supply.

Stages of development of osteochondrosis

The development of spinal osteochondrosis occurs gradually:

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

Complications of osteochondrosis, in addition to spinal nerve root compression with herniation:

  • Spondyloarthrosis. The decreased height of the intervertebral disc places more stress on the facet joints. They can develop inflammation and malnutrition, causing them to become "dry" and cause pain.
  • Spondylolisthesis 一 displacement of the vertebral bodies relative to each other due to damage to the ligaments
  • Degenerative processes in the region of the ligamentum flavum cause its thickening.  This is dangerous because the ligamentum flavum is in close proximity to the spinal canal and can narrow it, compressing the spinal cord
  • At the level of the 1st-2nd lumbar vertebrae it extends down from the spinal cord "ponytail" - a bundle of nerve roots responsible for the innervation of the lower limbs and pelvic organs: bladder, rectum, external genital organs. Cauda equina syndrome is one of the most dangerous complications of osteochondrosis, manifested by severe pain, muscle weakness in the legs, numbness of the perineum, incontinence of urine and feces.

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 the aging of the spine begins in every person.

In most people, these changes are minor and cause no symptoms: they are sometimes discovered incidentally during a magnetic resonance imaging (MRI) scan of the spine. The progression of degeneration leads to significant changes in the structure of the spine. The intervertebral discs can be so destroyed that they cease to perform a shock-absorbing function, bulging and putting pressure on the spinal nerves and even on the spinal cord itself.

It is impossible to predict exactly how severe the degenerative changes will be in a 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 accurate genetic test that can show personal risk. There are some factors that increase the risk of developing osteochondrosis. The measures to prevent osteochondrosis are aimed at them.

Risk factors for osteochondrosis include:

  • Excessive load on the spine: professional sports, weight lifting, regular hard physical work
  • Remaining in a static, incorrect position for a long time:  sitting, hunched, cross-legged, in a chair without lumbar support, working in a vertical position with an incline
  • A sedentary lifestyleresulting in weakness of body muscles that cannot effectively support the spine
  • Overweight 一 Obesity puts extra stress on the back and joints
  • Smoking - nicotine and other components of cigarettes disrupt the diffusion of nutrients from blood vessels into tissues, including intervertebral discs
  • Intake of alcohol - Regular consumption leads to the fact that calcium is poorly absorbed from food. A lack of calcium leads to a loss of density in the vertebrae
  • Back injuries with damage to the structure of the vertebrae or discs, due to which the recovery process is much slower 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 appear suddenly or gradually as the disease progresses. The main manifestations are back pain and reflex spasm of the back muscles. The localization of the symptoms depends on which part of the spine the problem occurs:

  • Degeneration of the cervical spine leads to muscle stiffness, neck pain radiating to the shoulder and arm or the back of the head and worse with head movements
  • Changes in the thoracic spine occur extremely rarely, as it is the most static. If a hernia occurs, pain appears between the shoulder blades
  • Hernia in the lumbar region occurs more often than others and is manifested by pain in the lower back or sacrum, radiating to the gluteal region, to the leg. Stiffness in the lower back is also noted. The pain is worse when sitting, standing for long periods of time and bending over.

If the pain radiates from the back to the limb, they talk about radiculopathy - damage to the nerve root. This is compression from a herniated spinal nerve. Radiculopathy, in addition to pain, is accompanied by other symptoms that are localized in a specific area supplied by the damaged nerve. Such manifestations may include:

  • weakness of the muscles of the limbs, up to paralysis
  • disorders in the sensitivity of the skin of the limbs
  • 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 quickly after menopause, when bone density decreases. In men, degenerative processes are more often caused by physical labor and develop from an earlier age, but gradually.

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

Osteochondrosis of the spine at an early age

It is generally accepted that osteochondrosis is a disease of the elderly. Degenerative spinal disease is indeed common in patients over the age of 60, but it is becoming more common in people in their 30s and even 20s. Usually the cause is a genetic predisposition, excess weight, a sedentary lifestyle or back injuries. Both one-off severe injuries, such as in a fall, and regular minor injuries, such as in professional sports, are important. Most often, the disease manifests itself in the lumbar region as the most mobile. Intervertebral hernias can form here, including Schmorl's nodes. The main mechanism of their occurrence is damage to the end plates, which cannot withstand intradisc pressure. Thus, protrusions are formed in the body of the upper or underlying vertebra, called Schmorl's hernias. They do not cause compression of the nerve roots and are usually not dangerous. In rare cases, they can grow and lead to back pain, but more often they are found incidentally during an MRI. Intervertebral hernias that protrude backward are usually 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 there is a threat of serious complications, such as progressive loss of bladder control or weakness in the lower limbs. Surgical treatment allows you to save a person from paralysis, but in itself does not relieve pain and further progression of the disease, which is why a special rehabilitation program is prescribed after the operation.
Uncomplicated hernias in many cases go away on their own. The resorption process can be accompanied by the formation of excess connective tissue and calcifications in the spine, which increases the likelihood of disease recurrence in the future. Existing physiotherapy techniques and special exercises help:

  • acceleration of hernia resorption
  • improve disk power
  • normalizes the biomechanics of movements and load distribution
  • avoiding the need for surgery in the future

For pain, drugs from the groups 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 condition of the spine in the long term. . You can reduce the intensity of degeneration by:

  • MLS laser therapy - the laser radiation used has an anti-inflammatory effect, expands lymphatic vessels, improving lymphatic drainage
  • Acupuncture - this method relieves pain, swelling and inflammation due to the body's reflex response to stimulation of biologically active points on the body with special needles.
  • Magnetotherapy - a method that stimulates blood flow, normalizes the diffusion of nutrients and removes toxins from the thickness of the intervertebral discs, accelerates recovery processes
  • Therapeutic physical education - special sets of exercises help to strengthen the muscles of the torso, learn how to properly distribute the load on the back, maintain the correct posture and relieve muscle spasms. To monitor the effectiveness, 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 done on an outpatient basis in the clinic. It has all the necessary equipment and a team of professionals specialized in the non-operative treatment of hernia. It is not recommended to go to hospitals where they use methods without a scientific basis and not approved by the world medical community - this can be dangerous to health. In a modern clinic, you can get advice at an affordable price and choose a further course of action together with your doctor.