The first signs of osteochondrosis

Osteochondrosis is an outdated name for degenerative diseases of the spine.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

What is osteochondrosis

To understand the processes that occur during osteochondrosis, you need to understand the anatomy of the spinal column. It includes the following structures:

• Vertebrae consisting of bodies, arches, appendages. Between the arches of adjacent vertebrae are joints called facets
• Intervertebral discs located between the bodies of adjacent vertebrae
• Ligaments of the spine
• The posterior and anterior longitudinal 一 pass along the body 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, located in the spinal canal, together with the nerve roots that extend from it. They are nerve cell processes. Through these processes, the brain receives information about the state of tissues, and in response sends signals that regulate their functioning: muscle contractions, changes in the diameter of blood vessels and much more.

Degeneration starts from the intervertebral discs, and as the changes progress, all the above-mentioned structures are involved in the process. This is partly due to the fact that the discs have no blood vessels. Nutrients and oxygen enter them by diffusion from the vertebrae and other surrounding structures.

Intervertebral discs make up a third of the length of the spine and serve as shock absorbers, protecting the vertebrae from overloading when lifting heavy loads, standing or sitting for long periods of time, bending and twisting. Each disc consists of:

• The nucleus pulposus, located inside, in the center, contains a lot of hyaluronic acid, type II collagen, which retains water. This gives the normal core a jelly-like consistency for effective cushioning. As the 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.
• Fibrous ring, 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 and protect it from damage. The fibers of the annulus are intertwined along the periphery with the posterior longitudinal ligament of the spine. This ensures the immobility of spinal structures in a healthy person - doctors call this condition spinal stability. In people with degenerative disease, the annulus fibrosus ruptures, and 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. These are thin cartilages that are located between the bodies of the vertebrae and the discs. They contain blood vessels that supply the disc. In degenerative diseases, calcium is deposited in the endplates, causing damage to the blood supply.

Stages of development of osteochondrosis

The development of osteochondrosis of the spine occurs gradually:

• Initial degeneration. The intervertebral disc does not receive sufficient nutrition, wears out, decreases in height and ruptures. Nucleus pulposus protrudes through microdamages of the annulus fibrosus, irritating the posterior longitudinal ligament and leading to pain and reflex spasm of the back muscles
• Protrusion of the intervertebral disc. The fibers of the annulus fibrosus are destroyed, the nucleus pulposus protrudes more, 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 extremities and a decrease in the sensitivity of the skin. One of the complications of a hernia is its sequestration - the separation of the disc protrusion from its main part.
• Progression of degeneration of the spine 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 bony outgrowths of 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 compression of herniated spinal nerve roots:

• Spondyloarthrosis. The reduced height of the intervertebral disc creates more stress on the facet joints. They can develop inflammation and malnutrition, causing them to become "dry" and cause pain.
• Spondylolisthesis 一 movement of the vertebral bodies in relation 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 yellow ligament is located near the spinal canal and can narrow it, compressing the spinal cord.
• In level 1. -2. of the lumbar vertebra, extends downward from the spinal cord"ponytail" - a bundle of nerve roots responsible for the innervation of the lower extremities and pelvic organs: the bladder, rectum, external genitalia. The 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, everyone's spine begins to age.

In most people, these changes are small 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 stop performing their cushioning function, bulge and put pressure on the spinal nerves and even on the spinal cord itself.

It is impossible to accurately predict how severe 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 exact genetic test to show personal risk. There are certain factors that increase the risk of developing osteochondrosis. They are the ones targeted by measures to prevent osteochondrosis.

Risk factors for osteochondrosis include:

• Excessive strain on the spine: professional sports, heavy lifting, regular heavy physical work
• Prolonged staying in a static, incorrect position:  sitting, bent over, cross-legged, on a chair without lumbar support, working in a vertical position with an incline
• Sedentary lifestyleleading to weakness in the trunk muscles that cannot effectively support the spine
• Excessive weight 一 obesity creates additional stress on the back and joints
• Smoking - nicotine and other components of cigarettes interfere with the diffusion of nutrients from blood vessels to tissues, including intervertebral discs
• Alcohol intake - Regular consumption leads to calcium being poorly absorbed from food. Calcium deficiency leads to a loss of vertebral density
• Back injuries with damage to the structure of the vertebrae or discs, due to which the recovery process takes place much more slowly than the degeneration process

Osteochondrosis of the spine in adults: symptoms

In the early stages of the 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 the part of the spine where the problem occurs:

• Degeneration of the cervical spine leads to muscle stiffness, pain in the neck that radiates to the shoulder and arm or the back of the head and worsens with head movement
• Changes in the thoracic spine occur extremely rarely, because it is the most static. If the hernia does appear, pain occurs between the shoulder blades
• Hernias in the lumbar region occur more often than others and are manifested by pain in the lower back or sacrum, which radiates to the gluteal region, to the leg. Stiffness in the lower back is also noticed. The pain worsens when sitting, standing for a long time and bending.

If the pain radiates from the back to the extremities, they are talking about radiculopathy - nerve root damage. This is spinal nerve compression. 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 of skin sensitivity of the extremities
• bladder and rectal dysfunction with lumbar radiculopathy

Signs of osteochondrosis of the spine in women and men generally 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 work and develop from an earlier age, but gradually.

Not all back pain is caused by osteochondrosis of the spine. Our specialists can perform a complete examination and decide whether you need an MRI.

Osteochondrosis of the spine in youth

It is generally accepted that osteochondrosis is a disease of older people. Degenerative spine disease is really common in patients over the age of 60, but it is increasingly common in people in their 30s and even 20s. Usually the cause is genetic predisposition, excess weight, sedentary lifestyle or back injuries. Both one-off serious injuries, for example from a fall, and regular minor injuries, for example, when you play professional sports, are important. The disease most often occurs in the lumbar region, as it is the most mobile. Intervertebral hernias can form here, including Schmorl's nodes. The main mechanism of their formation is damage to the end plates, which cannot withstand intradiscal pressure. This is how protrusions are formed in the body of the upper or lower vertebra, which are called Schmorl's hernias. They do not cause nerve root compression and are usually not dangerous. In rare cases, they can grow and lead to back pain, but are more often discovered incidentally during an MRI. Intervertebral hernias that protrude posteriorly 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 indicated only if serious complications threaten, such as progressive loss of bladder control or weakness in the lower extremities. Surgical treatment allows you to save a person from paralysis, but by itself it does not alleviate the pain and further progression of the disease, therefore a special rehabilitation program is prescribed after the operation.
Uncomplicated hernias resolve on their own in many cases. The process of resorption can be accompanied by the formation of excess connective tissue and calcifications in the spine, which increases the likelihood of recurrence of the disease in the future. Existing physiotherapeutic techniques and special exercises help:

• accelerate hernia resorption
• improve disk power
• normalize movement biomechanics and load distribution
• avoid the need for surgery in the future

Drugs from the group of nonsteroidal anti-inflammatory drugs, glucocorticoids, and muscle relaxants are also used against pain, 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 the degeneration as follows:

• MLS laser therapy - the laser radiation used has an anti-inflammatory effect, expands lymphatic vessels, improves lymphatic drainage
• Acupuncture - this method relieves pain, swelling and inflammation due to the reflex response of the body 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 removes toxins from the thickness of the intervertebral discs, accelerates recovery processes
• Therapeutic physical culture - special sets of exercises help strengthen trunk muscles, learn how to properly distribute the load on the back, maintain proper 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 done on an outpatient basis in the clinic. It has all the necessary equipment and a team of professionals specialized in non-surgical hernia treatment. It is not recommended to go to hospitals that use methods without a scientific basis and that are not approved by the world medical community - it can be dangerous to your health. In a modern clinic, you can get advice at an affordable price and choose a further course of action together with your doctor.