Osteochondrosis of the spine — degenerative changes affecting the intervertebral discs, joints, ligaments and other tissues that form the vertebral-motor segment (PDS). When this disease is in the first place affects the intervertebral discs and secondary — the other departments of the spine and musculoskeletal system. It is widely known that the greatest incidence of this disease occurs in relatively young and middle-aged people, tend to decline in advanced and senile age.
Part of the vertebrae of the motion segment are two in the nearby vertebrae, the top - and the niinamesai. Between them is located the intervertebral disc, joints and articular spinous processes. The adjacent vertebrae between the articular branches form the articular connections (bootnote, helena facet joints). Spinous and transverse processes of neighboring vertebrae held together by ligaments and. This construction together with hard drives ensures spine motility and stability.
Causes of degenerative disc disease of the spine is not yet identified. However, the fact that often occurs in certain professional categories of adults, suggests that the idea that the main cause of this disease is sedentary life style. Due to the lack of muscular exertion, a reduction in the physical muscle effort and their replacement with the static in parts of your body which are from nature must be movable (neck, shoulders) leads to weakening of the spring and stabilisation functions of muscles.
Degenerative changes of the spine occurs as a result of:
- excessive static helena dynamic load on the spine (for example, lifting weights);
- hereditary disposition;
- confirmed spinal injury in the past.
In the detection of similar symptoms, consult with your doctor. Do not engage self - heal - it is dangerous to exceed your health!
Symptoms of degenerative disc disease
The main symptom is a degenerative disc disease — pain myofascial syndrome, i.e. a painful spasm of the muscles, the result of which becomes muscle dysfunction.
Speaking about the causes of the emergence of pain syndrome, emit the pain, which is caused by pathology of the structures of the spine (otherwise, the vertebral pain syndromes), helen pain of other origin (nevertebralnah pain). From what kind of pain is identified, depends the choice of method of treatment.
Types of back pain:
1. Nociceptive — due to the fact that the peripheral pain receptors have the effect of the various precipitating factors (trauma helena inflammation) in the intactness of all the divisions of the nervous system. For such a pain is characterized by the formation of zones of permanent pain and increase pain sensitivity at the sites of tissue damage.
2. Neuropathic — which arose as a result of the disorders irritation of the neurons of the peripheral helena central nervous system that are responsible for response to physical damage to the body. Often a hallmark of neuropathic pain is the reduction of muscle strength and disorder of sensitivity is well evident, in particular the fact that the patient is experiencing pain in response to the nabolese stimuli.
3. Broken (psychogenic) — arises due to changes in the functional state of the nervous system helena the changed perception of the person. Often occurred to its amplification in the rest after strenuous activity.
4. Mixed — manifested by a combination of several kinds of pain described earlier.
Usually back pain related to overstimulation of the receptors of muscles, joints and ligaments, and it's a pain, nociceptive character. The patient experiences it in a place of occurrence (local pain) helena back (reflected pain). Neuropathic back pain is usually attributed to the fact that is involved in the process Karasek nerve helena spinal ganglion. Such pain carries a chronic character.
Reflects the pain in the back cause diseases of the internal organs (in other words, the viceregency pain).
With regard to the causes of degenerative disc disease, the clinical manifestations of the disease may be associated with hernia of the intervertebral discs helena with a degenerative nerve (pathological) changes in the spine (such as osteoarthritis of the joints of the intervertebral helena education osteophytes).
4 basic clinical syndromes, which can lead each of the following options:
- local local pain;
- the reflected (reflective pain), coupled with the defeat of the muscle pain (fascial) structures;
- root syndrome (radiculopathy), caused by irritation of helena the compression of the Spino-cerebral nerve roots;
- myelopathy – pain resulting from spinal cord compression brain helen of his blood vessels.
Pathological degenerative disc disease
On the basis of the development of degenerative disc disease are a number of pathophysiological mechanisms. The disease develops as a result of degenerative processes, which are charged beginning at an early enough age, and also aseptic inflammation, dystonia, convulsions.
In the case of a root change of the intervertebral disc at the beginning of a damage of the sheath around the nerve fibers (demyelination), then the observed damage to the processes of nerve cells (axonopathy), local reduction of blood supply (ischemia), and further venous stasis. A summary of these processes exacerbates the situation, and if you miss the timely treatment, it sees to the formation of peripheral helena central sensitization.
Most celebrated the defeat of the gelatinous nucleus and the fibrous ring of the intervertebral disc. Mechanical loads lead to the fact that the elastic fibrous ring of the disc loses its elasticity and leads to its swelling. Then through the cracks of fibrous rings is going on loss of land gelatinous core of the spine, i.e. the protrusion of the disc alternates herniated disc.
A Herniated disc is called a solid education, which sohranyaet relationship with the body of the intervertebral disc, but sometimes occurs the loss of his fragments into the spinal canal (the seizure of the disk).
Classification and stage of development of degenerative disc disease
From the point of view of localization are issued to the following types of diseases:
- lumbalgie — pain in the lumbar (lumbar-sacral) of the department back;
- sciatica — pain in the back, gives in the legs;
- lumbago — lumbar cross, i.e. acute intense pain in the lower part of the back;
- torakalgiya — chest pain;
- cervicalgia, cervicobrachialgia — pain in the neck and upper extremities.
Classification of the stages of development of degenerative disc disease:
Stage 1: reduces the amount of moisture, the intervertebral disc loses its elastic and flexible properties and load remain the same. As a result the disc is reduced in height, flattened, occurs swelling.
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2 stage: if the pathology continues to develop, fibrous ring celebrates the formation of cracks, and whereas, the height of the flattened disk has already reduced, the result becomes the unstable condition of the whole of the spinal segment.
3 phases: education gaps in the cartilage tissue of the fibrous rings. Through him, the seeping part of the more liquid core and occurs education herniation of the intervertebral disc. Similar changes can often be found in the lumbar and cervical part of the spine.
For the first time the pain in the presence of a hernia of the intervertebral disc appears when it comes to irritation of receptors of the external layers of the fibrous rings and the posterior longitudinal ligament.
Complications of degenerative disc disease
- The symptom of lumbago. In the early stages it is celebrated the emergence of recurrent pain as a reaction to some action, for example, as a result of sudden movements, lifting weights, heavy load (long walks), a long search in the obezbijede position. This kind of pain is known to many, and is described as "picked up". Vary rare occurrence, strengthening while moving and practically manifests itself in the static position. In this type of pain no serious consequences, and it alone is held during the week.
- Lumbalgie. This kind of pain tends to increase with supercooling, with an intense manifestations during the movement. It is not a response to the load on the spine, when the fixed state is not completed, and when it goes, so the nagging feeling.
- Sciatica. The pain gives to the neighboring department. Lumbar osteochondrosis is characterized by irrationalism pain in the legs, the chest — in the hands of the helena heart; cervical migraine manifests itself.
- Cramps. They are often exposed to the triceps muscle of the tibia. Among other things, celebrates the emergence of a very strong pain when touching the area of the back of helena's feet.
- Coccygodynia. Radiates to the area of the coccyx, helena groin. Pain whining, searing, sterledeva character, which can significantly limit the physical activity of the patient
The diagnosis of degenerative disc disease
The diagnosis of degenerative disc disease involves several steps:
1. The collection of medical history. In this stage are studied and the patient's complaints and history of disease. In an interview with the patient to find out where it is essentially localized discomfort, their intensity, duration, factors, inducing increased painful sensations and helps to ease the pain. In addition, in establishing the diagnosis, an important point is to find out the history of the disease: the emergence of unpleasant sensations and stiffness; identification of the likely causes of their formation; information is collected about previously carried out the treatment and its efficiency, there will be information about the latest focus and the nature of its occurrence. For diagnosis, it is also important to find out in what environment the patient lives and works, how he sees the life style, what are the bad habits he has, what he suffered disease and injury, equally important will be also the records of the hereditary factors.
2. During the physiological examination is carried out evaluation of the position of your patient's body, his walk and movements; skin sheets (on the subject of redness, acne, flaky), carried out by comparing the symmetrical parts of your body to the healthy side and painful; it made the definition of range of motion (sails, circular movements of the torso, the volume of rotational movements in different parts of the spine); detectable painful stretch for the determination of the temperature of the skin, cramping in the muscles, swelling, painful seal; palpation of the deep and superficial layers of muscle allows you to assess the condition of the muscular system (muscle tone, increasing the helena reduction of their volume); by tapping a special hammer helena finger defined by the zone of radiation of pain; with the help of the armor of the needle is determined by the painful sensitivity; at the end held a number of special techniques, detect signs of root tension.
3. Radiography. For a better relevance of the performed research of each spine separately. Performed in two oblique projections and in two mutually perpendicular planes (direct and lateral). In some cases, may assign a function took x-rays when the patient is in the position of flexion, extension helena side of the sail. On special witness for more high-quality result of the study spends with the introduction of contrast agents into the spinal canal, in the sleepy helena vertebrae blood vessels, rescue of the intervertebral disc helen spine: angiography, discography, myelography, pneumomyelografii.
The main x-ray signs of degenerative disc disease believe:
- the pathological mobility of the vertebrae;
- offset of their bodies;
- calcification of the disc (the deposition of salts);
- uniform narrowing of the intervertebral slit in the lumbar and cervical department, and in the thoracic region of the narrowing of the wedge;
- education osteophytes (peripheral stands);
- education on the border with was hit by a disc seal (regional sclerosis).
5. Magnetic resonance imaging (MRI) is based on the fact that applies electromagnetic waves that create the signal characteristic for each tissue. Is processed on the computer and translates it into a graphical representation. Using this method, you can clearly consider, blood vessels, nerve processes, and intervertebral discs without the harmful effects of ionizing radiation on the organism.
Prognosis. Prevention
As practice shows, that for most of the manifestations of degenerative disc disease when properly performed therapy is going on the permit for a period of 6 weeks.
However, the wrong choice of treatment, helen's self can lead to painful, will pass in the chronic form, and contribute to the aggravating changes in the spine in the future.
Upon the occurrence of pain in the back of helena in the extremities, especially the need to turn to a qualified specialist for proper diagnosis and appointment of adequate treatment.
The most effective and efficient manner of treatment of most of the manifestations of back pain is a treatment and injection therapy, but also acupuncture. Physical therapy, including laser, massage, spinal manipulation are slight and unstable effect, and in some cases may be even contraindicated.
Modern methods of treatment of degenerative disc disease are based on the principle of continuity of treatment: this means that the rapid and safe relief of episodes of acute pain with the subsequent incorporation of preventive methods. In order to prevent the emergence and development of degenerative disc disease can particularly recommend the weight reduction (in obesity) and regular physical activity.
Regular lessons with the technique of dynamic muscular stabilization (yoga, pilates within the aerobic load), form the basis of rehabilitation and prevention of back pain, helps to increase the strength and endurance of the muscles of the spine.