The first signs of osteochondrosis

Osteochondrosis is an outdated name for the degenerative disease of the spine.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 - the destruction of tissue structure. In this article we will consider the first signs of osteochondrosis, its development patterns and treatment options.

What is osteochondrosis?

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

• Beads composed of bodies, arches, processes. Between the arches of adjacent vertebrae there are joints called facets
• Intervertebral discs located between the bodies of adjacent vertebrae
• Spinal ligaments
• Longitudinal posterior and anterior 一 pass along the bodies 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, which is located in the spinal canal, along with the nerve roots that extend from it. They are nerve cell processes. 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 much more.

Degeneration begins with the intervertebral discs and as the changes progress, all of the above structures are involved in the process. This is partly due to the fact that the discs have no blood vessels. Nutrients and oxygen penetrate into 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, type II collagen, which holds water. This gives the normal kernel a jelly-like consistency for effective softening. As the degeneration progresses, the composition of the inner part of the disc changes, its water content 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 support the inner part of the disc and protect it from damage. The fibers of the ring 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 diseases, the annulus fibrosus cracks, so instability can develop: adjacent vertebrae can move forward or behind each other. This is dangerous because of the compression 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 the discs. They contain blood vessels that supply the disc. In degenerative diseases, calcium is deposited in the endplates, causing the blood supply to be impaired.

Stages of development of osteochondrosis

The development of spinal osteochondrosis occurs gradually:

• Initial degeneration. The intervertebral disc does not receive enough nutrition, wears out, its height decreases and cracks. The 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
• Swelling of the intervertebral disc. The fibers of the anulus fibrosus are destroyed, the nucleus pulposus protrudes more strongly, forming a hernia. It can compress the nerve roots of the spine, leading to the development of paresis or paralysis of the muscles of the limbs and a decrease in skin sensitivity. One of the complications of a hernia is its sequestration - the separation of the protrusion of the disc from its main part.
• Progression of degeneration of the extension and other structures of the spine. The disc becomes even more compact, and the body tries to compensate for the excess mobility of the spine by forming pathological bony growths of the vertebral bodies - osteophytes. They, like the hernia itself, can affect nerves and ligaments, disrupting their function and causing pain. Unlike a hernia, bone spurs do not dissolve.

Complications of osteochondrosis, in addition to compression of herniated spinal nerve roots:

• Spondyloarthrosis. Decreasing the height of the intervertebral disc places greater 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 in relation to each other due to damage to the ligaments
• Degenerative processes in the area of the ligamentum flavum cause its thickening.  This is dangerous because the ligamentum flavum is attached to the spinal canal and can narrow it, compressing the spinal cord.
• At the level of 1-2 lumbar vertebrae, it extends down from the spinal cord "horse tail" - a bundle of nerve roots responsible for the innervation of the lower extremities and pelvic organs: bladder, rectum, external genital organs. Cauda equina syndrome is one of the most dangerous complications of osteochondrosis, which manifests itself with severe pain, muscle weaknessstanding, 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, aging of the spine begins in every person.

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 destroyed so much that they cease to perform a shock-absorbing function, swell and put pressure on the spinal nerves and even the spinal cord itself.

It is impossible to accurately predict how severe the 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 accurate genetic test that would indicate personal risk. There are several factors that increase the risk of developing osteochondrosis. They are the target of measures for the prevention of osteochondrosis.

Risk factors for osteochondrosis include:

• Excessive load on the spine: professional sports, heavy lifting, regular heavy physical work
• Staying in a static and incorrect position for a long time:  sitting, lying, cross-legged, in a chair without lumbar support, working in a vertical position with an incline
• Sedentary lifestyleleading to weakness of the trunk muscles that cannot effectively support the spine
• Overweight 一 obesity creates additional stress on the back and joints
• Smoking - nicotine and other components of cigarettes inhibit the diffusion of nutrients from blood vessels to tissues, including the intervertebral discs
• Taking alcohol - Regular consumption leads to the fact that calcium is poorly absorbed from food. Calcium deficiency causes loss of bone density
• Back injuries with damage to the structure of the vertebrae or discs, due to which the recovery process occurs much more slowly 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 is in:

• Degeneration in the cervical spine leads to muscle stiffness, neck pain that radiates to the shoulder and arm or the back of the head and worsens with head movements
• Changes in the thoracic spine occur extremely rarely, as it is more static. If a hernia occurs, pain appears between the shoulder blades
• Hernias in the lumbar region appear more often than others and are manifested by pain in the lower back or sacrum, radiating to the gluteal region, legs. Stiffness in the lower back is also noted. The pain worsens when you sit, stand for long periods of time, and bend over.

If the pain radiates from the back to the limbs, 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
• disturbances in the sensitivity of the skin of the extremities
• bladder and rectal dysfunction with lumbar radiculopathy

Signs of spinal osteochondrosis in women and men generally do not differ, but in women, symptomatic degeneration develops faster 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 at a young age

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

• accelerates hernia resorption
• improve disk power
• normalization of biomechanics of movements and load distribution
• avoid the need for surgery in the future

Medications from the groups of nonsteroidal anti-inflammatory drugs, glucocorticoids and muscle relaxants are also used for pain, but the use of medications 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, 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 in 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, accelerating the recovery processes.
• Therapeutic physical education - special sets of exercises help strengthen the muscles of the torso, learn how to correctly distribute the load on the back, maintain the correct 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 completed 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 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.