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Osteochondrosis is an outdated name for degenerative diseases of the spine.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, 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:

• A vertebra consisting of bodies, arches, processes. There are facet joints between the arches of adjacent vertebrae
• Intervertebral discs located between the bodies of adjacent vertebrae
• Spinal ligaments
• Posterior and anterior longitudinal 一 passes anteriorly and posteriorly along the bodies of all vertebrae.
• 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 extending from it. They are processes of nerve cells. Through these processes, the brain receives information about the state of the tissues and in response sends signals that regulate their activity: muscle contraction, changes in the diameter of blood vessels, etc.

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 lack of blood vessels in the discs. Nutrients and oxygen enter them by diffusion from the spines and other surrounding structures.

Intervertebral discs make up one-third of the length of the spine and act 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:

• Inside, the nucleus pulposus, located in the center, contains a lot of hyaluronic acid, collagen type II, which retains water. This gives the normal nucleus a jelly-like consistency for effective cushioning. As the degeneration progresses, the composition of the inner part of the disc changes, its fluidity decreases, the core "dries up" and the height of the intervertebral disc decreases.
• Fibrous ring located outside the nucleus and consisting of 15-25 layers of collagen fibers. The collagen in the annulus fibrosus is type I. It is denser than the nucleus and is needed to hold the inside of the disc and protect it from damage. The ring fibers connect along the periphery with the posterior longitudinal ligament of the spine. This ensures immobility of 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 forward or backward relative to each other. This is dangerous due to the compression of the nerve root between them

It is also important to note the end tiles. These are thin cartilages located between the vertebral bodies and discs. They contain blood vessels that supply the disc. In a degenerative disease, calcium accumulates in the endplates and causes disruption of blood supply.

Stages of development of osteochondrosis

The development of spinal osteochondrosis occurs gradually:

• Primary degeneration. The intervertebral disc is not nourished enough, wears out, decreases in height, cracks. The nucleus pulposus protrudes through micro-damages of the annulus fibrosus, irritates the posterior longitudinal ligament, and causes pain and reflex spasm of the back muscles.
• Bulging of the intervertebral disc. The fibers of the annulus fibrosus are destroyed, the nucleus pulposus protrudes more strongly, forming a hernia. It can compress the roots of the spinal nerve, 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 herniation is its sequestration - separation of the disc protrusion from the main part.
• Progression of degeneration of the protrusion and other structures of the spine. The disc becomes more compact, and the body tries to compensate for the excessive mobility of the spine by forming pathological bone growths of the vertebral bodies - osteophytes. They, like the hernia itself, can affect nerves and ligaments, impairing their function and causing pain. Unlike a hernia, bone spurs do not dissolve.

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

• Spondyloarthrosis. A decrease in the height of the intervertebral disc places more stress on the facet joints. They can develop inflammation and malnutrition, which can make them "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 ligamentum flavum area cause its thickening.  This is dangerous because the yellow ligament is adjacent to the spinal canal and can compress the spinal cord, narrowing it.
• It extends down the spinal cord at the level of the 1st-2nd lumbar vertebrae "ponytail" - a group of nerve roots responsible for the innervation of the lower limbs and pelvic organs: bladder, rectum, external genitalia. Cauda equina syndrome is one of the most dangerous complications of osteochondrosis, it is 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 the degree to which degenerative changes in the spine are considered normal. Every person sooner or later begins to age the spine.

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 development of degeneration causes significant changes in the structure of the spine. The intervertebral discs can be destroyed to such an extent that they stop performing their shock-absorbing function, bulging and putting pressure on the spinal nerves and even the spinal cord itself.

It is impossible to predict exactly 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 precise genetic test that indicates personal risk. There are certain factors that increase the risk of developing osteochondrosis. It is they who are subjected to measures to prevent osteochondrosis.

Risk factors for osteochondrosis include:

• Excessive load on the spine: professional sports, heavy lifting, regular hard physical labor
• Remaining in a static, incorrect position for a long time:  sitting, bending, cross-legged, working in a chair without lumbar support, in an upright position with an inclination
• Sedentary lifestyleleading to weakness of 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 smoking disrupt the distribution of nutrients from blood vessels to tissues, including intervertebral discs.
• Alcohol intake - Regular consumption causes poor absorption of calcium from food. Calcium deficiency causes the spine to lose density
• Back injuries with damage to the structure of the vertebrae or discs, due to which the recovery process occurs 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 occur suddenly or gradually as the disease progresses. The main manifestations are back pain and reflex spasm of the back muscles. The localization of symptoms depends on the part of the spine where the problem occurs:

• Degeneration in the cervical spine causes 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 are rarely seen because it is the most static. If a hernia occurs, pain appears 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, spreading to the gluteal region and legs. Stiffness in the lower back is also noted. Pain intensifies when sitting, standing for a long time and bending over.

If the pain spreads around the back, they talk about radiculopathy - damage to the nerve root. This hernia is a compression by the spinal nerve. Radiculopathy, in addition to pain, is accompanied by other symptoms localized in a certain area supplied by the damaged nerve. Such manifestations may include:

• weakness of the muscles of the extremities, up to paralysis
• disorders in the sensitivity of the skin of the extremities
• bladder and rectal dysfunction with lumbar radiculopathy

Symptoms of spinal osteochondrosis in women and men generally do not differ, but in women after menopause, when bone density decreases, symptomatic degeneration develops more quickly. Degenerative processes in men are more often caused by physical labor 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 the elderly. Degenerative spine disease is actually common among patients over the age of 60, but it is becoming 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-off serious injuries, such as falls, and regular minor injuries, such as those involved in professional sports, are important. The disease occurs most mobile in the lumbar region. Intervertebral tears, including Schmorl's knots, can occur here. The main mechanism of their formation is damage to end plates that cannot withstand intradiscal pressure. This is how protrusions form in the body of the underlying vertebra, called Schmorl's hernias. They do not cause nerve root compression and are usually not dangerous. Rarely, they can grow and cause 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 degenerative disease cases can be treated with conservative methods.

Surgery is indicated only when there is a threat of serious complications such as progressive loss of bladder control or weakness in the lower extremities. Surgical treatment allows to save a person from paralysis, but in itself does not eliminate pain and further development of the disease, therefore, a special rehabilitation program is prescribed after surgery.
Uncomplicated hernias resolve on their own in many cases. The resorption process 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. Available physiotherapeutic methods and special exercises help:

• accelerates the resorption of tears
• improve disk power
• to normalize the biomechanics of movements and load distribution
• avoid the need for surgery in the future

Nonsteroidal anti-inflammatory drugs, glucocorticoids, and muscle relaxants are also used for 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 degeneration by:

• MLS laser therapy - the laser beam used has an anti-inflammatory effect, expands lymphatic vessels, and improves lymphatic drainage.
• Acupuncture - this method eliminates pain, swelling and inflammation due to the body's reflex response 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 recovery processes.
• Therapeutic physical training - special sets of exercises help to strengthen the muscles of the body, distribute the load correctly on the back, maintain the correct posture and eliminate muscle spasms. It is better to start working with an instructor to monitor the performance, 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 in an outpatient clinic. It has all the necessary equipment and a team of professionals specialized in non-surgical hernia treatment. It is not recommended to apply to hospitals where they use methods that have no scientific basis and have not been approved by the world medical community - this can be dangerous to health. In a modern clinic, you can get an affordable consultation and choose the next course of action together with your doctor.