The first signs of osteochondrosis

Osteochondrosis is an outdated name for degenerative spine disease. The old term is often used in our country, but does not reflect the essence of the disease, which is based on age-related degeneration - the destruction of tissue structures. In this article we will consider the first signs of osteochondrosis, the pattern of 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:

• A vertebra consisting of a body, arch, process. Between the arches of adjacent vertebrae there are joints called facets
• Intervertebral discs are located between adjacent vertebral bodies
• Spinal ligaments
• Posterior and anterior longitudinal 一 passes through the body of all the vertebrae in front and back
• Ligamentum flavum - connects adjacent vertebral arches
• Supraspinous ligament and interspinous ligament - connect the spinous process
• 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 this process, the brain receives information about the state of the tissue, and in response sends signals that control its function: muscle contraction, changes in the diameter of blood vessels, and more.

Degeneration begins with the intervertebral disc, and as the changes progress, all of the above structures are involved in the process. This is partly due to the fact that the disc has no blood vessels. Nutrients and oxygen penetrate into it from the vertebrae and other surrounding structures through diffusion.

Intervertebral discs make up one-third of the spine's length and function 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 retains water. This gives the normal core a jelly-like consistency for effective cushioning. As degeneration progresses, the composition of the inside of the disc changes, its water content decreases, the core "dry", 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 the core and is needed to hold the inside of the disc and protect it from damage. The fibers of the ring interlace along the periphery with the posterior longitudinal ligament of the spine. This ensures the immobility of the spinal structure 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 anteriorly or posteriorly relative to each other. This is dangerous because it pinches the nerve root between them

It is also important to mention the end plate. This is the thin cartilage that lies between the vertebral body and the disc. It contains the blood vessels that supply the disc. In degenerative diseases, calcium is deposited in the endplate, causing the blood supply to be disrupted.

Stages of development of osteochondrosis

The development of osteochondrosis of the spine occurs gradually:

• Early degeneration. The intervertebral disc does not receive enough nutrition, wears out, its height decreases, and it cracks. The nucleus pulposus protrudes through micro damage to the annulus fibrosus, irritating the posterior longitudinal ligament and leading to pain and reflex spasm of the back muscles
• Bulging intervertebral disc. Fibrous fibers of the annulus are destroyed, the nucleus pulposus protrudes more strongly, forming a hernia. It can compress the spinal nerve roots, which leads to the development of paresis or paralysis of the muscles of the limbs and decreased skin sensitivity. One of the complications of a hernia is its absorption - the separation of the protrusion of the disc from its main part.
• Progression of degeneration of protrusions and other structures of the spine. The disc becomes more compact, and the body tries to compensate for excessive movement of the spine by forming pathological bone growth of the vertebral body - osteophytes. They, like the hernia itself, can affect nerves and ligaments, disrupting their function and causing pain. Unlike hernias, bone spurs do not dissolve.

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

• Spondyloarthrosis. The reduced height of the intervertebral disc places greater pressure on the facet joints. They can suffer from 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 yellow ligament is adjacent to the spinal canal and can narrow it, compressing the spinal cord
• At the level of the 1st-2nd lumbar vertebrae, it extends downward from the spinal cord "horse tail" - a group of nerve roots responsible for the conservation of the lower part of the legs and pelvic organs: bladder, rectum, external genitalia. Cauda equina syndrome is one of the most dangerous complications of osteochondrosis, which is manifested by severe pain, muscle weakness in the legs, numbnessperineum, urinary and stool incontinence.

Causes of back osteochondrosis

There is still no consensus on the level of degenerative changes in the spine that should be considered normal. Sooner or later, aging of the spine begins in everyone.

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 leads to significant changes in the structure of the spine. The intervertebral disc can be destroyed until it stops performing its function of absorbing shock, bulging and putting pressure on the spinal cord 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 mutation responsible for the course of the disease has not been identified. Therefore, there is no accurate genetic test that will indicate personal risk. There are certain factors that increase the risk of developing osteochondrosis. It is they who are targeted by measures to prevent osteochondrosis.

Risk factors for osteochondrosis include:

• Excessive load on the spine: professional sports, weight lifting, frequent hard physical work
• Remaining in a static and incorrect position for a long time:  sitting, bending, cross-legged, on a chair without lumbar support, working in a vertical position with an inclination
• Sedentary lifestyleleading to weakness of the trunk muscles that cannot support the spine effectively
• Excess body weight 一 obesity creates additional pressure on the back and joints
• Smoking - nicotine and other components of cigarettes interfere with the diffusion of nutrients from the blood vessels into the tissues, including the intervertebral discs
• Alcohol consumption - Frequent consumption leads to the fact that calcium is less absorbed from food. Lack of calcium causes the vertebrae to lose density
• Back injury with damage to the vertebral or disc structure, which causes the recovery process to occur 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. It occurs suddenly or gradually as the disease progresses. The main manifestation is back pain and reflex spasms of the back muscles. The localization of symptoms depends on the part of the spine where the problem occurs:

• Degeneration in the cervical spine leads to muscle spasms, neck pain radiating to the shoulders and arms or the back of the head and worsening with head movement
• Changes in the thoracic spine appear very rare, 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 indicated by pain in the lower back or sacrum, radiating to the gluteal region, to the legs. Stiffness in the lower back is also noted. Pain worsens when sitting, standing for long periods of time and bending over.

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

• weakness of the muscles of the limbs, until paralysis
• disturbances in the sensitivity of the skin of the feet
• bladder and rectal dysfunction with lumbar radiculopathy

The symptoms of osteochondrosis of the spine in women and men are generally not different, but in women, the degeneration of symptoms develops faster after menopause, when bone density decreases. In men, the degenerative process is more often caused by physical labor and develops from an earlier age, but gradually.

Not all back pain is caused by osteochondrosis of the spine. Our experts can conduct a full 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 older people. Degenerative spine disease is 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 a genetic predisposition, being overweight, a sedentary lifestyle or a back injury. Both severe injuries, for example, from a fall, and common minor injuries, for example, while playing professional sports, are important. The disease most often occurs in the lumbar region as it is the most mobile. Intervertebral hernias, including Schmorl's nodes, can form here. The main mechanism of their occurrence is damage to the end plate, which cannot withstand intradiscal pressure. This is how a protrusion is formed into the vertebral body above or below it, called Schmorl's hernia. They do not cause nerve root compression and are usually harmless. In rare cases, they can grow and lead to back pain, but more often they are found incidentally during an MRI. An intervertebral hernia that protrudes backwards is 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 serious complications threaten, such as progressive loss of bladder control or weakness in the lower legs. Surgical treatment allows you to save a person from paralysis, but by itself does not relieve pain and the further development of the disease, therefore, after the operation, a special rehabilitation program is prescribed.
Uncomplicated hernias in many cases resolve on their own. The resorption process may be accompanied by the formation of excessive connective tissue and calcification in the spine, which increases the likelihood of disease recurrence in the future. Existing physiotherapeutic techniques and special exercises help:

• accelerate the absorption of the hernia
• increase disk power
• normalize the biomechanics of movement and load distribution
• avoiding the need for surgery in the future

For pain, drugs from the group of nonsteroidal 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 the 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 body's reflex response to stimulation of biologically active points on the body with special needles
• The magnetotherapy method stimulates blood flow, normalizes the distribution of nutrients and removes toxins from the thickness of the intervertebral disc, speeding up the recovery process
• Therapeutic physical education - a special set of exercises helps to strengthen the trunk muscles, learn how to properly 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 training yourself according to the recommendations

Depending on the manifestation of the disease and the characteristics of the patient, different combinations of the above methods can be used.

Both conservative treatment of spinal hernia and postoperative rehabilitation can be completed on an outpatient basis in the clinic. It has all the necessary equipment and a professional team that specializes 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 a reasonable price and choose further actions together with your doctor.