Treatment of osteochondrosis in Moscow in accordance with modern standards of therapy

Standard treatment for spinal osteochondrosis

Before moving on to considering methods of treatment for osteochondrosis, it is necessary to dwell on the factors that provoke the development of the disease, as well as its clinical picture.

Disc degradation and vertebral deformities occur because with age, the load distributed between individual parts of the spine changes. This can happen due to the influence of various factors leading to injury to the intervertebral discs. In this case, the pressure on the joints and cartilage in the affected part of the spinal column increases tenfold. This leads to the destruction of discs, and, accordingly, to pinching of nerves and blood vessels.

Among the factors that provoke the risk of osteochondrosis are:

hereditary predisposition;
disorders during intrauterine development of the organ;
age-related changes in cartilage tissue.

With age, the load on individual vertebrae increases, which leads to osteochondrosis with all the ensuing consequences. As a rule, the disease affects people who are professionally involved in sports, or, conversely, who lead a sedentary lifestyle (for example, when working sedentarily at a computer), regularly lifting weights, etc. Disproportionally distributed loads stimulate modifications in cartilage tissue at the points of highest pressure.

The development of osteochondrosis can be triggered by back injuries, curvature of the spinal column, various infections, long-term regular stay of a person in an uncomfortable position, etc.

The development of osteochondrosis can be caused by impaired metabolism, as well as a deficiency of minerals and trace elements.

The gold standard for the treatment of osteochondrosis is conservative therapy. It involves taking medications, physiotherapeutic procedures and physical therapy.

Surgical treatment of osteochondrosis is resorted to only in 1-3% of all cases when there are significant indications for it. Intervention on the spine is a complex manipulation that requires the highest qualifications of a surgeon. In addition, such an operation, even if it is successful, may be accompanied by a number of complications. Therefore, after surgery, the patient spends quite a long time in a hospital setting under the close supervision of medical personnel.

The main areas of treatment for osteochondrosis are:

relieving patients of pain;
elimination of spasm and tightness of muscle tissue;
stopping the inflammatory process.

Without qualified medical care, it is almost impossible to cope with the disease on your own. In addition, self-medication usually leads to complications. Often, with the wrong selection of treatment methods, patients take the disease from the stage of remission to the stage of exacerbation.

Recommendations for the prevention and prevention of osteochondrosis

To prevent osteochondrosis or reduce pain, people suffering from this disease are recommended to spend as much time as possible in a position in which the load on the intervertebral discs will be minimal, and at the same time, they need to stretch their back muscles as often as possible in order to support metabolic processes around the spine. General recommendations boil down to following the rules of a healthy lifestyle; in addition, in each specific case, the attending physician determines specific recommendations.

For prevention, the following rules should be observed:

Do not overload the spine, do not create conditions that increase pressure in the intervertebral discs:
do not make sudden movements, especially turning your body when bending over;
avoid falls and jumps from great heights, injuries and bruises of the spine;
change your body position more often;
keep your back straight;
try to maintain the natural physiological curves of the spine: when lying down, the load on the spine is minimal, but the bed should be semi-rigid (it is advisable to sleep on a solid orthopedic mattress and orthopedic pillow); in a sitting position, keep your back straight using your muscles or pressing it against the back of a chair or armchair (the seat should be quite rigid and the back should have a bend in the lumbar region), keep your head straight; when standing, change the leg on which you lean more often; getting out of bed or from a chair, as well as lying down and sitting down, should be done with the help of your hands without straining or bending your back;
before physical activity, drink water and massage your back, this will speed up the blood, speed up metabolic processes and allow the intervertebral discs to absorb a sufficient amount of moisture;
do not lift or hold heavy objects with outstretched arms; to lift an object, squat down and then stand up with it, while the objects should be as close to the body as possible;
when carrying heavy objects, try to distribute the load evenly, that is, do not carry bags in one hand, etc., if you have to carry an object in front of you, keep it as close to your body as possible, and when passing it, do not stretch your arms forward, and also use for carrying heavy loads, trolleys, bags or suitcases on wheels, backpacks;
when performing heavy work involving lifting, moving or carrying heavy objects, use a wide belt or a special corset;
You should not lift a load of more than 10 kg;
when performing any work, try to bend over and be in a bent state as little as possible and periodically unload the spine (hanging on the crossbar, stretching with raising your arms, resting while lying down);
wear comfortable shoes; women should limit wearing high-heeled shoes;
Regularly perform physical exercises aimed at strengthening and maintaining the muscle corset. Swimming lessons are useful.
Take a contrast shower and harden your body.
Don't get too cold.
Avoid scandals and stressful situations.
Eat right.
Do not smoke.

Author: V.I. Dikul

Drug therapy for osteochondrosis

The course of drug treatment involves taking the following drugs:

chondroprotectors. The action of this group of drugs is aimed at stopping the inflammatory process, as well as normalizing blood circulation and metabolic processes;
analgesics. They relieve pain and improve the quality of life of patients;
antispasmodics;
non-steroidal anti-inflammatory drugs, responsible for the normalization of metabolic processes in tissues, as well as the regeneration of cartilage tissue;
angioprotectors responsible for delivering blood to the spine;
vasodilators;
venotonics that promote better blood flow. They provide dilution of venous blood and prevent the occurrence of stagnation and blood clots.

Physiotherapeutic procedures for osteochondrosis

Osteochondrosis is a disease that requires an integrated approach to treatment. Against the background of drug therapy, doctors at the Yusupov Hospital prescribe various physiotherapeutic procedures to their patients:

electrophoresis;
magnetic therapy;
acupuncture;
laser therapy;
ultrasound therapy;
massages.

Physical therapy is also very effective in the treatment of osteochondrosis. Sometimes it can act as an independent method and lead to a pronounced therapeutic effect without taking any medications.

Standard treatment for spinal osteochondrosis. Order

The standards for providing medical care for degenerative disorders of the spine and spinal cord are set out in Order of the Ministry of Health No. 653n dated November 7, 2012. Anyone can familiarize themselves with its contents, as it is freely available on Internet sources and other resources.

At the clinic, during a consultation, doctors will tell patients about the tactics of treating osteochondrosis and select the most effective treatment plan for each patient, depending on the indications and contraindications, symptoms of the disease, the severity of osteochondrosis, and a number of other factors.

You can make an appointment with a specialist by calling the Yusupov Hospital.

Publications in the media

Spinal osteochondrosis is a disease characterized by the development of degenerative damage to the cartilage of the intervertebral disc and reactive changes in adjacent vertebral bodies and surrounding tissues. Frequency • Every second person experiences characteristic pain in the back or neck during their lifetime • At least 95% of cases of cervical and lumbar pain are caused by spinal osteochondrosis • Spinal osteochondrosis is one of the most common complaints when initially visiting a doctor. The predominant age is 25–45 years.

Risk factors • Spinal anomalies •• Lumbarization or, conversely, sacralization •• Asymmetrical arrangement of the joint spaces of the intervertebral joints •• Congenital narrowness of the spinal canal • Physical overstrain • Vibration, for example, when driving vehicles • Psychosocial factors •• Sedentary lifestyle •• Obesity .

Etiology and pathogenesis • Under the influence of unfavorable static-dynamic loads, the elastic nucleus pulposus, which plays a shock-absorbing role and ensures the flexibility of the spine, begins to lose its physiological properties primarily due to the depolymerization of polysaccharides. It loses water and sequesters over time • Under the influence of mechanical loads, the fibrous ring of the disc, which has lost its elasticity, protrudes, and subsequently fragments of the nucleus pulposus fall out through its cracks: the protrusion is replaced by prolapse - a herniated disc (see Herniated intervertebral disc of the lumbar spine, Herniated intervertebral disc) disc of the cervical and thoracic spine) • In conditions of instability of the spinal segment, reactive changes occur in the adjacent vertebral bodies and in the joints (spondyloarthrosis accompanying osteochondrosis).

Classification. Posyndromic principle - depending on which nerve formations are pathologically affected by the affected structures of the spine, compression and reflex syndromes are distinguished • Compression - tension, compression and deformation of the root, vessel or spinal cord (radicular, vascular, spinal syndromes, respectively) • Reflex: pathological impulses from the receptors of the affected structures of the spine (especially the posterior longitudinal ligament) enter through the dorsal root into the spinal cord, where they are switched to neurons of the anterior and lateral horns of the spinal cord. As a result, the tone increases and the trophism in the corresponding muscles changes.

Localization of the lesion . The most commonly affected areas are the lower lumbar and lower cervical spine. Accordingly, lumbar and cervical spinal syndromes are distinguished.

Clinical picture • Lumbar lesions •• Lumbar reflex syndromes ••• Acute vertebrogenic lumbar pain (lumbago). Pain occurs with physical stress, awkward movement, prolonged strain or cold, and sometimes for no apparent reason. Suddenly or within a few minutes or hours, a sharp pain appears, often of a shooting nature. The pain intensifies with movement, sitting, standing, lifting heavy objects, bending and turning, coughing, sneezing. The pain goes away at rest (lying down). The range of motion in the lumbar region is reduced, the lumbar region is painful on palpation, usually there is a spasm of the paravertebral muscles, flattening of the lumbar lordosis or kyphosis, often with scoliosis ••• Subacute and chronic vertebrogenic lumbar pain (lumbodynia) does not occur acutely, but within a few days. The clinical picture resembles lumbago ••• Lumboischialgia: pain and reflex manifestations caused by osteochondrosis, spreading from the lumbar to the gluteal region and leg. Back pain in the lumbar region with possible irradiation into the buttocks and along the back of the thighs, without reaching the feet ••• Piriformis syndrome: prolonged tonic tension of the piriformis muscle can lead to compression of the sciatic nerve passing under it. In this case, symptoms of irritation usually occur (pain and vegetative disorders in the lower leg and foot), with a long course, however, motor disorders may also occur (flaccid paresis of the muscles of the lower leg and foot) ••• Popliteal syndrome: pain in the popliteal fossa caused by dystrophic changes at the attachment point of the posterior thigh muscles, which is observed when they are overstretched. The latter occurs, in particular, with pathological hyperlordosis of the lumbar spine, accompanied by elevation of the posterior pelvis along with the ischial tuberosity (the origin of the posterior thigh muscles) •• Lumbar compression syndromes: compression of the lumbar roots, cauda equina or accessory radicular-spinal artery of Deproges-Gotteron (see Herniated disc of the lumbar spine).

• Cervical syndromes •• Cervical compression syndromes ••• Spinal cord compression ••• Vertebrogenic cervical myelopathy ••• Radicular compression syndromes (see Herniated intervertebral disc of the cervical and thoracic spine) •• Cervical reflex syndromes ••• Shoots (acute cervical pain) and cervicoalgia/cervicobrachialgia (subacute and chronic pain in the neck/neck and arm). Pain radiates to the back of the head, shoulder girdle; worsen with movements in the neck or, conversely, with prolonged stay in one position. Characterized by tension in the neck muscles, forced position of the head, straightening of the cervical lordosis ••• Humeroscapular periarthrosis: pain in the area of the periarticular tissues of the shoulder joint and limitation of mobility in it, caused by contracture of the shoulder adductor muscles (pectoralis major and minor, subscapularis) ••• Shoulder– syndrome hand - see Steinbrocker syndrome ••• Epicondylosis ••• Anterior scalene muscle syndrome: compression of the neurovascular bundle in the space between the anterior and middle scalene muscles, manifested by swelling and pain in the hand, possible hypoesthesia in the area of innervation of the ulnar nerve and dysfunction of the innervated ones them muscles, as well as weakening of the pulse on the radial artery on the affected side ••• Pectoralis minor syndrome: muscular-tonic and neurodystrophic changes in the muscle cause compression of the distal parts of the brachial plexus passing under it and the accompanying vessels. It manifests itself as pain in the pectoralis minor muscle, sensory disturbances and trophic disorders in the hand and its IV-V fingers ••• Posterior cervical sympathetic syndrome occurs as a result of irritation of the sympathetic plexus of the vertebral artery. It manifests itself as pain in the neck, radiating to the head, cochleovestibular (dizziness, tinnitus) and visual disturbances (photopsia, “fog” before the eyes).

Diagnostics • X-ray examination •• Change in the configuration of this segment •• Shift of adjacent vertebral bodies (pseudospondylolisthesis) •• Deformation of the end plates of adjacent vertebral bodies •• Flattening of the intervertebral disc •• Symptom of “spacer” - in the direct projection, unequal height of the intervertebral disc is detected, due to asymmetric muscle tension • Scanning of the skeletal system (scintigraphy) •• Accumulation of phosphorus labeled with 99Tc reflects the process of active bone mineralization •• Allows to exclude tumor, injury or infection • MRI, CT, myelography are indicated only for persistent symptoms or the development of neurological deficit.

Differential diagnosis • Spondylolisthesis • Inflammatory processes • Ankylosing spondylitis, associated inflammatory spondylopathies and sacroiliac joint damage • Infection - spinal osteomyelitis and inflammation of the discs • Rheumatoid arthritis • Neoplastic processes: primary tumors, metastases • Orthopedic - osteoarthritis of the hip joint • Fractures • Referred pain (diseases of internal organs and blood vessels) - gastrointestinal (peptic ulcer of the stomach and duodenum, chronic pancreatitis, irritable bowel syndrome, diverticulitis), genitourinary (pyelonephritis, urolithiasis, prostatitis), gynecological (pregnancy, endometriosis, ovarian cysts , inflammatory processes in the pelvic cavity), cardiovascular (abdominal aortic aneurysm, intermittent claudication).

TREATMENT Management tactics • Traction treatment • Strengthening the muscular corset (physical therapy) • Impact on pathological reflex processes - muscular-tonic and myofascial. Conservative therapy • Traction treatment • Epidural blockades • Infiltration of spasmodic muscles with procaine solution • Short-acting analgesics • NSAIDs for 10 days, then as needed • Desensitizing agents • Vitamin therapy (pyridoxine, cyanocobalamin) • In prolonged cases - amitriptyline, tranquilizers • Physiotherapy • Manual therapy • Massage • Postisometric relaxation • Acupuncture. Surgical treatment . Absolute indications for surgery • Acute development of the pattern of compression of the cauda equina with motor, sensory disturbances, dysfunction of the pelvic organs • Acute or subacute compression of the spinal cord.

Course and prognosis • Painful vertebrogenic syndromes occur in the form of exacerbations and remissions • Lumbago and cervical lumbago last 1–2 weeks • Secondarily associated diseases can interfere with a favorable outcome • Repeated attacks are often observed, often lasting longer with the addition of new syndromes.

Prevention • Normalization of body weight • Improvement of general physical condition • Precipitating conditions such as heavy lifting, bending, turning, rapid movements or a combination of these should be avoided.

ICD-10 • M42 Osteochondrosis of the spine