TREATMENT AND RESTORATION OF THE MUSCULOCAL SYSTEM

Often, with diseases of the spine, patients are very afraid of spinal surgery, believing that it is dangerous to health. The good news is that ninety percent of people who have problems in the spine (disc protrusion, osteochondrosis, spondylosis, disc herniation, scoliosis, kyphosis) and chronic back pain will never need spinal surgery, since most problems are resolved with using conservative treatment. Conservative treatments for back or neck pain include a wide range of treatment options, from conventional medications to more unusual techniques such as acupuncture or biofeedback. Treatment of the spine can be carried out using several methods simultaneously, although in some cases it is more optimal to use sequential methods. The goal of spine treatment is to make the most of less invasive treatment options, while more invasive treatment options are considered when conservative options fail.

Acute and chronic pain

Back pain can be divided into two categories: acute and chronic. Although traditionally chronic pain was defined as pain lasting more than six months, health care professionals have recently viewed chronic pain as persistent pain after the initial tissue damage has resolved. For example, pain after spinal surgery may take six months to be classified as chronic, but pain after a simple sprain may be classified as chronic much sooner.

Causes of spinal diseases

• Wrong lifestyle. It leads to problems in the functioning of the musculoskeletal system in most cases. Most often, low physical activity adversely affects the spine.
• Overweight. In this case, the spine cannot cope with excessive load.
• Hard physical labor. Constant excessive loads also lead to unpleasant consequences.
• The appearance in childhood of diseases associated with improper posture. These include scoliosis and other disorders.
• Bad habits. Alcohol and smoking negatively affect the musculoskeletal system.
• Lack of vitamins. Some musculoskeletal diseases are associated with a lack of important nutrients.

Passive and active treatment

There is a definite difference between passive and active treatment. Initially, these treatments can be used in combination to restore the patient's mobility more quickly, but in the long term, active treatments have a more lasting effect on the health of the spine.

Passive treatment

Passive techniques are used initially to reduce pain so the patient can prepare to resume activity. These procedures, such as ultrasound, TENS, etc., are aimed at reducing pain, while the real treatment is to restore the correct pattern of movements by strengthening the musculo-ligamentous system.

Active treatment

The active part of treatment is physical exercise, including stretching, strengthening and endurance components. Stretching helps improve flexibility and range of motion. Weight or resistance exercises are necessary to increase muscle strength. Strengthening muscles helps relieve stress on the spine and joints. Strengthening the spinal column is of particular importance for the treatment of back diseases. The so-called “dynamic stabilization” helps reduce the vectors of force loads on the spine, discs and nerves. To improve endurance, long repeated movements are used - this increases resistance to aerobic exercise and also reduces pain.

How to increase the effectiveness of drug therapy

To increase the effectiveness of drug treatment, patients are often prescribed manual therapy. Thanks to it, it is possible to reduce the dosage of prescribed medications, reduce the frequency and severity of pain, and also significantly speed up the body’s recovery processes and often avoid surgery.

A huge advantage of manual therapy is the ability to provide a complex effect on the body. This allows not only to effectively combat diseases of the spine, but also to eliminate their inevitable consequences in the form of disruptions in the functioning of internal organs, the quality of functioning of which is directly related to the condition of the spine.

The method has a small number of contraindications and can even be used to improve the condition of patients for whom medication is contraindicated.

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Conservative treatment

Medical and alternative treatments

Alternative treatments usually refer to non-traditional medical interventions that do not have a sufficient scientific evidence base. However, alternative medicine is becoming increasingly popular and is often used in spine treatment. The line between traditional and alternative treatments is becoming more blurred every year. A good example is the increased popularity and use of medical acupuncture.

Regardless of the conservative approach, greater success is achieved when patients actively participate in treatment, focusing on restoring function rather than just pain management.

Medications

Drug therapy is the most common method of treating both acute and chronic pain in the spine. Some medications not only relieve pain, but also reduce inflammation or help reduce muscle spasms. Typical categories of drugs that may be used in spine treatment include:

• Acetaminophen (analgesic)
• Nonsteroidal anti-inflammatory drugs (NSAIDs) (including aspirin, ibuprofen, naproxen and others)
• COX-2 inhibitors (Celebrex)
• Muscle relaxants (Flexeril, Zanaflex, Skelaxin and others)
• Antidepressants (Elavil, Pamelor, Cymbalta and others)
• Anticonvulsants (Neurontin, Lyrica and others)
• Analgesics (tramadol, Darvocet)
• Opioid analgesics (hydrocodone, oxycodone, OxyContin)
• Physical therapy and exercise

Diagnostics

To determine an accurate diagnosis, you may need to undergo the following tests:

• radiography – obtaining an overview image;
• pneumomyelography is a radiology method based on the injection of a coloring liquid into the spinal canal after a spinal puncture;
• angiography is a study involving the introduction of contrast into an artery: carotid or vertebral;
• myelography - fluid is injected into the subarachnoid spinal canal;
• discography – study of a specific disc using contrast fluid;
• spiral CT;
• MRI;
• Doppler ultrasound – a study to determine the degree of patency of a large artery located in the spine;
• Electromyography – study of peripheral nerves.

Exercise therapy

Exercise is considered the mainstay of treatment in conservative spine treatment. If there is pain in the back or leg, a person significantly reduces the range of motion in order to reduce the pain.

However, prolonged bed rest or immobilization causes deterioration, muscle wasting and joint stiffness, leading to a pathological cycle of pain and weakness, so immobilization should be limited.

Back strengthening and stretching exercises should be started as soon as possible. These exercises should not cause pain in your back, neck or limbs. Exercises can be recommended by any doctor, but it is better if the exercise program is selected by a physical therapy doctor and the selection is made taking into account the specific problems of each patient. In addition, changing the distribution of load vectors on the spine through weight loss, correct body mechanics and achieving correct ergonomics at work and at home is of great importance. This comprehensive approach to physical activity allows you to avoid re-injury or worsening pain.

Recommendations for selection

Let's look at what types of spinal diseases there are, which metropolitan clinics treat them, and what to look for in order to choose the best one.

Specifics of diseases of the spinal column

Causes of spinal diseases:

• excess weight - it is caused by poor nutrition and a sedentary lifestyle;
• insufficient physical mobility - especially typical for residents of cities with a population of one million people who spend a lot of time in transport, sitting at the computer;
• strong physical activity - lifting weights provokes the occurrence of hernias;
• bad habits;
• lack of vitamins;
• weak back muscles.

As a result, dystrophic and degenerative processes develop, deviations and disorders begin.

Ailments of this type have similarities:

• problems with movement are felt;
• long-term development;
• increase in negative manifestations;
• do not go away on their own, without the intervention of doctors.

Types of diseases:

1. degenerative-dystrophic - impaired blood supply, destruction of cartilage and bone tissue (example - osteochondrosis);
2. traumatic - falls, blows, excessive loads (fracture, bruise, hemorrhage);
3. tumors, vascular - lesions of intervertebral joints (hernia, protrusion, displacement of discs, vertebrae);
4. inflammatory - penetration of infection leading to dysfunction of the spine (abscess, osteomyelitis);
5. peripheral nervous system - as a result of pathologies (sciatica).

At the clinic, the patient undergoes an examination by a vertebrologist, complete diagnostics (CT, MRI, ultrasound, x-ray), receives a conclusion on the disease, a treatment regimen, and rehabilitation advice.

Criterias of choice

Type. Medical institutions based in city clinics are state (budget) and offer free services; private (commercial), treatment is provided for a fee. Which type is better depends on the qualifications of doctors, technical equipment, and attitude towards patients. In practice, private clinics are comfortable, efficient, competent in service, and the services are inexpensive. State clinics are burdened with excessive workload, as a result of which there are queues, and there are always no coupons for the required employee. Many are in need of major repairs and serious modernization of equipment.

Location. In order not to spend half a day traveling to the clinic and back, people tend to choose the one that is closer to home. It’s good when the clinic is near the metro station, or with spacious parking for visitors’ personal vehicles. Before you go, it is advisable to find out how to get there so that unnecessary difficulties do not arise.

Doctors. The popularity of the medical institution is due to the qualifications of the staff. Many metropolitan clinics are known in the city and the Moscow region thanks to competent specialists who use effective techniques that show the effect of getting rid of problems. Such doctors are recommended and people seek to see them.

Specialization. In addition to multifunctional medical centers, new highly specialized clinics are opened every year, where more and more patients choose to undergo examinations, therapy, and operations. They are equipped with the necessary equipment from the best manufacturers of medical equipment; surgical procedures of any complexity are available to them. The staff is staffed by narrow specialists, who are distinguished by diagnostic intuition and a wealth of specialized knowledge. This helps to carry out complex treatment and achieve a positive result without side effects.

Price. There is no shortage of clinics for treating spinal pain on the medical services market in the capital. Therefore, even popular establishments do not inflate prices, offering reasonable costs for diagnostics, therapy, and surgical treatment. You can find out how much this or that manipulation costs on the clinic’s official website or call the hotline number. The list of paid procedures is provided by the administrator at the registration desk.

Tips for visiting a vertebrologist

Throughout our lives, we notice pain in the spinal column, but this is not always a signal to visit a doctor.

Three decisive signs when this is necessary:

1. Change in the nature of pain: an alarming sign is the appearance of frequent, severe, regular pain in the vertebrae and joints.
2. Fatigue, decreased performance and endurance of the body.
3. Limitation of flexibility, mobility, the appearance of crunching, clicking in the joints during everyday movements.

The sooner you contact a specialist, the higher the chances of eliminating adverse symptoms and returning to health.

Spinal injections

A variety of spinal injections can be used to diagnose and/or treat pain in the cervical, thoracic, lumbar, and sacrococcygeal spine. Spinal procedures can be classified as either diagnostic or therapeutic, although some may be performed to achieve both.

These injections use an anesthetic and/or steroid drug. Spinal injections are best performed with the help of imaging techniques to ensure accuracy of the procedure. All injections performed for therapeutic purposes are intended to reduce inflammation and relieve pain. The type of injection depends on the specific diagnosis and the cause of the symptoms.

Epidural block

An epidural steroid injection is a procedure in which a steroid drug is injected into the epidural space. There are different methods used depending on whether there have been previous surgeries and the anatomy of the injection area. A selective nerve root block (SNRB) is very similar to an epidural injection, but without the use of a steroid. This injection, used for diagnostic purposes, relieves pain for several hours and helps determine the location of the source of pain.

Block of the medial branch of the root

There are small joints on each side of the vertebrae that connect the vertebrae, and changes in these joints can be a source of pain. When joint pain is diffuse and does not correspond to a specific nerve root structure, a medial branch root block may be used to diagnose pain that is caused by the facet joints. The gold standard is an injection into the facet joint and/or medial ramus. Intra-articular facet injection is a procedure in which a drug is injected into a joint and is usually therapeutic. Injections may also be used to treat sacral joint (SI) pain, which often occurs after acute trauma, pregnancy, and in patients with lumbosacral fusion. Injection into the joint capsule is therapeutic and diagnostic.

Physiotherapy.

This method of treating the spine is relevant both for acute pain syndrome and for rehabilitation. For acute pain syndrome, physiotherapy such as cryotherapy, chivamat, and electrophoresis are effective. Methods such as HILT therapy, shockwave therapy, etc. are successfully used to treat chronic conditions.

Manual therapy and osteopathy

can be used to identify symptoms and diagnose spinal problems and are usually effective when used in conjunction with active therapy, such as a consistent exercise program, that helps restore spinal function.

Traction therapy

. The method of spinal traction using special equipment is used to treat radicular syndrome and, by increasing the distance between the vertebrae, can reduce the compression effect on the root.

Massage.

This method of treating the spine is used very often to reduce muscle tension and improve local blood flow.

Acupuncture.

This method is quite often used in the treatment of diseases of the spine and, in combination with other techniques, can relieve pain and restore sensitivity.

Prolotherapy.

This treatment method improves the regeneration of damaged tissue in diseases of the spine.

Biofeedback

. In particular, psychotherapy can help reduce pain medication use and increase activity levels by changing behavior through changes in thoughts and self-awareness.

Disadvantages of drug therapy

Drug treatment of spinal diseases also has significant disadvantages. First of all, this is the development of side effects. Sometimes they are so pronounced that they cause more discomfort to patients than the disease itself. While taking medications, the following may develop:

• allergic reactions;
• inflammatory processes in the gastrointestinal tract, peptic ulcer;
• dizziness, headaches;
• nausea, vomiting, constipation, diarrhea;
• menstrual irregularities;
• increased blood pressure, etc.

Many modern medicines are expensive and remain inaccessible to a wide range of people. In addition, they must be taken over a long period of time and, unfortunately, this does not always give good results. Sometimes, even despite all the efforts, correctly selected drug therapy and the patient’s compliance with all the doctor’s recommendations, the disease progresses and requires surgical intervention.

Surgical methods of treatment

When conservative methods of treating the spine are ineffective, it is advisable to consider surgical treatment.

Spine surgery is usually used when there is compression of the roots (spinal cord) or when there is instability of the motion segments. Surgical treatment is only considered in cases where the source of the pain, such as a herniated disc, scoliosis or spinal stenosis, is clearly identified.

Before a patient agrees to undergo surgical treatment, it is recommended to undergo consultation with several neurosurgeons, which will allow an informed decision to be made about the treatment that will best help restore a normal lifestyle and the desired level of physical activity.

Open surgery or minimally invasive surgery?

Traditionally, spine surgery is usually performed as open surgery. This entails a large dissection of tissue for surgical access so that the surgeon can see the pathology and gain access to the anatomical structures of the spine. However, modern technologies are expanding the possibilities of minimally invasive surgical methods for treating the spine every year.

Because minimally invasive spine surgery does not involve large incisions and displacement of the muscles and tissues surrounding the spine, it significantly reduces surgical time. In addition, minimal tissue damage can significantly reduce pain after surgery and speed up recovery.

Recovering from a spinal injury using exercise equipment

Working with such disorders is one of the main directions of rehabilitation, therefore, a significant place in the recovery of patients is given to methods of robotic rehabilitation for spinal injuries. High-tech equipment during training builds feedback with the patient at the biological level. It has a virtual interface that helps assess motor functions before and after training, as well as create an effective individual program and properly motivate the patient throughout the course.

Special simulators for restoring mobility and walking after a spinal cord injury in Moscow in our center significantly reduce the duration of treatment, help to qualitatively consolidate the successes that are especially difficult for patients, and thereby strengthen their confidence that they are able to overcome the consequences of the injury.

Imaging methods for spine surgery.

Surgical interventions under X-ray control allow surgical manipulations to be carried out quite accurately, and this, for example, allows the installation of cages or implants with much greater accuracy than under visual control. Typically, a CT scan is performed preoperatively, and intraoperatively, the patient's intraoperative and preoperative images are compared to provide real-time anatomical positioning and guidance for the surgical approach. Preoperative computed tomography (CT) scanning and intraoperative fluoroscopy (real-time x-ray examination) are commonly used as they allow surgeons to perform operations with the highest level of accuracy and safety.

Not all patients are candidates for minimally invasive CT-guided surgical procedures. In some cases, extensive open surgery is necessary.

Basic surgical techniques

• Discectomy or microdiscectomy
  : removal of a herniated intervertebral disc to decompress the root. Microdiscectomy is a procedure performed under CT guidance.
• Laminectomy:
  Removal of a thin plate of bone from the back of a vertebra to increase space within the spinal canal and relieve pressure on the spine.
• Laminotomy
  : removal of part of the vertebral arch (lamina) that covers the spinal cord. A laminotomy removes less bone than a laminectomy.
• Both laminectomy and laminotomy are decompression procedures. Decompression usually means that the compressive effect on the spinal root is removed.
• Foraminotomy:
  Removal of bone or tissue near/in the foraminal canal where the spinal roots exit the spine.
• Disc replacement:
  As an alternative to the fusion procedure, the damaged disc is replaced with an artificial one.

• Spinal fusion
  : A surgical technique used to connect two vertebrae. Vertebral fixation may include the use of bone graft and instrumentation (eg, rods, screws). There are different types of bone graft, such as the patient's own bone (autograft) and donor bone (allograft).

Classification

Spinal diseases primarily affect the nervous system. Neurological pathologies are divided based on the reasons that provoked them:

• congenital anomalies affecting the number and relative position of the vertebrae;
• dystrophy, metabolic type lesions (osteochondrosis, spondylosis);
• damage resulting from trauma;
• oncology (malignant and benign neoplasms);
• inflammation caused by viruses, bacteria and parasites (syphilitic and tuberculous spondylitis, mycosis, ankylosing spondylitis).

There is a classification of diseases according to the area affected.

The following syndromes are characteristic of the cervical and thoracic spine:

• reflex;
• muscular-tonic;
• neurodystrophic;
• radicular.

Among the diseases of the lumbar region are:

• lumbago;
• coccydynia;
• osteoporosis;
• fibromyalgia;
• spinal cord canal stenosis.