Vertebral concrescence is a serious disease in which adjacent elements of the spinal column partially or completely fuse together. Pathology can occur during fetal development or as a result of injury.
Concrescence (blocking or fusion) of the vertebrae in the thoracic region is diagnosed extremely rarely. A disease in which fragments of the spinal column are fused at the level of the neck is more common. Doctors call this pathology Klippel-Feil syndrome. This defect is manifested by a shortening of the neck, limited mobility and a low border of hair on the neck.
Basic information about the disease
Sometimes the fusion of bone tissue is a normal variant. For example, as a person grows older, the pelvic bones grow together and become stronger. Concrescence of cervical vertebrae, fragments of the coccygeal or lumbar region is a pathology. There is no need to worry if cartilage tissue is replaced by bone tissue as you grow up. In this case, blocking of the vertebrae is normal.
Blocking of the vertebrae occurs when adjacent fragments merge with the spinal column. With complete synostosis (continuous connection of bones with bone tissue), the vertebral bodies, their processes and arches are blocked. In this case, the spine does not bend. Partial concrescence is manifested by incomplete damage to fragments of the spine.
Doctors distinguish 2 types of vertebral blocking in the cervical spine:
- Concrescence of the first and second vertebrae (C1 and C2) is associated with non-fusion of their arches.
- When the C1 vertebra and the occipital bone are fused, the height of the spine is lower than normal.
In some cases, fusion of the arches and processes of the vertebrae with the ribs and other adjacent bones is observed. Concrescence of the cervical, coccygeal or lumbar vertebrae occurs due to underdevelopment or absence of intervertebral tissue. Why the pathology occurs is still not known. According to doctors, the disease usually forms during intrauterine development.
It happens that the fetus receives a “harmful” gene from the mother, father, or both parents at once
Partial or complete blocking of the elements of the spinal column manifests itself even during the period of intrauterine development. Depending on the time when the deviation was detected, doctors distinguish its 3 phases:
- From 15 to 20 weeks of gestation.
- From 25 to 30 weeks.
- Blocking of the vertebrae after birth.
In some cases, spinal development disorders in the fetus can be diagnosed from 5 to 7 weeks of pregnancy. During this period, the vertebral discs have already formed, and its structures become more distinct.
Types of vertebral concrescence
Congenital pathology is relatively rare. It is diagnosed during screening at 20 weeks of pregnancy. Much more common is incomplete concrescence of the vertebral bodies, formed during the rehabilitation period after undergoing surgery to remove a segment of a damaged intervertebral disc.
Unfortunately, complete restoration of lost mobility of the vertebral bodies cannot be achieved even with timely treatment. But rehabilitation after surgery to fuse adjacent vertebral bodies eliminates the risk of complications and repeated recurrences of intervertebral hernia.
The most common type of pathology is partial concrescence of the vertebrae; it is characterized by the following features:
- mobility is lost, but some of the joints retain their mobility, which allows the patient to effectively adapt to everyday physical activity;
- hemodynamics in the cervical spine are not disturbed and posterior vertebral artery syndrome does not occur;
- Narrowing of the spinal canal due to protrusion of the intervertebral disc in the segment where fusion has not completely occurred is rarely observed.
With partial concrescence of the vertebral bodies, the transverse, arcuate and spinous processes remain free and mobile. Therefore, there is no effect of sweaty immobility. Complete fusion poses the greatest danger if it is associated with assimilation of the atlas by the occipital bone. In this case, even incomplete fusion of the vertebrae leads to the inability to make rotational movements with the head, bend back, etc. Klippel-Feil disease develops in the prenatal period. It cannot be purchased. It affects up to 5 cervical vertebrae simultaneously.
Factors in the development of pathology
There are several reasons why the thoracic vertebrae or C2 - C3 (cervical) are blocked in patients of a younger age category: infectious diseases that the mother experienced during gestation, transmission of a “harmful” gene from parents, various injuries, negative influences radioactive radiation on the body. It happens that spinal concrescence is a consequence of other similar diseases (formation of an extra vertebra).
Blocking of fragments of the spinal column occurs due to injury, after which the cartilage or periosteum is damaged. The pathology is manifested by ossification of the anterior longitudinal ligament after a marginal fracture or dislocation of the vertebral body. To avoid concrescence, careful diagnosis should be carried out after various injuries (bruises, fractures). It is important to identify cracks and broken bones in a timely manner and carry out proper treatment.
Elements of the spinal column in the cervical, thoracic or lumbar region can grow together for the following reasons:
- Infectious inflammation of the bone, periosteum and bone marrow.
- An infection of the abdominal organs caused by Salmonella typhoid.
- Brucellosis.
- Tuberculosis.
- Dystrophic damage to intervertebral discs and other tissues of the spinal column.
After identifying any of the above diseases, a thorough examination should be carried out.
Concrescence (fusion) of the thoracic vertebrae
Acquired concrescence of the thoracic vertebrae can be observed in people suffering from scoliosis and kyphoscoliosis of the 2nd and 3rd degrees. The displacement leads to partial fusion of the thoracic vertebrae, which further distorts the spinal column.
Incomplete fusion of the thoracic vertebrae is usually observed in the left or right lateral projection. If this clinical sign is detected, surgery is indicated to remove bone growths and restore mobility. Then a course of rehabilitation treatment and posture correction using manual therapy methods is carried out.
Signs of this pathology:
- impaired mobility in the thoracic spine;
- constant dull pain in the back and chest;
- restriction of rib movements when taking a deep breath;
- feeling of lack of air;
- muscle weakness in the upper limbs.
Diagnosis is carried out using an x-ray image, which shows complete closure of the intervertebral spaces and partial or complete fusion of bone tissue.
Symptoms
If the pathology was diagnosed after the birth of the child, then its main symptom is limited mobility in certain parts of the spine and a decrease in their size. Fusion of the vertebral bodies can be identified by the following symptoms:
- Neck curvature.
- Low hair growth limit on the neck.
- Deformation of the skull.
- Glottic stenosis.
- Increased location of the scapular zone.
- Skin sensitivity disorders.
- Restriction of movement of the upper and lower extremities.
- Functional disorders of internal organs.
As mentioned earlier, to identify pathology, you should undergo a thorough diagnosis
Diagnostics
This disease is diagnosed by the initial method - fluoroscopy of the cervical area. It is the x-ray that will help you see the full picture and determine the type of pathology.
There are two main types of concrescence.
The first is the fusion of two or four cervical vertebrae into a bone monolith. In this case, cleft arches and other defects of the vertebral region in the neck area are quite often recorded.
The second involves the fusion of only the first vertebra with the cranial occipital bone.
In addition to X-rays, if the diagnosis is in doubt or the case of pathology is severe, the patient is examined using a magnetic resonance imaging scanner, which allows one to examine the smallest details and clearly outlines the size of the abnormal area.
Computed tomography makes it possible to see bone tissue in different projections with high clarity.
To confirm the diagnosis, the patient undergoes ultrasound, radiography, MRI, rheoencephalography, genetic research, electrocardiogram
Only after an absolute comprehensive examination do doctors begin treatment planning.
Treatment methods
Concretion of spinal column fragments is treated with conservative methods. Taking medications to relieve pain. Any medications are taken for medical reasons. In addition, spinal stretching treatment is performed. During the procedures, special devices are used.
Therapeutic physical training helps restore mobility of the spinal column. Gymnastics is an important component of complex treatment that should not be ignored. Otherwise, it will continue to deform, which threatens to weaken the muscles. The set of exercises is determined by the doctor. During exercise therapy, the patient should avoid sudden movements.
Massage can be performed by health care workers or loved ones. For example, if a child is sick, the session can be conducted by the parents after consulting a doctor. When blocking the second and third vertebrae in the neck, it is necessary to wear special devices (Schanz corset).
Acupuncture, massage of internal organs, manual therapy of the spine. In advanced cases, surgical intervention cannot be avoided, which does not guarantee complete physical recovery. As a rule, surgery helps eliminate only cosmetic defects.
Traction is an effective method of therapy
Recovery prognosis
Unfortunately, the prognosis for a complete recovery in the presence of such a diagnosis as concretion of the cervical vertebrae is very small, since it is mainly associated with a variety of secondary genetic problems. Patients will have to devote their entire lives to treatment, but no real result will ever arise. .
Concrescence of the vertebrae can be complicated by degenerative disorders. In addition, as you grow older, , such as scoliosis, can occur
This unfavorable conclusion is due to the fact that concrescence is precisely the initial fusion of the vertebrae, without the possibility of their separation.
Even if after surgery you simply remove one or another area, it will not change anything, because even though the anomaly itself was eliminated, the problems that it brought: for example, diseases of the internal organs, have not gone away.
However, the prognosis is much more favorable if the disease is acquired. In this case, the problem can be solved operationally without the presence of any third-party factors.
Complications of the disease
In the absence of proper treatment for vertebral concrescence, the likelihood of dangerous consequences increases:
- Paralysis.
- Curvature of the spinal column to the right or left relative to the axis.
- Heart diseases.
- Deformation of the foot due to lengthening, shortening or transformation of the shape of ligaments, tendons and bones.
- Osteochondrosis.
- A pathological change in the musculoskeletal system in the neck area, which results in incorrect positioning of the head.
- Extra fingers.
- Congenital absence of the V lumbar vertebra or its partial fusion with the sacrum.
- The presence of an additional lumbar vertebra formed from the first sacral vertebra, which loses its connection with the sacrum.
- High scapula position.
- Hypoplasia and many other complications.
Based on all of the above, we can conclude that most often the disease occurs during intrauterine development, therefore there are no special preventive measures. However, parents can protect their unborn child from vertebral concretion. To do this, during pregnancy planning it is necessary to conduct a genetic study. Only in this way will the doctor be able to identify the risk of having a child with a pathology and determine the tactics of action.
Risk factors, causes
The disease is associated with improper formation of the spinal column during the intrauterine development of the child. This may be due to an infection suffered by the mother, or radiation, or a mutation in the fetus, but of course, most often it is a genetic factor.
However, there is a type of acquired concrescence, which is usually provoked by two factors:
- bone injuries and damage to the cartilage of the spine, leading to fusion of the vertebrae;
- various old chronic diseases, such as ankylosing spondylitis.
How is concrescence treated?
The difficulty is that at the current stage of development of medicine there is not a single treatment option that would lead to a tangible improvement in the patient’s condition. Conservative therapy is used to relieve pain and minimize the effect of a congenital orthopedic anomaly on the entire body.
Important! It is impossible to cure concrescence completely, no matter at what stage it is detected, and no matter what area of fusion the vertebrae have. Through persistent exposure to procedures and exercises, you can only achieve a reduction in the severity of the symptoms of the disease.
Table. Methods used to treat concrescence.
Clinical prognosis
From a functional point of view, the prognosis cannot be favorable, since limited mobility remains with the person for life. In addition, with age, secondary pathologies usually appear, which aggravate neurotic symptoms.
The prognosis is considered extremely unfavorable if the concretion is accompanied by diseases or pathological conditions of the heart and blood vessels, kidneys, blood vessels and other internal organs and systems
Over the years, the condition of patients suffering from concrescence becomes worse. When they stop growing, the process of intervertebral disc degeneration begins almost immediately.
Degenerative changes in the discs
As for preventive measures, they do not exist. Since the disease is congenital, it cannot be prevented by any specific preventive measures. The only thing that prenatal diagnosticians recommend is to undergo a genetic test to determine the risks of hereditary pathologies, especially if one of your relatives has a history of concretion of the cervical spine.