Polysegmental osteochondrosis: diagnosis and treatment

When an orthopedic traumatologist identifies osteochondrosis, the ICD code 10 m42 is entered in the medical history. This is an international classification accepted throughout the world for the convenience of prescribing therapy. When the final diagnosis is made, treatment of osteochondrosis is carried out according to the generally accepted scheme, which will be effective at this stage of the pathology.

The diagnosis according to ICD M42 is osteochondrosis, it refers to deforming dorsopathies, the latter term translated from Latin stands for “back pain”. Depending on its location, the cipher can additionally be supplemented with a code from 0 to 9:

• 0 – intervertebral discs of all parts of the spine are affected;
• 1 – first two;
• 2 – the entire cervical region;
• 3 – cervicothoracic region;
• 4 – thoracic region;
• 5 – thoracolumbar region;
• 6 – entire lumbar region;
• 7 and 8 – lumbar-sacral, sacral (in children) and/or coccygeal zone;
• 9 – no pathological area identified.

Usually, when a preliminary diagnosis of M42 code according to ICD 10 is made in adults, an unclear localization is first made, and after clarification, the location of the lesion is added. In childhood, ossification points have not yet formed in the sacral region, so localization of pathology in this region is the most dangerous.

Main symptoms and signs of cervical osteochondrosis

The disease develops gradually and is initially asymptomatic. Therefore, the diagnosis is often made in advanced cases. The main symptoms of the pathology include the following:

• Pain in the neck and occipital region, which increases with physical activity or coughing.
• Crunching sound when moving the head.
• Loss of sensitivity in the hands, burning sensation in the area of ​​the shoulder blades.
• Headaches that are localized in the back of the head and spread to the temples.
• General weakness, increased fatigue.
• Decreased visual acuity.
• Noise in ears.
• Hearing impairment.
• Increased heart rate.

Classification

Thoracic pain syndrome is characterized by severe pain in the chest of an intense nature. The syndrome is associated with damage to peripheral nerves. The damage is due to compression of the nerves by muscles and ligaments.

Degrees of thoracic osteochondrosis:

• The first degree is characterized by the absence of pronounced clinical manifestations. There is a loss of elasticity in the intervertebral discs, and their protrusions form.
• The second degree is marked by a further loss of elasticity of the intervertebral discs and a decrease in their height. The likelihood of a hernia increases. Pain syndrome appears, and concomitant pain symptoms are possible.
• In the third degree, the pain syndrome intensifies. A herniated disc located between the vertebrae may occur. The severity of symptoms depends on the location of the hernia.
• Fourth degree with complete disruption of elasticity and loss of function of the intervertebral discs, destruction of the bone structure of the vertebrae. Neurological disorders are most pronounced.

According to the types of pain symptoms:

• Vertebrogenic thoracalgia is based on spinal pathology.
• Nonvertebrogenic thoracalgia is caused by the formation of pathologies of internal organs: cardiovascular diseases, gastroduodenal reflux, traumatic and inflammatory lesions of the musculoskeletal system.
• Psychogenic thoracalgia is caused by panic attacks and damage to organs of neural origin.

Causes of cervical osteochondrosis

The first signs of the disease usually appear after 35 years. However, recently the pathology has begun to develop at a younger age - 18-30 years. Most often, the problem is faced by people who are forced to remain in one position for a long time.

The main causes of cervical osteochondrosis include the following:

• hereditary tendency;
• metabolic disorders;
• infectious diseases, intoxication of the body;
• violations in the diet - deficiency of fluid, vitamins, microelements;
• excess weight;
• traumatic injuries of the spine;
• poor posture;
• spinal instability;
• insufficiently active lifestyle;
• flat feet;
• influence of unfavorable environmental factors;
• frequent changes in body position;
• long stay in an uncomfortable position;
• excessive physical activity;
• hypothermia;
• stressful situations;
• Using the wrong pillows for sleeping.

Damage to the lumbar vertebrae

Lumbar osteochondrosis corresponds to the ICD code - M 42.16. The lower back bears half the body weight, so damage to this area is accompanied by unbearable pain while walking, which intensifies when bending the body and turning to the side.

Often the disease is preceded by damage. Then the diagnosis is post-traumatic osteochondrosis ICD 10 unspecified (M 42.9).

Patients experience the following symptoms:

• Shooting pain radiating to the tailbone and leg indicates pinching of the sciatic nerve roots. The symptom does not go away for a long time with rest and intensifies with any movement of the leg.
• Sexual dysfunction - men experience problems with erections.
• Urination is impaired and urinary incontinence may occur.
• Trophic disorders appear several months after an exacerbation. The hair on your legs gradually falls out and your nails begin to crumble.

If, when transferring a patient, the doctor sees osteochondrosis of the lumbar spine included in the medical history, the patient is prescribed intensive therapy.

What are the different degrees of the disease?

The disease develops gradually. There are 4 degrees of cervical osteochondrosis, each of which is characterized by certain features:

• The first is accompanied by the appearance of cracks in the intervertebral discs. This process is accompanied by mild, aching pain and stiffness of movement. The pathology has a wavy course. When the immune system deteriorates or the load increases, osteochondrosis worsens. If measures are not taken in time, there is a risk of worsening the abnormal process.
• Second, at this stage the destruction of the intervertebral discs continues and their protrusion is observed. This process is accompanied by pinching of nerve endings. A person experiences constant pain that increases with movement. At this stage, there is a decrease in working capacity, and numbness appears in the hands.
• The third is accompanied by the appearance of an intervertebral hernia. In such a situation, muscle tissue and nerve endings are involved in the pathological process. As a result, pain occurs in the neck and occipital region, and a feeling of weakness in the arms. If blood vessels are damaged, there is a risk of decreased visual acuity, dizziness and tinnitus. Sometimes the disease leads to fainting.
• Fourth – this stage is accompanied by bone growth. As a result, pressure on the nerve endings increases. With this form of osteochondrosis, neck mobility decreases and the spine becomes less flexible. As a result, a person cannot perform simple head movements.

Massage

A properly performed massage of the cervical-collar area can alleviate the condition, relieve muscle spasms, and improve mobility. Restrictions for the procedure are:

• pathology of the cardiovascular system in the stage of decompensation;
• tumor formations;
• skin diseases;
• exacerbation of chronic somatic pathologies;
• osteomyelitis.

Experienced massage therapists work at the Yusupov Hospital. The course of treatment is selected individually. Its average duration is 10-15 sessions.

Why should you consult a doctor immediately?

If symptoms of osteochondrosis appear, you should immediately consult a doctor - a neurologist or orthopedist. Otherwise, the pathology will cause dangerous health consequences.

First of all, the doctor must assess motor activity and the intensity of pain in the neck. The specialist is also interested in loss of sensitivity and other disorders.

Based on the results of the preliminary examination, additional procedures are prescribed. First of all, radiography is performed. It is made in several projections. If hernias are suspected, a computed tomography or magnetic resonance imaging scan may be required. If there is a disturbance in blood flow, there is a need for rheoencephalography and examination of the fundus.

Based on the results of the diagnostic examination, treatment is prescribed. With the development of cervical osteochondrosis, the following categories of drugs are most often used:

• Analgesics – help cope with pain. These include Analgin, Baralgin.
• Non-steroidal anti-inflammatory drugs - eliminate inflammatory processes and cope with swelling. The doctor may prescribe Diclofenac or Indomethacin.
• Antispasmodics – help eliminate muscle spasms. Most often, No-shpa is prescribed.
• Medicines to improve blood circulation. This category includes Trental, Mydocalm.
• Chondroprotectors – help restore the structure of intervertebral discs. These include Artracin, Teraflex.
• B vitamins – improve the functioning of nerve tissues.

In addition to drug therapy, other methods are prescribed. These include massage, therapeutic exercises, and physiotherapy. The use of osteopathy is highly effective. In this case, a gentle effect is applied to the affected muscles and vertebrae. In some cases, the doctor recommends wearing a special orthopedic device - a Shants collar.

Manual therapy is considered an effective way to treat pathology. Her methods are selected individually. The procedure consists of a targeted effect on the musculoskeletal elements. Thanks to this, it is possible to activate blood flow, improve lymph movement, and normalize metabolic processes. Manual therapy improves the mobility of the musculoskeletal system, strengthens the immune system, and helps prevent complications of osteochondrosis.

The spinal traction method is often used. Special equipment is used for traction. The procedure helps to increase the distance between the vertebrae to normal sizes and cope with disorders in the structure of the spine.

If acute cervical osteochondrosis is observed and intervertebral hernias appear, which provoke a decrease in sensitivity and impaired circulation, there is a need for surgical intervention.

The duration of treatment depends on the severity of osteochondrosis. Most often, therapy is carried out in long courses. To improve your condition, you should definitely make adjustments to your lifestyle. To do this, you need to eat right, give up bad habits, and play sports.

Diagnostics

Cervical osteochondrosis of the spine requires a comprehensive diagnosis. It includes:

• Collecting anamnesis of life and illness. The doctor clarifies the existing complaints, the time of their appearance, and the dynamics of severity. It is necessary to indicate the drugs that were used to alleviate the condition.
• Objective examination. After the survey, the specialist begins the inspection. The patient's skin and gait are examined. Upon palpation, painful areas are identified.
• Radiography. The first instrumental research method is radiography of the cervical spine. Most often, 2 projections are studied.
• CT, MRI. Thanks to research, it is possible to establish the source of the lesion and its exact location. Tomography allows you to assess the condition of blood vessels and nerves.
• Ultrasound Doppler. Ultrasound examination of the vessels of the head and neck makes it possible to assess their patency and the degree of stenosis.
• General blood analysis. First of all, indicators responsible for inflammation (leukocytes, ESR) are assessed.

Based on the data obtained, doctors determine the severity of cervical osteochondrosis. Doctors at the Yusupov Hospital use modern equipment that allows them to quickly and efficiently carry out any amount of diagnostic work.

Prevention of neck osteochondrosis

To prevent the occurrence of cervical osteochondrosis, you need to adhere to certain recommendations:

• correct spinal curvatures in a timely manner;
• play sports to form a muscle corset;
• eat foods that provide the body with calcium and magnesium;
• normalize body weight;
• Follow doctors' recommendations when working at the computer.

Cervical osteochondrosis is a serious pathology that leads to negative health consequences. To cope with the disorder, it is necessary to make a correct diagnosis in time. Therefore, any discomfort in the neck area should be a reason to consult a doctor.

Physiotherapy

Regular exercise therapy will not only relieve the severity of pain, but also have a preventive effect. Thanks to physical exercise, the muscle corset is strengthened, blood circulation in the affected area is improved, and the load in the affected area is reduced. Experienced instructors working at the Yusupov Hospital develop individual therapy programs for each patient. This helps to quickly and effectively get rid of the symptoms of cervical osteochondrosis. The selected course can be repeated at home.

Pathological forms

Today, it is customary to distinguish three forms of pathology, differing not only in symptoms, but also in the course of pathological changes:

1. Koenig's disease

   – inflammation of the cartilage tissue with subsequent detachment from the bone, which leads to difficulty in moving the knee. The form is most often found among adolescent and elderly patients.

2. Osgood-Schlatter disease

   – damage to the tibial tuberosity with subsequent thickening of the cartilaginous tissue of the knee, as well as the formation of a painful formation that limits the mobility of the leg. The pathology is most often diagnosed in adolescents who are actively involved in various sports (athletics, figure skating, etc.).

3. Larens-Johansson disease

   – characterized by a structural disorder of the patella, expressed in ossification. The damaged area is visible visually due to the appearance of edema. On palpation the patient experiences severe pain.

ICD-10 code

ICD – international classification of diseases. It is approved under the supervision of the World Health Organization and is designed to bring into unity the methods and principles used in medical practice in different countries.
In accordance with the ICD, each group of diseases is assigned a specific code. It contains complete information about the disease. The classifier is revised every 10 years. Currently, ICD-10 is relevant. Russia completely switched to its use in 1999. In ICD-10, a separate class is allocated for diseases of the musculoskeletal system. At the same time, pathologies of the spine, characterized by neurological symptoms and damage to bone and soft tissues, are allocated to the subsection “Dorsopathies”. Such diseases are numbered from 40 to 54 according to the ICD.

Osteochondrosis occupies a separate position here - M42. Next, a number from zero to 9 is placed through a dot to clarify the localization of the degenerative process. The cervicothoracic region is designated by the number 3. It, in turn, is divided into 3 possible options:

• M42.03 – youth.
• M42.13 – in adults.
• M42.93 – unspecified.