Osteochondrosis is the most common disease of the spine, expressed in the development of degenerative-dystrophic processes of connective tissues. The progression of the disease leads to a decrease in the gaps between the vertebrae and the appearance of bone growths (osteophytes). All this not only makes the spine less mobile, but is also a source of muscle and neuralgic pain, since it causes pinching of nerve roots and provokes muscle spasms.
According to statistics, about 70% of the world's population suffers from osteochondrosis. At the same time, the disease tends to rejuvenate. However, most often the disease affects older people, since over the years the development of degenerative changes in the spine is inevitable. Osteochondrosis is an incurable disease, but modern medicine has sufficient means to rehabilitate patients during periods of exacerbation and provide them with a normal lifestyle.
Rehabilitation for osteochondrosis of the cervical spine
Osteochondrosis is a degenerative-dystrophic lesion of all structures of the spine. This chronic disease in its later stages is accompanied by persistent pain, prolonged muscle spasm and dysfunction of the spine. Osteochondrosis is considered the most common disease of the musculoskeletal system. According to some estimates, about 70% of all humanity suffers from this disease. The problem of osteochondrosis is also relevant today because this disease affects more and more young people of working age every year.
Contraindications for surgery
It is impossible to proceed with surgical intervention if concomitant health problems of the following type are discovered:
- active infectious, inflammatory processes, local and general;
- autoimmune diseases in the stage of decompensation (diabetes mellitus, thyroiditis, etc.);
- uncompensated chronic pathologies of the heart, kidneys, lungs, liver;
- severe disorders of blood coagulation functions;
- severe deep vein thrombosis of the lower extremities;
- recent stroke or heart attack.
After eliminating the listed factors through a specific corrective course of treatment, which is feasible in most cases, surgical intervention for the consequences of osteochondrosis can be permitted.
Goals and objectives of rehabilitation for cervical osteochondrosis?
Acute pain, which appears due to degenerative changes in the intervertebral discs, forces the patient to take a forced position. A patient with osteochondrosis of the cervical spine avoids active turns and tilts of the head. Pain can radiate to the scapula, shoulder joint, forearm and hand. Often, cervical osteochondrosis is manifested by headache and dizziness, tinnitus, and visual disturbances. A person’s physical activity is significantly reduced, and his work and social opportunities are limited.
The main goals of rehabilitation include:
- Eliminate pain.
- Restoring mobility of the affected area.
- Stabilization of the spine by strengthening the muscles.
- Formation of the correct motor stereotype to prevent recurrent injuries.
For each patient with cervical osteochondrosis, an individual rehabilitation program is developed taking into account the severity of the pathological process and the nature of the symptoms.
Causes of osteochondrosis
Usually, the development of osteochondrosis is caused by the combined action of several causes. Here are the main ones:
- A sedentary lifestyle - sedentary work, constant use of a car, insufficient physical activity lead to stagnation of blood and lymph, and insufficient supply of the spinal structures with necessary nutrients.
- Excessive or unbalanced physical activity. Particularly dangerous are lifting heavy objects, simultaneous extensions and rotations of the body, and intense training without prior preparation.
- Posture disorders.
- Unbalanced diet or metabolic disorders.
- Cold and wet climate.
- Genetic features.
- Infections and injuries of the spine.
- Obesity.
- Age changes.
Treatment and rehabilitation of patients with osteochondrosis will differ depending on the causes. So, in case of vitamin deficiency, nutritional correction and taking vitamin-mineral complexes are necessary, in case of infectious causes of the disease - their treatment, in case of excess weight - its normalization.
What activities are included in the rehabilitation program?
The main directions of the rehabilitation process for osteochondrosis of the cervical spine include:
- Drug therapy
For the treatment of osteochondrosis of the cervical spine in the acute period, novocaine and lidocaine blockades and corticosteroid injections are used. Combinations of NSAIDs, antispasmodics and B vitamins are also effective.
- Exercise therapy
The objectives of physical therapy include restoring range of motion, reducing pain in the neck and upper extremities, strengthening weakened muscles, and preventing vestibular disorders. The exercises of the exercise therapy complex are selected by the doctor and instructor for each patient, taking into account the current objectives of the rehabilitation course. All patients with osteochondrosis are advised to perform a respiratory complex. Any exercise therapy exercises are performed in a Shants collar under the supervision of an experienced instructor.
- Physiotherapy
Electrophoresis is most often used by placing the active electrode in the back of the head. Also, patients with cervical osteochondrosis undergo phototherapy sessions.
- Massotherapy
Sessions are carried out with the aim of restoring functional activity, reducing pain intensity, and improving blood supply to the spine.
For osteochondrosis of the cervical spine, a classic and relaxing acupressure massage is used, aimed at the scalene muscles, shoulder girdles, and arms.
- Osteopathy
The specialist corrects pathological changes using manual manipulation. An effective osteopathic method for treating cervical osteochondrosis is traction (spinal traction), which is performed on a special table with an inclination.
Rehabilitation activities - exercise therapy, massage, physiotherapy - have different motor modes. In the subacute period of the disease, gentle and restorative classes are prescribed, and during remission, training sessions are prescribed.
Microdiscectomy
Microdiscectomy is the most popular method of surgery for osteochondrosis, since most often the pathology is complicated by an intervertebral disc herniation. To eliminate the hernial bulge, which compresses the nervous/vascular tissue around itself, it is excised with special microsurgical instruments. The entire hernia removal session takes place under the constant supervision of an intraoperative microscope with powerful magnifying and visualization capabilities. The procedure is performed under general anesthesia.
Tissue section.
First, the surgeon opens access to the disc by making a small skin incision (up to 4 cm) on the back in the projection of the affected IVD. If the lesion is concentrated in the cervical region, the incision and manipulation will be carried out from the anterior surface of the neck. Then, after loyally moving the muscles to the side (the muscles are not cut), the surgeon resects the ligamentum flavum sparingly. If necessary, a specialist with a special tool in the form of nippers removes osteophytes and partially intervertebral joints.
Afterwards, the hernial tissue is removed carefully with respect to the nerve roots, preserving the disc as much as possible. The operation is completed with laser irradiation of the operated disc in order to accelerate the regeneration of its tissues and prevent relapse.
If the disc cannot be saved (often at cervical levels), it is completely removed. After complete loss of a disc, interbody stabilizers must be installed - bone grafts, cages, disc implants, etc. In case of partial microdiscectomy, the feasibility of using stabilization systems is decided individually.
Disease prognosis
In advanced cases, cervical osteochondrosis can lead to persistent limitation of physical activity and serious neurological disorders. However, with comprehensive treatment and a properly selected rehabilitation program, the disease has a favorable prognosis.
Osteochondrosis of the cervical spine is best corrected at the initial stage of formation. In advanced cases of the disease, compression of the spinal nerve roots and spinal cord may occur. Symptoms of this severe complication include loss of mobility and sensitivity in the hands, and in the most serious cases, paralysis of the entire body (tetraparesis). To prevent such consequences, it is often necessary to resort to neurosurgical surgery. Therefore, you should seek medical help as early as possible. Even slight pain in the neck of a periodic nature is a reason to make an appointment with a doctor.
You can find out the cost of rehabilitation programs or make an appointment by calling: +7 (812) 425-67-96
Laminectomy
The spinal technique is common for osteochondrosis, which has caused a narrowing of the spinal canal with pinching of nerve formations. The essence of laminectomy is the resection of the lamina (arch) of the vertebra, thereby achieving decompression of the nerve root. The intervention can be an independent procedure or an auxiliary method to another operation to ensure maximum access to the contents of the spinal canal cavity.
Anesthesia during surgery is of a general type. The patient is placed on his stomach or side. The incision that provides access to the vertebrae can be from 3 cm to 10 cm in length. After dissecting and spreading the soft tissue over the area of interest, under X-ray control, the vertebral arches are removed (partial or complete) using pliers. Often, some fragment of the facet joints also needs to be cut.
If the procedure was used as an auxiliary method, surgical actions will continue to eliminate the hernia, osteophytic growths, scar formations, etc. Note that laminectomized bone units are too susceptible to destabilization. Therefore, at the final stage after any intervention where laminectomy was used, vertebral fusion is performed.
Lifestyle changes
Small, meaningful changes in your daily life can help improve your overall health, which in turn can improve your spine and muscle health. Some recommendations include:
- Avoid nicotine
- Avoid excess alcohol intake
- Adequate drinking water intake
- Increase physical activity in daily life and avoid staying in one position for long periods of time. For example, you need to get up every 20-30 minutes after sitting, stretch and walk a little.
- Use ergonomic furniture to support the spine, such as ergonomic work chairs, a table or special neck pillows
The focus of this part of treatment is on education and guiding the patient toward a healthy lifestyle while minimizing stress on spinal structures that may be causing or contributing to pain.
Puncture nucleoplasty
Nucleoplasty is the most non-aggressive neurosurgical tactic used for osteochondrosis. Manipulations are carried out through a tiny (up to 3-5 mm) puncture puncture; anesthesia can be of a local type. Indications for such a procedure are small disc prolapses at the protrusion stage (up to 6 mm, in the cervical region - up to 4 mm), combined with chronic discogenic pain.
The method is based on the impact on the nucleus pulposus of a certain type of radiation (laser, cold plasma, radio frequency) or the pressure of a saline solution. Radiating flows are supplied through an electrode inserted inside the disc, and isotonic fluid is supplied through a cannulated probe. All types of nucleoplasty involve the destruction of approximately 15% of the total volume of pulpal tissue, due to which the intradiscal pressure decreases. As a result, the deformed fibrous ring returns to its normal position, the disc parameters are restored, and the pain syndrome quickly disappears. The process of retracting the ring after this session takes up to 4 weeks.
Despite such a valuable advantage as minimal trauma, the nucleoplasty method does not always provide a stable and long-lasting effect; after it, sooner or later (after 1-3 years) relapses of the hernia occur. If a relapse occurs, the patient will be recommended to undergo a full-fledged operation - microdiscectomy. Nucleoplasty usually does not involve hospitalization; after it, a person can go home on his own within a couple of hours. Rehabilitation is usually quick and without complications.
Postoperative rehabilitation
Rehabilitation after surgery aimed at eliminating the consequences of osteochondrosis lasts on average 2.5-4 months. Sometimes the recovery period can take longer, up to 6-12 months. Most patients already experience a noticeable regression of pain and neurological deficit in the early period after the intervention. At the end of an ideal recovery (from start to finish) after a successfully completed operation, a full restoration of the quality of life or as close to normal as possible awaits.
For several weeks, the immobilization of the operated area is strictly observed, so as not to interfere with the proper regeneration of the tissues affected by the operation, and not to further injure them with unacceptable movements. After almost every intervention, a unique orthopedic regimen is prescribed, including wearing a lumbar bandage, chest corset or cervical collar for maximum unloading of the weak area. An integral part of all rehabilitation is exercise therapy (first, the exercises are performed in bed). Therapeutic gymnastics must be prescribed and monitored exclusively by the attending physician. From the middle of the rehabilitation cycle, physiotherapy and massage procedures are introduced.
Immediately after surgery, intensive courses of antibiotic therapy and antithrombotic treatment are always prescribed for about 3 weeks to avoid the development of wound infection, leg vein thrombosis and pulmonary embolism. For postoperative pain and swelling, oral or injectable painkillers from the NSAID category are used, less often from the corticosteroid series. Absolutely all medications and means of physical rehabilitation should be recommended by the operating neurosurgeon together with a rehabilitation physician!
Foraminotomy
Foramintomy is used for osteochondrosis accompanied by foraminal intervertebral stenosis and radicular pain syndrome. Decompression technology is carried out under the control of CT fluoroscopy, endoscope or microscope. Decompression of neural structures using the foraminotomy method is the expansion of the intervertebral (foraminal) foramen by removing the pathologically changed part of the vertebra (bone spines), possibly with a small part of the disc. Recently, foraminotomy has been performed using an endoscope, which has significantly reduced the degree of surgical invasion.
A neurosurgical session often involves the use of general anesthesia. If the main technical component of the control will be an endoscope, a small incision is made, usually not exceeding 1 cm. Through the incision, an endoscopic probe, which is equipped with a powerful light-emitting source and a video camera, is carefully brought to the pathological object, avoiding dangerous areas. Looking at the intraoperative screen, where information from the anatomical spaces of the spinal system is received thanks to the endoscope, the surgeon removes all stenotic factors. In order to remove bone or fibrocartilaginous tissue, micro-instruments are used that are inserted into the working compartment of the endoscope probe.
Spinal stabilization technologies
We have already repeatedly mentioned stabilization tactics, which are so often combined with open surgical methods. They are not used for puncture methods. Stabilizing surgery is various techniques for installing and fixing implantation and transplantation materials to prevent or eliminate spondylolisthesis and vertebral instability syndrome.
Fixation of the lumbar region using metal structures.
Stabilizing measures involve the implementation of a multicomponent set of labor-intensive tasks. The majority of them require complete removal of the intervertebral disc, sometimes even a corpectomy (extraction of the vertebral bodies). All implanted implants are attached to preserved bone elements located within the problematic PDS and/or in the immediate vicinity of it.
Among the popular implantation technologies used for severe osteochondrosis are rigid and dynamic fixation technologies. Rigid stabilization is aimed at achieving reliable immobility of one or another spinal level. The dynamic stabilizing technique involves correcting the mobility of the SAM, eliminating instability, but maintaining a certain range of motion between the bone surfaces. The leading tactics of the dynamic type are the installation of a functional endoprosthesis of the intervertebral disc and implantation between the spinous processes of a silicone-polyester implant with the functions of a stabilizer and shock absorber (for example, from the DIAM series).
In order to completely immobilize pathological spinal zones, pure bone autografts or implants filled with bone chips are used, which are placed in the free intervertebral space (between the vertebrae). After implantation of autologous bone or an interbody cage with a bone component, the corresponding level is firmly fixed with special connecting plates and screws made of titanium material. Rigid stabilization several months after surgery leads to the fusion of two or more adjacent vertebral bodies into a single immobile conglomerate. After such fusion, the vertebrae will no longer twist and slide relative to each other, irritating the nerve roots and causing pain to the patient.