Signs and prevention of juvenile osteochondrosis of the spine

general information

Youthful osteochondrosis of the spine is a dangerous pathological process that dissipates against the background of active growth of the musculoskeletal system. The disease manifests itself as degenerative changes in the intervertebral discs, joints, ligaments, and bones. The lack of comprehensive timely treatment often leads to patient disability.

Osteochondrosis in adolescents is diagnosed in the early stages by chance, since at the first stage the disease practically does not manifest itself at all. Both boys and girls are at risk. The main symptom by which characteristic changes can be suspected is back discomfort and muscle stiffness in the morning. In most patients, the pathological process proceeds safely, causing only minor inconvenience.

Causes

Osteochondrosis in a teenager appears during the period of active skeletal growth. But this is far from the only reason for the development of this disease. The following factors can provoke degenerative changes:

• History of injuries.
• Hereditary predisposition.
• Metabolic disease.
• Poor nutrition, lack of intake of beneficial vitamins and minerals into the body.
• Infectious, endocrine and autoimmune diseases.
• Lack of physical activity.
• Incorrect physical activity during intense sports activities.

Provoking factors for the development of this disease in a child are carrying a bag on one shoulder, sleeping on a surface that is too soft or uneven, and the habit of sitting in the wrong position at the computer. But the main impetus for the onset of degenerative changes is always internal processes.

The classic form leads to irreversible changes in the spine, and in the absence of comprehensive treatment, the patient can expect a serious decrease in quality of life and limited mobility even at a young age. The pathology affects any part of the ridge (cervical, thoracic, lower back), and although it develops slowly, you should consult a doctor as early as possible, when the first symptoms appear.

Characteristic differences

Osteochondrosis in children does not occur in the same way as in adult patients. Pathology has its own characteristic differences, allowing doctors to determine tactics of control and plan treatment. What are the features?

Neck pain in a child

• Changes in the younger generation are most often diagnosed in the cervical and lumbar spine. In the thoracic part it occurs in patients suffering from kyphosis or scoliosis.
• The symptoms are more pronounced, which makes it possible to identify the disease earlier than in an adult patient.
• Neurological disorders are mild and rarely coincide with standard innervation zones.
• In children, the disease almost never leads to loss of sensation or motor impairment.
• No changes in the functioning of the excretory system when diagnosing disorders in the lumbar region.

Diagnosing childhood osteochondrosis is much more difficult, although adolescents more often undergo preventive examinations at school and upon admission. In most cases, characteristic changes in cartilage tissue are discovered by chance.

Reviews

Victoria “My child (14 years old) was recently diagnosed with Scheuermann’s disease. For a long time I could not understand where this misfortune came from. They carried heavy boxes. This is the second time we are undergoing treatment at a special center. Parents, watch the boys, teach them to behave correctly, otherwise they will cripple themselves for life.”

Oleg “I recently literally fell ill with lower back pain. The doctor said juvenile osteochondrosis. I am an athlete, I have been lifting weights since childhood. It seems like everything was always fine. Nevertheless, the diagnosis has been made. There is a hernia in the vertebra. We need to give up on sports. This is me for those who think that everything is so simple... no.”

Symptoms

Juvenile osteochondrosis of the spine manifests itself in different ways, it all depends on the location of the pathological process. Degenerative changes can provoke headaches, general fatigue, create a constant feeling of tiredness, and back discomfort. These are common signs that parents need to pay attention to. At the initial stage, the disease shows almost nothing about itself. As destructive changes develop, patients experience the following symptoms:

• Cervical region: headache of varying intensity, frequent dizziness, decreased concentration, insomnia, increased fatigue, loss of consciousness, ear pain, ringing or extraneous noise. The patient complains of discomfort in the shoulders, spasms, muscle stiffness, and the inability to rotate the neck freely.
• Thoracic: lump in the throat, pain in the shoulder blades or heart, discomfort in the stomach, difficulty breathing. Symptoms are often mistaken for scoliosis, so it is important to carry out a differential diagnosis.
• Lumbar: sharp pain in the lower abdomen, discomfort when turning, aggravated by moving the limbs or trying to raise the arms and legs up.

The parent should pay attention to the appearance of stooping as the child grows sharply. Poor posture is also a symptom of degenerative changes in the spine. Also, do not ignore a teenager’s complaints of headaches, blurred vision or hearing, or discomfort anywhere in the back.

Stages

Osteochondrosis in adolescents goes unnoticed in the early stages, but it is at this moment that treatment has the best effect. The pathological process develops in several stages. It is determined at the time of diagnosis in order to formulate the most effective treatment tactics. There are three of them in total:

1. Latent. The patient does not notice changes in the body, since there are no characteristic signs of the disease. Rare unpleasant sensations in the back after exercise are practically not alarming, as they are attributed to overwork. But pathology can be noticed with a careful examination. The patient is diagnosed with kyphosis, which, although mildly expressed, does not allow him to reach the floor when bending over. This stage is most often observed in children aged 11 to 15 years.
2. Early. The patient has neurological abnormalities and characteristic symptoms of the disorder. Pathologists can provoke pain at the localization site due to pinched nerve endings. Curvature of the ridge, displacement of the vertebrae and other destructive changes are observed. Pathology can be diagnosed by a medical examination, during which the doctor determines impaired mobility of the spine and the presence of kyphosis.
3. Late. The signs of the disease in patients are already clearly expressed; the problem cannot be ignored. Against the background of severe pain, dysfunction, and limitation of motor activity, patients develop intervertebral hernias in the spine and spondylosis. Most patients develop kyphosis in the form of a hump, while some develop only scoliosis.

Stages of development of the pathological process clearly

The earlier the disease is diagnosed, the more effective the prescribed complex therapy will be. Therefore, it is important for parents not to ignore the first characteristic changes in the child’s health and to consult a doctor in a timely manner.

Diagnostics

Only an experienced specialist can visually detect dystrophic changes in the spine. To make a diagnosis, the patient’s complaints, anamnesis, medical history, and hereditary predisposition are taken into account. The doctor conducts an external examination, assesses the condition of posture and the spine as a whole, determines muscle tone and the presence of unnatural tension. For the purpose of clarification, the following types of examination are prescribed:

• X-ray. The resulting image allows you to assess the general condition of the bone tissue and identify even minor changes in the vertebrae.
• CT scan. Allows you to see the general condition of bones, intervertebral discs, the location of blood vessels and surrounding tissues. Appointed to clarify information obtained using x-rays.
• Magnetic resonance imaging. In particularly difficult cases, an MRI is prescribed to identify neurological disorders.
• Electromyography. This test determines the strength of the back muscles. It is not prescribed to all patients, but only if indicated.
• Ultrasound. It is used when there is suspected damage to blood vessels in the cervical spine or dysfunction of internal organs, to determine their general condition.
• Cardiogram. Allows you to eliminate disturbances in the functioning of the cardiovascular system due to pain in the chest area.
• General analysis of urine and blood. The results obtained determine the presence of an inflammatory process.

After diagnosis, the degree of development of the pathological process is assessed. This allows you to correctly determine the necessary set of measures to restore the patient’s quality of life.

The course of therapy is prescribed after determining the stage of progression and characteristic changes in the body

M42.9 - Osteochondrosis of the spine, unspecified

When a patient comes for an initial consultation, he is given a preliminary diagnosis - spinal osteochondrosis M42; further code is entered only after the examination. Sometimes the medical history contains code M 42.9, which indicates that the localization of the pathology is unspecified.

The code is set when a disease is accidentally detected, when the client is being examined for a different profile. Usually he is additionally prescribed a CT or MRI, after which the type of disease and the localization of degenerative-dystrophic changes are determined.

Treatment of osteochondrosis in children

Treatment of osteochondrosis in children and adolescents is a long process. The main task of the specialist is to relieve acute pain, slow down degeneration, eliminate other signs, and prevent complications or irreversible changes. For this purpose, various methods of therapy are prescribed.

An integrated approach, including medication, therapeutic exercises, physiotherapy and massage, allows you to achieve good results. Self-medication is excluded, since only an experienced specialist can assess the general condition and select an individual treatment regimen. It takes into account age, the presence of contraindications and chronic concomitant diseases.

Drug treatment

Elimination of symptoms is impossible without the use of pharmacological products. The drug group, dosage, and duration of use are always selected by the doctor. The complex includes the following medications:

• Non-steroidal anti-inflammatory drugs (Diclofenac, Ibuprofen). They are aimed at reducing the inflammatory process and eliminating pain.
• Muscle relaxants (Sirdalud, Baclofen). They are prescribed to eliminate muscle spasms. They are used with caution, taking into account the age of the child, as there are a number of serious contraindications.
• Chondroprotectors (“Dona”, “Teraflex”, “Arthra”). The drugs are aimed at starting the process of tissue regeneration, restoring damaged cells of the intervertebral discs. They are always used in courses of several months, as they have a cumulative effect.
• B vitamins (“Milgamma”). They promote the restoration of nerve fibers and damaged tissues, including bones.

Vitamin complexes are also useful for teenagers, promoting general stimulation of the immune system, normalizing blood flow and saturating tissues with useful substances. They are selected individually, taking into account the identified deficiency in the body.

Non-drug treatment

The use of pharmaceutical drugs is not enough to cure juvenile osteochondrosis. The complex effect on the pathological process also includes alternative methods. They are aimed at strengthening muscle tissue, improving their nutrition, and restoring the flexibility of the damaged area. The patient is recommended:

• Swimming lessons. They allow you to eliminate excess tension in muscle tissue, get rid of spasms, blockages in the back, and improve the nutrition of damaged tissues by normalizing the movement of all biological fluids in the body.
• Massage. A visit to a highly qualified specialist allows the patient to get rid of back pain, normalize the mental and physiological state, activate the body’s defenses, and relax stiff muscles. To obtain a lasting result, you will need to complete a course of 10 sessions.
• Acupuncture. Impact on certain biologically active points in the body allows you to start the process of regeneration in tissues, improve their condition, and even relieve attacks of acute pain. All manipulations should be carried out by an experienced specialist, otherwise the patient’s condition may worsen.
• Physiotherapy. Regular exercise and morning exercises, which include techniques developed by doctors, allows you to achieve stable remission of the pathology. Physical education restores spine mobility and functionality.
• Mud therapy. The use of healing mud helps to enhance the effectiveness of drug treatment.

If conservative treatment methods do not give the expected result, the patient is prescribed surgery. Timely intervention eliminates the possibility of disability or irreversible processes in the body that significantly reduce the quality of life. A radical method is prescribed in advanced stages, for herniation or protrusion of the intervertebral disc, or radicular syndrome.

Treatment of osteochondrosis in adolescents is carried out by a doctor after a visual examination and assessment of the patient’s condition

UZ "Bobruisk City Children's Hospital"

Osteochondrosis in children is a lesion of the osteoarticular area due to trauma, metabolic disorders, poor nutrition, and excessive stress. Osteochondrosis of the spine is dystrophy, or in other words, a violation of the nutrition of the tissues of the intervertebral disc with a weakening of its shock-absorbing properties. With osteochondrosis, the fixing ability of the spine, the condition of the paravertebral muscles and ligaments, especially under load, deteriorate, making them inelastic and weak.

First, dehydration of the nucleus pulposus and metabolic disorders in the cartilage occur. As a result, the disc loses its elasticity, dries out, decreases in size and cannot withstand physical activity. The annulus fibrosus of the disc also loses its elasticity, causing it to crack and rupture. The central part, the so-called nucleus pulposus, protrudes into the resulting defects and then falls out (partially or completely). This is a herniated intervertebral disc.

It is now known that the main cause of osteochondrosis is associated with our lifestyle, which leads to changes in the spine. These include sedentary work, emotional and physical overload, poor posture and poor nutrition. In order for the spine to remain healthy, it must be taken care of from a young age. Ancient doctors believed that human health was determined by the health of the spine. Modern medicine confirms the role of the spine in maintaining good health.

Causes

Osteochondrosis in children of congenital form is associated with:

• hereditary predisposition and autoimmune pathologies that lead to disruption of the development of bone and cartilage tissue and metabolic processes;
• congenital malformations of the musculoskeletal system (absence of a vertebra, deformation, weakness of the muscular system) and circulatory system, which leads to insufficient supply of oxygen and nutritional components to the spinal column.

Acquired osteochondrosis in children is associated with the following factors:

• hormonal imbalance and other endocrine pathologies;

• overweight in children and adolescents;
• excessive or insufficient physical activity;
• injuries of various natures, for example, the cervical spine can be damaged during passage through the birth canal;
• poor posture;
• poor diet with insufficient intake of vitamins and minerals.

For diagnosis, you need to consult an orthopedist and neurologist. The appointment begins with an examination and medical history. The basis for diagnosis is poor posture, pain and discomfort when palpating certain areas of the back, and the results of motor tests. To confirm the diagnosis, radiography, magnetic resonance and computed tomography of the back are prescribed. If hormonal imbalances are suspected, a general blood test and hormone testing are required. A detailed blood test allows you to identify infectious processes in the body

4 stages of development of osteochondrosis:

• First: the main symptom of osteochondrosis at this stage is instability, manifested in initial disorders of the vertebral discs. Feeling of malaise and discomfort.

• Second: the main symptom of the second stage of osteochondrosis is disc protrusion. The destruction of the fibrous ring begins, the gaps between the vertebrae decrease, and pinching of nerve endings with pain syndromes is possible.
• Third: at this stage of osteochondrosis, the destruction of the ring occurs with the appearance of intervertebral hernias. The third stage is characterized by significant deformation of the spine.
• Fourth: the last and most severe stage of osteochondrosis. It becomes difficult to move. Any movement leads to acute pain. Periodically, the condition improves and the pain subsides, but this clearly indicates the formation of bone growths. They connect the vertebrae, limiting the ability to move and leading to disability.

Clinical manifestations

In children, osteochondrosis occurs in an asymptomatic form. The first signs of the disease begin to bother you at puberty.

Symptoms of neck osteochondrosis:

• frequent headaches;
• dizziness;
• increased fatigue;
• feeling of discomfort and pain in the neck.

Symptoms of osteochondrosis of the thoracic region:

• pain in the area between the shoulder blades and behind the sternum;
• shortness of breath, difficulty breathing;
• numbness in the arms or thoracic back.

Symptoms of lumbar osteochondrosis:

• pain in the lower back, radiating to the lower extremities, which intensifies after prolonged standing in an upright position or lifting heavy objects;
• mobility impairment.

The difficulty of diagnosis in childhood lies in the absence of a clear clinical picture. When the first complaints appear in adolescents, there is a high probability of an incorrect diagnosis, since the symptoms are similar to other diseases. Cervical osteochondrosis occurs with similar symptoms characteristic of pathologies of the cardiovascular system. Symptoms of cervical osteochondrosis in children are pain, nausea. Pathology of the thoracic region occurs with signs of diseases of the heart muscle or damage to inflammatory nerve fibers.

The diagnosis is made in stages. First, the doctor interviews the child, studying his complaints and feelings. Then he finds out the history of the development of the disease, after which, getting acquainted with the life history, the doctor finds out the factors that provoke osteochondrosis, the presence of heredity and anomalies in the development of the spine.

Examination of the patient is the next step in making a diagnosis. Posture and range of motion in all parts of the spine are assessed, palpation (feeling), percussion (tapping) of the spine is performed, and muscle strength is studied. It is important to diagnose motor stereotype disorders, that is, to identify immobility of some parts of the spine and hypermobility of others. Based on the results of the examination, the doctor may prescribe examination methods.

X-ray examination (spondylography) is an important method for assessing the condition of the spine. Typically, an in-depth diagnosis of osteochondrosis begins with a spondylogram. Radiography allows you to obtain information about the condition of the vertebrae, and indirectly, the intervertebral discs and bone canals.

· Computed tomography (CT) is a hard x-ray that illuminates an object with a narrow beam and is captured by receiving equipment at the output. The received data is processed by a computer, and the image is visible on the display. The patient is placed between the emitter and the receiver, where the entire system rotates around the axis of the patient's body. X-ray absorption is recorded at all stages of rotation. As a result, vertebral bodies, soft tissues, intervertebral discs, ligaments, and blood vessels are visible. CT scans reveal disc contour ruptures, nerve root compression, and dura mater deformations.

Unlike X-rays, where images of entire sections of the spine can be taken, CT scans specifically target one or two segments. A CT scan is usually prescribed after an x-ray if it is necessary to clarify the condition of a specific intervertebral disc. With this type of study, the x-ray dose is significantly higher than with a spondylogram.

Magnetic resonance imaging (MRI) is prescribed in diagnostically difficult cases. It is mandatory when consulting a neurosurgeon and is always used during surgery. The method allows you to obtain an image due to the property of tissue hydrogen nuclei (protons) to give the phenomenon of resonance in a strong magnetic field. Constant and alternating magnetic fields are used, which create a signal characteristic of each tissue of the body. These signals are recorded, processed by a computer and produced an image on the screen. An anatomical cross-section of the body is obtained in three projections without the harmful effects of x-ray radiation. Sections are visible in different planes, the image has high contrast. Nerve roots, intervertebral discs and blood vessels are visible. On MRI, the nucleus pulposus, which has less hydrophilicity due to osteochondrosis, does not produce an MRI signal and is clearly visible. · Ultrasound Dopplerography (USDG) is a method for studying the blood supply to the brain, which allows you to study cerebral blood flow in cervical osteochondrosis.

Thus, having correctly diagnosed osteochondrosis using the above methods, treatment should begin. The therapy program is drawn up by the doctor, taking into account all the nuances or features of the manifestation of the disease in a particular person.

Treatment

Based on the data obtained as a result of research, a protocol is drawn up, the observance of which during the development of the musculoskeletal system makes it possible to completely cope with the disease.

Drug therapy

Treatment is comprehensive and includes the use of:

• vitamin and mineral complexes that are rich in B vitamins, vitamin D, calcium, phosphorus and Omega-3 to strengthen the immune system, normalize blood flow, metabolic processes, restore tissue of the spinal column and nerve fibers;

• muscle relaxants to relax muscles and eliminate muscle pain;
• non-steroidal anti-inflammatory drugs to suppress the inflammatory process and relieve pain;
• chondoprotectors with glucosamine and chondroitin, the action of which is aimed at restoring cartilage tissue;
• amino acids for the renewal and restoration of cartilage tissue.

Medicines are prescribed in the form of tablets, intramuscular injections, gels and ointments for external application. The dosage is selected individually, based on the degree of damage.

Non-drug therapy

Treatment of osteochondrosis in the initial stages of development in childhood and adolescence is carried out without the use of drugs and includes:

• Therapeutic exercise. Selection of exercises taking into account the localization of the pathological process. Helps improve general condition, relieve pain and discomfort in the back, restore mobility and performance of the spine, and strengthen the muscular corset of the back.

• Back massage has a general strengthening effect, improves blood flow and lymphatic drainage, tones and relaxes muscles.
• Acupuncture, which involves the use of needles or special rays to activate biologically active points responsible for the restoration of cartilage tissue.
• Swimming, which allows you to cope with muscle tension and spasms, prevents complications: hernias, scoliosis, kyphosis.
• Physiotherapy: electrophoresis, ultrasound, magnetotherapy, vibration and laser treatment, which are aimed at relieving tension, normalizing blood flow and metabolic processes. The use of electrophoresis helps in applying medications topically to the affected area. Detensor therapy is aimed at stretching the spine.

Complications

Cervical and thoracic osteochondrosis in the absence of timely treatment can lead to the following consequences:

• curvature of the spinal column;

• protrusion of intervertebral discs;
• growth slowdown;
• intervertebral hernia;
• impaired coordination of movements;
• risk of stroke.

If complications develop in the form of a hernia or protrusion in complex cases, the child is prescribed surgical treatment.

Prevention

Prevention of osteochondrosis begins in childhood. The most critical period of bone tissue activity is the youthful period of intensive growth, during which calcium consumption in the body increases.

Clinical recommendations from doctors for the prevention of osteochondrosis:

• annual preventive examinations with a neurologist and orthopedist;
• proper nutrition, rich in vitamins and minerals, for normal growth and development of the child;

• posture control and injury prevention;
• regular physical activity (exercise, swimming);
• correct choice of shoes (in size, with orthopedic insoles);
• long walks in the fresh air.

“Peak” bone mass can be increased by eating foods high in calcium and phosphorus. These include dairy products, fish, dried fruits, nuts, seeds, green vegetables and brown bread.

It is believed that physical exercise prevents the development of osteochondrosis. However, excessive physical activity can lead to a decrease in the level of sex hormones estogens, and then to osteoporosis, which is often combined with osteochondrosis.

Such changes in the spine are typical for professional athletes.

Vitamin D levels in the body are closely related to skin exposure to sunlight. Holidays in the south, sunbathing and trips to the sea are a pleasant and necessary measure to prevent osteochondrosis. Eating seafood, mainly red fish, plays an important role in obtaining vitamin D. Maybe someone will remember the “fish oil” that they hated in childhood. It is also an effective measure to prevent bone weakness. Calcium supplements with vitamin D are useful to improve bone health.

Thus, rational nutrition from childhood is an important factor in the prevention of osteochondrosis. Adequate nutrition is especially necessary for a growing body, because in youth a health program is laid for life.

Spinal injury is the second risk factor for osteochondrosis. In recent years, young people with back pain due to the spine have begun to attract the attention of doctors. It was found that the early development of osteochondrosis in them was facilitated by the incorrect position of the cervical vertebrae, which arose in newborn age as a result of birth trauma.

You should pay attention to the fact that during physical activity (physical education class), if you fall sharply on your tailbone after a jump, a cracking sound may appear in the cervical spine. Usually this causes pain that passes quickly, and children do not go to the doctor. However, the resulting traumatic redistribution of axial load on the spine and discs subsequently leads to increased wear and early osteochondrosis.

During an injury, you can stretch your back muscles, ligaments, or dislocate your spinal joints. Such microtraumas instantly aggravate osteochondrosis with sharp back pain.

The early development of osteochondrosis is facilitated by incorrect posture, especially from childhood. Poor posture (static) is a precursor and characteristic symptom of spinal osteochondrosis. The mechanisms of these changes are complex. And we will not delve into professional details, but will focus on the main thing: treatment and prevention of exacerbations of osteochondrosis necessarily includes posture correction to correct the impaired biomechanics of the spine.

Possible consequences

Cervical osteochondrosis is especially dangerous, because any changes in this area disrupt the blood supply to the brain. The patient develops problems with vision, hearing, vestibular apparatus, and blood pressure. In the absence of treatment for osteochondrosis in the thoracic region, problems associated with the intestines, bile, stomach, lungs, and heart gradually develop. Pathology in the lumbar region leads to inflammatory processes in the genitourinary system and the development of paralysis of the lower extremities.

Measures to prevent lumbar osteochondrosis

Lumbar osteochondrosis is a serious chronic disease that significantly reduces a person’s quality of life. Timely treatment of lumbar osteochondrosis allows you to slow down the course of pathological processes and avoid radical measures and the development of dangerous complications.

The best treatment for lumbar osteochondrosis is its prevention. In order to prevent degenerative-dystrophic processes, it is important:

• determine and maintain a moderate schedule of physical activity;
• take systematic breaks from work (5-7 minutes per hour);
• sleep only on a flat surface or an orthopedic mattress;
• wear suitable shoes;
• Healthy food;
• to refuse from bad habits.

Remember that a healthy body is an integral component of a full life for every person. Prevention and timely treatment of many diseases ensure the elimination of the disease and improve the quality of life.

Preventive actions

It is extremely important to prevent the development of osteochondrosis in a child, since treatment does not completely eliminate all changes in the body. To do this, parents are recommended to take the following preventive measures:

• Monitor the child’s posture from early childhood, organize the workplace, and avoid long periods of sitting at the computer in the wrong position.
• Select high-quality orthopedic sleep accessories (mattress and pillow).
• Balance your diet by adding more fresh vegetables, fruits, and dairy products to your menu.
• Control the child’s weight, eliminating the gain of extra pounds.
• Enroll your teenager in a sports section for regular dosed physical activity.
• Organize a regimen of rest, walks and work, encourage the growing body to stay in the fresh air.
• Eliminate the possibility of injury as a result of extreme sports.

Juvenile osteochondrosis is a dangerous pathological process that develops in adolescents during a period of active growth. The main reasons for the appearance of degenerative changes are uneven physical activity, injuries, poor quality nutrition, poor posture and hormonal levels. It is better to identify pathology in the early stages, when it can be successfully treated.

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