Degenerative diseases of the spine

In accordance with the ICD, degenerative-dystrophic diseases of the spine (DDSD) in medicine are understood as a broad group of pathologies of osteochondral tissue, which often cause chronic pain and gradual destruction of the spinal column. Such changes, sometimes with disabling consequences, include: intervertebral hernias, protrusions, osteochondrosis, spondylolisthesis, long-term consequences of spinal fractures and injuries.

Degenerative diseases of the spine may not bother the patient until a certain point, so they are most often “incidental findings” on CT or MRI. However, over time, the situation worsens - stenosis leads to narrowing of the intervertebral foramina and spinal canal, osteoporosis - to increased fragility and degeneration of the vertebrae, osteophytes and hernias - to neuralgia.

Contrary to popular stereotypes, degenerative spinal diseases are not only common in older patients and adults (median age 40 years), but can also be detected in younger patients. Some common DDSDs, such as Schmorl's hernia, do not affect the patient's quality of life and do not require special treatment or surgery. However, their timely diagnosis will help the patient adjust their lifestyle (change motor habits, add exercise therapy, conservative treatment procedures) and thus prevent possible complications.

In this article we will tell you what other diseases belong to the group of DDSD, how they manifest themselves, and what to do if this diagnosis appears in the CT report?

What are the types of degenerative-dystrophic diseases of the spine?

A large group of degenerative-dystrophic diseases of the spine are united by at least three characteristics:

DDSDs are potentially chronic diseases. In the absence of adequate therapeutic and conservative measures, the negative effects increase over time.
Most degenerative diseases of the spine are associated with the natural aging of osteochondral tissue, but its destruction, thinning, and fragility can also be caused by other reasons (sports or household injury, physical inactivity, metabolic disorders, congenital connective tissue dysplasia).
Some DDSDs, such as spinal stenosis, intervertebral hernias, and tumors lead to compression of the nerve endings or roots of the spinal cord. This causes a gross disruption of the biomechanics of the human body, muscle atrophy, weakness of the limbs, lameness, as well as intense pain, which can lead to depression.

Depending on the location, it is customary to distinguish degenerative-dystrophic diseases:

Cervical spine;
Thoracic spine;
Lumbosacral spine.

The localization of DDZP influences treatment tactics.

Degenerative-dystrophic diseases of the spine include:

Osteochondrosis;
Intervertebral hernia;
Protrusion;
Spondylosis;
Spondyloarthrosis;
Spondylolisthesis;
Spinal stenosis;
Spinal cyst;
Osteophytes;
Spondylosis;
Spinal osteoporosis;
Sacroiliitis;
Myofascial syndrome;
Facet syndrome (facet joint syndrome).

Prevention measures

To prevent distortion and other diseases of the spine, you must follow simple recommendations. First of all, if we are talking about the cervical spine, all movements of the head must be controlled, so all turns of the head must be smooth and accurate. It is not recommended to make any jerks or sudden movements.

If you want to learn in more detail the structure of the human spine, its sections, functions, and also consider disease prevention, you can read an article about this on our portal.

Prevention

If you are used to constantly dealing with heavy loads, then you need to follow some rules:

when lifting weights, the back should always be straight and the gaze directed forward;
you cannot bend down before lifting any heavy object - you must sit down before doing this;
try to always shift your weight in the center of your body, thereby distributing the load evenly;
avoid jerks or sudden movements when lifting objects, trying not to look to the side at this time - only in front of you;
You also need to put the load in place correctly, performing all movements in the reverse order so as not to injure your back.

How to lift objects correctly

The quality of the pillow and the firmness of the mattress also play an important role. Therefore, to prevent distortion, it is necessary to provide optimal conditions for sleep: the pillow should not be too large and hard, and the mattress, on the contrary, should not be too soft. It is advisable to give preference to moderately hard sleeping products - these are ideal conditions.

Orthopedic mattresses

Causes of degenerative spine diseases

Among the “triggers” for the development of degenerative-dystrophic diseases of the spine, the following should be mentioned:

Aging of osteochondral tissue , loss of moisture and elasticity by the intervertebral discs (accordingly, a decrease in shock-absorbing properties, as well as the height and density of the disc, higher trauma);
Connective tissue dysplasia (excessive elasticity, fragility, fibrousness);
Physical inactivity or “sedentary” lifestyle: weak back muscles reduce the intensity of local blood circulation, as a result of which the nutrition of the vertebrae is disrupted;
Overweight;
Diabetes; ;
Primary metabolic diseases (gout, mucopolysaccharidosis, pathologies of protein metabolism);
Genetic predisposition to DDSD, congenital anomalies of the structure of the spine;
Infectious and inflammatory processes;;
Systematic overload , violation of biomechanics (work related to heavy lifting, heavy physical labor, professional sports);
Injuries, vertebral displacement.

Pain in the spine (dorsopathies)

Dorsopathies in medicine refer to a variety of pain in the back (and limbs) caused by degenerative-dystrophic diseases of the spine.

If the patient experiences pain for longer than 12 weeks, it is called chronic. The causes of dorsopathies are clarified based on the results of MRI of the spine (CT is most often only an auxiliary method). Treatment is carried out by neurologists, osteopaths, algologists or spinal neurosurgeons.

Degenerative-dystrophic diseases of the spine often lead to compression of the nerve endings and roots of the spinal cord, so the pain syndrome can be very intense and spread to other associated parts of the skeleton: arms, feet, chest, etc.

Thus, problems with the spine are indicated not only by dorsopathies localized in the back area, but also by other pains - with irradiation and neuralgic symptoms, for example:

Symptom of intermittent claudication;
“Shooting” pain in the leg;
Numbness in the arms or legs;
Dizziness and headaches;
Weakness of the limbs, marked decrease in muscle tone;
Loss of sensation in limbs.

As a rule, pain becomes more intense after physical activity and goes away during rest, but it also happens the other way around, when it is at rest that the patient begins to experience pain.

DDZD of the cervical spine causes pain in the neck and forearm, paresis of the arms, headaches and dizziness, tinnitus and blurred vision.

DDSD of the thoracic spine can manifest as pain behind the sternum, which intensifies with breathing and coughing. The pain spreads along the ribs with radiation to the back. The symptoms are somewhat reminiscent of angina pectoris.

DDSD of the lumbosacral spine is associated with intense lower back pain radiating to the legs (numbness, weakness, lameness). It becomes difficult for the patient to play sports, walk, bend over, or remain in a static position for a long time.

Risk factors and causes of pathology development

The disease in most cases develops in patients aged 20 to 45 years. Most often, physically busy people and drivers experience spinal distortion.

In addition, the following reasons can provoke the disease::

sudden lifting of heavy objects, including when performing sports exercises;
sudden braking of a vehicle and getting into an accident;
sleeping on a high pillow and an overly soft surface;
lack of physical activity;
falling on your back, including from a small height;
sharp turn of the body and neck;
diseases of the spine, which reduces the strength of the ligaments.

Attention! In most cases, sudden braking of the car, even when secured with a belt, leads to distortion of the cervical spine. The complexity of injury in such a development of events depends on the speed of the vehicle; the higher it is, the greater the likelihood of a violation in the neck.

Consequences

Usually, after starting therapy and after it has been completed, the patient does not see or feel any negative consequences of distortion. But if prescribed recommendations are violated, there is no bed rest, or if the affected area is re-injured, the patient develops chronic pain in the head, neck and lower back . In some cases, distortion became an indirect cause of inflammatory processes and curvatures in the spine and chest.

Spinal injuries

Spinal fractures can result from accidents, sports injuries, falls from a height, blows and bruises. Secondarily, they occur against the background of osteoporosis, aggressive growth of hemangiomas or other tumors. It should be noted that not all spinal fractures are visible on x-rays - due to the low resolution and two-dimensional nature of the visualization, the capabilities of this method in diagnosing fractures and injuries are limited. The “gold standard” is considered to be a CT scan of the spine - a high-precision volumetric slice-by-slice scan that allows you to obtain an authentic 3D model of the body area under study.

Spinal injuries are classified into three groups, depending on the severity of the injury:

Vertebral fractures (compression wedge-shaped, comminuted) without distraction and axial torsion - the spinal cord and important neurovascular components are not affected.
Fractures of the vertebral bodies with distraction (rupture) of the anterior and/or posterior segments, there are fracture-dislocations, local compression of the spinal cord is possible.
Vertebral fractures with distraction, displacement (twisting) of the vertebrae, compression of nerve fibers and parts of the spinal cord.

At the moment, computed tomography is the only diagnostic method that provides comprehensive answers about the nature of the bone injury and a complete visual picture.

Diagnostics

Methods for diagnosing the disease are determined by a specialized specialist: a neurologist

,
surgeon
,
orthopedist-traumatologist
. At the first visit, the doctor conducts an external examination, and then additional diagnostic procedures may be prescribed:

radiography
;
magnetic resonance imaging
(MRI);
computed tomography
(CT).

All these modern methods give an idea of the overall picture of the disease, on the basis of which the doctor chooses the correct treatment tactics.

Osteochondrosis

Behind the term “osteochondrosis” is a large group of pathologies that lead to degenerative processes affecting the intervertebral discs. As a result, they become smaller, delaminate, lose elasticity and ultimately rupture, leading to the formation of a protrusion or intervertebral hernia.

Osteochondrosis is considered to be the starting point for the development of other DDDDs, but in itself it is not their cause. A predisposition to osteochondrosis can be hereditary, but more common causes include metabolic disorders, posture and physical inactivity (weak back muscles, poor circulation and, accordingly, nutrition of the intervertebral discs).

Osteophytes of the spine

Osteophytes are hard, abnormal growths on the bone tissue around a vertebra. Such growths have a jagged shape and can painfully compress nerve endings and narrow the lumen of the vertebral foramen. Sometimes osteophytes are formed from the tissues of dead ligaments. In most cases, they do not affect quality of life due to their small size. However, if osteophytes grow over time, they ultimately cause acute compression, damage to surrounding tissue, and inflammation. Symptoms of spinal osteophytes are dull pain in the back or neck, which intensifies when walking or standing (sometimes radiating to the leg or arm) and paresis. In this case, osteophytes require surgical removal. If they are found along with the operated hernia, they can complicate surgical tactics, so in this case they are also removed.

Spinal stenosis

Stenosis is a pathological narrowing of the spinal canal caused by hyperplasia of bone tissue, tumor growth, and the entry of fragments of osteochondral fragments during injury into the space occupied by the roots of the spinal cord or nerve fibers, which leads to their compression. Spinal stenosis manifests itself as pain with neuralgic symptoms. The most common complaint is back pain, which increases with walking and decreases with sitting (flexing the spine). An accompanying symptom is most often numbness and weakness of the legs, pain of a “shooting” nature. The latter is typical for lesions of the lumbosacral segment.

Our treatment methods

Treatment of displacement begins only after a detailed examination of the spine!

Chiropractor massage the female patient spine and back

We use the latest diagnostic systems and effective non-surgical methods for treating vertebral displacement. It is possible to completely get rid of symptoms and stop further development of the disease only with an integrated approach to treatment.

At the first appointment, the doctor diagnoses back pain, assesses motor function, the condition of the spine, checks muscle strength, evaluates reflexes, skin sensitivity, conducts functional tests, identifies changes in the musculoskeletal system, and determines the stage of the pathological process.

If necessary, additional examinations are prescribed to make a diagnosis:

Radiography
CT (computed tomography)
MRI (magnetic resonance imaging)
Laboratory research
Consultations of narrow specialists

Pain relief is possible already at the first session using nerve root blockade, acupuncture, biopuncture, vacuum therapy, hirudotherapy, and certain massage techniques.

Pain relief does not treat the cause, but removes the reflex muscle spasm, relaxes the muscles and releases the pinched nerve root.

After a complete diagnostic procedure, the doctor draws up an individual treatment plan. During treatment, the regimen may change.

Orthopedics (production of orthoses)
Physiotherapy
UVT
Massage
Exercise therapy
Manual therapy
Hirudotherapy

Our task is to help the body launch and accelerate natural recovery processes. Treatment of the disease is completed when the load on the spine is removed, metabolic processes and blood supply are restored.

Surgery is a last resort measure that is required only if the disease is advanced or noticeably progressing. If necessary, we cooperate with leading clinics in Russia and abroad and provide referrals for a consultation with a surgeon.

Remember, self-relief of pain with pharmacological drugs, physiotherapy or folk remedies only allows you to temporarily suppress the symptoms, but does not stop the development of the disease.

Intervertebral hernia

Intervertebral hernia is a local displacement of disc material (nucleus, cartilaginous nodule, fragments of the fibrous ring) into the spinal canal and intervertebral foramen. Intervertebral hernias can also cause compression of nerve fibers and spinal cord roots.

Depending on the stage of development of the disease, the following types of hernias are distinguished:

Protrusion is a displacement of disc material (nucleus pulposus, annulus fibrosus) towards the spinal canal. Visualized as a small protrusion. The fibrous ring is stretched.
Extrusion is a more pronounced displacement of disc material into the spinal canal. Often leads to damage to the fibrous ring.
Sequestration is the prolapse of the nucleus pulposus and fragments of disc material into the spinal canal with rupture of the fibrous ring. Provokes severe pain.

Schmorl's hernias are cartilaginous nodules that invade the bodies of adjacent vertebrae and deform them. The depression forms at the border of the vertebra and the disc. Large Schmorl's hernias can provoke immune reactions in the body, accompanied by pain. However, the vast majority of such hernias do not affect the quality of life and do not require surgical treatment.

Possible complications

A disease that is not cured in time can lead to irreversible destructive consequences for the human body. Spinal pathology is dangerous because it affects both the musculoskeletal system and the central nervous system. Possible complications:

partial or complete paralysis;
arachnoiditis, spinal cord abscess;
periarthritis;
neurological problems of the muscles of the back of the head;
impairment of motor functions of the legs and arms;
loss of skin sensitivity in the affected area;
complete prolapse of the vertebra.

There are currently a lot of methods for treating vertebral rotation, and the disease detected in time is very treatable. To avoid serious complications, it is extremely important to seek medical help at the first symptoms of displacement.

Spinal neoplasms

Spinal tumors can be benign or malignant. The prevalence of the latter is relatively low, and most often it is not bone cancer that is diagnosed, but spinal cord cancer, which paralyzes the entire human body.

As benign tumors grow, they can also have disabling consequences. Neoplasms can compress nerve fibers and roots of the spinal cord, causing pain, neuralgia, and muscle atrophy.

Spinal injuries, bone diseases, and heredity increase the risk of spinal tumors.

Benign tumors of the spine include:

Osteoma - develops from bone cells in the pedicles of the posterior part of the vertebra. It manifests itself as back pain, which bothers you at night. They are poorly visualized on X-ray; the only accurate method of visualizing them is CT.
Bone cyst - a tumor forms on the back of the vertebra or affects it completely. Most often found in the cervical spine. If there are compressions, they are removed surgically.
Giant cell tumors are formed primarily from bone cells and represent a deviation from their normal development. They reach large sizes and therefore cause pain. They are removed surgically and require pre- and postoperative monitoring, as they can degenerate into a malignant tumor of the spine.
Granuloma is a spinal tumor, usually small in size. Accompanying damage to the vertebra, namely the thinning of its body. Vertebral granuloma can be an independent disease, or it can indicate malfunctions and damage to other organs. Treatment is carried out using surgical or radiation methods.

Malignant neoplasms of the spine include:

Metastases are secondary foci of oncology, formed from malignant cells that migrated from other organs, bones and joints through the circulatory system or lymph flow. As a rule, the primary focus is located close, and depending on the segment of the spine, it can be the lungs, abdominal cavity, mammary gland, prostate gland, etc.
Osteogenic sarcoma is a malignant tumor of bone tissue. Common among children (adolescents) and elderly patients.
Myeloma (or multiple myeloma) is a malignant tumor of bone tissue. Multiple myeloma often affects not only the spine, but also other osteochondral structures. The highest prevalence of the disease is among patients over 40 years of age.

First aid for spinal injury and choice of treatment tactics

It is important not to move or lift the patient after receiving a blow or other traumatic impact and immediately call an ambulance. Under no circumstances should the victim be allowed to sit or stand, but it is worth giving pain medication and attempting to calm him down. If there is no breathing or heartbeat, resuscitation should be performed. Specialists who arrive at the scene carefully immobilize the patient at the scene by securely fixing him on a rigid shield using a rigid head holder, and then transport him to a medical facility.

Any patient who is suspected of having a spinal injury is immediately treated with a spinal injury protocol until a full investigation has been completed and it is proven that no injury has occurred.

If the presence of an injury is confirmed, its type and characteristics are clarified, it becomes clearly clear what treatment is indicated in a particular case. Conservative therapy is carried out only in the mildest cases in the absence of signs of neurological deficit, when only a violation of the anatomy of bone structures is observed without signs and risks of complications, in particular compression of the spinal cord. It is usually indicated for mild compression fractures, dislocations, fractures of processes, arches, and vertebral bodies without the formation of fragments.

Conservative treatment consists of:

bed rest or immobilization of the affected part of the spine;
drug therapy appropriate to the situation;
traction therapy (spinal traction using a special apparatus);
physiotherapy;
manual therapy.

If necessary, vertebral reduction is initially performed.

But in the vast majority of cases, surgery is indicated for spinal injuries. Emergency surgery is required when:

the presence and especially intensification of signs of neurological deficit;
severe deformation of the spinal canal due to bone fragments, dislocated vertebrae or significant curvature;
the presence of a large hematoma formed as a result of injury to a herniated intervertebral disc, injury to the yellow ligament, the presence of a foreign body that threatens compression of the spinal cord;
the presence of isolated hematomyelia, i.e. hemorrhage in the spinal cord;
compression of a large blood vessel supplying the spinal cord;
pronounced compression of the spinal roots;
instability of spinal motion segments when creating a threat of their displacement and compression of the spinal cord;
the presence of foreign bodies in the spine;
liquorrhea, i.e. leakage of cerebrospinal fluid through defects at the base of the skull;
injuries received from gunshot or stab wounds.

But there are also contraindications for performing the operation even if there are compelling indications for it. In such situations, spinal surgery is postponed until the patient's condition is stabilized. This is about:

traumatic or hemorrhagic shock with unstable hemodynamics;
the presence of severe damage to internal organs, leading to internal bleeding, associated with the risk of developing peritonitis;
extremely severe traumatic brain injuries with signs of intracranial hematoma formation.

However, it is also possible to carry out the operation as planned. They are required when conservative therapy is ineffective, but they allow you to carefully prepare the patient for the upcoming surgical intervention and select a treatment tactic that suits him.

Spondylolisthesis of the vertebral segment

Spondylolisthesis is an abnormal displacement or slipping of a vertebra. As a result, the spinal segment loses stability. The consequences can be traumatic and dangerous - sometimes the displacement of one vertebra in relation to another (upper to lower) reaches 75%.

Spondylolisthesis of the spinal segment can be a consequence of injury, surgery, improper bone development, systematic improper loads, and diseases of the osteochondral tissue. Causes pain (passes after rest) with neuralgic symptoms, dysfunction of the pelvic organs.

To stabilize the spinal segment, the patient may be indicated for neurosurgical surgery with the installation of an implant, metal structure, or interbody cage.

A CT scan revealed a degenerative disease of the spine - what to do?

If back pain does not bother you, but the “accidental finding” on a CT or MRI turned out to be “degenerative-dystrophic disease of the spine,” you should clarify what kind of disease it is and assess the possible health risks in the future.

Timely consultation with a neurologist or osteopath will help develop measures for effective treatment of DDSD and prevention of complications. The worst option would be to ignore the problem and “let go” of the situation to the point of traumatic consequences and the need for surgical intervention.

If there is severe pain associated with an intervertebral hernia, stenosis or other type of DDSD, the patient should consult a neurologist, algologist or neurosurgeon. The pain must be relieved, as it makes it difficult to move and provokes the development of depression, thus aggravating the situation. The patient will also be prescribed therapy (NSAIDs, therapeutic blockades, exercise therapy, radiofrequency ablation, physiotherapy, etc.) or surgery will be recommended.

Degrees of vertebral rotation

First. Usually asymptomatic. The detection of the disease, as a rule, occurs by chance during the diagnosis of another pathology. Pain may occur occasionally with increased physical activity or sudden changes in body position.
Second. The pain does not go away as quickly as during the first stage of rotation and manifests itself as more pronounced unpleasant sensations. This becomes especially noticeable after physical activity.
Third. The person feels stiffness in movements. Disturbances in the functioning of the genitourinary system may occur. There is a possibility of pinching the spinal cord nerves. In this case, the pain will be severe.
Fourth. At the last stage of rotation of the vertebral bodies, the disease clearly progresses and makes irreversible changes to the structure of the spine. The patient feels severe weakness in the legs, lameness or changes in gait may appear. Severe chronic pain usually forces you to see a doctor. But if no measures are taken, the disease becomes a disability.