Treatment of spondyloarthrosis: modern approach and effective methods

The most common pathologies of the spine are acquired. Usually they are degenerative-dystrophic in nature and originate from osteochondrosis. In addition to dystrophic processes, inflammatory processes are involved in the pathogenesis of spondylosis and spondyloarthrosis, which will be discussed in the article. These diseases are progressive, which is why they often lead to complications.

Spondylosis and spondyloarthrosis

In the article we will look at the similarities and differences between diseases such as spondylosis and spondyloarthrosis, how to diagnose them and treat them correctly and effectively.

general characteristics

A pathology such as spondylosis is characterized by detachment of the ligamentous apparatus from the vertebral bodies and the formation of osteophytes at the site of this very detachment. The disease is progressive. The process of ossification at the site of detachment, in other words - ossification, gradually increases and leads to the formation of bone condyles in the shape of an arc. The height of the intervertebral discs decreases. Spondylosis is typical for older people. It is not surprising that, along with disorders of a degenerative-dystrophic nature, involutional processes are observed in pathogenesis. The disease can also occur in younger males, especially in those whose active work involves constant lifting of weights.

With spondylosis, osteophytes are formed - bone growths

Spondylosis progresses slowly, but it can affect all segments of the spine. The intervertebral disc becomes fibrotic, and the disease spreads to the joints and their ligaments. Posterior and posterolateral bone growths lead to the manifestation of polyradiculopathies.

Spondyloarthrosis primarily affects the cartilage of the facet joints. After primary lesions, pathological processes already spread to ligaments, bones, synovial membranes and joint capsules. In most cases, spondyloarthrosis is observed in the cervical region. Less often - in the lumbar region. The development of spondyloarthrosis directly depends on the presence of osteochondrosis. Since intervertebral discs act as shock absorbers of the spinal column, when they become thinner, the load on the cartilage of the facet joints increases. This contributes to the degenerative process of these small joints. Since pain in isolated spondyloarthrosis is rare, the disease remains uncured and leads to the formation of bone spurs. This is what gives rise to spondylosis. In addition to spondylosis, the presence of spondyloarthrosis contributes to the appearance of protrusions of intervertebral discs.

With spondyloarthrosis, cartilage tissue and facet joints are affected

The etiopathogenesis of arthrosis can be schematically presented as follows:

Arthrosis:

• dystrophic-degenerative;

1. Dysplastic.
2. Dishormonal.
3. Dislocation.

• inflammatory-destructive.

Dysplastic and idiopathic (of unknown etiology) spondyloarthrosis are the primary variants of the disease.

Dysplastic spondyloarthrosis develops as a result of improper development of articular elements. This is due to tropism anomalies, which are manifested by disturbances in position and orientation, as well as insufficient development or complete absence of vertebral processes. Spondyloarthrosis is characterized by increased pain when changing body position, which is accompanied by stiffness and stiffness. This manifestation is called spondyloarthralgia syndrome. This syndrome is characterized by slowly progressive dorsalgia with symptoms of varying intensity. Patients note lack of coordination of rotational movements and rapid fatigue.

With spondyloarthrosis, periodicity is observed. Exacerbations of the disease are replaced by periods of symptom relief - remissions. Pain with spondyloarthrosis is not the result of compression of the roots, as with spondylosis, but the spread of impulses along the sclerotomes.

Types of treatment for spondyloarthrosis

The choice of treatment method depends on the stage of the disease, but they always begin with the removal of acute symptoms. The main goals of therapy are pain relief, unloading of the spine and stopping further progress of the disease.

Pharmacological

Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for the shortest possible course to eliminate pain and inflammation. The drugs of choice are Diclofenac, Indomethacin, Ibuprofen, Ketoprofen and their derivatives. Important! If pain persists, they switch to selective NSAIDs that are less toxic to the body - Meloxicam, Celecoxib, Nimesil.

Persistent pain is relieved with steroid medications. If NSAIDs do not help, then they are replaced with one of the following drugs:

• Diprospan;
• Hydrocortisone;
• Dexamethasone.

They are most effective in the form of intramuscular injections.

In especially severe cases, cytostatics (Methotrexate) and immunosuppressants (Leflunomide), Sulfasalazine are prescribed. If pronounced muscle spasms are observed, muscle relaxants are used - Sirdalud, Mydocalm, Baclofen.

Non-drug

After the severe pain caused by spondyloarthrosis has been relieved, treatment continues with non-drug methods. It includes physiotherapy, manual therapy sessions and therapeutic exercises. The most effective physiotherapy procedures are:

• phonophoresis with Hydrocortisone;
• ionogalvanization with local anesthetics - Lidocaine, Novocaine;
• magnet;
• SMT therapy (sinusoidally modulated currents).

With the help of manual techniques, the range of motion of the spine increases by relaxing spastic muscles and optimizing the load. Manual techniques of manual therapy can minimize the negative consequences of pathology - pain, stiffness in the body. After a course visit to the procedures, posture improves significantly./p>

Therapeutic exercises help correct the motor pattern and strengthen the back muscles. Thanks to regular exercise, the overall tone of the body increases.

Surgical

Surgery is performed if conservative methods do not produce results. The essence of the operation is to install a special structure between the spinous processes of the damaged vertebrae. After implantation, the spinal motion segment experiences less load, the spinal ligaments and posterior sections of the intervertebral disc are stretched. As a result, the foraminal openings for the exit of the nerve roots and the spinal canal itself expand.

Etiopathogenesis

Spondylosis and spondyloarthrosis are more common in women with hormonal disorders and fluctuations. It's no surprise that illnesses are common in menopausal women. This group of diseases develops much less frequently in pregnant women, since the hormonal levels during this period are the least favorable for the development of pathology. Other causes include trauma, autoimmune pathologies, genetic predisposition to skeletal degeneration and congenital anomalies.

Changes in spondylosis and spondyloarthrosis lead to pathological disruption of the biomechanical parameters of the spine. This leads to curvature of posture. There is a risk of developing scoliosis, as well as excessive lordosis in the lumbar region.

The provoking factors of the disease are untreated injuries, age-related changes and excess weight.

Provoking factors for the development of degenerative diseases are:

1. Overweight.
2. Traumas and microtraumas.
3. Age-related changes in the locomotor system.
4. Chronic diseases.
5. Heavy loads on the axial skeleton.
6. Estrogen production disorders.
7. Infectious diseases.
8. Diabetes.

Causes of the occurrence and development of spondyloarthrosis

Spondyloarthrosis can be caused by congenital spinal abnormalities, spinal injuries and chronic microtraumas. Spondyloarthrosis can also be caused by poor posture and metabolic disorders (especially in old age). Constant static loads that cause overload of the spinal column (sedentary work - for example, at a computer) can cause spondyloarthrosis.

Another cause of spondyloarthrosis is prolonged physical activity (professional sports, weightlifting, etc.). In addition, the cause of this disease may be flat feet (of various types). With this disease, gait disturbance occurs and, accordingly, improper distribution of the load on the spine in a vertical position, which in turn leads to spondyloarthrosis.

Stages and classification

Spondylosis and its variety - spondyloarthrosis, as well as osteochondrosis, can manifest themselves in different parts of the spine. These diseases are characterized by stages, so the clinical picture does not develop immediately, which interferes with the early diagnosis of diseases.

Important! Staging is determined using instrumental methods. The criteria are the size, nature of the growth, and the height of the intervertebral disc.

Table No. 1. Stages of diseases.

According to the rate of progression, spondylosis can be classified into:

Causes of the disease

In older people, natural aging slows down the body's recovery processes and collagen production. In young people, it is provoked by spinal injuries and excessive physical activity.

Note!

Osteochondrosis can be a provocateur; obesity; spondylosis; menopause; joint hypermobility; autoimmune diseases; metabolic disorders. The prerequisites are low mobility, poor nutrition, developmental abnormalities, etc.

Classification

By localization: cervical, thoracic spondyloarthrosis, lumbar, and also combined, involving several parts of the spine at the same time.

According to the nature of the process, they are divided into: inflammatory-destructive and dystrophic-destructive.

Types of disease:

• dislocation - the appearance of which provokes scoliosis or osteochondrosis;
• dyshormonal - initiated by dysregulation of the endocrine glands;
• dysplastic - caused by dysplasia.

According to the results of tomography (A.V. Vasilyeva), the following are distinguished: articular surface syndrome; subsequent hyperplasia of the articular processes; degree of morphological decompensation.

According to the clinical course, stages IV are distinguished:

• I - the elasticity of the disc decreases, there are small changes in the paravertebral ligaments;
• II - the process involves the fibrous rings of the intervertebral discs;
• III - the beginning of the growth of osteophytes, nonspecific inflammation involves the ligamentous apparatus, the surface of the intervertebral joint;
• IV - changes in the structure of the vertebral joints become significant, complicated by ankylosis and spondylosis, blood circulation and innervation of the segment involved in the process are disrupted.

Symptoms

The manifestation of diseases depends on which part is affected and which structures are affected by the deformation of the spinal elements.

The following is characteristic of cervical spondylosis.

1. Pain in the occipital area, which is pulsating in nature, radiates to the upper limbs and jaw. It is the result of radicular syndrome.
2. Restricted neck mobility and reflex muscle spasm. These symptoms are associated with the presence of staples, which were formed as a result of complete fusion of osteophytes.
3. Intense headaches. The cause of headaches and migraines is compression. If it is strong, it can lead to fainting.

The following is characteristic of thoracic spondylosis.

General information

Spondyloarthrosis is chronic and first affects cartilage tissue, after which it spreads to the bones. Gradually, osteophytes (bone growths) form, which can cause severe pain and deformation of the vertebrae. Destroyed intervertebral joints, in turn, provoke problems with blood vessels and nerve endings. The result is dysfunction of internal organs (heart, lungs and gastrointestinal tract).

Gradually, spondyloarthrosis can damage the entire spinal column, but this usually takes several decades. Cartilage tissue does not immediately lose its elasticity, and in most cases this occurs due to an acute disruption of its nutrition. Over time, it becomes thinner, cracks appear, and the joint tissue becomes inflamed.

The growth of bone tissue is considered a natural response of the body to destabilization of the intervertebral joint. But this happens unevenly, so small tubercles, antennae and spines appear. Such processes are called osteophytes. They are the ones who limit the mobility of the ridge. Characteristic changes occur not only in bones, but also in muscles. The patient feels this as a spasm, which leads to the development of intercostal neuralgia.

Diagnostics

In case of symptoms that raise suspicion of spondylosis and spondyloarthrosis, you must contact a neurologist, traumatologist, surgeon, or orthopedist. For differential diagnosis, the specialist must first collect anamnesis. The patient describes exactly what worries him, whether there is a person in the family who complains of the same symptoms, whether the patient’s profession and his life activities are associated with an increased risk of injury and carrying heavy loads, whether he has a history of previous injuries and spinal surgeries.

By palpation and neurological examination, the specialist determines pain in a particular area. The doctor pays attention to the patient's breathing pattern and the position in which he sits. The presence of a forced fetal position and shallow breathing allows one to suspect pain syndrome due to spondylosis and spondyloarthrosis. After a subjective and objective examination without the use of diagnostic equipment, the patient is examined using instrumental methods, which are more informative. The most accessible method is radiography. It is carried out both in direct and lateral projections. Computed tomography is also used for diagnosis. This method is more expensive, but more effective. Signs of spondylosis and spondyloarthrosis during CT scanning will be:

• bone growths;
• uneven edges of the vertebrae;
• reduction in the standing height of the intervertebral cartilage;
• protrusion.

Pathologies can be diagnosed using different methods: X-ray, MRI, CT

MRI can evaluate degenerative processes of the facet joints.

Differential diagnosis can be carried out using instrumental methods. But some distinctive features can be observed without them. With spondylosis, palpation of the lateral processes of the vertebrae causes pain, which is different from osteochondrosis. For differential diagnosis with ankylosing spondylitis, it is necessary to take into account the age and sex correlation of this pathology. In addition, laboratory tests can be performed. If inflammatory processes are present in the pathogenesis, ESR will be increased. This laboratory indicator, together with an increase in temperature, is characteristic of ankylosing spondylitis.

What happens with spondyloarthrosis

Dystrophic changes in this disease affect different structures of the spine - its facet joint. Bone and cartilage tissue, ligaments and even periarticular muscles are damaged. The pathology develops slowly and without symptoms. When a person seeks help, the intervertebral joints are already sufficiently damaged and require serious treatment.

• After sleeping or sitting for a long time, a person feels discomfort in the back or mild pain.
• Unpleasant sensations go away after intense bending and rotation of the body.
• Over time, symptoms worsen and it becomes difficult to move after prolonged periods of rest or sitting.
• In the later stages, it is impossible to straighten up and take a step.

General recommendations

To prevent degenerative-dystrophic processes, it is recommended to lead an active lifestyle and eat well. The preferred sport for the spine is swimming, which strengthens the muscular frame of the axial skeleton and improves blood circulation. However, any moderate physical activity with proper warm-up is considered beneficial in preventing degenerative and dystrophic diseases. When working sedentarily, it is recommended to constantly change your position and avoid staying in one position for a long time.

It is important to follow certain recommendations - this will help protect yourself from spinal pathologies

The prognosis for these diseases is favorable if you consult a doctor in a timely manner and follow his recommendations.

You can supplement the main treatment with folk remedies that will improve sleep and speed up metabolic processes. Lavender tincture and medicinal valerian are effective to improve sleep, and garlic tincture and berries are effective to speed up metabolism. But it is advisable to hear the doctor’s opinion about this or that folk remedy.

Basically, treatment is carried out on an outpatient basis, and a visit to the hospital is necessary only to assess the effectiveness of the treatment course and to carry out procedures. Therefore, a favorable prognosis largely depends on the patient himself.

Self help

If you don’t have time to visit the hospital or pain prevents you from getting there, you can try to help yourself. This must be done with caution so as not to provoke a worsening of the situation.

The following tips are used:

• Sleep with a pillow between your legs. Reduces the amount and aggressiveness of pain.
• Use heat and cold alternately in the affected lumbar region.
• Do not lift heavy objects, avoid possible physical exertion.
• Buy an orthopedic pillow and mattress. Special items help keep the spine in good shape and reduce the load on the muscles.
• Stick to a diet. Excess weight is a direct provocateur of spondyloarthrosis.

These measures are only temporary and are not a direct treatment for the disease. If the situation begins to deteriorate sharply, you should immediately visit the hospital or call an ambulance at home.