Spine structure
Berezhkova Lyudmila Vasilievna
Neurologist, Chiropractor
April 24, 2021
Osteochondrosis can manifest itself with different symptoms. Patients visit many specialist doctors. They complain to the ophthalmologist about flashing “spots” before the eyes and decreased visual acuity, to the ENT doctor they tell about tinnitus, hearing loss, discomfort when swallowing and frequent choking, to the neurologist about headaches, dizziness and unsteadiness of gait, and to the psychotherapist about depression , restless sleep and forgetfulness. Drops in the eyes and ears, various medications do not help them. Because the main cause of ailments is osteochondrosis of the cervical spine.
The most well-known and common symptom of osteochondrosis is pain in the back, neck, lower back, shoulder and pelvic girdle. Acute low back pain is the most common cause of disability in people under 45 years of age. Between the ages of 45 and 65, back pain ranks third in frequency after heart and joint diseases (arthritis). It was found that 60 ~ 80% of the population experienced such pain at least once. Currently, this disease is as common as influenza and cardiovascular diseases, and is not inferior to them in terms of financial costs of treatment. Foreign scientists have calculated that low back pain syndrome ranks third (as the most expensive disease after heart disease and oncology), because it is associated with significant costs for diagnosis and treatment, operations, disability compensation and disability subsidies.
Spine structure
The structure of the human spine is determined by its functions: supporting, protective, shock-absorbing and motor. The spine is a curved vertical column that supports the head from above and rests on the pelvis and lower limbs from below. The human spine consists of 33-34 vertebrae, of which 24 are connected by intervertebral discs and are mobile. There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4-5 coccygeal vertebrae.
Vertebrae are called (vertebrae) in Latin, and the science that studies the spine and its diseases is vertebrology. Sometimes in the diagnosis you can find the word vertebrogenic or vertebral, which means “derived from the spine.” In the cervical vertebrae, unlike others, there are special openings in the transverse processes that form a canal. The vertebral artery passes through the canal into the cranial cavity. It nourishes the brain, including areas responsible for coordination of movements, hearing, emotions, sleep, wakefulness and much more. This explains the many-sided medical histories of people with cervical osteochondrosis.
The spine as a whole is a flexible rod and support for the head, shoulder girdle and arms, thoracic and abdominal organs. It connects the upper part of the skeleton to the lower. The supporting function of the spine is due to a gradual increase in the size of the vertebrae from top to bottom from the cervical to the sacral region. The largest size is at the lumbar vertebrae. The underlying sacral vertebrae fuse into a single massive bone (sacrum). The coccyx is a remnant of the tail that disappeared in humans.
The protective function of the spine is to protect the spinal cord from damage. Due to the end of the spinal cord at the level of the second lumbar vertebra, the vertebral foramen in the lower vertebrae gradually narrows and completely disappears at the coccyx.
A characteristic feature of the spine that ensures its shock-absorbing function is its physiological curves. Between the bodies of all vertebrae, except the first and second cervical, there are intervertebral discs. Thanks to the discs, the spine is mobile, elastic and resilient, and can withstand significant loads. Simple extension of the spine causes pressure on the spinal discs of up to 90-123 kg. If extension is combined with lifting a load, then the force acting on the disc increases many times. It was experimentally found that a load of 100 kg reduces the height of the disk by 1.4 mm and increases its width by 0.75 mm. Painful changes in the condition of the disc lead to dysfunction of the spine. Staying in a horizontal position for several hours straightens the discs and lengthens the human spine by more than 2 cm. Due to the loss of elasticity of the disc, which occurs with age due to a decrease in its ability to bind water, a person’s height can sometimes decrease by more than 7 cm .
Ligamentous apparatus and muscles.
Ligaments (dense connective tissue structures) firmly connect the vertebrae, directing and holding their movements in different directions. The ligaments can withstand heavy loads and are so tensile that they do not tear during injury. Usually there is a tearing of a section of bone at the site of attachment of the ligaments. Numerous back muscles, along with ligaments, ensure reliable connection of the vertebrae and mobility of the spine.
Anatomy of the spinal cord.
Protecting the spinal cord, the structures of the spine closely interact with it, its roots and nerves, ensuring the functioning of their corresponding internal organs and parts of the musculoskeletal system. The spinal cord lies in the spinal canal, located from the edge of the occipital foramen of the skull to the level of the first and second lumbar vertebrae, gradually thinning and ending in a cone. Below the spinal cord in the spinal canal there is a bundle of nerve roots extending from it, which is called the “cauda equina.”
The spinal cord is surrounded by three membranes: soft, arachnoid and hard. The pia mater directly covers the spinal cord. Between it and the arachnoid membrane there is a subarachnoid space in which the spinal cord and its roots lie freely, “floating” in the cerebrospinal fluid. The dura mater is adjacent to the vertebrae. Spinal nerves depart from the spinal cord: 8 pairs of cervical, 12 - thoracic, 5 - lumbar, 5 - sacral and 1 or 2 - coccygeal. Each spinal nerve exits through its own intervertebral foramen with two roots: the posterior (sensitive) and the anterior (motor), which are connected into one trunk. Each pair of spinal nerves is responsible for a specific part of the body, skin, muscles, bones, joints and internal organs. All learned automatic and reflex (involuntary) movements are controlled by the spinal cord.
Statics and biomechanics of a healthy spine.
Maintaining the correct position of adjacent vertebrae and the entire spinal column as a whole is called statics. Normal statics allow the spine to perform its functions of support and protection. The curves of the spine are held by the strength of muscles, ligaments and the shape of the vertebrae themselves. The S-shaped profile of the human spine is due to upright posture. The double curvature of the spinal column gives it strength, softening shocks and impacts during movements.
For most people, the line of gravity runs in front of the spine, so body weight does not increase all the curves, but straightens the lumbar lordosis. When standing, muscles and ligaments tense and increase pressure on the vertebral bodies. Excessive mobility of the vertebrae is dangerous for the spinal cord located in the spinal canal. The degree of mobility (dynamics) of the spine is determined by the movement of adjacent vertebrae and changes in the configuration of the entire spine and its position relative to other parts of the body.
Movements of the spine are possible along three axes: flexion and extension along the transverse axis; lateral tilts around the sagittal axis, rotation around the longitudinal axis. Rotation is maximum in the cervical and upper thoracic regions, and flexion and extension are maximum in the cervical and lumbar regions. Lateral bending with the greatest amplitude is possible in the lower thoracic spine. The movements involve the passive part of the spine (vertebrae, joints, ligaments and discs) and the active part (muscular apparatus).
Correct statics and dynamics ensure stately posture and good mobility of the spinal column, its flexibility. Good flexibility is a sign of the optimal state of all anatomical structures of the spine, and therefore its health.
Spinal arthrosis: causes, symptoms, treatment
Causes
Arthrosis is very rare in young people. In most cases, this diagnosis is made to older people. In the younger generation, this disease occurs only in cases of spinal injury in the past, if the person has any defects in the structure of the spinal column, disorders of the spinal disc, or excess body weight.
If the spine has already been damaged, it often happens that the joints begin to wear out as a result. This issue is especially acute for overweight people, since in this case the joints are at risk even without injury.
Since the cartilage tissue becomes much thinner than before, this leads to pain in the back. Due to painful sensations, a person tries to change the position of the body, which leads to overload of the spinal column and significantly complicates the situation.
Since with age, irreversible aging processes occur in the body and, as a result, disruption of the nutrition of cartilage, ligaments, and joints. All this leads to the fact that the synovial fluid loses its functions and this is what becomes the cause of arthrosis.
Signs
Frequent pain is often the main indicator of arthrosis. As a rule, they are felt in a specific area of the spine. But if the disease is already in an advanced stage and osteophytes have appeared, the joints become inflamed, quite painful sensations may appear during any movement and discomfort in the spine in the morning, which is associated with hypertonicity of the muscles of the spinal column.
Diagnostic tests
To establish an accurate diagnosis, the doctor will necessarily analyze everything that the patient tells him about his condition and prescribe all the necessary tests. As a rule, this is a biochemical blood test, radioisotope scanning, radiography and magnetic resonance imaging. In order for the doctor to rule out a head disease, the patient is often also prescribed an ultrasound of the brain.
Treatment methods
To improve the patient’s health and cure the disease, the doctor prescribes the necessary medications, attending physical therapy, following a certain diet, using external medications, which are usually specialized ointments or rubs, physiotherapeutic procedures and surgery. Treatment of spinal diseases is always difficult and time consuming. Therefore, the patient must perform all the procedures prescribed by the doctor in combination to obtain a high-quality result.
In cases where parts of the spine are already affected by arthrosis, the doctor must prescribe painkillers and anti-inflammatory drugs. The use of muscle relaxants is also usually prescribed in order to relieve muscle tone.
If arthrosis or spondyloarthrosis, as it is also called, is only in the initial first stage, chondroprotectors that help restore intervertebral discs and medications designed to improve blood circulation are very helpful in its treatment. For the same purpose, abdominal decompression can be prescribed, in which artificial negative pressure is applied to the lower part of the person’s body. This not only helps increase blood circulation, but also helps slow down or completely eradicate inflammatory processes in the body.
A noticeable improvement in the patient’s condition occurs after regular visits to physiotherapeutic procedures such as acupuncture or reflexology, as it is also called, phonophoresis and magnetic therapy.
If the use of medications, attending procedures, following a special diet do not produce positive results and the disease does not recede, the patient must undergo surgery.
Usually it consists of replacing vertebrae damaged by arthrosis with artificial ones. Or doctors perform thermal disconnection of the patient’s nerve endings, which is called “denervation surgery.” Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr