Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.In terms of injury frequency, the cervical spine is second only to the lumbar spine.Treatment of osteochondrosis of the cervical spine is carried out in most cases using conservative methods and depends on the stage of the disease and the severity of destructive processes in the intervertebral discs.Surgical treatment is indicated for 5-7% of patients with persistent disease, lack of effect of conservative therapy for 3-4 months, and also with the development of serious neurological complications.
Clinical manifestations of the disease.
Osteochondrosis of the cervical spine has a wide variety of manifestations.Symptoms depend on the predominance of one or more syndromes that develop as a result of the impact of pathologically altered structures of the spine on the spinal cord, its roots or vertebral arteries.The clinical picture of the disease is determined by the following syndromes:
- Vertebral: manifested by pain of varying intensity and duration, located in the neck or occipital region of the head.
- Spinal - the appearance of innervation disorders, which are manifested by motor and sensory disorders, as well as trophic changes in the muscles of the upper extremities.
- Radicular: manifested by pain in various locations (upper extremities, thoracic and abdominal organs), requires a differential diagnosis with many diseases of the internal organs and cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders arising from insufficient blood supply to the structures of the brain (headaches, hearing impairment, tinnitus, dizziness, short-term loss of consciousness).
How to treat cervical osteochondrosis?
The reason for seeking medical help is the first appearance of symptoms or the next exacerbation of the disease.In any case, the treatment of cervical osteochondrosis should be prescribed only by a doctor after a mandatory examination of the patient and the necessary instrumental and laboratory studies to exclude concomitant pathologies.
After confirmation of the diagnosis, outpatient treatment is prescribed in most cases.Patients with severe neurological disorders, high probability of complications and severe concomitant pathology require inpatient treatment.Conservative treatment of osteochondrosis involves the use of the following methods.
Drug therapy
The use of medications is necessary during an exacerbation of the disease to combat pain.For this they prescribe:
- Non-narcotic analgesics.Non-steroidal anti-inflammatory drugs are taken orally or parenterally, with the mandatory use of topical preparations: ointments, gels, balms and rubs.Complex anti-inflammatory therapy helps reduce soft tissue swelling, the main cause of pain in spinal syndrome.The duration of use of drugs from this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral blocks of anesthetics with hormonal agents are used in an amount of 1 to 3 manipulations.
- Antispasmodics, vitamins of group B. In the acute period, in the presence of severe edema, the prescription of diuretics in a short course for 2 to 4 days is indicated.They reduce vascular spasm and improve microcirculation in the inflammatory focus.
- Sedatives (peony tincture, valerian root, herbal teas and infusions) to prevent the development of neurotization if the patient has prolonged unbearable pain.
- External warming agents: balms, ointments, rubs that have a mild irritating effect and contain biologically active substances of plant and animal origin.Medicines with a strong irritating effect cannot be used, as they increase swelling, which can lead to a worsening of the condition.
therapeutic massage
Massage is an integral part of the complex treatment of osteochondrosis.It is used after the exacerbation has been eliminated to consolidate the effect of drug therapy and periodically during remission for prophylactic purposes.The therapeutic massage course is 10-14 sessions and is prescribed 2-4 times a year in the absence of severe pain.
Massage improves blood supply, lymphatic flow and relaxes spasmodic muscles in the neck and neck area.Thanks to this, the nutrition of the cartilaginous tissue of the intervertebral discs is improved, preventing the progression of the process and reducing the risk of subsequent relapses.
therapeutic exercise
Physiotherapy exercises for cervical osteochondrosis should be performed daily, except in case of exacerbation of the disease, accompanied by severe pain.In case of severe pain, it is necessary to follow a gentle regimen, which involves the maximum limitation of movements in the cervical spine.
Systematic exercise therapy helps strengthen the neck muscles, which helps reduce the static load on the intervertebral discs.The exercises are performed without problems;At first, sudden, large movements are prohibited.Exercises should be started carefully, gradually increasing the load, avoiding the appearance of unpleasant sensations.
The exercises are performed standing or sitting.The most common exercises consist of:
- turning the head to the sides;
- tilt your head back and forth;
- raising your shoulders, with your arms relaxed or fixed, holding them in this position for 15-20 seconds;
- Static loads, with the head stationary, produce alternating tension in the flexors and extensors of the neck.
The exercises must be repeated 5-7 times, the duration of the lesson is 15-20 minutes.
traction
To avoid possible complications, traction should be performed in a hospital under the supervision of a doctor.The procedure is performed with extreme caution and if pain occurs it should be stopped immediately, as it may cause an exacerbation of the disease.
During traction, the elastic tissues of the ligaments of the spine stretch, which leads to an increase in the distance between adjacent vertebrae.Increases from 1 to 3 mm.This turns out to be enough to reduce, and in some cases completely eliminate, compression when a root or artery is compressed by a herniated disc or osteophyte.During the procedure, the pressure inside the intervertebral disc decreases, causing a partial retraction of the hernial protrusion and an increase in the intervertebral foramen.
Traction has a beneficial effect on the intervertebral joints, eliminating subluxations that have formed in them and helps reduce muscle contractures.Immediately after traction, it is imperative to fix the cervical spine with the help of special devices for several hours.The treatment course includes 10 to 20 procedures.
Physiotherapeutic treatment
The use of medicinal electrophoresis has a good effect.The technique allows the administration of drugs to the tissues involved in the pathological process.For cervical osteochondrosis, electrophoresis is used with non-steroidal anti-inflammatory drugs, hormonal anesthetics and other medications.
The use of diadynamic currents helps to improve blood circulation and has a good analgesic and anti-inflammatory effect, helping to reduce the excitability of nervous tissue.When using complex treatment with conservative methods, the initial appearance of osteochondrosis can be cured, provided that an active lifestyle, adequate and nutritious nutrition is maintained, and bad habits are abandoned.
With a very advanced destructive process, proper treatment and lifestyle will allow you to achieve long-term remission.In some patients it is impossible to achieve improvement with conservative treatment;In such cases, neurosurgical methods are used.
Surgical treatment
Before surgically treating cervical osteochondrosis, all available canning methods should be tried.Typically, surgical treatment is indicated when therapy has been unsuccessful for three months or more.As well as the development of spinal cord compression in the patient, which is accompanied by severe neurological symptoms that can lead to disability.
Currently, the most used operations are microdiscectomy and endoscopic surgery.The manipulation is performed using microsurgical instruments and a 10x microscope, which allows the compressed areas of the spinal cord to be clearly observed.Excision of part of the hernial protuberance is performed by pressing on the root or spinal cord.Sometimes it is necessary to remove a small fragment of a vertebra or remove a ligament.