Osteoarthritis

What is osteoarthritis of the spine in simple terms?

Spinal chondrosis is a chronic disease based on degenerative-dystrophic changes in the intervertebral disc with subsequent involvement of adjacent vertebrae, intervertebral joints and spinal ligaments in the process.

The word “osteochondrosis” has two Greek origins: οστό - bone and χόνδρος - cartilage.

Vertebrae are formations consisting of spongy bone.They are connected to each other by cartilage discs.There are ligaments along the front and back surfaces of the vertebrae.Cartilaginous discs prevent vertebrae from coming together and ligaments from moving apart.Thanks to the coordination of intervertebral discs and ligaments, the spine is elastic and this allows it to perform important functions:

• ensure balance in an upright position,
• soothes shocks and vibrations when walking and jumping,
• protects the skull and the brain located therein from shock caused by excessive shocks.

When osteonecrosis occurs, the intervertebral discs protrude beyond the vertebral body.Depending on the direction in which the protrusion occurs, as well as its size, pain, numbness, muscle disorders and other symptoms will develop.

ICD-10 code:

• M42 Osteoarthritis of the spine
• M42.0 Osteoarthritis of the spine in youth
• M42.1 Osteonecrosis of the spine in adults
• M42.9 Osteonecrosis of the spine, unspecified
• M43.1 Spondylolisthesis
• M47 Spondylosis
• M47.0 Anterior vertebral or vertebral artery compression syndrome
• M47.1 Other degenerative spondylosis with myelopathy
• M47.2 Other degenerative spondylosis with radiculopathy
• M48.0 Spinal stenosis
• M50.0 Cervical disc injury with myelopathy
• M50.1 Cervical disc injury with radiculopathy
• M50.2 Displacement of cervical disc of other type
• M50.3 Other cervical disc degeneration
• M51.0 Injury to lumbar disc and other organs with myelopathy
• M51.1 Damage to lumbar disc and other parts with radiculopathy
• M51.2 Other specified intervertebral disc displacement
• M51.3 Other specified disc degeneration
• M53 Other back disorders, not elsewhere classified

Types of osteoarthritis

Depending on which part of the spine is affected, there are several variations of the disease:

• cervical,
• chest,
• belt,
• sacred,
• mixed variants (cervicothoracic, lumbosacral).

Depending on the duration of symptoms, the disease can be:

• acute (up to 3 weeks),
• subacute (3-12 weeks),
• chronic (more than 12 weeks).

According to the predominant neurological manifestation:

• have myelopathy (spinal cord damage),
• have radiculopathy (nerve roots are compressed and inflamed).

Causes of osteoarthritis

To date, there is no accurate data on the causes of osteoarthritis.

The role of genetic predisposition, mechanical damage, and inflammation is recognized in the occurrence of premature disc wear.

The intervertebral disc does not have its own blood vessels or lymphatic vessels.The vessels of the vertebrae play a role in providing nutrition and clearing harmful substances.With age and/or exposure to harmful influences, blood and lymph flow decreases, the discs receive less oxygen and nutrients, and harmful substances can accumulate in them.All this leads to gradual wear and tear.The degree and rate of disc wear increases with exposure to risk factors.

Risk factors:

• Congenital defects of the vertebrae and spinal canal;
• flat feet;
• occupational hazards (vibration, lifting heavy objects, being in an uncomfortable position for a long time, contact with toxic substances);
• sedentary lifestyle;
• obesity;
• unbalanced diet in terms of protein, fat, vitamins and minerals;
• insufficient consumption of clean water;
• smoke;
• environmental pollution.

Symptoms of degenerative spine disease

List by frequency of appearance:

• painful;
• decreased range of motion;
• numbness, loss of sensitivity;
• decreased muscle strength;
• dysfunction of organs that are associated with the problematic part of the spine.

Clinically significant manifestations of spondylolisthesis were observed in 51 people per 1000 population.

The location of pain and other symptoms depend on the part of the spine that is problematic.

Cervical bone degeneration:

• pain in the arms, shoulders, neck, worse when turning and tilting the head;
• headache;
• decreased muscle strength in the arms;
• noise in the head, dizziness, flashing "floaters", colored spots in front of the eyes combined with burning, throbbing headache (vertebral artery syndrome).

The health of the brain depends on the condition of the cervical spine, since the arteries to the brain pass through the channel formed by the vertebral processes.If due to osteonecrosis, the lumen of the tube narrows, blood flow through the artery is interrupted and the brain is deprived of oxygen and nutrients.

Osteochondrosis of the chest:

• pain in the chest, under the shoulder blades, in the heart area, worse when turning around, coughing, sneezing;
• dysfunction of the gallbladder, stomach, and esophagus.

Degeneration of lumbar and/or sacral cartilage:

• pain in the lower back, back and side of the thighs;
• numb toes;
• increased frequency of urination (10-12 times a day, possibly more), involuntary loss of urine during physical activity;
• sexual disorders.

Due to frequent pain, half of people with osteoarthritis show signs of constant mental stress.

Stages of development and process of osteoarthritis

The first stage of cartilage degeneration is manifested by a dull pain in the back or lower back that occurs when standing for a long time, after walking or running;pain in the neck, aggravated by turning and tilting the head.

As the pathology of the disc(s) progresses, it can bulge (herniate) and, as a result, compress the nerve root (radiculopathy).This leads to severe pain spreading to the arms or legs, muscle weakness, disorders of skin sensitivity, vascular tone and function of organs that receive distribution from the problematic part of the spine.In the most severe cases, the spinal cord can be compressed, leading to paralysis or paralysis.

Osteonecrosis is a chronic disease.After adequate treatment, remission occurs, that is, symptoms decrease or disappear completely.If a new protrusion of the disc forms, aggravation will occur and pain and other symptoms will return.

Diagnose

1. Examination by a neurologist.

2. Basic tool research methods:

   • magnetic resonance imaging (MRI),
   • computed tomography (CT).

3. Additional:

   • spondylography (in-depth x-ray examination of the spine),
   • electromyography (EMG),
   • electromechanics (ENMG),
   • bone densitometry (performed to detect osteopenia/osteoporosis).

4. Basic experimental methods:

   • general blood tests,
   • general urinalysis,
   • biochemical blood tests (glucose, creatinine, urea, electrolytes, bilirubin, liver and pancreatic enzymes; glycated hemoglobin, C-reactive protein),
   • coagulation map.

5. Additional:Calcium and phosphate levels in the blood.

Treatment of osteoarthritis

Conservative treatment

It is performed if the patient does not have acute progressive neurological symptoms.

Target:

• reduce or alleviate pain,
• regulate muscle tone,
• reduces inflammation and swelling,
• prevents the progression of dystrophic changes in the structure of the spine,
• corrects the weakened function of internal organs,
• increase the patient's daily activities,
• Teach patients how to cope with pain.

Conservative treatment of osteochondrosis includes:

• adhere to a reasonable exercise regime,
• drug use,
• physical therapy,
• massage,
• Exercise therapy (after pain relief and stabilization of the condition),
• acupuncture,
• manual therapy.

Drug treatment

The main groups of drugs that can reduce or relieve pain and stabilize the condition of patients with osteoarthritis are listed.Only a doctor can choose an appropriate treatment regimen, taking into account the features of the clinical picture of a particular patient.

1. Nonsteroidal anti-inflammatory drugs(NSAID):

   • for oral administration,
   • for intramuscular injection,
   • for intravenous injection,
   • for administration into the rectum (rectal suppositories),
   • for external use (ointment, gel).

2. Muscle relaxants(medicine that reduces muscle spasticity).

   Used for severe tension and painful muscle spasms.

3. Diuretics(to reduce local swelling).

4. The drug improves the condition of cartilage tissue(cartilage protectant):

   • sodium chondroitin sulfate,
   • combination of sodium chondroitin sulfate and glucosamine.

5. B vitamins:

   • thiamin (B1),
   • pyridoxine (B6),
   • cyanocobalamin (B12),
   • combination B1+B6+B12.

In the acute stage, with severe pain, 1-2 days of bed rest can help relax the muscles and reduce pressure inside the cartilage disc.A lumbar stabilizing corset or Shants collar should be worn.

As the pain intensity decreases, treatment will be supplemented with special therapeutic exercises aimed at stretching the spine and relaxing the muscles, gradually including exercises to form a muscle corset.Therapeutic manual massage is indicated.

With appropriate treatment, the pain will gradually decrease and may disappear completely.There was also regression of neurological symptoms.The improvement in the condition is due to a decrease in the size of the herniated disc and associated inflammatory changes in the surrounding tissues.

Surgical treatment

Urgent neurosurgical intervention is indicated for pelvic disorders presenting with anogenital numbness and upward foot paralysis (cauda equina syndrome).

The need for surgery may also arise if conservative therapy is not effective within 3-6 months.

Prevent back pain

• Avoid excessive physical activity (lifting heavy objects, carrying heavy bags with one hand, etc.).

• Avoid prolonged static loads (sitting, holding uncomfortable positions).

  If your job causes such stress, you should take a 10-minute break every 45 minutes, during which you need to walk.

• Avoid hypothermia.

• Maintain adequate levels of physical activity through regular exercise, swimming and/or walking.

• Sleep on a mattress of moderate firmness.

Nutrition for osteoarthritis

A balanced diet and appropriate fluid intake will ensure normal blood supply and nutrition to the vertebrae and cartilage discs.As a result, metabolism and energy are normalized and harmful products do not accumulate.

Basic principles:

1. Daily calorie content, is calculated individually, taking into account height, age, gender.

   For patients who are overweight or obese, calorie intake should be limited.

2. Drinking regimen– Drink pure water, mineral water and herbal tea at least 1 liter per day, ideally 30 ml/kg body weight.

3. Daily use:

   • whole grain products (buckwheat, millet, oats);
   • Sufficient amount of protein (taking into account age and kidney function): animals - lean beef, chicken, turkey, rabbit, chicken eggs (4-5 pieces per week);vegetables - beans, lentils, peas;
   • healthy fats containing monounsaturated and polyunsaturated fatty acids (fish, seafood, unrefined vegetable oils, nuts, unroasted and unsalted seeds);
   • vegetables (both fresh and cooked), lettuce, herbs and greens;
   • berries - blueberries, raspberries, raspberries, cherries.

4. Exclude from the diet:

   • white bread and bread products made from premium flour;
   • sugar, industrial sweets - candy, cakes, cookies, gingerbread, waffles;
   • industrial drinks with added sugar - carbonated water, packaged juices;
   • processed meat products - sausages, sausages, canned goods.