Polysegmental osteochondrosis of the spine
The content of the article:
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Description
- Features:
- Stages
- The reasons
- Symptoms
-
Treatment
- Conservative therapy
- Surgery
- Video
Polysegmental osteochondrosis is a chronic destructive disease that damages several parts of the spinal column at once. The degenerative process begins at the level of the elements of the intervertebral disc, and over time, the articular surfaces of the vertebrae, the musculo-ligamentous apparatus, the vascular plexuses and nerve roots are involved. Often in the development process, due to the redistribution of the load, several segments of the spine can be subjected to degenerative processes at once.
Polysegmental osteochondrosis develops in 12% of patients suffering from this disease
Description
Possible options:
- cervicothoracic osteochondrosis;
- thoracolumbar;
- lumbosacral.
A combined lesion, as in the first two groups, as well as a lesion of two segments located at some distance, occurs somewhat less frequently.
Features:
- More often occurs in the lumbosacral region, since this segment of the spinal column has a maximum load.
- Several adjacent intervertebral joints may be affected at once.
- The stages of the process in different parts of the spine may not coincide (in the cervical segment, the stage of chondrosis, and in the lumbar segment, the stage of hernia formation).
- It occurs more often in people over 50 years old, since with age, natural processes associated with thinning of bone tissue begin (leaching of calcium and phosphorus salts).
- It makes up no more than 12% of all possible forms of osteochondrosis of the spinal column.
Stages
The development is based on the same stages of the disease as for isolated forms of osteochondrosis:
- Chondrosis stage associated with damage to the internal structures of the intervertebral disc without violating its integrity. This degree is difficult to diagnose and has few symptoms.
- The stage of instability, which is caused by the spread of pathology to the entire surface with the capture of the annulus fibrosus, nucleus and other elements of the disc. The stage has clinical manifestations of an emerging intervertebral hernia, but the anatomically given formation has not yet been formed.
- A stage characterized by the occurrence of a typical intervertebral hernia. It occurs as a result of the loss of the fixation function of the articular surface and the muscular frame (the elements of the intervertebral disc protrude beyond the joint in different directions relative to the axis of the spinal column).
- Fibrosis stage. The final stage, which arises as a protective reaction of the body and consists in the replacement of the affected area of the disc with fibrous tissue. This, in turn, leads to a total loss of function (in the case of polysegmental osteochondrosis of the spine, the probability of disability is 90%).
At the heart of the pathogenesis is the violation of local blood circulation and, as a result, disc nutrition. Over time, with constant pressure on the spinal column in the process of vital activity, this leads to chronic ischemia and destruction of the cartilage plates.
The reasons
It is not possible to determine the exact cause of the occurrence, but the predisposing factors are known:
| Cause | Characteristic |
| Congenital malformations | There is a violation of the formation of bone and cartilage tissue at the level of embryogenesis (weak areas, deformed zones). Osteochondrosis itself is not formed in utero. |
| Hereditary predisposition | There are no clear clinical studies of this aspect, but there are studies confirming the genetic weakness of bone tissue in close relatives (phenomena of osteoporosis, destructive processes in the bones). |
| Traumatic injuries (dislocations, fractures) |
Most often occur with simultaneous tilt and turn of the body to the side (slipping of the articular surface). In this case, the fibrous core is displaced in the opposite direction due to the increased load. This option does not apply to classic hernias, since all stages of development do not go through (the disease immediately begins with the appearance of an intervertebral hernia). |
| Infectious diseases | In particular, bone tuberculosis causes thinning of bone structures (cavities and sequesters are formed). There is a high risk of pathological fractures and displacements of bone structures relative to the axis. |
| Benign and malignant neoplasms | We are talking about processes that capture not only bone tissue, but also other organs and systems (in this case, metastases occur in the bone, including the spine). |
| Excessive physical activity | The intervertebral discs perform a shock-absorbing function, and under constant significant loads, disproportionate pressure on the cartilage occurs. This leads to wear and tear and gradual destruction. |
| Consequences of surgical interventions on the spine | An extremely rare reason considering modern surgical methods. It may be associated with incorrect installation of titanium plates, incorrect prosthetics or graft rejection, mechanical damage to the intervertebral space. |
| Overweight | Causes undue stress on the entire body support frame. |
| Involutional processes in tissues | Cartilage degeneration due to natural aging of cartilage and bones. |
| Orthopedic diseases (scoliosis, flat feet) | Lead to impairment of the shock-absorbing function of the spine, gradual compression of the intervertebral disc and its ischemia. |
| Features of professional activity (long-term uncomfortable posture) | The development of osteochondrosis is associated with excessive loads on various segments of the spine (polysegmental osteochondrosis of the lumbar spine occurs more often). |
| Metabolic disease | Of particular importance is the violation of the exchange of calcium and phosphorus (diagnosis is required, first of all, the work of the parathyroid glands). |
The emergence of osteochondrosis is associated, as a rule, not with one, but with a number of factors acting simultaneously.
Symptoms
The manifestations of polysegmental osteochondrosis are directly dependent on the levels of spinal lesions:
- involvement of two intervertebral discs within one segment of the spine with the emergence of a characteristic of this department of the clinic (for example, only the lumbar region);
- involvement of two different segments of the spine (for example, cervical and thoracic) with the development of a mixed clinical picture.
The features of the clinic are presented in the table (for ease of understanding, symptoms are presented for lesions within the same level).
| Level | Characteristic |
| Polysegmental osteochondrosis of the cervical spine |
· Local pain with the possibility of radiation to nearby structures (shoulder, scapula, jaw); Dizziness and headaches, which are associated with compression of the vertebral artery; · Noise and crackling in the ears, loss of visual fields due to cerebral hypoxia; Violation of motor and sensory activity in the zones of innervation (numbness, paresis, paralysis) |
| Chest department |
· Local soreness and muscle tension; · Decrease in the range of motion in this section of the spine and upper limbs; Loss of some types of sensitivity (pain, thermal, tactile); Intercostal neuralgia (pain worsens with breathing) |
| Lumbosacral |
· Pronounced pain syndrome, which increases with movement; Dysfunction of the pelvic organs (sometimes); Violation of motor and sensory activity of the lower extremities |
Treatment
Treatment can be conservative or surgical.
With this form of the disease, surgical methods are rarely used, since the operation is an additional burden on the already injured spine. It is permissible to use various surgical techniques for intervertebral hernias and fibrosis with loss of function.
Conservative therapy
Includes:
- Medication methods of treatment (non-steroidal anti-inflammatory drugs, analgesics, steroid drugs, muscle relaxants, chondroprotectors, vasadilators, novocaine and lidocaine blockades, local therapy).
- A set of exercises (exercise therapy). It is used both in the preoperative and postoperative period.
- Physiotherapy. The main methods are electrophoresis, phonophoresis, magnetotherapy, UHF, laser therapy.
- Massage. Used to relieve tension from muscle tissue (attempts to reposition the disc are inadmissible).
- Corsets, bandages and other orthopedic devices are used to fix and support the spinal column.
Massage is one of the effective methods for osteochondrosis, provided it is carried out correctly by a trained specialist
Surgery
Surgical techniques include partial removal of the affected disc - microdiscectomy, complete removal with endoprosthetics, and a number of other techniques. The scope of the operation is determined by the neurosurgeon.
Video
We offer for viewing a video on the topic of the article.
Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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