Osteochondrosis Of The 2nd Degree: Cervical, Thoracic, Lumbar Spine

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Osteochondrosis grade 2

The content of the article:

1. What is stage 2 osteochondrosis
2. Symptoms
3. Diagnostics
4. Treatment
5. Video

Osteochondrosis of the 2nd degree is a degenerative-dystrophic disease of the spine, which has a long course with a gradual destruction of the inter-articular discs and damage to the adjacent structures (vessels, nerves, muscles and cartilage tissue). Pathology can occur in various parts of the spinal column (cervical, thoracic, lumbar, sacral). With the formation of osteochondrosis, a combined lesion (L5-S1) occurs at the border of two segments. There is no exact cause of the occurrence (refers to polyetiological diseases).

At the second stage of osteochondrosis, the intervertebral disc is deformed, but pronounced symptoms are still absent

What is stage 2 osteochondrosis

There are several types of disease classifications.

Classification L. Armstrong (1952) by stages of development:

1. Initial changes in the center of the annulus fibrosus.
2. The stage is associated with the displacement of the nucleus of the fibrous disc and, as a result, deformation of the inter-articular space. Deformed elements can protrude anteriorly, laterally, medially relative to the vertebral bodies, or towards the spinal canal. In fact, this period is equivalent to the appearance of a herniated intervertebral disc.
3. The stage associated with the replacement of the disc with fibrous tissue.

HW Meyerdin (1932) classifications by level of displacement:

1. Displacement of two adjacent vertebrae by 0.25 relative to the axis.
2. Displacement of two adjacent vertebrae by 0.5 relative to the axis (going beyond the articular area).
3. Displacement of the vertebrae by 0.75 relative to the axis.
4. Almost complete separation of the articular surfaces.
5. Spondyloptosis.

Classification I. M. Mitbraith and V. E. Belenky (1978), which takes into account the angle of inclination:

1. Tilt 50-60 degrees.
2. Tilt 61-70 degrees.
3. Tilt 71-90 degrees.
4. Tilt 91-105 degrees.
5. Tilt more than 106 degrees.

A. I. Osna also makes a division according to the stages of progression:

1. Intradiscal pathological process.
2. Loss of fixation ability of the affected disc. This period is associated with the involvement of all elements of the disc. The intervertebral joint begins to lose the ability to fix the vertebrae in place and acquires pathological mobility. Despite the pronounced deformation, the articular structures on this tapa do not extend into the surrounding space.
3. Stage of formation of herniated intervertebral discs.
4. Fibrosis of the intervertebral disc.

At the moment, the preference is given to the Osna classification, since it takes into account the important period of instability of the spine (there is an intermediate stage between the onset of osteochondrosis and the formation of an intervertebral hernia).

Symptoms

The disease has several classic syndromes. Each level has its own characteristics of the manifestation of the disease, but there are four permanent classic syndromes (not pronounced at grade 2):

1. Static syndrome. It is associated with a violation of the anatomical integrity of the elements of the intervertebral joint (discs, cartilage, vertebrae). When they shift, the supporting structures of the spinal column (muscular frame) are not able to maintain the integrity of the structure.
2. Neurological syndrome. It is associated with compression of the nerve roots and impaired nerve conduction. Nerve structures can be compressed at the exit from the spinal canal (local symptoms) or directly in the canal itself (radicular symptoms).
3. Vascular Syndrome. It occurs due to the occlusion of the arteries and the appearance of local ischemic processes. Due to the presence of collaterals, severe circulatory disorders can be detected only at the terminal stages (3-4).
4. Trophic syndrome. It flows smoothly from the vascular and neurological, since a violation of nutrition and innervation causes a shift in metabolic processes in tissues.

The table shows only the symptoms characteristic of the 2nd degree of osteochondrosis according to the Osna classification (disc instability without signs of intervertebral hernia - pre-hernia) without taking into account other clinical manifestations.

The Department	Symptoms
Cervical	Vascular syndrome dominates (compression of the vertebral artery). Clinical manifestations: · Cervicalgia (local pain syndrome in the neck with the possibility of irradiation in the adjacent areas); Vertebral artery syndrome (visual impairment, crackling and noise in the ears, dizziness, headaches); · Unexpressed impairment of motor activity (from the side of the upper extremities, from the side of the cervical spine - flaccid paralysis); · A slight violation of the sensory innervation of the upper limbs (numbness, tingling, paresis).
Thoracic (rarely affected)	Static syndrome dominates. Clinical features: · Local pain syndrome (pain can intensify during deep breathing); · A slight violation of the motor activity of the upper limbs (flaccid paralysis, decreased range of motion); · Slight violation of the sensitive sphere (temperature, pain, proprioceptive); Reflex local muscle spasm.
Lumbar	Dominated by neurological syndrome (often radicular). Clinical symptoms: Lumbodynia (local pain in the lower back, which increases with movement); · Slight violation of motor activity in the lumbar spine and lower extremities; · Minor sensory disturbances in the lower extremities (tingling, goose bumps).
Sacral	More often it occurs in combination with the lumbar at the L5-S1 level with corresponding manifestations (typical clinic of lumbar osteochondrosis).

The tactics of further patient management depends on the level of damage to the spinal column.

Diagnostics

Diagnostic methods for osteochondrosis of the spine of the 2nd degree of the 2nd department, as well as other departments, are presented by the general scheme:

1. Taking anamnesis. Provided that in the 2nd period of osteochondrosis there is no pronounced deformity of the intervertebral joint (protrusion, displacement of the vertebrae), the complaints will be somewhat blurred - pain of different localization and intensity, periodic disturbance of sensitivity.
2. Physical examination. Each section has its own characteristics on palpation: the cervical region is associated with the onset of Sperling's symptom (inclination towards the lesion increases pain) and the Putman-Schultz symptom (the phenomenon of nocturnal brachialgia); for osteochondrosis of the 2nd degree of the thoracic spine
3. the symptom of Dejerine is characteristic (when coughing, the pain in the back begins to grow stronger); lesion of the lumbar spine is characterized by the Lasego symptom (pain when flexing the hip joints in the supine position) and the Amos symptom (support is required to raise from a horizontal position).
4. X-ray of the spinal column (survey, sighting). At the second stage, the images can be used to determine a slight deformation of the inter-articular space, narrowing of the joint space, local destruction of the vertebrae.
5. CT / MRI. Allows you to clarify the degree of degeneration of intervertebral discs, impaired circulation, patency of the spinal canal.

These are the main methods for detecting the second degree of osteochondrosis (too slight destructive changes), however, for the purpose of differential diagnosis, the scheme may change, for example, others may be additionally used (epidurography, venospondylography, arteriography).

Treatment

It is permissible to treat the disease at this stage only by conservative methods (surgical intervention is required when there is a picture of an intervertebral hernia and fibrous degeneration). Treatment does not depend on the level of the lesion and is carried out according to a single scheme.

Conservative therapy includes:

• drug therapy;
• non-drug treatment.

Drug therapy consists in taking drugs of various groups:

1. Non-steroidal anti-inflammatory drugs (NSAIDs). They are used to relieve pain and suppress inflammatory processes in tissues. Typical representatives include Meloxicam, Ibuprofen.
2. Analgesics are drugs directly aimed at eliminating pain syndrome (somewhat stronger than NSAIDs).
3. Novocaine and lidocaine blockades (rarely used at this stage).
4. Steroid drugs - for intramuscular or epidural injections in combination with pain relievers (prolong the effect of other drugs).
5. Muscle relaxants - used to relieve muscle spasm that occurs in response to prolonged painful irritation caused by an illness.
6. Local therapy in the form of various ointments and gels with analgesic effect (Nise gel). Sometimes a person is advised to use a medicine with an irritating effect (Fastum gel) in order to change the dominant in the central nervous system (switching back pain to another area).

In addition to classical therapy, multivitamin complexes are shown, which contribute to some strengthening of the spinal frame.

Exercise therapy is one of the most effective methods of treating the second degree of osteochondrosis

Non-drug treatments include:

1. A set of exercises exercise therapy. It is selected strictly individually, taking into account the peculiarities of the process. The first course of treatment is carried out under the supervision of a specialist and lasts on average 7-14 days. The goal is to restore metabolic processes and develop the affected spine.
2. Physiotherapy. Electrophoresis, phonophoresis, magnetotherapy, ultrasound are often used as prescriptions. The goal is to relieve local pain, local inflammation and enhance the regeneration processes.
3. Massage. It is indicated for the purpose of reducing muscle tension. It is permissible to use various techniques (vacuum, self-massage, point, classical).
4. Reflexology has a point effect on the projections of the nerve plexuses on the skin. An accurate knowledge of topography and anatomy is required as there is a risk of additional nerve irritation and increased pain.
5. Wearing special orthopedic devices (corset). It mainly performs the function of additional support, and also carries out minor traction of the spinal column, which somewhat facilitates the load of the affected area.

The treatment is the same for any level of injury. The lack of effect after three courses of conservative therapy is a direct indication for switching to other methods of patient management. This means that additional diagnostics and clarification of the degree of the disease may be required.

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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