The specialist spoke about modern approaches in the treatment of patients with osteochondrosis of the spine
Alexey Peleganchuk, head of the neuroorthopedic department, orthopedic-traumatologist, neurosurgeon, candidate of medical sciences, spoke today about what technologies are available for doctors to help such patients.
What disease do patients usually call "cervical chondrosis"? What is the correct diagnosis?
- In fact, "cervical chondrosis" is slang, the disease is correctly called "osteochondrosis of the cervical spine". This term is used by doctors in the post-Soviet space and corresponds to the current ICD (International Classification of Diseases) with which we work. But in most countries there is no such disease, they call it "degenerative-dystrophic disease". When making a diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which motion segments of the spine are affected.
Often people associate this disease with cervical back pain. Is this the main and/or only symptom?
- Pain is the most common reason for such patients to consult a neurologist. The main clinical manifestation of degenerative pathology - osteochondrosis of the cervical spine, in this case we can say that there is pain. In addition, the more dangerous manifestations of common degenerative pathologies are weakness of the upper extremities (perhaps in the lower extremities) and sensory impairment - numbness.
Can headache and tinnitus occur with osteochondrosis of the cervical spine?
– These are complaints that are not typical for neck osteochondrosis, but sometimes they happen. If such a patient comes, first of all, this is a reason to order an MRI of the brain to rule out any organic changes. If the patient has done this, he is not suitable for conservative treatment and there is a substrate in the form of disc protrusions, which is extremely rare, but it can be a reflexive cause of these events, then there is an option to help this patient, but the effectiveness is significantly lower than the classic treatment of cervical back painwill be low.
What are the causes of pain and what options are available for the treatment of such patients today?
- Three groups of patients can be distinguished. The first group is reflex pain syndromes, the second group is radicular syndromes, myelopathy - lesions of the spinal cord itself, as in severe stenosis, and the third is extremely rare patients, but the most complex, the most suffering from neuropathy.
Reflex pain syndrome can spread locally in the cervical region and spread to the shoulder girdle and upper limbs. But the peculiarity of this pain syndrome is that the nerve tissue - that is, the spinal cord and its roots - is not compressed (compressed).
Accordingly, in this case, if we consider the option of surgical treatment, these are outpatient methods - for example, blockades. More invasive procedures include radiofrequency denervation and cold plasma coblation of intervertebral discs - a hardware puncture procedure performed without incisions.
The goal is to eliminate the pain syndrome or significantly reduce its intensity and free the patient from the need for analgesics.
The second group of patients are patients with hernia. Tears in the cervical spine can cause compression of the roots, and if conservative treatment methods are ineffective, surgical intervention is resorted to. The purpose of the operation is to perform decompression, i. e. remove the hernia, accordingly, the spinal cord root will be free and the pain syndrome will return.
With large hernias, there are also conduction disorders: in addition to compression of the spinal cord root, the spinal cord itself can be compressed (compressed). Then the person experiences more severe clinical manifestations in the form of tetraparesis, that is, weakness in both upper and lower limbs. In this case, it is necessary to decompress - to create spare spaces for the spinal cord to recover a second time. It is important to understand that the operation does not restore the spinal cord and nerve, but rather creates conditions, i. e. creates spare spaces.
Along with hernias, there are circular strictures. They develop due to complex problems in the cervical spine that cause a circular narrowing of the canal.
These are critically ill patients who sometimes remain ill for years and, unfortunately, are often admitted with severe neurologic deficits, often requiring two-stage surgery.
Another group of patients are people with neuropathic pain syndrome. In this case, if the patients do not have stenosis, neuropathy (the nerve itself hurts). Then help neuromodulation (neurostimulation) is used. This involves the installation of special epidural electrodes in the posterior structures of the spinal cord. It's a special device - you can say it's like physical therapy that you always have with you: you can turn it on and increase the power to reduce pain. And it helps well even in very difficult situations.
All these technologies are accessible to patients, there are various sources of funding, including compulsory health insurance and quotas for high-tech medical care.
Is it possible to treat osteochondrosis?
- The disease itself, osteochondrosis, cannot be treated. What can be done? Suppose a conventional patient: osteochondrosis of the cervical spine, a predominant lesion at the level of C6 - C7 vertebrae, with degenerative stenosis at this level and compression of the C7 spinal cord roots on the right.
During the operation, it is possible to remove the stenosis, remove the hernia or, if the spinal cord itself is compressed, decompress the spinal cord root. But the first four words of the diagnosis (osteochondrosis of the cervical spine) will remain for life, because it is incurable. Surgeons affect the substratum of this clinic, and the substratum of the clinic is, say, a hernia that causes a stenosis.
How is the treatment strategy determined?
- There is such a concept - clinical-morphological compatibility. The doctor should look at the patient from all sides - orthopedic examination, neurological examination, anamnesis, collect complaints and correlate this information with research.
Screening studies for osteochondrosis of the cervical spine are MRI, if there is no contraindication for the patient for one reason or another. If necessary, the MSCT is also assigned to determine the tactics of the operation.
However, not every hernia shown on an MRI requires surgery. Hernia itself is not a reason for surgery. How much compression, etc. is the expert. must determine the cause and decide on the expediency of the operation.
At what age do such problems occur more often?
- The average age of our patients is over forty, but it happens that if their degenerative cascade started early, which leads to the formation of a substrate in the form of a hernia, even young people need surgical intervention. In this case, the first step is conservative treatment, if there is no effect, then the only way out is surgery.
What are the risk factors?
- We do not live in India and our compatriots do not wear anything on their heads. Therefore, it goes without saying that work or habits lead to premature wear and formation of these formations.
The main risk factor is genetics. This applies not only to the cervical, but also to the thoracic and lumbar regions - this is the weakness of the tissues of the fibrous ring. And other risk factors - excess body weight, in the form of overwork - are more reflected in the waist area.
Is it possible to prevent it in some way?
- Prevention is first of all exercise therapy, so that the muscles have tone, the muscles work properly and there are no spasms. The fact is that when a degenerative process develops, and it can develop both in the discs and in the joints of the spine, it causes muscle spasm and the person experiences pain. Therefore, for reflex pain syndrome, massage, acupuncture, etc.
What determines the effectiveness of treatment?
- When a problem arises: pain in the cervical spine spreading to the upper limbs, numbness and weakness in the arms, and loss of strength, it is important to consult a neurologist. Very serious pathologies are circular stenosis, when the spinal cord is already affected, when weakness in the lower extremities is added.
It happens that people endure for years and think that it is just "due to age". But every year they get worse, and eventually the disease leads to limitations in their movement - they can only walk a few meters.
The specialist will assess the degree of danger and, if necessary, refer to additional research methods and, if indicated, to a vertebrologist who deals with the surgical treatment of spinal pathology. The purpose of the consultation is to determine the need for surgical intervention. If there is no need for surgery, the neurologist already deals with conservative treatment. If surgical treatment is required, an operation is performed, after which the patient is sent to a neurologist for rehabilitation.
The goal of conservative treatment is to achieve very long periods of remission and to minimize the frequency of exacerbations, both in terms of duration and frequency. This also applies to puncture methods of treatment. However, if there are gross changes in the form of rupture and compression of the spinal cord roots, conservative treatment may not work.
At the same time, the operation must be done on time. The goal of the operation is to save the nerve tissue, be it the spinal cord or the roots. If a person has been sick for years, this leads to myelopathy - a change in the spinal cord itself, which may not be cured even with excellent surgery, or radiculopathy - damage to the root of the spinal cord.
If the operation is carried out on time, according to the standards, then there is a high probability of recovery of both the spinal cord root and the spinal cord itself, and after rehabilitation the person will feel practically healthy.
With advanced pathology, the effectiveness of surgical intervention decreases. In the case of persistent neurological disorders, the operation may not lead to noticeable improvements, because the spinal cord itself or the root has already died at the time of the operation.
Each patient with one or another variant of the pathology needs an individual consultation with a specialist. At the same time, most patients with cervical osteochondrosis can be helped without surgery using complex conservative treatment methods.