Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.In terms of the frequency of injuries, the cervical spine ranks second, 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 the 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 spinal column 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, localized in the neck or occipital region of the head.
- Spinal - the appearance of innervation disorders, manifested by motor and sensory disorders, as well as trophic changes in the muscles of the upper extremities.
- Radicular - manifested by pain in various localizations (upper extremities, thoracic and abdominal organs), requires differential diagnosis with many diseases of the internal organs and cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders resulting from insufficient blood supply to brain structures (headaches, hearing impairment, tinnitus, dizziness, short-term loss of consciousness).
How to treat cervical osteochondrosis?
The reason for seeking medical help is the first occurrence of complaints or subsequent exacerbation of the disease.In any case, treatment of cervical osteochondrosis should be prescribed only by a doctor after a mandatory examination of the patient and the necessary laboratory and instrumental studies to exclude concomitant pathologies.
After confirmation of the diagnosis, outpatient treatment is prescribed in most cases.Patients with severe neurological disorders, a 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 drugs is necessary during an exacerbation of the disease to combat pain.To this end they prescribe:
- Non-narcotic analgesics.Nonsteroidal anti-inflammatory drugs are taken orally or parenterally, with the obligatory use of local preparations: ointments, gels, balms, rubs.Complex anti-inflammatory therapy helps reduce soft tissue swelling, the main cause of pain in spinal syndrome.The duration of use of drugs in this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral blocks of anesthetics with hormonal agents are used in the amount of 1-3 manipulations.
- Antispasmodics, B vitamins. In the acute period, in the presence of severe edema, the prescription of diuretics in a short course for 2-4 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 excruciating pain.
- External warming agents: balms, ointments, rubs that have a mild irritating effect and contain biologically active substances of plant and animal origin.It is not possible to use drugs with a strong irritating effect 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 course of therapeutic massage lasts 10-14 sessions and is prescribed 2-4 times a year in the absence of severe pain.
Massage improves blood supply, lymph outflow and relaxes spasmodic muscles in the neck and collar 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, with the exception of exacerbation of the disease, accompanied by severe pain.In case of severe pain it is necessary to follow a delicate regime, which involves maximum limitation of movements of the cervical spine.
Systematic physical therapy helps strengthen the neck muscles, which helps reduce the static load on the intervertebral discs.The exercises are performed smoothly;At the beginning, sudden movements of large amplitude are prohibited.Exercises should be started carefully, gradually increasing the load, avoiding the occurrence of unpleasant sensations.
The exercises are performed in a standing or sitting position.The most common exercises consist of:
- turn your head to the sides;
- tilt your head forward and backward;
- raise your shoulders, with your arms relaxed or fixed, keeping them in this position for 15-20 seconds;
- static loads, with a stationary head, alternating tension occurs 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 setting under the supervision of a doctor.The procedure is carried out with the utmost caution and if pain occurs it should be stopped immediately, as it can provoke an exacerbation of the disease.
During traction, the elastic tissues of the spinal ligaments are stretched, which leads to an increase in the distance between adjacent vertebrae.Increases by 1-3 mm.This is sufficient to reduce, and in some cases completely eliminate, compression when a root or artery is compressed by a herniated disc or osteophyte.During the operation, the pressure inside the intervertebral disc decreases, causing partial retraction of the hernial protrusion and increase in the intervertebral hole.
Traction has a beneficial effect on the intervertebral joints, eliminating the subluxations that have formed in them, and helps reduce muscle contractures.Immediately after traction, it is imperative to fix the cervical spine using special devices for several hours.The treatment course includes 10 to 20 procedures.
Physiotherapy 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 with nonsteroidal anti-inflammatory drugs, hormonal anesthetics and other drugs is used.
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 you maintain an active lifestyle, proper and nutritious nutrition and give up bad habits.
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 these cases neurosurgical methods are used.
Surgical treatment
Before surgically treating cervical osteochondrosis, it is necessary to try all available canning methods.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, microdiscectomy and endoscopic operations are often used.Manipulation is performed using microsurgical instruments and a 10x microscope, which allows you to clearly visualize the compressed areas of the spinal cord.Excision of part of the hernial protuberance pressing on the root or spinal cord is performed.Sometimes it is necessary to remove a small fragment of a vertebra or remove a ligament.