Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.In terms of 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 by conservative methods and depends on the stage of the disease and the severity of destructive processes in the intervertebral discs.Surgical treatment is indicated for 5 to 7% of patients with persistent disease, lack of effect from conservative therapy for 3 to 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, located in the neck or occipital region of the head.
- Spinal - occurrence 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 different locations (upper limbs, thoracic and abdominal organs), requires differential diagnosis with various diseases of internal organs and the cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders arising 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 the next worsening of the disease.In any case, treatment of cervical osteochondrosis should be prescribed only by a doctor after mandatory examination of the patient and the necessary laboratory and instrumental studies to exclude concomitant pathology.
After confirming the diagnosis, in most cases outpatient treatment is prescribed.Patients with severe neurological disorders, a high probability of complications and severe concomitant pathology require hospital treatment.Conservative treatment of osteochondrosis involves the use of the following methods.
Drug therapy
The use of medications is necessary during an exacerbation of the disease to combat pain.To this end, they prescribe:
- Non-narcotic analgesics.Non-steroidal anti-inflammatory drugs are administered orally or parenterally, with the obligatory use of local preparations - ointments, gels, balms, rubs.Complex anti-inflammatory therapy helps to reduce soft tissue swelling, the main cause of pain in vertebral syndrome.The duration of taking medications in this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral blockades of anesthetics with hormonal agents in the amount of 1-3 manipulations are used.
- Antispasmodics, B vitamins. In the acute period, in the presence of severe edema, the prescription of diuretics in a short course for 2 to 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 experiences prolonged unbearable pain.
- External warming agents - balms, ointments, rubs that have a slight irritating effect and contain biologically active substances of plant and animal origin.Medicines with a strong irritating effect cannot be used, as they increase swelling, which can worsen the condition.
Therapeutic massage
Massage is an integral part of the complex treatment of osteochondrosis.It is used after elimination of the exacerbation to consolidate the effect of drug therapy and periodically during remission for prophylactic purposes.The course of therapeutic massage is 10-14 sessions and is prescribed 2-4 times a year in the absence of severe pain.
Massage improves blood supply, lymphatic flow and relaxes spasmodic muscles in the neck and collar region.This improves the nutrition of the cartilaginous tissue of the intervertebral discs, preventing the progression of the process and reducing the risk of subsequent relapses.
Therapeutic exercise
Physiotherapeutic exercises for cervical osteochondrosis should be performed daily, except in case of exacerbation of the disease, accompanied by severe pain.In case of severe pain, it is necessary to follow a gentle regimen, which involves maximum limitation of movements of the cervical spine.
Systematic exercise therapy helps to strengthen the neck muscles, which helps to reduce the static load on the intervertebral discs.Exercises are performed without problems;Sudden large-amplitude movements are prohibited in principle.Exercises should be started with caution, gradually increasing the load, avoiding the occurrence of unpleasant sensations.
Exercises are performed standing or sitting.The most common exercises consist of:
- turn the head to the sides;
- tilt your head back and forth;
- raise your shoulders, with your arms relaxed or fixed, keeping them in this position for 15-20 seconds;
- static loads, with the head stationary, there is alternating tension in the neck flexors and extensors.
The exercises must be repeated 5 to 7 times, the class duration is 15 to 20 minutes.
Traction
To avoid possible complications, traction must be performed in a hospital environment under the supervision of a doctor.The procedure is carried out with the utmost care and if pain occurs, it must be stopped immediately, as it may worsen 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 ends up being enough to reduce and, in some cases, completely eliminate compression when a root or artery is compressed by a herniated disc or osteophyte.During the procedure, the pressure inside the intervertebral disc decreases, which causes partial retraction of the hernial protrusion and enlargement of the intervertebral foramen.
Traction has a beneficial effect on the intervertebral joints, eliminating subluxations that have formed in them and helping to reduce muscle contractures.Immediately after traction, it is imperative to fix the cervical spine with special devices for several hours.The course of treatment includes 10 to 20 procedures.
Physiotherapy treatment
The use of medicinal electrophoresis has a good effect.The technique allows the delivery of medicines to the tissues involved in the pathological process.In cervical osteochondrosis, electrophoresis with non-steroidal anti-inflammatory drugs, hormonal anesthetics and other medications 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 treatments with conservative methods, the initial appearance of osteochondrosis can be cured, provided that an active lifestyle is maintained, adequate and nutritious nutrition and abandonment of 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, all available canning methods should be tried.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 the most used.Manipulation is carried out 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 protrusion that presses on the root or spinal cord is performed.Sometimes it is necessary to remove a small fragment of a vertebra or excise a ligament.