Osteochondrosis is the most common pathology of the spine, in which all parts are affected.In terms of the frequency of lesions, the cervical spine ranks second, just behind the lumbar spine.Treatment of osteochondrosis of the cervical spine in most cases is carried out using conservative methods and depends on the stage of the disease and the severity of destructive processes in the intervertebral discs.Surgical treatment is indicated in 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 variety of manifestations.Symptoms depend on the predominance of one or more syndromes arising from the influence of pathologically changed structures of the spine 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, which are manifested by motor and sensory disorders, as well as trophic changes in the muscles of the upper extremities.
- Radicular - manifested by pain in various places (upper limbs, chest and abdominal organs) and requires differential diagnosis in many diseases of internal organs and the cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders due to insufficient blood supply to brain structures (headache, hearing impairment, tinnitus, dizziness, short-term loss of consciousness).
How to treat cervical osteochondrosis?
The reason for seeking medical attention is the first appearance of symptoms or the next 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 pathology.
After confirming the diagnosis, in most cases, outpatient treatment is prescribed.Patients with severe neurological disorders, a high risk of complications and severe concomitant pathology require inpatient treatment.Conservative treatment of osteochondrosis includes the use of the following methods.
Drug therapy
If the disease worsens, the use of medication to combat pain is necessary.To this end they prescribe:
- Non-narcotic analgesics.Nonsteroidal anti-inflammatory drugs are taken orally or parenterally, with mandatory 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 drug use in this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral anesthetic blocks with hormonal agents are used in the amount of 1-3 manipulations.
- Antispasmodics, B vitamins.In the acute phase, with severe edema, the prescription of diuretics is indicated in a short course of 2-4 days.They reduce vascular spasms and improve microcirculation in the focus of inflammation.
- Sedatives (peony tincture, valerian root, herbal teas and infusions) to prevent the development of neurotization if the patient experiences excruciating pain for a long time.
- External warming agents – balms, ointments, liniments, which have a slightly irritating effect and contain biologically active substances of plant and animal origin.Drugs with strong irritating effects cannot be used, 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 eliminating the exacerbation to consolidate the effect of drug therapy and periodically during remission for prophylactic purposes.Therapeutic massage includes 10 to 14 sessions and is prescribed 2 to 4 times a year if there is no severe pain.
The massage improves blood circulation, lymphatic drainage and relaxes the tense muscles in the neck and collar area.This improves the nutrition of the cartilage tissue of the intervertebral discs, preventing the progression of the process and reducing the risk of subsequent relapses.
Therapeutic exercise
Physiotherapy exercises for cervical osteochondrosis should be performed daily, except for exacerbation of the disease, which is accompanied by severe pain.If the pain is severe, gentle therapy is required that includes maximum restriction of movement of the cervical spine.
Systematic exercise therapy strengthens the neck muscles, thereby reducing the static load on the intervertebral discs.The exercises are carried out smoothly;Sudden movements with a large amplitude are initially prohibited.Exercises must be started carefully and the load increased gradually to avoid the occurrence of unpleasant sensations.
The exercises are performed standing or sitting.The most common exercises consist of:
- turn your head to the side;
- tilting the head forward and back;
- With your arms relaxed or fixed, raise your shoulders and hold them in this position for 15 to 20 seconds.
- When the head is at rest, static stress causes alternating tension 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 the hospital under medical supervision.The procedure is carried out with great caution and should be stopped immediately if pain occurs, as this may worsen the disease.
During traction, the elastic tissue of the ligaments of the spine is stretched, which leads to an increase in the distance between adjacent vertebrae.It increases by 1-3 mm.It turns out that this is 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 in the intervertebral disc decreases, which leads to partial retraction of the hernial protrusion and enlargement of the intervertebral foramen.
Traction has a positive effect on the intervertebral joints, eliminating subluxations that have arisen there and helping to reduce muscle contractures.Immediately after traction, the cervical spine must be fixed with special devices for several hours.The course of treatment includes 10 to 20 procedures.
Physiotherapeutic treatment
The use of medical electrophoresis has a good effect.The technique allows the delivery of drugs to tissues involved in the pathological process.For cervical osteochondrosis, electrophoresis is used with nonsteroidal anti-inflammatory drugs, hormonal anesthetics and other drugs.
The use of diadynamic currents helps to improve blood circulation, has a good analgesic and anti-inflammatory effect, and helps to reduce the excitability of nervous tissue.Complex treatment using conservative methods can cure the initial appearance of osteochondrosis, provided you maintain an active lifestyle, a proper and nutritious diet and give up bad habits.
With a highly advanced destructive process, you can achieve long-term remission with the right treatment and lifestyle.In some patients, no improvement can be achieved with conservative treatment;In such cases, neurosurgical methods are used.
Surgical treatment
Before surgical treatment of cervical osteochondrosis, all available canning methods should be tried.Typically, surgical treatment is indicated when therapy has been unsuccessful for three months or longer.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, microdiscectomies and endoscopic surgeries are most commonly used.The manipulation is carried out using microsurgical instruments and a 10x microscope, which allows you to clearly see the compressed areas of the spinal cord.Removal of part of the hernia protrusion that presses on the root or spinal cord is carried out.Sometimes it is necessary to remove a small vertebral fragment or cut out a ligament.