Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.In terms of the frequency of lesions, the cervical spine ranks second, right behind 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 the destructive processes in the intervertebral discs.Surgical treatment is indicated for 5-7% of patients with persistent disease, absence of conservative therapy for 3-4 months, as well as with the development of serious neurological complications.
Clinical manifestations of the disease
Osteochondrosis of the cervical spine has a wide range 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 in the occipital part of the head.
- Spinal - the appearance of innervation disorders, which is manifested by motor and sensory disorders, as well as trophic changes in the muscles of the upper extremities.
- Radicular - which is manifested by pain in different localizations (upper limbs, chest and abdominal organs), requires a differential diagnosis with many diseases of internal organs and the cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders caused by 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 help is the first appearance of complaints or the next worsening of the disease.In any case, the treatment of cervical osteochondrosis should only be prescribed by a doctor after a mandatory examination of the patient and the necessary laboratory and instrumental studies to rule out accompanying pathology.
After confirming the diagnosis, outpatient treatment is prescribed in most cases.Patients with severe neurological disorders, a high probability of complications and severe accompanying pathology require hospital treatment.Conservative treatment of osteochondrosis includes the use of the following methods.
Drug therapy
The use of drugs is necessary during the exacerbation of the disease to suppress pain.For this purpose, 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 vertebral syndrome.The duration of use of drugs of 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.
- Spasmolytics, B vitamins. In the acute period, in the presence of severe edema, the prescription of diuretics for a short course of 2-4 days is indicated.They reduce vascular spasm 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 has long-term excruciating pain.
- Means for external heating - salves, ointments, rubs that have a slightly irritating effect and contain biologically active substances of plant and animal origin.Medicines with a strong irritating effect must not be used, because they increase the 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 elimination of 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, lymph drainage and relaxes spasmodic muscles of the neck and collarbone.This improves the nutrition of the cartilage tissue of the intervertebral discs, prevents the progression of the process and reduces the risk of later relapses.
Therapeutic exercise
Physical therapy 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 adhere to a gentle regimen that implies maximum restriction of movement in the cervical spine.
Systematic exercise therapy helps strengthen the neck muscles, which helps reduce the static load on the intervertebral discs.Exercises are performed smoothly;initially, sudden movements of high amplitude are prohibited.Exercises should be started carefully, gradually increasing the load, avoiding the appearance of unpleasant sensations.
Exercises are performed in a standing or sitting position.The most common exercises consist of:
- turning the head to the side;
- tilting the head forward and backward;
- raising shoulders, relaxed or fixed arms, holding them in this position for 15-20 seconds;
- static loads, with an immovable 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
In order to avoid possible complications, traction should be performed in hospital conditions under the supervision of a doctor.The procedure is performed with extreme caution and if pain occurs, it should be stopped immediately, as it can cause the disease to worsen.
During traction, the elastic tissues of the ligaments of the spinal column are 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 the root or artery is compressed by a herniated disc or osteophyte.During the procedure, the pressure inside the intervertebral disc is reduced, which causes partial withdrawal 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 necessary to fix the cervical spine with special devices for several hours.The course of treatment includes from 10 to 20 procedures.
Physiotherapy treatment
The application of medical electrophoresis has a good effect.The technique enables the delivery of drugs to the tissues involved in the pathological process.In cervical osteochondrosis, electrophoresis is used with non-steroidal anti-inflammatory drugs, hormonal anesthetics and other drugs.
The use of diadynamic currents helps to improve blood circulation and has a good analgesic and anti-inflammatory effect, helps to reduce the irritability of nervous tissue.Using complex treatment with conservative methods, the initial appearance of osteochondrosis can be cured, provided you lead an active lifestyle, proper and nutritious diet and giving up bad habits.
With a far advanced destructive process, proper treatment and lifestyle will enable you to achieve long-term remission.In some patients, it is impossible to achieve improvement with conservative treatment;in such cases they resort to neurosurgical methods.
Surgical treatment
Before surgical treatment of cervical osteochondrosis, it is necessary to try all available conservation methods.Usually, 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 most commonly used.The manipulation is performed using microsurgical instruments and a 10x microscope, which allows you to clearly see the compressed areas of the spinal cord.Excision of part of the hernial protrusion is performed by pressing on the root or spinal cord.Sometimes it is necessary to remove a small fragment of a vertebra or cut a ligament.