Osteochondrosis is the most common pathology of the spinal column, in which all its parts are affected.In terms of frequency of lesions, 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 destructive processes in the intervertebral discs.Surgical treatment is indicated for 5-7% of patients with persistent disease, lack of effect from 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 several 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 region of the head.
- Spinal - the 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 various localizations (upper limbs, 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 arising from insufficient blood supply to the 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 exacerbation of the disease.In any case, treatment for 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 confirmation of the diagnosis, in most cases outpatient treatment is prescribed.Patients with severe neurological disorders, a high likelihood 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 medications is necessary during an exacerbation of the disease to combat pain.For this purpose they prescribe:
- Non-narcotic analgesics.Non-steroidal 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 in this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral blockades 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 irritant effect and contain biologically active substances of plant and animal origin.Drugs with a strong irritating effect 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 the exacerbation has been eliminated 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 outflow and relaxes spasmodic muscles of the neck and collar area.Due to this, the nutrition of the cartilage tissue of the intervertebral discs is improved, preventing the progression of the process and reducing the risk of subsequent relapses.
Therapeutic exercise
Physical therapy exercises for cervical osteochondrosis should be carried out daily, except for 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 in the cervical spine.
Systematic exercise therapy helps strengthen the neck muscles, which helps reduce the static load on the intervertebral discs.The exercises are performed smoothly; sudden movements of large amplitude are prohibited at first.Exercises must be started carefully, gradually increasing the load, avoiding the occurrence of unpleasant sensations.
Exercises are performed in a standing or sitting position.The most common exercises consist of:
- turning the head to the sides;
- tilting the head forward and backward;
- raising the shoulders, with relaxed or fixed arms, holding them in this position for 15-20 seconds;
- static loads, with a stationary head, alternate 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 physician.The procedure is performed 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 ligaments of the spinal column are stretched, which leads to an increase in the distance between adjacent vertebrae.It increases by 1-3 mm.This turns out to be enough to reduce, and in some cases completely eliminate, compression when a root or artery is compressed by a disc herniation or osteophyte.During the procedure, the pressure inside the intervertebral disc decreases, which causes partial retraction of the hernial protrusion and an increase in the intervertebral foramen.
Traction has a beneficial effect on the intervertebral joints, eliminating 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 from 10 to 20 procedures.
Physiotherapeutic treatment
The use of medicinal electrophoresis has a good effect.The technique allows the delivery of drugs to tissues that are involved in the pathological process.For cervical osteochondrosis, electrophoresis with non-steroidal anti-inflammatory drugs, hormonal anesthetics and other drugs is used.
The use of diadynamic currents helps 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 giving up bad habits.
With a far 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 such cases, neurosurgical methods are resorted to.
Surgical treatment
Before treating cervical osteochondrosis surgically, 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 most often used.The manipulation is performed using microsurgical instruments and a 10x microscope, which allows you to clearly view the compressed areas of the spinal cord.Excision of part of the hernial protrusion pressing on the root or spinal cord is performed.Sometimes it is necessary to remove a small fragment of a vertebra or excise a ligament.