Osteochondrosis is a degenerative-dystrophic spinal disease, the basis of which is damage to the intervertebral discs.The development of a degenerative disease of the spine is facilitated by prolonged microtraumatization, excessive static and dynamic load, hereditary predisposition, advanced age.The most common location of the lesion is the cervical and lumbar spine.This is due to their largest mobility and load.
A common concept of osteochondrosis
Over time, the intervertebral disc loses its fluid and loses its function, absorbing shock.It becomes less resistant to exercise.The fibrous ring, which is located on the periphery of the disc, is gradually smaller, with cracks forms in it.The pulpitic nucleus is shifted around the periphery in the cracks formed and forms formedProtub(local convexity, 1 degree).Due to intense physical activity, convexity can increase spasmodically and move to the lumen of the spinal canal.In this case, they talk about the hernia of the disc (2 degrees).Sometimes the free fragments of the nucleus can form -SequestersS
In the initial stages of the disease, the pain can be explained by overcoming the fibrous ring and irritation of the posterior longitudinal ligament.The pain can be localized locally in the back or neck, as well as in remote areas.With cervical osteochondrosis, pain can affect the back of the head, blade and inter -space, shoulder and arm carrier.
The pain is accompanied by reflex spasm of segmental muscles.This phenomenon is protected and stabilizes the certain part of the spine.Over time, muscle contraction becomes an independent source of pain.When moved to the intervertebral opening, the hernia presses adjacent nerve roots.Radicular pain has a firing, penetrating character, clearly localized during the innervation of the nerve.It is accompanied by appropriate neurological manifestations:
- reduction of sensitivity;
- reflex failure;
- Muscle weakness.
Disc degeneration disrupts the normal anatomical ratio between the components of the spine: discs, vertebrae, joints and ligaments.The gradual decrease in the height of the intervertebral disc leads to a change in joints and the formation of subluxation and dislocations of the vertebrae.This fact shows the instability of the spine and reduces the resistance to injuries, which can lead to exacerbation of osteochondrosis.
With age, the stability of the spine is restored due to the formation of osteophytes, hypertrophy of the joint processes, the discs fibrosis, the thickening of the joints and the capsules.The last stage of the pathological process is called spondylosis.The pain so far has disappeared.
The main symptoms of cervical osteochondrosis
At the level of cervical segments, nerve roots and their arteries, the spinal cord and its vessels and spinal arteries can be compressed.Spinal cord compression is possible due to posterior intervertebral hernia or posterior osteophytes.People with a narrow vertebrae are particularly prone to it.With hernia, the compression signs of cervical osteochondrosis develop fairly quickly and the symptoms of the cerebrospinal fluoric current block are softer.
It is very difficult to distinguish compression of the spinal cord with tumor and hernia.Osteochondrosis of the cervical spine is manifested by spastic paresis of the legs, disorders of the conduction of sensitivity, pain and weakness in the hands.In some cases, the signs of compression are combined with signs of ischemia of the spinal cord substance resulting from compression of the spinal artery and radicular vessels.
Symptoms of damage to the anterior horns and ventral departments may suddenly develop with the participation of pyramidal pathways (blood supply to the anterior spinal artery).Anterior spine syndrome occurs: slow paresis of the hands, spastic paresis of the legs, impaired sphincter function.Sometimes symptoms of gross impairment of deep sensitivity in the hands develop.After 2-3 weeks, signs of spinal stroke begin to regress.With regard to the volume of pathological focus, we can say about the severity of the residual phenomena.
Cervical myelopathy
Myelopathy is a chronic ischemization of cervical osteochondrosis.A big role in the development of this syndrome is played by compression of blood vessels.The most characteristic is the defeat of the ventral parts of the side pillars and the front horns.It is manifested by spastic athotrophic paresis of the hands, spastic paresis of the legs, impaired deep sensitivity of the legs (classic triad).
In a number of patients, a symptom of Lermita occurs: a feeling of passing the electrical discharge throughout the spine with irradiation of pain in the hands and feet in the title.It is possible to develop lateral amyotrophic sclerosis, in which there are no symptoms of Bulbar.
An important role in the confirmation of milopathy is played by MRI and CT, which reveal the compression of the bag of osteophyte shells and a bold yellow pile.
Signs of radicular compression
As the main discs wear out faster, spondylarthrosis develops in the relevant segments.The osteophytes narrow the intervertebral holes and squeeze the roots (at the lumbar level more frequent compression of the hernia of the disc in the epidural space).When the growth head moves, the spine is wounded, which causes the formation of edema, which further narrows the intervertebral opening.They develop reactive inflammatory reactions.
Clinical manifestations:
- C3 -core (under 2 cervical vertebra, occurs quite rarely) - pain in the corresponding half of the neck, sensation of swelling of the tongue, feeling of coma in the throat;
- C4 -core - pain in the corresponding shoulder, clavicle, atrophy of the trapezoidal muscle, reduction of the tone of the neck muscles (irritation of 3 and 4 cervical roots increases the tone of the diaphragm, leading to displacement in the liver and the appearance of angina papal pain);
- C5 -Decor - neck pain and outer surface of the shoulder, hypotrophy of the deltoid muscle;
- The C6 -Correction (one of the most common locations) -the neck, the blades, the shoulder, the radial surface of the forearm spreads to 1 finger, the parepesia in the hands, the weakness of the biceps of the two -headed muscle;
- C7-Koreshok-Pain spreads to 2-3 fingers, accompanied by paresthesia, weakness of the three-headed muscle;
- C8 -core -the pain extends to the elbow surface of the forearm to the 5th finger, accompanied by paresthesia.
Cervical reflex syndromes
The vertebrae syndrome is manifested by acute pain in the cervix (bastard, cervical), rarely chronic or subacute pain.The main sources of pain syndrome are fibrous ring, posterior longitudinal ligament, joint capsule, tense muscles.Curvosha is not as pronounced as the curvature of the spine at the lumbar level.
The pain is pain, radiating to the back of the head.Intense when driving or prolonged stay in one position.Palpation determines the soreness of the spinous processes and capsules of the joints from the inflamed side (along the posterior surface of the neck of 3-4 cm is lateral than spicy processes).Participation in the process not only on the back, but also the front muscles of the spine (front staircase, etc.) is characteristic.
Front staircase syndrome
The staircase tension very often happens with cervical osteochondrosis.The muscle is determined by the side of the muscle in the form of a bone in the form of a stressful degree, dense and enlarged in size compared to the healthy side.Due to the tension, compression of the sucking vessels occurs, which is accompanied by pain and swelling in the arm, impaired sensitivity and motor activity (along the elbow nerve).The pain increases in a horizontal position.
Syndrome of small breasts
The development mechanism is similar to the previous one.The compression of the vascular frozen beam occurs between the muscle and the shoulder bone (or insidious process) in conditions of increased abduction of the arm.It is accompanied by chest pain, shoulder, arm.
Existing characteristics are often considered heart pain with VSD (no acute attacks, the effect of taking nitroglycerin or sedatives is not, increased symptoms during movement and palpation of pain points).
The posterior sympathetic syndrome
Remote, vasomotor disorders that occur as a result of irritation of the sympathetic plexus of the spinal artery are characteristic.The branches of the plexus are located in the tissues of the brain and skull.It manifests itself clinically by dizziness, ringing in the ears, grandiose disorders, anxiety.
The compression of the spinal arteries with osteophytes emitted by the joints of the spine, in combination with atherosclerotic damage to these vessels, is an important pathogenetic factor for the development of insufficiency of the arteries of the brain and spinal cord.
Conclusion
In most cases, the pain in the hands and neck is associated with cervical osteochondrosis.In some patients, the pain is caused by hernia on the intervertebral disc, in others - osteophytes and arthrosis of the joints of the spine.Any of these options can lead to local or reflected pain, radicular syndrome and myelopathy.When examining patients with neck pain, it is necessary to exclude such pathologies as:
- spinal tumors;
- epidural abscess;
- spondylitis;
- subarachnoid hemorrhage;
- meningitis;
- Living room abscess;
- Stratification of the carotid artery;
- Cervical vertebrae fracture.