Osteochondrosis is a degenerative-dystrophic spinal disease, the basis of which is the 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 frequent localization of the lesion is the cervical and lumbar spine.This is due to their greatest mobility and load.
General concept of osteochondrosis
The intervertebral disk over time loses its liquid and loses its shock -absorbing function.It becomes less resistant to physical exertion.The fibrous ring, which is located on the periphery of the disk, is gradually thinner, cracks form in it.The pulpic nucleus shifts along the periphery in the formed cracks and formsProtub(local protrusion, 1 degree).Due to intensive physical activity, protrusion can be spasmodically increasing and shifting into the lumen of the vertebral channel.In this case, they talk about the hernia of the disk (2 degree).Sometimes free fragments of the nucleus can form -Sequesters.
In the initial stages of the disease, pain can be explained by overexing 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, the pain can be reflected in the back of the head, blade and interspace area, shoulder bearer and hand.
The pain is accompanied by reflex spasm of segmental muscles.This phenomenon has a protective nature and stabilizes the defined part of the spinal column.Over time, muscle contraction becomes an independent source of pain.When shifting towards the intervertebral hole, the hernia squeezes neighboring nerve roots.The radicular pain has a shooting, permeating character, clearly localized during the innervation of the nerve.It is accompanied by appropriate neurological manifestations:
- decrease in sensitivity;
- failure of reflexes;
- muscle weakness.
The degeneration of the disk violates the normal anatomical ratio between the components of the spinal column: disks, vertebrae, joints and ligaments.The gradual decrease in the height of the intervertebral disc leads to a change in articular ties and the formation of subluxation and dislocations of the vertebrae.This fact indicates the instability of the spinal column and reduces 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 articular processes, disks fibrosis, thickening of the articular ligaments and capsules.The final stage of the pathological process is called spondylosis.Pain to this time subside.
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 subjected to compression.Compression of the spinal cord is possible due to the posterior intervertebral hernia or rear osteophytes.People with a narrow vertebral canal are especially predisposed to this.With a hernia, compression signs of cervical osteochondrosis develop quite quickly, and the symptoms of the cerebrospinal fluvine current block are softer.
It is very difficult to clinically distinguishing the compression of the spinal cord with a tumor and hernia.Osteochondrosis of the cervical spine is manifested by a spastic paresis of the legs, conduction disorders of sensitivity, pain and weakness in the hands.In some cases, signs of compression are combined with signs of ischemia of the spinal cord substance that arose as a result of compression of the spinal artery and radicular vessels.
Symptoms of damage to the anterior horns and ventral departments may suddenly develop with the involvement of pyramidal paths (blood supply to the anterior spinal artery).The anterior spinal syndrome occurs: sluggish paresis of the arms, spastic paresis of the legs, impaired sphincter function.Sometimes symptoms of gross violation of deep sensitivity in the hands develop.After 2-3 weeks, the signs of a spinal stroke begin to regress.In terms of the volume of the pathological focus, we can say about the severity of residual phenomena.
Cervical myelopathy
Myelopathy is a chronic ischemization for cervical osteochondrosis.A large 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 a spasticoatrophic paresis of the arms, a spastic paresis of the legs, a violation of the deep sensitivity of the legs (classic triad).
In a number of patients, Lermitta’s symptom appears: a feeling of passing the electric discharge along the entire spine with irradiation of pain in the hands and legs when heading.It is possible to develop side amyotrophic sclerosis in which there are no bulbar symptoms.
An important role in confirmation of myalopathy is played by MRI and CT, which reveal the compression of the shell bag with osteophytes and a thickened yellow bunch.
Signs of radicular compression
Since the underlying discs wear out faster, spondylarthrosis develops in the corresponding segments.Osteophytes narrow the intervertebral holes and squeeze the roots (at the lumbar level more often a compression of the hernia of the disk in the epidural space).When moving the head of the growth, the spine is injured, which causes the formation of edema, which further narrows the intervertebral hole.Develop reactive inflammatory reactions.
Clinical manifestations:
- C3 -Koreshok (below 2 cervical vertebra, occurs quite rarely) - pain in the corresponding half of the neck, a feeling of swelling of the tongue, a feeling of a coma in the throat;
- C4 -Koreshok - pain in the appropriate shoulder stream, clavicle, atrophy of the trapezoid muscle, a decrease in the tone of the neck muscles (irritation of 3 and 4 cervical roots increases the tone of the diaphragm, which leads to a shift in the liver and the appearance of angina papardical pain);
- C5 -decor - pain in the neck and outer surface of the shoulder, hypotrophy of the deltoid muscle;
- C6 -Koreshok (one of the most common localizations) - pain in the neck, blades, shoulder shoulder, the radial surface of the forearm spreads to 1 finger, parepezesia in the hands, 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 -Koreshok - the pain extends to the elbow surface of the forearm to the 5th finger, accompanied by paresthesia.
Cervical reflex syndromes
The vertebral syndrome is manifested by acute cervical pains (bastards, cervicals), less often chronic or subacute pain.The main sources of the pain syndrome are a fibrous ring, the rear longitudinal ligament, joint capsule, tense muscles.Krivosheya is not as pronounced as the curvature of the spine at the lumbar level.
The pains are aching, radiate to the back of the head.Intensify when driving or prolonged stay in one position.On palpation, the soreness of the spinous processes and capsules of the joints on the sore side (along the posterior surface of the neck of 3-4 cm is lateral than spicy processes) is determined.The involvement in the process of not only the back, but also the front muscles of the spine (anterior staircase, etc.) is characteristic.
Anterior staircase syndrome
The stair muscle tension very often occurs with cervical osteochondrosis.The muscle is determined by the side of the sternum-coat-shaped muscle in the form of stressful grade, dense and increased in size compared to the healthy side.Due to the voltage, compression of the supravichical vessels occurs, which is accompanied by pain and swelling in the hand, impaired sensitivity and motor activity (along the elbow nerve).The pain intensifies in a horizontal position.
Small chest muscle syndrome
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 corave process) in conditions of increased abduction of the hand.It is accompanied by pain in the chest, shoulder blade, hand.
The existing features are often considered as pain in the heart with VSD (there are no acute attacks, the effect of taking nitroglycerin or sedatives is not, increased symptoms during movement and palpation of pain points).
The rear sympathetic syndrome
Distrophic, vasomotor disorders that occur as a result of irritation of the sympathetic plexus of the vertebral artery are characteristic.The branches of the plexus are located in the tissues of the brain and skull.It is clinically manifested by dizziness, a ringing in the ears, spectacular disorders, anxiety.
The compression of the vertebral arteries with osteophytes emanating from the joints of the spinal column, in combination with the atherosclerotic damage to these vessels, is an important pathogenetic factor in the development of insufficiency of the arteries of the brain and spinal cord.
Conclusion
In most cases, pain in the hands and neck is associated with cervical osteochondrosis.In some patients, the pain is caused by hernia of the intervertebral disc, in others - osteophytes and arthrosis of the joints of the spine.Each of these options can lead to local or reflected pain, radicular syndrome and myelopathy.When examining patients with pain in the neck, it is necessary to exclude such pathologies as:
- tumors of the spine;
- epidural abscess;
- spondylitis;
- subarachnoid hemorrhage;
- meningitis;
- Hall abscess;
- stratification of the carotid artery;
- Fracture of the cervical vertebrae.