- The essence of the disease
- Clinical manifestations
- Therapeutic tactics
Deforming spondylarthrosis is a dystrophic change in the intervertebral joints that lead to anatomical disruption of joints and a decrease in mobility of the spinal column. The disease is typical for elderly people due to the emergence of involutive processes - the natural extinction of the functional activity of the body's systems, including the musculoskeletal system. Under the influence of unfavorable factors of the external and internal environment, the pathological process can debut in young people due to the violation of metabolic processes in this or that part of the spine.
The chronic progressive course of the disease causes disability, which leads to disability and significantly reduces the quality of life.
The essence of the disease
As you know, the bodies of the vertebrae are interconnected by intervertebral discs, which are cartilaginous layers for amortization of movements. Violation of the structure and function of the discs leads to the development of osteochondrosis, protrusion and hernia of the spinal column. Spondyloarthrosis develops in the defeat of the facet joints - small joints that are between the processes of the vertebrae. Therefore, its second name is facet arthropathy.
Such joints have a flat shape and contribute to the flexibility of the spine in physiological limits by tilting the vertebrae in opposite directions relative to each other. In this case, the wedge-shaped arrangement of the facet joints does not allow the vertebrae to move forward, backward and sideways, which maintains the integrity and functional activity of the spinal column.
Joints between the processes of the vertebrae, like any other joint, have an articular bag, cartilage surfaces of bones, a synovial fluid for smoothness and painless movements. Keeps the facet joints in anatomically correct position and limits the excessive mobility of the ligament-muscle apparatus. Small ligaments between the spinous and transverse processes of the vertebrae, the anterior and posterior longitudinal ligaments, deeply located vermiform muscles and the superficial muscular skeleton of the back cause the normal operation of the spine and contribute to maintaining the habitual motor activity.
Osteochondrosis promotes the formation of facet arthropathy
In spondyloarthrosis, the cartilaginous interlayers between the arcs of the vertebrae are thinned and destroyed, the articular cleft decreases, which subsequently leads to disruption in the ligament and spinal column muscles.
With the progression of the disease, osteophytes are formed-bone growths of the affected vertebrae, which injure surrounding soft tissues. Chronic inflammatory process and degenerative disorders in the vertebrae lead to a block of facet joints and immobility of the spine in the pathology sites. Such anatomical and functional changes are called spondylosis and are the last stage of development of spondylarthrosis.
Elderly age is a common cause of dystrophic changes in the spinal column. In the body of elderly people, the activity of metabolism decreases, the blood supply of tissues worsens, the reparative( regenerative) processes in cells are slowed down, which is a natural sign of aging of the organism. However, in recent decades, spondyloarthrosis is diagnosed in young patients of working age. The appearance of the disease contributes to the following adverse factors:
- weakness of the muscular backbone;
- is a sedentary lifestyle;
- scoliosis, violation of posture;
- flat feet;
- professional features of labor activity associated with long-term static position;
- excessive axial load on the spine( lifting weights);
- intensive sports;
- back injury;
- endocrine pathology;
- congenital diseases of the spinal column.
Schematic comparison of normal spine and spondylarthrosis affected
The development of the pathological process in most cases is formed against the background of osteochondrosis and aggravates its course. In this case, the disease is prone to rapid progression and causes persistent impairment of mobility of the spinal column in the event of untimely recourse to medical care.
Clinical manifestations of
The first and permanent sign of spondylarthrosis is back pain. In this case, the pain syndrome at the initial stages of the disease has a clear localization without spreading to other parts of the body. It has a constant aching character and is strengthened by prolonged walking, standing or physical activity. Depending on the localization of the pathological process, several types of the disease are distinguished.
The disease develops in the cervical spine, most often against the background of osteochondrosis. Therefore, the pains are dull aching in nature and can spread to the interlateral or occipital region, the forearm, the arm on the side of the lesion of the facet joints.
As the disease progresses, stiffness occurs in the neck, mainly after a morning awakening, which takes place during the day. Then the discomfort in the cervical region is felt during sleep and causes the patient to seek a position to relieve the suffering. In far-reaching stages of the disease, neurovascular bundles are impaired, the vertebral artery is injured by osteophytes, which leads to impaired cerebral circulation. There are headaches, dizziness, numbness or tingling in the hands, imbalance, reduced visual acuity and hearing.
Disease rarely occurs in the thoracic spine due to anatomical features and low amplitude of movements. In addition, the pathological process in this area for a long time is asymptomatic and difficult to diagnose. In most cases, the disease affects people who have a sedentary lifestyle or are associated with sedentary work.
Spondyloarthrosis in later stages of development causes discomfort in the interblade area, which occurs after a prolonged static position( sitting, standing).Due to the progression of the disease, the mobility of the spine is reduced during bends and torso of the trunk, pressure in the chest appears during deep breathing.
The deforming spondylarthrosis of the lumbar region and the region of the sacrum takes the second place after the onset of the cervical localization of the disease. The pain syndrome in this case appears in the lower back, is aching in nature, increases with tilts and turns of the trunk. As the pathology progresses, the stiffness of the lumbar spine develops, and pain can spread to the buttock, leg on the side of the lesion due to infringement of the spinal roots.
On the roentgenogram arrows indicate osteophytes of the vertebrae
The degree of manifestation of signs of the disease depends on the stage of development of the pathological process. At the initial stages of spondyloarthrosis, structural changes in the vertebrae are minor, which leads to a meager symptomatology. Progression of the disease causes destruction not only of articular cartilage, but also periarticular tissues, which makes the clinical picture more distinct. It is important to consult a doctor at the first symptoms of the disease, when you can completely repair damaged joints and avoid complications.
Before starting therapy, it is necessary to undergo a screening. The doctor collects complaints of the patient, reveals the possible cause of the disease, examines the patient, determines the localization of pain and mobility of the spinal column. For the final diagnosis, instrumental survey methods are conducted, including:
- radiography - examination of the spine with X-rays, performed in a straight and lateral projection, reveals structural changes in bone tissue, narrowing of the joint gap, localization and form of osteophytes;
- computer and magnetic resonance imaging ( CT, MRI) - highly informative diagnostics, which allows to obtain layered photographs of pathologically altered area, determines structural changes in bones, cartilage tissue, ligaments, tendons, muscles;
- radioisotope scanning - is used to detect the localization of the inflammatory process by intravenous introduction of isotopes and to study the degree of accumulation of radioactive substances in the pathology site;
- ultrasound ( ultrasound) is designated as an additional method for determining structural changes in vessels, nerves and other structures of soft tissues.
In some cases diagnostic blockades are used to detect spondylarthrosis, in which an anesthetic is injected into the affected joint. In favor of the disease says the fact of temporary elimination of pain syndrome.
To treat facet arthropathy begin conservative methods. The main goal of therapy is to reduce discomfort and pain in the affected vertebral column, reduce the inflammatory response of the periarticular tissues, restore the physiological mobility of the trunk. Conservative methods include the appointment:
Manual therapy is effectively used in the initial stages of
- spondyloarthrosis of non-steroidal anti-inflammatory drugs( NSAIDs) -movalis, nimesulide, diclofenac;
- muscle relaxants to normalize the tone of the muscular framework of the back - midolma;
- enzymatic agents for improving tissue trophism in the pathology site - caripain;
- B vitamins to improve the conduct of the nerve impulse and restore the innervation of tissues;
- blockade of facet joints with anesthetics for pain relief - novocaine, lidocaine;
- intraarticular injections of hormones for the purpose of anesthetizing and reducing inflammation - hydrocartisone, kenalog;
- chondroprotectors to prevent the destruction of cartilaginous tissue and restore normal metabolism in it - hyalgan, chondroxide, aflutope;
- physiotherapy in the period of remission of the acute phase of the disease - magnetotherapy, electrophoresis with novocaine or lidase, ultrasound;
- of Physical Therapy( LFK).
In the far-reaching stages of the pathological process in the formation of osteophytes, the fusion of structural joints, the appearance of immobility in the affected parts of the spine, persistent pain syndrome recommend surgical methods of treatment. To eliminate the infringement of the nerve root and reduce pain, a distractor is installed, which widens the vertebral openings in the area of pathology. A more radical way is considered to be laminoplasty, which consists in removing the damaged vertebrae and replacing it with a titanium implant. In the case of the formation of large osteophytes, blocking joints and causing intense pain, surgical excision of pathological bone formations is performed.
Deforming spondylarthrosis has a favorable prognosis in the case of early diagnosis and complex treatment. The progression of the disease causes irreversible changes in the facet joints and surrounding soft tissues, which disrupts the movement in the spine and leads to disability.