Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.In terms of injury frequency, the cervical spine ranks second, second only to the lumbar spine.The treatment of osteochondrosis of the cervical spine is carried out in most cases with 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, lack of effect from conservative treatment 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 variety of manifestations.Symptoms depend on the prevalence of one or more syndromes that develop as a result of the impact of pathologically altered spinal structures on the spinal cord, roots or vertebral arteries.The clinical picture of the disease is determined by the following syndromes:
- Spinal - manifested by pain of varying intensity and duration, located in the neck or occipital region of the head.
- Spinal column - the appearance of innervation disorders, manifested by motor and sensory disturbances, as well as trophic changes in the muscles of the upper limbs.
- Radical - manifested by pain in various localizations (upper limbs, thoracic and abdominal organs), requires differential diagnosis with many diseases of internal organs and the cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders resulting from insufficient blood supply to brain structures (headaches, hearing problems, 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 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 organ studies to exclude concomitant pathology.
After the diagnosis is confirmed, outpatient treatment is prescribed in most cases.Patients with severe neurological disorders, high probability of complications and serious accompanying pathology require inpatient treatment.Conservative treatment of osteochondrosis involves the use of the following methods.
Pharmacotherapy
The use of drugs is necessary during an exacerbation of the disease to combat pain.For this purpose, they define:
- Non-narcotic analgesics.Non-steroidal anti-inflammatory drugs are taken orally or parenterally, with mandatory use of topical preparations - ointments, gels, balms, rubs.Complex anti-inflammatory therapy helps reduce soft tissue swelling, the main cause of pain in spinal syndrome.The duration of use of drugs in this group is 5-10 days, sometimes 2 weeks.If there is no result, paraspinal blocks of anesthetics with hormonal agents are used in the amount of 1-3 manipulations.
- Antispasmodics, vitamins of the B complex. 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 decoctions and decoctions) to prevent the development of neuroticism if the patient has prolonged excruciating pain.
- External heating agents - balms, ointments, rubbing that have a mild irritating effect and contain biologically active substances of plant and animal origin.Drugs with a strong irritant 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 elimination of the 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 flow and relaxes spasmodic muscles in 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
Physiotherapy exercises for cervical osteochondrosis should be performed daily, except for the exacerbation of the disease, which is accompanied by severe pain.In case of severe pain, it is necessary to follow a mild regimen, which includes maximum restriction of movements in the cervical spine.
Systematic exercise therapy helps to strengthen the neck muscles, which helps to reduce the static load on the intervertebral discs.Exercises are performed smoothly.Sudden movements of large amplitude are initially prohibited.Exercises should be started carefully, gradually increasing the load, avoiding the appearance of unpleasant sensations.
The 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 the shoulders, with relaxed or firm hands, holding them in this position for 15-20 seconds.
- static loads, with a stationary head, alternating tension occurs in the flexors and extensors of the neck.
The exercises should 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 carried out with the utmost care and if pain occurs it should be stopped immediately, as it can cause an exacerbation of the disease.
During traction, the elastic tissues of the spinal ligaments are stretched, which leads to an increase in the distance between adjacent vertebrae.Increases by 1-3 mm.This proves sufficient to reduce, and in some cases completely eliminate, compression when a root or artery is compressed by a herniated disc or osteophyte.During the operation, the pressure inside the intervertebral disc is reduced, which causes partial retraction of the herniated disc and enlargement of the intervertebral foramen.
Traction has a beneficial effect on the intervertebral joints, eliminating the subluxations that have formed in them and helps to reduce muscle contractions.Immediately after traction, it is imperative to fix the cervical spine using special devices for several hours.The course of treatment includes from 10 to 20 procedures.
Physiotherapy treatment
The use of medicinal electrophoresis has a good effect.The technique allows the administration of drugs to tissues involved in the pathological process.For cervical osteochondrosis, electrophoresis is used with non-steroidal anti-inflammatory drugs, hormonal anesthetics and other drugs.
The use of alternating currents helps to 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 diet and give up bad habits.
With a very advanced destructive process, the right treatment and the right 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 surgical treatment of cervical osteochondrosis, all available preservation methods should be tried.Typically, surgical treatment is indicated when treatment is 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 procedures are used more often.The manipulation is performed using microsurgical instruments and a 10x microscope, which allows you to clearly see the compressed areas of the spinal cord.A portion of the herniated disc is resected by pressing on the root or spinal cord.Sometimes it is necessary to remove a small fragment of a vertebra or remove a ligament.