Dorsopathy of the cervical spine

A diagnosis defined as cervical dorsopathy means that the patient has nonspecific pain and other symptoms in the neck area that are not related to internal organ disease.

Depending on the morphologic form of musculoskeletal pain syndrome, cervical dorsopathy has codes in the range M40-M54 (in the class of musculoskeletal and connective tissue diseases) according to ICD-10. Dorsopathy - as a less specific and detailed diagnostic code - was introduced to simplify morbidity statistics during the transition from the previous version of the ICD.

Epidemiology

According to clinical data, in eight to nine cases of cervical dorsopathy out of ten patients have degenerative changes in the spinal joints and intervertebral discs.

According to some reports, cervical spondylosis affects more than 85% of people over the age of 60.

The worldwide prevalence of disc herniation is estimated at 1-2% of the population, with cervical disc herniation accounting for about 20% of cases.

Causes of the cervical dorsopathy

Localized in the cervical spine dorsopathy, defined by many specialists as back pain (Latin dorsum - back), is caused by various reasons: sprains, inflammation or damage to the vertebral joints, synovial and fibrocartilaginous joints of the vertebrae, as well as muscles or nerves that make up the cervical part of the spinal column - from the first vertebrae to the seventh (CI-CVII).

In fact, cervical dorsopathy is pain in the cervical spine. In this case, among the nosologic forms, accompanied by pain syndrome, are diagnosed:

• degenerative changes in the intervertebral discs - dorsopathy and osteochondrosis of the cervical spine. And pain associated with osteochondrosis of the cervicothoracic spine, which affects the lower cervical and upper thoracic vertebrae, may be defined as dorsopathy of the cervical and thoracic spine; [1]
• damage to the discs between the vertebrae (cartilage "shock absorbers" of the spinal column) - cervical vertebral hernia; [2]
• Damage to cartilage in the arch (facet) joints of the cervical vertebrae with the development of osteoatrosis (osteoarthritis); [3]
• Spondylolisthesis - cervical vertebrae displacement; [4]
• rheumatoid arthritis of the spine; [5]
• Facet joint syndrome or cervical facet syndrome, [6] which by the nature of the pathology is deforming arthrosis - spondyloarthrosis of the arcuate joints;
• CIII-CVI vertebral curvature - cervical scoliosis; [7]
• pathological cervical lordosis with absence of natural bending, outward or sideways bending, i.e. Hypo- or hyperlordosis, which is formed in case of incorrect sitting posture, scoliosis, kyphosis, spondylolisthesis, in the elderly - in case of osteoporosis, i.e. Decreased bone density; [8]
• atlanto-axial subluxation (vertebrae CI-CII) due to trauma or ankylosing spondylitis; [9]
• stenosis (narrowing) of the spinal canal in cervical spondylosis or osteoarthritis of the cervical vertebrae with osteophytes (bone growths). [10]

The complex of symptoms caused by diseases of the cervical vertebrae can be defined as spondylopathy (from Greek spondylos - vertebrae) or vertebrogenic dorsopathy of the cervical spine (from Latin vertebrae - vertebrae). And pain in the paravertebral (periorbital) muscles of the neck may be called fibromyalgia, myofascial syndrome or cervical muscular dorsalgia. In many cases, its etiology is related to myogelosis of the cervical spine - nodular thickening of muscle tissue, the appearance of which occurs due to hypothermia or muscle overstrain.

Dorsopathy of the cervical spine in a child may be a consequence of posture disorders in children or a symptom of vertebral lesions of the neck in Still's disease - juvenile rheumatoid arthritis; is seen in Grisell syndrome, a non-traumatic subluxation of the atlanto-axial joint of the cervical spine caused by inflammation of the adjacent soft tissues, including a pharyngeal or peritonsillar abscess.

Also, neck pain is one of the many symptoms of congenital Klippel-Feil syndrome - short-neck syndrome.

Risk factors

Since dorsopathy of the cervical spine unites almost all diseases of the cervical vertebrae, the risk factors for their development are associated with both musculoskeletal pathologies of the spine - inflammatory and degenerative character, and with impaired innervation of the cervical muscles, which in most cases is secondary and is a consequence of lesions of bone and ligamentous structures of the vertebrae.

And a higher probability of their development is noted in spinal injuries in the neck, with increased load on this section of the spine (including prolonged static), sedentary lifestyle (negatively affecting the blood supply to the vertebrae, surrounding tissues and muscle tone), as well as people with congenital bone defects, thyroid pathologies, systemic metabolic disorders (including mineral metabolism), malignant tumors.

The likelihood of cervical disc herniation and cervical spondylosis is increased in the elderly.

Pathogenesis

About the mechanism of pain syndrome development in cervical vertebral herniation read - Herniated disc.

The pathogenesis of dorsopathy in cervical spine osteochondrosis is covered in detail in the publication - Osteochondrosis pain.

Detailed information about how neck muscle pain occurs and develops in the material - Myofascial pain syndrome.

Symptoms of the cervical dorsopathy

Often the first signs of problems with the cervical vertebrae or paravertebral muscles are manifested by a feeling of discomfort when tilting and turning the head, but they can manifest suddenly and acutely. At the same time, manifestations can be short, more prolonged (up to one and a half to three months) or become chronic: chronic dorsopathy of the cervical spine is defined when symptoms are observed for longer than three months.

Progression of the pathological process is always accompanied by pain - from aching to sharp, irradiating to the scapular region of the back, to the clavicles and shoulder girdle.

For example, in patients with cervical herniation, neck pain radiates to the shoulder blade, dizziness, numbness in the arms, increased BP, worsened sleep.

As a result of cervical nerve compression due to stenosis of the vertebral foramen (foramen vertebrale), patients with degenerative changes in the vertebrae develop the so-called cervical radiculopathy - dorsopathy of the cervical spine and muscle-tonic syndrome, characterized by shoulder and/or arm pain in the neck, muscle weakness, numbness and limitation of movement. [11]

With a lute specific diagnosis, it is possible for cervical dorsopathy to worsen, leading to increased pain and other symptoms.

In addition to pain and loss of mobility, pathologic cervical lordosis is associated with neck, shoulder and back muscle spasms; dizziness, drowsiness and nausea; lethargy, arterial hypertension and insomnia. And in cases of Grisell syndrome, there is progressive neck pain (radiating to the arm on the affected side), neck muscle stiffness and paresthesias.

Cervical dorsopathy and cervicocranialgia refers to neck pain (cervicalgia) and headache, especially severe in the occipital region. The etiology of such headaches in patients with cervical osteochondrosis is hypertonus of the inferior oblique muscle of the head (attached to the atlantus - cervical vertebra CI), as a result of which the vertebral artery (a. Vertebralis) and the great occipital nerve (n. Occipitalis major) are subjected to compression, leading to deterioration of the cerebral blood supply. This condition is referred to as vertebral artery syndrome, and ICD-10 defines it as cervicocranial syndrome.

By the way, this syndrome is also noted in deforming arthrosis of the arcuate joints of the vertebrae of the neck, and in myogelosis of the cervical spine.

Dorsopathy of the cervical and lumbar spine is possible with a high degree (III- IV) of curvature (scoliosis) of the spine in the thoracic and lumbar spine, as well as with severe stooping and round back.

Complications and consequences

Almost all forms of musculoskeletal pain syndrome, combined in cervical dorsopathy, have complications and consequences, including neurological complications. See - Osteochondrosis of the spine: neurological complications

In cases of cervical spondylosis or osteoarthritis of the cervical vertebrae, narrowing of the spinal canal leads to pinching of the occipital nerve, as well as lesions of the cervical plexus (plexus cervicalis) with muscle cramps (neck strap muscle and inferior oblique muscle of the head), numbness and pain in the back of the head.

If spinal canal stenosis in the cervical vertebrae is not treated, the consequences can include upper extremity dysfunction, loss of mobility, and urinary incontinence.

Ankylosing spondylitis and cervical spondylosis can lead to the development of chronic myelopathy, which is manifested by muscle weakness and paresthesia of the extremities, problems with arm mobility and movement, and various neurological disorders, including dysfunction of the sensory systems of the CNS.

The consequence of cervical muscular dorsalgia in myogelosis is an overgrowth of connective tissue within the muscle - myofibrosis.

In some cases, it is possible to develop vertebrogenic torticollis (torticollis) with neck pain, muscle hypertonus and forced turning of the head, most often - chin to shoulder.

Diagnostics of the cervical dorsopathy

Careful history taking and physical examination of the patient are necessary to determine the etiology of cervical spine pain.

Blood tests: general and biochemical; for C-reactive protein; for Ca levels (total and ionized) and inorganic phosphorus; for calcitonium, calcitriol and osteocalcin; for antibodies, etc.

Instrumental diagnostics are used for visualization: X-ray, CT or MRI of the spine, as well as myelography and electromyography. Read more in the publications:

• Diagnosis of spinal pain
• Diagnosis of osteochondrosis of the cervical spine
• Radiologic diagnosis of osteochondrosis
• Scoliosis diagnosis

Differential diagnosis

Differential diagnosis should distinguish musculoskeletal pain syndrome (with identification of the specific disease), and neuralgia - from visceral pain (related to internal organs).

Treatment of the cervical dorsopathy

For cervical dorsopathies, treatment includes pain management, decreased physical activity, and physical therapy.

Read more:

• Cervical osteochondrosis treatment
• Treatment for spinal pain
• Spinal hernia treatment
• Scoliosis treatment

Read about which medications are used in more detail:

• Medication treatment of osteochondrosis of the spine
• Pills for muscle and joint pain

External remedies with NSAIDs and other analgesic components are:

• Ointments for osteochondrosis.
• Effective ointments for neck pain

For painful muscle spasms, myorelaxants are prescribed, such as Baclofen (Baclosan), Tolperisone (Midocalm), Thiocolchicoside (Muscomed).

It is obligatory to prescribe physiotherapeutic treatment, for example, physiotherapy for spinal osteochondrosis includes electrical procedures, manual techniques, balneo- and peloidotherapy, etc.

If the vertebral joints are unstable, surgical treatment may be required - spondylosis, i.e. Fusion of two vertebrae with screws or plates. A laminectomy (open decompression of a pinched nerve root) is performed to remove a vertebral osteophyte, while a bulging fibrous disc can be corrected with a microectomy.

Read more about physical therapy for cervical dorsopathy in the article - Therapeutic exercise for cervical osteochondrosis. The publication contains exercises that should be performed regularly for problems with the cervical spine, as well as therapeutic exercises for cervicocranialgia with vertebral artery syndrome.

Doctors' recommended diet for cervical dorsopathy - Diet for osteochondrosis

Prevention

Basic preventive measures to help prevent pain-causing cervical spine conditions:

• posture correction
• Prevention of posture disorders in school-age children

Forecast

In cervical dorsopathy, the prognosis of its outcome is in direct correlation with the specific morphologic form of musculoskeletal pain syndrome and the degree of damage to the vertebrae and their connective structures.

The question of whether dorsopathy of the cervical spine and the army are compatible, the medical commission decides on the basis of examination, study of medical history and objective conclusions about the physical capabilities of each individual conscript.

A list of some books and studies related to the study of cervical spine dorsopathy

1. "Neck Pain: Causes, Diagnosis and Management" - by Nikolai Bogduk (Year: 2003)
2. "Cervical Spine Surgery: Challenges and Controversies" - by Edward C. Benzel (Year: 2007)
3. "Clinical Anatomy of the Spine, Spinal Cord, and Ans" - by Gregory D. Cramer, Susan A. Darby (Year: 2014)
4. "The Cervical Spine: The Cervical Spine Research Society Editorial Committee" - by John M. Abitbol (Year: 2018)
5. "Management of Cervical Spine Injuries" - by Edward C. Benzel (Year: 2015)
6. "Cervical Radiculopathy: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References" - by James N. Parker, Philip M. Parker. Parker (Year: 2004)
7. "Cervical Spondylosis: Advances in Diagnosis, Management, and Outcomes" - by Theodoros P. Stavridis, Anna H. Charalampidis, Andreas F. Mavrogenis (Year: 2017)
8. "The Human Cervical Spine: The Cervical Spine Research Society Editorial Committee" - by John M. Abitbol (Year: 2021)

Literature

Kotelnikov, G. P. Traumatology / edited by Kotelnikov G. P.., Mironov S. P. - Moscow : GEOTAR-Media, 2018.