Osteochondrosis and back pain
Last reviewed: 23.04.2024
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Unfortunately, the term "osteochondrosis" has become firmly established in doctors' practice, which has become a convenient diagnostic cliche for back pain.
It should be remembered that this term was probably justified at a time when neurologists invaded the field of orthopedics (muscle and joint diseases), creating a doctrine called manual medicine. "Masking" their intrusion into the field of orthopedics, neurologists were forced, firstly, when formulating the diagnosis of the syndrome ("cervicalgia", "lumbalgia", etc.) to put ahead of nosology, and secondly, to call the studied science not manualal medicine as in world, and vertebro neurology. At present, rheumatologists, orthopedists, and neurologists and specialists in manual medicine are engaged in the treatment of musculoskeletal pain. It's time to bring in the terminology relating to back pain, in line with the international one. The same applies to the principles of the formulation of the diagnosis for a specified reason (nosology in the first place, and syndrome in the second).
According to the dictionary of medical terms Stedman's, osteochondrosis is one of the group of diseases of the centers of ossification in children, characterized by degeneration or aseptic necrosis followed by re-classification, which includes various groups of aseptic necrosis of the epiphyses.
The Webster's medical terms dictionary treats Osteochondrosis as: "Diseases that disrupt the growth of the developing bone, causing the death of bone tissue." Osteochondrosis occurs only in children and adolescents whose bones still grow. "
"Osteochondrosis" is a noninflammatory noninfectious disorder of bone growth and various centers of ossification, occurring at the time of their maximum activity and damaging the epiphyses (the Merck Manual 18th Edition).
[What causes osteochondrosis?
The etiology is unknown, inheritance is complex. Osteochondrosis is characterized by anatomical distribution, course and prognosis. Usually they cause algic symptoms and have orthopedic consequences.
Rare forms of osteochondrosis involve the following bones:
- Freiberg's disease (head of the second metatarsal bone);
- Partner's disease - distal humerus head articulating with the ray head);
- Blount disease (proximal tibia);
- Sever's disease (heel bone);
- syndrome Sindling-Larsen-Johansson (patella).
More frequent forms of osteochondrosis: Kohler's disease - Kohler's bone disease - osteochondrosis of the head of the scaphoid bone; Legg-Calve-Perthes disease - idiopathic aseptic necrosis of the epiphysis of the head of the femur; Osgood-Schlatter disease - osteochondrosis tuberosity pain of the sternum;
Scheuermann's disease - causes local changes in the vertebral bodies, leading to back pain and kyphosis development. Scheuermann's disease manifests in adolescence, relatively often, is slightly more frequent among young men. It probably represents a group of diseases with similar symptoms, the etiology and pathogenesis of which is unclear. It can be a consequence of ostochondritis of the upper and lower end plates of the vertebrae or trauma. There are family cases. Most patients have a round back and persistent low-intensity back pain. Some have a similarity to Marfan's syndrome, a disproportion of body length and limbs. Normal thoracic kyphosis is strengthened diffusely or locally.
Diagnosis of osteochondrosis
Some cases are diagnosed by routine clinical screening for deformity of the spine at school age. Lateral radiography confirms the diagnosis of the presence of anterior wedge-shaped deformation of vertebral bodies, usually the lower thoracic and upper lumbar regions. Later the closing plates of vertebral bodies become uneven and sclerotized. Vertebral symptoms of osteochondrosis are mainly expressed by kyphosis, sometimes partial scoliosis. In atypical cases, it is necessary to exclude generalized dysplasia of the skeleton with the help of radiography of the skeleton. The course is mild, but prolonged, often for several years (however, the duration varies greatly). Trivial vertebral functional disorders often persist after the subsidence of the disease.
Treatment of osteochondrosis
In the case of a mild non-progressive flow of osteochondrosis, weight loss and avoidance of high physical exertion can be recommended. With more severe kyphosis, the wearing of a reclinator (orthopedic correction) or rest lying on a rigid bed is shown. Less often, in the case of progression, surgical treatment of osteochondrosis and correction of vertebral deformations are required.
Thus, osteochondrosis can be the cause of back pain in Scheuermann's disease.