Osteochondrosis and back pain

Unfortunately, the term "osteochondrosis" has become firmly established in medical practice and has become a convenient diagnostic cliché for back pain.

It should be acknowledged that this term was probably justified at the time when neurologists invaded the field of orthopedics (diseases of muscles and joints), creating a doctrine called manual medicine. "Masking" their invasion of the field of orthopedics, neurologists were forced, firstly, to put the syndrome ("cervicalgia", "lumbago", etc.) ahead of the nosology when formulating a diagnosis, and secondly, to call the science studied not manual medicine as in the world, but vertebroneurology. At present, rheumatologists, orthopedists, neurologists and specialists in manual medicine are involved in the treatment of musculoskeletal pain. The time has come to bring the terminology concerning back pain into line with the international one. The same applies to the principles of formulating a diagnosis when the cause is established (nosology comes first, syndrome comes second).

According to Stedman's Dictionary of Medical Terms, osteochondrosis is one of a group of diseases of the ossification centers in children, characterized by degeneration or aseptic necrosis followed by reossification, including various groups of aseptic necrosis of the epiphyses.

Webster's Dictionary of Medical Terms defines Osteochondrosis as "Diseases that interfere with the growth of developing bone, causing the bone tissue to die. Osteochondrosis occurs only in children and adolescents whose bones are still growing."

"Osteochondrosis" is a non-inflammatory, non-infectious disorder of bone growth and various ossification centers that occurs at the time of their maximum activity and affects the epiphyses (the Merck Manual 18th Edition).

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What causes osteochondrosis?

The etiology is unknown, inheritance is complex. Osteochondrosis differs in anatomical distribution, course and prognosis. They usually 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 head of the humerus articulating with the head of the radius);
• Blount's disease (proximal tibia);
• Sever's disease (calcaneus);
• Sindling-Larsen-Johansson syndrome (patella).

More common forms of osteochondrosis: Kohler's disease - bone disease Kohler's - osteochondrosis of the head of the scaphoid; Legg-Calve-Perthes disease - idiopathic aseptic necrosis of the epiphysis of the head of the femur; Osgood-Schlatter disease - osteochondrosis of the tuberosity of the tibia;

Scheuermann's disease - causes local changes in the vertebral bodies, leading to back pain and the development of kyphosis. Scheuermann's disease manifests itself in adolescence, is relatively rare, slightly more common among young men. It probably represents a group of diseases with similar symptoms, the etiology and pathogenesis of which are unclear. It can be a consequence of osteochondritis of the upper and lower endplates of the vertebrae or trauma. Familial cases occur. Most patients have a rounded back and persistent low-intensity back pain. Some have similarities with Marfan syndrome, disproportion between the length of the body and limbs. Normal thoracic kyphosis is increased diffusely or locally.

Diagnosis of osteochondrosis

Some cases are diagnosed by routine clinical screening for spinal deformity in school-age children. Lateral radiography confirms the diagnosis by the presence of anterior wedge-shaped deformity of the vertebral bodies, usually in the lower thoracic and upper lumbar regions. Later, the endplates of the vertebral bodies become irregular and sclerotic. Vertebral symptoms of osteochondrosis are mainly expressed by kyphosis, sometimes partial scoliosis. In atypical cases, generalized skeletal dysplasia must be excluded by skeletal radiography. The course is mild but prolonged, often for several years (however, the duration is highly variable). Trivial vertebral functional impairment often persists after the disease has subsided.

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Treatment of osteochondrosis

In case of mild non-progressive course of osteochondrosis, weight loss and avoidance of high physical activity may be recommended. In case of more severe kyphosis, wearing a reclinator (orthopedic correction) or resting lying on a hard bed is indicated. Less often, in case of progression, surgical treatment of osteochondrosis and correction of vertebral deformities is required.

Thus, osteochondrosis can be the cause of back pain in Scheuermann's disease.