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Osteochondrosis
Last reviewed: 04.07.2025
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[ Causes osteochondrosis
The causes of osteochondrosis, i.e. degeneration of the intervertebral disc, have not yet been precisely established. In essence, osteochondrosis is a polyetiological disease. Among the main causes, one can note the age factor, microtraumatization of discs, metabolic disorders in the body, poor physical development, genetic predisposition, etc.
Pathogenesis
In osteochondrosis, the tissues of the intervertebral disc, due to a number of reasons leading to trophic disorders, lose moisture, the fibrous ring becomes less elastic, and the nucleus pulposus becomes hypermobile. The intervertebral disc loses its shock-absorbing function. Cracks may appear in the fibrous ring, through which the nucleus pulposus may protrude, up to a complete rupture of the fibrous ring with the nucleus pulposus extending beyond it). Due to the anatomical features and biokinetics of the spine, protrusions occur more often in the posterior or posterolateral direction, that is, towards the spinal canal, which leads to compression of the anatomical structures located there (spinal cord, spinal roots, vessels).
In addition to intervertebral discs, osteochondrosis affects hyaline plates, disturbances occur in small joints of the spine, vertebrae change, in which additional growths of bone tissue along the edges of the vertebral bodies (osteophytes) are adaptively formed. The latter, in turn, can also have a compressive effect both on structures inside the spinal canal and outside the spine.
The processes of intervertebral disc dystrophy during the further development of osteochondrosis entail compensatory changes in the bodies, joints, ligaments with the involvement of blood vessels, muscles and nerves in the pathological process.
In some cases, degenerative changes lead to a disruption of the strength of the vertebral joints, and their displacement relative to each other occurs (spondylolisthesis). Displacement of the disc without a rupture of the fibrous ring is called "protrusion" of the disc. In cases where a rupture of the fibrous ring is accompanied by a part of the degeneratively changed gelatinous nucleus going beyond its limits, we speak of a disc prolapse.
Symptoms osteochondrosis
The cervical (CV-CVII) and lumbar (LV-SI) regions are most often affected by osteochondrosis.
Cervical osteochondrosis and its symptoms are largely due to the anatomical and physiological features of the cervical spine. Compression-radicular cervical vertebrogenic syndromes are caused by irritation or compression of a certain root. This causes pain in the innervation zone of the corresponding dermatome, sensory and motor disorders. Irritative-reflex syndromes (cervicalgia, cervicocranialgia, cervicobrachialgia) are caused by irritation of the sinuvertebral nerve, often with the addition of a vegetative component.
Muscular-tonic syndromes also arise as a result of irritation of the pain receptors of the sinuvertebral nerve with excitation of the segmental apparatus of the spinal cord. They are manifested by prolonged muscle tension, the appearance of pain in them, and the development of fibrous changes. Sometimes this is accompanied by the appearance of reflected pain within the segmental vegetative innervation (Zakharyin-Geda zone). With prolonged irritation of the vegetative-trophic structures of the segmental and suprasegmental apparatus, neurodystrophic syndromes develop (syndrome of the inferior oblique muscle of the head, scapular-costal syndrome, scapulohumeral periarthritis, shoulder-hand syndrome, etc.).
One of the most important features of the structure of the cervical spine is the presence of openings in the transverse processes of CVI-CII, through which the vertebral artery passes with the sympathetic nerve of the same name (Frank's nerve). In osteochondrosis of the cervical spine, mainly due to the proliferation of osteophytes, insufficiency of cerebral circulation in the vertebrobasilar basin of compression or reflex genesis can form.
In case of protrusion or prolapse of the intervertebral disc, clinical symptoms of spinal cord compression (compressive vertebrogenic myelopathy) may develop with segmental, conductive symptoms, vegetative-trophic disorders and dysfunction of the pelvic organs.
When intervertebral discs in the lumbar region are affected, the main complaint of patients is lower back pain, and only in rare cases do other disorders come to the fore. Usually, the pain is localized in the lumbosacral region and radiates to the lower extremities. In some cases, the disease begins gradually, in others - acutely, with the appearance of sharp pain, which can increase over several hours or days.
The pathogenesis and nature of pain are similar to those in cervical osteochondrosis. When coughing and straining, the pain increases, which is explained by increased pressure in the subarachnoid space. In a lying position and in a forced pose, the pain may decrease.
The zones of pain irradiation to the lower limb have different topography and are almost always of a distinct mono- or biradicular nature. During examination, attention is drawn to the presence of characteristic scoliosis (homo- or goterolateral), more often - flattening of the physiological lordosis in the lumbar region. Tension of the long muscles of the back in the lumbar region is almost always noted. Palpation reveals pain in the spinous processes of the vertebrae. A positive Lasegue symptom is one of the most constant symptoms in the posterior displacement of the discs of the lower lumbar and first sacral vertebrae.
The second most important symptom of osteochondrosis is sensitivity disorder in the innervation zones of the affected roots and the form of paresthesia, hypoesthesia or anesthesia. Usually, the root dermatome is determined much more clearly by sensory disorders than by pain irradiation. In addition to sensory disorders, motor disorders may also occur with a decrease in the function of the muscles innervated by the corresponding root, their atrophy and decreased reflexes.
Rarely, when a herniated disc compresses the LIV or LV roots, a syndrome of spinal cord damage at the level of the conus and epiconeus (acute myeloradiculoischemia syndrome) occurs. This occurs in cases where this section is supplied with blood by the artery of the LIV or LV root (the artery of Deproge-Gotteron).
Stages
In 1971, L.I. Osna proposed a classification of the stages of osteochondrosis.
- Stage I - intradiscal displacement of the nucleus is greater than normal, which leads to stretching or compression of the fibrous ring).
- Stage II - the occurrence of cracks in the fibrous ring and instability of the affected vertebral segment.
- Stage III - complete rupture of the fibrous ring with disc prolapse, inflammatory process with possible compression of nerves and blood vessels.
- Stage IV - there is degenerative damage to other components of the intervertebral disc with the addition of spondylosis, spondyloarthrosis and other compensatory changes.
Diagnostics osteochondrosis
X-ray examination of the spine is part of a comprehensive clinical examination of neurological patients, with the help of which the nature of changes in the vertebrae, disks, spinal canal, and facet joints is clarified. X-rays can reveal changes in the spinal axis - straightening of the cervical and lumbar lordosis or strengthening of the thoracic kyphosis. X-rays with functional tests help to determine the presence of vertebral displacement (instability). Sometimes, gas accumulation (vacuum symptom) or lime deposition (a direct sign of osteochondrosis) can be observed in a degeneratively changed disk.
Radiographic signs of osteochondrosis reflect changes in the vertebral bodies, which manifest themselves as degenerative-atrophic (destruction of the endplates of the vertebral bodies and the introduction of the disintegrated disc into the body in the form of small Pommer nodes) and degenerative-reactive changes (marginal bone growths - osteophytes - and subchondral sclerosis). Radiographic signs of osteochondrosis also include slanted angles of the vertebral bodies, narrowing and deformation of the intervertebral openings. Osteochondrosis of the intervertebral discs can be complicated by displacement of the vertebrae (spondylolisthesis).
X-ray diagnostics of disc herniations is quite difficult and is most often based on indirect symptoms: straightening of lordosis, scoliosis, often expressed on the painful side, the symptom of a spacer, osteoporosis of the posterior-inferior angle of the vertebra, the presence of posterior osteophytes. MRI and CT are of great importance in the diagnostics of osteochondrosis, which allow not only to evaluate degenerative-dystrophic processes in the disc, but also to identify reactive changes in the surrounding tissues and to clarify the anatomical and topographic relationships at the level under study.
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Treatment osteochondrosis
Treatment of pain syndrome in disc pathology begins with conservative methods, including the use of medications, physiotherapy procedures, special therapeutic exercises, mechanical unloading, manual therapy, acupuncture, as well as spa treatment.
The question of surgical treatment is decided individually based on clinical and instrumental data.
Osteochondrosis, the treatment of which by conservative methods has not brought relief to the patient and in the case of development of acute compression of the spinal cord or roots of the equine tail should be treated using emergency neurosurgical care.
Planned surgical interventions are performed in case of prolonged pain syndrome (from 2-3 to 6 months), detection of syndromes of decreased root function, chronic compression myelopathy, compression vertebrobasilar insufficiency, presence of disc prolapse or its protrusion over 5-8 mm. Among the existing methods of surgical treatment of osteochondrosis, the most common today are microsurgical removal of disc herniations by flavotomy or interlaminectomy in the lumbar region, partial corporotomy with subsequent corporodesis in the cervical region, endoscopic removal and puncture laser vaporization of the disc.