Osteochondrosis 1, 2, 3, 4, 5 degree – description of all stages and types
Osteoarthritis is a degenerative disease affecting the intervertebral discs and causes their destruction with further progression and the appearance of neurological complications (disc protrusion, intervertebral hernia, etc.).
More often pain cause spondylarthrosis (arthrosis of the joints of the spine, such as facet, uncovertebral), spondylolisthesis (displacement of vertebrae relative to each other) and nonspecific back pain. So often in life under the degenerative disc disease is a collective term for different types of degenerative changes in the spinal column, including joints of the spine and ligaments.
How to recognize degenerative disc disease
In patients suffering from osteoarthritis and other degenerative diseases of the vertebral column, most often found following complaints:
- fatigue and discomfort in the spine (primary stages);
- paroxysmal pain in the neck, back and extremities in the form of "crosses";
- limited mobility and range of motion in the spine depending on the suffering of the Department;
- pain in the heart, simulating angina
- muscle weakness, atrophy or the appearance of spasms or seizures;
- impaired sensation in the hands and feet (reduce or increase), paresthesia (numbness, "tingling", tingling);
- headache, dizziness due to impaired blood supply to the brain;
- swelling of the limbs, stiffness in their joints;
- dizuricheskie and sexual disorders (reduced potency, impaired urination)
- girdle pain along the ribs;
- sleep disturbance, loss of appetite.
During the examination by a neurologist to the clinic may be added the symptoms of loss or weakening of reflexes (dependent on level of lesion and presence of compression), reduction of muscle strength in a particular muscle / muscle group.
In the modern medical literature there are many classifications of osteochondrosis, depending on different criteria: localization, stage of the lesion, clinical manifestations.
Views localization of pathology
With regard to the affected area and highlight the local common low back pain. Local is localized within the same anatomical and physiological field, common covers more than two regions.
Local process is:
Classification of disc degeneration
divided into 4 stages (extent) according to OCHA, 1971 (currently not being used for clinical assessment and formulation of diagnosis):
- degenerative disc disease of the 1st degree – phase shift of the nucleus pulposus within the discus intervertebralis, is characterized by uti. In certain cases there may be symptoms of discharge (pain in the area of the disk) associated with involvement in the pathological process of nerve fibers surrounding a vertebra, and pain reflected corresponding to the location of the affected spinal nerves (limbs, internal organs). Does not require treatment.
- degenerative disc disease of the 2nd degree – stage vertebrae dystopia is characterized by the appearance of cracks in discus intervertebralis, weakening of the annulus fibrosus, and lesions of the posterior longitudinal ligament. The main symptoms are constant fatigue, discomfort in the spine, protrusion of disks, scoliosis, spondylolisthesis, subluxations of the vertebrae. Responds well to conservative treatment (protective agents, NSAIDs, muscle relaxants, anticonvulsants, cardiovascular and other drugs).
- low back pain 3rd degree – the stage of complete rupture of the intervertebral disc is determined by the appearance of severe irreversible complications vertebrogenic syndromes(intervertebral hernia, entrapment of the nerve roots, deformation of the spine). The main treatment is surgery.
- degenerative disc disease of the 4th degree – stage progression of the degenerative process is characterized by the spread of destruction on the structures surrounding the vertebral vessels (microangiopathy, thrombosis), spinal cord (myelitis, lesion of the Dura mater), ligaments (the destruction of the interosseous and yellow cords); is formed by ankylosis of the vertebral column.
The Stage of unstable degenerative disc disease (characterized by the occurrence of destabilization of the vertebral column):
- Discogenic – in the pathological process becomes involved only discus intervertebralis.
- Discountlasuna – degenerative changes affecting the intervertebral joints and ligaments.
- Discounttriamterene process progresses that is accompanied by lesions of the bony structures and the development of spondylolysis and spondylolisthesis.
The Degree of destruction of the intervertebral disc by Sachs, 1987 (in the same classification revised):
0 – changes are not detected;
1 – the destruction of 1/3 of annular plates of fibrousring;
2 – remain integral for the outer fibers of the disc that prevent the formation of hernia;
3 – the total destruction of the discus intervertebralis and tear of longitudinal ligament, severe clinical symptoms.
At the present time to determine the stage and severity of osteochondrosis often use x-ray classification of Sekera:
- the First stage is characterized by minor changes in lordosis of the one or more segments.
- the Second stage is installed when the radiograph is determined by the smoothness of lordosis + the thickening of the disk, moderately prominent exostosis in front or behind, the deformation of the uncinate processes.
- the Third stage is characterized by the appearance on the background of previous changes of narrowing of the intervertebral holes.
- the Fourth stage (the extent) is a significant narrowing of the intervertebral holes and the spinal canal.
The classification of Clinical manifestations of osteochondrosis used by neurologists:
- Cervical spine:
- reflex manifestations (cervicalgia, cervicobrachialgia, cervical with myotonic, vascular-circulatory and neurodegenerative symptoms)
- radicular syndromes (compression lesion of the S1-S8, characterized by paralysis of the upper limb)
- radiculare cardiovascular manifestations.
- Thoracic spine:
- reflex symptoms;
- radicular syndromes (compression of the intercostal nerve Th1-12).
- Lumbar-sacral spine:
- reflex symptoms (lumbago, lumbodynia, lumbar ischialgia with myotonic, vascular-circulatory and neurodegenerative symptoms)
- radicular syndromes (compression lesion of L1-5, S1-5)
- radiculare cardiovascular manifestations.
The Main methods of diagnosis pathology are ray methods (radiography, computer tomography) and magnetic resonance imaging.
Stage degenerative disc disease with contrast computed tomography:
- Contrast entered into a pulpous nucleus, does not penetrate through its borders.
- Contrast material extends to the inner third of the annulus.
- Contrast agent is distributed on two thirds of the annulus.
- Contrast substance penetrates up to the outer annulus fibrosus lamellae, which are well innervated by; this studiebyen the first symptoms occur.
- Contrast is distributed around the circumference of the disk to 30 degrees.
- Contrast material beyond the disk and penetrates into the epidural space.
The Degree of degenerative disc disease with magnetic resonance imaging:
M0 is a pulpous nucleus is not damaged, normal form.
M1 – local reduction of illumination and degradation of the nucleus pulposus, scarring of the disc.
M2 – complete cessation of illumination of the nucleus pulposus.
How to deal with degenerative disc disease
|Medication (usually takes 2-3 weeks)|
|Nonsteroidal anti-inflammatory drugs||Reduce the feeling of pain, tissue swelling, inflammation, and improve blood circulation. A feature of this group is a wide variety of drugs:
• for external use – ointments, creams, gels, aerosols, plasters – "Voltaren", "Diclofenac", "Diclac", "Ciklavit", "Dtlogin", "Dorasan", "Ortofen", "Nise", "Nurofen", "Ketonal";
• oral – tablets, capsules, powder "Movalis", "Nurofen", "Nise", "Diclofenac", "Voltaren", "Ketonal", "Dexalgin", "Airtel" etc.;
• for injection – "Dexalgin", "Ketanov", "Diclac", "Ketorol", "Diclofenac", "Ketonal, Movalis, Newmaximum"
|Muscle relaxants and anticonvulsants||Relieve painful spasm of the muscle tissue, prevent the development of seizures.
The muscle relaxants include: "Sirdalud", "Chiseled", "Titanyl", "Mydocalm", "Comparison", "Lyrics", "Algeria", "Pregabalin"
|Decongestant medications||"Furosemide", "Torasemid" remove excess fluid from the body, reduce swelling of inflamed muscles and nerves, thereby relieving pain|
|Neurotropic substances||Complex supplements of vitamins of the group To restore the myelin sheath, improve the blood supply to nerve fibers.
Basic preparations: "Neurorubine", "Milgamma", "Vitacon", "Metagama", "Combilipen", "Neurobion", "Neuromultivit"
|Chondroprotectors||Contribute to the restoration of cartilage, prevent further destruction of interchondral tissue. Contain chondroitin and glucosamine.
From chondroprotectors usually recommend: "teraflex", "Artra", "Glucosamine High", "Artradol", "Dona", "Mucosal", "hondroksid", etc.
|Novocaine blockade||injection of local anesthetic "Novocaine" 0,5% (5-10 ml) in paravertebral or epidural space for pain|
|Patients with significant size of the intervertebral hernias doctorsrecommend performing the following operations:||• discectomy (removal of a destroyed intervertebral disc);
• microdiscectomy and laser ablation, chemonucleolysis;
|non-pharmacological methods of treatment (lasts up to six months)|
|Unloading of the spine||In the period of exacerbation the patient is often advised bed rest: lying on a firm surface, under the head – an orthopedic pillow. This is true in the presence of disc herniation on the background of degenerative changes. In the absence of compression syndrome preservation of normal physical activity (the key word is normal, common, moderate) contributes to faster recovery|
• Irradiation in erythermal doses;
• electrophoresis of novocaine, hydrocortisone, hyaluronidase;
• diadynamic currents;
• cryotherapy reflex zones;
|Manual therapy||Methods of manual therapy are flexion and extension of the spine, tilt, intermittent application of forces in different directions|
|Massage||Patients during the period of recovery or remission are advised to undergo 10-15 sessions of classical massage gentle|
|LFC||the system of specially selected physical exercises that help restore normal muscle tone, elimination of contractures|
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