The specialist spoke about modern approaches to the treatment of patients with osteochondrosis of the cervical spine
Pain in the cervical spine is a fairly common phenomenon, which people far from medicine often call "chondrosis". It is believed that almost "everyone" has this disease up to a certain age, which means you just need to "be patient. "
Alexey Peleganchuk, head of the department of neuroorthopedics, orthopedic traumatologist, neurosurgeon, Ph. D. , spoke about what technologies are available to doctors today to help such patients.
What disease do patients often call "cervical chondrosis"? What is the correct diagnosis?
– In fact, "cervical chondrosis" is a slang term; the disease is correctly called "osteochondrosis of the cervical spine". This term is used by doctors in the post-Soviet space and corresponds to the current ICD (International Classification of Diseases), according to which we work. However, in most countries such a disease does not exist; they call it "degenerative dystrophic disease. "When making the diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which motion segments of the spine are affected.
Most of the time, people associate this disease with pain in the cervical spine. Is this the main and/or only symptom?
– The most common reason for these patients to see a neurologist is pain. We can say that the main clinical manifestation of degenerative pathology - osteochondrosis of the cervical spine, in this case, is pain. In addition, even more dangerous manifestations of common degenerative pathologies are weakness in the upper extremities (perhaps in the lower extremities) and impaired sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are complaints that are not very characteristic of cervical osteochondrosis, but they sometimes happen. If such a patient comes, then, first of all, this is a reason to prescribe an MRI of the brain to rule out any organic changes. If the patient did this, he does not lend himself to conservative treatment and there is a substrate in the form of disc protrusions, which is extremely rare, but can cause these phenomena reflexively, so there is an option to help this patient, but the effectiveness will be significantly less than the classic treatment of cervical spine pain.
What are the causes of pain and what options are available today to treat these patients?
– Three groups of patients can be distinguished. The first group are reflex pain syndromes, the second group are radicular syndromes, myelopathies - lesions of the spinal cord itself, as in severe stenosis, and the third group are extremely rare patients, but the most complex, those who suffer most are the patients with neuropathy.
Reflex pain syndrome can spread locally in the cervical region and can radiate to the shoulder girdle and upper limbs. But the peculiarity of this painful syndrome is that the nervous tissue - namely the spinal cord and its roots - is without compression (without compression).
So, in this case, if we are considering the option of surgical treatment, these are outpatient methods - for example, blocks. More invasive procedures include radiofrequency denervation and cold plasma coblation of intervertebral discs - a hardware puncture procedure performed without incisions.
The aim is to eliminate the pain syndrome or significantly reduce its intensity and relieve the patient of the need for analgesics.
The second group of patients are patients with hernias. Hernias in the cervical spine can cause compression of the roots, and if conservative treatment methods are ineffective, surgery is resorted to. The purpose of the operation is to perform decompression, i. e. remove the hernia, respectively, the root of the spinal cord will become free and the pain syndrome will regress.
With large hernias, conduction disorders also occur: in addition to compression of the spinal cord root, the spinal cord itself can be compressed (compressed). Then the person presents more serious clinical manifestations in the form of tetraparesis, that is, weakness in the upper and lower extremities. In this case, decompression is necessary - to create reserve spaces for the spinal cord so that it can recover a second time. It is important to understand that the operation does not restore the spinal cord and nerve, but creates conditions, that is, reserves spaces.
In addition to hernias, there are circular strictures. They develop due to complex problems arising in the cervical spine, which lead to a circular narrowing of the canal.
These are critically ill patients who sometimes remain ill for years and, unfortunately, are most often admitted with severe neurological deficits and often require two-stage surgery.
And another group of patients are people with neuropathic pain syndrome. In this case, patients, in the absence of stenosis, experience neuropathy (the nerve itself hurts). Then help is provided through neuromodulation (neurostimulation). It involves the installation of special epidural electrodes in the posterior structures of the spinal cord. This is a special device - one might say, like physiotherapy, that you always carry with you: you can turn it on and increase the power to reduce pain. And this helps a lot even in very difficult cases.
All these technologies are available to patients; there are different sources of financing, including compulsory medical insurance and quotas for high-tech medical care.
Can osteochondrosis be cured?
– The disease itself, osteochondrosis, has no cure. What can be done? Let's say a conditional patient: osteochondrosis of the cervical spine, with predominant damage at the level of the C6 – C7 vertebra, degenerative stenosis at this level and with compression of the C7 medullary roots on the right.
During surgery, it is possible to remove the stenosis, remove a hernia, or decompress the spinal cord root if the spinal cord itself is compressed. But the first four words of the diagnosis (osteochondrosis of the cervical spine) will remain for life, because it is incurable. Surgeons influence the substrate of this clinic, and the substrate of the clinic is, say, a hernia that led to stenosis.
How are treatment tactics determined?
– There is such a concept – clinical-morphological correspondence. The doctor must look at the patient from all sides - carry out an orthopedic examination, neurological examination, collect anamnesis, complaints - and correlate this data with studies.
Screening studies for osteochondrosis of the cervical spine are MRI, unless this study is contraindicated for the patient for one reason or another. If necessary, MSCT is also prescribed to determine the tactics of the operation.
However, not every hernia described on an MRI requires surgery. The hernia itself is not a reason for surgery. The specialist must determine how much it causes compression, etc. , and decide on the convenience of the operation.
At what age do these problems most often occur?
– The average age of our patients is over forty years, but it happens that young people also require surgical intervention if their degenerative cascade started early, which led to the formation of a hernia-shaped substrate. In this case, the first step is conservative treatment and, if there is no effect, the only option is surgery.
What are the risk factors?
– We don’t live in India and our compatriots don’t wear anything on their heads. Therefore, it is not necessary to say that work or habits lead to premature wear and tear and the formation of these formations.
The main risk factor is genetic. This applies not only to the cervical region, but also to the thoracic and lumbar regions - this is the weakness of the fibrous ring tissues. And other risk factors - in the form of excess body weight, extreme work - are more reflected in the lower back.
Is it possible to avoid it somehow?
– Prevention is, first and foremost, exercise therapy, so that there is muscle tone, the muscles function correctly and there are no spasms. The fact is that when a degenerative process develops, which can develop both in the discs and in the joints of the spine, this leads to muscle spasm and the person feels pain. Therefore, massage, acupuncture, etc. are good for reflex pain syndrome.
What determines the effectiveness of the treatment?
– It is important to consult a neurologist in a timely manner if there are any problems: pain in the cervical spine that spreads to the upper limbs, numbness and weakness in the arms, decreased strength. Very serious pathologies are circular stenosis, when there is also weakness in the lower extremities, when the spinal cord is already affected.
It turns out that people resist it for years and think it's just "age-related. "But every year they get worse and, as a result, the disease causes them to have movement restrictions - they can only walk a few meters.
The specialist will assess the degree of danger and, if necessary, refer to additional research methods and, if indicated, to a vertebrologist who deals with the surgical treatment of spinal pathology. The purpose of the consultation is to determine the need for surgical intervention. If there is no need for surgery, the neurologist is already carrying out conservative treatment. If surgical treatment is necessary, an operation is performed, after which the patient is sent for rehabilitation to a neurologist.
The aim of conservative treatment is to achieve very long periods of remission and minimize the frequency of exacerbations, both in duration and frequency. This also applies to puncture treatment methods. But if there are already gross changes in the form of hernia and compression of the roots of the spinal cord, conservative treatment may not work.
At the same time, the operation must be timely. The aim of the operation is to save the nervous tissue, whether from the spinal cord or its roots. If a person has been ill for years, this leads to myelopathy - a change in the spinal cord itself, which even with an excellent operation may not recover, or to radiculopathy - damage to the root of the spinal cord.
If the operation is performed on time, according to standards, there is a high probability of restoration of both the root of the spinal cord and the spinal cord itself, and the person after rehabilitation will feel practically healthy.
With advanced pathology, the effectiveness of surgical intervention decreases. In the case of persistent neurological disorders, the operation may not lead to noticeable progress, because the spinal cord or root itself has already died at the time of the operation.
Every patient with one or another variant of the pathology needs a personal consultation with a specialist. At the same time, most patients with cervical osteochondrosis can be helped without surgery, using complex methods of conservative treatment.