The expert 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 is often referred to as "chondrosis" by doctors far from medicine. It is believed that almost "everyone" of a certain age suffers from this disease, which means that all you need is "patiencemust have.
Alexey Peleganchuk, Head of the Department of Neuroorthopedics, Orthopedic Traumatologist, Neurosurgeon, Ph. D. , talked about what technologies are available to doctors today to help such patients.
What disease do patients usually call "cervical chondrosis"? What is the correct diagnosis?
– In fact, "cervical chondrosis" is colloquial; 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; It is called a "degenerative-dystrophic disease". When diagnosing it, we state "osteochondrosis of the cervical spine" and then decipher which movement segments of the spine are affected.
Most often, this disease is associated with pain in the cervical spine. Is this the main and/or only symptom?
– The most common reason for such patients to see a neurologist is pain. We can say that the main clinical manifestation of degenerative pathology - in this case osteochondrosis of the cervical spine - is pain. In addition, weakness of the upper extremities (possibly lower extremities) and impaired sensitivity - numbness - are even more dangerous manifestations of common degenerative diseases.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are atypical symptoms of cervical osteochondrosis, but sometimes it occurs. If such a patient comes, this is, first of all, a reason to prescribe an MRI of the brain to rule out organic changes. If the patient has done this, he is not amenable to conservative treatment and there is a substrate in the form of disc protrusions, which is extremely rare but can cause these phenomena reflexively, there is a possibility of helping this patient, but the effectivenesswill be significantly lower than with the classic treatment of pain in the cervical spine.
What are the causes of pain and what options are there today to treat such patients?
– Three patient groups can be distinguished. The first group is reflex pain syndromes, the second group is radicular syndromes, myelopathy – lesions of the spinal cord itself, as in severe stenosis, and the third group is extremely rare patients, but the most complex ones who suffer the most are patients with neuropathy.
Reflex pain syndrome can spread locally in the neck area and radiate to the shoulder girdle and upper limbs. However, the peculiarity of this pain syndrome is that the nerve tissue - namely the spinal cord and its roots - is without compression (without compression).
Accordingly, if we think about the possibility of surgical treatment in this case, we are talking about outpatient methods - for example, blockades. More invasive procedures include radiofrequency denervation and cold plasma coblation of intervertebral discs - a hardware puncture procedure that is 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 lead to 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. H. If the hernia is removed, the root of the spinal cord will be freed and the pain syndrome will decrease.
Large hernias also lead to conduction disorders: In addition to the compression of the spinal cord root, the spinal cord itself can also be compressed. This then leads to more serious clinical manifestations in the form of quadriparesis, i. e. weakness of both the upper and lower extremities. In this case, decompression is necessary to create reserve spaces for the spinal cord to recover a second time. It is important to understand that the operation does not restore the spinal cord and nerves, but creates conditions, i. e. H. Reserve rooms.
In addition to hernias, there are also circular stenoses. They arise from complex problems in the cervical spine area, which lead to a circular narrowing of the canal.
These are seriously ill patients who sometimes remain ill for years and are unfortunately usually admitted with severe neurological deficits and often require a two-stage operation.
And another group of patients are people with neuropathic pain syndrome. In this case, patients without stenosis have neuropathy (the nerve itself hurts). Neuromodulation (neurostimulation) is then used to help. Special epidural electrodes are attached to the posterior structures of the spinal cord. This is a special device - you could say like physiotherapy - that you always have with you: you can turn it on and increase the power to relieve pain. And that helps even in very difficult cases.
All of these technologies are available to patients; There are different sources of financing, including compulsory health insurance and quotas for high-tech medical care.
Can osteochondrosis be cured?
– The disease itself, osteochondrosis, cannot be cured. What can be done? Let's say a conditional patient: osteochondrosis of the cervical spine, with a predominant lesion at the level of the C6 – C7 vertebra, degenerative stenosis at this level and with compression of the roots of the C7 spinal cord on the right side.
During surgery, it is possible to remove a 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) remain for life because it is incurable. Surgeons influence the substrate of this clinic, and the substrate of the clinic is, for example, a hernia that has led to a stenosis.
How is the treatment tactics determined?
– There is such a concept – clinical-morphological correspondence. The doctor must look at the patient from all sides - conduct an orthopedic examination, a neurological examination, collect anamnesis, complaints - and correlate these data with studies.
Screening studies for osteochondrosis of the cervical spine are MRI studies, 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 strong the compression etc. is and decide on the advisability of the operation.
At what age do such 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 substrate in the form of an inguinal hernia. 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 the formation of these formations.
The main risk factor is genetic. This applies not only to the neck, but also to the thoracic and lumbar regions - this is the weakness of the tissue of the fibrous ring. And other risk factors - in the form of excess weight, extreme work - are more likely to be reflected in the lumbar region.
Can I prevent this somehow?
– Prevention is primarily exercise therapy so that the muscles are toned, the muscles function properly and there are no cramps. The fact is that when a degenerative process develops, which can develop both in the intervertebral discs and in the joints of the spine, this leads to muscle spasms and the person feels pain. Therefore, massage, acupuncture, etc. are good for reflex pain syndrome.
What determines the effectiveness of treatment?
– It is important to consult a neurologist in a timely manner if there is a problem: pain in the cervical spine spreading to the upper limbs, numbness and weakness in the arms, reduced strength. Very serious pathologies are circular stenoses, which are also accompanied by weakness in the lower extremities if the spinal cord is already affected.
It happens that people endure for years and think that it is just "age-related". But every year they get worse and the disease leads to them having limited mobility - they can only walk a few meters.
The specialist will assess the degree of danger and, if necessary, refer other examination methods and, if necessary, a vertebrologist who deals with the surgical treatment of spinal pathologies. The purpose of the consultation is to determine the need for surgical intervention. If surgery is not required, the neurologist already carries out conservative treatment. If surgical treatment is required, an operation is performed, after which the patient is sent to a neurologist for rehabilitation.
The goal of conservative treatment is to achieve very long periods of remission and to minimize the frequency of exacerbations in both duration and frequency. This also applies to puncture treatment methods. However, if there are already gross changes in the form of a hernia and compression of the spinal cord roots, conservative treatment may not work.
At the same time, the operation must be carried out on time. The aim of the operation is to preserve the nerve tissue, be it the spinal cord or its roots. If a person is sick for years, this leads to myelopathy - a change in the spinal cord itself, which then may not recover even with an excellent operation, or radiculopathy - damage to the spinal cord root.
If the operation is carried out on time according to the standards, there is a high probability that both the root of the spinal cord and the spinal cord itself will be restored, and the person will feel practically healthy after rehabilitation.
With advanced pathology, the effectiveness of surgical interventions decreases. If neurological disorders persist, the operation may not lead to noticeable progress because the spinal cord itself or the root 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 by complex conservative treatment methods without surgery.