Cervical osteochondrosis

pain in the neck

Arthrotic lesions of the cervical spine are second only to lumbar disease. The variety of clinical manifestations of cervical osteochondrosis is determined by the anatomical and physiological features of the cervical spine and the complexity of many pathogenetic mechanisms. Usually, in the course of the disease, the same patient has several syndromes that occur simultaneously or sequentially. The severity of the clinical manifestations of osteochondrosis of the cervical spine depends on the severity and nature of structural and functional changes in the disc and surrounding tissues.

Arthrotic process in osteochondrosis develops gradually and progresses with age. In the elderly and old people, in contrast to young and middle age, cervical osteochondrosis is often combined with spondylosis, uncovertebral arthrosis, arthrosis of the facet joints and interspinous arthrosis. The greatest severity and frequency of clinical manifestations is observed in persons of the most working age - 30-50 years. Usually the clinical picture develops slowly, gradually, without a clearly expressed beginning. Most often it is characterized by soreness localized in the lower part of the neck. However, pain can come on suddenly in the form of acute cervicobrachialgia or torticollis.

Clinical manifestations and symptoms of cervical osteochondrosis

With cervical osteochondrosis, the clinical manifestations of the disease are more frequent with reflex, then radicular and root-vascular syndromes. In addition, compression-spinal (discogenic cervical myopathy) and cerebral syndromes associated with circulatory disorders in the vertebral-basilar arteries are often observed.

Reflex syndromes are manifested by muscle-tonic, autonomic-vascular and neurodystrophic disorders. With cervicalgia (lumbago), acute pain is localized in the cervical spine, increases with movement. Chronic cervicalgia is characterized by pain, discomfort, "crunch" when moving the head. Often, in this case, the patient assumes a forced position of the head due to pain syndrome; on examination, flattening or intensification of cervical lordosis, limitation of mobility and curvature of the neck in the lateral direction, muscle tension and soreness, palpation - tenderness of the spinous processes and intervertebral discs. p>

In cervicocranialgia, pain is pressing, compressing, sometimes radiating to the temples and eyeballs, sometimes a temporary decrease in visual acuity, occasionally a feeling of "spots" before the eyes, photophobia. In the genesis of these complaints, irritation of the cervical sympathetic ganglia plays a role.

When the nerve plexus of the vertebral artery is irritated, a vertebral artery syndrome occurs, which is often erroneously diagnosed in the clinic as "a violation of cerebral circulation in the vertebral-basilar basin". In addition to the complaints described above, the leading manifestation of vertebral artery syndrome is dizziness. Dizziness syndrome can occur suddenly with a sharp turn of the head, is, as a rule, systemic, accompanied by nausea, vomiting. To objectify the vertebral artery syndrome, the presence of pain when pressing at the point of the vertebral artery is checked, an orthopedic test Bartschi-Rochaix (manual traction behind the head) is performed. Vestibular disorders with an interest in the vertebral artery are confirmed by the presence of nystagmus, de Klein's breakdown (the appearance of nystagmus when tilting the head back with a sharp turn to the side). Irritation (irritation) of the nerve sympathetic plexus of the vertebral artery or its compression are usually caused by osteochondral growths of the lunate processes of the cervical vertebrae, hypermobility of the motor segment.

In cervicobrachialgia, pain in the cervical spine radiates to the shoulder girdle, arm and is usually accompanied by muscular-tonic (anterior scalene muscle syndrome) or vegetative-vascular or dystrophic manifestations (humeral periarthrosis, shoulder-hand syndrome, epicondylitis, styloiditis). . . When vegetative formations are involved in the process, the pain becomes burning in nature, accompanied by paresthesias, a feeling of "heat" or increased chilliness of the hands.

Humeroscapular periarthrosis is characterized by limitation and soreness during shoulder abduction and rotation. In epicondylitis and styloiditis, pain on pressure in the area of ​​the condyle of the shoulder or styloid process without marked restriction of movement in the arm.

Scalenus anterior syndrome is characterized by aching pain in the area of ​​this muscle, especially when turning and tilting the head in the opposite direction. The anterior scalene muscle on palpation is compacted, enlarged, painful. The pain occurs not only in the neck, but also in the arm on the affected side, in the girdle of the upper limbs, axillary region, and in the chest. A sure proof of the syndrome is the disappearance of pain and other manifestations under the influence of novocainization.

Cardialgic is one of the reflex visceral syndromes of cervical osteochondrosis. In this syndrome, symptoms resembling angina pectoris are leading in the clinic. It is not isolated and, as a rule, proceeds against the background of other manifestations of cervical osteochondrosis. In the differential diagnosis of cardiological syndrome in cervical osteochondrosis, the combination of pain in the region of the heart with pain in the cervical and cervical-shoulder regions, the dependence of pain on the position of the head, the ineffectiveness of coronarolytics, the absence of changes in the ECG with multiple studies is important.

Radicular syndrome (discogenic cervical radiculitis) occurs most often when the spinal root is compressed by a herniated intervertebral disc, osteophyte, or a thickened yellow ligament. The disease usually develops acutely after physical exertion and cooling. Along with pain, muscular-tonic and vegetative-vascular manifestations, changes in sensitivity, reflex (decrease or extinction of reflexes) and motor (paresis, paralysis) spheres are characteristic. C4-C8 roots are most often affected in the cervical spine. With the defeat of C4-C5 roots, proximal is characteristic, and for C5-C8 - distal paresis of the hand.

Radicular vascular syndrome (radiculopathy)should be diagnosed when, against the background of the disappearance of pain syndrome, acute movement and sensory disorders of the radicular type occur. When the process is localized in the roots of C5-C6, weakness of the muscles of the shoulder girdle (Parsonage Turner syndrome) occurs. With the defeat of the roots C7-C8, weakness and numbness develop in the fingers.

Spinal syndromes caused by cervical osteochondrosis can develop when the spinal cord and its vessels are compressed by disc herniation, posterior osteophyte, hypertrophied yellow ligament. Clinically, they are manifested by pain in the cervicobrachial region, flaccid paresis of the arms and spastic paresis of the legs, and sensory disorder. The lesion of the spinal cord has a relatively small proportion among other complications of osteochondrosis. However, in terms of its clinical significance, discogenic cervical myelopathy is one of the important branches of the study of degenerative lesions of the spine.

Chronic spinal circulation disorder (myelopathy)is more common in older people with severe atherosclerosis and cervical osteochondrosis. It is characterized by a slow increase in flaccid paresis of the hands, and movement disorders usually prevail over sensitive ones.

Clinical manifestations of cervical osteochondrosis in people of different ages are very diverse both in terms of the combination of syndromes and symptoms, and in severity. With age, the sensitivity of nerve conductors to mechanical stimuli decreases significantly, which leads to a decrease in the severity of reflex muscle-tonic neurodystrophic reactions. On the other hand, as a person ages, as dystrophic-destructive changes in the spinal column develop, protective, compensatory reactions of the body come into play, limiting the degree of instability and fixing it, which naturally leads to a decrease in its clinical manifestations.

Treatment of cervical osteochondrosis

Effective treatment of cervical osteochondrosis is possible if the main principle of its therapy is long-term, staged, systematic and differentiated use of therapeutic methods. Moreover, treatment methods should be chosen taking into account the modern theory of the mechanism of the development of the pathological process. That is why, when prescribing the treatment of cervical osteochondrosis, we take into account the chronic and progressive nature of the course of this disease. The variety of clinical manifestations of cervical osteochondrosis dictates the need for the use of various therapeutic factors that affect various links in the pathogenetic chain. A good therapeutic effect in the treatment of patients with such a pathology is observed when combined acupuncture with pharmacopuncture, vacuum therapy, physiotherapy, manual therapy, moxa therapy, etc. It should also be noted that preference is given to gentle and gentle methods of manual therapy.

The average duration of treatment for cervical osteochondrosis in our clinic is 10-15 sessions. After completing the course of treatment, the patient receives recommendations for conducting exercise therapy and further prevention of recurrence of the disease.