Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.In terms of frequency of injuries, the cervical spine comes in second place, just behind the lumbar spine.Treatment of osteochondrosis of the cervical spine is carried out in most cases using conservative methods and depends on the stage of the disease and the severity of the destructive processes of the intervertebral discs.Surgical treatment is indicated for 5-7% of patients with persistent disease, lack of effect of conservative treatment for 3-4 months, as well as the development of serious neurological complications.
Clinical manifestations of the disease
Osteochondrosis of the cervical spine has a wide variety of manifestations.Symptoms depend on the predominance of one or more syndromes that develop as a result of the impact of pathologically altered structures of the spine on the spinal cord, its roots or vertebral arteries.The clinical picture of the disease is determined by the following syndromes:
- Vertebral - manifests itself as pain of varying intensity and duration, localized in the neck or in the occipital region of the head.
- Spinal - the appearance of innervation disorders, manifested by motor and sensory disorders, as well as trophic changes in the muscles of the upper limbs.
- Radicular - manifested by pain in various localizations (upper extremities, thoracic and abdominal organs), requires differential diagnosis with many diseases of internal organs and the cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders resulting from insufficient blood supply to brain structures (headaches, hearing impairment, tinnitus, dizziness, short-term loss of consciousness).
How to treat cervical osteochondrosis?
The reason for seeking medical help is the first appearance of complaints or the next exacerbation of the disease.In any case, treatment of cervical osteochondrosis should be prescribed only by a doctor after a mandatory examination of the patient and the necessary laboratory and instrumental studies to exclude concomitant pathology.
After confirmation of the diagnosis, outpatient treatment is in most cases prescribed.Patients with severe neurological disorders, high risk of complications and serious concomitant pathology require inpatient treatment.Conservative treatment of osteochondrosis involves the use of the following methods.
Drug therapy
The use of medications is necessary during an exacerbation of the disease to combat pain.To this end, they prescribe:
- Non-narcotic analgesics.Nonsteroidal anti-inflammatory drugs are taken orally or parenterally, with the obligatory use of local preparations - ointments, gels, balms, frictions.Complex anti-inflammatory therapy helps reduce soft tissue swelling, the main cause of pain in spinal syndrome.The duration of use of drugs of this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral blockades of anesthetics with hormonal agents are used in the amount of 1-3 manipulations.
- Antispasmodics, B vitamins. In the acute period, in the presence of severe edema, the prescription of diuretics in a short course for 2 to 4 days is indicated.They reduce vascular spasms and improve microcirculation in the inflammatory focus.
- Sedatives (peony tincture, valerian root, herbal teas and infusions) to prevent the development of neuroticization if the patient experiences prolonged excruciating pain.
- External warming agents - balms, ointments, frictions that have a mild irritating effect and contain biologically active substances of plant and animal origin.Medicines with a strong irritant effect cannot be used, as they increase swelling, which can lead to a worsening of the condition.
Therapeutic massage
Massage is an integral part of the complex treatment of osteochondrosis.It is used after the elimination of the exacerbation to consolidate the effect of drug treatment and periodically during remission for prophylactic purposes.The duration of therapeutic massage includes 10-14 sessions and is prescribed 2-4 times a year in the absence of severe pain.
Massage improves blood supply, lymphatic flow and relaxes spasmodic muscles in the neck and collar area.As a result, the nutrition of the cartilaginous tissue of the intervertebral discs is improved, preventing the progression of the process and reducing the risk of subsequent relapses.
Therapeutic exercise
Physiotherapy exercises for cervical osteochondrosis should be carried out daily, unless there is an exacerbation of the disease, accompanied by severe pain.In case of severe pain, it is necessary to follow a gentle diet, which involves maximum limitation of movements of the cervical spine.
Systematic exercise therapy helps to strengthen the neck muscles, which helps to reduce the static load on the intervertebral discs.The exercises go smoothly;sudden movements of large amplitude are initially prohibited.Exercises should be started carefully, gradually increasing the load, avoiding the appearance of unpleasant sensations.
Exercises are performed in a standing or sitting position.The most common exercises consist of:
- turn your head to the sides;
- tilt your head forward and back;
- raise the shoulders, with the arms relaxed or fixed, holding them in this position for 15 to 20 seconds;
- static loads, with a stationary head, alternating tensions occur in the neck flexors and extensors.
Exercises should be repeated 5-7 times, the duration of the lesson is 15-20 minutes.
Traction
To avoid possible complications, traction should be performed in a hospital setting under the supervision of a doctor.The procedure is carried out with great caution and if pain appears, it should be stopped immediately, as it can provoke an exacerbation of the disease.
During traction, the elastic tissues of the spinal ligaments are stretched, resulting in an increase in the distance between adjacent vertebrae.It increases by 1 to 3 mm.This proves sufficient to reduce, and in some cases completely eliminate, compression when a root or artery is compressed by a herniated disc or osteophyte.During the procedure, the pressure inside the intervertebral disc decreases, which causes partial retraction of the hernial protrusion and an increase in the intervertebral foramen.
Traction has a beneficial effect on the intervertebral joints, eliminating subluxations formed there and helping to reduce muscle contractures.Immediately after traction, it is imperative to fix the cervical spine using special devices for several hours.The treatment course includes from 10 to 20 procedures.
Physiotherapeutic treatment
The use of medicinal electrophoresis has a good effect.The technique allows the delivery of drugs to tissues involved in the disease process.For cervical osteochondrosis, electrophoresis with nonsteroidal anti-inflammatory drugs, hormonal anesthetics and other drugs is used.
The use of diadynamic currents helps to improve blood circulation and has a good analgesic and anti-inflammatory effect, helping to reduce the excitability of nervous tissue.When using complex treatment with conservative methods, the initial appearance of osteochondrosis can be cured, provided that you maintain an active lifestyle, proper and nutritious diet and abandon bad habits.
With a very advanced destructive process, proper treatment and lifestyle will allow you to achieve long-term remission.In some patients, it is impossible to achieve improvement with conservative treatment;in such cases, neurosurgical methods are used.
Surgical treatment
Before surgically treating cervical osteochondrosis, all available canning methods should be tried.Typically, surgical treatment is indicated when treatment has failed for three months or more.As well as the development of spinal cord compression in the patient, which is accompanied by severe neurological symptoms that can lead to disability.
Currently, microdiscectomy and endoscopic operations are most often used.The manipulation is carried out using microsurgical instruments and a 10x microscope, which allow the compressed areas of the spinal cord to be clearly visualized.Excision of part of the hernial protrusion pressing on the root or spinal cord is carried out.Sometimes it is necessary to remove a small fragment of a vertebra or excise a ligament.