Osteochondrosis is the most common pathology of the spine, in which all its parts are affected.The cervical spine is second in frequency of lesions after the lumbar spine.Treatment of osteochondrosis of the cervical spine in most cases is carried out using conservative methods and depends on the stage of the disease and the severity of the destructive processes in the intervertebral discs.Surgical treatment is indicated in 5-7% of patients with persistent disease, lack of effect of conservative therapy for 3-4 months, as well as with the development of serious neurological complications.
Clinical manifestations of the disease
Osteochondrosis of the cervical vertebrae has a wide variety of manifestations.Symptoms depend on the predominance of one or several syndromes that develop as a result of the impact of pathologically changed structures of the spine on the spinal cord, its roots or spinal arteries.The clinical picture of the disease is determined by the following syndromes:
- Vertebral - manifested by pain of varying intensity and duration, localized in the neck area or in the occipital area 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 - manifests itself with pain in different localizations (upper limbs, thoracic and abdominal organs), requires a differential diagnosis with many diseases of the 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 (headache, 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, the treatment of cervical osteochondrosis should be prescribed only by a doctor after a mandatory examination of the patient and the necessary laboratory and instrumental tests to exclude concomitant pathology.
After confirmation of the diagnosis, outpatient treatment is prescribed in most cases.Patients with severe neurological diseases, high probability of complications and severe concomitant pathology require inpatient treatment.Conservative treatment of osteochondrosis includes the use of the following methods.
Drug therapy
The use of drugs is necessary during an exacerbation of the disease to combat pain.For this purpose they prescribe:
- Non-narcotic analgesics.Nonsteroidal anti-inflammatory drugs are taken orally or parenterally, and local preparations - ointments, gels, balms, rubs - must be used.Complex anti-inflammatory therapy helps reduce soft tissue swelling, the main cause of pain in vertebral syndrome.The duration of use of drugs from this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral blocks of anesthetics with hormonal agents are used in the amount of 1-3 manipulations.
- Antispasmodics, vitamins of group B. In the acute period, in the presence of severe edema, the prescription of diuretics in a short course for 2-4 days is indicated.They reduce vascular spasm and improve microcirculation in the focus of inflammation.
- Sedatives (tincture of peony, valerian root, herbal teas and infusions) to prevent the development of neurotization if the patient has prolonged excruciating pain.
- External warming agents - balms, ointments, rubs, which have a slightly irritating effect and contain biologically active substances of plant and animal origin.Drugs with a strong irritating 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 elimination of exacerbation to consolidate the effect of drug therapy and periodically during remission for prophylactic purposes.The course of therapeutic massage is 10-14 sessions and is prescribed 2-4 times a year in the absence of severe pain.
Massage improves blood supply, lymph flow and relaxes spasmodic neck and collar muscles.Thanks to this, the nutrition of the cartilage tissue of the intervertebral discs is improved, preventing the progression of the process and reducing the risk of subsequent relapses.
Physical therapy
Physiotherapy exercises for cervical osteochondrosis should be performed daily, except for exacerbation of the disease accompanied by severe pain.In case of severe pain, it is necessary to observe a sparing regimen, which includes maximum limitation of movements in the cervical spine.
Systematic exercise therapy helps to strengthen the neck muscles, which helps to reduce the static load on the intervertebral discs.Exercises are performed smoothly;at the beginning, sharp movements with a large amplitude are 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:
- turning the head to the side;
- tilting the head back and forth;
- raising the shoulders, with relaxed or fixed arms, holding in this position for 15-20 seconds;
- static loads, with a stationary head, alternating tension occurs in the flexors and extensors of the neck.
The 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 the greatest care, and if pain occurs, it must 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 1-3 mm.This has been found to be 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, resulting in partial retraction of the herniated protrusion and enlargement of the intervertebral opening.
Traction has a beneficial effect on the intervertebral joints, eliminates subluxations that have formed in them, and helps reduce muscle contractures.Immediately after pulling, it is imperative to fix the cervical spine using special devices for several hours.The course of treatment includes from 10 to 20 procedures.
Physiotherapy treatment
The use of medicinal electrophoresis has a good effect.The technique allows the delivery of drugs to the tissues involved in the pathological process.In cervical osteochondrosis, electrophoresis is used with non-steroidal anti-inflammatory drugs, hormonal anesthetics and other drugs.
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 applying complex treatment with conservative methods, the initial manifestation of osteochondrosis can be cured, provided you maintain an active lifestyle, proper and complete nutrition and give up bad habits.
With a far-advanced destructive process, the right 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 resorted to.
Surgical treatment
Before surgical treatment of cervical osteochondrosis, all available preservation methods should be tried.Surgical treatment is usually indicated when therapy 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 commonly used.The manipulation is performed using microsurgical instruments and a 10x microscope, which allows you to clearly see the compressed areas of the spinal cord.Excision of part of the hernial protrusion pressing on the root or spinal cord is performed.Sometimes it is necessary to remove a small fragment of a vertebra or cut a ligament.