The expert talked about modern approaches to the treatment of patients with osteochondrosis of the cervical spine.
Pain in the cervical spine is a fairly common phenomenon that people far from medicine often call "chondrosis. "It is believed that almost "everyone" suffers from this disease at a certain age, which means that you just have to "be patient. "
Alexey Peleganchuk, head of the department of neuroorthopedics, orthopedic traumatologist, neurosurgeon, Ph. D. , talked about the technologies that doctors have at their disposal today to help these patients.
What disease do patients usually call "cervical chondrosis"? What is the correct diagnosis?
– In fact, "cervical chondrosis" is slang; 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 there is no such disease; They call it "degenerative-dystrophic disease. "When making a diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which segments of the spine are affected.
Very often, people associate this disease with pain in the cervical spine. Is this the main and/or only symptom?
– The most common reason why these patients visit the neurologist is pain. We can say that the main clinical manifestation of the degenerative pathology, osteochondrosis of the cervical spine, in this case is pain. In addition, even more dangerous manifestations of common degenerative pathologies are weakness of the upper extremities (perhaps in the lower ones) and impaired sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are untypical complaints of cervical osteochondrosis, but sometimes it happens. If such a patient arrives, then, first of all, this is a reason to prescribe an MRI of the brain to rule out any organic changes. If the patient has done this, is not amenable to conservative treatment and there is a substrate in the form of disc bulges, which is extremely rare, but can cause these phenomena reflexively, then there is an option to help this patient, but the The effectiveness will be significantly less than the classic treatment of pain in the cervical spine.
What are the causes of pain and what options exist today to treat these patients?
– Three groups of patients 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, but the most complex patients, those who Patients with neuropathy suffer the most.
Reflex pain syndrome can spread locally in the cervical region and can radiate to the shoulder girdle and upper extremities. But the peculiarity of this pain syndrome is that the nervous tissue, that is, the spinal cord and its roots, is not compressed (no compression).
Consequently, in this case, if we are considering the option of surgical treatment, then we are talking about outpatient methods, for example, blockages. More invasive procedures include radiofrequency denervation and cold plasma coblation of intervertebral discs, a hardware puncture procedure that is performed without incisions.
The goal 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 not effective, surgery is resorted to. The objective of the operation is to perform decompression, i. e. Remove the hernia, respectively, the root of the spinal cord will be free and the pain syndrome will return.
With large hernias, there are also conduction disturbances: in addition to compression of the spinal cord root, the spinal cord itself can be compressed (compressed). The person then experiences more serious clinical manifestations in the form of tetraparesis, that is, weakness in both the upper and lower extremities. In this case, it is necessary to perform decompression, 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 nerves, but rather creates the conditions, that is, reservation of spaces.
In addition to hernias, there are circular stenoses. They develop due to complex problems that arise in the cervical spine, which leads to a circular narrowing of the canal.
These are serious patients who sometimes remain ill for years and, unfortunately, most of the time they are 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, have neuropathy (the nerve itself hurts). Help is then provided through neuromodulation (neurostimulation). It involves installing special epidural electrodes in the posterior structures of the spinal cord. This is a special device, you could say, like physiotherapy, that you always carry with you: you can turn it on and increase its 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 health insurance and fees 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 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.
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 has caused stenosis.
How are treatment tactics determined?
– There is such a concept: clinical-morphological correspondence. The doctor must observe the patient from all sides (conduct an orthopedic examination, neurological examination, collect anamnesis, complaints) and correlate these 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 all hernias described on an MRI require surgery. The hernia itself is not a reason for surgery. The specialist must determine how much it produces compression, etc. , and decide on the convenience of the operation.
At what age do these problems occur most frequently?
– The average age of our patients exceeds forty years, but it happens that young people also require surgical intervention if their degenerative cascade began early, which led to the formation of a substrate in the form of a hernia. In this case, the first step is conservative treatment and, if no effect is produced, the only option is surgery.
Which are the risk factors?
– We do not live in India and our compatriots have nothing on their heads. Therefore, it goes without saying that work or habits cause premature wear and formation of these formations.
The main risk factor is genetic. This applies not only to the cervical, but also thoracic and lumbar regions; This is the weakness of the annulus fibrosus tissues. And other risk factors, in the form of excess body weight and extreme work, are more reflected in the lumbar region.
Is it possible to prevent it in any way?
– Prevention is, above all, exercise therapy, so that there is tone in the muscles, the muscles function correctly and there are no spasms. The fact is that when a degenerative process develops, and it can develop both in the discs and in the joints of the spine, this causes muscle spasms and the person experiences pain. Therefore, massages, acupuncture, etc. They 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 is any problem: pain in the cervical spine that extends to the upper limbs, numbness and weakness in the arms, decreased strength. Very serious pathologies are circular stenosis, when weakness in the lower extremities is also added, when the spinal cord is already affected.
It happens that people put up with it for years and think that it is simply "age-related. "But every year they get worse and, as a result, the disease leads 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 dealing with surgical treatment of spinal pathology. The objective of the consultation is to determine the need for surgical intervention. If there is no need for surgery, then the neurologist is already carrying out conservative treatment. If surgical treatment is required, an operation is performed, after which the patient is sent for rehabilitation to a neurologist.
The objective 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 significant changes in the form of herniation and compression of the roots of the spinal cord, conservative treatment may not work.
At the same time, the operation must be timely. The goal of the operation is to save the nervous tissue, whether it is the spinal cord or its roots. If a person is sick for years, this leads to myelopathy - a change in the spinal cord, which then, even with an excellent operation, may not recover, or radiculopathy - damage to the root of the spinal cord.
If the operation is performed on time, in accordance with the 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 case of persistent neurological disorders, the operation may not produce noticeable progress, because the spinal cord or 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 without surgery, using complex conservative treatment methods.