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, which people far from medicine often call "chondrosis". It is believed that almost "everyone" has this disease by a certain age, which means you just have to "be patient. "
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 jargon; 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; they call it "degenerative-dystrophic disease". When making the diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which segments of spinal movement are affected.
Most often, people associate this disease with pain in the cervical spine. Is this the main and/or only symptom?
– The most common reason these patients turn to a neurologist is pain. We can say that the main clinical manifestation of degenerative pathology - osteochondrosis of the cervical spine, in this case, is pain. Moreover, even more dangerous manifestations of common degenerative pathologies are weakness of the upper limbs (perhaps in the lower limbs) and reduced sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are unusual complaints for cervical osteochondrosis, but sometimes it happens. If such a patient comes, then, first of all, this is a reason to prescribe an MRI of the brain to exclude 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 protrusions, which is extremely rare, but can cause these phenomena reflexly, then there is an option to help this patient, but the effectiveness will be significantly lower than the classic treatment of cervical spine pain.
What are the causes of pain and what options are available today for treating such 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 consists of extremely rare, but the most complex patients, those suffering from the more patients with neuropathy.
Reflex pain syndrome can spread locally to the cervical region and can radiate to the shoulder girdle and upper extremities. But the peculiarity of this painful syndrome is that the nervous tissue - namely the spinal cord and its roots - is without compression (without compression).
Accordingly, in this case, if we consider the option of surgical treatment, we are talking about outpatient methods, for example, blocks. More invasive procedures include radiofrequency denervation and coblation of the intervertebral discs with cold plasma, a hardware puncture procedure 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 ineffective, surgery is resorted to. The purpose of the operation is to perform decompression, i. e. removing the hernia, respectively, the root of the spinal cord will be free and the pain syndrome will regress.
In large hernias, conduction disorders also occur: in addition to compression of the root of the spinal cord, the spinal cord itself can be compressed (compressed). Subsequently the person experiences more serious clinical manifestations in the form of tetraparesis, i. e. weakness of both the upper and lower limbs. In this case it is necessary to carry out a decompression, to create reserve spaces for the spinal cord so that it can recover a second time. It is important to understand that the surgery does not restore the spinal cord and nerves, but creates conditions, that is, reserve spaces.
In addition to hernias, there are circular strictures. They develop due to complex problems arising in the cervical spine, which lead to a circular narrowing of the canal.
These are serious patients who sometimes remain ill for years and, unfortunately, are often hospitalized 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). Then help is provided using neuromodulation (neurostimulation). It involves the installation of special epidural electrodes on the posterior structures of the spinal cord. It 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 reduce pain. And this helps well even in very difficult cases.
All these technologies are available to patients; There are several sources of financing, including compulsory medical insurance and fees 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.
During surgery it is possible to remove a stenosis, remove a hernia, or decompress the root of the spinal cord 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, for example, a hernia that led to stenosis.
How are 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, 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 compression causes, etc. , and decide on the appropriateness of the operation.
At what age do such problems most often occur?
– The average age of our patients is over forty years old, but it happens that even young people require surgery if their degenerative cascade started 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 achieved, the only option is surgery.
What are the risk factors?
– We don't live in India and our countrymen don't wear anything on their heads. Therefore it is not necessary to say that work or habits lead to premature wear and tear of these formations.
The main risk factor is genetic. This applies not only to the cervical region, but also to the thoracic and lumbar region - this is the weakness of the tissues of the fibrous ring. And other risk factors - in the form of excess body weight, extreme work - are most reflected in the lumbar region.
Is it possible to somehow prevent it?
– Prevention is, first of all, physical therapy, so that there is tone in the muscles, the muscles work properly and there are no spasms. The fact is that when a degenerative process develops, which can develop both in the discs and in the joints of the spine, this leads to muscle spasm and the person feels pain. Therefore, massage, acupuncture, etc. they are useful for reflex pain syndrome.
What determines the effectiveness of the treatment?
– It is important to promptly consult a neurologist if there is a 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 of the lower limbs is also added, when the spinal cord is already affected.
It happens that people hold on for years and think it's just "age related". But every year they get worse, and as a result, the disease leads to the fact that they have restrictions in movement: they can walk only a few meters.
The specialist will assess the degree of danger and, if necessary, will send further research methods and, if indicated, to a vertebrologist who deals with surgical treatment of spinal pathology. The purpose of the consultation is to determine the need for surgery. If surgical intervention is not necessary, the neurologist is already engaged in conservative treatment. If surgical treatment is necessary, an operation is performed, after which the patient is sent for rehabilitation to a neurologist.
The goal of conservative treatment is to achieve very long periods of remission and minimize the frequency of flare-ups, both in terms of duration and frequency. This also applies to sting treatment methods. But if there are already noticeable changes in the form of hernia and compression of the roots of the spinal cord, conservative treatment may not work.
At the same time, the operation must be timely. The purpose of the operation is to save the nervous 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, even with an excellent operation, may not recover, or to radiculopathy - damage to the root of the spinal cord.
If the operation is performed on time, according to standards, then 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 lead to noticeable progress, because at the time of the operation the spinal cord itself or the root was already dead.
Each 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.