The expert spoke 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" gets this condition at some age, which means you just need to "be patient. "
Alexey Peleganchuk, head of the department of neuroorthopedics, orthopedic traumatologist, neurosurgeon, Ph. D. , spoke about the technologies available to doctors 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 rightly 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; it is called "degenerative-dystrophic disease". When diagnosing, we indicate "osteochondrosis of the cervical spine", then we decipher which segments of movement of the spine are affected.
Most often, people associate this disease with pain in the cervical spine. Is this the main and/or only symptom?
– Pain is the most common reason these patients see a neurologist. It can be said that the main clinical manifestation of degenerative pathology - osteochondrosis of the cervical spine, in this case, is pain. In addition, even more dangerous manifestations of common degenerative pathologies are weakness in the upper extremities (possibly in the lower extremities) and impaired sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are unusual complaints for cervical osteochondrosis, but it happens sometimes. If such a patient arises, this is, first of all, a reason to prescribe an MRI of the brain in order to exclude any organic changes. If the patient has done this, he is not amenable to conservative treatment and there is a substrate in the form of disc protrusions, which is extremely rare, but can reflexively provoke these phenomena, then there is an optionto help this patient, but the effectiveness will be significantly lower than that of conventional treatment of pain in the cervical spine.
What are the causes of pain and what options are available 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 - damage to the spinal cord itself, as in severe stenoses, and the third is extremely rare patients, but the most complex, those who suffer the most are patients with neuropathy.
Reflex pain syndrome can spread locally in the cervical region and radiate to the shoulder girdle and upper extremities. But the particularity of this pain 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, then these are outpatient methods - for example, blockades. More invasive procedures include radiofrequency denervation and cold plasma coblation of intervertebral discs – 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 painkillers.
The second group of patients consists of patients suffering from hernias. Hernias of the cervical spine can cause compression of the roots, and if conservative treatment methods are ineffective, surgical intervention is used. The purpose of the operation is to carry out decompression, i. e. remove the hernia, respectively, the root of the spinal cord will be free and the pain syndrome will regress.
With large hernias, there are also conduction disturbances: in addition to compression of the spinal cord root, the spinal cord itself can be compressed (squeezed). Then the person has more serious clinical manifestations in the form of tetraparesis, that is, weakness of the upper and lower limbs. In this case, it is necessary to carry out 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 nerve, but creates conditions, that is, reserve spaces.
In addition to hernias, there are circular stenoses. They develop due to complex problems that occur in the cervical spine, which leads to circular narrowing of the canal.
These are severe patients who sometimes remain ill for years and who, unfortunately, are most often admitted with severe neurological deficits and often require two-stage surgery.
And another group of patients are people suffering from neuropathic pain syndrome. In this case, patients, in the absence of stenosis, suffer from neuropathy (the nerve itself hurts). Help is then provided thanks to neuromodulation (neurostimulation). This involves installing special epidural electrodes on the posterior structures of the spinal cord. This is a special device - one could say, like physiotherapy, which you always have with you: you can turn it on and increase the power in order to reduce pain. And it helps even in very difficult cases.
All of these technologies are accessible to patients; there are different sources of financing, including compulsory health insurance and quotas 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 C7 medullary roots on the right.
During surgery, it is possible to eliminate 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 they are 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 – clinico-morphological correspondence. The doctor must examine the patient from all angles - 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 by an MRI require surgery. The hernia itself does not warrant surgery. The specialist must determine to what extent this causes compression, etc. , and decide on the appropriateness of the operation.
At what age do these problems most often occur?
– The average age of our patients is over forty, 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 there is no effect, the only option is surgery.
What are the risk factors?
– We do not live in India, and our compatriots do not wear anything on their heads. Therefore, it is not necessary to say that work or habits lead to premature wear and the formation of these formations.
The main risk factor is genetic. This applies not only to the cervical regions, but also to the thoracic and lumbar regions - this is the weakness of the annulus fibrosus tissues. And other risk factors - in the form of excess weight, extreme work - are more reflected in the lumbar region.
Is it possible to prevent it somehow?
– Prevention is above all exercise therapy, so that there is tone in the muscles, that the muscles function correctly and that 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 leads to muscle spasms and the person feels pain. Therefore, massage, acupuncture, etc. are good for reflex pain syndrome.
What determines the effectiveness of treatment?
– It is important to consult a neurologist in time in case of problems: 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.
Sometimes people endure for years and think it’s just "age-related. "But every year their situation worsens, and as a result the disease leads to restrictions in movement - they can walk only a few meters.
The specialist will assess the degree of danger and, if necessary, direct to additional 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 surgical intervention. If there is no need for surgical intervention, the neurologist already carries out 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 to 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 nerve 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 itself, which, even with an excellent operation, may not recover, or to radiculopathy - damage to the root of the spinal cord itself. spinal cord.
If the operation is carried out 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 practically feel wellhealth.
With advanced pathology, the effectiveness of surgical intervention decreases. In case of persistent neurological disorders, the operation may not lead to noticeable progress, because the spinal cord itself or the root is already dead at the time of the operation.
Each patient with one or another variant of pathology needs a personal consultation with a specialist. At the same time, the majority of patients with cervical osteochondrosis can be helped without surgical intervention, using complex conservative treatment methods.