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" has this disease by a certain age, which means you just need to "be patient. "
Alexey Peleganchuk, head of the department of neuroorthopedics, orthopedic traumatologist, neurosurgeon, Ph. D. , spoke 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 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 such a disease does not exist; they call it "degenerative-dystrophic disease. "When making a diagnosis, we indicate "osteochondrosis of the cervical spine, " and then we decipher which spinal motion segments 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 for such patients to visit 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. In addition, even more dangerous manifestations of common degenerative pathologies are weakness of the upper extremities (maybe in the lower extremities) and impaired sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are uncharacteristic 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 rule out 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 cause these phenomena reflexively, then there is an option to help this patient, but the effectiveness will be significantly lower than the classical treatment of pain in the cervical spine.
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 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 can radiate to the shoulder girdle and upper limbs. But the peculiarity 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 are considering 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 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 ineffective, surgery is resorted to. The purpose of the operation is to perform decompression, i. e. remove the hernia, respectively, the spinal cord root 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 (compressed). Then the person experiences more severe clinical manifestations in the form of tetraparesis, that is, weakness in both the upper and lower extremities. In this case, it is necessary to do 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, i. e. reserve 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 severe patients who sometimes remain ill for years, and, unfortunately, are most often 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). Then help is provided using neuromodulation (neurostimulation). It involves installing special epidural electrodes on the posterior structures of the spinal cord. This is a special device - one might say, like physical therapy, which you always have with you: you can turn it on and increase the power in order to reduce pain. And this helps well even in very difficult cases.
All these technologies are available to patients; there are different sources of financing, including compulsory medical 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 spinal cord roots on the right.
During surgery, it is possible to remove 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 led to stenosis.
How is 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, a 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 every hernia that is described in an MRI requires surgery. The hernia itself is not a reason for surgery. The specialist must determine how much it causes compression, etc. , and decide on the advisability 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 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, then 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 formation of these formations.
The main risk factor is genetic. This applies not only to the cervical, but also to the thoracic and lumbar regions - 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 more reflected in the lumbar region.
Is it possible to somehow prevent it?
– Prevention is, first of all, exercise therapy, so that there is tone in the muscles, the muscles work 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 leads to muscle spasm, and the person experiences 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 a timely manner if there is a problem: pain in the cervical spine that spreads 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 endure for years and think that 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 only walk a few meters.
The specialist will assess the degree of danger and, if necessary, refer for 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 surgery, then the neurologist is already engaged in conservative treatment. If surgical treatment is required, 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 exacerbations, both in duration and frequency. This also applies to puncture methods of treatment. But if there are already gross changes in the form of a hernia and compression of the spinal cord roots, then 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 radiculopathy - damage to the spinal cord root.
If the operation is performed on time, according to the standards, then there is a high probability of restoration of both the spinal cord root 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 the spinal cord itself or the root has already died by the time of the operation.
Every patient with one or another variant of the pathology needs personal consultation with a specialist. At the same time, the majority of patients with cervical osteochondrosis can be helped without surgery, using complex conservative treatment methods.