Experts talk about modern approaches to the treatment of patients with osteochondrosis of the cervical spine
Alexey Peleganchuk, head of the neuroorthopedic department, orthopedic traumatology, neurosurgeon, Ph. D. , talks about the technology available to doctors today to help such patients.
What is the disease that patients usually call "cervical chondrosis"? What is the correct diagnosis?
- Actually, "cervical chondrosis" is slang; this 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 diseases do not exist; they call it "degenerative-dystrophic disease. "When making a diagnosis, we indicate "osteochondrosis of the cervical spine, " and then we describe the affected segment of spinal motion.
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, more dangerous manifestations of common degenerative pathology are weakness of the upper part (perhaps in the lower part) and impaired sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– This is an unusual complaint for cervical osteochondrosis, but sometimes it happens. If such a patient comes, then, first of all, this is the reason to prescribe a brain MRI to rule out any organic changes. If the patient has done this, he cannot receive conservative treatment and there is a substrate in the form of a disc protrusion, which is very rare, but can cause this phenomenon reflexively, then there is an option to help this patient, but the effectiveness will be much lower than the classical treatmentpain in the cervical spine.
What are the causes of pain and what options are available today to treat such patients?
– Three groups of patients can be distinguished. The first group is reflex pain syndrome, the second group is radicular syndrome, myelopathy - lesions on the spinal cord itself, as in severe stenosis, and the third is very rare patients, but the most complex, those who suffer the most are patients withneuropathy.
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 nerve tissue - that is, the spinal cord and its roots - is without compression (without compression).
Therefore, in this case, if we consider the option of surgical treatment, then this is an outpatient method - for example, a block. More invasive procedures include radiofrequency denervation and cold plasma coblation of intervertebral discs - hardware puncture procedures performed without incisions.
The goal is to eliminate the pain syndrome or significantly reduce its intensity, and relieve the patient from the need for analgesics.
The second group of patients are hernia patients. Hernia in the cervical spine can cause root compression, and, if conservative treatment methods are ineffective, surgery is required. 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 recede.
With a large hernia, there is also a conduction disorder: 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 perform a decompression - to create a storage space 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 creates a condition, that is, a storage space.
In addition to the hernia, there is a round stenosis. They develop due to a complex problem that arises in the cervical spine, which leads to a narrowing of the circular 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, the patient, if there is no stenosis, has neuropathy (the nerve itself hurts). Then help is given using neuromodulation (neurostimulation). It involves the installation of a special epidural electrode on the posterior structure of the spinal cord. This is a special device - one might say, like physical therapy, 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 of these technologies are available to patients; there are different sources of funding, 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 the main lesion at the level of vertebrae C6 - C7, degenerative stenosis at this level and with compression of the C7 spinal cord root on the right side.
During surgery, it is possible to remove the stenosis, remove the 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. The surgeon affects this clinical substrate, and the clinical substrate is, say, a hernia that has led to stenosis.
How is the treatment strategy 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 relate this data to the study.
The screening study for osteochondrosis of the cervical spine is MRI, unless this study is contraindicated for the patient for one reason or another. If necessary, the MSCT is also designated to determine operational tactics.
However, not every hernia described in an MRI requires surgery. The hernia itself is not a reason for surgery. Experts must determine how much it causes compression, etc. , and decide the appropriateness of the operation.
At what age do these problems most often occur?
– The average age of our patients is more than forty years, but it happens that young people also need surgical intervention if their degenerative cascade starts earlier, which leads to the formation of the 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 countrymen 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 genetics. This applies not only to the cervix, but also to the thoracic and lumbar regions - this is the weakness of the fibrous ring tissue. 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?
– Prevention is, first of all, exercise therapy, so that there is tone in the muscles, the muscles work properly and there are no spasms. The fact is that when the degenerative process develops, and it can develop both in the disc and in the spinal joints, this leads to muscle spasms, and the person experiences pain. Therefore, massage, acupuncture and others are good for reflex pain syndrome.
What determines the effectiveness of treatment?
– It is important to consult a neurologist in time if there are problems: pain in the cervical spine that spreads to the upper limbs, numbness and weakness in the arms, decreased strength. A very serious pathology is circular stenosis, when weakness in the lower part of the leg is also added, when the spinal cord is already affected.
It happens that people survive for many years and think that it is just "related to age. "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 the surgical treatment of spinal pathologies. 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 involved in conservative treatment. If surgical treatment is required, the operation is carried out, after which the patient is sent for rehabilitation to a neurologist.
The goal of conservative treatment is to achieve a very long period of remission and minimize the frequency of exacerbations, both in duration and frequency. This also applies to the puncture treatment method. But if there are already gross changes in the form of hernia and compression of the spinal cord root, then conservative treatment may not work.
At the same time, operations must be timely. The purpose of surgery is to save nerve tissue, either the spinal cord or the root. If a person is sick for many years, this leads to myelopathy - changes in the spinal cord itself, which then, even with excellent operations, may not recover, or radiculopathy - damage to the roots of the spinal cord.
If the operation is performed on time, according to the standards, then there is a high probability of recovery of both the root of the spinal cord and the spinal cord itself, and the person after recovery will feel practically healthy.
With advanced pathology, the effectiveness of surgical intervention decreases. In the case of persistent neurological disorders, the operation may not lead to significant progress, because the spinal cord itself or the roots have died at the time of the operation.
Each patient with one or another pathological variant requires a 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.