The expert spoke about modern approaches to the treatment of patients with osteochondrosis of the cervical spine
Alexey Peleganchuk, head of the neuroorthopedic department, orthopedic traumatologist, neurosurgeon, Ph. D. , talked about what technologies are available to doctors today to help such patients.
What disease do patients usually call "neck chondrosis"? What is the correct diagnosis?
"Cervical chondrosis" is actually 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 BNO (International Classification of Diseases) according to which we work. In most countries, however, such a disease does not exist, it is called a "degenerative-dystrophic disease". When establishing the diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which spinal movement 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 is osteochondrosis of the cervical spine, in this case pain. In addition, even more dangerous manifestations of common degenerative pathologies are weakness of the upper limbs (perhaps in the lower limbs) and impaired sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These complaints are not characteristic of cervical osteochondrosis, but they sometimes occur. If such a patient arrives, this is the first reason to order an MRI of the brain to rule out any organ changes. If the patient has done this, he is not suitable for conservative treatment, and there is a substrate in the form of a disc protrusion, which is extremely rare, but can reflexively cause these phenomena, then it is possible to help the patient, but its effectiveness will be significantly lower than the classic treatment of pain in the cervical spinehis treatment.
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 syndromes, the second group is radicular syndromes, myelopathy - changes in the spinal cord, as in the case of severe stenosis, the third group is extremely rare patients, but the most complex, who suffer the most. neuropathy.
Reflex pain syndrome can spread locally in the neck region and radiate to the shoulder girdle and upper limbs. But the peculiarity of this pain syndrome is that the nerve tissue - namely the spinal cord and its roots - without compression (without compression).
Accordingly, in this case, if the possibility of surgical treatment is considered, then these are outpatient methods - for example, blockades. More invasive procedures include radiofrequency denervation and cold plasma coblation of the intervertebral discs—a hardware puncture procedure performed without an incision.
The goal is to eliminate the pain syndrome or significantly reduce its intensity, as well as relieve the patient of his need for painkillers.
The second group of patients are patients with hernia. Hernias of the cervical spine can cause compression of the roots, and if conservative treatment methods are ineffective, surgery should be used. The purpose of the operation is to perform decompression, i. e. remove the hernia, the root of the spinal cord is exposed, and the pain syndrome regresses.
Conduction disorders also occur with large hernias: 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 limbs. In this case, decompression should be performed - reserve spaces should be created for the spinal cord to recover a second time. It is important to understand that surgery does not restore the spinal cord and nerves, but rather creates conditions, i. e. reserve spaces.
In addition to hernias, there are also circular strictures. They develop due to complex problems arising in the cervical spine, which leads to a circular narrowing of the canal.
These are serious patients who sometimes stay ill for years and, unfortunately, are most often admitted with severe neurological disorders and often require two-stage surgery.
And another group of patients are those with neuropathic pain syndrome. In this case, patients suffer from neuropathy (the nerve itself hurts) in the absence of stenosis. They then provide help using neuromodulation (neurostimulation). This involves placing special epidural electrodes on the posterior structures of the spinal cord. It's a special tool - you could say it's like physical therapy that you always have with you: you can turn it on and increase the power to reduce pain. And this helps even in very difficult cases.
All these technologies are available to patients, and there are various sources of financing, including compulsory health insurance and quotas for high-tech healthcare.
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 predominantly lesions at the level of the C6-C7 vertebra, degenerative narrowing at this level, compression of the C7 spinal cord roots on the right side.
During surgery, it is possible to remove the stenosis, remove the 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) remain for life, because it is incurable. Surgeons affect the substrate of this clinic, and the substrate of the clinic is, say, a hernia that has led to a stenosis.
How are treatment tactics determined?
- There is such a concept - clinical-morphological correspondence. The doctor must examine the patient from all sides - perform an orthopedic examination, a neurological examination, collect anamnesis and complaints - and correlate these data with studies.
Screening tests for osteochondrosis of the cervical spine are MRI, unless this test is contraindicated for the patient for one reason or another. If necessary, an MSCT is also required to determine the tactics of the operation.
However, not all hernias described in an MRI require surgery. A hernia in itself is not a reason for surgery. The professional must determine how much it causes compression, etc. , and you have to decide on the expediency of the operation.
At what age do these problems most often appear?
- The average age of our patients is over forty years, but it happens that young people also require surgical intervention if their degenerative cascade started early, which led to the formation of a herniated substrate. 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 don't live in India, and our compatriots don't wear anything on their heads either. "Therefore, it goes without saying that work or habits lead to premature wear and formation.
The main risk factor is genetic. This applies not only to the neck, but also to the chest and lumbar regions - this is the weakness of the tissues of the fibrous ring. And other risk factors - in the form of excess weight, extreme work - are more reflected in the lumbar region.
Is there any way to prevent it?
– Prevention is primarily movement 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, it leads to muscle spasms and a person experiences pain. Therefore, massage, acupuncture, etc. are good for reflex pain syndrome.
What determines the effectiveness of the treatment?
- It is important to consult a neurologist in time if there is a problem: pain in the cervical spine that spreads to the upper limbs, numbness and weakness of the arms, loss of strength. Very serious pathologies are circular stenosis, when weakness of the lower limbs is added, when the spinal cord is already affected.
It happens that people persist for years and think that it is just "age related". But every year they get worse and as a result the disease leads to the fact that they are limited in movement - they can only walk a few meters.
The specialist assesses the extent of the danger and, if necessary, refers to additional research methods and, in justified cases, to a vertebrologist who deals with the surgical treatment of spinal pathology. The purpose of the consultation is to determine the need for surgical intervention. If surgery is not necessary, the neurologist already performs conservative treatment. If surgical treatment is required, an operation is performed, after which the patient is sent to a neurologist for rehabilitation.
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 gross changes in the form of a 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 aim of the operation is to save the nerve tissue, be it the spinal cord or its roots. If someone is sick for years, it leads to myelopathy - a change in the spinal cord itself, which cannot be cured even with excellent surgery, or to radiculopathy - damage to the spinal cord root.
If the operation is carried out on time, in accordance with the standards, then there is a high probability of restoring the root of the spinal cord and the spinal cord itself, and after rehabilitation the person feels practically healthy.
With advanced pathology, the effectiveness of surgical intervention decreases. In the case of persistent neurological disorders, surgery may not lead to noticeable progress because the spinal cord or root itself is already dead by the time of surgery.
All patients suffering from one or another version of the pathology need a personal consultation with a specialist. At the same time, the majority of patients with cervical osteochondrosis can be helped without surgery, with complex conservative treatment methods.