Manifestations of cervical osteochondrosis
Cervical spine lesions are accompanied by pain and autonomic disorders. One of the prominent manifestations is visceral syndrome, which mimics cardiac pathology.
Pseudocardiac pain ("cervical angina"):
- Pain begins in the shoulder girdle and interscapular region, then radiates toward the heart.
- Depends on the position of the head, arms, or coughing.
- Lasts for a long time (up to 2 hours).
- Not relieved by nitroglycerin, but subsides with cervical traction.
- No changes are present on the ECG.
Specific tests:
- Spurling and Scoville test: axial load on the head tilted toward the shoulder causes radicular pain.
- Bärtschi test: head traction reduces pain and cerebral symptoms.
Thoracic spine symptoms
Thoracic osteochondrosis is frequently triggered by static load and sleep, while pain is relieved by morning walking.
- Interscapular sympathalgia: sensation of tightness ("iron vises"), more frequent at night.
- Radicular syndrome: resembles intercostal neuralgia, intensifies with deep inspiration.
- Vasomotor reactions: vascular spasm causes coldness of the legs, brittle nails, and skin peeling.
Visceral syndromes of the thoracic region depend on the level of the lesion:
- Pseudocardiac syndrome (upper and middle levels): breathing stiffness, fear, radiation under the scapula or into the jaw.
- Gastralgic syndrome ($Th_{6} - Th_{11}$): epigastric pain unrelated to eating, but intensifying after work.
- Pain in the right hypochondrium: mimics cholecystitis or urolithiasis, requiring strict exclusion of abdominal pathology.
Lumbar osteochondrosis: pain stages and status
The lumbar region is most frequently affected following generalized osteochondrosis, facilitated by a traumatic factor.
Pain syndrome:
- Lumbago — pain localized in the lower back and sacrum.
- Lumbodynia / lumboischialgia — lower back pain radiating into the leg.
- Ischialgia — pain exclusively in the leg.
- Provoked by coughing and sharp movements.
Objectively: The patient adopts a forced antalgic posture, shifting weight to the healthy leg. Lumbar lordosis is flattened, muscles are tense (forming a painful ridge). The tripod sign (resting on hands when sitting) is characteristic.
Tension signs:
- Lasegue's sign: pain upon raising a straight leg and its disappearance when flexing at the knee.
- Bechterew's sign (crossed): pain on the affected side when raising the healthy leg.
Principles of diagnostics and conservative therapy
The key diagnostic task is comparing clinical findings with instrumental data, as radiography does not always correlate with symptom severity. CT or MRI is used, especially when deciding on surgery.
Conservative treatment: The main goal is spinal decompression to relieve muscle spasm and intradiscal pressure.
- Traction: using a Glisson's loop for the neck, on an inclined plane or with weights (on a special table) for the thoracic and lumbar regions.
- Blockades: novocaine blockade of the anterior scalene muscle (according to Popeliansky) for cervical localization; paravertebral and epidural blockades for lesions of lower segments.
- Drug therapy: analgesics, NSAIDs, muscle relaxants, diuretics (to reduce edema), and sedatives.
- Physiotherapy and manual therapy.
Briefly: answers to topical questions
What anatomical structures make up the intervertebral disc and what is their structure?
The intervertebral disc resembles a biconvex lens in shape and consists of two main parts. The peripheral part is represented by the fibrous ring (annulus fibrosus) formed by fibrocartilage, whose fibers ensure the connection of adjacent vertebrae. The central part is occupied by the nucleus pulposus (nucleus pulposus), which is an elastic substance and the remnant of the notochord, compressed by the bodies of two vertebrae and acting as a shock absorber. The intervertebral disc is also considered a hemijoint, where the nucleus pulposus acts as an analogue of the joint cavity, the hyaline plates of the vertebral bodies act as an analogue of joint surfaces, and the fibrous ring acts as an analogue of the joint capsule.
What stages are distinguished in the pathogenesis of spinal osteochondrosis?
Sequential stages are distinguished in the pathogenesis of intervertebral disc degeneration. First, changes occur in the nucleus pulposus in the form of drying or dehydration, leading to a partial loss of shock-absorbing function. In the second stage, changes affect the fibrous ring, which thins and develops cracks. The third stage is protrusion, in which the nucleus pulposus shifts toward the formed cracks of the fibrous ring. The final stage is herniation or extrusion, which occurs upon complete rupture of the fibrous ring.
Class and exam questions
How to differentiate pain in cervical osteochondrosis from angina pectoris?
Pseudocardiac pain lasts up to 2 hours, depends on head movements and coughing, is not relieved by nitroglycerin, subsides with cervical traction, and is not accompanied by ECG changes.
What is Lasègue's sign and how is it tested?
This is a nerve root tension sign. When raising a straightened leg in a lying patient, pain occurs, which disappears if the leg is flexed at the knee joint.
What is the essence of Spurling's and Scoville's sign?
This is the appearance of radicular pain upon an axial load on the head tilted toward the affected shoulder. It indicates pathology in the cervical spine.
What is the main goal of orthopedic treatment during an exacerbation period?
The main goal is to decompress the spine. This reduces reflex muscle spasm, intradiscal pressure, and edema, thereby eliminating irritation of nerve roots.
What else to study on this topic
- Pathogenesis of widespread and generalized osteochondrosis
- Detailed technique of novocaine blockades (according to Popeliansky, epidural)
- Instrumental diagnostics: signs of osteochondrosis on a spondylogram
- Visceral disorders in cauda equina root compression
- Methods of physiotherapeutic treatment and reflexotherapy
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