Prevention of osteochondrosis and radicular syndrome
The development of degenerative changes is closely linked to risk factors: chronic microtraumatization, static or dynamic overloads, and prolonged awkward postures (driving, working at a machine or an office desk).
Key prevention principles:
- Systematic physical exercise to strengthen the muscle corset.
- Ergonomic organization of the workstation and regular changes in body position.
- Adherence to biomechanical rules: heavy objects should be lifted from the ground with a straight back, by squatting. The load should be carried as close to the torso as possible, and the heaviest items are best carried on the shoulder.
- Drivers are advised to take breaks after several hours of driving: get out of the vehicle, perform head movements, rub the neck, and do 2–3 warm-up exercises (4–6 repetitions each).
Maintaining the remission stage: To prevent exacerbations, patients are advised to sleep on a comfortable (preferably firm) bed, perform daily gymnastics (twice a day, including occupational gymnastics), and swim three times a week. An important role is played by normalizing body weight through a special diet and a course of back and neck muscle massage. Wearing an orthopedic corset (orthosis) during physical work is permitted strictly in combination with mandatory daily massage.
Spondylosis: pathogenesis and clinical presentation
Spondylosis is a slowly progressive local "aging" of spinal segments. The anatomical changes act as the body's adaptive response to continuous overloads.
Pathomorphology of the process:
- Primary changes affect the outer fibers of the annulus fibrosus (annulus fibrosus).
- The nucleus pulposus (nucleus pulposus) retains its elasticity.
- Calcification of the anterior longitudinal ligament (lig. longitudinale anterius) occurs, leading to the formation of osteophytes (often beak-shaped).
Diagnostics: The classic radiological triad includes the absence of endplate sclerosis, preserved intervertebral space height, and the presence of stabilizing "bracket-like" osteophytes along the anterolateral surfaces.
Clinically, spondylosis often presents with only mild pain syndrome, causing patients to take analgesics and rarely consult a doctor. In individuals over 50, the disease often proceeds without typical signs of lumbago and sciatica, manifesting only as restricted lumbar mobility (often an incidental radiological finding). In old age, a peculiar "self-cure" is possible due to the formation of a bony block (fusion of osteophytes). However, if adjacent osteophytes do not fuse, there is a risk of developing pronounced radicular syndrome. Treatment is usually conservative (ultrasound with hydrocortisone, B vitamins, NSAIDs) aimed at relieving nerve root irritation.
Forestier's disease and dyshormonal spondylopathy
Diffuse idiopathic skeletal hyperostosis / Forestier's disease is considered a variant of spondylosis whose etiology is not fully understood, but it is often associated with diabetes mellitus. It predominantly affects the lumbar or cervical spine.
- Clinical presentation: Back pain is characteristic, which resolves completely within 2–3 years. Subsequently, the main complaint becomes marked restriction of mobility. Examination reveals muscle hypotrophy.
- Radiography: Unlike typical spondylosis with isolated osteophytes, here there is massive ossification and detachment of the anterior longitudinal ligament over several segments. Endplate sclerosis and osteophytes are absent.
Dyskinesia/dyshormonal spondylopathy is a secondary condition associated with age-related suppression of adrenal or gonadal function. Severe mineral metabolism disorders lead to specific changes in the thoracic and lumbar spine:
- Clinically, lumbosciatic syndrome has a diffuse character (unlike in osteochondrosis), and tension signs are weakly expressed.
- Radiographs show pronounced osteoporosis, biconcave deformation of the vertebral bodies ("fish vertebrae"), and bulging intervertebral discs. Marginal condensations ("work sign") are visible around the osteoporotic vertebra, and pathological fractures are frequent.
- Therapy requires normalization of hormonal balance and mineral metabolism.
Briefly: answers to topical questions
What tension signs are checked when diagnosing radicular syndrome in lumbar osteochondrosis?
When diagnosing radicular syndrome in lumbar osteochondrosis, the following tension signs are checked:
- Lasegue's sign — the appearance of pain upon passive raising of a fully extended straight leg (from an angle of 30–50°) in the supine position and its disappearance upon knee flexion. Pain may increase with dorsiflexion of the foot and forward head flexion.
- Crossed Lasegue's sign (Bechterew's sign) — occurrence of pain on the affected side when lifting the healthy leg.
What stages of the degenerative process are distinguished in the pathogenesis of intervertebral osteochondrosis?
In the pathogenesis of intervertebral disc degeneration, sequential changes in the nucleus pulposus and annulus fibrosus are distinguished:
- first, the nucleus pulposus swells;
- then it dries out;
- the disc flattens;
- the annulus fibrosus begins to bulge;
- circular and longitudinal cracks and tears form in the dystrophically altered fibers of the annulus fibrosus.
What groups of drugs are used for conservative treatment of radicular syndrome in lumbar osteochondrosis?
For conservative drug treatment of radicular syndrome and back pain, the following are used:
- nonsteroidal anti-inflammatory drugs (NSAIDs) or paracetamol;
- muscle relaxants;
- a short course of corticosteroids with a gradual dose reduction.
Novocaine blocks can also be used to relieve pain.
What conditions require differential diagnosis with lumbar osteochondrosis?
Differential diagnosis of lumbar osteochondrosis and its complications must be carried out with the following pathologies:
- Hip joint pathologies (coxarthrosis) — can mimic osteochondrosis and radiculopathies.
- Dyshormonal spondylopathy — unlike osteochondrosis, lumbosciatic syndrome is diffuse in nature.
- Vascular claudication — differentiated from neurogenic intermittent claudication in lumbar stenosis.
- Malignant neoplasms (spinal cord or vertebral body tumors) and infectious processes — ruled out in the presence of "red flags".
Class and exam questions
What biomechanical rules must be followed when lifting heavy objects to prevent osteochondrosis?
Lifting a load from the floor must be done with an absolutely straight back, by squatting. Items should be carried in front of you and as close to the torso as possible, and the heaviest things are best carried on the shoulder.
How to differentiate spondylosis from Forestier's disease on radiographs?
With typical spondylosis, isolated osteophytes are visualized. With Forestier's disease, there are no osteophytes, but massive ossification of the anterior longitudinal ligament is detected, encompassing multiple segments at once.
What are the specific features of the course of spondylosis in elderly patients?
The disease often proceeds without acute attacks (lumbago) and sciatica, manifesting only as lumbar stiffness. When osteophytes fuse into a bony "block", clinical "self-cure" of the pain syndrome is possible.
What does dyshormonal spondylopathy look like on X-ray?
Pronounced osteoporosis, bulging intervertebral discs, and biconcave vertebral bodies, which are radiologically called "fish vertebrae", are characteristic.
What else to study on this topic
- Cervical radiculopathy: causes of unilateral pain and paresthesias
- Cervical myelopathy in the elderly: bilateral symptoms and gait disturbance
- Anatomy of the spinal cord and intervertebral foramina
- Pavlov-Torг Index: calculation and clinical significance in stenosis
- Percentage of spinal canal filling at different levels (C1 and C6)
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