The expert spoke about modern approaches in 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 "cervical chondrosis"? What is the correct diagnosis?
– In fact, "chondrosis of the cervix" 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 we make a diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which segments of the movement of the spine 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 (perhaps 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 does not undergo conservative treatment and has a substrate in the form of disc protrusions, which is extremely rare, but can cause these phenomena reflexively, then there is an opportunity to help this patient, but the effectiveness will be significantly lower than the classic treatment of pain in the cervical spine.
What are the causes of pain and what options exist today for the treatment of such patients?
– Three groups of patients can be distinguished. The first group are reflex pain syndromes, the second group are radicular syndromes, myelopathy - lesions of the spinal cord itself, as in severe stenosis, and the third are extremely rare patients, but the most complex, those who suffer the most are patientswith 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 nerve tissue - namely the spinal cord and its roots - are without compression (without compression).
Therefore, in this case, if we are considering the possibility of surgical treatment, then these are outpatient methods - for example, blockade. More invasive procedures include radiofrequency denervation and cold plasma coupling of the intervertebral discs - a hardware drilling procedure that is 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. Hernias in the cervical spine can cause root compression and, if conservative treatment methods are ineffective, surgery is used. The purpose of the operation is to perform decompression, d. m. th. remove the hernia, respectively, the root of the spinal cord will be free and the pain syndrome will regress.
With large hernias, there are also conduction disturbances: in addition to compression of the root of the spinal cord, the spinal cord itself can be compressed. Then the person experiences more severe clinical manifestations in the form of tetraparesis, that is, weakness in the upper and lower extremities. In this case, it is necessary to decompress - to create spare spaces for the spinal cord so that it can heal 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 space.
In addition to hernias, there are also circular stenosis. 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, most often present 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 the installation of special epidural electrodes in the posterior structures of the spinal cord. This is a special device - you can say, like physical therapy, which 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 these technologies are available to patients; there are various 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 patient conditionally: 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 roots of the C7 spinal cord on the right.
During the operation, it is possible to remove the stenosis, remove a 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) will 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 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 - perform 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 seen on 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 these problems appear most often?
– The average age of our patients is over forty years old, but it happens that even young people require surgical intervention if their degenerative cascade has started early, which has led to the formation of a hernia-shaped 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 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 cervix, but also to the chest and waist 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 waist 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 properly 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, it 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 at the right time if there is a problem: pain in the cervical spine that spreads to the upper limbs, numbness and weakness in the arms, loss of strength. Very serious pathologies are circular stenosis, when the 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 this is simply "related to age". But every year they get worse, and as a result the disease leads to the fact that they have limitations in movement - they can only walk a few meters.
The specialist will assess the degree of risk and, if necessary, will refer him for additional research methods and, if indicated, 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 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 flare-ups, both in duration and frequency. This also applies to drilling treatment methods. But if there are already major changes in the form of a hernia and compression of the roots of the spinal cord, then conservative treatment may not work.
At the same time, the operation must be on time. The goal of the operation is to save the nerve tissue, either 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 excellent surgery, may not be cured, or radiculopathy - damage to the root of the spinal cord.
If the operation is performed on time, according to the standards, then there is a high probability of restoration of both the root of the spinal cord 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 significant progress, because the spinal cord itself or the root is already dead at the time of the operation.
Each patient with one or another variant of the pathology needs a personal consultation with a specialist. At the same time, most patients with cervical osteochondrosis can be helped without surgery, using complex methods of conservative treatment.