The specialist spoke about modern approaches to the treatment of patients with osteochondrosis of the cervical spine
Alexey Peleganchuk, head of the department of neuroorthopedics, 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?
– Actually "cervical chondrosis" is slang; the disease is properly called "osteochondrosis of the cervical spine". This term is used by doctors of the post-Soviet space and corresponds to the current ICD (International Classification of Diseases), according to which we work. However, in most countries there is no such disease; they call it "degenerative-dystrophic disease". When we make a diagnosis, we indicate "osteochondrosis of the cervical spine" and then decipher which parts of the spinal movement 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 visiting 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 limbs (perhaps in the lower limbs) and reduced sensitivity - numbness.
Can headaches and tinnitus occur with osteochondrosis of the cervical spine?
– These are uncharacteristic complaints of 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, is not subject to conservative treatment, and there is a substrate in the form of disc protrusions, which is extremely rare, but can reflexively cause these phenomena, then there is an option to help this patient, but theeffectiveness will be significantly lower than the classic treatment of pain in the cervical spine.
What are the causes of pain and what options are there today for the treatment of such patients?
– Three groups of patients are distinguished. The first group is reflex pain syndromes, the second is root syndromes, myelopathy - damage to the spinal cord itself, as in severe stenosis, and the third is extremely rare patients, but the most complex, those who suffer the most are patients with neuropathy.
Reflex pain syndrome may spread locally to the cervical region and may radiate to the shoulder girdle and upper extremities. But the peculiarity of this pain syndrome is that the nervous tissue - that is, the spinal cord and its roots - is without compression (without compression).
Accordingly, in this case, if we consider the option of surgical treatment, then these are outpatient methods - for example, exclusions. More invasive procedures include radiofrequency denervation and cold plasma intervertebral disc—a material puncture procedure performed without incisions.
The goal is to eliminate the pain syndrome or to significantly reduce its intensity, and to free the patient from the need for analgesics.
The second group of patients are patients with hernias. Hernias in the cervical spine can cause compression of the roots, and if conservative treatment methods are ineffective, surgery is resorted to. The purpose of the operation is to decompress, i. e. remove the hernia, respectively, the root of the spinal cord will be free and the pain syndrome will subside.
With large hernias, there are also conduction disorders: in addition to compression of the root of the spinal cord, the spinal cord itself can be compressed (compressed). Then the person shows more severe clinical manifestations in the form of tetraparesis, i. e. weakness in both the upper and lower limbs. In this case, it is necessary to decompress - to create reserve spaces 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 nerve, but creates conditions, that is, binds spaces.
In addition to hernias, there are also circular strictures. They develop due to complex problems that arise in the cervical spine, which leads to circular narrowing of the canal.
These are serious 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, 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 - one might 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 different sources of funding, including compulsory medical insurance and quotas for high-tech medical care.
Can osteochondrosis be cured?
– The disease itself, osteochondrosis, is not curable. What can be done? Let's say a conditional patient: osteochondrosis of the cervical spine, with a dominant 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 surgery, 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 resulted in a stricture.
How is the treatment regimen determined?
– There is such a concept – clinicomorphological correspondence. The doctor must look at the patient from all sides - perform an orthopedic examination, a neurological examination, collect memories, complaints - and correlate these data with studies.
Preventive studies for osteochondrosis of the cervical spine are magnetic resonance imaging, unless this study is contraindicated in the patient for one reason or another. If necessary, MSCT is also prescribed to determine the tactics of the operation.
However, not every hernia described 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 feasibility of the operation.
At what age do such problems most often occur?
– The average age of our patients is over forty years old, but it also happens that young people need surgery if their degenerative cataract started early, which led to the formation of a substrate in the form of a hernia. In this case, the first step is conservative treatment and if there is no result, 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 thoracic and lumbar regions - this is the weakness of the tissues of the annulus fibrosus. And other risk factors - in the form of excess body weight, extreme work - are more reflected in the lumbar region.
Is it possible to prevent this somehow?
– Prevention is in principle exercise, 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. it is good for reflex pain syndrome.
What determines the effectiveness of treatment?
– It is important to consult a neurologist in time if there is a problem: pain in the cervical spine spreading to the upper limbs, numbness and weakness in the hands, reduced strength. Very serious pathologies are circular stenosis, when weakness in the lower limbs is added, when the spinal cord is already affected.
It happens that people endure 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 have restrictions on movement - they can only walk a few meters.
The specialist will assess the degree of risk and, if necessary, will refer for additional research methods and, if appropriate, to a spondylologist who is engaged in the surgical treatment of spinal pathology. The purpose of the consultation is to determine the need for surgery. 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 to minimize the frequency of exacerbations, both in duration and frequency. This also applies to acupuncture treatment methods. But if there are already big changes in the form of herniation and compression of the roots of the spinal cord, then conservative treatment may not work.
At the same time, the intervention must be timely. The purpose of the operation is to save the nerve tissue, whether it is 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 an excellent operation, may not recover, or radiculopathy - damage to the root of the spinal cord.
If the operation is done in time, according to the standards, then there is a high probability of restoring both the root of the spinal cord and the spinal cord itself, and the person after the restoration will feel practically healthy.
With advanced pathology, the effectiveness of surgery decreases. In case of persistent neurological disorders, the operation may not lead to noticeable progress because the spinal cord or root itself is already dead by 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, the majority of patients with cervical osteochondrosis can be helped without surgery, using complex conservative treatment methods.