Osteochondrosis

introduction

Osteochondrosis is one degenerative spinal diseasewhich usually occurs in the second half of life. As part of the disease, there is ultimately an increasing Ossification of the spine. This process is triggered by heavy wear or stress on the intervertebral discs.

The first step is when the spine is overloaded, for example through long periods of sitting or heavy physical work Compression of the intervertebral discs. The intervertebral discs usually regenerate, especially at night. The intervertebral discs store more water again and can resume their function as "dampers" the next day. However, if it is a chronic process or if the intervertebral discs are permanently exposed to this stress, this regeneration will not take place at some point, so that the intervertebral discs remain in a compressed state and the intervertebral disc height remains reduced. The function of the intervertebral disc as a shock absorber to the adjacent vertebral body decreases, resulting in greater pressure.

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In response to this increased pressure, the body forms Osseous outgrowths (Osteophytes) to distribute the pressure over a larger area. These bones ultimately provide the one associated with osteochondrosis Spine pain. Because if these bones rub against each other or if the new bone appendix rubs against a vertebral bone (simplified: rubs bone against bone), pain occurs.

In the further course of the ossification it can lead to a stiffening of the affected spinal column section so that the affected person not only feels pain, but also in his Limited mobility is. In the case of osteochondrosis, one can practically speak of ossification of the intervertebral discs.

The entire spine is usually not affected by osteochondrosis. It can occur in isolation or in combination in the cervical, thoracic or lumbar spine. However, the cervical and lumbar spine are affected much more frequently than the more immobile thoracic spine. Most frequently is the Lumbar spine affected, as this is the most stressed. Which part of the spine is affected also depends on the type of stress exposed.

There are osteochondrosis different shapes, on the one hand the Osteochondrosis intervertrebalis, which this article will mainly be about, on the other hand Osteochondrosis dissecans, Scheuermann's disease and Perthes disease.

Excursus: Osteochondrosis dissecans

A short digression on osteochondrosis dissecans: In contrast to the already described osteochondrosis of the spine, osteochondrosis dissecans occurs mostly through trauma, such as sports accidents on. The trauma results in one Inflammation in the bonewhich leads to the decomposition of bone tissue. Usually it comes to Osteochondrosis dissecans in the knee.

In a healthy body, when a joint is heavily stressed, increased cartilage formation occurs, which then becomes secondary to bone. With an existing osteochondrosis dissecans, however, no secondary bone tissue can develop, so that a thickened cartilage layer results. Cartilage is not supplied with blood, however, so that the deep cartilage layers ultimately die off and part of the joint surface can be rejected. The disease goes with you severe pain hand in hand.

Causes of Osteochondrosis

Osteochondrosis comes from one Overloading of the intervertebral discs conditions. One-sided physical stress leads to increasing wear of the intervertebral disc. This process begins as early as the age of 20 and represents a completely normal aging process. However, if the intervertebral discs are overloaded, this results in excessive wear and tear, to which the body ultimately reacts with bone formation.
The excessive wear and tear is caused, for example, by constant standing or sitting, as well as a lack of movement. Due to the reduced movement, the surrounding muscles are not strong enough to bear loads or to support the intervertebral disc in its function, so that the intervertebral disc is even more stressed by the weak muscles.

In addition to one-sided activities, also plays Obesity a major role. Due to the increased body weight, the intervertebral discs are constantly exposed to strong pressure and can only recover little.

Also the illness of one Scoliosis can promote the development of osteochondrosis. In scoliosis, there is also a normal S-shape of the spine lateral curvaturewhich results in poor posture and the intervertebral discs are only loaded on one side and ultimately osteochondrosis can result.

Also one Disc surgery or one Disc inflammation can promote osteochondrosis.

A special form of osteochondrosis that occurs in Teenagers occurs is the so-called Scheuermann's disease. In contrast to "normal" osteochondrosis, the disease mainly affects the Thoracic spine noticeable. It is usually associated with tall stature and poor posture. Those affected develop a hump over the course of the process.

Diagnosis of osteochondrosis

Most often, patients look for non-improving ones Back pain a doctor / orthopedic surgeon. After an admission interview, he will arrange for further diagnostics X-ray image of the spine.

Osteochondrosis is easy to diagnose using an X-ray. On an X-ray you can usually see a reduced height of the intervertebral discs determine. The decrease in height often does not occur on both sides of the intervertebral disc, but only on one side, for example due to one-sided wear.

In addition to the decrease in height of the intervertebral discs, one can sometimes also increase Hardening of the tissue find a so-called Sclerotherapy.

If the disease is more advanced, you can also use the new bone deposits recognize in the X-ray.

In most cases, an X-ray is sufficient to establish the diagnosis, but in cases of doubt, a CT or MRI scan of the spine be consulted.

Symptoms of osteochondrosis

The symptoms of osteochondrosis are characteristic of symptoms that are usually resistant to therapy Back pain, say they are through Painkiller difficult to get to grips with. It is also typical that the pain is not only present in certain movements or positions, but is also present when standing, walking and lying down. This means that the pain does not improve through rest or stress.

The specific symptoms depend on which section of the spine is affected. Compared to the cervical and lumbar spine, causes one Osteochondrosis of the thoracic spine mostly only minor complaintsso that the diagnosis of osteochondrosis is made much later. Usually only when, due to the disease, increasing stiffness occurs.

Sometimes a disc prolapse be caused by osteochondrosis. In the case of a herniated disc, the intervertebral disc tears, so that the gelatinous nucleus located in the middle comes out of its socket and presses on the spinal cord nerves.
Accordingly, a Tingling or numbness in the arms or legs up to further loss of function, also secondary to osteochondrosis.

As the disease progresses, it increases Stiffening of the spinewhich results in limited mobility of the affected segment. The advantage for those affected is that the usually severe pain is reduced. Because the pain in osteochondrosis is caused by the newly created bone fragments rubbing against each other. However, if the spine becomes stiffened, they can rub less against each other and the pain is reduced.

Symptoms of lumbar osteochondrosis

Does the osteochondrosis affect the Lumbar spine (LWS) what is in the most cases is the case, it comes to Lower back pain. The pain can radiate to the legs and sometimes to the toes. The pain can become so severe that there is a significant restriction in movement. In some cases, the pain does not have to be permanent, but with an incorrect load it comes to suddenly shooting severe pain.
Often a relieving posture is adopted due to the pain, in which the pain is easier to bear. As a result, however, there can often be accompanying complaints, such as tension, which can also be painful.

Symptoms of osteochondrosis of the cervical spine

Is the Cervical spine Affected by osteochondrosis, patients usually face it Pain in the neck to the doctor. Some patients also report that the pain radiates into their arms and even their fingers. As it often increases in response to the pain Muscle tension in the neck comes, these can turn to those affected a headache trigger as a symptom.

As the disease progresses, turning the head becomes more and more difficult and is often only possible to a certain extent at some point. If at some point certain nerves are additionally affected, one can develop Torticollis come.

The nerves can be affected in osteochondrosis when the increasing ossification of the vertebral canal leads to a narrowing of the spinal canal so that nerves are squeezed. In addition to the development of a torticollis, this can also lead to other neurological deficits such as paralysis.

Staging according to Modic 1/2/3

Osteochondrosis of the spine is divided into different stages on the basis of radiological imaging. These were named after their descriptor Michael T. Modic and in three stages assigned.

• Modic 1 is inflammatory changes, bone marrow edema.
• In stage 2 according to Modic, the bone marrow that normally forms blood is replaced by adipose tissue; this is called fatty degeneration.
• In the last stage, in Modic Stage 3, there is ultimately sclerosis, which corresponds to a hardening of connective tissue or bone tissue.

Therapy of osteochondrosis

In the early stages of osteochondrosis, conservative therapy is definitely in the foreground. An operation is therefore not the first choice of therapy. Usually one is drug pain therapy supported with specific exercises for the back. The exercises aim to strengthen the core muscles so that there is relief for the spine. In drug therapy, painkillers are mainly used. In some cases, however, anti-inflammatory drugs can also provide relief. The pain relievers are usually taken orally. However, if the pain becomes too severe, the doctor can inject a pain reliever directly into the affected area.

The pain medication should first overcome the acute phase of pain, so that afterwards with a physical therapy can be started. The aim is to relax the muscles in the initial phase, which can be achieved, for example, by a Electro or heat therapy in the form of red light, fango ("mud treatment") and massage can be achieved. Only when the muscles are no longer tense can the actual exercises begin so that the muscles are built up to help relieve the spine.

Partly can be supportive to therapy Support corset (Orthosis) are prescribed. In addition to the muscle building exercises is one Back school makes sense. There, those affected are taught a healthy posture that is easy on the back.

If you are overweight you should try that at the same time Reduced body weight. These measures can prevent a full clinical picture at an early stage of osteochondrosis.

However, conservative therapy is more difficult if the Cervical spine is affected, since the muscles in this area can relieve the spine little. The main aim here is to loosen up the muscles in order to reduce the pain. In addition, pain-relieving injections are often used to treat nerve irritation.

If the disease has progressed too far, surgery is often necessary. A severely affected intervertebral disc can be removed and replaced with a Intervertebral disc prosthesis be replaced. Stabilization and alignment operations can also be performed.

Prognosis of osteochondrosis

The prognosis of osteochondrosis depends entirely on the stage the diagnosis. If it is diagnosed at an early stage, it can be contained well with conservative therapy, which mainly consists of muscle-building exercises and posture training. This is especially true if the complaints occur in the lumbar spine area.
In the area of ​​the cervical spine this is of less help and one should try to reduce the triggering factors above all.
At an advanced stage, it is too late to stop the rest of the process. Often only a stabilizing operation helps, which limits the mobility of the person affected.