Osteonecrosis is the most common pathology of the spine, in which all its parts are affected.In terms of frequency of injury, the cervical spine ranks second, only after the lumbar spine.Treatment of cervical spondylosis is carried out in most cases by conservative methods and depends on the stage of the disease and the severity of the destructive process in the intervertebral disc.Surgical treatment is indicated for 5-7% of patients with refractory disease, lack of effectiveness of conservative treatment for 3-4 months, and also the development of serious neurological complications.
Clinical manifestations of the disease
Cervical spine degeneration has many different manifestations.Symptoms depend on the predominance of one or several syndromes that develop due to the impact of pathologically altered structures of the spine on the spinal cord, roots or vertebral arteries.The clinical picture of the disease is determined by the following syndromes:
- Vertebral - manifested by pain of varying intensity and duration, localized in the neck or occipital region of the head.
- Spine - the appearance of neurological disorders, manifested by motor and sensory disorders, as well as trophic changes in the muscles of the upper limbs.
- Roots - manifested by pain in various locations (upper limbs, chest and abdominal organs), requiring differential diagnosis with many diseases of internal organs and cardiovascular system.
- Vertebral artery syndrome is characterized by the development of vestibular disorders due to insufficient blood supply to brain structures (headache, hearing loss, tinnitus, dizziness, short-term loss of consciousness).
How to treat cervical spondylosis?
The reason for seeking medical help is when the first complaint or subsequent exacerbation of the disease appears.In any case, treatment of cervical spondylosis should be prescribed by a doctor only after a mandatory examination of the patient and the necessary laboratory and instrumental studies to exclude accompanying pathology.
After confirming the diagnosis, in most cases outpatient treatment is prescribed.Patients with severe neurological disorders, high likelihood of complications and severe comorbidities require inpatient treatment.Conservative treatment of osteoarthritis includes the use of the following methods.
Treatment with medication
The use of medication is necessary during the exacerbation of the disease to combat pain.For this purpose, they prescribe:
- Non-addictive pain relievers.Nonsteroidal anti-inflammatory drugs are administered orally or by injection, it is mandatory to use topical preparations - ointments, gels, balms, rubs.Complex anti-inflammatory therapy helps reduce soft tissue swelling, the main cause of pain in spondylolisthesis.The duration of drug use in this group is 5-10 days, sometimes 2 weeks.If there is no effect, paravertebral anesthesia with hormonal drugs is used in an amount of 1-3 operations.
- Antispasmodics, vitamin B. In the acute phase, when edema is severe, short-term use of diuretics for 2-4 days is indicated.They reduce blood vessel spasms and improve microcirculation in inflamed areas.
- Sedatives (tincture of peony, valerian root, herbal teas and infusions) to prevent the development of neurosis if the patient experiences prolonged severe pain.
- External warming agents - balms, ointments, rubs have a mild irritating effect and contain biologically active substances of plant and animal origin.It is impossible to use drugs with a strong stimulant effect because they increase swelling, which can make the condition worse.
Massage therapy
Massage is an indispensable part of the complex treatment of osteoarthritis.It is used after the exacerbation has been eliminated to consolidate the effectiveness of drug treatment and periodically during remission for prophylactic purposes.The course of therapeutic massage is 10-14 sessions and is prescribed 2-4 times a year in the absence of severe pain.
Massage improves blood supply, lymph circulation and relaxes muscle spasms in the neck and neck area.Thanks to that, the nutrition of the cartilage tissue of the intervertebral disc is improved, preventing progression and reducing the risk of subsequent recurrence.
Therapeutic exercises
Physical therapy exercises for cervical spondylosis should be performed daily, except in cases where the disease is more severe, accompanied by severe pain.In case of severe pain, it is necessary to follow a gentle diet and minimize movements in the cervical spine.
Systematic exercise therapy strengthens the neck muscles, which reduces the static load on the intervertebral discs.The exercises are performed smoothly;Initially sudden movements of large amplitude were prohibited.Exercises must be started carefully, gradually increasing the load, avoiding the appearance of discomfort.
Exercises are performed in a standing or sitting position.The most popular exercises include:
- turn your head to the sides;
- tilt your head forward and backward;
- raise your shoulders, relax or fix your arms, hold them in this position for 15-20 seconds;
- static load, with the head stationary, alternating tension occurs in the flexors and extensors of the neck.
Exercises must be repeated 5-7 times, each session lasts 15-20 minutes.
Traction force
To avoid possible complications, traction should be performed in a hospital setting under a doctor's supervision.The procedure is performed with utmost caution and if pain occurs it must be stopped immediately, as it can worsen the condition.
During traction, the elastic tissues of the spinal ligaments are stretched, resulting in an increase in the distance between adjacent vertebrae.It increases by 1-3 mm.This turns out to be enough to reduce, and in some cases completely eliminate, compression when the root or artery is compressed by a herniated disc or bone spur.During the procedure, the pressure inside the disc decreases, causing the herniated part to partially shrink and the intervertebral foramen to increase.
Traction has a beneficial effect on the joints between the vertebrae, eliminating subluxations that have formed in them and helping to reduce muscle spasms.Immediately after traction, it is imperative to immobilize the cervical spine with special devices for several hours.The course of treatment includes from 10 to 20 procedures.
Physical therapy treatment
The use of medical electrophoresis has a good effect.This technique allows drug delivery to tissues involved in the pathological process.For cervical spondylosis, electroporation with nonsteroidal anti-inflammatory drugs, hormonal anesthetics and other drugs is used.
The use of diadynamic current helps improve blood circulation and has good analgesic and anti-inflammatory effects, helping to reduce the excitability of nerve tissue.When using complex treatment with conservative methods, initially appearing osteochondrosis can be cured provided that you maintain an active lifestyle, proper and adequate nutrition, and give up bad habits.
With advanced destruction, appropriate treatment and lifestyle will allow you to achieve lasting remission.In some patients improvement cannot be achieved with conservative treatment;In such cases, neurosurgical methods are used.
Surgical treatment
Before treating cervical spondylosis with surgery, all available canning methods should be tried.Typically, surgical treatment is indicated when treatment has been unsuccessful for three months or more.As well as the development of spinal cord compression in patients, accompanied by severe neurological symptoms that can lead to disability.
Currently, microsurgery and endoscopy are most commonly used.The operation is performed using microsurgical instruments and a 10x microscope, which allows you to clearly see compressed areas of the spinal cord.Removal of a portion of the hernia compressing the roots or spinal cord is performed.Sometimes it is necessary to remove a small piece of the vertebra or remove a ligament.