Download 05. Osteochondrosis

OSTEOCHONDROSIS
is a polyfactorial disease that
develops
In case of two conditions:
 Decompensation of trophic
systems
 Local excessive load on
spinal segments
PATHOGENESIS OF
OSTEOCHONDROSIS
The first stage. There are
degenerative changes of pulp nuclei
 The second stage. There are
degenerative changes in fibrous
ring, disc protrusion and disc hernia
The third stage. There are
changes of hyaline plates subchondral sclerosis

X –RAY SIGNS OF OSTEOCHONDROSIS
 Low
height of between vertebral
discs
 Sclerosis of final plates
 Osteophytes on the edges of
vertebras’ bodies. They are located
perpendicularly to the spinal axis
 Local scoliosis
 Spondilolisthesis – dislocation of
neighbouring vertebras’ bodies
 Local cyphosis (instead of lordosis)
VERTEBRAL DISC’S
HERNIA
Main positions are:
 Medial (clinical features of horse tail lesion)
 Paramedial (a little bit out side the medial
position – several radixes are compressed)
 Posterior – medial (much more out side the
medial position – 1 or 2 radixes are
compressed)
 Foraminal - (– 1 radix is compressed)
PATHOGENESIS OF
NEUROLOGICAL SIGNS
 Irritation
of vessels and nerves with
vascular spasm.
 Compression of vascular – nervous
complex.
 Edema (perivascular edema and
radicular edema)
 Reactive process of neibouring
structures (straining of muscles)
 Autoimmune reactions (a part of disc
becomes antigen)
Compressive
syndrome
occurs at compression and
deformation of radix, vessels
and spinal cord.
Reflex syndrome occurs at
irritation of different
receptors (such as Lushka
nerve).
CLASSIFICATION.
Reflex syndromes

Lumbago (backache)

Lumbalgia

Lumbar ischialgia (muscular – tonic, neurodystrophic, autonomic vascular)
Compressive radicular syndromes.
Compressive vascular radicular – spinal
syndromes (radicular ischemia)

Acute

Transient

Strokes

Chronic ischemic myelopathy
VERTEBROGENOUS SYNDROME
 Limitation
of movements in lumbar – sacral
part of spinal cord (bending forward,
backward)
 Increasing of pain while movements,
coughing and laughing
 Protective straining of long back muscles
 Extension of lumbar lordosis, cyphosis in
lumbar – sacral division
 Scoliosis, sometimes with rotation
 Painful paravertebral points and vertebral
processes
VERTEBROGENOUS
SYNDROME
 Discharge
– postures and symptoms
 Knee
– elbow position
 While standing the patient
keeps his leg aside in order to
make the load less on his leg
 While lying in the bed he bends
his leg in all joints.
 The
symptoms of spinal cord
instability (it is difficult for the
patient to stand, to wash himself, but
it is much more easier to walk)
REFLEX SYNDROMES

on lumbar – sacral level are divided into:
1. Lumbago
2. Lumbalgia
3. Lumbar ischialgia
muscular – tonic

vascular

neuro- dystrophic
THE POINTS OF PAIN:
 Pain
along the crista iliaca
 The point of iliosacral joint
 The point of m. gluteus minimus
(just under the crista iliaca)
 The point of m. gluteus medius (1 sm
lower)
 The point under the backside fold
 Trochanter os iliaca
 Along
the ischiadic nerve (the
posterior surface of hip and fossa
subpoplitea)
THE SYMPTOMS OF
STRAIN
 Lasegue’s
symptom – in case of straining
and lifting the leg the low back pain
appears
 Neri symptom – there is pain in leg at
bending head forward
 Matskevych symptom – there is pain in
the anterior surface of the leg at knee
bending while lying on abdomen
 Wasserman symptom – the same clinical
picture at lifting the leg
THE SYMPTOMS OF
STRAIN
Sequar
symptom – there is pain
on posterior surface of leg at foot
flexing
Turin symptom – the same
clinical picture at toe’s flexing
Bechterev’s symptom – there is
pain at knee – flexed leg
extension
Dejerine’s symptom - there is
pain in posterior surface of the
leg at coughing, sneezing
PIRIFORMIS SYNDROME
Clinical features:
Painful palpation of Trochanter
major
Painful m.Piriformis
Symptom of Soobrase (painful
cross-legged position)
Symptom of Bone –
Bobrovnikova (painful abduction
of leg)
PIRIFORMIS SYNDROME
Popelyansky
intermittent
claudication (while walking the
patient is forced to sit down
because of the pain. That is the
result of spasm of the vessels.
Sphincter disorders (pause
before the urination)
Signs of n. ischiadicus lesion
(muscles hypotrophy, low Achille
reflex, hyposthesia, pain)
NEURODYSTROPHIC FORM OF
LUMBAR ISCHIALGIA
Sacroiliac
periartrosis - pain
and limitation of movements in
hip joint. The patients cannot
run and so on.
Knee joint periartrosis– sudden
pain in knee joint
Coccygodynia
Neurodystrophic changes of
Achille tendon (it is very rare)
RADICULOPATHY

Radix L5 ( Disc L4 – L5)
 Pain in the external edge of hip, on
the anterior –external surface of crus
until the internal surface of foot and
great toe.
 Sensory disorders (hypalgesia,
analgesia) in the same zones
 Paresis of great toe extensors and foot
extensors
 Hypotonia and hypotrophy on the
anterior surface of crus
 The patient cannot stand on heels
RADICULOPATHY
Radix S1 (Disc L5 – S1)
 Pain in external – posterior
surface of hip, crus, foot, the IV –
th and Vth toes.
 Sensory disorders (hypalgesia,
analgesia) in the same zones
 Paresis of toes flexors
 Absent or low Achille reflex
RADICULOPATHY
Radix L4 (Disc L3 – L4)

Pain in anterior – internal surface of hip

Sensory disorders (hypalgesia, analgesia) in
the same zones prevail over motor ones

Weakness of m. Quadriceps femoris

Hypotrophy of m. Quadriceps femoris

Knee reflex is low or sometimes increased
RADICULOPATHY
Radix L2 – L3

Clinical features include pain and sensory
disorders on anterior – medial surface of hip.

Symptoms of Matskevych, Wasserman

Low knee reflex

Weakness of m. Quadriceps femoris

Cruralgia

Symptoms of lesion of horse tail

Irradiation of pain into lower part of abdomen,
genital organs
COMPRESSION OF HORSE
TAIL
It is created by radix L2 – S5. It is
observed at hernia of discs L4 –
L5.
Clinical features:
Significant pain in legs
Sensory and motor disorders in
certain zones of innervation
Pelvic disorders (incontinence of
urine and feces)
CLASSIFICATION ON CERVICAL

LEVEL
Reflex symptoms.
 Stiff
neck
 Cervicalgia
 Cervical cranialgia
 Cevical brachialgia
Muscle – tonic syndrome
Autonomic – vascular syndrome
Neurodystrophic

Compressive radicular syndrome
CLASSIFICATION ON CERVICAL LEVEL
Compressive – spinal syndrome
 Compressive vascular radicular – spinal
syndrome
 Acute

 Transient
 Strokes
Chronic ischemic myelopathy
 A. vertebralis syndrome

CERVICAL CRANIALGIA
Clinical features of posterior cervical
sympathetic syndrome:
Cranialgia – occipital pain with
irradiation in temporal, parietal parts.
 Vestibulo – cochlear disturbances –
dizziness, vomiting
 Eyes symptoms – eyes pain, tears.
 Autonomic upper quadrant syndrome –
asymmetry of blood pressure,
temperature, pulse, sensation, cardiac
pain and so on.

CERVICAL BRACHIALGIA
Muscle
– tonic form
Neurodystrophic form
Autonomic – vascular
one
MUSCLE – TONIC FORM
Muscle – tonic form - Scalenus –
syndrome.
Clinical features:
There are pains above and under
clavicle at the muscle straining
There are pains at head movements
with irradiation in the arm
Edema in above clavicle region
CERVICAL BRACHIALGIA
Neurodystrophic form
Shoulder – scapula
periartrosis
Shoulder – hand syndrome
Epicondilosis
CERVICAL BRACHIALGIA
Shoulder – scapula periartrosis Clinical
features:
 Pain and limitation of movements in shoulder
 Painful palpation of caput os humeri
 Limitation of arm movements (the patient cannot
comb his hair)
 The symptom of frozen shoulder
 M. deltoideus, m. supraspinatus atrophy
SHOULDER – HAND SYNDROME
This syndrome includes
clinical features of shoulder
– scapula periartrosis and
autonomic – trophic changes
of hand.
Clinical features of algic
stage:
Severe hand pain
Edema, hyperemia and
cyanosis
SHOULDER – HAND SYNDROME
Hyperesthesia
 Decreased muscle strength and limitation
of movements
Clinical features of dystrophic stage:
 Muscle atrophy
 Osteoporosis on X – rays examinations

COMPRESSIVE RADICULAR
SYNDROMES
Radiculopathy C6 radix
(C5 – C6 discs)
Pain, parasthesia and
hypalgesia on anterior
external surface of arm
Weakness, hypotrophy of m.
biceps brachii
Absent or low flex elbow
reflex
COMPRESSIVE RADICULAR
SYNDROMES
Radiculopathy C7 radix
(C6 – C7 discs)
Pain, parasthesia and
hypalgesia
Weakness, hypotrophy of
m. triceps brachii
Low extensor elbow reflex
COMPRESSIVE RADICULAR
SYNDROMES
Radiculopathy C8 radix
(C7 – C8 discs)
Pain, parasthesia and
hypalgesia
Low extensor elbow and
carpo – radial reflex
ADDITIONAL METHODS
OF DIAGNOSTICS
Spinal
X – ray –
examination
CT of spinal cord
TREATMENT
Orthopedic
 Medicines:









In edema: Euphyllinum 2.4% 10.0; Lasix 2.0;
Dexamethasonum 4 – 8 mg; NaCl 0.9% 200.0 i/v by
drops
Platiphillinum, No – spa, Baralginum
Analgesics - Reopirini, Voltareni 2.5% 3.0; Tramadol,
Aminasini
Non steroids medicines– Ketanov, Dicloberl, Movalis,
Ranselex, Celecoxib
Myorelaxants – Midocalm, Baclofen
Chondro- protectors – Rumalon
Vitamins and biostimulators
Physical methods
TREATMENT
Surgical
methods (Horse tail
compression, Long lasting (3 – 6
months) pains, Huge hernia
(over 15 mm), Acute compression
of radicular – spinal artery)
Sanatorium
PREVENTION
 Hypokinesia
prevention
 Moderate physical
activity
 Treatment of chronic
diseases