Arthrotic lesions of the cervical spine are in second place after lumbar disease. The variety of clinical manifestations of cervical osteochondrosis is determined by the anatomical and physiological features of the cervical spine and the complexity of many pathogenetic mechanisms. Usually, as the disease progresses, the same patient has several syndromes that appear simultaneously or one after the other. The severity of the clinical manifestations of osteochondrosis of the cervical spine depends on the severity and nature of the structural and functional changes in the intervertebral disc and surrounding tissues.
The arthritic process in osteochondrosis develops gradually and progresses with age. In the elderly and old, in contrast to young and middle-aged people, cervical osteochondrosis is often combined with spondylosis, uncovered arthrosis, arthrosis of the facet joints and interspinous arthrosis. The greatest severity and frequency of clinical manifestations are observed in people of the most working age - 30-50 years. Usually the clinical picture develops slowly and gradually without a clearly expressed beginning. Most often it is characterized by pain in the lower part of the neck. However, pain can appear suddenly in the form of acute cervicobrachialgia or torticollis.
Clinical manifestations and symptoms of cervical osteochondrosis
With cervical osteochondrosis, with the clinical manifestations of the disease, reflex, then radicular and root vascular syndromes are more common. In addition, compression spinal cords (discogenic cervical myopathy) and cerebral syndromes are often observed, which are associated with circulatory disorders in the vertebral-basilar arterial system.
Reflex syndromes manifest themselves in muscle-strengthening, autonomous-vascular and neurodystrophic disorders. In cervicalgia (lumbago), acute pain is localized in the cervical spine and increases with movement. Chronic cervicalgia is characterized by pain, discomfort, and "crunching" when moving the head. In this case, often due to the pain syndrome, the patient takes a forced position of the head: when examining, flattening or intensifying the cervical lordosis, limitation of mobility and curvature of the neck in the lateral direction, muscle tension and pain, palpation - sensitivity of the spinous processes and intervertebral discs.
In cervicocranialgia the pain is pressing, narrowing, sometimes it radiates to the temples and eyeballs, sometimes a temporary decrease in visual acuity, occasionally a feeling of "spots" in front of the eyes, photophobia. The irritation of the cervical sympathetic ganglia plays a role in the development of these complaints.
When the nerve plexus of the vertebral artery is irritated, a vertebral artery syndrome occurs, which is often mistakenly diagnosed in the clinic as "violation of the cerebral circulation in the vertebral basilar pelvis". In addition to the symptoms described above, dizziness is the most common manifestation of vertebral artery syndrome. Vertigo syndrome can appear suddenly with a sharp turn of the head, it is usually systemic, accompanied by nausea, vomiting. To objectify the vertebral artery syndrome, the presence of pain when pressing is checked at the site of the vertebral artery and a Bartschi-Rochaix orthopedic test (manual traction behind the head) is carried out. Vestibular diseases with an interest in the vertebral artery are confirmed by the presence of nystagmus, De Klein's breakdown (the appearance of nystagmus when the head is tilted backwards with a sharp turn to one side). Irritation (irritation) of the nerve-sympathetic plexus of the vertebral artery or its compression is usually caused by osteochondral growth of the insane processes of the cervical vertebrae, hypermobility of the motor segment.
With cervicobrachialgia, pain in the cervical spine radiates to the shoulder girdle, arm and is usually accompanied by muscular-tonic (anterior scalene muscle syndrome) or vegetative-vascular or dystrophic manifestations (humeral periarthrosis, shoulder-hand syndrome, epicondylitis), styloiditis. . . . If vegetative formations are involved in the process, then the pain turns into a burning character, accompanied by paresthesia, a feeling of "heat" or increased coldness of the hands.
Humeroscapular periarthrosis is characterized by restriction and pain during shoulder abduction and rotation. In epicondylitis and styloiditis, tenderness in the area of the shoulder condyle or the styloid process without pronounced restriction of movement in the arm.
Scalenus anterior syndrome is characterized by aching pain in the area of this muscle, especially when the head is turned and tilted in the opposite direction. The anterior scalene muscle when palpating is compressed, enlarged, painful. The pain occurs not only in the neck, but also in the arm on the affected side, in the belt of the upper limbs, in the armpit area, and in the chest. Certain evidence of the syndrome is the disappearance of pain and other manifestations under the influence of novocainization.
Cardialgic is one of the visceral reflex syndromes of cervical osteochondrosis. With this syndrome, symptoms similar to angina pectoris appear in the clinic. It is not isolated and, as a rule, proceeds against the background of other manifestations of cervical osteochondrosis. In the differential diagnosis of cardiac syndrome in cervical osteochondrosis, the combination of pain in the area of the heart with pain in the cervical and cervical shoulder area, the dependence of the pain on the position of the head, the ineffectiveness of coronary lytic drugs and the absence of changes in the ECG in repeated studiesimportant.
Radicular syndrome (discogenic cervical radiculitis) most commonly occurs when the spine root is compressed by a herniated disc, osteophyte, or a thickened yellow band. The disease usually develops acutely after physical exertion and cooling off. In addition to pain, muscular-tonic and vegetative-vascular manifestations are characteristic of changes in sensitivity, reflex (decrease or extinction of reflexes) and motor (paresis, paralysis) spheres. C4-C8 roots are most commonly affected in the cervical spine. In the case of the defeat of the C4-C5 roots, proximal and for C5-C8 the distal paresis of the hand is characteristic.
Radicular vascular syndrome (radiculopathy)should be diagnosed if there are acute movements and sensory disorders of the radicular type against the background of the disappearance of the pain syndrome. If the process is localized in the roots of C5-C6, then weakness of the muscles of the shoulder girdle (Parsonage Turner syndrome) occurs. With the defeat of the roots C7-C8, weakness and numbness develop in the fingers.
Spinal syndromes caused by cervical osteochondrosis can develop when the spinal cord and its vessels are compressed by a herniated disc, posterior osteophytes, and hypertrophied yellow ligament. Clinically they manifest themselves in pain in the cervicobrachial area, flaccid paresis of the arms and spastic paresis of the legs, as well as sensory disorders. The lesion of the spinal cord has a relatively minor share among other complications of osteochondrosis. However, in terms of its clinical importance, discogenic cervical myelopathy is one of the important branches of the study of degenerative lesions of the spine.
Chronic disorder of spinal circulation (myelopathy)occurs more often in older people with severe atherosclerosis and cervical osteochondrosis. It is characterized by a slow increase in flaccid paresis of the hands, and movement disorders usually outweigh sensitive ones.
Clinical manifestations of cervical osteochondrosis in people of different ages vary widely, both in terms of the combination of syndromes and symptoms, and in terms of severity. With age, the sensitivity of the nerve conductors to mechanical stimuli decreases significantly, leading to a decrease in the severity of neurodystrophic reflex muscle-tonic responses. On the other hand, as people age, when dystrophic-destructive changes develop in the spine, protective, compensatory reactions of the body come into play, which limit and fix the degree of instability, which of course leads to a decrease in its clinical manifestations.
Treatment of cervical osteochondrosis
Effective treatment of cervical osteochondrosis is possible if the main principle of its therapy is the long-term, graduated, systematic and differentiated application of therapeutic methods. In addition, methods of treatment should be chosen taking into account the modern theory of the mechanism of development of the pathological process. That is why, when prescribing treatment for cervical osteochondrosis, we take into account the chronic and progressive nature of the course of the disease. The multitude of clinical manifestations of cervical osteochondrosis requires the use of various therapeutic factors that affect different links in the pathogenetic chain. A good therapeutic effect in the treatment of patients with such a pathology is observed when acupuncture is combined with pharmacopuncture, vacuum therapy, physiotherapy, manual therapy, moxa therapy, etc. It should also be noted that gentle and gentle methods of manual therapy are preferred.
The average duration of treatment for cervical osteochondrosis in our clinic is 10-15 sessions. Upon completion of the treatment, the patient receives recommendations on how to perform exercise therapy and to further prevent the disease from recurring.