Symptoms of cervical osteochondrosis
Osteochondrosis is a degenerative-dystrophic disease of the spine, the basis of which is the defeat of the intervertebral discs. The development of degenerative diseases of the spine is facilitated by prolonged microtraumatisation, excessive static and dynamic stress, hereditary predisposition and age. The most common localization of the lesion is the cervical and lumbar spine. This is due to their greatest mobility and load.
General concept of osteochondrosis
The intervertebral disc loses fluid over time and its shock-absorbing function. He becomes less resistant to physical stress. The ring of fibers, located on the periphery of the disc, gradually thins, cracks form in it. The nucleus pulposus moves along the resulting gaps along the periphery and forms aprotrusion(local protrusion, grade 1). Due to intense physical activity, the protrusion can increase abruptly and shift into the lumen of the spinal canal. In this case they speak of a herniated disc (grade 2). Sometimes exposed fragments of the nucleus can form -sequesters.
In the early stages of the disease, pain can be explained by overstretching the annulus fibrosus and irritation of the posterior longitudinal ligament. The pain can be localized in the back or neck, as well as in distant areas. With cervical osteochondrosis, pain can be reflected in the back of the head, shoulder blade and interscapular region, shoulder girdle and arm.
Pain is accompanied by reflex spasms of the segment muscles. This phenomenon is of a protective nature and stabilizes the damaged area of the spine. Over time, muscle contraction becomes an independent source of pain. When shifting towards the intervertebral foramen, the hernia compresses the adjacent nerve roots. Radicular pain has a stabbing, piercing character, which is clearly localized along the innervation of the nerve. It is accompanied by the appropriate neurological manifestations:
- decrease in sensitivity;
- loss of reflexes;
- muscle weakness.
Disc degeneration disrupts the normal anatomical relationship between the components of the spine: discs, vertebrae, joints, and ligaments. A gradual decrease in the height of the intervertebral disc leads to a change in the joints of the joints and the formation of subluxation and dislocation of the vertebrae. This fact indicates instability of the spine and reduces its resistance to injury, which can lead to exacerbation of osteochondrosis.
With age, the stability of the spine is restored due to the formation of osteophytes, hypertrophy of the articular processes, disc fibrosis, thickening of the articular ligaments and capsules. The final stage of the pathological process is called spondylosis. At this point, the painful sensations subside.
The main symptoms of cervical osteochondrosis
At the level of the cervical segments, the nerve roots and their arteries, the spinal cord and its vessels, and the vertebral arteries can be compressed. Spinal cord compression is possible due to a posterior intervertebral hernia or posterior osteophytes. People with a narrow spinal canal are particularly prone to this. With an inguinal hernia, signs of compression of cervical osteochondrosis develop quickly and symptoms of cerebrospinal fluid flow obstruction are milder.
It is clinically very difficult to distinguish between a compression of the spinal cord by a tumor and a herniated disc. Osteochondrosis of the cervical spine is manifested by spastic paresis of the legs, conduction disorders of sensitivity, pain and weakness in the arms. In some cases, signs of compression are combined with signs of spinal cord ischemia resulting from compression of the spinal artery and radicular vessels.
Symptoms of the anterior horns and ventral regions that affect the pyramidal tract (blood supply to the anterior cerebrospinal artery) may suddenly develop. Anterior spinal syndrome occurs: flaccid paresis of the arms, spastic paresis of the legs, impaired sphincter function. Sometimes symptoms of a gross violation of deep sensitivity in the hands develop. After 2-3 weeks, the signs of a spinal stroke begin to form. Based on the volume of the pathological focus, one can talk about the severity of the residual effects.
Myelopathy is chronic ischemia associated with cervical osteochondrosis. Vascular compression plays an important role in the development of this syndrome. The most characteristic lesion is the ventral sections of the lateral columns and anterior horns. It manifests itself in spastic atrophic paresis of the hands, spastic paresis of the legs, impaired depth sensitivity of the legs (classic triad).
A number of patients develop the Lermitte symptom: the feeling of an electrical discharge along the entire spine with irradiation of pain in the arms and legs when moving the head. Possibly the development of amyotrophic lateral sclerosis with no bulbar symptoms.
MRI and CT scans, which show compression of the meningeal pouch by osteophytes and a thickened ligamentum flavum, play an important role in confirming myalopathy.
Signs of radicular compression
Since the intervertebral discs underneath wear out more quickly, spondyloarthrosis develops in the corresponding segments. Osteophytes narrow the intervertebral foramen and compress the roots (at the lumbar level, compression of a herniated disc in the epidural space is more common). When the head moves, the growths injure the root, leading to the formation of edema, which further narrow the intervertebral foramen. Develop reactive inflammatory responses.
- C3 root (below the 2nd cervical vertebra, occurs quite rarely) - pain in the corresponding half of the neck, a feeling of swelling of the tongue, a feeling of a lump in the throat;
- C4 root - pain in the corresponding shoulder girdle, collarbone, atrophy of the trapezius muscle, decreased neck muscle tone (irritation of the 3rd and 4th roots of the neck increases the tone of the diaphragm, which leads to a shift of the liver downwards and the appearance of angina pectoris);
- C5 root - pain in the neck and on the outer surface of the shoulder, hypotrophy of the deltoid muscle;
- C6 root (one of the most common localizations) - pain in the neck, shoulder blade, shoulder girdle along the outer surface of the shoulder, radial surface of the forearm extends up to 1 finger, paresis in the hands, weakness of the biceps muscles;
- C7 root - pain spreads to 2-3 fingers, accompanied by paresthesia, weakness of the triceps muscle;
- C8 root - pain spreads to the ulnar surface of the forearm up to the 5th finger, accompanied by paresthesia.
Cervical reflex syndromes
The vertebral syndrome manifests itself in acute neck pain (lumbago, cervicalgia), less often in chronic or subacute pain. The main sources of pain are the annulus fibrosus, the posterior longitudinal ligament, the joint capsule, and the tense muscles. Torticollis is not as pronounced as the curvature of the spine in the lumbar spine.
Painful pains radiating to the back of the head. Strengthened by movement or by staying in one position for a long time. Palpation determines the sensitivity of the spinous processes and joint capsules on the diseased side (along the back surface of the neck 3-4 cm to the side of the spinous processes). Characterized by the involvement not only of the back, but also of the anterior muscles of the spine (anterior scalena, etc. ).
Anterior Scal Muscle Syndrome
Scale muscle tension is very common in cervical osteochondrosis. The muscle is somewhat defined on the side of the sternocleidomastoid muscle in the form of a tense cord, dense and larger compared to the healthy side. Tension leads to compression of the supraclavicular vessels, which is accompanied by pain and swelling in the hand, impaired sensitivity and motor activity (along the ulnar nerve). The pain is worse in a horizontal position.
Pectoralis Minor Syndrome
The development mechanism is similar to the previous one. Compression of the neurovascular bundle occurs between the muscle and the humerus (or the coracoid process) under conditions of increased arm abduction. It is accompanied by pain in the chest, shoulder blade, arm.
The signs present are often viewed as heartache with VSD (there are no acute attacks, there is no effect from taking nitroglycerin or sedatives, increased symptoms during exercise and palpation of pain points).
Posterior sympathetic syndrome
Characteristic are dystrophic vasomotor disorders caused by irritation of the sympathetic plexus of the vertebral artery. Branches of the plexus are also found in the tissues of the brain and skull. Clinically manifested by dizziness, tinnitus, visual disturbances, anxiety.
The compression of the vertebral arteries by osteophytes emanating from the joints of the spine, in combination with atherosclerotic lesions of these vessels, is an important pathogenetic factor in the development of insufficiency of the arteries of the brain and spinal cord.
In most cases, pain in the arms and neck is associated with cervical osteochondrosis. In some patients pain is caused by a herniated disc, in others by osteophytes and osteoarthritis of the spinal joints. Either of these options can result in local or reflected pain, radicular syndrome, and myelopathy. When examining patients with neck pain, pathologies such as:
- spinal tumors are excluded;
- epidural abscess;
- subarachnoid hemorrhage;
- retropharyngeal abscess;
- dissection of the carotid artery;
- fracture of the cervical vertebrae.