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 microtraumatization, excessive static and dynamic load, hereditary predisposition, old 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 loses its shock-absorbing function. He becomes less resistant to physical exertion. The annulus fibrosus, which is located on the periphery of the disc, gradually becomes thinner, 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 abruptly increase and shift into the lumen of the spinal canal. In this case, they speak of a disc herniation (grade 2). Sometimes free-lying fragments of the nucleus can form -sequesters.
In the initial stages of the disease, pain can be explained by overstretching of the annulus fibrosus and irritation of the posterior longitudinal ligament. The pain can be localized locally in the back or neck, as well as in distant areas. With cervical osteochondrosis, pain can be reflected in the back of the head, scapula and interscapular region, shoulder girdle and arm.
Pain is accompanied by reflex spasm of segmental muscles. This phenomenon is of a protective nature and stabilizes the damaged area of the spinal column. Over time, muscle contraction becomes an independent source of pain. When displaced towards the intervertebral foramen, the hernia compresses the adjacent nerve roots. Radicular pain has a shooting, piercing character, clearly localized along the innervation of the nerve. It is accompanied by the corresponding neurological manifestations:
- decrease in sensitivity;
- loss of reflexes;
- muscle weakness.
Disc degeneration disrupts the normal anatomical relationship between the components of the spinal column: discs, vertebrae, joints and ligaments. A gradual decrease in the height of the intervertebral disc leads to a change in articular connections and the formation of subluxation and dislocation of the vertebrae. This fact indicates instability of the spinal column and reduces 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. Painful sensations subside by this time.
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. Compression of the spinal cord is possible due to posterior intervertebral hernia or posterior osteophytes. People with a narrow spinal canal are especially prone to this. With a hernia, the compression signs of cervical osteochondrosis develop quite quickly, and the symptoms of a block of cerebrospinal fluid flow are milder.
It is very difficult to distinguish clinically between spinal cord compression 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 ischemia of the spinal cord substance resulting from compression of the spinal artery and radicular vessels.
Symptoms of the anterior horns and ventral regions may suddenly develop with involvement of the pyramidal tract (blood supply to the anterior spinal artery). Anterior spinal syndrome occurs: flaccid paresis of the hands, 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 spinal stroke begin to regress. By the volume of the pathological focus, one can say about the severity of the residual effects.
Myelopathy is a 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 the anterior horns. It is manifested by spastic atrophic paresis of the hands, spastic paresis of the legs, impaired deep sensitivity of the legs (classic triad).
A number of patients develop Lermitte's symptom: a sensation of an electric discharge along the entire spine with irradiation of pain in the arms and legs when moving the head. Perhaps the development of amyotrophic lateral sclerosis in which there are no bulbar symptoms.
An important role in confirming myalopathy is played by MRI and CT, which reveal compression of the meningeal sac by osteophytes and a thickened ligamentum flavum.
Signs of radicular compression
Since the underlying discs wear out faster, spondyloarthrosis develops in the corresponding segments. Osteophytes narrow the intervertebral foramen and squeeze 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, which causes the formation of edema, which further narrows the intervertebral foramen. Develop reactive inflammatory reactions.
- 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, clavicle, atrophy of the trapezius muscle, decreased neck muscle tone (irritation of the 3rd and 4th cervical roots increases the tone of the diaphragm, which leads to displacement of the liver downward and the appearance of angina pectoris);
- C5-root - pain in the neck and outer surface of the shoulder, hypotrophy of the deltoid muscle;
- C6-root (one of the most common localizations) - pain in the neck, scapula, shoulder girdle along the outer surface of the shoulder, radial surface of the forearm extends to 1 finger, paresisia in the hands, weakness of the biceps muscle;
- C7-root - pain spreads to 2-3 fingers, accompanied by paresthesias, weakness of the triceps muscle;
- C8-root - pain spreads to the ulnar surface of the forearm to the 5th finger, accompanied by paresthesias.
Cervical reflex syndromes
Vertebral syndrome is manifested by acute neck pain (lumbago, cervicalgia), less often chronic or subacute pain. The main sources of pain are the annulus fibrosus, posterior longitudinal ligament, joint capsule, tense muscles. Torticollis is not as pronounced as the curvature of the spine at the lumbar level.
Aching pains, radiating to the back of the head. Strengthened by movement or prolonged stay in one position. On palpation, tenderness of the spinous processes and joint capsules on the diseased side is determined (along the posterior outer surface of the neck 3-4 cm lateral to the spinous processes). Characterized by the involvement in the process of not only the back, but also the anterior muscles of the spine (anterior scalene, etc. ).
Anterior scalene muscle syndrome
Scale muscle tension very often occurs in cervical osteochondrosis. The muscle is defined somewhat on the side of the sternocleidomastoid muscle in the form of a tense cord, dense and increased in size compared to the healthy side. Due to tension, compression of the supraclavicular vessels occurs, 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 coracoid process) under conditions of enhanced arm abduction. It is accompanied by pain in the chest, scapula, arm.
The existing signs are often considered as pain in the heart with VSD (there are no acute attacks, there is no effect from taking nitroglycerin or sedatives, increased symptoms during movement and palpation of pain points).
Posterior sympathetic syndrome
Dystrophic, vasomotor disorders are characteristic, which arise as a result of irritation of the sympathetic plexus of the vertebral artery. Plexus branches are also located in the tissues of the brain and skull. Clinically manifested by dizziness, tinnitus, visual disturbances, anxiety.
Compression of the vertebral arteries by osteophytes emanating from the joints of the spinal column, 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, the pain is caused by a herniated disc, in others - by osteophytes and arthrosis of the joints of the spine. Each of these options can lead to local or reflected pain, radicular syndrome and myelopathy. When examining patients with neck pain, it is necessary to exclude pathologies such as:
- spinal tumors;
- epidural abscess;
- subarachnoid hemorrhage;
- retropharyngeal abscess;
- dissection of the carotid artery;
- fracture of the cervical vertebrae.