Vertebrology: diseases — симптомы, диагностика и лечение

Osteochondrosis is age-related degenerative changes in the intervertebral discs and joints of the spine. It is important to understand: to one degree or another, almost all people after 30–35 years have them, and in themselves they are not a disease. The problem is that this diagnosis in post-Soviet medicine is used to explain almost any pain - in the back, neck, head, arm, heart. Meanwhile, in most cases, back pain is not associated with “salt deposits”, but with muscles and joints, and responds well to movement, rather than rest and IVs.

A herniated disc is the release of the internal contents of the disc beyond its outer ring. The diagnosis sounds alarming, and most patients immediately think about surgery. In reality, the picture is different: a significant proportion of hernias exist asymptomatically, and of those that cause pain, the majority resolve conservatively within 6-12 weeks. Moreover, large hernias and sequesters often decrease or completely resolve on their own - the body “digests” them. Surgery is necessary for a minority, but there are a few situations where delay is unacceptable.

Scoliosis is a three-dimensional deformation of the spine with lateral curvature and rotation of the vertebrae. Most often it is idiopathic, that is, it develops without an established cause, and appears during a period of rapid growth, much more often in girls. The main feature of scoliosis is that it progresses during the child’s growth and stops after its completion. Therefore, timing is everything: scoliosis detected in time can be supported with a corset, but if missed, it will require surgery. Posture and “correct sitting” have almost no effect on true scoliosis, and it’s worth knowing this so as not to waste months.

Thoracalgia is pain in the thoracic spine and chest associated with its joints, muscles, ligaments or nerve roots. It can be dull and aching between the shoulder blades, or it can shoot along the ribs, intensifying when inhaling, coughing and turning the body. Most often, the cause is benign: muscle overload, prolonged slouching posture, arthrosis of the costovertebral joints. But it is in this area that pain can easily be confused with cardiac, pulmonary or gastric pain, and sometimes it is the first sign of a vertebral fracture in osteoporosis. Therefore, it is always worth showing a doctor if you experience chest pain for the first time.

Most adults experience back pain at least once in their lives. In the vast majority of cases, it is nonspecific: the source is the muscles, ligaments and small joints of the spine, and not a hernia or “displacement of the vertebrae.” Such pain usually decreases significantly within a few weeks, and the main thing in its treatment is not bed rest, but maintaining feasible activity. It is much more important to recognize rare dangerous causes in time: fracture, infection, tumor, compression of nerve roots. They are the ones the doctor's examination is aimed at, and they are the ones who determine whether images are needed.

Cervicalgia is pain in the neck, one of the most common reasons for visiting a neurologist. In most cases, it is nonspecific: it is associated with overstrain of muscles and ligaments, an uncomfortable posture at the computer or with a smartphone, or sleeping on a high pillow. It is often accompanied by headache and stiff shoulders. This pain usually goes away within a few days or weeks with moderate activity. Less commonly, the cause is a herniated disc with compression of the root, trauma, inflammatory diseases of the joints, and sometimes diseases not related to the spine. Chronic pain is considered if it persists for more than three months. The main thing is not to miss warning signs and not to treat your neck with long bed rest and a collar without a doctor’s prescription.

Vertebrobasilar insufficiency is a violation of the blood supply to the posterior parts of the brain, which are fed from the vertebral and basilar arteries. These departments are responsible for balance, coordination, vision, swallowing and speech. In the strictest sense, we are talking about transient ischemic attacks - short-term episodes in which dizziness suddenly appears along with double vision, speech impairment, unsteadiness or numbness, and then goes away. The main cause is atherosclerosis, less commonly arterial dissection or a blood clot from the heart. Such episodes are a harbinger of a stroke and require urgent examination. At the same time, isolated dizziness, especially when turning the head, is often associated with the inner ear rather than with the vessels, and the diagnosis of VBI in such cases is often made incorrectly.

Hyperlordosis is an excessive forward curve of the spine, most often in the lumbar region. Every person has a slight lordosis: it absorbs the load when walking. When the deflection becomes excessive, the pelvis tilts forward, the stomach protrudes, the buttocks seem to be pushed back, and the load is redistributed to the intervertebral joints and back muscles. The reasons include weakness of the abdominal and buttock muscles, shortening of the hip flexors, excess weight, pregnancy, prolonged sitting, and in children - growth characteristics. Hyperlordosis itself is not a disease, but it causes fatigue and pain in the lower back and, over time, accelerates wear and tear on the joints of the spine. In most cases, the situation is corrected with exercises and habit correction.

Schmorl's hernia is a depression of the cartilage tissue of the intervertebral disc into the body of an adjacent vertebra. Unlike the usual disc herniation, it is not directed back, towards the nerves, but up or down, into the bone. Therefore, it does not compress the nerve roots and spinal cord and does not itself cause pain, numbness or weakness. Such nodes are found by chance on X-rays or MRIs in a large number of people, including those who do not complain about their back at all. Most often this is a reflection of structural features and loads, less often - a sign of a previous injury, Scheuermann's disease or weakening of the bone. Special treatment is usually not required.

A Tarlov cyst, or perineural cyst, is an expansion of the nerve root sheath filled with cerebrospinal fluid. Most often, such cysts are found in the sacral spine, less often in the lumbar and thoracic spine. Most of them do not manifest themselves and are discovered incidentally during an MRI performed for another reason. Symptoms appear only when a large cyst grows and puts pressure on the root or bone of the sacrum: then there is pain in the sacrum and coccyx, radiating to the leg or perineum, numbness, problems with urination and bowel movements. The mere presence of a cyst in an MRI does not mean that surgery is needed: the decision is made by comparing the size of the cyst with actual complaints and neurological examination data.