Vertebrology: diseases — симптомы, диагностика и лечение

Kyphosis is a backward curvature of the spine. In the thoracic region it exists in everyone and is the norm; the disease is indicated when the bend exceeds the permissible values ​​and the back becomes excessively round. The reasons depend on age: in adolescents, most often it is postural stoop, easily corrected with effort, or Scheuermann's disease, in which the vertebrae acquire a wedge-shaped shape and the deformity becomes rigid. In older people, the leading cause is osteoporosis with compression fractures of the vertebrae, which causes the formation of a characteristic hump and reduced growth. Determining the cause is important because treatments vary dramatically.

A compression fracture of the spine is an injury in which the vertebral body is compressed in height and takes on a wedge-shaped shape. For young people, this is the result of a serious blow: a fall from a height, a jump into water, an accident. In older people, especially women after menopause, the vertebra can break from minor forces - sudden bending, lifting a bag, or coughing if the bone is weakened by osteoporosis. The lower thoracic and upper lumbar vertebrae are most often affected. The main danger is not the pain itself, but a possible narrowing of the spinal canal with pressure on the spinal cord and roots, as well as gradual deformation of the back with repeated fractures. Therefore, the diagnosis needs to be confirmed with pictures, not sensations.

Lumbago, or lumbago, is a sudden sharp pain in the lumbar region, which often occurs when bending over, lifting something heavy, or making a sharp turn. The pain can be so severe that the person freezes in a forced position and cannot straighten up. In most cases, the cause is overload and spasm of the muscles, ligaments and small joints of the spine, and not a dangerous disease. This nonspecific back pain usually improves markedly within a few days or weeks. Maintaining all possible activity, heat and painkillers as recommended by a doctor help, and strict bed rest slows down recovery. Urgent help is needed for numbness in the perineum, difficulty urinating, weakness in the legs, injury or fever.

Myelopathy is a general name for damage to the spinal cord of any nature. Most often in adults, it develops due to gradual compression of the spinal cord in the cervical region by bone growths, herniated discs and thickened ligaments. Less commonly, the cause is tumors, circulatory problems, inflammation, vitamin B12 deficiency, or the consequences of injury. Manifestations accumulate gradually: first, clumsiness in the fingers and difficulty with small movements appear, then unsteadiness of gait, weakness and numbness in the legs, and later urination problems. The insidiousness of myelopathy is that there may be no pain, so people do not see a doctor for a long time, and in the meantime the nerve fibers are damaged irreversibly.

Myofascial pain syndrome is acute or chronic muscle pain associated with the formation of trigger points: dense, painful nodules in tense muscle fibers. When pressing on such a point, a sharp pain occurs, which often radiates to distant parts of the body. The syndrome develops due to muscle overload, prolonged awkward posture, injury, stress and lack of mobility. The muscles of the neck, shoulder girdle, lower back and buttocks are most often affected. Myofascial pain is one of the most common causes of back and neck pain and is often mistaken for a herniated disc or “osteochondrosis.” The diagnosis is made upon examination, without complex studies. Without treatment, the pain can become chronic. The condition is not life-threatening and responds well to treatment if the provoking factors are eliminated and normal muscle function is restored.

Poor posture is a persistent deviation of the usual body position from the optimal one, in which the spine is structurally unchanged. This is a fundamental difference from scoliosis: if posture is impaired, a person can straighten up by force of will, and the deformation disappears in a lying position, whereas with true scoliosis, changes in the vertebrae always remain. Most often, the problem develops at school age against the background of long periods of sitting, heavy backpacks, weak back and abdominal muscles, and prolonged use of gadgets. Poor posture itself is not a disease, but over time it leads to back and neck pain, headaches and fatigue.

Cervical instability is a condition in which the vertebrae, when bending and straightening, move relative to each other more than normal, because the ligaments, intervertebral disc and muscles no longer hold them securely. It can be a consequence of trauma, degenerative changes in the disc, previous surgeries, congenital features and systemic connective tissue diseases. Typical complaints are pain and fatigue in the neck, crunching, a feeling of “unstable” head, headaches in the back of the head, dizziness when turning. The diagnosis is made not by complaints alone, but by functional x-rays in flexion and extension. Most patients are treated without surgery, but it is important to notice early signs of compression of the nerve structures.

Intervertebral disc protrusion is a protrusion of the disc beyond the vertebral bodies without rupture of its outer fibrous ring. This is one of the stages of disc degeneration that may precede a herniation. The lumbar and cervical regions are most often affected. Protrusions are very often found on MRI in adults without any complaints, and such a finding in itself is not a diagnosis requiring treatment. Pain occurs if the protrusion irritates the nerve root or is combined with overload of the muscles and joints. Then you are worried about pain in the lower back or neck, shooting in the leg or arm, and numbness. It is important to evaluate not only the image, but also the symptoms. In the vast majority of cases, protrusion is treated conservatively: movement, exercises and pain relief as prescribed by the doctor.

Sacroiliitis is an inflammation of the sacroiliac joint, which connects the sacrum to the pelvic bones. These joints are almost immobile, but bear a large load, and their inflammation causes deep pain in the buttock and sacrum, radiating to the back of the thigh. A distinctive feature of inflammatory pain is that it is stronger at night and in the morning, accompanied by stiffness for more than half an hour and decreases with movement rather than at rest. Sacroiliitis is not an independent diagnosis, but a key symptom of a group of diseases, primarily axial spondyloarthritis. Less commonly, it is infectious or associated with pregnancy and trauma. Early diagnosis is important because modern treatment can stop progression.

Piriformis syndrome is pain in the buttock associated with tension or spasm of the piriformis muscle and irritation of the adjacent sciatic nerve. The piriformis muscle is located deep under the gluteus maximus muscle and is involved in external rotation of the hip. The pain intensifies with prolonged sitting, climbing stairs, crossing legs and can radiate along the back of the thigh, reminiscent of sciatica. The syndrome often occurs after overload, a fall on the buttock, in people with sedentary work and in runners. The diagnosis is made after excluding disc herniation, diseases of the hip and sacroiliac joints. Treatment is conservative: stretching, physical therapy, painkillers, and, if necessary, injections.