Vertebrology: diseases — симптомы, диагностика и лечение

The anterior scalene muscle runs from the cervical vertebrae to the first rib. Together with the middle scalene muscle, it forms a narrow gap through which the lower trunks of the brachial plexus and the subclavian artery pass. If the muscle is shortened, tense, or an additional cervical rib interferes with this gap, the neurovascular bundle is compressed. There is aching pain in the neck and shoulder girdle, numbness along the inner edge of the forearm and in the little finger, weakness of the hand, and sometimes coldness and paleness of the hand. Complaints intensify when raising the arm, turning the head and carrying a bag on the shoulder. The condition is referred to as thoracic outlet syndrome, and in most cases it is treated without surgery.

The vertebral arteries are two vessels that ascend to the brain inside the bony foramina of the cervical vertebrae and supply the brain stem, cerebellum and occipital lobes. Vertebral artery syndrome is a set of symptoms that occurs when blood flow through these vessels is obstructed or when the nerve plexus surrounding them is irritated. It manifests itself as dizziness, tinnitus, throbbing pain in the back of the head moving to the temple, flickering and darkening in the eyes, especially when turning and throwing back the head. The reasons are different: bone growths and instability of the cervical vertebrae, atherosclerosis, muscle spasm, vascular abnormalities. An accurate diagnosis requires both an examination by a neurologist and a vascular examination.

Spondylosis and spondyloarthrosis are age-related degenerative changes in the spine. With spondylosis, bone growths - osteophytes - form along the edges of the vertebral bodies; with spondyloarthrosis, the cartilage of small intervertebral (facet) joints wears out. These changes develop gradually, especially in older people, and are often detected on photographs by chance, without any complaints. The lumbar and cervical regions, which bear the greatest load, are most often affected. Pain occurs when joints become inflamed or overgrowths narrow nerve root openings and the spinal canal. Possible consequences include chronic pain, stiffness, and, rarely, nerve compression. There is no cure for age-related changes, but exercise and proper treatment can help you control pain and remain active. You should consult a doctor if pain interferes with your normal life or if numbness occurs.

Spondylolisthesis is a displacement of one vertebra relative to the underlying one, often forward. The lumbar region is usually affected, especially the levels L4–L5 and L5–S1. In young people and athletes, the cause is often a defect of the vertebral arch (spondylolysis); in older people, it is wear and tear of the intervertebral disc and joints. Degenerative spondylolisthesis is more common in women over 50 years of age. The misalignment disrupts the stability of the spine and can narrow the spinal canal, compressing the nerve roots. It manifests itself as pain in the lower back, sometimes radiating to the legs, numbness and fatigue when walking. A slight displacement is often asymptomatic. The diagnosis is confirmed by radiography and MRI. Most patients benefit from conservative treatment, and surgery is needed when the displacement progresses and persistent neurological impairments occur.

Spinal stenosis is a narrowing of the space in which the spinal cord and nerve roots pass. Most often it develops with age: discs lose height, joints thicken, ligaments thicken and bulge into the canal. Due to compression of the nerve structures, a characteristic picture appears: pain, heaviness and numbness in the legs when walking and standing, which goes away if you sit or lean forward. With cervical localization, the spinal cord is already affected, and clumsiness of the hands and unsteadiness of gait occur. The course is usually slow; many people manage with conservative treatment for years, but when neurological disorders increase, surgery is discussed.

Cervicogenic headache is pain that originates in the neck and is felt in the head. The upper cervical vertebrae, their joints, ligaments and muscles are connected to the trigeminal nerve system, so the brain perceives irritation of these structures as pain in the back of the head, behind the ear, in the temple and even around the eye. The pain is usually one-sided, starts from the back and spreads forward, intensifies with an uncomfortable position, turning the head and working at the computer for a long time. It is often confused with migraine and has been treated for years as “osteochondrosis.” Examination helps to distinguish it, and treatment is based primarily on movement and work with the neck muscles.

Scheuermann-Mau disease is a developmental disorder of the vertebrae in adolescence, in which the thoracic spine bends posteriorly more than normal and a persistently round back is formed. Unlike ordinary stoop, this deformity cannot be straightened by force of will or at the request of a doctor: the anterior sections of several neighboring vertebrae grow more slowly than the posterior ones, the vertebrae become wedge-shaped, and the bend is fixed. The disease usually appears between 10 and 15 years of age and is often accompanied by aching back pain after exercise. Early detection is important: while the skeleton is growing, the deformity can be noticeably reduced with exercises and a corset, but after growth is complete, this can no longer be the case.

Radiculopathy is damage to the nerve root as it exits the spine. In everyday life it is called “pinched nerve” or radiculitis. A distinctive feature is that the pain does not remain in the back, but “shoots” along the nerve: in the arm to the fingers if the cervical spine is affected, or in the buttock and along the back of the leg with lumbar pain. Along with the pain comes numbness and weakness. Most cases resolve with conservative treatment, but there are several situations in which delay is dangerous.