Cervical Chondrosis: Symptoms and Treatment

Experts describe modern methods of treating patients with cervical osteochondrosisCervical pain is a very common phenomenon, and people who are far away from medicine often refer to it as "chondrosis". It is believed that almost "everyone" will develop the disease by a certain age, which means you just need to "be patient".Orthopedic traumatologist and neurosurgeon Alexey Peleganchuk, PhD, chief of the Department of Neuro-Orthopaedics, talks about the technologies available to doctors today to help such patients.

What disease is "cervical chondrosis" commonly referred to by patients? What is the correct diagnosis?

– In fact, "cervical osteochondrosis" is slang; the correct name for this disease is "cervical osteochondrosis". This term is used by doctors of the post-Soviet era and corresponds to the current ICD (International Classification of Diseases) on which we work. However, in most countries this disease does not exist; they call it "degenerative dystrophic disease". When making a diagnosis, we indicate "cervical osteochondrosis" and then we decipher which spinal motion segments are affected.

Most often, people associate this disease with pain in the cervical spine. Is this the main and/or only symptom?

– The most common reason such patients see a neurologist is pain. It can be said that the main clinical manifestation of cervical osteochondrosis, a degenerative disease, is pain. In addition, a more dangerous manifestation of common degenerative pathologies is weakness of the upper limbs (and possibly lower limbs) and impaired sensitivity - numbness.

Will cervical osteochondrosis cause headaches and tinnitus?

– These are atypical symptoms of cervical osteochondrosis, but they sometimes occur. If such a patient were to appear, then, first of all, this would be a reason to order an MRI of the brain to rule out any organic changes. If the patient has already done this, he is not suitable for conservative treatment and there is a matrix in the form of a herniated disc, which is extremely rare but can cause these phenomena reflexively, then there is an option that can help this patient, but the effect will be significantly lowerClassic treatment for cervical pain.

What is the cause of the pain? What options are currently available to treat such patients?

– Three groups of patients can be distinguished. The first group are reflex pain syndromes, the second group are radiculopathy syndromes, myelopathy - lesions of the spinal cord itself, such as severe stenosis, and the third group are extremely rare patients, but the most complex and severely affectedThe patient is neurotic.Reflex pain syndrome can spread locally in the neck and radiate to the shoulder girdle and upper extremities. But this pain syndrome is characterized by a lack of compression (absence of compression) of the nervous tissue—that is, the spinal cord and its roots.So in this case, if we consider the option of surgical treatment, then these are outpatient approaches - such as blockade. More invasive procedures include radiofrequency denervation and cold plasma radiofrequency ablation of the disc—a hardware-based procedure that can be performed without an incision.

The goal is to eliminate the pain syndrome or significantly reduce its intensity and reduce the patient's need for analgesics.

The second group of patients were hernia patients. Cervical hernias can cause root compression and may require surgery if conservative treatments fail. The purpose of this operation is to decompress, that is, to remove the hernia individually, the roots of the spinal cord will be freed and the pain syndrome will subside.With large hernias, there is also a conduction disorder: in addition to compression of the roots of the spinal cord, the spinal cord itself may be compressed (compressed). Patients then develop more severe clinical manifestations of quadriparesis, which is weakness in the upper and lower limbs. In this case, decompression is needed - creating space for the spinal cord to recover a second time. What needs to be understood is that surgery does not restore the spinal cord and nerves, but creates conditions, that is, reserves space.In addition to hernias, there are also circular strictures. They form due to complex problems in the cervical spine, resulting in a rounded narrowing of the cervical spinal canal.These critically ill patients sometimes remain ill for several years, and unfortunately, they are often admitted to the hospital with severe neurological deficits and often require two-stage surgery.Another group of patients are people with neuropathic pain syndromes. In this condition, the patient develops neuropathy (pain in the nerve itself) in the absence of stenosis. Neuromodulation (neurostimulation) is then used to help. It involves the installation of special epidural electrodes on the structures at the back of the spinal cord. It's a special piece of equipment - one might say, like a physical therapy machine you carry around with you: you can turn it on and increase the power to relieve pain. This is helpful even in very difficult situations.All of these technologies are available to patients; financing comes from a variety of sources, including mandatory health insurance and quotas for high-tech medical care.

Can osteochondrosis be cured?

– Osteochondrosis itself is incurable. What can be done? Assume a conditional patient: cervical osteochondrosis, the main lesion is at the C6-C7 vertebral level, there is degenerative stenosis at this level, and the right C7 spinal cord root is compressed.During surgery, if the spinal cord itself is compressed, strictures can be removed, hernias removed, or the roots of the spinal cord can be decompressed. But the first four words of the diagnosis (cervical osteochondrosis) will remain for life because it is incurable. The surgeon affects the clinic's foundation, and the clinic's foundation is the hernia that causes the stenosis.

How is the treatment strategy determined?

——There is such a concept-clinical morphology correspondence. Physicians must observe patients from all aspects—performing orthopedic examinations, neurological examinations, taking medical histories, chief complaints—and correlate these data with research.The screening study for cervical osteochondrosis is MRI, unless for some reason the study would be detrimental to the patient. If necessary, MSCT can also be performed to determine action strategies.However, not all hernias depicted on MRI require surgery. The hernia itself is not a reason for surgery. Experts must determine the extent to which it causes compression, etc. , and decide whether surgery is advisable.

At what age do these problems most commonly occur?

– The average age of our patients is over forty years, but surgical intervention is also required in young people if the degenerative cascade starts earlier, leading to the formation of hernia matrix. In this case, the first step is conservative treatment, and if that doesn't work, then the only option is surgery.

What are the risk factors?

– We don’t live in India and our countrymen don’t wear anything on their heads. It need not be said, therefore, that work or habit leads to the premature wear and formation of these forms.The main risk factor is genetics. This applies not only to the cervical spine, but also to the thoracic and lumbar areas – this is the weak point of the annulus fibrosus tissue. Other risk factors—excess weight, extreme work—are reflected more in the lumbar region.

Is it possible to prevent it somehow?

– Prevention starts with exercise therapy so that there is tone in the muscles, the muscles work normally and spasms do not occur. The fact is that when degenerative processes occur, it can occur in the discs and spinal joints, which can cause muscle spasms and the person will feel pain. Therefore, massage, acupuncture, etc. are beneficial for reflex pain syndrome.

What determines the effectiveness of treatment?

– Please consult a neurologist promptly if the following problems occur: cervical spine pain spreads to the upper limbs, arm numbness and weakness, and decreased strength. A very serious condition is annular stenosis, which can also increase weakness in the lower limbs when the spinal cord is already affected.It happens that people live with it for years and think it's just "age related". But their condition gets worse every year, so the disease limits their movement - they can only walk a few meters.The expert will assess the degree of risk and, if necessary, refer to other research methods and, if necessary, consult a chiropractor responsible for the surgical treatment of spinal pathologies. The purpose of the consultation is to determine whether surgical intervention is required. If surgery is not required, a neurologist is already treating it conservatively. If surgical treatment is needed, surgery is performed and the patient is sent to a neurologist for rehabilitation.

The goals of conservative treatment are to achieve a long period of remission and to minimize the frequency of exacerbations, both in duration and frequency. This also applies to acupuncture treatment methods. However, if significant changes such as hernia and spinal root compression have occurred, conservative treatment may not be effective.

At the same time, operations must be timely. The goal of surgery is to save nervous tissue, either the spinal cord or its roots. If a person has the disease for many years, this can lead to myelopathy (changes in the spinal cord itself that may not recover, even with excellent surgery) or radiculopathy (damage to the roots of the spinal cord).If the surgery is performed on time and to standard, there is a high chance that both the spinal cord root and the spinal cord itself will be restored, and the person who recovers will feel actually healthy.As the pathology progresses, the effectiveness of surgical intervention decreases. In cases of persistent neurological disease, surgery may not result in significant progress because the spinal cord itself or the roots are already dead at the time of surgery.Every patient suffering from one or another pathological variant requires a personal consultation with a specialist. At the same time, most patients with cervical osteochondrosis can be helped without surgery and with complex conservative treatments.