OSTEOCHONDROOSTEOCHONDROSISSIS

is a polyfactorial disease that develops

In case of two conditions: Decompensation of

trophic systems Local excessive load on

spinal segments

PATHOGENESIS OF PATHOGENESIS OF OSTEOCHONDROSISOSTEOCHONDROSIS The first stage. There are degenerative changes of pulp nuclei

The second stage. There are degenerative changes in fibrous ring, disc protrusion and disc hernia

The third stage. There are changes of hyaline plates - subchondral sclerosis

X –RAY SIGNS OF X –RAY SIGNS OF OSTEOCHONDROSISOSTEOCHONDROSIS

Low height of between vertebral discs

Sclerosis of final plates Osteophytes on the edges of

vertebras’ bodies. They are located perpendicularly to the spinal axis

Local scoliosis Spondilolisthesis – dislocation of

neighbouring vertebras’ bodies Local cyphosis (instead of

lordosis))

VERTEBRAL DISC’S VERTEBRAL DISC’S HERNIAHERNIAMain positions are: Medial (clinical features of horse tail

lesion) Paramedial (a little bit out side the

medial position – several radixes are compressed)

Posterior – medial (much more out side the medial position – 1 or 2 radixes are compressed)

Foraminal - (– 1 radix is compressed)

PATHOGENESIS OF PATHOGENESIS OF NEUROLOGICAL SIGNSNEUROLOGICAL SIGNS

Irritation of vessels and nerves with vascular spasm.

Compression of vascular – nervous complex.

Edema (perivascular edema and radicular edema)

Reactive process of neibouring structures (straining of muscles)

Autoimmune reactions (a part of disc becomes antigen))

Compressive syndrome occurs at compression and deformation of radix, vessels and spinal cord.

Reflex syndrome occurs at irritation of different receptors (such as Lushka nerve).

CLASSIFICATIONCLASSIFICATION.Reflex syndromes

Lumbago (backache) Lumbalgia Lumbar ischialgia (muscular – tonic, neuro-

dystrophic, autonomic vascular)Compressive radicular syndromes.Compressive vascular radicular – spinalsyndromes (radicular ischemia) Acute

Transient Strokes

Chronic ischemic myelopathy

VERTEBROGENOUS SYNDROMEVERTEBROGENOUS SYNDROME

Limitation of movements in lumbar – sacral part of spinal cord (bending forward, backward)

Increasing of pain while movements, coughing and laughing

Protective straining of long back muscles Extension of lumbar lordosis, cyphosis in

lumbar – sacral division Scoliosis, sometimes with rotation Painful paravertebral points and

vertebral processes

VERTEBROGENOUS VERTEBROGENOUS SYNDROMESYNDROMEDischarge – postures and symptoms

Knee – elbow positionWhile standing the patient keeps his leg aside in order to make the load less on his leg

While lying in the bed he bends his leg in all joints.

The symptoms of spinal cord instability (it is difficult for the patient to stand, to wash himself, but it is much more easier to walk)

REFLEX REFLEX SYNDROMESSYNDROMES on lumbar – sacral level are divided

into:

1. Lumbago 2. Lumbalgia3. Lumbar ischialgia- muscular – tonic vascular neuro- dystrophic

THE POINTS OF THE POINTS OF PAIN:PAIN:Pain along the crista iliaca The point of iliosacral jointThe point of m. gluteus minimus

(just under the crista iliaca)The point of m. gluteus medius (1

sm lower)The point under the backside foldTrochanter os iliacaAlong the ischiadic nerve (the

posterior surface of hip and fossa subpoplitea)

THE SYMPTOMS OF THE SYMPTOMS OF STRAINSTRAIN

Lasegue’s symptom – in case of straining and lifting the leg the low back pain appears

Neri symptom – there is pain in leg at bending head forward

Matskevych symptom – there is pain in the anterior surface of the leg at knee bending while lying on abdomen

Wasserman symptom – the same clinical picture at lifting the leg

THE SYMPTOMS OF THE SYMPTOMS OF STRAINSTRAINSequar symptom – there is pain on posterior surface of leg at foot flexing

Turin symptom – the same clinical picture at toe’s flexing

Bechterev’s symptom – there is pain at knee – flexed leg extension

Dejerine’s symptom - there is pain in posterior surface of the leg at coughing, sneezing

PIRIFORMIS PIRIFORMIS SYNDROMESYNDROME

Clinical features: Painful palpation of Trochanter major

Painful m.PiriformisSymptom of Soobrase (painful cross-legged position)

Symptom of Bone – Bobrovnikova (painful abduction of leg)

PIRIFORMIS PIRIFORMIS SYNDROMESYNDROMEPopelyansky intermittent claudication (while walking the patient is forced to sit down because of the pain. That is the result of spasm of the vessels.

Sphincter disorders (pause before the urination)

Signs of n. ischiadicus lesion (muscles hypotrophy, low Achille reflex, hyposthesia, pain)

NEURODYSTROPHIC FORM OF LUMBAR ISCHIALGIA Sacroiliac periartrosis - pain and limitation of movements in hip joint. The patients cannot run and so on.

Knee joint periartrosis– sudden pain in knee joint

Coccygodynia Neurodystrophic changes of Achille tendon (it is very rare)

RRADICULOPATHYADICULOPATHY

Radix L5 ( Disc L4 – L5) Pain in the external edge of hip, on

the anterior –external surface of crus until the internal surface of foot and great toe.

Sensory disorders (hypalgesia, analgesia) in the same zones

Paresis of great toe extensors and foot extensors

Hypotonia and hypotrophy on the anterior surface of crus

The patient cannot stand on heels

RRADICULOPATHYADICULOPATHYRadix S1 (Disc L5 – S1) Pain in external – posterior

surface of hip, crus, foot, the IV –th and Vth toes.

Sensory disorders (hypalgesia, analgesia) in the same zones

Paresis of toes flexors Absent or low Achille reflex

RRADICULOPATHYADICULOPATHYRadix L4 (Disc L3 – L4) Pain in anterior – internal surface of hip Sensory disorders (hypalgesia, analgesia)

in the same zones prevail over motor ones Weakness of m. Quadriceps femoris Hypotrophy of m. Quadriceps femoris Knee reflex is low or sometimes increased

RRADICULOPATHYADICULOPATHYRadix L2 – L3 Clinical features include pain and sensory

disorders on anterior – medial surface of hip.

Symptoms of Matskevych, Wasserman Low knee reflex Weakness of m. Quadriceps femoris Cruralgia Symptoms of lesion of horse tail Irradiation of pain into lower part of

abdomen, genital organs

COMPRESSION OF COMPRESSION OF HORSE TAILHORSE TAILIt is created by radix L2 – S5. It is observed at hernia of discs L4 – L5.

Clinical features:Significant pain in legsSensory and motor disorders in certain zones of innervation

Pelvic disorders (incontinence of urine and feces)

CLASSIFICATION ON CERVICAL LEVELCLASSIFICATION ON CERVICAL LEVEL Reflex symptoms.

Stiff neckCervicalgiaCervical cranialgiaCevical brachialgia

Muscle – tonic syndromeAutonomic – vascular syndromeNeurodystrophic

Compressive radicular syndrome

CLASSIFICATION ON CERVICAL CLASSIFICATION ON CERVICAL LEVELLEVEL

Compressive – spinal syndrome Compressive vascular radicular – spinal

syndrome Acute

TransientStrokes

Chronic ischemic myelopathy A. vertebralis syndrome

CERVICAL CERVICAL CRANIALGIACRANIALGIA

Clinical features of posterior cervical sympathetic syndrome:Cranialgia – occipital pain with

irradiation in temporal, parietal parts.

Vestibulo – cochlear disturbances – dizziness, vomiting

Eyes symptoms – eyes pain, tears. Autonomic upper quadrant

syndrome – asymmetry of blood pressure, temperature, pulse, sensation, cardiac pain and so on.

CERVICAL CERVICAL BRACHIALGIABRACHIALGIAMuscle – tonic formNeurodystrophic formAutonomic – vascular one

MUSCLE – TONIC FORM

Muscle – tonic form - Scalenus – Muscle – tonic form - Scalenus – syndrome. syndrome. Clinical features:Clinical features:There are pains above and under There are pains above and under clavicle at the muscle strainingclavicle at the muscle strainingThere are pains at head movements There are pains at head movements with irradiation in the armwith irradiation in the armEdema in above clavicle regionEdema in above clavicle region

CERVICAL CERVICAL BRACHIALGIABRACHIALGIA

Neurodystrophic form Shoulder – scapula periartrosis

Shoulder – hand syndromeEpicondilosis

CERVICAL CERVICAL BRACHIALGIABRACHIALGIAShoulder – scapula periartrosis Clinical

features: Pain and limitation of movements in shoulder Painful palpation of caput os humeri Limitation of arm movements (the patient

cannot comb his hair) The symptom of frozen shoulder M. deltoideus, m. supraspinatus atrophy

SHOULDER – HAND SYNDROMESHOULDER – HAND SYNDROME

This syndrome includes clinical features of shoulder – scapula periartrosis and autonomic – trophic changes of hand.

Clinical features of algic stage:

Severe hand painEdema, hyperemia and cyanosis

SHOULDER – HAND SYNDROMESHOULDER – HAND SYNDROME

Hyperesthesia Decreased muscle strength and

limitation of movementsClinical features of dystrophic stage: Muscle atrophy Osteoporosis on X – rays examinations

COMPRESSIVE RADICULAR COMPRESSIVE RADICULAR SYNDROMESSYNDROMES

Radiculopathy C6 radix (C5 – C6 discs)

Pain, parasthesia and hypalgesia on anterior external surface of arm

Weakness, hypotrophy of m. biceps brachii

Absent or low flex elbow reflex

COMPRESSIVE RADICULAR COMPRESSIVE RADICULAR SYNDROMESSYNDROMES

Radiculopathy C7 radix (C6 – C7 discs)

Pain, parasthesia and hypalgesia

Weakness, hypotrophy of m. triceps brachii

Low extensor elbow reflex

COMPRESSIVE RADICULAR COMPRESSIVE RADICULAR SYNDROMESSYNDROMES

Radiculopathy C8 radix (C7 – C8 discs)

Pain, parasthesia and hypalgesia

Low extensor elbow and carpo – radial reflex

ADDITIONAL METHODS OF DIAGNOSTICS

Spinal X – ray – examination

CT of spinal cord

TREATMENTTREATMENT Orthopedic Medicines:

In edema: Euphyllinum 2.4% 10.0; Lasix 2.0; Dexamethasonum 4 – 8 mg; NaCl 0.9% 200.0 i/v by drops

Platiphillinum, No – spa, Baralginum Analgesics - Reopirini, Voltareni 2.5% 3.0;

Tramadol, Aminasini Non steroids medicines– Ketanov, Dicloberl,

Movalis, Ranselex, Celecoxib Myorelaxants – Midocalm, Baclofen Chondro- protectors – Rumalon Vitamins and biostimulators Physical methods

TREATMENTTREATMENTSurgical methods (Horse tail compression, Long lasting (3 – 6 months) pains, Huge hernia (over 15 mm), Acute compression of radicular – spinal artery)

Sanatorium

PREVENTIONPREVENTIONHypokinesia Hypokinesia preventionprevention

Moderate physical Moderate physical activityactivity

Treatment of chronic Treatment of chronic diseasesdiseases