Among dorsopathies, osteochondrosis, spondylolisthesis, ankylosing spondylitis, curvature of the spinal column and congenital malformations are most common. Common manifestations for these pathologies are pain in the spinal column, as well as disorders of the motor and sensory functions. The diagnostic complex includes a neurological examination, EMG, CT and MRI. Treatment is based on the use of anti-inflammatory, analgesic and antispasmodic drugs.
What is dorsopathy?
The term dorsopathy means a number of pathologies of the bone and muscle systems, as well as connective tissue. A distinctive feature of these diseases is the mandatory damage to the spinal column with the presence of pain and functional disorders.
Spinal column diseases occupy the 3rd place in cases of disability among all diseases of the human body. So, according to the World Health Organization, more than 5% of the world’s population suffers from various ailments of the spine, which is about 400 million people around the world.
Spinal column diseases provoking neurological disorders were combined into a group of so-called dorsopathies. These diseases significantly worsen the quality of life of patients and often lead to disability of patients, which gives the problem social significance.
The course of this group of diseases with dorsopathies is usually chronic with periodic exacerbations. At the same time, various structures of the spinal column are often involved in the pathological process: intervertebral disc, ligamentous and muscular apparatus, as well as arched joints. The basis of the dorsopathy clinic is pain, but with a concomitant lesion of the spinal roots (or the spinal cord itself), neurological symptoms may join.
According to the ICD, dorsopathies are divided into:
- Pathologies associated with deformation of the spinal column, destruction of the intervertebral discs and slipping of the vertebrae;
- Spondylopathy – a number of diseases provoked by a violation of the “nutrition” of the spinal column (the so-called dystrophic disorders) due to hormonal imbalance, inflammation, etc .;
- Dorsalgia – lesions of the nerve roots and plexuses, manifested by back pain. Depending on the level of occurrence of the pain syndrome, cervic-, thorac- and lumbalgia are distinguished – the appearance of pain in the neck, chest and lower back, respectively.
The most common dorsopathies today are osteochondrosis, spondylolisthesis, ankylosing spondylitis, curvature of the spinal column (scoliosis, kyphosis) and congenital malformations (lumbarization, sacralization).
Why does it arise?
The main reasons for the development of dorsopathies are:
- Genetic predisposition or congenital defects of dorsopathies;
- Natural aging of the body with appropriate age-related changes;
- Overweight and malnutrition with a deficiency of vitamins and minerals;
- Hormonal and metabolic disorders (diabetes, gout), infectious lesions (tuberculosis, gonorrhea), as well as intoxication with industrial and other substances (including nicotine and alcohol);
- Injury to the spinal column (bruises, subluxations, etc.);
- Deformations, as well as increased mobility (instability) of the spine;
- Orthopedic pathologies (clubfoot, flat feet, valgus, varus and other curvatures);
- Increased stress on the spinal column with excessive physical activity, weight lifting or prolonged stay in uncomfortable postures;
- A sedentary lifestyle or the sudden cessation of professional sports activities.
Dorsopathy is also facilitated by living in adverse environmental conditions – a cold and humid climate, which provokes frequent hypothermia.
It is worth noting that according to a number of studies, the percentage of patients with dorsopathy is significantly higher among people who are constantly experiencing emotional upheaval and stress.
Manifestations of dorsopathies depend on their immediate appearance. However, the following are common:
- pain syndrome with dorsopathy due to damage to the intervertebral disc, ligamentous apparatus, joint bags, meniscoid (“shock absorbers” of the vertebral joints) or muscle tension;
- neurological disorders due to overexposure, as well as direct compression of the nerve roots (or the spinal cord itself).
This pathology includes destruction of the articular cartilage observed in any joint of the body. However, most often the disease affects the intervertebral discs with dorsopathy.
Depending on the level of damage, the following symptoms are possible:
- Cervical – lumbar or chronic pain during dorsopathy, extending to the back of the head, shoulders and arms. When the vertebral artery (the blood supply to the brain) is impaired, visual, hearing and balance disorders, frequent fainting conditions occur. There are also paroxysmal attacks with dizziness, nausea, vomiting and speech impairment, reminiscent of a stroke;
- Thoracic segment – pain varies from burning to aching, while pain with dorsopathy often mimics the pathology of the internal organs (heart, lungs, stomach), which greatly complicates the diagnosis;
- Loin – pains are often sharp, occur against the background of lifting weights, extend to the lower limbs and sacrum. When the final part of the spinal cord (ponytail) is pinched, the pain syndrome is localized on the inner thighs and in the perineum. Also there is incontinence of urine, feces and sexual dysfunction.
It is worth noting that pain in dorsopathies is often accompanied by muscle spasm, which is why the mobility of the affected spine is significantly limited.
Pathology consists in sliding the vertebra anterior or posterior to the underlying one. As a rule, patients are concerned about lower back pain and sacrococcygeal pain. In this case, the pain syndrome often spreads to the lower extremities.
The pelvis of patients deviates, the thoracic and lumbar bends of the spine intensify. The gluteal muscles are depleted, and there is a relative lengthening of the limbs due to visual shortening of the trunk.
In the advanced stages, neurological disorders of dorsopathy appear: paresthesia (“false sensations” in the form of burning or tingling sensations), as well as a loss of skin sensitivity and motor activity. In some patients, horse tail syndrome may occur, accompanied by a violation of the functions of the pelvic organs.
The disease develops systemically with a predominant lesion of the junction of the bones of the pelvis with the sacrum. Usually, the “starting” symptoms are pain in the sacral region, as well as stiffness that occurs after a night’s sleep or prolonged rest.
With the progression of the disease, the pain of dorsopathy extends to the entire spinal column. When examining the back, its significant rounding (stoop) is observed, and when palpating, the tension of the muscular skeleton is observed.
In the later stages, complete immobilization (ankylosis) of the joints of the spinal column occurs, because of which a person “freezes” in a hunched state, and his growth decreases. In some cases, pathological changes can occur in the joints of the upper and lower extremities, as well as in the membranes of the eyes and heart.
Spinal deformities include kyphosis (“hump”), lordosis (anterior bend) and scoliosis (lateral curvature). Kyphosis and lordosis are normally observed in the thoracic / sacral, as well as the cervical / lumbar. However, scoliosis is always a pathological condition.
Kyphous posture is a pronounced stoop, shoulders are brought forward, and the chest is compressed. Lordosis is manifested by protrusion of the abdomen and buttocks, as well as smoothing of the chest. Patients with scoliosis have a different level of the shoulders and wings of the pelvis, while examination of the spinal column shows its S-shaped curvature.
Patients are concerned about aching back pain, which is associated with an inadequate distribution of the load on the deformed spine. With age, in such patients, the likelihood of osteochondrosis and intervertebral hernia increases.
Congenital malformations of dorsopathies:
- Lumbarization is an abnormality associated with the formation of an additional lumbar vertebra. Pathology usually manifests in youth with the occurrence of acute pain after lifting weights and other physical activity. Over time, the pain syndrome becomes chronic, spreads to the buttocks and lower extremities. Sometimes the sciatic nerve is involved in the process with the development of its inflammation – sciatica. In this case, patients have burning pains on the back of the thighs. In the same area, skin sensitivity disappears, and muscle strength is significantly weakened.
- Sacralization is the opposite of lumbarization, associated with a decrease in the number of lumbar vertebrae. Most often, the course of the disease is asymptomatic or in the form of slightly discomfort. However, in some cases, patients may be disturbed by pain in the lower back and sacrum, extending to the lower extremities. As a rule, soreness disappears when lying down and worsens with physical exertion. It is worth noting that sciatic nerve lesions (in contrast to lumbarization) are rare.
Diagnostic searches for dorsopathies include:
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The tactics of medical care is to get rid of the pain syndrome, as well as to restore sensitive and motor disorders.
Patients are advised to maintain physical activity to prevent muscle weakness and immobilization of the spinal column. In each case, a set of physiotherapy exercises is developed to preserve and increase the range of motion in the spine.
Kinesiotherapy is also recommended for patients with dorsopathy – a method of movable fixation of the spine using special adhesive tapes made of cotton. Such “patches” have an analgesic and stabilizing effect, while normalizing muscle tone. They wear teyp tapes around the clock for 5 days, after which they are replaced.
In acute pain, patients are prescribed non-steroidal anti-inflammatory drugs (Lornoxicam, Diclofenac, Ketorolac) or non-narcotic analgesics (Flupirtine). For the relief of intolerable pain syndrome, narcotic substances – opioids (Tramadol and Fentanyl) are used.
In order to reduce muscle tone during their pronounced spasm, muscle relaxants are introduced into the treatment regimen of dorsopathies (Tolperison, Cycllobenzaprine). To improve peripheral blood circulation, patients are prescribed vasodilators that promote vasodilation (Petoxifylline).
In case of impaired motor and sensory functions, cholinesterase inhibitors are used that improve the transmission of the “signal” from the nerve fiber to the muscle (Galantamine). For the same purpose, vitamins B1, B6 and B12 are used – Thiamine, Pyridoxine and Cyanocobalamin.
Usually, dorsopathy is treated on an outpatient basis with planned hospitalization every 6 months. The effectiveness of therapy is evidenced by a decrease in pain; increase in motor, sensory and reflex functions; as well as disability recovery.
As a rule, surgical treatment is not used for dorsopathies. However, with compression of the spinal cord by hernial protrusion, the disc can be removed and replaced with an artificial implant. In the case of progressive spondylolisthesis, reconstructive operations are used to fix unstable vertebrae – spinal fusion.
In case of persistent pain syndrome in patients with a diagnosis of lumbarization or sacralization, the processes of the lumbar vertebra are excised, followed by fixation with a bone or artificial graft.
The basis for the prevention of dorsopathies is:
- Monitoring the condition of patients with abnormalities of the development of the spinal column or born in families with similar diseases;
- Normalization of body weight and rationalization of nutrition in order to increase the vitamin and microelement composition of food;
- Recovery of hormonal and metabolic disorders (diabetes, gout), treatment of infectious lesions (tuberculosis, gonorrhea), as well as intoxication with industrial and other substances (including nicotine and alcohol);
- Prevention of trauma to the spinal column (bruises, subluxations, etc.);
- Correction of deformities, as well as increased mobility (hypermobility) of the spine;
- Treatment of orthopedic pathologies (clubfoot, flat feet, hallux valgus, varus and other curvatures);
- Reducing the load on the spinal column by reducing physical activity, avoiding heavy lifting or prolonged stay in uncomfortable static poses;
- Refusal from a sedentary lifestyle or the sudden cessation of professional sports activities.
Patients are advised to avoid adverse environmental conditions (cold and humid climate, which contributes to frequent hypothermia), as well as emotional stress and stress.
Remember, dorsopathies are a whole complex of diseases that affect the spinal column. In the absence of adequate treatment, the quality of life of patients deteriorates significantly: they lose their ability to work and the possibility of self-care, becoming disabled.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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