Osteochondrosis is a degenerative change of the spine, i.e. a wear disease. In this case, poor posture leads to changes in the intervertebral disc cartilage as well as bony attachments to the vertebral bodies. The result is, among other things, back and neck pain, which occurs primarily at rest. But how does osteochondrosis develop? What is behind the disease and how it is treated, read here.
What is osteochondrosis?
In the original sense of the word, osteochondrosis is a disorder of the transformation of cartilage cells into bone cells during bone formation (osteochondrosis dissecans). However, when it comes to osteochondrosis of the spine, this clinical picture is understood to mean a gradual change in the cartilage of the intervertebral disc and the adjacent vertebral body, usually caused by overload. It is also referred to as osteochondrosis intervertebralis.
Osteochondrosis of the spine: causes.
As a result of poor posture and wear and tear, for example also due to a spinal curvature to the side (scoliosis), the intervertebral disc is subjected to unilateral loads over many years, changes and wears out. Its shock-absorbing effect diminishes and it loses height. The bone of the vertebral bodies is subjected to greater stress and the vertebral body becomes unstable. As a countermeasure, so to speak, and to stabilize the spine, the body forms nnöcherne side attachments (spondylophytes),which are supposed to absorb the increased pressure: a process called spondylosis. Normally, the base plate and the top plate of the vertebrae adjacent to the “diseased” disc provide a barrier between the bone and the disc. As a result of wear, enzymes attempt to dissolve the disc’s gelatinous core. As a result, metabolic products also enter the adjacent vertebral bone, which reacts with an extremely painful edema, i.e. a kind of bone swelling. The spinal column loses its natural S-shape and increasingly stiffens. If vertebral arch joints are affected by arthrosis as a result of wear and tear, this is referred to as spondylarthrosis. Not only incorrect loads, but also previous herniated discs as well as intervertebral disc operations, rarely also inflammations of the intervertebral disc, can lead to osteochondrosis of the lumbar spine, the cervical spine or the thoracic spine. Increased age and obesity further increase the risk of developing osteochondrosis.
Back pain as a typical symptom
Often, the bulging disc presses on a nerve that branches off near the vertebral arch joints (root compression), causing severe pain and/or paralysis. In osteochondrosis of the cervical spine, spondylosis of the vertebrae (i.e., bony side attachments) also causes narrowing of the nerve exit openings. Back pain as well as tension are unavoidable. In the early stages, there are no or only minor symptoms, but these increase in the course of the disease if no timely treatment is given. Particularly in the morning and at rest, sufferers of advanced osteochondrosis experience severe back pain. Although the pain improves with movement, it increases again after a longer period of time. Standing, walking, bending forward, but also lying down increasingly becomes a torture. Other symptoms may include headaches, nausea and dizziness, restricted movement and pain in the muscles, neck or nerves. Tingling and numbness or short-term paralysis in the arms and legs are also possible signs.
Osteochondrosis: course and stages
The course of osteochondrosis intervertebralis is divided into three stages:
- Modic I means edema formation (bone marrow edema).
- Modic II means fatty degeneration of the bone (hematopoietic bone marrow is replaced by fatty marrow).
- Modic III means bone sclerosis, which is the hardening of the bone.
Modic classifications are radiological classifications used to assess changes in the vertebral body. These classifications are used in various diseases of the spine. When the disease is very advanced, specialists refer to it as erosive osteochondrosis. It is called multisegmental osteochondrosis when several joints are affected at the same time.
Diagnosis of osteochondrosis
After a thorough anamnesis, i.e. a doctor-patient discussion, the doctor can often already make the suspected diagnosis of osteochondrosis.This diagnosis is then confirmed by imaging procedures such as X-ray, CT (computer tomography) or MRI (magnetic resonance imaging). If necessary, further examinations may be required, such as measurement of nerve conduction velocity or myelography, which works similarly to an X-ray examination but with the use of contrast agents.
Treatment: what to do about osteochondrosis.
Osteochondrosis therapy for osteochondrosis intervertebralis depends largely on the individual findings. Pain relievers, cortisone-free anti-inflammatory drugs, and muscle-relaxing drugs can be used to treat pain that occurs. Once acute pain is relieved, physiotherapy can improve the mechanical conditions of the intervertebral disc as well as the vertebral body.
Therapy for osteochondrosis of the lumbar spine
In osteochondrosis of the lumbar spine, it is still possible at an early stage to prevent osteochondrosis from progressing by consistently building up muscles in the abdomen and back and by posture training. Physical measures such as heat in the form of red light, fango, massage or electrotherapy are also helpful. In advanced osteochondrosis, therapy may consist of a combination of a support corset (orthosis) and muscle building.
Therapy for osteochondrosis of the cervical spine
If osteochondrosis of the cervical spine is present, osteochondrosis therapy is more difficult. However, it is possible to relax the tense muscles with physical therapy. Existing nerve irritation can be reduced by targeted analgesic injections. In advanced stages of osteochondrosis of the lumbar spine and osteochondrosis of the cervical spine, stabilization surgery and implantation of a disc prosthesis are possible.
OCD: osteochondrosis as a bone formation disorder.
In addition to osteochondrosis intervertebralis, there is another form of osteochondrosis: osteochondrosis dissecans (OCD), also known as activated osteochondrosis. This form of osteochondrosis occurs primarily in the knee joint, the upper ankle joint, and the elbow joint. This is a bone decomposition resulting from a bone formation disorder below the articular cartilage. The causes are not yet fully understood. However, it is considered certain that initially there are bony circulatory disturbances below the cartilage. The bone tissue gradually dissolves. Initially, the cartilage is still well supplied by the synovial fluid, but as the disease progresses it changes and softens. The cartilage cover may tear or pieces of cartilage bone may detach into the joint.
Therapy of osteochondrosis dissecans
Therapy for osteochondrosis dissecans depends on the extent of the changes. First, the joint must be immobilized for months if possible, which means no sports and the use of forearm crutches are important. If there is no improvement or if the symptoms are more severe, osteochondrosis requires arthroscopy of the joint and surgery, if necessary, with bone and/or cartilage cell transplantation.
Other forms of osteochondrosis
Osteochondrosis intervertebralis and osteochondrosis dissecans are the best-known forms of osteoporosis. In addition, there are other types:
- Scheuermann’s disease already occurs in adolescents. Here, a misgrowth of the vertebral bodies leads to a curvature of the spine, which results in a hunchback (“humpback”).
- Perthes disease is a disease that occurs in children and leads to an enlargement of the femoral head.
