SPONDYLARTHROSIS

From Big Medical Encyclopedia

SPONDYLARTHROSIS (Greek spondylos a vertebra + arthron a joint - osis) — dystrophic damage of intervertebral (dugootrostchaty) and costal and cross joints. Distinguish primary S. representing a private form of a widespread dystrophic disease of the bone and joint device — primary deforming osteoarthrosis (see. Arthroses ), and the secondary S. developing as a result of the postponed inflammatory, traumatic or inborn changes of vertebrae.

Etiology and pathogeny Pages are similar to arthroses of other joints (see. Arthroses ).

Morphologically at S. of any etiology dystrophic changes begin in joint cartilages of intervertebral joints and in subchondral departments of a bone tissue, adjacent to them, that leads to narrowing of joint cracks, to formation of osteophytes, to-rye can make mechanical impact on roots of spinal nerves and on the vessels passing through intervertebral foramens. The irritation of a neurovascular bunch which is the cornerstone a wedge, S.'s symptoms becomes especially expressed at the combined dystrophic damage of intervertebral joints and intervertebral disks that can cause sharp narrowing of intervertebral foramens.

In cervical department of a backbone in connection with features of its structure the size of intervertebral foramens depends considerably and on a condition of so-called unkoverteb-ralny joints (Lushki's joints) — peculiar joints between posterolateral departments of basic platforms of vertebral bodies. Dystrophic process in unko-vertebralny joints (unkoverte-bralny arthrosis) is characterized by partial implementation in these slit-like joints of substance of the changed intervertebral disk and the subsequent development osteophytes (see).

Wedge, picture Page it is diverse. Dystrophic process can proceed for many years asymptomatically, but at a considerable part of patients, especially at defeats of cervical and lumbar departments, is shown by various syndromes: vegetative, neurodystrophic, vascular.

S.'s clinic depends on localization of process. Symptoms can be local, accurately connected with the struck segment of a backbone, and remote, localized on nek-rum distance from a backbone. At defeat of cervical department of a backbone (cervical S., tservikoartroz) the first symptom usually is pain, edges appears or amplifies at the movement by the head. Pains sometimes remind an attack of migraine and last in some cases up to several days, being followed by nausea and vomiting. There can be headaches in a nape as neuralgia of a big occipital nerve. They cover all occipital area or happen unilateral. At a palpation morbidity in the place of an exit of a big occipital nerve is noted. In some cases the movements by the head are followed by a crunch. At survey note reduction of cervical lordosis (see), tension of cervical muscles, restriction of movements, positive symptoms of a tension of roots of spinal nerves. At patients with cervical S., especially in combination with osteochondrosis (see), various pain in a neck and upper extremities and a syndrome of a vertebral artery with signs of vertebrobazilyarny insufficiency is possible (see. Barret — Lyeu a syndrome ).

At S. of chest department of a backbone (chest S., dorsoartroz) pains are localized both in the place of defeat, and on a distance, irradiating in various departments of a thorax or an upper half of a stomach. They appear or amplify after exercise stresses, at cough, sneezing, deep breath or after long stay in one situation. The interscapular simpatalgiya which is shown the burning, aching or dull aches between shovels is characteristic. Pains in heart (a pseudo-anginous syndrome) are noted also intercostal neuralgia. At localization of defeat at the V—XII level of chest vertebrae functional disturbances from abdominal organs can be observed (a stomach, a gall bladder, a large intestine). At palpation morbidity in juxtaspinal points over the affected vertebras is established.

The page of lumbar department of a backbone (lumbar S., lyumboartroz) is characterized generally by the pains in lumbar and sacral areas which are quite often irradiating in a leg (lumbar ishialgia) or leg pains (ischialgia), disturbances of sensitivity, positive symptoms of a tension of roots of spinal nerves (see. Radiculitis ). At the osteochondrosis which is usually accompanying S. (see) the symptomatology acute or hron is possible. lumbago (see).

the Roentgenogram of chest department of a backbone (a direct projection) at a spondylarthrosis: shooters specified aculeiform bone growths at the edges of the joint surfaces of costal and cross joints.

Diagnosis Pages put mainly on the basis of clinic and data of X-ray inspection. On roentgenograms narrowing of joint cracks, subchondral is defined osteosclerosis (see), regional bone growths (fig.), the continuing joint surfaces, lengthening and deformation of joint shoots.

As standard (in direct and side projections) the X-ray analysis does not create optimal conditions for judgment of a condition of dugootrostchaty joints, usually apply special aim pictures at turn of the patient along a longitudinal axis on 30 — 45 °. As additional techniques can be applied a tomography and x-ray films in the provision of the maximum bending and extension of a backbone.

Treatment Page and prevention aggravations are based on the same principles, as therapy of primary deforming osteoarthrosis (see Arthroses): unloading, extension of a backbone, impact on the broken metabolism in joint cartilages, anesthetics, rehabilitation actions.

S.'s current chronic. The forecast depends as on degree of manifestation of changes of intervertebral joints, and, more, on mechanical irritation of spinal nerves and a prelum of the vessels passing through intervertebral foramens.



Bibliography: Kosinskaya N. S. Degenerative and dystrophic defeats of the kostnosustavny device, D., 1961; T and - e r And. JI. Radiodiagnosis of diseases of a backbone, page 131, M., 1983; Yumashev G. S. Traumatology and orthopedics, M., 1977; SchmorlG. u. Jun g-h a n n s H. Die gesunde und die kranke Wirbelsaule in Rontgenbild und Klinik, Stuttgart, 1957.


E. R. Agababova, H. M. Mylov.

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