SPONDYLOSIS

From Big Medical Encyclopedia

SPONDYLOSIS (spondylosis; Greek spondylos vertebra; synonym the deforming spondylosis) — the chronic disease of a backbone arising owing to dystrophic changes of outside fibers of a fibrous ring of an intervertebral disk. The coronoid bone growths surrounding an intervertebral disk are most characteristic of S. At the same time height of an intervertebral disk remains normal.

The page almost equally often occurs at men and women. Its first signs can be revealed at the age of 20 — 30 years, and at persons 50 years are more senior S.'s signs are found in 80%) men and 60% of women. More often the lumbar department of a backbone, according to N. S. Kosinskaya (1961), more than in 84% of cases is surprised.

An etiology and a pathogeny

In 1844 K. Rokitansky noticed frequent coincidence of calcification of a front longitudinal ligament of backbone to dystrophy of an intervertebral disk. It gave Benekke's reason (R. Benecke, 1897) to draw a conclusion that S. — a consequence of dystrophic changes of a jellylike (pulpozny) kernel of an intervertebral disk. This point of view and to a crust, time is divided by many scientists. However in 1932 K. Shmorl, based on results morfol. researches, proved that S. is the cornerstone local dystrophy of outside fibers of a fibrous ring of an intervertebral disk, leads edges to a peculiar dystrophic damage of a backbone (see. Diskosis ).

Among the factors causing dystrophic changes in outside departments of a fibrous ring of an intervertebral disk, have the greatest value hron. traumatization, mechanical loadings, and especially overloads, and also toxi-infectious influences.

Local dystrophic defeat of outside fibers of a fibrous ring of an intervertebral disk happens iod influence of the proceeding repeated repeated vertical loadings to anguishes of these fibers near their attachment to bone edge of a body of a vertebra. The central departments of an intervertebral disk at the same time remain intact. At vertical loads of an intervertebral disk and transformation of vertical forces in radiarny in this weakened site the fibrous ring is stuck out knaruzh of a little more usual and injures a front longitudinal ligament of a backbone. At the same time the front longitudinal sheaf exfoliates at the place of the attachment to a limb, and at more considerable loadings — partially and from a body of a vertebra. Response of a front longitudinal sheaf to constant irritation is its calcification, a cut and leads to formation of the bone growths inherent to S. Vnachale the small coronoid bone outgrowth at the place of an attachment of a sheaf to edge of a body of a vertebra appears. The fact that in process of increase of ossification the bone outgrowth goes to the next vertebra is characteristic of S., bending around an intervertebral disk. Usually from the next vertebra towards to it the same bone outgrowth is formed. In nek-ry cases ossification begins at the level of an intervertebral disk. Then the site of ossification is limited to its front or side surfaces, without connecting to bodies of vertebrae.

Also the fact that bone growths are formed on the small front or side site of a front longitudinal sheaf, but not on all its width is characteristic of S. Sometimes ossification is noted in two, usually symmetric, sites of this department of a backbone.

Depending on number of the changed vertebral segments C. can be isolated, limited, extended and seldom or never — total.

The clinical picture

In some cases S. proceeds asymptomatically and comes to light as an accidental find at rentgenol. research on other occasion. More often it corresponds to the I stage of its development and is shown by existence of insignificant bone growths of bodies of vertebrae. In this stage of S. it can be shown by the moderate pains at the beginning of movements passing after warm-up, a nek-eye restriction of mobility of a backbone. Pains can disappear and develop again. Developing of pains is connected with dystrophic changes of elements of a backbone and reaction from juxtaspinal fibrous educations and muscles.

More intensive and constant pains arise in the II stage of a disease that is connected with bigger prevalence of dystrophic and reactive changes in juxtaspinal fabrics. Pains are followed by restriction of mobility of a backbone, fatigue, functional insolvency. Changes in a type of strengthening chest can be objectively revealed kyphosis (see), flattening cervical and especially lumbar lordosis (see).

In the III stage of a disease the bone growths which are meeting halfway each other come into contact and merge, forming uniform ossificate, to-ry blocks the movements in the relevant department of a backbone. Clinically it is shown by disappearance of pains and an obezdvizhennost of the relevant department of a backbone.

The page can be combined with other dystrophic diseases backbone (see), most often with intervertebral osteochondrosis. In these cases a wedge, displays of a disease are more diverse.

Diagnosis

Tomograms of lumbar department of a backbone at various stages of a spondylosis (a direct projection): and — the I stage: insignificant bone growths at edges of bodies of vertebrae and calcification of a longitudinal ligament of backbone (it is specified by an arrow); — the II stage: the expressed bone growths at edges of vertebras with education of a neoarthrosis between them (it is specified by an arrow); in — the III stage: formation of the bone bracket connecting vertebrae (it is specified by an arrow).

In S.'s diagnosis results rentgenol are of great importance. researches. Depending on localization of defeat it can be visible on the roentgenogram in a direct or side projection better. Therefore it is necessary to conduct a research in two standard projections. At insignificant S. (the I stage) regional bone growths do not go beyond the plane of the platform of a body of a vertebra, being located at the level of a regional limb at a side, perednebokovy or front surface (fig., a). At the expressed S. (the II stage) bone growths go beyond the plane of the platform of a body of a vertebra and bend around an intervertebral disk. If they develop towards each other, then owing to movements in a segment between them the neoarthrosis can be formed (fig., b). Sometimes the bone outgrowth going from one vertebra reaches a body of another and forms a neoarthrosis with the respective site of a front or side surface of a body of an adjacent vertebra.

At sharply expressed S. (the III stage) the continuing ossification under a front longitudinal sheaf leads to formation of the powerful bone bracket which is connecting bodies of adjacent vertebrae and completely fixing a segment (fig., c). After that ossification on this site stops.

Differential diagnosis is based on kliniko-rentgenol. data. Intervertebral osteochondrosis differs from S. in the nature of pains, existence of radicular, and at times and spinal symptoms, and also symptoms of a likvorny push (see. Spinal cord, tumors ), character of osteophytes, decrease in height of an intervertebral disk, etc. (see. Osteochondrosis ). Unlike bone growths at osteochondrosis, to-rye are always perpendicular a long axis of a backbone and never grow together with each other, at S. these growths are parallel to a long axis of a backbone and can grow together with each other, blocking mobility of a vertebral segment. The differential diagnosis with Shmorl's hernia (see. Shmorlya small knots ) and Forestye's disease (see Forestje a syndrome) is under construction on comparison of data of a spondilogra-fiya. Forestye's disease is characterized by a thickening and ossification under a front longitudinal sheaf in cervical or cervicothoracic departments of a backbone, and clinically shown by disappearance of mobility at appropriate level. Bekhterev's disease arises preferential at men at the age of 20 — 40 years, a certain localization of defeat, the sub-febrile temperature accelerated by ROE, an early ankilozirovaniye of sacroiliac joints is characteristic of it (see. Bekhtereva disease ). Not progressing ossification under a front longitudinal sheaf reminding S. can result from a single massive spine injury.

Treatment

Treatment at the expressed pain syndrome is carried out by salicylates and their derivatives. Repeated courses are reasonable massage (see), physiotherapeutic procedures, balneoterapiya (see), rational to lay down. gymnastics (see). Are useful local rubbing in of analgesic ointments and liquids.

Lech. the physical culture at S. gives the chance by activation of muscle performance to improve conditions of blood circulation in a backbone, to support a functional condition of muscles at the satisfactory level and to keep mobility of a backbone. Tasks to lay down. physical cultures depend on degree of manifestation patol. process in a backbone. At the initial bone changes in a backbone which are characterized a wedge, signs of moderate restriction of amplitude of its movements and pain, the purpose to lay down. physical cultures mobilization of a backbone, its dosed extension is. At the expressed bone growths, calcification of a front longitudinal ligament of backbone, a strong spayaniye of the next vertebrae, sharp restriction of mobility of certain sites of a pla of all backbone to lay down. the physical culture shall promote increase in its stability by strengthening of muscles and improvement of conditions of blood circulation (use of the physical exercises increasing flexibility of a backbone can break the created compensation patol. process and to promote strengthening of pains).

Physical exercises carry out preferential in the initial positions providing unloading of a backbone (lying, on all fours). Only at unsharply expressed pain syndrome separate exercises carry out in a standing position. Use the exercises strengthening the muscles of a back and a stomach improving function of respiratory system, fortifying exercises. At S. the dosed inclinations and turns and also extending a backbone of exercise are shown to initial degree (e.g., having hung on hands, standing at wall bars). At sharply expressed S. amplitude of extension of a trunk (in a ventral decubitus), necessary for strengthening of muscles of a back, shall be reduced, and strengthening of muscles of a stomach can be reached by performance of exercises in joints of the lower extremities causing tension of a prelum abdominale. It is reasonable to combine physical exercises with massage of muscles of a back (first of all the muscular groups located paravertebralno). Lech. the physical culture is carried out against the background of the mode of reduced load of a backbone, it is frequent in combination with purpose of carrying a corset (see. Orthoses ).

Treatment and Prevention

Treatment, as a rule, favorable.

Prevention consists in rational load of a backbone, edges shall correspond extent of development of muscles, a balanced diet, maintenance of normal body weight that is promoted by physical culture, sport and a hardening.



Bibliography: To and p t e l and A. F N. Recovery treatment, physiotherapy exercises, massage and work therapy at injuries and deformations of a musculoskeletal system, page 362, M., 1969; Kosins to and I am N. S. Degenerative and dystrophic defeats of the kostnosustavny device, page 135, L., 1961; Mazo I. S. and B e y l and N L. G. Osteokhondroz, spondi-rods and a spondylarthrosis of lumbar department of a backbone in the light of functional X-ray inspection, in book: Second Vseros. congress rentgenol. and radio-gramophones., page 55, L., 1966; P e y N e r S. A. Radiodiagnosis of diseases of bones and joints, t. 2, page 504, M., 1964; T and of e r I. L. and Dyachenko V. A. Radiodiagnosis of diseases of a backbone, page 218, M., 1971; C and in I am Ya. L. N and P and y x and V. E N matte. Intervertebral disks, Novosibirsk, 1977; H e p about y V. M. Inflammatory and degenerative diseases of a backbone, page 212, M., 1978; S with h m about of 1 G. u. J u n g h a n n s H. Die gesunde und die Kranke Wirbelsaule in Rontgenbild und Klinik, Stuttgart, 1957; Tedeschi G. o. Cervical myelopathy by spondylosis, limits and results of decompressive laminectomy, Acta neurol. (Napoli), v. 35, p. 191, 1980.


Ya. L. Tsivyan; P. L. Zharkov (rents.), A. F. Kaptelin (to lay down. physical.).

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