OsteochondrosisOsteochondrosisis a polyfactorial disease that is a polyfactorial disease that
developsdevelopsIn case of two conditions:In case of two conditions: Decompensation of trophic Decompensation of trophic
systemssystems Local excessive load on spinal Local excessive load on spinal
segmentssegments
Pathogenesis of Pathogenesis of osteochondrosisosteochondrosis
The first stage. The first stage. There are There are degenerative changes of pulp nuclei degenerative changes of pulp nuclei
The second stage. The second stage. There are There are degenerative changes in fibrous ring, degenerative changes in fibrous ring, disc protrusion and disc herniadisc protrusion and disc hernia
The third stage.The third stage. There are changes There are changes of hyaline plates - subchondral of hyaline plates - subchondral sclerosissclerosis
X –ray signs of X –ray signs of osteochondrosisosteochondrosis
Low height of between vertebral discsLow height of between vertebral discs Sclerosis of final platesSclerosis of final plates Osteophytes on the edges of vertebras’ Osteophytes on the edges of vertebras’
bodies. They are located perpendicularly to bodies. They are located perpendicularly to the spinal axisthe spinal axis
Local scoliosisLocal scoliosis Spondilolisthesis – dislocation of Spondilolisthesis – dislocation of
neighbouring vertebras’ bodiesneighbouring vertebras’ bodies Local cyphosis (instead of lordosisLocal cyphosis (instead of lordosis))
Vertebral disc’s herniaVertebral disc’s herniaMain positions are:Main positions are: Medial (clinical features of horse tail lesion)Medial (clinical features of horse tail lesion) Paramedial (a little bit out side the medial Paramedial (a little bit out side the medial
position – several radixes are compressed)position – several radixes are compressed) Posterior – medial (much more out side the Posterior – medial (much more out side the
medial position – 1 or 2 radixes are medial position – 1 or 2 radixes are compressed)compressed)
Foraminal - (– 1 radix is compressed)Foraminal - (– 1 radix is compressed)
Pathogenesis of neurological Pathogenesis of neurological signssigns
Irritation of vessels and nerves with Irritation of vessels and nerves with vascular spasm. vascular spasm.
Compression of vascular – nervous Compression of vascular – nervous complex.complex.
Edema (perivascular edema and radicular Edema (perivascular edema and radicular edema)edema)
Reactive process of neibouring structures Reactive process of neibouring structures (straining of muscles)(straining of muscles)
Autoimmune reactions (a part of disc Autoimmune reactions (a part of disc becomes antigenbecomes antigen))
Compressive syndromeCompressive syndrome occurs at occurs at compression and deformation of compression and deformation of radix, vessels and spinal cord.radix, vessels and spinal cord.
Reflex syndromeReflex syndrome occurs at occurs at irritation of different receptors irritation of different receptors (such as Lushka nerve).(such as Lushka nerve).
ClassificationClassification..Reflex syndromesReflex syndromes
Lumbago (backache)Lumbago (backache) LumbalgiaLumbalgia Lumbar ischialgia (muscular – tonic, neuro- Lumbar ischialgia (muscular – tonic, neuro-
dystrophic, autonomic vascular)dystrophic, autonomic vascular)
Compressive radicular syndromes.Compressive radicular syndromes.Compressive vascular radicular – spinalCompressive vascular radicular – spinalsyndromes (radicular ischemia)syndromes (radicular ischemia) AcuteAcute
TransientTransient StrokesStrokes
Chronic ischemic myelopathyChronic ischemic myelopathy
Vertebrogenous syndromeVertebrogenous syndrome
Limitation of movements in lumbar – sacral Limitation of movements in lumbar – sacral part of spinal cord (bending forward, part of spinal cord (bending forward, backward) backward)
Increasing of pain while movements, coughing Increasing of pain while movements, coughing and laughingand laughing
Protective straining of long back musclesProtective straining of long back muscles Extension of lumbar lordosis, cyphosis in Extension of lumbar lordosis, cyphosis in
lumbar – sacral divisionlumbar – sacral division Scoliosis, sometimes with rotationScoliosis, sometimes with rotation Painful paravertebral points and vertebral Painful paravertebral points and vertebral
processes processes
Vertebrogenous Vertebrogenous syndromesyndrome
Discharge – postures and symptomsDischarge – postures and symptomsKnee – elbow positionKnee – elbow positionWhile standing the patient keeps his While standing the patient keeps his
leg aside in order to make the load leg aside in order to make the load less on his legless on his leg
While lying in the bed he bends his leg While lying in the bed he bends his leg in all joints.in all joints.
The symptoms of spinal cord instability The symptoms of spinal cord instability (it is difficult for the patient to stand, to (it is difficult for the patient to stand, to wash himself, but it is much more easier wash himself, but it is much more easier to walk)to walk)
Reflex syndromesReflex syndromes on lumbar – sacral level are divided on lumbar – sacral level are divided
into:into:1. Lumbago 1. Lumbago 2. Lumbalgia2. Lumbalgia3. Lumbar ischialgia3. Lumbar ischialgia- muscular – tonicmuscular – tonic vascularvascular neuro- dystrophicneuro- dystrophic
The points of pain:The points of pain:Pain along the crista iliaca Pain along the crista iliaca The point of iliosacral jointThe point of iliosacral jointThe point of m. gluteus minimus (just The point of m. gluteus minimus (just
under the crista iliaca)under the crista iliaca)The point of m. gluteus medius (1 sm The point of m. gluteus medius (1 sm
lower)lower)The point under the backside foldThe point under the backside foldTrochanter os iliacaTrochanter os iliacaAlong the ischiadic nerve (the posterior Along the ischiadic nerve (the posterior
surface of hip and fossa subpoplitea)surface of hip and fossa subpoplitea)
The symptoms of strainThe symptoms of strain Lasegue’s symptom – in case of straining Lasegue’s symptom – in case of straining
and lifting the leg the low back pain appearsand lifting the leg the low back pain appearsNeri symptom – there is pain in leg at Neri symptom – there is pain in leg at
bending head forwardbending head forwardMatskevych symptom – there is pain in the Matskevych symptom – there is pain in the
anterior surface of the leg at knee bending anterior surface of the leg at knee bending while lying on abdomen while lying on abdomen
Wasserman symptom – the same clinical Wasserman symptom – the same clinical picture at lifting the legpicture at lifting the leg
The symptoms of strainThe symptoms of strainSequar symptom – there is pain on Sequar symptom – there is pain on
posterior surface of leg at foot flexingposterior surface of leg at foot flexingTurin symptom – the same clinical Turin symptom – the same clinical
picture at toe’s flexingpicture at toe’s flexingBechterev’s symptom – there is pain Bechterev’s symptom – there is pain
at knee – flexed leg extensionat knee – flexed leg extensionDejerine’s symptom - there is pain in Dejerine’s symptom - there is pain in
posterior surface of the leg at posterior surface of the leg at coughing, sneezingcoughing, sneezing
Piriformis syndromePiriformis syndrome
Clinical features: Clinical features: Painful palpation of Trochanter majorPainful palpation of Trochanter majorPainful m.PiriformisPainful m.PiriformisSymptom of Soobrase (painful cross-Symptom of Soobrase (painful cross-
legged position)legged position)Symptom of Bone – Bobrovnikova Symptom of Bone – Bobrovnikova
(painful abduction of leg)(painful abduction of leg)
Piriformis syndromePiriformis syndromePopelyansky intermittent claudication Popelyansky intermittent claudication
(while walking the patient is forced to (while walking the patient is forced to sit down because of the pain. That is sit down because of the pain. That is the result of spasm of the vessels. the result of spasm of the vessels.
Sphincter disorders (pause before the Sphincter disorders (pause before the urination) urination)
Signs of n. ischiadicus lesion (muscles Signs of n. ischiadicus lesion (muscles hypotrophy, low Achille reflex, hypotrophy, low Achille reflex, hyposthesia, pain)hyposthesia, pain)
Neurodystrophic form of lumbar Neurodystrophic form of lumbar ischialgiaischialgia
Sacroiliac periartrosis - pain and Sacroiliac periartrosis - pain and limitation of movements in hip joint. limitation of movements in hip joint. The patients cannot run and so on.The patients cannot run and so on.
Knee joint periartrosis– sudden pain in Knee joint periartrosis– sudden pain in knee jointknee joint
Coccygodynia Coccygodynia Neurodystrophic changes of Achille Neurodystrophic changes of Achille
tendon (it is very rare)tendon (it is very rare)
RRadiculopathyadiculopathy Radix L5 ( Disc L4 – L5)Radix L5 ( Disc L4 – L5)
Pain in the external edge of hip, on the Pain in the external edge of hip, on the anterior –external surface of crus until the anterior –external surface of crus until the internal surface of foot and great toe.internal surface of foot and great toe.
Sensory disorders (hypalgesia, analgesia) in Sensory disorders (hypalgesia, analgesia) in the same zonesthe same zones
Paresis of great toe extensors and foot Paresis of great toe extensors and foot extensorsextensors
Hypotonia and hypotrophy on the anterior Hypotonia and hypotrophy on the anterior surface of crussurface of crus
The patient cannot stand on heelsThe patient cannot stand on heels
RRadiculopathyadiculopathyRadix S1 (Disc L5 – S1)Radix S1 (Disc L5 – S1) Pain in external – posterior surface of Pain in external – posterior surface of
hip, crus, foot, the IV –th and Vth toes.hip, crus, foot, the IV –th and Vth toes. Sensory disorders (hypalgesia, Sensory disorders (hypalgesia,
analgesia) in the same zonesanalgesia) in the same zones Paresis of toes flexorsParesis of toes flexors Absent or low Achille reflex Absent or low Achille reflex
RRadiculopathyadiculopathyRadix L4 (Disc L3 – L4)Radix L4 (Disc L3 – L4) Pain in anterior – internal surface of hipPain in anterior – internal surface of hip Sensory disorders (hypalgesia, analgesia) Sensory disorders (hypalgesia, analgesia)
in the same zones prevail over motor onesin the same zones prevail over motor ones Weakness of m. Quadriceps femorisWeakness of m. Quadriceps femoris Hypotrophy of m. Quadriceps femorisHypotrophy of m. Quadriceps femoris Knee reflex is low or sometimes increasedKnee reflex is low or sometimes increased
RRadiculopathyadiculopathyRadix L2 – L3 Radix L2 – L3 Clinical features include pain and sensory Clinical features include pain and sensory
disorders on anterior – medial surface of hip. disorders on anterior – medial surface of hip. Symptoms of Matskevych, WassermanSymptoms of Matskevych, Wasserman Low knee reflexLow knee reflex Weakness of m. Quadriceps femorisWeakness of m. Quadriceps femoris CruralgiaCruralgia Symptoms of lesion of horse tailSymptoms of lesion of horse tail Irradiation of pain into lower part of Irradiation of pain into lower part of
abdomen, genital organsabdomen, genital organs
compression of horse compression of horse tailtail
It is created by radix L2 – S5. It is It is created by radix L2 – S5. It is observed at hernia of discs L4 – L5.observed at hernia of discs L4 – L5.
Clinical features:Clinical features:Significant pain in legsSignificant pain in legsSensory and motor disorders in certain Sensory and motor disorders in certain
zones of innervation zones of innervation Pelvic disorders (incontinence of urine Pelvic disorders (incontinence of urine
and feces)and feces)
Classification on cervical levelClassification on cervical level Reflex symptoms.Reflex symptoms.
Stiff neckStiff neckCervicalgiaCervicalgiaCervical cranialgiaCervical cranialgiaCevical brachialgiaCevical brachialgia
Muscle – tonic syndromeMuscle – tonic syndromeAutonomic – vascular syndromeAutonomic – vascular syndromeNeurodystrophicNeurodystrophic
Compressive radicular syndromeCompressive radicular syndrome
Classification on cervical Classification on cervical levellevel
Compressive – spinal syndromeCompressive – spinal syndrome Compressive vascular radicular – spinal Compressive vascular radicular – spinal
syndromesyndrome AcuteAcute
TransientTransientStrokes Strokes
Chronic ischemic myelopathyChronic ischemic myelopathy A. vertebralis syndrome (radiculopathy of A. vertebralis syndrome (radiculopathy of
C8 radix, disc C7 – C8C8 radix, disc C7 – C8))
Cervical cranialgiaCervical cranialgiaClinical features of posterior cervical Clinical features of posterior cervical
sympathetic syndrome:sympathetic syndrome:Cranialgia – occipital pain with irradiation in Cranialgia – occipital pain with irradiation in
temporal, parietal parts.temporal, parietal parts.Vestibulo – cochlear disturbances – Vestibulo – cochlear disturbances –
dizziness, vomitingdizziness, vomitingEyes symptoms – eyes pain, tears. Eyes symptoms – eyes pain, tears. Autonomic upper quadrant syndrome – Autonomic upper quadrant syndrome –
asymmetry of blood pressure, temperature, asymmetry of blood pressure, temperature, pulse, sensation, cardiac pain and so on. pulse, sensation, cardiac pain and so on.
Cervical brachialgiaCervical brachialgia
Muscle – tonic formMuscle – tonic formNeurodystrophic formNeurodystrophic formAutonomic – vascular oneAutonomic – vascular one
Muscle – tonic formMuscle – 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 brachialgiaCervical brachialgia
Neurodystrophic form Neurodystrophic form Shoulder – scapula periartrosis Shoulder – scapula periartrosis Shoulder – hand syndromeShoulder – hand syndromeEpicondilosisEpicondilosis
Cervical brachialgiaCervical brachialgia
Shoulder – scapula periartrosis Clinical Shoulder – scapula periartrosis Clinical features:features:
Pain and limitation of movements in shoulderPain and limitation of movements in shoulder Painful palpation of caput os humeriPainful palpation of caput os humeri Limitation of arm movements (the patient Limitation of arm movements (the patient
cannot comb his hair)cannot comb his hair) The symptom of frozen shoulderThe symptom of frozen shoulder M. deltoideus, m. supraspinatus atrophyM. deltoideus, m. supraspinatus atrophy
Shoulder – hand syndromeShoulder – hand syndrome
This syndrome includes clinical This syndrome includes clinical features of shoulder – scapula features of shoulder – scapula periartrosis and autonomic – periartrosis and autonomic – trophic changes of hand.trophic changes of hand.
Clinical features of algic stage:Clinical features of algic stage:Severe hand painSevere hand painEdema, hyperemia and cyanosisEdema, hyperemia and cyanosis
Shoulder – hand syndromeShoulder – hand syndrome
HyperesthesiaHyperesthesiaDecreased muscle strength and Decreased muscle strength and
limitation of movementslimitation of movements
Clinical features of dystrophic stage:Clinical features of dystrophic stage:Muscle atrophyMuscle atrophyOsteoporosis on X – rays examinationsOsteoporosis on X – rays examinations
Compressive radicular Compressive radicular syndromessyndromes
Radiculopathy C6 radix (C5 – C6 Radiculopathy C6 radix (C5 – C6 discs)discs)
Pain, parasthesia and hypalgesia Pain, parasthesia and hypalgesia on anterior external surface of on anterior external surface of armarm
Weakness, hypotrophy of m. Weakness, hypotrophy of m. biceps brachiibiceps brachii
Absent or low flex elbow reflexAbsent or low flex elbow reflex
Compressive radicular Compressive radicular syndromessyndromes
Radiculopathy C7 radix (C6 – C7 Radiculopathy C7 radix (C6 – C7 discs)discs)
Pain, parasthesia and Pain, parasthesia and hypalgesia hypalgesia
Weakness, hypotrophy of m. Weakness, hypotrophy of m. triceps brachiitriceps brachii
Low extensor elbow reflexLow extensor elbow reflex
Compressive radicular Compressive radicular syndromessyndromes
Radiculopathy C8 radix (C7 – C8 Radiculopathy C8 radix (C7 – C8 discs)discs)
Pain, parasthesia and hypalgesiaPain, parasthesia and hypalgesiaLow extensor elbow and carpo – Low extensor elbow and carpo –
radial reflexradial reflex
Additional methods of Additional methods of diagnosticsdiagnostics
Spinal X – ray – Spinal X – ray – examinationexamination
CT of spinal cordCT of spinal cord
TreatmentTreatment Orthopedic Orthopedic Medicines:Medicines:
In edema: Euphyllinum 2.4% 10.0; Lasix 2.0; In edema: Euphyllinum 2.4% 10.0; Lasix 2.0; Dexamethasonum 4 – 8 mg; NaCl 0.9% 200.0 i/v by dropsDexamethasonum 4 – 8 mg; NaCl 0.9% 200.0 i/v by drops
Platiphillinum, No – spa, BaralginumPlatiphillinum, No – spa, Baralginum Analgesics - Reopirini, Voltareni 2.5% 3.0; Tramadol, Analgesics - Reopirini, Voltareni 2.5% 3.0; Tramadol,
AminasiniAminasini Non steroids medicines– Ketanov, Dicloberl, Movalis, Non steroids medicines– Ketanov, Dicloberl, Movalis,
Ranselex, CelecoxibRanselex, Celecoxib Myorelaxants – Midocalm, BaclofenMyorelaxants – Midocalm, Baclofen Chondro- protectors – RumalonChondro- protectors – Rumalon Vitamins and biostimulatorsVitamins and biostimulators Physical methodsPhysical methods
TreatmentTreatmentSurgical methodsSurgical methods (Horse tail (Horse tail
compression, Long lasting (3 – 6 compression, Long lasting (3 – 6 months) pains, Huge hernia (over 15 months) pains, Huge hernia (over 15 mm), Acute compression of radicular mm), Acute compression of radicular – spinal artery)– spinal artery)
SanatoriumSanatorium
PreventionPrevention
Hypokinesia preventionHypokinesia preventionModerate physical activityModerate physical activityTreatment of chronic Treatment of chronic
diseasesdiseases