Dorsopathy( pain syndromes in the back): description, diagnosis

In the practice of a neurologist, the term "dorsopathy" is often encountered. What does it mean? In which cases is it used? It is not always easy for a person without medical education to understand this term. If you translate the term verbatim from Latin, it translates as "back disease".Dorsopathy is pain syndromes in the back in combination with neurological symptoms that are associated with degenerative-dystrophic lesions of the spine, its ligaments and muscles. Unfortunately, there is a simplified understanding that dorsopathy is synonymous with osteochondrosis. In fact, dorsopathy is a complex, multi-stage process, the leading symptom of which is back pain.

Causes and risk factors

Scoliosis-odn of the common factors dorsopathies risk.

A major role in the development of dorsopathy is given to risk factors:

• Low physical activity.
• Anomalies in the development of the spine.
• Genetic predisposition.
• Disorder of posture( scoliosis).
• Obesity.
• Harmful habits( smoking, alcoholism).
• Professions associated with high statodynamic loads on the spine.

Pain syndrome in the back can be caused by two groups of causes:

1. Vertebrogenic pain. Spine pathology( osteochondrosis, spondylarthrosis, trauma, spondylitis, spinal tumors, spondylosis, etc.) is caused by
2. . Nonvertebrate pains are caused by muscle and ligament damage( myositis, myalgia, myofascial syndrome).

Classification of

In the international classification of diseases, dorsopathies are divided into:

1. Deforming dorsopathies. They are manifested by deformation of the spine, damage( degeneration) of the intervertebral discs without their protrusion( spondylolisthesis, osteochondrosis, metastatic damage to vertebral bodies, congenital developmental anomalies, compression fractures, infectious lesions).This group is found most often.
2. Dorsopathies that have arisen in the degeneration of intervertebral discs( MTD) with protrusions( protrusions), accompanied by pain syndromes( hernia of the MTD, protrusion of the MTD).

The structure of the spine

The spine of a human being is constructed from 33-34 vertebrae. Each vertebra consists of a body and an arc that closes the vertebral foramen. Vertebral openings form a channel in which the spinal cord, vessels, nerve fibers pass. Between the bodies of the vertebrae are located intervertebral discs. They perform a cushioning function and prevent the bony surfaces of the vertebrae from touching when moving. The intervertebral disc consists of a pulpous nucleus surrounded by a fibrous ring. From each vertebra( except sacral), the articular processes that connect with the same processes of the superior and underlying vertebrae form, forming the facet joints. Facet joints provide flexibility of the spine. All this bone-joint apparatus is supported by paravertebral muscles and ligamentous apparatus. In the facet joints, there are channels for the exit of the vascular-neural bundles to the organs, muscles.

All the structures of the spine, as well as the muscles and vessels surrounding the spine, are provided with pain receptors( nociceptors), which are free ends of nerve fibers.

Adverse factors, acting on the spine, lead to spinal injury and cause activation of pain receptors in these structures. Pain is a nonspecific symptom, from which the manifestation of various forms of dorsopathy begins.

Clinical manifestations of dorsopathy

Myofascial syndrome - the source of pain are the muscles of the spine

One of the mechanisms of the development of pain in dorsopathy is muscle spasm. The person feels pain during the movements of the spine and at rest, locally there is a sharp soreness in the palpation of the affected muscle.

When irritating pain receptors in the muscles there is a muscle spasm. The muscles are spasmodic, condensed and the focus of irritation is limited. If at this time the effect of provoking factors ceases, then the pain subsides. If, against a background of muscle spasm, the triggering factor continues to act, the muscles become even more dense, spasm leads to the restriction of the affected segment and causes local muscular densification. Patients complain of regional pain in the muscle, restriction of movements in the back, a "pain" in the muscle is palpated during examination, when pressing the painful points in the muscles, there is a sharp soreness.

Osteochondrosis - a severe form of degenerative changes in the spine

With this disease, vertebrae( spondylosis) and intervertebral disks are deformed.

Interruption of intervertebral disk nutrition leads to its dehydration. It shrinks, and eventually breaks up into separate parts( sequestration), becomes more sensitive even to minimal mechanical influences, losing its damping function. In osteochondrosis, pain can be of a shooting nature, amplified by changing the position of the body, mainly localized in the lumbar region.

As with progression of degenerative processes, the fibrous ring of the disc decreases, shifts to the periphery - protrusions form( protrusions), fragments of the pulpous nucleus( hernia of the MTD) drop out through its cracks. Herniated disc of large size damages the spinal cord, which leads to the development of radiculopathy( radicular syndrome).Patients are concerned about severe pain in the lumbar region with irradiation into the groin, on the back of the thigh to the foot. Numbness of the skin area, a feeling of "crawling crawling," weakness in the legs. Pain occurs with minimal physical exertion, bears a shooting character. Antalgic( gentle) gait is formed.

Spondylarthrosis

Another source of pain is facet joint damage( arthrosis).In spondylarthrosis leading symptoms are dull, deep pain, without irradiation, stiffness of movements in the back.

Spondylosis

Spondylosis causes damage to the vertebral bodies. On their surface, bone tissue grows in the form of sharp spines, which damage a number of underlying structures( muscles, spinal cord, ligaments of the spine).Patients experience aching pain, heaviness in the back. Pain increases with prolonged position in one pose.

For all of the above diseases, neurologic symptoms may join the pain syndrome: weakness in the legs( paresis), numbness of the skin areas, a feeling of "crawling crawling," intermittent claudication. The pain radiates to the tips of the toes, the muscles are hypotrophic.

Diagnosis

Diagnosis of dorsopathy includes:

• clinical examination by a neurologist;
• radiation diagnostic methods: roentgenogram of the spine, CT, MRI.

The clinical picture does not always correspond to the severity of the lesion detected by radiation diagnostic methods. With minimal changes in the pictures, the patient may experience severe pain and, conversely, with severe lesions - the symptoms do not bother.

Treatment of

To ease the pain, the patient is prescribed injections of NSAIDs and muscle relaxants or the same drugs in the form of tablets.

The main directions of treatment:

1. Correct the cause.
2. Gentle mode of physical activity.
3. Removing the pain syndrome( details below).
4. Physical Exercise( LFK).
5. Physiotherapy.
6. Surgical treatment. With long-term absence of the effect of drug therapy or the addition of severe neurological complications, surgical methods of treatment are used.

Methods for withdrawal of pain syndrome

• Non-steroidal anti-inflammatory drugs( NSAIDs).They have a pronounced analgesic, antipyretic and anti-inflammatory effect. These include: dexketoprofen, diclofenac, ibuprofen, ketorolac, meloxicam, nimesulide( Naise), etc.
• Muscle relaxants. These drugs help reduce the severity of the pain syndrome, reduce muscle spasm. These include: baclofen, sirdalud, midokalm, etc.
• Vitamins of group B( combiliphen, vitagamma, neuromultivitis, neurobion, etc.).Contribute to the restoration of damaged nerve fibers. High efficiency was proved when used together with NSAIDs.
• Chondroprotectors( alflutope, chondroitin sulfate, rumalone, etc.).Protect intervertebral discs and facet joints from further destruction.
• Local therapy: blockades with anesthetics and glucocorticoids, ointments, acupuncture.
• Manual therapy.

Dorsopathies without clinical manifestations do not require special treatment. When they are identified, therapeutic and prophylactic measures are recommended, aimed at reducing the frequency of relapses, preventing neurological complications.

Conclusion

To date, dorsopathies are one of the leading causes of disability of the working-age population, despite modern diagnostic and treatment methods. Low circulation of the population to specialists at the initial stages of the disease leads to a chronicization of processes in the spine and an increase in the number of neglected cases.

The earlier the treatment measures are initiated, the higher the likelihood of a favorable outcome of the disease.

The neurologist NN Sperling tells us the difference between dorsopathy and osteochondrosis:

Osteochondrosis and dorsopathy, what's the difference?(the doctor explains about dorsopathy).

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The specialist of the Moscow doctor clinic talks about dorsopathy:

Dorsopathy

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