Types of spinal dystrophy, treatment methods and prevention. What is vertebral fatty degeneration

Bone marrow accounts for approximately 5% of the total body weight and plays an active role in hematopoiesis (blood formation). Bone marrow consists mainly of stem cells (all types of cellular elements of the blood), surrounding supporting cells - macrophages, adipocytes and large number others involved in nutrition, proliferation (growth) and differentiation of stem cells. Red bone marrow contains about 40% fat, yellow bone marrow contains up to 80%. This feature helps in identifying various pathologies associated with changes in this ratio during MRI of the spine.

T1-weighted MRI is most sensitive to adipose tissue. They are the basis of the MRI protocol. In addition, T2-weighted MRI with fat suppression is used. Below we will focus on the main pathologies that appear on MRI of the spine, such as bone marrow pathology in the first place.

• Hemangioma, single or multiple, accounts for 10-12% of changes in the vertebrae. It refers to vascular anomalies and has characteristic features on MRI of the spine - round or trabecular, light on T1-weighted and T2-weighted MRI, does not change MRI with signal suppression techniques from fat.
• Local fat deposits appear with age and are a variant of the norm. Fat deposits also observed in osteochondrosis along the endplates (fatty degeneration, or type 2 according to the Modic classification). They are bright on T1-weighted MRIs of the spine and become dark on fat-suppressed MRIs. Sometimes there are mixed variants of bone marrow changes in osteochondrosis, which are not completely suppressed when using the STIR MRI sequence.
• Paget's disease refers to metabolic disorders and is observed in 1-3% of people over 40 years of age. Damage to the vertebrae ranks second after the pelvic bones. In diagnosing Paget's disease, identifying lytic foci in the bones of the skull is very helpful. Paget's disease goes through 3 stages - lytic, mixed and blastic. In accordance with these stages, MRI of the spine shows a different picture. In the lytic stage, the lesion signal is bright on T2-weighted MRI and low on T1-weighted MRI, then becomes hypointense on both types of MRI as sclerosis and fibrosis increase. MRI of the spine also reveals other character traits Paget's disease - thickening of the cortical plates of the vertebral bodies, fatty degeneration on late stage and during successful treatment.

MRI of the spine. T1-weighted sagittal MRI of the lumbosacral region. Replacement of sacral bone marrow with fat in Paget's disease.

• Lipoma refers to benign tumors from adipose tissue. They make up about 1% of all primary bone tumors and no more than 4% of them are localized in the vertebrae. On MRI of the spine, lipomas are difficult to distinguish from fat deposits, however, they are more clearly defined and may undergo internal necrosis and calcification
• hemorrhages in the vertebrae occur with injuries. MRI of the spine reveals characteristic blood dynamics depending on the duration of the hemorrhage.
• Consequence radiation therapy boil down to replacing red bone marrow with yellow. When the absorbed dose exceeds 36 Gy, this process becomes irreversible. MRI of the spine shows diffuse increase signal on T1-weighted MRI with a clear boundary corresponding to the irradiation field. After radiation therapy and chemotherapy, myelofibrosis - bone marrow replacement - can also develop fibrous tissue. In MRI of the spine, the signal is very low on both T1-weighted and T2-weighted MRIs.

MRI of the spine. T1-weighted sagittal MRI thoracic. Fatty degeneration bone marrow after radiation therapy.

• Osteoporosis leads to a decrease in cellular composition bone marrow and increased fat. MRI of the spine often shows diffuse increased signal from the vertebral bodies on T1-weighted MRI. There are also focal changes that require MRI of the spine differential diagnosis with hemangiomas. MRI diagnostics for osteoporosis is also presented in a separate article.
• Spondyloarthropathy on MRI of the spine often manifests as “glowing” angles on T2-weighted MRI. This is especially true for acute stage ankylosing spondylitis. Change acute phase to chronic leads to transformation inflammatory reaction in a depot of adipose tissue, clear on T1-weighted MRI. MRI of the spine for various diseases belonging to the group of spondyloarthropathies is discussed in a special article on our other website.
• Anorexia is accompanied various changes in the body, including osteoporosis and decreased signal intensity on T1-weighted MRI, as well as bone marrow edema, which is referred to as “gelatinous transformation.” On T2-weighted MRI (especially fat-suppressed MRI), there is a slight diffuse increase in signal from the vertebrae. MRI of the spine with contrast shows amorphous signal enhancement.

MRI of the spine. T2-weighted sagittal MRI. Gelatinous transformation due to malnutrition.

• Hemosiderosis is a phenomenon observed when hemolytic anemia. MRI of the spine shows low signal in the bone marrow. In differential diagnosis, it is important that the liver and spleen acquire the same low signal.
• Gaucher disease is an autosomal recessive disorder hereditary disease classified as sphingolipidosis and manifested by the accumulation of glucocerebrosides in histiocytes. The diagnosis is made based on puncture of the spleen and detection of specific cells. On MRI of the spine, red bone marrow is replaced by Gaucher cells, which are hypointense on T1- and T2-weighted MRI. In addition, bone infarcts are often observed on MRI of the spine.

MRI of the spine. T1-weighted MRI of the thoracic spine. Gaucher's disease.

• Myeloproliferative and myelodysplastic syndromes, which include chronic myeloid leukemia and others chronic leukemia, polycythemia, mastocytosis, essential thrombocytopenia on MRI of the spine manifest as a uniformly reduced signal on T1-weighted MRI. T2-weighted MRIs of the spine often show “reverse” brightness intervertebral discs, they become lighter than the vertebral bodies. MRI of the brain for tumors of the hematopoietic system can also reveal its damage.

MRI of the spine. T2-weighted sagittal MRI cervical spine spine. Chronic myeloid leukemia.

• Sarcoidosis affects the bone marrow in 1-3% of cases. Damage to the brain and spinal cord is much more common in sarcoidosis. MRI of the spine reveals sclerotic foci that closely resemble metastases, often multiple. The lesions can be mixed lytic with sclerotic rims. MRI of the spine with contrast may show increased signal from lesions.
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Fatty degeneration of the vertebrae or other organs is a pathological process in which normal organ tissue is replaced by fatty tissue. In the case of vertebrae adipose tissue replaces hematopoietic bone marrow tissue. Typically, degeneration is associated with aging of the body. For example, in some patients who have reached 60-70 years of age, the bone marrow consists of 50% fat.

If the patient's quality of life does not deteriorate, some specific treatment fatty degeneration is not required. But in some cases, replacement of normal tissue may begin in more early age. In such patients, the onset and development of the disease does not depend on the age factor, but occurs for other reasons. The process is often accompanied by complications and poses a threat to the life and health of the patient - in this case, conservative or surgical treatment. It often happens that therapy is effective only for initial stage diseases. If the process has progressed greatly, it may be possible to only stop the development of the pathology, but not eliminate it completely.

Causes and mechanism of development of the disease

To better understand what fatty degeneration of the vertebrae is, let’s consider the mechanism of development of the pathology and the reasons that initiate the process. The mechanism of degeneration of vertebral tissue is triggered by myeloid cells contained in bone marrow. These cells are responsible for the production of blood cells. Very slowly, but irreversibly, fatty grains penetrate into the cells of the vertebrae, as a result of which the cell sooner or later dies, and adipose tissue takes its place. Not only the vertebrae, but also the tissues surrounding them - intervertebral discs, muscles, ligaments - can be subject to degeneration.

Such complex pathological changes in the tissues of the musculoskeletal system primarily affect the condition of the spine. They are actively starting to develop additional diseases spinal column – , . Changes may also begin in other organs and tissues of the body. The consequences of fatty degeneration of the vertebrae are anemia, anemia, Simmonds-Schien disease, deterioration of blood vessels and other pathologies.

Causes of fatty degeneration of the vertebrae (if the process is not associated with the patient’s advanced age):

1. Oncological pathologies, especially with metastases to the bone marrow.
2. Infectious and inflammatory diseases.
3. Metabolic disease.
4. Impaired blood circulation and/or trophism of musculoskeletal tissues.
5. Systematic use of certain medications (NSAIDs; drugs prescribed for hypertension or other diseases of cardio-vascular system, antibiotics, barbiturates).
6. Alcohol, medication, chemical intoxication of the body.

In some cases, osteochondrosis becomes not a consequence, but a cause of fatty degeneration of the vertebrae. The fact is that with osteochondrosis, patients are often prescribed NSAIDs, long-term use of which provokes the onset of the process of tissue replacement.

Symptoms of fatty vertebral degeneration

It is very difficult to diagnose fatty degeneration of the vertebrae on your own, since the symptoms of the pathology are similar to those of other diseases of the musculoskeletal system:

• back pain, most often in the neck and chest;
• lack of coordination;
• headaches, fatigue;
• decreased sensitivity in the extremities, a feeling of coldness or numbness, “crawling goosebumps”;

The main symptom of fatty degeneration of the vertebrae is limited movement, a feeling of stiffness, decreased motor activity. In order to accurately diagnose the disease, you need to consult a specialist. The doctor will conduct an external examination, order an MRI and, based on its results, make a diagnosis and prescribe treatment.

Treatment of fatty vertebral degeneration

Treatment of pathology can be either conservative or surgical. It is worth noting that conservative methods mostly aimed at stopping pain syndrome, stopping the progression of the disease, preventing possible complications.

Conservative therapy:

1. During an exacerbation of the disease - bed rest, muscle relaxants, novocaine blockade.
2. During the period of remission - NSAIDs, chondroprotectors, physiotherapy, manual therapy, exercise therapy, spinal traction, massage, kinesiotherapy.

Surgical methods of treatment:

1. Discectomy.
2. Intradiscal decompression, laser decompression, or steroid management.
3. Laser therapy.
4. Electrothermal plastic surgery of the fibrous ring.
5. Replacement of the nucleus pulposus (this restores the integrity of the fibrous disc).

The choice of treatment method is within the competence of the doctor and depends on many factors - technical capabilities, age and health status of the patient, and the prognosis of the success of a particular method of therapy.

Fatty degeneration of the vertebrae, if it is associated with the aging of the body, is an irreversible process and a normal variant. If replacement of healthy tissue occurs in middle age and threatens the development of serious complications, immediate treatment will be required. Conservative therapy will help alleviate the patient's condition. Surgical methods are used in the most severe and dangerous cases diseases.

Fatty degeneration of the bone marrow is a natural age-related process, which is characterized by the replacement of hematopoietic tissue with adipose tissue. Bone marrow degeneration can be caused by both pathological and physiological reasons. Treatment methods depend on the causative disease and the patient's health status. Symptoms are nonspecific, and sometimes the disorder is asymptomatic. The prognosis depends on the degree of fatty tissue degeneration, the patient’s age and concomitant diseases.

Age-related degeneration of yellow bone marrow increases the likelihood of developing spinal osteochondrosis

Bone marrow is a spongy red substance that is located in the inside of the bones. He plays important role in the formation bone tissue. It contains multipotent stem cells. They form white blood, red blood cells and platelets.

Yellow bone marrow is composed primarily of fat cells (hence the color), which increase in content as each person ages. Red bone marrow is the site of formation of cellular components of blood. In a child, bone marrow fills all the bones. Over time, red bone marrow turns yellow. In adults, red is found only in flat bones: sternum, vertebral bodies, ribs, cranial bones, pelvic bones. In case of anemia, yellow bone marrow can be replaced with red bone marrow.

The prevalence of early fatty degeneration caused by hypoplastic or aplastic anemia is low in the United States and Europe: 2–6 cases per million people. Much more often, fatty degeneration of the bone marrow occurs as a result of acute myelogenous leukemia and multiple myeloma: 27-35 cases per 1,000,000 people. The incidence of myelodysplasia has increased from 143 cases reported in 1973 to 15,000 cases annually in the United States.

In Japan and Far East the incidence of fatty bone marrow degeneration is at least 3 times higher than in the United States and Europe. Mexico and Latin America also have high performance morbidity, which are explained by the liberal use of chloramphenicol. Factors environment and widespread use of insecticides have been seen as causes of this disease. The incidence of myelodysplasia is estimated to be approximately 4-5 cases per 100,000 people per year in Germany and Sweden.

In the International Classification of Diseases, 10th revision (ICD-10), fatty degeneration in the bone marrow is designated by code M42.

Symptoms

Age-related degeneration of yellow bone marrow increases the likelihood of developing osteochondrosis (dystrophy) of the vertebral bodies (in the spinal area). In most cases, the pathological process is asymptomatic or manifests minor symptoms. Symptoms depend on the rate of lipoid bone marrow degeneration and the underlying disease.

Causes

Deficiency of folic acid in the body leads to fatty degeneration of the bone marrow

Degenerative bone marrow diseases can be inherited or acquired during life.

Main reasons:

• Decreased concentration or damage to hematopoietic stem cells, leading to hypoplastic or aplastic anemia.
• Deficiency of folic acid or vitamin B12.
• Myelodysplasia.

Damage to hematopoietic stem cells can be caused by congenital or acquired disorders. The main mechanisms of stem cell destruction:

• Acquired stem cell damage is caused by viruses, toxins, or chemicals(chloramphenicol, insecticides), which leads to a quantitative or qualitative change in cellular composition.
• Abnormal humoral or cellular control of hematopoiesis.
• Antibody, T cell, or lymphokine-mediated suppression of hematopoiesis.
• Mutations in genes that accelerate fatty degeneration of the bone marrow. The identification of these mutations has led to progress in determining the precise functions of the corresponding proteins in normal cells
• Hereditary syndromes.

Hereditary syndromes that accelerate bone marrow degeneration:

• Fanconi anemia.
• Congenital dyskeratosis.
• Shwachman-Diamond syndrome.
• Diamond-Blackfan anemia.
• Amegakaryocytic thrombocytopenia.
• Congenital neutropenia.

Constitutional aplastic anemia is associated with chronic failure bone marrow congenital anomalies, familial morbidity or thrombocytopenia at birth.

Red bone marrow aplasia may be a consequence of thymoma. Sometimes it occurs as a result viral infection. Bone marrow aplasia can also be permanent, e.g. as a result of viral hepatitis. In rare cases, aplasia is caused malignant neoplasms lymphoid tissue or collagen vascular diseases(for example, systemic lupus erythematosus).

Decreased concentrations of all 3 types of blood cells are the most common manifestation of a bone marrow disorder. Aplastic or hypoplastic anemia can develop due to secondary causes. Myelodysplastic may also reduce all types of blood cells.

Dangerous complications

Severe bone marrow degeneration requires rapid initiation of therapy - early search for donors for bone marrow transplantation

The morbidity and mortality from fatty bone marrow degeneration is caused by low levels of mature blood cells. Severe anemia can cause heart failure and fatigue. Neutropenia can predispose people to bacterial and fungal infections. A decrease in platelet count can increase the risk of severe bleeding.

The severity and extent of fatty degeneration determine the prognosis. Severe multiple bone marrow degeneration is an emergency medical situation, requiring a quick start of therapy - an early search for donors for bone marrow transplantation.

Long-term transfusion of donor red cells increases the overall burden on the patient. Increased levels iron are toxic to various organs, including for the heart. High dosages can cause arrhythmia, diabetes and cirrhosis of the liver. Iron may also produce a bronze coloration in people with soft skin. Therefore, it is necessary to measure the patient's reserves of the element (in the form of ferritin).

The introduction of a chelating agent is effective method removing excess iron. Chelating agents are made up of molecules that bind tightly to free iron and remove it.

Monitoring serum ferritin levels and measuring total urinary excretion may determine the effectiveness of therapy. Most bone marrow tissue damage can be reversed with timely treatment.

Diagnostics

First, a physical examination is performed and a medical history is taken. Then the doctor prescribes blood tests that show the qualitative and quantitative composition of the blood. Red blood cells are morphologically normal in tests. The reticulocyte count is usually less than 1%, indicating a lack of red blood cell production. Sometimes the average cell volume increases.

The platelet count is lower than usual, and sometimes there is a severe decrease in platelet count. The platelet size is normal, but low level may lead to bleeding.

There is a decrease in all granular leukocytes, including neutrophils, eosinophils and basophils, as well as a decrease in monocytes. Sometimes relative lymphocytosis occurs. Folic acid, vitamin B12 and serum erythropoietin levels are usually elevated in fatty bone marrow degeneration.

Fanconi anemia should be considered in all young adults and children with hypoplastic or aplastic anemia, unexplained macrocytosis, myelodysplastic syndrome, acute myeloid leukemia or skin malignant tumors.

Bone marrow tests help confirm the diagnosis. Pure red cell aplasia characteristically affects red blood cell progenitor cells; amegakaryocytic thrombocytopenia is confirmed by the absence of megakaryocytes. Detection of bone marrow hypoplasia distinguishes aplastic anemia from aleukemic leukemia.

Classification

To assess changes in the bone marrow of the vertebral bodies using magnetic resonance imaging, the Modic classification is used:

• Type I: areas of low magnetic resonance signal intensity on T1-weighted images and high-intensity areas on T2-weighted images. Patients experience bone marrow changes due to inflammation and swelling.
• Type II: high signal intensity on T1- and T2-weighted images due to fatty degeneration of the bone marrow.
• Type III: low intensity signal on T1- and T2-weighted images. Sclerotic changes are visible in the spongy substance of the vertebral bodies.

Treatment

The choice of treatment method (conservative or surgical) depends on many factors - technical capabilities, age and health status of the patient, prognosis for the success of a particular method of therapy

Infections leading to neutropenia should be treated as an emergency medical conditions. After taking blood and other biological materials antibiotics are prescribed wide range actions. The choice of antibiotic may be changed later, depending on the results of the microbiological analysis.

Sepsis, pneumonia, infections urinary tract and cellulite are common complications of neutropenia.

Patients with severe aplastic anemia who receive antithymocyte or antilymphocyte globulin have a 1-year survival rate of 55%. Androgen supplementation increases treatment response rates to 70%, with a 1-year survival rate of 76%. Although their mechanism of action is unknown, antithymocyte or antilymphocyte globulin should be given with corticosteroids to prevent serum sickness.

Forecast

The prognosis of bone marrow degeneration depends on the underlying disease. Majority hereditary syndromes diseases, such as Fanconi anemia, can develop into leukemia after a few years. Acquired idiopathic aplastic anemia is usually a permanent and life-threatening blood disorder. Half of patients die within the first 6 months.

If fatty degeneration of the bone marrow is caused by harmless causes - aging - the prognosis is favorable and life expectancy does not decrease.

Magnetic resonance imaging is one of the modern methods research, thanks to which it is possible to check internal tissues for the presence of various pathologies or diseases. This method makes it possible to obtain tomographic recorded images, which help to carry out high-quality diagnostics of the object. This examination is carried out on the basis of emitted electromagnetic waves, which are reflected by the tissues. Thanks to this type examinations have become quite common, they are increasingly being prescribed in order to prevent serious disorders or the development of pathologies.

MRI - new method diagnostics that allows you to check internal organs and tissues and identify various pathologies

In this article you will learn:

When is a bone marrow MRI performed?

An MRI of the organ is performed if there are suspicions of the diseases indicated in the table.

MRI is also prescribed for various injuries different parts of the spine.

In addition, MRI can detect early stages or prevent the occurrence of various disorders associated with the hematopoietic organ, showing its slightest changes.

Fatty degeneration

Fatty degeneration is a process that occurs along with age-related changes. With it, the tissues that are responsible for the formation of blood are replaced by fatty tissue compounds. Other causes of this pathology may be tumor diseases, as well as the presence of infections. The course of such replacement may be accompanied by complications. Fatty bone marrow degeneration is detected on MRI by the presence of fat cells in the organ.

Organ reconversion

Bone marrow reconversion on MRI shows damage hematopoietic organ. The study shows pathologies of adipose tissue, which is replaced by cells responsible for the formation of blood. The cause of this disorder is chronic anemia.

MRI allows diagnosis of bone marrow reconversion

How to prepare the patient

Preparing the patient for this procedure is to ensure that he adheres to the following aspects:

1. Electrical devices and other equipment cannot be kept in the office where the research will be carried out, as they may fail.
2. Before the procedure itself, it is necessary to remove or remove metal objects from the body.
3. The clothing in which the patient must undergo the examination must be without metal accessories.

It is forbidden to take electrical appliances and equipment with you into the MRI room.

In addition, two days before such an examination it is necessary to adhere to a small diet that will help cleanse the intestines. To do this, it is recommended not to consume or abstain from foods that cause increased gas formation:

• bakery;
• flour products;
• sweets;
• cabbage;
• legume products;
• gas drinks;
• alcohol.

In addition, a patient with bone marrow edema should be reassured by MRI that the procedure is painless and noninvasive. Before the test, your doctor may recommend taking some medications, which is taken into account individually for each patient.

Two days before the diagnosis, you need to exclude flour and baked goods from the menu.

How to perform the procedure

The order of the procedure is to perform the following steps:

1. The patient wears clothing specially designed for the procedure.
2. Performs all preparatory measures, removing metal objects.
3. Then he needs to lie down on a special couch. They are fixed with special belts to ensure complete immobility of the body.
4. The couch moves into the tomograph, which has the shape of a cylinder.
5. During the procedure, when the patient is inside the tomograph, it produces various noises. Using electromagnetic radiation, it records changes in the body.

If a person has an acute fear of closed spaces, the doctor may give a sedative to take so that the patient does not experience anxiety.

Such a study can last 40–90 minutes.

Is contrast used in MRI?

Whether to use contrast during MRI is decided by the doctor who conducts the diagnosis. It is possible that this substance may need to be introduced into the body. It is used to make images of soft tissues clearer. It highlights and visualizes the tissue structures of the patient's body.

Exist different kinds contrast agents, which are used in MRI. But the most commonly used is the one that is administered intravenously. Its basis is iron oxide, it makes circulatory system clearer in pictures.

The contrast leaves the body naturally within 24 hours.

What changes are visible on MRI?

Bone marrow MRI shows:

• form of tissue swelling;
• ratio of bone joints in the vertebrae;
• the ratio of fat accumulation, as well as bone connective tissue;
• an increase in the amount of water, which causes inflammation;
• presence of infections;
• properties of soft tissue compounds;
• exact location of inflammation.

MRI results can reveal the presence of infections in bone marrow tissue

Thanks to this research method, it is possible to assess the condition of the spine itself, hematopoietic tissues, the size of the existing damage, as well as other pathologies. All these indicators help to put accurate diagnosis, appoint the most effective treatment or methods of disease prevention.

What could be the causes of cerebral edema?

The causes of bone marrow edema are the following:

• ligament-related injuries;
• spine fracture;
• torn tendons;
• inflammation of the osteofibrous canal;
• connective tissue damage.

With cancer, swelling occurs in the bone marrow

Edema may be present in the presence of the following diseases:

• cancerous formations;
• bone softening;
• osteoarthritis;
• reducing the rate of bleeding in blood vessels;
• aseptic necrosis.

Sometimes several diseases can contribute to the accumulation of fluid in tissues, which, as they progress, give a negative clinical picture.

What consequences can there be after an MRI?

Possible consequences of MRI for the body may include the following pathologies:

• neurogenic systemic nephrosis;
• skin thickening;
• violation of flexible movements of the arms and legs.

Often Negative consequences after such a procedure, they arise when contraindications are ignored. For example, if some metal objects are not removed, damage may occur on the patient's body during the procedure. The presence of metal implants must be reported to the doctor in advance.

The video details bone marrow MRI:

When the procedure is contraindicated

There are 2 types of contraindications:

• absolute;
• relative.

In the presence of absolute contraindications the procedure is unacceptable. But if there are relative contraindications, it is possible under certain conditions.

Absolute contraindications:

• presence of a heart rate stimulator;
• implants in the middle ear of the electronic type;
• the presence of metal implants.

Painful sensations in the back are the most common complaint of patients when visiting a traumatologist and orthopedist. Without necessary treatment acute diseases the spine goes into chronic form and can significantly reduce the patient’s quality of life.

The intervertebral disc is located between the vertebral bodies and consists of three structures - the fibrous ring surrounding the intervertebral joint, the nucleus pulposus and two hyaline plates that close the disc and adjacent to the adjacent vertebrae. The fibrinous ring is needed to keep the nucleus in the correct position, because it is a kind of shock absorber of the spinal column when walking, jumping, bending, and turning.

Intervertebral discs make up almost a third of the entire spinal column. The gelatinous nuclei contained within it are very hydrophilic (they love water), they need it for elasticity and resilience, thanks to which they can serve as a shock absorber.

How does vertebral degeneration develop?

When the spinal column is malnourished, various degenerative diseases, they lead to a decrease in height intervertebral disc and movement disorders in the spine. Gradually, surrounding structures - joints, muscles, ligaments - are also involved in the process. A major role in the pathological process is played by fatty degeneration of the vertebrae, or rather the yellow ligaments that hold the spine. As a result, the spinal canal that runs inside the vertebrae begins to narrow. It is this stenosis (narrowing) that causes back pain.

Due to the fact that the vertebrae do not have their own innervation and blood supply system (it is present only in the outer plates of the fibrous ring), and also due to the fact that during life the greatest pressure is exerted on the spinal column, degenerative processes in it begin much earlier than in other large joints.

This fact is also associated with the fairly young age of the majority of patients; this process gradually intensifies and leads to the fact that by the age of 60–70, more than half of the population has vertebral degeneration to one degree or another. Gradual erasure of the border between the fibrous ring and the nucleus leads to a decrease in the height of the spine and infringement of the inner part intervertebral disc- nucleus pulposus.

Besides, age-related changes occur in blood vessels, due to which delivery deteriorates necessary substances(protein glycans) to internal structures ligamentous apparatus spine. A complex of factors - deterioration of trophism and compression of the vertebrae, leads to the formation of cracks in the nucleus pulposus, it loses moisture and its elastic properties decrease. In addition, prolapse (protrusion) of the disc occurs in spinal canal. This is how degeneration develops intervertebral discs, and now the vertebrae are not sufficiently cushioned, any careless, and sudden movements may cause pain.

However, the process is not limited to spinal disc degeneration. A decrease in the height of the spinal column promotes the involvement of neighboring formations in the process - ligaments, facet joints, this leads to their overstrain and increased removal of calcium from them and the development of osteoporosis. Naturally, the yellow ligaments, which fill the spaces between the vertebrae and are attached to the vertebral arches, weaken, because the spine has become shorter. The yellow ligaments, or as they are also called fatty ligaments, lose their elasticity, thicken and wrinkle. Due to the fact that serious changes occur in the yellow (fatty) ligaments pathological processes, the disease is called fatty degeneration of the spine.

As a result of long-term studies, it has been proven that protrusion of the disc into the intervertebral canal is not always the only cause of pain. Passes in the spinal canal spinal cord, which is represented by the roots of the spinal nerves. When there is a protrusion at any level of the intervertebral disc, compression of the root occurs and the appearance of pain is quite logical. However, scientists have found that painful sensations also appear due to “sterile” autoimmune inflammation of the root. The source of inflammation is a crushed vertebral disc that is in contact with the root.

The main reason for the degeneration of intervertebral discs is the deterioration of the nutrition of their cells - they are more sensitive to a decrease in the amount of oxygen, glucose and changes in the acid-base balance in the blood. This in turn initiates degenerative processes in the disc.

What causes eating disorders? There are many reasons, these include, in addition to metabolic changes, various diseases blood, for example, anemia, also atherosclerotic changes, insufficient or excessive loads on the spine, unhealthy diet.

Classification of degenerative-dystrophic changes in the spine

Degenerative-dystrophic changes in the vertebrae occur in several stages.

Thus, at stage 0, disturbances in the disc are not yet registered, but at the first stage it is already possible to see small gaps in the disc during the study. inner layers fibrous ring.

During the transition to the second stage, the outer layers of the fibrous ring are still preserved (which still prevents the protrusion of the disc into the intervertebral canal), however, back pain appears, which can radiate to the lower limb and knee joint.

The third stage is characterized by extensive ruptures of the fibrous ring along the entire perimeter, as a result of which the disc prolapses into the spinal canal, and lumbar pain intensifies. A tear of the longitudinal ligament is visible.

Treatment of pain caused by vertebral degeneration

Surgical and conservative methods are used to relieve pain. They are aimed at alleviating the patient’s condition, and therefore can only be considered palliative.

1. Bed rest for the period of the most intense pain. Getting up late aggravates the situation and leads to less recovery of the spine;
2. Non-steroidal anti-inflammatory drugs - ibuprofen, diclofenac, piroxicam, indomethacin, naproxen, ibuprol, nimesulide, diclofenac patch;
3. Muscle relaxants - baclofen, tizanidine, cyclobenzaprine, tolperisone, methocarbamol;
4. Local anesthesia - novocaine blockades are most often used;
5. Chondroprotectors - chondroitin sulfate, glycosamine sulfate and diacerein.
6. Physical therapy - dosed load on the spine, strength special exercises, warming up, electrical stimulation. Often, the complex of these effects has a more significant result than long-term pharmacological treatment.
7. A specially selected set of exercises, massotherapy, in some cases manual therapy.

As for surgical treatment This pathology, the attitude towards it in most leading countries of the world is rather restrained, it is applied only to a small percentage of patients.

Among surgical methods treatments can be used:

• Discectomy with arthrodesis;
• Intradiscal injection of steroids;
• Intradiscal decompression;
• Laser therapy.

IN last years Minimally invasive treatment methods have become widespread - electrothermal plastic surgery of the fibrous ring, laser decompression of discs, percutaneous endoscopic removal disk. Methods for replacing the nucleus pulposus with restoring the integrity of the fibrous disc have also begun to be used.