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Dorsopathy of the cervical, lumbosacral and thoracic spine

A little about the terms ...

Medical science, like other branches of human knowledge, does not stand still. And even in the already familiar diagnostic formulations innovations appear. Older diagnoses recommend “not writing” at the beginning departmental employees who deal with doctors in advanced training faculties. Then comes the official letter of the Ministry, and, finally, the order.

This happened with “dyscirculatory encephalopathy”, instead of which doctors began to write “chronic cerebral ischemia” or “hypertensive encephalopathy”. So it became with the concept of “intellectual and mental disorders”, which fell out of use in the 1990s. It is now customary to write “cognitive disorders” in case histories.

Finally, the same fate befell everyone’s clear diagnosis of “spinal osteochondrosis,” but in a special way. Since spinal osteochondrosis is the official diagnosis approved in ICD 10 under the code M42, it was necessary to supplement it. Now this disease is related to deforming dorsopathies, and not just to dystrophic-degenerative lesions of intervertebral discs.

Deforming dorsopathy, osteochondrosis - these words can be considered almost synonymous, and when the doctor who treated you for osteochondrosis writes you the diagnosis “deforming dorsopathy” - you can not worry - except for the name, nothing has changed.

Interestingly, the same ICD of the tenth revision includes non-deforming dorsopathies spondylosis, spondyloarthritis and spondylopathies, that is, lesions of the vertebrae, as well as dorsalgia. We will understand this issue in more detail.

Content

Dorsopathy - what is it?

Dorsopathy

Compare two diagnoses in the outpatient map. Here is the first:

Chronic vertebral dorsopathy, left-sided cervicalgia, on the background of osteochondrosis of the cervical spine, moderate pain and musculo-tonic (myofascial) syndrome, stage of incomplete remission.

And here is the second wording:

Osteochondrosis of the cervical spine, left-sided cervicalgia, moderate pain and muscle-tonic (myofascial) syndrome, stage of incomplete remission.

Almost no difference: clinical manifestations - pain (cervicalgia), its localization (left half of the neck). The mechanism of damage (discogenic-osteochondrosis), concomitant syndromes (muscular-tonic), the stage of the disease (incomplete remission) all coincide.

Only the first diagnosis is correct, and it will fall into payment after checking by the OMS fund, and the second is not, because now there is no such independent diagnosis as osteochondrosis. Ahead it is necessary to write "dorsopathy". What is this condition, or term?

That is the whole problem, that it does not mean anything special: dorsopathy is literally a “problem with the back”, since dorsum is “back” and “pathos” is suffering.

Why was this “diagnostic unit” added if it does not carry any independent value? To designate a larger category in the ICD - 10. Now, the dorsopathies section includes lesions of the vertebrae, discs and dorsalgia, or unspecified back pain.

This section of the ICD - 10 classification does not belong to nervous diseases, but refers to lesions of the musculoskeletal system.

Causes or what is considered dorsopathy?

Now you can quite officially assume that you have dorsopathy, if there is not only a pathology with vertebrae or intervertebral discs, but in general, any pain in any part of the back (dorsalgia). Of course, no one can guarantee that this pain is not reflected, and it is not a consequence of coronary heart disease, or chronic pancreatitis.

That is why the term "dorsopathy" became an example of an incredibly broad interpretation. However, officially the causes of dorsopathy are:

  • Pathological kyphosis of the thoracic spine, pathological lordosis of the cervical and lumbar spine ;
  • Scoliotic deformity;
  • Osteochondrosis of all parts of the spine, and intervertebral disc lesions of different parts of the spine can now be put into diagnosis without connection with osteochondrosis, for example, as a result of a car accident and injury;
  • Ankylosing spondylitis, or ankylosing spondylitis;
  • Spondylopathies, including inflammatory: sacroiliitis, (including psoriasis), vertebral osteomyelitis, secondary purulent foci in vertebrae;
  • Discitis, or inflammation of the intervertebral discs in different departments;
  • Spondylosis (arthrosis of the vertebra, arthrosis-arthritis), as with myelopathy, so with radiculopathy.

These conditions develop with the growth of bone matter and compression of the corresponding structures. Thus, myelopathy develops with stenosis of the central canal (compression of the spinal cord occurs), and with radiculopathy, there is compression of the nerve root coming out of the intervertebral openings.

  • Traumatic spondylopathy;
  • Spinal stenosis;
  • Ankylosing hyperostosis (Forestier disease). When it occurs, excessive bone formation occurs at the site of the ligaments, which leads to ankylosis (immobility);
  • Infections (brucellosis, vertebral tuberculosis), as well as neuropathic spondylopathy.

On the factors of various dorsopathies

Predisposing factors that often lead to these diagnoses are:

  • "Office" lifestyle, hypodynamia and low physical activity;
  • pronounced osteochondrosis of intervertebral discs (it turns out that one of the dorsopathies leads to other dorsopathies);
  • persistent violations of posture;
  • the use of a large number of refined foods, sweets, fats, canned foods, smoked meats, alcohol;
  • the presence of bad habits;
  • postmenopausal period in women;
  • the presence of osteoporosis, calcium deficiency in the body;
  • lack of vitamin D3;
  • high levels of uric acid in the blood;
  • harmful working and living conditions (dampness, wind, low air temperature);
  • wearing heavy workwear, including protective clothing.

Dorsopathy: symptoms of common manifestations

Dorsopathy symptoms

When is it worth to see a doctor? After all, every person ever had back pain, what signs should alert the patient? These are the symptoms that are worth paying attention to and do not postpone the visit to the doctor:

  1. Back pain has become constant, especially it is worse at night, and is not stopped by any drugs.
  2. The painful sensations are of a radicular nature, that is, they abruptly and suddenly intensify with shaking, coughing, sneezing, laughing, straining, and sudden movement.
  3. There is a sensitivity disorder associated with pain or discomfort in the back (numbness, "crawling"), reduced pain and temperature sensitivity.
  4. The appearance of weakness in the muscles of the arms and legs, muscular hypotrophy (one arm or leg "lost weight").
  5. Disturbance of the trophism in the limbs (dry and flaky skin, hair loss, dullness and brittle nails).
  6. Decrease in the amplitude of movements in the joints, pain in the muscles.

Since now almost the entire spectrum of lesions of the vertebrae and discs, as well as a violation of the biomechanics of the spine, belongs to dorsopathies - let's analyze the most frequent manifestations of dorsopathies at all levels of the spinal column

Dorsopathy of the lumbosacral spine

Osteochondrosis is best known; this dorsopathy of the lumbosacral spine occurs in every adult. Even in the event that there are no signs of the disease, the intervertebral discs are still dehydrated.

From the deforming dorsopathies in the lumbar spine often there is a change in lordosis, both upwards and downwards.

Relatively frequent manifestations of radicular symptoms occur in the form of a painful lumbago lumbago . Often with the defeat of this particular department manifests Bechterew's disease and psoriatic polyarthritis. The criterion of the systemic process is the appearance of signs of sacroiliitis, or inflammation of very strong sacroiliac joints.

Sometimes, dorsopathies at this level cause shooting pains in the pelvic region, lower back, radiating to the bladder and rectum.

Dorsopathy of the cervical spine

Dorsopathy of the cervical spine is most often manifested by secondary myofascial syndrome, in which the tone of the cervical muscles is much higher than normal. This leads to head and neck pain, impaired blood circulation in the upper extremities, disorders of sensitivity (for example, to "crawling goose bumps" in the hands).

Often there is instability of the cervical spine, various protrusions and hernias of the lower (C5-C7) cervical vertebrae.

Also in the cervical spine there are violations of the physiological curves of the spinal column, which consist in hyperlordosis or flattening of its arc.

Dorsopathy of the thoracic spine

Thoracic dorsopathy may be more diverse than the cervical. After all, the thoracic spine is the longest, and as a result, it can be deformed. As a result, either kyphosis or kyphoscoliosis occurs (especially in young men), as well as acquired scoliotic deformity.

It is the thoracic vertebrae that are most vulnerable to tuberculous and brucellosis spondylitis, and tumor metastases can penetrate the vertebrae of the thoracic section.

Dorsopathy of the thoracic spine often creates a pronounced pain syndrome, also due to muscle tissue. There are often signs of intercostal neuralgia , which is necessary, first of all, to differentiate from acute pathology of the heart (myocardial infarction, an attack of coronary heart disease).

It is at the level of the thoracic vertebrae that compression fractures often occur with an accidental fall, with the development of subsequent traumatic spondylopathy.

Treatment of spinal dorsopathy

Treatment of spinal dorsopathy

Almost all types of dorsopathies are treated conservatively. The exceptions are post-traumatic spondylosis and pronounced destruction of intervertebral discs. Such a discogenic lumbar dorsopathy in need of surgery, which has not been treated in a timely manner, may even cause a disorder in the work of the pelvic organs.

The main principles of dorsopathic treatment are:

  1. Elimination of pain and inflammation, which often joins in the phase of chronic disease;
  2. The elimination of chronic muscle spasm;
  3. Improving tissue microcirculation;
  4. Appointment of chondroprotectors to improve the metabolism of cartilage tissue;
  5. Antioxidant therapy and multivitamin preparations, the fight against sensitivity disorders;
  6. Mineral deficiency recovery;

Non-drug therapy, which includes physiotherapy, physiotherapy, massage, acupuncture, balneotherapy, swimming, manual therapy and other effective ways to relieve the intervertebral discs and improve the function of the back muscle frame, is of great (and paramount) importance.

Orthopedic pillows and mattresses are very popular for normalizing sleep, the treatment of cervical dorsopathy provides for the short-term use of a Trench collar - to prevent pain from occurring when physical activity is needed, as well as to reduce pain during exacerbation.

Complications

Since the diagnosis of dorsopathy is a collective term, and it unites many diseases by only one sign - localization, it is impossible to give a general and correct picture of complications.

It is probably worth explaining that in most cases they lead to disability and a deterioration in the quality of life, since the outcomes of the processes are scoliosis, ankylosis, melting of the vertebrae, the occurrence of transverse myelitis, which can chain a person to a wheelchair for many years.

In conclusion, it is worth noting that dorsopathy is a whole “family” of painful conditions of the spine, ribs, and back muscle structure. Like any disease, dorsopathy is easier prevented than treated. Therefore, it is worthwhile to take care of the health of your back from a young age in advance so as not to regret it in your mature years.

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