What is fatty degeneration. Lipoid degeneration of the bone marrow. What diseases are accompanied by fatty degeneration of the bone marrow

WE RECOMMEND – the age-related process of replacing the hematopoietic tissue of the bone marrow with fatty tissue. In some cases, it begins earlier against the background of oncological or infectious diseases, uncontrolled drug therapy. This natural process can be complicated. Among them are osteoporosis, anemia, hormonal imbalance and spinal stenosis. In most cases, specific therapy is not required, but if complications threaten the patient's quality of life, surgery may be indicated.

The main risk factor is age. Tissue degeneration begins to occur, including the bone marrow of the spine. This is natural, and if the patient is seventy, often his bone marrow is half fat.

Myeloid cells initiate the process. They are found in the bone marrow and make all the blood cells. Muscles and internal organs, such as the liver, are also formed from them.

In some cases, degeneration occurs much earlier. The cause may be metabolic disorders, malignant neoplasms and metastasis, infections. Unfortunately, such changes can occur regardless of the age factor.

The accelerated process of "obesity" of the vertebrae can occur due to the intake of certain medications. These include non-steroidal anti-inflammatory drugs. This is especially bad, given that many people suffering from osteochondrosis mainly use NSAIDs - a vicious circle of back tissue degeneration is obtained. You can also write down pressure-reducing drugs, cardiac medications and antibiotics here.

How does it develop

When blood circulation and metabolism of the spine are disturbed, osteochondrosis does not remain the only problem. An additional pathology may be fatty degeneration of the bone marrow and ligaments that fix the back. The result of this pathological process may be, and in the future - compression of the spinal cord. And if there is some kind of mechanical effect on the spinal cord, a whole bunch of severe neurological symptoms are inevitable. Including partial and complete paralysis.

Due to the fact that the vertebral bodies do not have independent internal nerves and blood vessels, but are fed through the endplates, fatty degeneration in them begins quickly. In addition to the vertebrae, the arteries also change. The path of nutrients to the vertebrae and discs is complicated. This is another reason why the nucleus pulposus loses its shock-absorbing properties.

Osteochondrosis and fatty degeneration lead to the fact that the space between the vertebrae decreases. To reduce spasms of the vertebral ligaments, the body tries to get rid of calcium. This leads to a disease such as osteoporosis.

Prognosis and complications

Fatty degeneration of the bone marrow leads to poor production of blood cells. There is anemia, decreased immunity. Decreased vascular tone. The condition of not only the spine, but the entire human body is deteriorating. The tissues of the internal organs begin to "suffocate", not receiving enough oxygen.

Fatty degeneration of the vertebrae can lead to the development of diseases such as:

• Simmond-Schien disease. Usually middle-aged females are affected. Hormonal changes begin, due to which a large number of body tissues suffer;
• Anemia. The degeneration of the cells that create blood cells does not go unnoticed;
• . Too much fat in the bone prevents the body from producing collagen. Because of this, a person stops properly processing calcium, and the vertebrae become fragile.

Blood coagulates worse, and as a result, traumatic effects can be fatal. Especially severe consequences can occur if such a symptom accompanies osteoporosis - bone tissue degeneration. Bones break easily, and if a fracture occurs, non-stop internal bleeding can begin.

Treatment

Both conservative treatment measures and operations are used. But unfortunately, they are by and large only symptomatic. Degeneration of vertebral tissues due to aging is an irreversible process. But if complications, inflammatory processes, nerve infringement occur, the following recommendations are suitable:

• In the acute period, when attacks are constantly tormented, it is necessary to give the patient complete rest. Eliminate both mental and physical stress factors;
• Non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac);
• Muscle relaxants to relieve painful muscle spasms (for example, Sirdalud);
• Injection blockade of the spine with novocaine;
• Chondroprotectors - drugs that help regenerate cartilage tissues;
• Physiotherapy (Magnet, Electrophoresis, Low-frequency current, Shock wave therapy);
• Physiotherapy exercises (after the acute period has ended);
• Massage procedures, acupuncture.

Most often, at a doctor's appointment, people complain of discomfort in the neck and back. Without timely treatment, back disease can develop into a chronic one and significantly complicate the patient's life. One of these diseases of the locomotor system is fatty degeneration of the vertebral bodies, and in the article we will understand what this disease is.

Intervertebral discs are composed of several structures: annulus fibrosus, intervertebral joint, nucleus, and lamina. The annulus fibrosus serves as a holder for the core and its correct location, because it works like a kind of shock absorber that helps keep the spine straight when walking, turning, bending and running.

One third of the spinal column is the intervertebral discs. The cores in them “love” moisture - thanks to it, they become soft and elastic and can cushion.

A degenerative disease of the locomotor system is the loss of softness of the intervertebral discs due to the harmful effects of sedentary work, extra pounds, back injuries, and twisted posture. Destroyed tissues, ligaments and joints lead to metabolic disorders, poor cell nutrition. Depleted intervertebral discs, their compaction, growths after some time lead to the appearance of cracks, hernia, incessant pain and discomfort, numbness, restriction of movement, and even to a wheelchair.

The human spine is designed in such a way that it is able to independently distribute the pressure exerted on it. With an even posture and strong muscle tissue, the spine is able to withstand all the "tests" without harm to it. People who lead an inactive lifestyle wear out their muscles and ligaments, rendering them unusable, which results in wear of the spinal discs. Excessive load for an unprepared organism also has a detrimental effect and has serious consequences.

Important! The depletion of the intervertebral discs is almost always the result of a sedentary lifestyle. During the exertion of loads on the spine, weak ligaments consume excessive moisture, which is why injuries, sprains, and cracks appear. A disturbed metabolism and blood supply worsen the process of tissue regeneration, delaying it for a long period.

Changes can be provoked by a variety of reasons, which will not at all depend on age, physical fitness and the presence of injuries. Main reasons:

• cells and tissues begin to age, the incoming nutrition of nutrients is disturbed;
• genetic inheritance;
• abuse of bad habits (smoking, alcohol);
• inactive lifestyle;
• overweight;
• inflammatory and infectious processes in the body;
• various minor and severe injuries received due to a very large load on the spine;
• heavy loads with heavy weight, for example, when playing sports.

Dystrophic changes in the ligaments occur slowly and can take a long period of time, so it is not always possible to identify the cause in time. People who try to cure their ailment with the help of traditional medicine without going to a specialist only exacerbate their situation.

Signs of degenerative-dystrophic changes in the lower back

Dystrophic changes in the lower back have the following characteristic features:

• weak, which increases with movement, bending and walking. Can disappear in a calm position;
• there may be pain in the legs and arms;
• reduced activity of the cervical vertebrae is created;
• the organs in the pelvis begin to work incorrectly;
• constant fatigue;
• "naughty" limbs.

With untimely prevention of dystrophy, paralysis, paresis can occur.

Provocative diseases

Symptoms can be accompanied by several ailments, which usually occur in parallel:

• vertebrae destroyed during are the result of the appearance of microcracks;
• spondylosis with seals is provoked, limited actions appear, pain during movement;
• . The annulus fibrosus is destroyed, and compression of the nerve roots by the nucleus pulposus provokes discomfort.

Degenerative changes in the cervical region

Over time, each person is faced with a feeling of pain in the neck, but most often such pain does not cause a serious illness and goes away on its own. People often claim that they were just "blown out" or that they slept on an uncomfortable pillow, which in some people can really be the cause of pain, but you should not always write off discomfort for such "harmless" reasons.

Very often, pathological changes are the cause of neck pain. This happens naturally due to wear and tear of tissues, and not all disorders that have occurred in the spine can be cured.

What does all this mean?

The first question that interests a patient who has heard such a diagnosis is “what does this mean?”. Of course, any doctor knows this disease and its treatment regimen, but he cannot always recognize the cause of such changes; the causes of the ongoing process may also remain unclear.

A healthy human neck is quite mobile - he can turn his head 180 degrees, lower it so that his chin can touch his chest, and tilt it back. Such actions are possible only if there are elastic joints in the cervical region.

The cervical region consists of seven vertebrae. Their adhesion is carried out by the joints, which is why they are so flexible and can perform such a large range of movements. The vertebrae are connected by three joints, which ensures their stability. But the mobility of the spine becomes less, because the spinal cord is located inside the spine, which is extremely dangerous to damage.

The spinal cord is a tissue made up of nerves located inside the spinal tube. Branching out from it are nerves that control the functionality of different parts of the body. The spinal cord transmits signals that ensure the functioning of various areas of the body. The spine protects the spinal cord from injury.

Note! Joints are the surfaces of a bone that are opposite to each other. Some of them are covered with cartilage, allowing the vertebrae to "slide" freely.

But the most important and basic connecting element of the vertebrae remains the gel-like intervertebral disc. It consists of tissue that connects the surface of the vertebrae, while providing them with mobility. Intervertebral discs are extremely important for the movement of the entire spinal column. But, unfortunately, they are most susceptible to deformation and injury.

Over time, the intervertebral disc is depleted and loses its softness and elasticity, thereby losing the ability to perform its main function. The vertebrae become so close to each other that friction occurs, the discs between the vertebrae can no longer hold all the load and “shift” it onto the joints. The main load in this case is on the facet joints, but since they are not at all designed for such pressure, the cartilage begins to disintegrate, during which the bones under them protrude. An inflammatory process occurs, leading to irritation and pain. Each time, disintegrating more and more, the facet joints become unable to cope with the loads on the spine.

Complications of degeneration of the vertebrae in the neck

Spinal stenosis

Disorders of the intervertebral discs also affect the vertebrae, the connection between them becomes weaker, the affected segment is now unstable, and this leads to an incorrect ratio of the vertebrae relative to each other.

To give the vertebral segment stability and reduce slip, the bone tissue grows, osteophytes appear. In the case when they form near the nerve, they can pinch and damage it. This leads to debilitating pain in the spinal region, neck numbness, muscle weakness - this is what is called narrowing of the spinal canal.

Intervertebral hernia

The degeneration process can proceed quite differently. Trying to cope with the given load, the annulus fibrosus can gradually collapse.

In a healthy state, the annulus fibrosus should contain a gel layer inside. Some of this layer may extrude through the hole in the annulus. This is what is called. If the pathology is located near the spinal cord or between the nerves, then there may be a problem with the nervous system. The presence of a herniated disc can cause serious harm in the form of paralysis, although such situations are rare.

Most often, when such a hernia appears, a person begins to complain of discomfort in the neck, which can be given to the upper limbs, shoulders, and back of the head. There are cases when the hernia could decrease in size or completely disappear, and it also happened that the size of the hernia only increased, the pains that appeared became stronger, leading to problems with the central nervous system, which could only be eliminated with the help of surgery.

Spondylosis

- this is what often happens with the vertebrae in older people. This term refers to the growth and aging of the bones in the spine.

The moment of formation of osteophytes as a consequence of the destruction of intervertebral discs in an unstable vertebral segment has already been discussed above. However, this theory is ambiguous, since in most patients spondylosis proceeded without appreciable pain and discomfort. The other part of patients with cervical spondylosis experienced acute pain. The most likely justification for this phenomenon may be how quickly and how long the process of degeneration occurs.

There are many factors that cause pain and stiffness in the neck and lower back. Even an intense load on the muscles can cause pain. But there are more compelling reasons, such as arthritis, arthrosis, osteochondrosis, meningitis and tumors of various origins. Only a doctor can determine the nature of the cause and determine the course of treatment after a complete examination and testing.

Development of the disease

In the event that the nutrition of the spine is disturbed, the loss of the height of the intervertebral disc and its impaired movement begin. Over time, the pathology affects adjacent muscles, joints, and nerves. One of the reasons for this is the fatty degeneration of the vertebrae, or rather, the yellow ligaments that help hold the spine. The spinal canal narrows, causing back pain.

Important! The vertebrae are not equipped with a blood supply system, so degeneration progresses here much faster than in the joints.

With age, a violation of the blood vessels can also be noted; the intake of the necessary substances into the internal structure of the spine becomes worse. Compression of the vertebrae leads to "squeezing out" of the nucleus pulposus, the nucleus will lose moisture and elasticity, and the disc will "fall out" into the spinal canal. Thus, the destruction of the vertebral tissues proceeds, the joints will lose their flexibility and now any wrong movement will cause severe pain.

But degeneration is by no means the worst thing that can happen. When the height of the spine is lost, ligaments and joints are involved in the destructive process, a large load begins to be created, calcium is excreted, and osteoporosis develops. The yellow ligaments that fill in the gaps are weakened due to the shortening of the height of the spine. Fat ligaments are no longer elastic, they begin to deform and narrow.

After a long study of the disease, it was found that the ingress of the fatty ligament into the spinal canal is far from the only cause of the resulting pain. The spinal cord is located in it, and the protruding disc puts pressure on it - therefore, pain and loss of coordination appear. However, another source of pain was identified - autoimmune inflammation of the spine. The inflammatory process occurs at the site of a compressed disc that is in contact with it.

Pathology develops due to impaired nutrition of cells that need oxygen and glucose, as well as a normal acid-base balance.

Why is the nutrition received by the cells becoming insufficient? For example, due to blood diseases, metabolic disorders, problems with the nervous system, atherosclerosis, abuse of bad habits and an unbearable load on the locomotor system.

Table number 1. Stages of development of fatty degeneration

In order to understand in more detail the process of the appearance of pathology, it is only necessary to determine the causes of diseases that become the start of the process of destruction. It all starts with a change in the structure of the vertebral tissue - myeloid cells located in the bone marrow. They carry out the production of blood bodies. A slow, but already irreversible process of penetration of fat deposits into the cells begins, as a result of which, over time, the cell dies, and a fatty formation is placed in its place. The pathological process can affect not only the bones of the spine, but also nearby joints, muscles, ligaments.

Such a destructive process adversely affects the functioning of the spine and back as a whole, disrupting the musculoskeletal function. In parallel, other diseases of the locomotor system begin to develop; it is also possible the occurrence of neoplasms in other organs and tissues. Fatty degeneration provokes the appearance of anemia, anemia, and negatively affects blood vessels.

In the case when fatty degeneration did not arise due to the advanced age of a person, there are certain reasons for its formation in the tissues:

• the presence of metastases;
• inflammatory processes in the tissues of the spine;
• disturbed metabolism;
• poor circulation;
• intoxication in the body.

There are cases when osteochondrosis is the cause of fatty degeneration of the vertebrae, and not a consequence, as many believe. This is due to the fact that with osteochondrosis, patients are often prescribed NSAIDs. If the patient does not follow the recommendations and takes the medicine for too long, this can provoke the start of the process of tissue replacement.

Important! Age over 45 years is the main factor in the appearance of problems with the musculoskeletal system. The process of tissue and bone marrow degeneration starts.

But there are cases when the pathology occurs at a younger age. Disturbed metabolism, tumors and internal infections can become a trigger for the start of the process of tissue degeneration.

Symptoms

Degenerative processes that begin in the vertebrae have certain symptoms:

• arising pain in the chest and back, radiating to the neck;
• impaired coordination, fatigue, migraine, vascular dysfunction and asthenia;
• aches in the back of the head, which become more intense when lying down;
• frequent "goosebumps" on the legs, numbness, chills;
• broken motor system. This pathology leads to high energy costs to maintain the spine in an even position.

Symptoms may vary for each patient.

The appearance of bone pathologies is a serious disease, because it is inside the bones that many stem cells are located.

Stem cells become blood cells and, due to oxygen saturation, provide increased immunity and good blood clotting. However, when the bone marrow malfunctions, fatty degeneration develops.

As a result of this process, healthy tissues become less and less, their condition worsens, and fatty degeneration continues its progression. The composition of the blood sharply becomes worse, therefore, all the functions performed by the blood are disturbed. The disease is progressing.

Features of the pathology

During circulatory and metabolic disorders in the spine, osteochondrosis is not the only worrying problem. In addition, fatty degeneration of cells and ligaments that support the spinal column may be added. As a result of this process, stenosis is formed. Therefore, it is so important during this period not to have any effect on the spine, otherwise problems with the nervous system will be added, as well as partial or complete paralysis.

The process of fat deposits is also accelerated by the fact that the vertebrae do not have nerve endings and blood vessels, and they also receive nutrition through the closing platinum. The arteries also undergo changes, and food is delivered to the vertebrae intermittently.

The reduced space between the vertebrae is always a consequence of the presence of fatty degeneration or osteochondrosis. To calm spasms, the body gets rid of calcium, and calcium deficiency already leads to osteoporosis.

Possible Complications

With the formation of fatty degeneration of the vertebrae, the production of blood cells becomes impaired, anemia and immunodeficiency are observed, the tone in the vessels decreases, and the whole body becomes worse. The tissues inside the body "suffocate", not receiving oxygen in full.

Fatty degeneration of the vertebrae can cause the following pathologies:

• Simmonds-Schien disease. Most often, this disease is diagnosed in middle-aged women. There is a change in the hormonal background, and most tissues begin their destruction;

• anemia. The process of insufficient creation of blood cells leads to irreparable consequences;
• - excess fat deposits in the bones do not allow the body to produce collagen, so the body begins to process calcium incorrectly, the bones become brittle;
• blood clotting is worse, and any injury can be fatal. Poor clotting is especially dangerous in case of bone tissue dystrophy. The bones are very fragile, so getting a fracture is not so difficult, and internal bleeding often occurs at the fracture site.

Localization and varieties

The degenerative process has both post-traumatic and natural appearance. A natural process is the process of aging of tissues and bones, in old age up to 70% of healthy tissue is replaced by adipose tissue.

But in case of injury or the appearance of an infectious process, degeneration progresses very quickly without the possibility of tissue repair.

cervical

Neck pain can be far more dangerous than just being in an uncomfortable position or tired after a day's work. Degeneration of the cervical vertebrae is the most common occurrence due to the insecurity of the vertebrae of the neck.

A pinched nerve and compressed vessels often provoke a slight bruise or an intense load. The danger is due to the fact that there are many blood vessels and arteries in the neck, and their damage can lead to serious health problems.

Important! The growth of bone tissue increases the friction of the vertebrae against each other, a feeling of tightness and discomfort appears in the neck.

Causes of early fatty degeneration of the vertebrae in the neck:

• injury;
• long fixation in one position;
• heredity;
• nervousness;
• uncomfortable pillow;
• hypothermia of the cervical region.

With constant pain in the neck, the appearance of numbness or discomfort, you should immediately consult a specialist, since not always these pains can only speak of fatigue.

Thoracic

Fatty degeneration of the vertebrae in the chest can be called a pathology that appeared due to insufficient supply of nutrients by the cells. In the future, the structure of the cartilage changes, and the synovial fluid ends.

The constant appearance of new cracks can attract inflammation in the plates of the spine, causing pain and pinching.

• uneven posture, increasing the load on the spine. As a result, osteochondrosis and scoliosis appear;
• spinal defects present from birth;
• insufficient amount of incoming useful elements for tissue nutrition;
• heredity;
• trauma in the thoracic region;
• constant stress;
• sleep deprivation.

Treatment

To get rid of or stop the development of fatty degeneration of the vertebrae, two methods are used: conservative and operative. Moreover, the latter is resorted to only in extreme cases - for example, if the patient's condition is getting worse every day, and medications and physiotherapy do not give any result.

Table number 2. Medications for the treatment of fatty degeneration

Moderate and proper physical activity on the diseased spine, applying a heating pad, electrical stimulation can have a quick positive effect, in contrast to the incessant use of pharmacological drugs.

It is only important to correctly distribute the load on the spine, to choose a special massage course. Sometimes manual therapy becomes effective.

What can be said about surgery? Medicine in most countries prefers to do without surgical procedures. Surgery is possible, but only for seriously ill patients.

Operation types:

• discectomy with arthrodesis;
• implant placement;
• intradiscal decompression;
• laser therapy.

Recently, a minimally invasive procedure has gained popularity - electrothermal plastic surgery of a fractured annulus, laser decompression of the disc, removal of a deformed disc using endoscopy. The method of replacing the nucleus pulposus is also widely used in medicine - thanks to it, it became possible to restore the integrity of the fibrous disc.

Video - Massage for fatty degeneration of the cervical vertebrae

Measures for the prevention and prevention of pathology

In the field of medicine, such diseases have not been fully cured, unfortunately, but they are able to successfully maintain the patient's condition, restoring his working capacity and habitual way of life. However, it is best to prevent this ailment than to endlessly deal with its treatment in the future.

The process of bone aging and deformation of the intervertebral tissue, unfortunately, cannot be stopped. But each person is able to slow down this process, delaying it for many years. The spine experiences daily stress - sometimes it can be very strong - so it is important not to forget about prevention, which can slow down the process of tissue wear, keeping the musculoskeletal system in perfect order. Simple exercises will strengthen the muscles of the back, give elasticity to the ligaments, keeping the back healthy and strong for a long time.

Preventive measures.

1. Strengthening the muscles of the back with the help: even 15 minutes after waking up will make the back stronger and more resilient.
2. You should always try to get out of bed on both legs - this allows you to evenly distribute the load on your back.
3. It is important to try to always keep your back straight, and in no case allow a bent posture. Walk, sit, read a book, keeping your back straight. This will prevent spinal deformity.
4. A well-chosen mattress is the key not only to good sleep, but also to good health. The mattress should provide the spine with complete relaxation, giving it the opportunity to rest after a working day. An excessively hard or very soft mattress will not be able to provide the necessary conditions for resting the back.

Degenerative-dystrophic change in the spine is a serious pathological disorder of the locomotor system, which is almost impossible to correct. Violation leads to constant pain, discomfort during movement, disability. Therefore, it is more correct not to allow such violations in your body, so that later you do not deal with their treatment all your life. But if, nevertheless, back pain has made itself felt, there is no need to delay the moment of going to the doctor - this can only aggravate the condition of the body, adding new ones to the existing problems.

bone marrow degeneration

Bone marrow is a tissue mass that fills the cavity of the bones of the spine. The bone marrow is responsible for blood formation, and it constantly replaces dead cells with new ones, and also maintains and builds immunity.

When any pathologies develop in the bone marrow, they are instantly displayed on hematopoiesis, blood clotting, vascular function and the body as a whole. The altered composition of the blood causes poor passage through the vessels, which also adversely affects the functioning of the body.

The degenerative process begins to run in everyone with age. If degeneration occurred at the age set for it, then there are not so many problems from it, as, for example, if it began earlier than the time set by physiology. When the pathological process begins, the myeloid tissue in the bone marrow changes to adipose tissue.

With age, degenerative processes become more active, which is why by the age of 70 most of the tissues in the spine are replaced by fat, and at an even older age they completely occupy the entire space.

The replacement of myeloid adipose tissue occurs due to impaired metabolism, the presence of metastases in the bone marrow, and chronic infection.

In what diseases does a degenerative-fatty process occur in the bone marrow?

1. Osteoporosis.

Osteoporosis

Not so long ago, scientists believed that adipose tissue could protect the spine from osteoporosis. However, over time it became clear that this was not the case. The presence of fat cells impairs collagen production and proper absorption of calcium. As a result, the bone tissue weakens, degenerative processes are triggered, which leads to osteoporosis.

Summing up

If you do not treat degenerative-dystrophic changes in the spine in time, you may encounter some complications, which will be difficult to get rid of. This includes fatty degeneration of the vertebral bodies. There are quite a few reasons for its development, and no one is immune from such a pathology, however, if prevention is carried out from an early age, then the chances of encountering such a problem become much less.

Pain is the main symptom of the disease. Pain can occur both with inflammatory processes of the vertebrae, and with abnormal changes in the case of degenerative-dystrophic conditions.

Symptoms of the disease

The presence of painful manifestations in different parts of the spinal column is a pathological change in the musculoskeletal system and can lead to disability.

For example, fatty degeneration of the bone marrow of the spine is formed with the gradual replacement of the normal consistency of the tissue with a fatty layer.

Degenerative-dystrophic conditions are an irreversible process of metabolic disorders in bone tissue. Thus, it becomes clear that pain in the back muscles, which is often attributed to fatigue or salt deposition, must be sought in the deterioration of the performance of the vertebrae themselves.

Common causes of the disease can be called:

• incorrect distribution of the load on the spine;
• natural aging;
• hormonal changes;
• injuries and bruises;
• passive lifestyle;
• genetic factors.

Types of abnormal changes

Deviations in work can be experienced by different areas of the back muscles, it can be both dystrophy of the thoracic spine and lumbosacral. The cervical region also experiences no less stress.

For a long time, pain may be absent, but gradually the patient begins to feel discomfort caused by pain, weakness and muscle strain.

With a sedentary lifestyle, there are often suspicions of dystrophy of the lumbar spine, but in most cases this problem is provoked by osteochondrosis.

The main component of hematopoiesis is the bone marrow, which is located directly in the bones. With pathological changes in the body, dystrophy of the bone marrow of the spine can also be observed, for example, in diseases such as osteochondrosis, spondylarthrosis, cartilaginous nodes.

With inflammatory processes or improper metabolism, it is possible to replace healthy bone tissue with a layer of fat. Then they talk about fatty degeneration of the vertebral bodies of the bone marrow. This can significantly worsen the composition of the blood.

Treatment Methods

An absolute cure for changes occurring in the skeletal system is impossible. Modern medical techniques involve only a temporary suspension of the development of pathology and the elimination of pain in the patient.

Therapeutic treatment consists in taking painkillers that are part of the group of analgesics, or the use of local preparations - ointments and gels.

Muscle relaxants also affect the elimination of pain. Doctors advise eating foods rich in B vitamins.

Each case is individual, so in no case should you self-medicate by purchasing medicines in pharmacies without a doctor's prescription! All drugs are prescribed only by a doctor after a diagnosis.

Therapeutic exercise perfectly strengthens the cartilaginous tissue and back muscles. Exercises are selected for each patient individually, depending on the characteristics of the disease. Nutritionists usually prescribe a special diet rich in gelatin.

In some cases, surgical intervention is used. So, with fatty degeneration of the bone marrow of the spine during movement, a severe inflammatory process can begin, which often leads to urgent surgical care, after which the patient will have a long course of rehabilitation.

How to prevent disease

The main preventive ways to maintain a normal patient with dystrophy of the lumbosacral region are weight loss and moderate but regular physical activity. To do this, you need to eat right and exercise.

Physiotherapy and massage are excellent. In case of cervical dystrophy, orthopedic collars are used that fix the vertebrae of the cervical region, which relax the muscles and reduce the load on them.

• daily perform a set of exercises that help strengthen the muscles of the back;
• always keep an even posture;
• get comfortable bedding;
• in order to avoid an unexpected load on the spine when waking up in the morning, get up slowly, preferably on both legs at once.

These simple behavioral techniques will help to significantly alleviate pain conditions and extend the period of normal operation of the spine.

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Everyone has experienced back pain at least once in their life. 10-20% of people constantly suffer from low back pain, and 1-3% need surgical treatment.

The term "degenerative changes in the spine" generalizes a number of diseases. From the third decade of life, gradual dehydration of the intervertebral disc and loss of elasticity begin. The loss of water is due to the depolymerization of mucopolysaccharides. Simultaneously with the dehydration of the nucleus, microcracks, cracks and ruptures appear in the outer part of the fibrous ring. Gradually, they spread to the deep sections of the fibrous ring, giving way to the material of the nucleus pulposus to the outside. A decrease in pressure inside the disk leads to the suction of nitrogen into the nucleus and the appearance of bubbles - a "vacuum - phenomenon". The cartilage of the endplate degenerates (chondrosis) with the transition to the bone tissue of the endplate (osteochondrosis).

In the late stage of disc dehydration, disc flattening occurs. The fibers of the annulus fibrosus bulge outside the intervertebral space, and the endplates sclerosis. The bone marrow in areas adjacent to the degenerative disc also changes. There are 3 types of change.

• I type - Vascular. This aseptic inflammation is aseptic spondylodiscitis.
• Type II - Fatty degeneration.
• Type III - Sclerotic.

Degeneration of the peripheral fibers of the annulus fibrosus leads to a weakening of their connection with the cortical bone tissue, the formation of gaps and an anterior displacement of the disc. This leads to tension in the perforating fibers (collagen filaments of the nucleus passing into the bone) at the point of their contact with the endplate and the formation of osteophytes. Initially, they are formed in a horizontal plane. But in this direction they are restrained by the posterior longitudinal ligament and they continue vertically, up to the coracoid growths. Osteophytes are detected radiographically in 60-80% of people over 50 years of age. They are usually bilateral and anterolateral.

An increase in load leads to secondary degeneration of the facet joints - erosion and gaps in the cartilage - "osteoarthritis", and then bone formation - "osteoarthrosis".

On radiographs, these processes look like a decrease in the joint space, bone sclerosis and marginal osteophytosis. It occurs in almost all persons over 60 years of age.

Osteoarthritis leads to a decrease in the lateral pocket (normally 5 mm in the anteroposterior dimension), which contributes to root compression. In addition, the synovial fluid of the joint can exit through the gaps in the capsule anteriorly, become encysted and form a synovial cyst. The cyst leads to compression of the root, often calcified.

The typical location of the cyst is at the level of the L4-5 disc.

Degenerative changes in the spine in the lumbar region

Degeneration of the articular apparatus leads to weakening of the ligaments and their calcification. Bone bridges between the bodies of four adjacent vertebrae due to calcification of the anterior longitudinal ligament are observed in 15-20% of adults. A more extensive process is called diffuse idiopathic skeletal hyperostosis or Forestier's disease. It affects approximately 12% of adults. A variant of Forestier's disease can be considered systemic calcification of the posterior longitudinal ligament - "Japanese disease", usually observed at the cervical level.

A sharp decrease in the distance between the vertebrae leads to the closure of the spinous processes. As a result, pseudo-joints are formed, a granulomatous reaction develops in the surrounding soft tissues. This condition is called Baastrup's disease.

Rough degeneration of the facet joints leads to slippage of the vertebral bodies forward or backward. Most often this is observed at the level of L4-5, because the joints at this level are oriented more sagittally. Even normally, the L4 body at this level is somewhat posteriorly displaced. In osteochondrosis, the sliding of the lower L4 facet to the upper L4 facet increases, leading to retrospondylolisthesis.

Herniated disc should be distinguished by direction. Osteochondrosis and erosion of the endplates lead to displacement of the nucleus pulposus into the vertebral body with the formation of cartilaginous nodules or, otherwise, Schmorl's hernias.

Displacement of the disc forward or forward and laterally, leads to anterior hernias, since the anterior longitudinal ligament is well innervated, a “vertebrogenic symptom complex” occurs: pain in the lumbosacral region or lower extremities, lumbodynia and paresthesia.

The most significant, from a clinical point of view, is posterior and posterolateral displacement. Hernias at the foramen inlet (lateral) and into the foramen (foraminal) involve the overlying root (i.e. L3-4 disc herniation compresses the L3 root). Such hernias make up 2-10% of the total number, 80% of hernias of this type are localized at the level

L4-5 and L3-4. Purely median, or medial hernias occur in no more than 10% of cases. The vast majority of protrusions have a median-lateral orientation and are called paramedial. Most often they are observed at the level of L5-S1.

According to the degree of protrusion, there are:

1. Protrusion - bulging of the disc due to the weakness of the fibrous ring, but without its rupture.
2. Prolapse - rupture of the fibrous ring with a breakthrough of the substance of the nucleus pulposus.
3. Extrusion - rupture of the posterior longitudinal ligament.

Less than 0.1% have a dural rupture with an intradural herniation.

Rupture of the posterior longitudinal ligament often leads to the formation of sequesters consisting of a fragmented nucleus. They may migrate up and down the anterior epidural space and somewhat laterally. On the medial side, movement is limited by the medial septum.

It is important to remember that disc herniations are not necessarily "symptomatic". This seriously complicates the diagnostic problem in hernias at several levels. The etiology of neurological symptoms is much more complex than just mechanical compression of the root or ganglion.

Seek medical help from specialists, not miracle workers.

What is called a dystrophic change in the vertebral bodies?

Spinal dystrophy is a pathological process during which osteoporosis is formed, but the normal morphology and functioning of the intervertebral discs are preserved. Dystrophic changes in the vertebral bodies are observed during the development of osteochondrosis, spondylarthrosis, spondylosis, cartilage nodes.

The mechanism of the occurrence of pathology

Gradually, the vertebral bodies begin to flatten, and the gelatinous nucleus expands and leads to deflection of the adjacent end plates of the vertebral bodies, especially their central sections. As a result of the above processes, the discs become biconvex, and the vertebrae become biconcave and look like the vertebrae of fish. Because of this similarity, Schmorl suggested calling the disease a deformity of the vertebrae like a fish.

Nerve fibers extending from the spinal cord are pinched and swollen, due to which signals do not pass well from the brain to the organs. In some cases, the nerves completely lose their ability to conduct signals and atrophy.

Dystrophic changes in the vertebral bodies cause changes in the growth processes of bone tissue: the bone begins to grow in width, trying to increase the area of ​​the vertebral body, reducing the load on the vertebra. Osteochondrosis develops.

If bacteria (mainly chlamydia) or fungi penetrate the spine, then arthrosis and arthritis occur, leading to changes in the cartilaginous discs and the appearance of hernias.

It is also possible displacement of the vertebrae and the development of scoliosis.

Causes of pathology

Basically, violations in the spine appear due to excessive loads and their incorrect distribution.

The disease can be caused:

• overweight;
• frequent weight lifting;
• incorrect posture;
• weak muscular corset;
• sedentary work;
• injuries;
• inflammatory processes;
• body aging.

There is no blood supply in the intervertebral discs. Therefore, even small damage to the disk can lead to its destruction.

Symptoms of degenerative processes

Dystrophic changes in the vertebral bodies are accompanied by:

• deformation of the vertebrae and intervertebral discs;
• feeling of discomfort and fatigue in the spine;
• pain syndrome;
• numbness and tingling in the legs (if a hernia has formed).

• localized in the lower back and last more than 1.5 months;
• may spread into the thigh;
• in the lower back dull and aching, and in the legs - burning;
• aggravated in a sitting position, with prolonged standing, with bending, turning and lifting objects.

Diagnosis of dystrophic changes

To make a diagnosis, the doctor examines the history, examines the patient and sends him for an X-ray examination or magnetic resonance imaging.

If there are dystrophic changes in the vertebral bodies, then the examination will show:

• destruction of disk space by more than half;
• the onset of degenerative changes in the disk space, primarily its dehydration;
• the presence of cartilage erosion;
• rupture of the fibrous ring;
• protrusion or intervertebral hernia.

Treatment of the disease

Basically, dystrophic changes in the vertebral bodies are treated conservatively, with the help of medications and physiotherapy.

First of all, the patient is credited with several days of bed rest, which is not canceled immediately, but gradually.

Treatment begins with the appointment of anti-inflammatory nonsteroidal drugs. They will help relieve inflammation, swelling, as a result of which the compression of the nerve roots disappears, and, consequently, pain. In some cases, it may be necessary to use analgesics (for very severe pain), muscle relaxants, if there are muscle spasms, and chondroprotectors (they will help restore damaged cartilage tissue).

When swelling and inflammation disappear, and the pain subsides significantly, they move on to physiotherapy procedures: traction, massage and therapeutic exercises.

Traction allows you to increase the distance between the vertebrae, which contributes to the flow of water and nutrients to the intervertebral disc.

Massage and therapeutic exercises will strengthen the muscular corset, restore the normal functioning of the ligamentous apparatus, restore mobility to the vertebrae and eliminate residual pain.

Comprehensive treatment will not only relieve pain, but also completely defeat the disease.

But if the patient's condition is too neglected and degenerative changes have begun to affect the functioning of internal organs, one has to resort to surgical intervention.

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Differential diagnosis of degenerative changes in the bone marrow of the vertebrae

With degenerative changes of the 1st type, there are grounds for differential diagnosis with spondylitis. An inflammatory disc at T2 has a high signal and accumulates more contrast than a torn annulus. In addition, the boundaries between the disc and marginal vertebrae in spondylodiscitis are unclear. Pathological changes in the surrounding soft tissues with degenerative changes are rarer than with an infectious process.

Bone marrow degenerative changes in type 2 can be differentiated from spinal hemangioma based on a high signal in both T1 and T2. Hemangioma can occupy the entire vertebra or part of it in the form of a sharply demarcated substrate. Unlike hemangioma, degenerative changes in the red bone marrow have a linear shape, indistinct delimitation, and a less sharp increase in signal. The possibility of a malignant tumor is completely ruled out on the basis of a high signal in T1.

MRI diagnosis of spondylitis

In a typical picture of spondylitis, edema and hyperemia of the bone marrow cause a distinct decrease in the bone marrow signal of the affected vertebrae in the T1-weighted image. In the T2-weighted image, the vertebral bodies have a high signal, after the use of gadolinium compounds, its increase occurs. The affected intervertebral disc has an increased signal in T2, and as the process progresses, it accumulates a contrast agent. In the future, there is a decrease in the height of the disc, deformation, masking of the intranuclear fissure and a fuzzy demarcation from the endplates of the border vertebrae. In 30% of cases of spondylitis in the acute stage, deformation of the vertebrae and damage to the epidural space are observed. In 20% - moderately pronounced changes in the paravertebral soft tissues.

In tuberculous spondylitis, paraspinal leaks are observed in almost all patients, and in 68% the epidural space is involved in the process.

Brucellosis spondylitis is characterized by the most frequent involvement of the anterior end plates of the lower lumbar segments. Changes in the anterior endplates resemble small Schmorl hernias. In the intervertebral discs of patients with brucellosis spondylitis, a vacuum phenomenon is often found, which is generally not typical for banal spondylitis.

Literature

Osna A.I. Discography. Kemerovo, 1969

Osteocondritis of the spine. Sat. scientific papers edited by prof. A.I.Osna. Leningrad, 1975

General guide to radiology. Volume 1. Edited by N. Petterson. Nycomed, 1996

Tager I.L., Dyachenko V.A. X-ray diagnostics of diseases of the spine. "The medicine". Moscow. 1971

M. Vahlensieck, M. Reiser. MRT des Bewegungsapparats. G. Thieme Verlag, 1997.

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Degenerative-dystrophic lesions of the spine: diagnosis, clinic and treatment

About the article

For citation: Tyurnikov V.M. Degenerative-dystrophic lesions of the spine: diagnosis, clinic and treatment // RMJ. 2008. No. 26. S. 1739

Currently, it is considered that degenerative-dystrophic diseases of the spine are the most common chronic diseases characterized by progressive degenerative-dystrophic changes in the tissues of the vertebral segments - degradation of the tissues of the intervertebral discs, joints, ligaments, bone tissue of the spine, in advanced cases manifested by severe orthopedic, neurological and visceral disorders and often leading to disability.

It is no coincidence that in recent years, both in our country and abroad, numerous symposiums and conferences devoted to this problem have been held. Numerous statistical data testify not only to the high frequency of degenerative-dystrophic diseases of the spine, but also to the absence of a tendency to reduce the frequency of these diseases. Affecting most often people of working age, degenerative-dystrophic diseases of the spine lead to significant labor losses, and often to disability. Of the total number of sick leaves issued only by neuropathologists, more than 70% are for various clinical manifestations of degenerative-dystrophic diseases of the spine. Among the causes of temporary disability and disability, this disease still occupies one of the first places. The level of disability among patients with degenerative-dystrophic diseases of the spine is 4 people per 10 thousand of the population and ranks first in this indicator in the group of diseases of the musculoskeletal system.

The problem of preventing the development of degenerative-dystrophic diseases of the spine and eliminating the pain syndrome is becoming increasingly important and needs to be addressed both in terms of developing an effective physical rehabilitation program and in terms of its availability for all categories of the population. In the era of total computerization, a sharp transition from physical to mental labor, there is a decrease in human motor activity. Sedentary work, driving in a car lead to a decrease in muscle tone. Studies have shown that 80% of the time the spine is in a forced half-bent position. A long stay in this position causes stretching of the back flexor muscles and a decrease in their tone. This is one of the main factors that lead to the occurrence of degenerative-dystrophic diseases of the spine.

A brief history of the study of compression syndromes of degenerative-dystrophic diseases of the spine:

Cotugno (1794) - the infectious theory of sciatica;

Virchov (1857) described a herniated cervical intervertebral disc (MD) called extradural chondroma;

Babinsky (1888), Bekhterev (1913) - the clinic of damage to the roots of the spinal cord (SC) is described when they are compressed in the spinal canal;

Dandy (1929) - suggested that compressive cartilage fragments could come from the disc;

Schmorl (1932) - a classic work on cartilage nodes and degenerative lesions of MD;

Hildenbrandt (1933) - characterization of degenerative changes in MD, the concept of "osteochondrosis" was introduced;

Mixter and Barr (1934) - first used the term "herniated disc";

Margulis (1940) - introduced the term "lumbosacral sciatica";

Popelyansky Ya.Yu., Osna A.I., Lutsik A.A. a school for the study of spinal osteochondrosis was established (1970–1980).

In 1984, in the collective monograph "Osteochondrosis of the spine", academician of the Academy of Medical Sciences, professor of GS. Yumashev and Professor M.E. Furman gave a definition of this disease: “Osteochondrosis is the most severe form of degenerative-dystrophic lesions of the spine, which is based on disc degeneration with subsequent involvement of the bodies of adjacent vertebrae, intervertebral joints and ligamentous apparatus. In each section of the spinal column, osteochondrosis has a typical localization and features.

In the 1980s and 1990s, the theory of the predominant myogenic origin of dorsalgia began to prevail. Many clinicians believe that almost 90% of back pain is a manifestation of myofascial syndrome.

However, the vertebrogenic factor in the development of dorsalgia should not be underestimated. Vertebrogenic causes of dorsalgia [Voznesenskaya TG, 2004]: - degenerative-dystrophic diseases of the spine and their manifestations - disc herniation, deforming spondylosis, spondylarthrosis.

To a greater extent, pain syndrome is associated with diseases that are not associated with degenerative-dystrophic diseases of the spine: sacralization, lumbarization, ankylosing spondylitis, osteoporosis, Bechterew's disease.

The nucleus pulposus of an unchanged intervertebral disc is a gelatin-like, homogeneous mass limited by the annulus fibrosus and terminal cartilaginous plates of adjacent vertebral bodies above and below (Fig. 1 and 2).

With age, a decrease in the amount of mucopolysaccharides and a change in their qualitative composition leads to a decrease in the fluid content in the nucleus. The core loses its properties of the gel, the disk itself becomes thinner and loses its functions as an elastic body. In addition, the adhesion forces between the collagen plates of the fibrous ring are weakened, the ring is stretched and cavities appear in it. These processes occur against the background of gradual atrophy of the vessels supplying the intervertebral discs with blood. Replacing the blood supply with a diffusion mechanism, the efficiency of which is much lower, leads to serious changes in the nucleus pulposus. There are cracks and ruptures in the fibrous ring, intervertebral hernias are formed (Fig. 3 and 4).

The vertebrae are composed of an internal spongy and compact external substance. Spongy substance in the form of bony crossbars provides strength to the vertebrae. The outer compact substance consists of bone lamellar tissue, which provides the hardness of the outer layer and the ability of the vertebral body to take loads, such as compression when walking. Inside the vertebra, in addition to the bone crossbars, there is a red bone marrow, which carries out the function of hematopoiesis.

The bone structure is constantly updated: cells of one type are busy with the decomposition of bone tissue, the other type - with its renewal. Mechanical forces, loads, which the vertebra is exposed to, stimulate the formation of new cells. Strengthening the impact on the vertebra leads to accelerated formation of denser bone tissue and vice versa. Various theories have been put forward to explain the etiopathogenesis of degenerative-dystrophic diseases of the spine.

The involutive theory is based on the assumption that the cause of degenerative-dystrophic diseases of the spine is premature aging and wear of the intervertebral discs.

At the heart of the muscular theory, the cause of the appearance and development of degenerative-dystrophic diseases of the spine was considered constant muscle tension or muscle hypotension, inflammation of the muscles and ligaments. A number of authors believe that the development of degenerative-dystrophic diseases of the spine is based on the creation of an incorrect muscular motor stereotype, which leads to mechanical overload of the corresponding components of the intervertebral segment and, ultimately, to the appearance of degeneration and involution processes.

Proponents of endocrine and metabolic theories tried to link the occurrence and development of degenerative-dystrophic diseases of the spine with endocrine and metabolic disorders. The theory of heredity suggests a hereditary predisposition to the development of degenerative-dystrophic diseases of the spine.

Supporters of the rheumatoid and autoimmune theory drew attention to the fact that the processes occurring in the joints in rheumatoid arthritis are identical to the processes occurring in the intervertebral joints. The reliability of these views is confirmed, for example, by the similarity of biochemical changes in the ground substance and cellular elements of the disc, which are characteristic of diseases classified as "collagenosis", including rheumatoid arthritis. These changes lead to a violation of the metabolism of the synovial membrane, which begins to produce less synovial fluid, as a result of which the nutrition of the cartilage and adjacent bone tissues is disturbed. The emergence of the traumatic theory is associated with attempts to determine the role of the traumatic (microtrauma) mechanical factor in the etiopathogenesis of the development of degenerative-dystrophic diseases of the spine.

The role of visceral pathology in the development of degenerative-dystrophic diseases of the spine has also been proven. There are still quite a large number of theories and assumptions that, to one degree or another, repeat the above.

Clinical syndromes are divided into vertebral and extravertebral. Extravertebral syndromes are divided into two large groups: reflex and compression. Reflex syndromes often precede compression syndromes. Reflex syndromes include syndromes caused by irritation of the receptors of the Luschka sinuvertebral nerve, which penetrates the spinal canal through the intervertebral foramina and innervates the periosteum, ligaments, annulus fibrosus, and blood vessels. Irritation of receptors occurs as a result of compression by a hernia, bone growths, in violation of fixation, vascular disorders (edema, poor blood circulation), inflammation (reactive, immune). Impulses propagating along the Luschka nerve travel through the posterior root to the posterior horn of the spinal cord. Switching to the anterior horns, they cause reflex-tonic disorders. Switching to the sympathetic centers of the lateral horn, they cause vasomotor or dystrophic disorders. This kind of dystrophic changes are primarily affected by low-vascularized tissues (tendons, ligaments), especially at the points of attachment to bone prominences. In some cases, these neurodystrophic changes cause intense pain, which occurs not only locally when touching the diseased area (trigger zone), but also at a distance. In the latter case, the pain is "reflected", it can sometimes be reflected over considerable distances. Reflected pain can be in the form of a lightning-fast "lumbago" or it turns out to be prolonged. Vegetative disturbances are possible in the trigger zones and in the area where pain is reflected.

In the origin of dorsalgia, functionally reversible blocking of the intervertebral joints is of great importance, which may precede the development of degenerative-dystrophic diseases of the spine, but may also occur in already affected joints. The most common cause of blockage can be static or dynamic loads, anti-physiological postures and microtrauma. Blockage in one area of ​​the spine causes functional changes in adjacent areas in the form of the formation of compensatory hypermobility [Vorobeva O.V., 2003].

Myofascial pain (syndrome of painful muscular-fascial dysfunction) can occur as part of reflected spondylogenic pain. Myofascial pain is intense, at times worsening pain that leads to limitation of movement. The patient remembers which movements cause increased pain and the occurrence of a reflected pain reaction, and tries to avoid these movements and irritation of trigger zones.

Muscle spasm can be associated with many painful conditions of the spine and internal organs. In some cases, localized muscle spasm may be a protective physiological mechanism that limits the mobility of the affected parts of the spine. However, then spasmodic muscles become a secondary source of pain, which triggers a vicious circle of "pain-muscle spasm-pain" that contributes to the formation of myofascial pain syndrome MFPS.

The leading pathogenetic mechanisms of MFPS include local vasomotor dysfunction and reflex tonic changes in the entire muscle or its limited area [Popelyansky Ya.Yu., 1989].

Reflex syndromes include lumbago in the acute development of the disease and lumbalgia in subacute or chronic course. These pains are characterized by flattening of the lumbar lordosis. This is the first stage of neurological complications. Of the compression syndromes, radiculopathy is the most common, accounting for 40% of all extravertebral syndromes. Due to the physiological characteristics of the structure of the spine, the lumbar region most often suffers. When the spinal motion segment is damaged at the level of the lumbar region, sanogenetic reactions begin in the body in order to limit movement in the affected segment, which leads to a change in the motor stereotype, which is formed due to the close interaction of the pyramidal and extrapyramidal systems.

The second (radicular) stage, or the stage of discogenic sciatica, is due to increased disc prolapse and penetration of disc tissue into the epidural space, where the spinal roots are located. The resulting radicular symptoms correspond to the level of the affected spinal segment. The most commonly affected roots are L5 and S1.

The third (vascular-radicular) stage of neurological disorders is due to the ongoing compression of the hernia on the root and the radicular artery passing along with it. At the same time, “paralytic sciatica” can develop catastrophically quickly, characterized by peripheral paresis or paralysis of the extensor muscles of the foot. In such cases, the appearance of motor disorders is accompanied by the disappearance of the pain syndrome.

The fourth stage of neurological manifestations is due to a violation of the blood supply to the spinal cord due to damage to the radicular-spinal arteries. The blood flow is more often disturbed in the artery of Adamkevich and the additional artery of Desproges-Hutteron. At the same time, chronic dyscirculatory myelopathy develops, usually at the level of the lumbar thickening of the spinal cord. A patient with a lesion of Adamkevich's artery develops a syndrome of intermittent claudication of the spinal cord. With the defeat of the Deproge-Gutteron artery, the syndrome of intermittent claudication of the cauda equina develops.

An unfavorable variant of lumbar vertebrogenic radicular syndromes is the compression of the cauda equina, the so-called caudal syndrome. Most often it is caused by a prolapsed median disc herniation, which compresses all the roots at the level of the affected segment.

Degenerative-dystrophic diseases of the spine (often in combination with prolapse or disc herniation) lead to the development of segmental stenosis of the spinal and root canals. The most common cause of narrowing of the spinal canal is a combination of a progressive degenerative process in the discs, joints and ligaments of the spine with a pre-existing relatively small capacity of the canal as a result of congenital or constitutional structural features of the vertebral bodies.

Instability of the spinal motion segment (SDS) is a condition characterized by an inability to endure physiological stress and is accompanied by clinical and radiological manifestations.

The origin of PDS instability: trauma, tumor lesion, degenerative-dystrophic lesions, congenital pathology (spondylolisthesis).

X-ray signs: displacement of the vertebral bodies more than 3.5 mm; the angle of inclination between the vertebral bodies during flexion–extension is greater than 12 (Fig. 5).

Diagnosis of degenerative-dystrophic diseases of the lumbar spine is based on the clinical picture of the disease and data from additional examination methods (radiography, computed tomography, magnetic resonance imaging). MRI is especially informative (Fig. 6 and 7).

Syndromes of lesions of individual lumbar roots:

L3: pain and paresthesia in the L3 dermatome, paresis of the quadriceps femoris muscle, decreased or loss of the tendon reflex from the quadriceps muscle (patellar reflex).

L4: Pain, possible paresthesia or hypalgesia in the L4 dermatome, paresis of the quadriceps femoris and tibialis anterior muscles, decreased knee jerk.

L5: Pain, possible paresthesia or hypalgesia in the L5 dermatome, paresis, possible atrophy of the extensor hallucis longus and extensor digitorum brevis, absence of posterior tibial reflex.

S1: pain, possible paresthesias or hypalgesia in the S1 dermatome, paresis of the triceps muscle of the leg, loss of the Achilles reflex (Fig. 8).

The complexity of the interaction of compensatory and pathogenic mechanisms in vertebrogenic pathology largely explains the lack of clear correlations between the severity of clinical symptoms and the degree of morphological changes in vertebral and neural structures according to radiography, computed tomography, and MRI, which is well known to practitioners (especially neurosurgeons operating on disc herniations).

Therefore, the doctor's tactics when choosing a treatment is determined primarily by clinical data, although the results of additional examination methods are important.

The prevailing opinion in most medical institutions today is that surgical treatment of discogenic disease is indicated only in 10–12% of patients. All other patients with degenerative-dystrophic diseases of the spine and complications can and should receive conservative treatment.

Methods of conservative treatment include the mandatory use of drugs that have a chondroprotective, chondrostimulating effect. These requirements are fully met by the domestic drug Chondroxide, which contains the active ingredient chondroitin sulfate. Chondroitin is an acidic mucopolysaccharide from the cartilage of the trachea of ​​cattle. Chondroxide, presented in pharmacies with ointment. gel for external use and tablets.

Chondroxide stimulates the regeneration of cartilaginous tissue, has an anti-inflammatory, analgesic effect.

Chondroxide is involved in the construction of the basic substance of cartilage and bone tissue; affects metabolic processes in hyaline and fibrous cartilage. Inhibits the processes of degeneration of cartilage and connective tissue; inhibits enzymes that cause cartilage damage. Chondroxide stimulates the biosynthesis of glycosaminoglycans, promotes the regeneration of the articular bag and cartilaginous surfaces of the joints, increases the production of intraarticular fluid. This leads to a decrease in inflammation, an increase in the mobility of the affected joints.

Chondroxide in tablet form is taken 0.5 g (2 tablets) 2 times a day, washed down with a small amount of water. The recommended initial course of treatment is 6 months. Chondroxide ointment or gel is applied to the skin and gently rubbed (in the lesion) until completely absorbed. The course of treatment is at least 2-3 weeks. In addition, the use of therapeutic blockades, muscle relaxants, physiotherapy, kinesitherapy, reflexology, massage, and manual therapy is common. Of the physiotherapeutic procedures, electrophoresis with the proteolytic enzyme caripazim is currently widely used. It is known that therapeutic physical culture and massage are integral parts of the complex treatment of patients with spinal lesions. Therapeutic gymnastics pursues the goals of general strengthening of the body, increasing efficiency, improving coordination of movements, and increasing fitness. At the same time, special exercises are aimed at restoring certain motor functions.

Despite the availability of effective means of conservative treatment, the existence of dozens of techniques, some patients need surgical treatment. To date, 0.3% of all patients are operated on.

Indications for surgical treatment are divided into relative and absolute. The absolute indication for surgical treatment is the development of caudal syndrome, the presence of a sequestered herniated intervertebral disc, a pronounced radicular pain syndrome that does not decrease despite the treatment. The development of radiculomyeloishemia also requires emergency surgical intervention, however, after the first 12-24 hours, indications for surgery in such cases become relative, firstly, because of the formation of irreversible changes in the roots, and, secondly, because in most cases in the course of treatment and rehabilitation measures, the process regresses within approximately 6 months. The same terms of regression are observed in delayed operations.

Relative indications include the ineffectiveness of conservative treatment, recurrent sciatica. Conservative therapy in duration should not exceed 3 months and lasts at least 6 weeks. It is assumed that the surgical approach in the case of acute radicular syndrome and the failure of conservative treatment is justified during the first 3 months after the onset of pain to prevent chronic pathological changes in the root. Relative indications are cases of extremely pronounced pain syndrome, when there is a change in the pain component with an increase in neurological deficit.

The main goal of surgery is not disc surgery, but decompression of the root, which must remain mobile and intact. A neurosurgeon should, if possible, minimize the formation of scar tissue and not create additional conditions of instability in the operated segment of the spine. A prerequisite is an accurate diagnosis, when clinical manifestations correlate with the data of additional examination methods.

Currently, minimally invasive methods of endoscopic nucleotomy under CT control, laser vaporization of intervertebral discs are increasingly being used. In the last 5 years, a new method of minimally invasive plasma disc nucleoplasty has appeared, based on the controlled supply of low temperatures to the disc with ablation and coagulation. South Korean orthopedists demonstrated encouraging results of using Prodisc prostheses at the 24th International Conference on Minimally Invasive Technologies.

The "gold" standard at the moment is microdiscectomy, which minimizes trauma to the tissues of the epidural space, does not cause disturbances in the normal anatomy of the osteoarticular apparatus of the spine, which greatly reduces the risk of postoperative complications.

Morbidity and mortality from cerebrovascular diseases (CVD) in Russia.

Chronic pain is characterized by the development of specific neurophysiological reactions in the body.

© "RMJ (Russian Medical Journal)"

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The bone marrow plays an important role in the formation and maintenance of immunity.

Problems that arise in the bone marrow inevitably affect hematopoiesis, blood composition, the state of blood circulation, blood vessels, and soon the whole organism. In violation of the functions of the bone marrow in the blood, the number of leukocytes, platelets, erythrocytes decreases. The composition of the blood changes, and hence the nutrition of the organs, that is, their functions also suffer. Due to changes in the composition of the blood, the nature of its movement through the vessels also changes, which also causes many unpleasant consequences.

bone marrow degeneration

Degenerative processes sooner or later begin in any organism. Such processes also take place in the bone marrow. To a certain extent, they are normal physiological processes, of course, if they begin on time. In degenerative-dystrophic processes, normal (myeloid) bone marrow tissue is gradually replaced by connective and adipose tissue. Moreover, it is fat substitution that prevails.

With age, these processes increase and accelerate. So, by the age of 65, about half of the bone marrow in a person is replaced by adipose tissue. At an older age, fat cells can occupy half of its volume. Fatty degeneration of the bone marrow today is the object of attention of medical science. An earlier and more intensive process of such replacement of one tissue by another causes the development of various diseases.

Where do fat cells come from

When scientists studied fat precursor cells, the first suspects were myeloid cells in the bone marrow. These cells give rise to blood cells (except lymphocytes), cells from which muscles are formed, liver cells, and can also be the progenitors of fat. Thus, perhaps due to the low "specialization" of myeloid cells in the bone marrow, their significant replacement with fat cells occurs.

Pathological replacement of myeloid tissue with adipose tissue can occur due to metabolic disorders in the body, bone marrow lesions with metastases, infectious processes, especially chronic ones.

What diseases are accompanied by fatty degeneration of the bone marrow?

• Simmonds-Schien Syndrome,
• Hypoplastic and aplastic anemias,
• Osteoporosis.

This is a list of diseases in which a link has been established between bone marrow degeneration and symptoms or causes of disease.

Simmonds-Schien syndrome

Another name for this disease is hypothalamic-pituitary cachexia. It most often affects older women. Initially, the pathological process occurs in the adenohypophysis and hypothalamus. Further, the secretion of hormones, including growth hormone, is disrupted. This causes degenerative-dystrophic and atrophic processes in tissues and organs and a wide variety of symptoms.

Hypoplastic and aplastic anemias

This group of anemias develops as a result of hematopoiesis suppression, which, in turn, is caused by the replacement of the myeloid tissue of the bone marrow with adipose tissue. The reasons for this may be toxic or infectious and viral effects.

Among the substances that negatively affect the state of the bone marrow, arsenic, benzene, and some drugs are called. This is one of the arguments that you should not self-medicate, any medicine should be prescribed by a doctor. He does this with the potential consequences in mind.

Medicines that can cause or accelerate bone marrow degeneration:

• cytotoxic agents,
• Non-steroidal anti-inflammatory drugs, for example, acetylsalicylic acid, analgin,
• Sleeping pills (barbiturates),
• Blood pressure lowering agents such as captopril
• Thyrostatics,
• anti-tuberculosis drugs,
• Sulfonamides,
• Some antibiotics, in particular, chloramphenicol,
• Antiarrhythmic drugs.

The main manifestation of hypoplastic and aplastic anemia is thrombocytopenia, manifested by hemorrhagic syndrome. Bleeding, bleeding of the skin and mucous membranes, hemorrhagic rashes - these are the most common symptoms of this type of anemia.

Osteoporosis

Until recently, it was believed that a large amount of adipose tissue protects the body from osteoporosis, since it compensates for the missing hormones. However, recent studies have shown that this is not entirely true. Excess fat cells prevent the body from producing collagen and absorbing calcium. This leads to a weakening of the bone tissue, to degenerative processes in it, that is, to bone fragility - the main manifestation of osteoporosis.

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brain. The most common causes of this condition are aplastic

anemia, the effects of radiation or chemotherapy. This state manifests itself

the appearance of areas of high-intensity MR signal on T1- and T2-WI,

corresponding to the fatty bone marrow in those parts of the skeleton where normal

contains red bone marrow.

Bone marrow reconversion - reverse replacement of fatty marrow

hematopoietic in pathological conditions accompanied by an increase

the needs of the body for blood formation. Seen in chronic anemia

blood clotting disorders, prolonged hemorrhagic conditions.

The duration of anemization directly affects the prevalence and reversibility

bone marrow reconversion. Regardless of patient age, reconversion to MR

intensity of the MR signal on T1-WI against the background of normal high-intensity

fatty bone marrow.

Bone marrow infiltration is observed in tumor, degenerative

dystrophic, inflammatory and systemic processes. MR picture of infiltration

depends on the type of pathological tissue infiltrating the bone marrow, the presence of

concomitant edema, necrosis or fibrosis of the bone marrow, processes of reactive

calcification and ossification. In most cases, this condition

characterized by a lower intensity on T1-WI, and a higher intensity on T2-WI

in relation to the image of fatty bone marrow.

Inflammatory infiltration of the bone marrow is characterized by replacement

bone marrow with purulent exudate, granulation tissue, accompanied by

destruction of bone tissue, the formation of sequesters. Around the inflammation may be

zone of edema, osteosclerosis and bone marrow fibrosis.

Tumor infiltration of the bone marrow in the MR - image depends on

the degree of aggressiveness of the neoplasm, the nature and rate of its growth in

Expansive neoplasms (benign and slow growing)

malignant) on MRI are manifested by the presence of a volumetric formation

homogeneous or cellular-trabecular structure, delimited by a zone

endosteal ossification in the form of a hypointense rim on T1 and T2-WI;

Infiltrative neoplasms (malignant) are characterized by

rapid spread in the medullary canal in the longitudinal and

transverse direction with elements of necrosis in the center;

On MRI, tumors appear as small-focal or diffuse

bone marrow infiltration, often with indistinct contours, surrounded by

periphery with an edema zone hypointense on T1 and hyperintense on T2-

The tumor focus can be homogeneous and heterogeneous structure in

depending on the presence of necrosis, hemorrhage and gives an MR signal on T1-WI

more often hypointense, on T2-WI hyperintense.

Systemic bone marrow infiltration is characterized by multiple

polyosseous lesion. It is observed in secondary metastatic

tumors, neoplasms of the lymphoid and hematopoietic system, histiocytosis,

lipid metabolism disorders. Distribution of areas of infiltration in the bones of the skeleton,

usually corresponds to the normal distribution of red bone marrow -

bone marrow neoplastic processes primarily develop from cells

hematopoietic bone marrow. Image characteristic of a tumor

infiltration, may not differ from a normal distribution or reconversion

hematopoietic bone marrow.

characterized by bone marrow replacement with defective osteoid or

fibrous connective tissue, accompanied by hemorrhages and areas

colliquative necrosis. Bone marrow fibrosis may have multiple

diffuse or focal character in chronic inflammatory and neoplastic

processes, Paget's disease, fibrous ankylosis. subchondral fibrosis

determined in arthritis and osteoarthritis. It appears as hypointense

areas against the background of high-intensity fatty bone marrow on T1-WI.

Cystic cavities of degeneration have a homogeneous or cellular-trabecular

structure with liquid or hemorrhagic contents and give hypointense

signal on T1-VI, reverse on T2-VI.

1. MRI demonstrates high information content in the detection of pathological

bone marrow changes in various types of pathological conditions.

2. The MRI picture of changes in the bone marrow is not very specific, so the goal is to

MRI is the earliest detection of bone changes

brain or an assessment of their prevalence in established disease.

1. Bryukhanov A.V., Vasiliev A.Yu. Magnetic resonance imaging in

osteology. – M.: Medicine, 2006.- 200p.

2. Trofimova T.N., Karpenko A.K. MRI diagnostics of knee joint injury. -

St. Petersburg: SPbMAPO Publishing House, 2006 - 150p.

The Youth Conference on Organic Chemistry continues the series of school-conferences held annually since 1998 (Yekaterinburg.

State educational institution of higher professional education

Northern Socio-Ecological Congress "Horizons of Economic and Cultural Development"

"Information technologies in the educational process of a research university"

Moscow on the basis of the "mother - Russian State Technological University named after K. E. Tsiolkovsky".

E. R. Schrager - scientific editorial board "Mechanics, Mathematics"; dt., prof. A. M. Gortsev -

Treasured crusts - highlights of Komi Vladimir Sharkov, instead of wishes, his condolences

What is spinal fat degeneration?

Fatty degeneration of the vertebrae is an age-related process of replacing the hematopoietic tissue of the bone marrow with fatty tissue. In some cases, it begins earlier against the background of oncological or infectious diseases, uncontrolled drug therapy. This natural process can be complicated. Among them are osteoporosis, anemia, hormonal imbalance and spinal stenosis. In most cases, specific therapy is not required, but if complications threaten the patient's quality of life, surgery may be indicated.

The reasons

The main risk factor is age. Tissue degeneration begins to occur, including the bone marrow of the spine. This is natural, and if the patient is seventy, often his bone marrow is half fat.

Myeloid cells initiate the process. They are found in the bone marrow and make all the blood cells. Muscles and internal organs, such as the liver, are also formed from them.

In some cases, degeneration occurs much earlier. The cause may be metabolic disorders, malignant neoplasms and metastasis, infections. Unfortunately, such changes can occur regardless of the age factor.

The accelerated process of "obesity" of the vertebrae can occur due to the intake of certain medications. These include non-steroidal anti-inflammatory drugs. This is especially bad, given that many people suffering from osteochondrosis mainly use NSAIDs - a vicious circle of back tissue degeneration is obtained. You can also write down pressure-reducing drugs, cardiac medications and antibiotics here.

How does it develop

When blood circulation and metabolism of the spine are disturbed, osteochondrosis does not remain the only problem. An additional pathology may be fatty degeneration of the bone marrow and ligaments that fix the back. The result of this pathological process may be stenosis of the spinal canal, and in the future - compression of the spinal cord. And if there is some kind of mechanical effect on the spinal cord, a whole bunch of severe neurological symptoms are inevitable. Including partial and complete paralysis.

Due to the fact that the vertebral bodies do not have independent internal nerves and blood vessels, but are fed through the endplates, fatty degeneration in them begins quickly. In addition to the vertebrae, the arteries also change. The path of nutrients to the vertebrae and discs is complicated. This is another reason why the nucleus pulposus loses its shock-absorbing properties.

Osteochondrosis and fatty degeneration lead to the fact that the space between the vertebrae decreases. To reduce spasms of the vertebral ligaments, the body tries to get rid of calcium. This leads to a disease such as osteoporosis.

Prognosis and complications

Fatty degeneration of the bone marrow leads to poor production of blood cells. There is anemia, decreased immunity. Decreased vascular tone. The condition of not only the spine, but the entire human body is deteriorating. The tissues of the internal organs begin to "suffocate", not receiving enough oxygen.

Fatty degeneration of the vertebrae can lead to the development of diseases such as:

• Simmond-Schien disease. Usually middle-aged females are affected. Hormonal changes begin, due to which a large number of body tissues suffer;
• Anemia. The degeneration of the cells that create blood cells does not go unnoticed;
• Osteoporosis. Too much fat in the bone prevents the body from producing collagen. Because of this, a person stops properly processing calcium, and the vertebrae become fragile.

Blood coagulates worse, and as a result, traumatic effects can be fatal. Especially severe consequences can occur if such a symptom accompanies osteoporosis - bone tissue degeneration. Bones break easily, and if a fracture occurs, non-stop internal bleeding can begin.

Treatment

Both conservative treatment measures and operations are used. But unfortunately, they are by and large only symptomatic. Degeneration of vertebral tissues due to aging is an irreversible process. But if complications, inflammatory processes, nerve infringement occur, the following recommendations are suitable:

• In the acute period, when attacks are constantly tormented, it is necessary to give the patient complete rest. Eliminate both mental and physical stress factors;
• Non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac);
• Muscle relaxants to relieve painful muscle spasms (for example, Sirdalud);
• Injection blockade of the spine with novocaine;
• Chondroprotectors - drugs that help regenerate cartilage tissues;
• Physiotherapy (Magnet, Electrophoresis, Low-frequency current, Shock wave therapy);
• Physiotherapy exercises (after the acute period has ended);
• Massage procedures, acupuncture.

• See also: Instability of the vertebrae.

Surgical intervention is justified only if there is a narrowing of the spinal canal. Here the work of the surgeon is necessary, because otherwise the patient will experience loss of sensitivity and mobility, and possibly paralysis.

What is uncovertebral arthrosis of the cervical spine?

Epiduritis of the spine what is it

Tuberculosis of the spine: how to defeat the disease?

MRI of the spinal cord, MRI myelography, which reveals when it is contraindicated

What is MR Myelography

MR myelography is a study of the spinal canal, the spinal cord with its membranes. Its difference from traditional x-ray myelography is that MR myelography is a non-invasive highly informative procedure, and, therefore, completely safe and harmless to the patient.

Indications for scanning are:

• pain in the back, in the lower extremities, of varying severity, unilateral or bilateral
• sensory disturbance (paresthesia, numbness) or movement disorders in the legs (up to paresis / paralysis)
• previous spinal injury
• search for metastases or primary cancerous node
• upcoming or postponed surgery
• presence of signs of a neurological disorder in other organs (for example, impaired breathing, vision, heat intolerance)

What does an MRI of the spinal cord show?

1. Degenerative diseases of the spine, namely, compression of the brain by a burst hernia. Depending on the degree of compression, patients will be disturbed by pain (like electric shocks, backache), numbness, impaired motor functions.
2. Spinal cord injury. Injuries are divided into concussion, bruise and traumatic compression. Shake may not manifest itself in any way, but may manifest itself as short-term motor, sensory disturbances. At injury, and traumatic compression develops spinal shock with peripheral (hypotonic) paralysis, impaired pelvic functions. Shock passes on average in 3-8 weeks.
3. Tumors of the spinal cord, primary/secondary. For every 6 brain tumors, there is 1 spinal tumor. It should be noted that primary vertebral tumors affecting the spinal cord are not brain tumors. They are divided into intra- and extramedullary (from the tissues surrounding the brain, membranes, roots, vessels, fiber). For extramedullary tumors(meningiomas, neurinomas) is characterized by a half conduction disturbance, radicular pain, when sneezing or coughing, the pain is reflected at the site of the tumor, the same happens when tapping on the spinous processes. intramedullary tumors(ependymomas, astrocytomas, hemangiomas, granulomas) there is no pain, but there are motor and sensory disorders. metastatic(secondary) lesion is characterized by rapidly progressive flaccid (hypotonic) paraparesis (of both limbs), which then turns into spastic paralysis. These pathologies often show bone marrow fibrosis on MRI, as well as bone marrow edema, although these changes may be signs of other diseases.
4. Demyelinating diseases of the brain (both spinal and brain). These include multiple sclerosis and acute disseminated encephalomyelitis. Multiple sclerosis- This is a chronic autoimmune constantly progressive disease in which the myelin sheath of the nerves, which is responsible for the rapid passage of the nerve impulse, is affected. This pathology can have many clinical pictures, but they all have similarities. Both debut and exacerbation in patients cause: transferred viral infections; hyperinsolation, taking hot vans, baths, etc.; pregnancy. This can be manifested by spasticity in the lower extremities (most often), pelvic disorders (empirical urge, incontinence), headaches, later they are joined by swallowing, vision, hearing, and breathing disorders. Currently, MRI is the only way to visualize demyelination foci, in its time it was a breakthrough in the diagnosis of MS. After the first debut, the patient must be prescribed an MRI, it is based on the results of the scan that a conclusion is made with the final diagnosis, if the criteria for the detected number of foci have been met. Each focus of demyelination of the spinal cord on MRI is equated to in the brain, which is taken into account when making a diagnosis. MRI of the spinal cord in multiple sclerosis is performed simultaneously with the study of the brain, while using gadolinium-containing contrast to search for fresh lesions. Acute disseminated encephalomyelitis has a benign course, it appears after a viral neurotropic infection (measles, influenza, rubella, herpes and others, including after vaccinations). It is characterized by an acute onset with fever, signs of encephalitis, paresis, paralysis. With adequate treatment, the symptoms disappear within a month. A hallmark of contrast-enhanced MRI of the spinal cord is the “symptom of rings, half rings”.
5. amyotrophic lateral sclerosis, or motor neuron disease, or Charcot's disease, is characterized by damage to the motor pathways, as a result of which a person slowly develops paralysis of all muscles. The suspected cause is a mutation in the genes. Debuts at age. MRI of the spinal cord in ALS reveals the pathology of the anterior horns of the spinal cord, especially diffusion tractography helps in the diagnosis.
6. Ischemia or infarction of the bone marrow develops when the artery that feeds the spine is blocked, its spasm or compression. At the same time, MRI of the vessels of the spinal cord is performed to identify the localization of the source of impaired blood supply.
7. chronic anemia, more precisely, one of its signs is bone marrow reconversion (replacement of adipose tissue with blood-forming cells as an attempt by the body to increase the production of red blood cells).

Benefits of MRI

MRI of the brain and spinal cord is always preferable to other diagnostic methods. It allows not only to carry out myelography with three-dimensional reconstruction, it can be used to perform MR-myelography in the diffusion tractography mode, which makes it possible to study the pathways that are affected in many pathologies (for example, in ALS, multiple sclerosis). With regard to demyelinating diseases, MRI is the only way to visualize lesions; before the advent of MRI, this diagnosis was made only when pronounced clinical manifestations appeared.

Such excellent information content is due to the fact that the spinal cord is a soft tissue structure, and MRI, as is known, reveals its full diagnostic potential precisely when scanning soft tissues.

Whether surgery is required or surgery can be dispensed with, myelography of the spine will help determine the indications.

A significant plus to the above is the fact that during magnetic resonance scanning there is no exposure to ionizing X-rays, which allows MRI of the spinal cord to be performed in children.

Where to do myelography of the spine

If you are faced with the question of the need for an MRI of the spinal cord, you need to choose a center with a high-field closed-type tomograph (from 1.5 T). Only a device of this class can provide the information content necessary for scanning this area. The procedure takes about a minute, decryption takes another 30 minutes.

Remember that the presence of metal objects in the body (stents, vascular clips, a pacemaker, metal structures, etc.) is an absolute contraindication to scanning.

or CT scan

All rights reserved © MRI and CT of the spine, 2018

And that a lot of hackneyed and streamlined formulations in expert opinions (as well as all these universal terms “more likely; more likely”, as well as “trabecular edema”, in different descriptions and declensions), only say that an accurate picture of MRI changes more often not able to install everything. And the final result is entirely at the mercy of the experience and / or subjectivity of the doctor himself at the computer. You just need to understand that such favorite topics are “nothing” in any diagnostic path. But if in classical x-rays they love to incline the lung pattern in this way: reinforced - deformed - enriched (options: according to the perivascular / peribronchial type - and it’s good if they see it all on real pictures!), Then in MRI such a fad and a favorite topic, of course, are trabecular edema. That is, changes in the very bone tissue that MRI, in fact, sees the worst, giving here the absolute palm of primacy to MSCT and standard X-ray. Therefore, it is clear that it would be most appropriate and most pleasant to put a good face on a bad game here.

“The earliest NON-SPECIFIC (highlighted in capital letters in the same place! - A.K.) syndrome of a large number of diseases of the KSS.

Edema is a characteristic manifestation of traumatic contusions, latent subcortical and stress fractures, an early (reversible) stage of aseptic necrosis.

It is the only MRI tomographic manifestation of such processes as idiopathic transient osteoporosis and transient bone marrow edema syndrome ... "(From the manual "MRI-Expert:" MRI diagnostics in oncoosteology "(a manual for oncologists, traumatologists. Authors: k.m. Pasechnaya V.G., Candidate of Medical Sciences Korobov A.V., Karavaev A.A., Voronezh, 2011)

Option 2: A mildly pronounced non-uniform increase in the intensity of the MR signal on T2 with fat suppression is determined. Signs of bone-destructive changes were not revealed, the cortical layer was not changed. More likely, these changes reflect residual red bone marrow; for trabecular edema, the above changes are nonspecific ... "

There is no effusion in the joint cavity and in the subdeltoid bursa. A small amount of effusion is determined in the subcoracoidal bag and in the area of ​​the tendon of the biceps muscle ... "

Conclusion: MR-picture of partial rupture of the tendons of the rotator cuff (supraspinatus, subscapularis), subcoracoidal bursitis; tenosynovitis. Impeachment syndrome stage II-III.

Stage 1 - suspicion of changes (blurring of the edges of the joints)

Stage 2 - minimal changes (small local areas with erosions or sclerosis in the absence of changes in the width of the gap)

Stage 3 - moderate to severe sacroiliitis with erosions, sclerosis, dilation, narrowing, or partial ankylosis

Stage 4 - significant changes with complete ankylosis of the joint

Stage I - changes suspicious of sacroiliitis, i.e. subchondral osteosclerosis, some unevenness and fuzziness of the articular surfaces, which does not exclude the possibility of a normal age-related radiographic picture;

Stage II - obvious pathological changes (pronounced osteosclerosis not only on the iliac, but also on the sacral sides of the joint space, pseudo-expansion of the joint space and / or limited areas with erosions)

IIa (unilateral changes) and lIb (bilateral changes).

Stage III reflects in more detail the possibility of regression of subchondral sclerosis and the presence of erosions;

Stage IV - partial ankylosis (formally corresponds to stage III according to Kellgren).

Stage V - complete ankylosis.

“In the acute phase of ischemic stroke, pathological signs of brain damage are better and earlier (with the exception of CT perfusion!) are detected by MRI

(Source: V.G. Kornienko, I.N. Pronin "Diagnostic neuroradiology" M., 2003)

CT – CT + CT angiography + CT perfusion

MRI - standard MRI on a high-field tomograph /DWI, Flair, T2/

Again about the dubious value of MRI-4

spine health ©

All information on the site is for informational purposes only. Do not use this information for self-medication. Possible contraindications. Be sure to consult your doctor.

Bone marrow reconversion?

Zones of change in the intensity of the MR signal from the bone marrow of the femur and tibia (hypointense in T1 and T2 WI) - bone marrow reconversion? Are there other options?

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I am for conversion

I also think it's a conversion.

Thank you so much! And what is the longitudinal linearly curved zone of the hypointense MR signal according to T1 and T2 VI in the central parts of the femoral shaft, the vessel, perhaps? Not a fracture?

And where is the swelling then, if the fracture?

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What is bone marrow reconversion?

The MRI image of the normal bone marrow (BM) of the spine is mainly dependent on the appropriate proportion of blood-forming cells and fat cells (adipocytes) within the medulla of the vertebral bodies. MRI usually detects two types of bone marrow - active, functioning red bone marrow (RMB) and inactive - yellow bone marrow (JBM). The latter, due to the high content of adipose tissue, has an MR signal intensity similar to that of subcutaneous fat. A significant help in describing the state of the bone marrow in MRI studies is the well-known phenomenon of age-related, progressive transformation of BCM into FCM - the so-called BM conversion. There are several variants of these changes (conversions):

Option II (peripheral): the vertebral body has areas of high signal intensity of the ribbon-like and triangular shape of the LC, located in the peripheral parts of the vertebral bodies under both endplates; this variant can be caused by mechanical damage, which is usually less intense in the thoracic region due to the stabilizing effect of the chest, and can also be associated with degeneration of adjacent intervertebral discs; the frequency of this conversion variant increases with age, reflecting a gradual increase in the replacement of BCM by yellow BM in the peripheral variant, reaching its maximum manifestations in persons under 70 years of age;

Variant III (diffuse-small-focal or “variegated pattern” type): the vertebral body has small, diffusely located dotted areas of high signal intensity (from 1 to 3 mm) due to inclusions of JCM; this conversion variant reflects the replacement of CM by yellow CM with its maximum prevalence in aged individuals;

Variant IV (diffuse-focal): the vertebral body has a few, as a rule, round-oval foci of high signal intensity, in some places confluent, with fuzzy, uneven contours with sizes of the latter from 10 to 40 mm with a predominant orientation along the basivertebral vein; the frequency of this conversion variant is increased in the age categories of years with the greatest manifestations of this variant in patients in the fifth and sixth decade and in the absence of young people (under 30 years old);

Option V (vascular): the vertebral body has in the center, which is represented by a cone-shaped dilated basivertebral vein, along which there are linear, thin (2-3 mm) sections of the gastrointestinal tract (this variant is visualized mainly in patients of older age categories and is accompanied by osteoporosis [osteopenia); this conversion variant is not detected on images of the lumbar spine in patients under 50 years of age, but is most pronounced in patients over 60 years of age.

[read] article "Magnetic resonance imaging in the diagnosis of bone marrow conversion of the lumbar spine" Myagkov S.A., State Institution "Zaporozhye Medical Academy of Postgraduate Education of the Ministry of Health of Ukraine" (magazine "Pain. Joints. Spine" No. 3(11), 2013 )

Pain in the back is the most common complaint of patients visiting a traumatologist and orthopedist. Without the necessary treatment, acute diseases of the spine become chronic 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 are 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, tilting, turning.

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

How does degeneration of the vertebrae develop?

In case of malnutrition of the spinal column, various degenerative diseases develop, they lead to a decrease in the height of the intervertebral disc and impaired movement in the spine. Gradually, the surrounding structures are also involved in the process - joints, muscles, ligaments. An important 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 narrowing of the spinal canal begins, passing inside the vertebrae. It is this stenosis (narrowing) that causes back pain.

Due to the fact that the vertebrae do not have their own system of innervation and blood supply (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 a fairly young age of the main number 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 some degree of degeneration of the vertebrae. The gradual erasure of the boundary between the fibrous ring and the nucleus leads to a decrease in the height of the spine and infringement of the inner part of the intervertebral disc - the nucleus pulposus.

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

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

As a result of long-term studies, it has been proven that the protrusion of the disc into the intervertebral canal is not always the only cause of pain. The spinal cord, which is represented by the roots of the spinal nerves, passes through the spinal canal. When protrusion at any level of the intervertebral disc, the root is compressed and the appearance of pain will be quite logical. However, scientists have found that pain also appears 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 cause of degeneration of the intervertebral discs is the deterioration in 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 disk.

What causes malnutrition? There are a lot of reasons, this includes, in addition to metabolic changes, various blood diseases, such as anemia, also atherosclerotic changes, insufficient or excessive stress on the spine, and malnutrition.

Classification of degenerative-dystrophic changes in the spine

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

So, at stage 0, disc disorders are not yet recorded, but at the first stage it is already possible to see small gaps in the inner layers of the fibrous ring during the study.

At the transition to the second stage, the outer layers of the annulus fibrosus are still preserved (which still keeps the disc protrusion into the intervertebral canal), but there are back pains that can radiate to the lower limb and knee joint.

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

Treatment of pain caused by degeneration of the vertebrae

To relieve pain, surgical and conservative methods are used. They are aimed at alleviating the patient's condition, and therefore they can only be considered as 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 - a dosed load on the spine, special strength 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, therapeutic massage, in some cases manual therapy.

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

Among the surgical methods of treatment can be used:

• Discectomy with arthrodesis;
• Intradiscal administration of steroids;
• intradiscal decompression;
• laser therapy.

In recent years, minimally invasive methods of treatment have become widespread — electrothermal plasty of the annulus, laser decompression of discs, and percutaneous endoscopic disc removal. Methods for replacing the nucleus pulposus with restoring the integrity of the fibrous disc have also been used.