Lipoid degeneration of the bone marrow of the vertebral bodies. Fatty degeneration of the vertebrae: why does the back hurt? Complications of degeneration of the vertebrae in the neck

Liver steatosis - synonyms: fatty hepatosis, fatty degeneration of the liver, fatty infiltration, lipodystrophy is a disease of the liver, which is characterized by focal or dispersed deposition of fat in the liver cells. It is considered a common pathology, often without causing any symptoms. In some cases, it is manifested by an inflammatory process with further development cirrhosis and signs of liver failure.

ICD-10 code

K76.0 Fatty liver, not elsewhere classified

Causes of fatty degeneration of the liver

A small number of fat cells are present in the liver tissue in all healthy people. Their share is approximately 5%. They speak of fatty degeneration if such a percentage is more than 10. With advanced pathology, the amount of fat can be 50 percent or more.

Why is this happening? There can be many reasons, and here are some of them.

Prolonged liver toxicity:

due to excessive intake of alcoholic beverages (the so-called alcoholic steatosis);
due to prolonged use of medications, for example, hormonal drugs, chemotherapy drugs, antibiotics, anti-tuberculosis drugs.

Disrupted exchange processes:

hyperfunction of the adrenal cortex;
thyroid diseases;
diabetes;
obesity.

Wrong nutrition:

excessive passion for fatty and sweet foods, which is a big burden on the liver;
a chronic form of the inflammatory process in the pancreas or intestines;
irregular meals, long-term strict diets, inadequate intake of proteins, vitamins and minerals;
rare and small meals;
regular overeating.

Insufficient supply of oxygen to the tissues of the body, which can be observed in pathologies respiratory tract or cardiovascular disease.

The pathogenesis of the development of the disease can proceed in different ways. So, etiological reasons There can be two illnesses.

Firstly, fats can accumulate in the liver with their increased intake into the body:

due to excess fat in food;
due to an excess of carbohydrates in food (carbohydrates stimulate the formation fatty acids);
due to an increase in the consumption of glucose reserves in the liver, which causes the body to withdraw fat reserves from the depot and deposit them in the liver tissues;
due to under-oxidation of fats, which can be observed with metabolic disorders, anemia;
due to increased output somatotropin, which happens with diseases of the pituitary gland, with traumatic brain injuries, or in patients with diabetes mellitus.

Secondly, in some cases, fat does not leave the liver:

with a deficiency of transport proteins that contribute to the removal excess fat(in chronic alcoholics, with a lack of protein in the body);
with a hereditary predisposition to insufficient protein synthesis;
at chronic lesion toxic substances (in alcoholics, drug addicts, in the presence of malignant diseases).

Symptoms of fatty liver

The problem is that the disease does not reveal itself for a long time. For example, in the initial stages, when fat is just beginning to accumulate in the liver tissue, external signs fatty degeneration is not observed.

At the second stage of the development of the pathology, the fat "points" become larger, they tend to merge, which leads to the necrosis of hepatocytes directly. Only from this moment the first signs of the disease begin to appear:

feeling of weakness;
sometimes - bouts of nausea;
feeling of heaviness in the projection area of the liver;
increased gas formation;
appearance of disgust fatty foods;
heaviness in the abdomen;
pain in the right hypochondrium for no apparent reason.

At the third stage, which is considered a harbinger of cirrhosis, the process of destruction of the liver tissue begins. Instead, it grows connective tissue, which leads to a deterioration in liver function and impaired bile output. During this period, the following symptoms may occur:

yellowing of the eye sclera;
yellowing skin;
bouts of not only nausea, but also vomiting;
the appearance of a skin rash.

In addition, there is a general decrease in immunity, which can provoke the addition of infectious and colds.

Acute fatty degeneration of the liver of pregnant women

Acute fatty degeneration of the liver in pregnant women is one of the most serious complications that can occur during pregnancy. Fortunately, this disease occurs very rarely.

The development of the disease can lead following states pregnant:

state of indomitable vomiting;
hepatosis with cholestasis;
preeclampsia with hepatic-renal syndrome;
acute form of fatty hepatosis.

The first symptoms of pathology occur even in the period from 30 to 38 weeks of gestation, in rare cases- earlier. Initially, there is a feeling of weakness, lethargy, with recurring nausea and vomiting, abdominal pain. After some time, heartburn joins, the esophagus becomes painful, especially when swallowing - this is due to the formation of ulcers on the surface of the esophageal tube.

At the next stage, jaundice appears, vomit becomes Brown color. Fluid often accumulates in abdominal cavity, anemia.

The doctor in this situation should orient in time and distinguish the onset of development of acute fatty degeneration from infectious diseases. digestive system. Accurate diagnosis largely determines the further outcome of the disease, because not only health is at stake, but also the life of the expectant mother and her child.

Forms

With the progression of the disease in the liver, various structural changes in tissues occur. This allows us to conditionally divide the pathology into several forms of the course:

Focal disseminated liver dystrophy is a pathology in which fat points are located little by little in different parts of the hepatic organ. Usually this form does not differ in any symptoms.
Severe disseminated fatty degeneration of the liver is a form of the disease when there are a lot of inclusions of fat and they are located throughout the organ. The first signs of the disease may appear.
Zonal dystrophy is a form of dystrophy in which fat points can be found in certain lobes (zones) of the liver.
Diffuse fatty degeneration of the liver is a pathology when there is a uniform filling of the entire hepatic lobe with fat. Symptoms in this form are already quite pronounced.
Alcoholic fatty degeneration of the liver can occur in a rare special form called Ziwe's syndrome. This form has the following features:
- symptoms appear abruptly and are pronounced;
- a blood test indicates an increase in bilirubin (a yellow bile substance formed from red blood cells);
- increases the level of cholesterol in the blood;
- an increase in triglycerides (fatty foods that damage small capillaries);
- the amount of hemoglobin drops noticeably (due to the massive destruction of erythrocytes due to the growing deficiency of tocopherol, which is formed and accumulates in hepatocytes).

Also, depending on the form, acute and chronic dystrophy is poured.

In chronic fatty degeneration of the liver, the smallest droplets of fat accumulate in the cytoplasm of the liver cells, which gradually combine into larger drops, or into a large vacuole that completely fills the cytoplasm and displaces the nucleus to the cell edge. With the defeat of most of the liver tissue, the diagnosis of "fatty hepatosis" is established. This condition is characterized by the fact that liver cells filled with big amount fat, burst with the formation of fatty cysts.
Acute fatty degeneration of the liver is characterized by a sharp development, rapidly increasing symptoms, often turning into cirrhosis or other complex liver pathologies. Such a disease is usually the result of severe hepatitis, deep intoxication of the body (for example, poisoning with mushrooms or chloroform), and alcoholism. Symptoms acute form always pronounced: an increase in the size of the liver, large fluctuations in temperature in one direction or another, convulsive and delusional states, bleeding. The condition of patients is usually severe and requires immediate specialized medical attention.

Diagnosis of fatty degeneration of the liver

Collecting complaints, questioning the patient about the symptoms of the disease.
Questioning the patient about his lifestyle, about the presence bad habits about other comorbidities.
Examination of the patient, palpation of the abdomen and the liver area, tapping the area of the liver and spleen.

Conducting laboratory research:

complete blood count (erythrocytopenia, hemoglobinemia, thrombocytopenia, anemia, leukocytosis);
blood biochemistry (assessment of the functional ability of the pancreas, gallbladder);
analysis of the consequences of alcoholism (level of immunoglobulins, measurement of the average erythrocyte volume, transferrin level, etc.);
assessment of the content of markers for viral hepatic pathologies;
general study urine;
stool analysis.

Carrying out instrumental diagnostic procedures:

Ultrasound scanning of the abdominal organs, evaluation external borders And general condition hepatic organ;
method of esophagogastroduodenoscopy - endoscopic examination of the state of the digestive system;
liver puncture for biopsy and further histological examination(removal of a sample of liver tissue for analysis);
method computed tomography– getting layered x-rays liver;
method of magnetic resonance imaging;
elastography method - ultrasound analysis to assess the depth of hepatic fibrosis;
method retrograde cholangiography– procedure for taking x-rays after insertion contrast agent into the biliary system (usually prescribed for cholestasis).

Additional consultations of narrow specialists medical profile- it can be a gastroenterologist, narcologist, surgeon, etc.

Treatment of fatty degeneration of the liver

There is no special treatment regimen as such for fatty liver disease. Therapeutic activities provide for the exclusion of provoking factors and stabilization metabolic processes, restoration of liver tissues and elimination of toxic effects on hepatocytes. In combination with drug treatment Explain to the patient the need for healthy lifestyle life and proper nutrition.

Treatment of the disease with drugs is carried out with drugs such as membrane stabilizers and antioxidants. Drugs for fatty liver can be divided into several groups:

Agents consisting of essential phospholipids, for example, drugs based on phosphatidiethanolcholine, which is able to create protection for liver cells. Such medications include Essentiale, Hepabos, Essliver, etc.
Means that relate to sulfoamino acids (Heptral, Dibicor, etc.);
Funds based herbal ingredients(Karsil, Liv 52, artichoke extract, etc.).

Heptral is prescribed as an injection, in an amount of 400 to 800 mg per day for 14-20 days. Then go to 2-4 tablets per day.

Essentiale is taken 600 mg three times a day. The course of admission should be at least 2-3 months. After 20-30 days of treatment, the dosage is slightly reduced, up to 300 mg three times a day.

Alpha-lipoic acid (Alpha-lipon) is administered intravenously in an amount of up to 900 mg per day, for a month. After 2 weeks from the start of treatment, the infusion can be replaced with oral administration 600 mg / day.

Artichoke-based remedy - Hofitol - has a choleretic and hepatoprotective effect, normalizes metabolism. Hofitol is prescribed 3 tablets three times a day before meals. The duration of therapy is up to 1 month.

Liv 52 is taken in 1-2 tsp. twice a day, or in tablet form - 2-3 tablets up to 4 times a day half an hour before meals.

Apart from medicines, to reduce liver toxicity is prescribed vitamin remedies such as vitamin E, ascorbic acid, niacin and vitamin B².

From funds traditional medicine can be successfully used:

powder and cinnamon sticks - help reduce the amount of glucose and cholesterol in the blood, prevent the accumulation of fat in the liver;
turmeric is an excellent antioxidant, enhances bile production, lowers blood glucose levels;
milk thistle - relieves spasms in gallbladder, outputs toxic substances, restores hepatocytes. can be accepted and pharmaceutical preparations with milk thistle - this is the oil of the plant, or finished product Gepabene (assign 1 capsule three times a day);
sorrel - helps to remove bile, stabilizes its production. Reduces the amount of fat in the liver.

Diet for fatty liver

One of the factors in the development of fatty liver is sedentary image life combined with overeating. Therefore, it is very important to monitor your diet and maintain normal weight. If the patient is obese, then he is advised to follow a diet (but not strict) with a weight loss of about 0.5 kg per week. Moderate physical activity is welcome: exercise bike, swimming, walking.

Diet in fatty liver is not just important - it plays a leading role in the effectiveness of treatment of patients. IN medical institutions usually appointed diet table No. 5, with the use of protein foods up to 120 g per day, limiting animal fat, as well as enough products useful for the liver - cottage cheese, cereals (oatmeal, buckwheat, millet, wild rice). Vegetarian food is welcome - fruits and vegetables, greens, all types of cabbage.

Instead of meat products, it is recommended to eat fish and seafood. It is advisable to avoid fried foods - steam, boil or bake, with the minimum amount butter (it is better to replace with vegetable).

We must not forget about drinking mode: in the absence of contraindications, you should drink at least 2 liters of water per day, mainly in the morning.

It is necessary to limit or exclude fatty dairy products: whole milk, sour cream, cheeses. Allowed to use low-fat kefir, ryazhenka, yogurt.

Should be done regularly preventive examinations especially if suspicious symptoms are present, such as weakness, discomfort in the right hypochondrium, nausea, and loss of appetite. If a person has noticed signs of jaundice, then you should immediately visit a doctor. For fatty liver disease, it is very important to diagnose and treat on time.

Particular attention should be paid to the health of the liver for people at risk:

persons who consume alcohol;
patients with viral infectious diseases liver;
patients who have chronic diseases that require permanent reception any medication;
people working in hazardous enterprises;
persons with a hereditary predisposition to liver diseases;
people who adhere strict diets with restriction of proteins or sitting on "hungry" diets;
in the presence of helminths in the body.

You can not ignore the symptoms of liver diseases - even if everything is in order with the organ, it is better to make sure of this once again and consult a doctor.

Forecast

The course of the disease is largely dependent on its origin. If missing inflammatory process and hepatocytes are not damaged, then the pathology in most cases is not aggravated. However, if there are signs of hepatitis, then sooner or later the dystrophy develops into cirrhosis of the liver. This complication occurs most often in the elderly pronounced violation metabolic processes, with obvious obesity, diabetes.

With timely prescribed treatment and the implementation of all the recommendations of the doctor, fatty degeneration of the liver can be reversible. Over time, the patient will be able to return to a normal lifestyle. But in neglected situations or when ignoring the doctor's prescriptions (continued drinking of alcoholic beverages, the presence of errors in nutrition, constant intoxication of the body), life expectancy can be significantly reduced. With the progression of the disease, cirrhosis of the liver develops, the person becomes disabled.

Spinal dystrophy means pathological changes, consisting of . On initial stage diseases remain in their natural state intervertebral discs.

The main symptom of the disease are pain. 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

Availability painful manifestations V different departments 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 normal consistency fatty tissue.

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 experience different areas of the back muscles, it can be like dystrophy 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.

At seated life often there are suspicions of dystrophy lumbar spine, but in most cases a similar problem is provoked.

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, cartilage nodes.

In inflammatory processes or wrong exchange substances, 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

Absolute cure of changes occurring in skeletal system, 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 analgesics included in the group, or using local preparations – .

They 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 in pharmacies medications without a doctor's prescription! All drugs are prescribed only by a doctor after a diagnosis.

In some cases, it applies surgical intervention. 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

Main preventive methods maintaining a normal patient with dystrophy of the lumbosacral region are a decrease excess weight and moderate but regular exercise stress. To do this, you need to eat right and exercise.

Excellent help and. With dystrophy cervical applied, fixing the vertebrae of the cervical region, which relax the muscles and reduce the load on them.

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

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

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

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

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

MRI of the spine. T1-weighted sagittal MRI of the thoracic region. Fatty degeneration of the bone marrow after radiotherapy.

Osteoporosis leads to a decrease in the cellular composition of the bone marrow and an increase in fat. MRI of the spine often shows a diffuse increase in the signal from the vertebral bodies on T1-weighted MRI. There are also focal changes requiring an MRI of the spine differential diagnosis with hemangiomas. MRI diagnostics for osteoporosis is also presented in a separate article.
Spondyloarthropathies on MRI of the spine often present with “glowing” angles on T2-weighted MRI. This is especially true for acute stage ankylosing spondylitis. The change from the acute phase to the chronic one leads to the transformation inflammatory response in a depot of adipose tissue, light on T1-weighted MRI. MRI of the spine for various diseases belonging to the group of spondyloarthropathies is devoted to a special article on our other site.
Anorexia is accompanied various changes in the body, including osteoporosis and a decrease in signal intensity on T1-weighted MRI, as well as bone marrow edema, which is denoted by the term “gelatinous transformation”. On T2-weighted MRI (especially with suppression of the signal from fat), there is a slight diffuse increase in the signal from the vertebrae. Contrast-enhanced MRI of the spine shows amorphous signal amplification.

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

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

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

Myeloproliferative and myelodysplastic syndromes, which include chronic myeloid leukemia and others chronic leukemias, polycythemia, mastocytosis, essential thrombocytopenia on MRI of the spine are manifested by a uniformly reduced signal on T1-weighted MRI. On T2-weighted MRI of the spine, “reverse” brightness of the intervertebral discs is often observed, they become lighter than the vertebral bodies. MRI of the brain in tumors of the hematopoietic system can also reveal its defeat.

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

Sarcoidosis affects the bone marrow in 1-3% of cases. Damage to the brain and spinal cord in sarcoidosis is much more common. MRI of the spine shows sclerotic lesions, very reminiscent of metastases, often multiple. Lesions may be mixed lytic with sclerotic rims. An MRI of the spine with contrast may show an increase in the signal from the foci.

Fatty degeneration of the vertebrae or other organs is a pathological process in which normal tissues of organs are replaced by fat. In the case of calls adipose tissue replaces the hematopoietic tissue of the bone marrow. Usually, degeneration is associated with aging of the body. For example, in some patients who have reached the age of 60-70, the bone marrow is 50% fat.

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

Causes and mechanism of the development of the disease

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

Such complex pathological changes in the tissues of the musculoskeletal system primarily affect the condition of the spine. Additional diseases of the spinal column are actively beginning to develop -,. Changes in other organs and tissues of the body may also begin. The consequences of fatty degeneration of the vertebrae are anemia, anemia, Simmonds-Shien's disease, deterioration of the vessels and other pathologies.

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

Oncological pathologies, especially with metastases to the bone marrow.
Infectious and inflammatory diseases.
Metabolic disease.
Violation of blood circulation and / or trophic tissues of the musculoskeletal system.
Systematic use of certain drugs (NSAIDs; drugs prescribed for hypertension or other diseases of cardio-vascular system, antibiotics, barbiturates).
Alcoholic, drug, chemical intoxication of the body.

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

Symptoms of fatty degeneration of the vertebrae

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

back pain, most often in the neck and chest;
lack of coordination;
headaches, fatigue;
decreased sensitivity in the limbs, a feeling of cold or numbness, "creeping goosebumps";

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

Treatment of fatty degeneration of the vertebrae

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

Conservative therapy:

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

Surgical methods of treatment:

Discectomy.
Intradiscal decompression, laser decompression, or steroid administration.
laser therapy.
Electrothermal plastics of the annulus fibrosus.
Replacement of the nucleus pulposus (in this case, the integrity of the fibrous disc is restored).

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

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

Pain in the back is the most common complaint of patients visiting a traumatologist and orthopedist. Without necessary treatment acute diseases spine go into chronic form and can significantly reduce the quality of life of the patient.

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 (they love 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 height intervertebral disc and movement disorders 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 spinal column is greatest pressure, degenerative processes in it begin much earlier than in other large joints.

This fact is also associated with a rather 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 to some extent degeneration of the vertebrae. 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. intervertebral disc- nucleus pulposus.

Besides, age-related changes also occur in blood vessels, due to which delivery is deteriorating essential substances(protein glycans) to internal structures ligamentous apparatus 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 in spinal canal. This is how degeneration of the intervertebral discs develops, and now the vertebrae are not sufficiently cushioned, any careless, and jerky 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. Passes through the spinal canal spinal cord, which is represented by the roots of the spinal nerves. 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 acid-base balance in blood. This in turn initiates degenerative processes in the disk.

What causes malnutrition? There are a lot of reasons, these include, in addition to metabolic changes, various diseases blood, for example, anemia, also atherosclerotic changes, insufficient or excessive loads on the spine, malnutrition.

Classification of degenerative-dystrophic changes in the spine

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

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

During the transition to the second stage, the outer layers of the fibrous ring are still preserved (which still keeps the protrusion of the disc into the intervertebral canal), however, there are back pains that can radiate to 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.

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

As for 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 last years Minimally invasive methods of treatment are widely used - electrothermal plasty of the annulus fibrosus, laser decompression of discs, percutaneous endoscopic disc removal. Methods for replacing the nucleus pulposus with restoring the integrity of the fibrous disc have also been used.