Stages and reflex syndromes of cervical osteochondrosis

In the pathogenesis and clinical course of cervical osteochondrosis , four stages are schematically distinguished. In stage I , the initial dystrophy of the disk develops, accompanied by a decrease in the elasticity and hydrophilicity of the pulposum core, intradiscal movements of the pulpous substance and irritation of the nerve endings in the fibrous ring of the disk (dyscalgic stage). Depending on the severity of these changes, clinical manifestations can be different – from a feeling of discomfort in the neck to sudden and very intense pain, most often after sudden movements.
In stage II , cracks appear in the fibrous ring of the disk, the fixation of adjacent vertebrae is disturbed, which leads to instability of the vertebral segments (possibly their “block”), overload of the vertebral muscles, their constant overfatigue, and the development of reflex muscular-tonic syndromes. At this stage, false and true vertebral displacements (listez) can be observed.

In stage III , the disc ruptures and its parts fall out into the spinal canal, and compression of nerve and vascular formations is often noted. In some cases, the disease is complicated by a scar-curing (reactive-proliferative) process.

In stage IV, not only discs, but also joints of the spine (spondylarthrosis) are involved in the dystrophic process.

Under our supervision were 600 patients with neurological manifestations associated to a greater or lesser extent with cervical osteochondrosis and isolated lesions of the vertebral arteries. Among the neurological syndromes that develop with cervical osteochondrosis, it is advisable, in our opinion, to distinguish the following: reflex, radicular, vascular spinal (radicular-spinal), circulatory disorders in the vertebrobasilar pool, mixed syndromes, cochleovestibular syndrome.

Reflex syndromes of cervical osteochondrosis . Among these syndromes, there are: cervicalgia, cervicocranialgia or posterior cervical sympathetic syndrome.

Reflex syndromes in the neck (myalgia) are manifested by pain in the form of “lumbago” or more constant pain. At the same time, neck mobility is limited. The cause of “cervical lumbago” is the swelling of the gelatinous nucleus of the intervertebral discs that occurs with injuries, the effects of cold and other factors. Pain arises as a result of irritation of pain receptors in the fibrous and muscle tissues of the spine, in the capsule, intervertebral joints, ligaments, tendons of the neck muscles. The pain can be localized in the neck.

On palpation of the neck, soreness in the area of ​​paravertebral points, spinous processes is often determined; along the vessels, nodules of Cornelius and Müller in the muscles, soreness and tension of the anterior scalene muscle (the syndrome of the anterior scalene muscle of Naftsicher) are revealed. This syndrome is accompanied by symptoms of compression of the lower nerve trunk of the brachial plexus, as well as the subclavian artery and vein. There is a feeling of pain and heaviness in the upper limb, sometimes aggravated by inspiration and tilting the head to the healthy side. Pain can spread to the shoulder girdle and chest. Left-sided localization of pain often simulates heart pain.

The upper limb is swollen, especially the hand, trophic disorders on the skin, nails, as well as weakening of the pulse are noted . On roentgenograms of a brush osteoporosis of bones is revealed. Neurodystrophic brachialgia is manifested by ileo-scapular periarthrosis, brachial epicondylosis, styloidosis, shoulder-wrist syndrome (Steinbroker). Patients develop pain in the area of ​​the shoulder joint, aggravated by movements, radiating to the upper limb and neck. On palpation in the joint area, painful areas are determined. Gradually, the upper limb is fixed in the adduction position, atrophy of the deltoid muscle develops. On the radiograph of the shoulder joint, signs of deforming arthrosis are visible.

An important factor in the occurrence of these syndromes is the involvement in the pathological process of local (cervical sympathetic nodes and fibers) and general (as a type of reflex involvement of hypothalamic vegetative centers) vegetative formations.

With right-sided localization of cervical osteochondrosis, the above changes are localized in the right upper limb and shoulder girdle on the right. They are often accompanied by cholecystitis (B. G. Petrov).

Y. Yu. Popelyansky considers reflex syndromes as a result of the vegetative-dystrophic process – “osteofibrosis”, which develops as a result of pathological impulse along the altered roots and cervical sympathetic formations. The most common cause of these changes is cervical osteochondrosis, which subsequently leads to the development of osteofibrosis and spondylarthrosis.

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