Spondylarthrosis
| Classification according to ICD-10 | |
|---|---|
| M47.- | Spondylosis (including degeneration of the joint surfaces) |
| ICD-10 online (WHO version 2019) | |
Degenerative changes in the spine can affect the vertebral arch joints , which is referred to as spondylarthrosis (syn. Spondylarthrosis deformans) , a wear disease (namely arthrosis ) of the small intervertebral joints . Even if these joints are quite small compared to a knee , all processes that are part of osteoarthritis can also occur here. The body reacts to the damaged cartilage surfaces with widening of the bony parts, the bone located under the cartilage is compressed and sclerosed . The joint capsule swells and an effusion occurs .
The nerve root emerging from the spinal canal runs in the immediate vicinity of the vertebral arch joint. The degenerative irritation of the joint often leads to a bruising or irritation of the nerve root, which, depending on the affected segment, can result in lumbar pain , sciatica or cervicobrachialgia .
Degenerative changes in the vertebral bodies (and intervertebral spaces) are known as spondylosis deformans (syn. Spondylosis) .
Diagnosis
The anamnesis provides the first clues that recurring pain conditions, sometimes linked to the season, often have arthrotic changes in the vertebral joints as their background. The clinical findings are often inconclusive; the external pain and functional failures can have very different causes.
Imaging procedures
X-rays of the affected spinal column clearly show the compression in the area of the bone near the joint. The differential diagnosis of ankylosing spondylitis is difficult using conventional radiological methods . The computed tomography , this changes much clearer. The MRI is less suited to represent bony changes.
therapy
It always makes sense not to let an illness develop in the first place. Exercise such as swimming and running as well as stabilizing gymnastics are valuable for prevention.
Physiotherapy , such as various forms of massage, gymnastics, electrotherapy , hydrotherapy , but also exercises for targeted relaxation are useful. There is no panacea in this context either, a precise diagnosis is essential before therapy, otherwise measures that are normally well tolerated can worsen the clinical picture.
Depending on the severity of the symptoms, pain therapy may be necessary, and targeted, local infiltration can also be very helpful. Another possibility is facet infiltration under CT control, a dose of crystalline cortisone together with a local anesthetic is injected into the joint spaces.
Acupuncture for pain relief has the great advantage of being free from significant side effects. The indication for surgical measures should be handled just as cautiously as with intervertebral disc operations .
In particular, the position of the indication, i.e. whether the intervertebral disc space (for example in the case of chondrosis ) is being tackled surgically or the altered vertebral joint, harbors some possibilities of failure: If the complaints actually originate from the vertebral joint, but the intervertebral disc space is surgically cleared, the movement segment slips further together. The vertebral joints, previously damaged by degeneration, are compressed further into one another. The pain increases. This process is known as "telescoping". If there is a herniated disc , the operation of the vertebral joints intensifies the existing instability, and here too the clinical picture worsens.
If these therapeutic measures no longer work, an operative measure is necessary. Depending on the severity, the following surgical techniques are performed:
- Expansion of the spinal canal, relieving nerve compression.
- Spondylodesis , ie stiffening of several vertebral segments.
See also
literature
- J. Munzenberg: Orthopedics in practice . VCH-Verlag, 1988, ISBN 3-527-15320-9 , pp. 270-300.
- R. Glauner: Roentgen (Volume III - Joints) . Thieme-Verlag, 1973, ISBN 3-13-471201-6 , pp. 480-488.
