Osteochondrosis: What is this vertebral disease, and what are its symptoms?

Osteochondrosis of the spine is referred to in connection with degenerative changes that primarily affect the intervertebral discs.

The process is long, evolving over many years, starting at a young age. The first symptoms may appear around the age of 40, or earlier.

There are other issues associated with back pain that result from chronic damage to the spine, discs, and vertebrae.

Initially, it concerns the plaque, but, over time, the pathological process also affects the intervertebral joints and vertebrae and the surrounding structures, i.e. the entire segment. At this point, the condition is called spondylosis.

What is an intervertebral disc

The spine is an important part of the support and locomotor system. The spinal cord runs through the spine. It is the connection between the brain and the rest of the organism. Its protective function is also very important.

The spine consists of a cervical, thoracic, lumbar, sacral segment and the coccyx.

It consists of vertebrae and intervertebral discs. The discs are located between the vertebrae of the cervical, thoracic and lumbar segments of the spine.

The vertebrae are interconnected. This connection is strong and flexible, which allows us to move, including sideways, and to rotate.

The spine has 33 to 34 vertebrae:

• teh cervical spine consists of 7 vertebrae labelled from C1 to C7
• the thoracic spine consists of 12 vertebrae, from T1 to T12
• the lumbar spine consists of 5 vertebrae, from L1 to L5
• the sacral spine consists of 5 or 6 vertebrae, forming the sacrum, S1 to S5 (S6)
• the coccyx consists of 4 to 5 vertebrae, Co1 - Co4 (Co5)

Latin names: 
C - vertebrae Cervicales 
Th - vertebrae Thoracicae 
L - vertebrae Lumbales 
S - vertebrae Sacrales
Co - vertebrae Coccygeae 

There are fewer intervertebral discs = 23, as they are not located among all the vertebrae. 

They are located in the space from the second cervical vertebra C2 - C3 to L5 and S1.

Intervertebral discs, in Latin: disci intervertebrales.
The name "disc, discs" is derived from this name - i.e. discs of platelets.

The important role of the plates is shock absorption. However, their function is also important in other respects. They balance the compressive and tensile forces that are exerted on the spine. These physical forces are evenly distributed over a larger area.

Plus, they help stabilise and maintain balance.

Intervertebral discs have a specific composition that helps their functionality, namely:

1. The ring, which forms the outer part of the disc - protective layer.

It contains a number of collagen fibers which are arranged in a circle. There are 15 to 20 of them, similar to the layers of an onion. There is water and elastin fibres in the space between these laminae.

The ring, also called the anulus fibrosus, also contains nerve fibres. Hence, when it is damaged, it hurts.

2. The nucleus is the inner part of the disc. It is stored in the centre of the ring and has a gel-like consistency. It contains water, collagen fibres, and proteins. 

The nucleus - nucleus pulposus
After birth, it is made up of 90% fluid.
The water content decreases with age.
After the age of 50, it is about 70%.

The core has a firmer consistency than the ring. It does not contain any blood vessels or nerves.

However, even if it does not have blood vessels, it needs to be supplied with nutrients and waste removed from it.

In this case, the transfer of nutrients and waste is ensured by a mode of transfer - fluid flow.

Let's use an illustration:

It acts like a sponge in water - it sucks fluid by squeezing.

Movement helps to better wash and flow fluids. Movement is the source of repeated pressing and releasing of the discs.

Walking is, therefore, very important for nourishing the discs.

The opposite is inactivity. Long-term sitting or a monotonous position negatively affects their nutrition.

3. The vertebral endplate is the third part. It is basically hyaline cartilage, a layer about 1 millimetre thick. This layer covers the discs at the point of contact with the vertebrae.

It is important for the exchange of nutrients, oxygen and waste products from intervertebral discs. It, therefore, contains blood vessels and nerves.

However, some of these small vessels disappear with age.
This also plays a role in the degenerative process.

General information will help in further understanding the topic.

Osteochondrosis is defined as...

...a degenerative process affecting intervertebral discs. It is based on a metabolic disorder, congestion, which causes gradual damage.

A healthy disc has a certain height. This is important for its proper functioning.

Over time, the height decreases, and this negatively affects the overall stability of the segment. This also has an impact on the flexibility and strength of the disc.

Colloquially, one might described the condition as withering discs.

Overall, the physical force distribution ratio is changing. Long-term uneven spine overload contributes to disease changes.

Osteochondrosis then turns into spondylosis. At this point, pathological changes already affect the entire segment, vertebrae, intervertebral joints, ligaments, muscles and discs.

The process can affect several segments at once.

This can impair the stability, the curvature and overall function of the spine. Uneven distribution of forces is the root of the problem in the long run.

Damaging it runs the risk of spinal disc herniation. The result of this bulging of the disc may be radiculopathy where the spinal cord or a nerve is pinched.

Osteochondrosis is further subdivided according to the section of the spine.

For example...

Cervical osteochondrosis.
It is the second most common form of osteochondrosis. The reason is mainly a sedentary lifestyle and long-term work at the computer, but also driving.

Thoracic osteochondrosis.
Less common type. The thoracic spine has the lowest range of motion, i.e. it attaches the ribs.

Lumbar osteochondrosis.
It is the most common form. It is also caused mainly by long-term overload of the spine.

To an increased extent, this affects the part between vertebrae L4 - L5 and L5 -S1.

In addition to the above types, osteochondrosis can occur in several parts of the spine.

Back pain is the most common problem that makes people see their GP. It occurs for a variety of reasons. Degenerative changes is one of them. If they affect an intervertebral disc, we call the condition osteochondrosis.

It is based on a metabolic disorder and blood flow to the intervertebral disc. The water content decreases. This is the basis of the degenerative process and dystrophic changes.

The discs degenerate, their height decreases. This process is the basis of the dysfunction. The disc is not able to distribute the load evenly.

The healthy disc is located between two vertebrae, copying their shape. When a degenerative change occurs, this space narrows, which can also be seen in X-rays.

As a result, minor injuries to the disc and the entire segment occur. In turn, they accelerate the next degenerative process.

Damage to the ring + hyaline cartilage + nucleus + reduction in disc height = osteochondrosis.

Osteochondrosis is a precursor to spondyloarthrosis and spondylosis. Spondylarthrosis involves damage to small intervertebral joints. Spondylosis is characterised by damage to the entire segment with the formation of bone growths.

Together, they pose an increased risk of:

1. spinal disc herniation
2. spondylolisthesis
3. radicular syndrome or spinal canal stenosis
4. cauda equina syndrome

Degenerative changes are affected by various risk factors:

• aging organism
• genetic predisposition
• metabolic disorder and vascular problems on case of reduced blood flow
• spinal injuries
• long-term spine overload
  • hard physical work
  • vibration, as in the case among professional drivers
  • sports activities, strength training, sports with sharp changes in position and direction of movement
• poor posture and poor movement habits
• flat feet
• weakened muscles of the spine
• incorrect curvature of the spine
• inactivity, sedentary lifestyle and sedentary work
• inappropriate diet, radical diets and starvation
• back pain from draught
• unsuitable shoes, high heels
• in pregnant women due to increased load
• long-term stress
• hormonal disorders
• metabolic disorders
• other diseases, such as rheumatism, birth defects
• overweight and obesity
• smoking
• alcoholism

Osteochondrosis is a long-term degenerative disease. It is stated that pathological changes occur from the age of 20-30.

The first symptoms may appear as early as the age of 40, and even earlier.

The first to occur is pain in the area of damage to the vertebral segment.

Depending on the extent, other difficulties arise next. Examples are: shooting pain to another part of the body, muscle stiffness or other neurological problems.

In osteochondrosis, the following symptoms occur:

• pain that can be dull or sharp
• radiating pain to the head, limbs or chest
• aggravation of movement pain
• tingling, pins and needles and other discomfort - paraesthesia
• muscle stiffness
• muscle cramps
• dizziness
• moving dots, flashes in the eye - floaters
• tinnitus

Table: Symptoms of spinal cord involvement

Diagnosis is based on looking at the medical history. In addition to pain, it describes the affected clinical condition. The doctor examines the general condition of the spine, posture, movement, neurological examinations also include the maintenance of reflexes.

Imaging techniques that reveal the condition of vertebrae, intervertebral discs, spinal curvature, and more are also important.

Examples include:

• RX-ray
• CT
• MRI
• Lumbar provocative discography
• EMG

Doctors from several fields cooperate for the examination, namely a GP, neurologist, orthopedic radiologist, neurosurgeon or physiotherapist.

Differential diagnosis is important, whose task is to reveal another cause. In this case, laboratory tests of blood or cerebrospinal fluid are included.

Another issue might be vertebral shifting, i.e. spondylolisthesis, spondyloarthritis or Bechterev's disease, but also diseases other than the spine (diseases of the digestive, excretory system or oncological process).

The course of the disease is usually asymptomatic as it is a long-term degenerative process.

The initial stage is characterised by a reduction in the flexibility of an intervertebral disc.

The height of the disc decreases. This carries the risk of damaging the disc first in the form of small cracks or tears. In this first stage, sharp pain may occur at the site of the problem.

During the second stage, the pathological process continues, the height of the disc is constantly decreasing. There are tears in the ring, followed by an inflammatory process. The nerve endings are still irritated, which is the source of the pain.

These changes are the reason for instability in the segment.

In the final stage, the ring is affected, the disc core bulges out. Disc herniation can push on the spinal cord or spinal nerves and result in associated issues.

A pinched nerve is risky mainly in terms of possible complications. In the area of the cervical spine, there may be compression of the spinal cord or vertebral vessels (in the arteries) that carry blood to the brain. In the lumbar type, the pain radiates to the lower limb.

The symptoms resulting from spinal cord or nerve compression are called radicular syndrome (radiculopathy).