Spinal Osteochondrosis: Symptoms, Treatment, and Psychological Impact

What is spinal osteochondrosis?

Spinal osteochondrosis is a chronic degenerative-dystrophic disease affecting the intervertebral discs and adjacent vertebral bodies. Essentially, it is a natural process of aging and wear-and-tear of the spinal structures, which can manifest at various ages. In medical literature, the terms "intervertebral disc degeneration" (IVDD) or "intervertebral disc degeneration (IVDD)" are often used to describe this condition [1].

Intervertebral discs, located between the vertebrae, act as shock absorbers, ensuring the flexibility and mobility of the spine. In osteochondrosis, these discs lose their elasticity and flatten, leading to a reduced distance between the vertebrae. This, in turn, can cause compression of nerve roots, the spinal cord, or blood vessels, resulting in pain and other neurological disorders.

How osteochondrosis manifests: main symptoms

Symptoms of osteochondrosis depend on the location of the lesion (cervical, thoracic, or lumbar spine) and the degree of nerve structure involvement. The most common manifestations include:

• Pain: Can be localized (in the neck, chest, lower back), aching, or sharp. Pain often intensifies with movement, physical exertion, or staying in one position for a long time. With nerve root compression, pain can radiate into the limbs (arms in cervical osteochondrosis, legs in lumbar), a condition known as radiculopathy.
• Neurological disorders: Numbness, tingling, "pins and needles" in the affected areas, weakness in the limb muscles, reduced sensitivity or reflexes. In rare and severe cases, pelvic organ dysfunction may occur (when the lumbar region is affected).
• Limited mobility: Stiffness in the affected part of the spine, difficulty with turns and bends.
• Muscle spasm: The body's protective reaction to pain, leading to additional back muscle tension.

In addition to physical manifestations, chronic back pain, often associated with intervertebral disc degeneration, is closely linked to psychological disorders. Numerous studies show that depression and anxiety are frequent comorbidities in adult patients with chronic discogenic back pain and intervertebral disc degeneration (IVDD) [1]. These mental states not only impair quality of life but can also influence pain perception and treatment efficacy.

Diagnostics: accurate problem identification

To make an accurate diagnosis and determine treatment tactics, the physician conducts a comprehensive examination, which includes:

• Anamnesis and physical examination: The doctor finds out the nature of the pain, its location, duration, and the presence of concomitant symptoms. Neurological status (sensitivity, reflexes, muscle strength) and range of spinal motion are assessed.
• Spinal X-ray: Allows assessment of the condition of bone structures, the height of intervertebral discs, and the presence of osteophytes (bone growths).
• Magnetic resonance imaging (MRI): Considered the "gold standard" for diagnosing osteochondrosis. MRI provides detailed visualization of the intervertebral discs, spinal cord, and nerve roots, and identifies herniations, protrusions, and their impact on surrounding structures.
• Computed tomography (CT): Used for a more detailed evaluation of the spinal bone structures, especially when spinal stenosis or other bone changes are suspected.
• Electroneuromyography (ENMG): May be prescribed to assess the function of nerve roots and peripheral nerves in the presence of pronounced neurological symptoms.

Comprehensive treatment of osteochondrosis: from conservative methods to surgery

Treatment of osteochondrosis generally begins with conservative methods aimed at reducing pain, relieving inflammation, restoring spinal function, and preventing disease progression. It is important to note that the effectiveness of treatment for intervertebral disc degeneration (IVDD) largely depends on the patient's mental state [1].

Conservative treatment:

• Pharmacotherapy:
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation relief.
  • Muscle relaxants to reduce muscle spasms.
  • B vitamins to improve nerve conduction.
  • In some cases, with severe pain syndrome and concomitant depression or anxiety, antidepressants may be prescribed, as these conditions can negatively affect treatment outcomes [1].
• Physiotherapy: Includes various methods such as UHF therapy, magnetotherapy, laser therapy, and electrophoresis, aimed at improving blood circulation and reducing inflammation and pain.
• Exercise therapy (kinesiotherapy): Individually tailored exercises to strengthen the back muscle corset and improve spinal flexibility and mobility. This is a key component of long-term treatment.
• Massage and manual therapy: Help relieve muscle tension, improve blood circulation, and restore the normal position of the vertebrae.
• Lifestyle changes: Weight correction, quitting bad habits, and compliance with ergonomics at work and in everyday life.

Invasive and surgical methods:

• Paravertebral blocks: Administration of local anesthetics and/or corticosteroids into the affected nerve root area for rapid pain relief.
• Minimally invasive procedures: For example, radiofrequency denervation aimed at destroying painful nerve endings.
• Surgical intervention: Considered when conservative treatment is ineffective over a long period, with progressive neurological deficits (e.g., limb weakness, pelvic organ dysfunction), or with large disc herniations causing spinal cord compression. The goal of surgery is to decompress nerve structures and, if necessary, stabilize the spine.

It is important to consider that depression and anxiety are risk factors for complications, chronic pain, and readmission after spinal surgery. Ineffective pharmacotherapy and inadequate surgical interventions that do not take the patient's mental state into account can significantly and negatively impact treatment outcomes [1].

The psychological factor in combating chronic pain

Chronic back pain caused by osteochondrosis has a significant impact on a person's mental state. Studies show a high comorbidity (co-occurrence) of anxiety-depressive disorders and chronic discogenic back pain [1]. Patients suffering from constant pain often experience feelings of helplessness, fear, and irritability, which can lead to the development of depression and anxiety.

Symptoms associated with psychological stress, including depression and anxiety, can significantly worsen treatment outcomes for intervertebral disc degeneration [1]. Moreover, these conditions can be risk factors for complications, increased chronic pain, and even readmissions after spinal surgeries [1].

Therefore, a comprehensive approach to treating osteochondrosis must include not only pharmacological and physical therapy, but also psychological support. This may involve cognitive-behavioral therapy, relaxation methods, or working with a psychologist or psychotherapist. Accounting for and correcting anxiety-depressive states helps improve pain tolerance, increase motivation for treatment and rehabilitation, and significantly enhance long-term therapy outcomes.

Prevention and recommendations for living with osteochondrosis

Completely preventing the development of osteochondrosis is impossible, as it is a natural aging process. However, its progression can be slowed down and its manifestations minimized:

• Regular physical activity: Moderate loads such as swimming, yoga, pilates, and walking strengthen back muscles and maintain spinal flexibility.
• Maintaining a healthy weight: Excess weight increases the load on the spine and intervertebral discs.
• Proper posture: Monitor your posture when sitting, standing, and walking.
• Workplace ergonomics: Use a comfortable chair with lumbar support, place the monitor at eye level, and take regular breaks to stretch.
• Proper lifting techniques: Bend your knees, keep your back straight, and use your leg muscles rather than your back.
• Quitting bad habits: Smoking and excessive alcohol consumption negatively affect the nutrition of disc tissues.

Living with osteochondrosis requires attentive care for your body and adherence to medical recommendations. A comprehensive approach, including physical activity, medication support, and, if necessary, psychological help, will help significantly improve your quality of life and control the symptoms of the disease.

Sources

1. [1] Incidence of Anxiety and Depression in Adult Patients with Chronic Discogenic Back Pain. (Psychiatria Danubina, 2024) https://pubmed.ncbi.nlm.nih.gov/39378464/

The information provided in the article is for informational purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment tactics.