Dysplastic instability of cervical department of a backbone
- Symptoms of Dysplastic instability of cervical department of a backbone
- Reasons of Dysplastic instability of cervical department of a backbone
- Treatment of Dysplastic instability of cervical department of a backbone
Instability represents pathological mobility in a vertebral segment. It can be either increase in amplitude of normal movements, or emergence of new degrees of freedom of movements, uncharacteristic for norm. An indicator of instability of a backbone is the shift of vertebrae. Shift of vertebrae is a radiological find while instability of a backbone represents a clinical concept. Shift of vertebrae can proceed without pain, and instability is characterized by pain. Instability has characteristic signs:
1. Disturbance of the bearing ability of a backbone happens at influence of external loadings, both physiological, and excessive. The backbone loses the ability to keep certain ratios between vertebrae.
2. Instability testifies to insolvency of basic complexes which protect a backbone from deformation, and the spinal cord and its structures protect from irritation.
3. Disturbance is shown in the form of deformation, pathological movement of vertebrae or destruction of elements of a backbone. Instability causes pain, neurologic frustration, a muscle tension and restriction of movements.
Symptoms of Dysplastic instability of cervical department of a backbone:
Dysplastic instability of a backbone develops because of a dysplastic syndrome. Symptoms of a dysplasia are found in a vertebra body, an intervertebral disk, intervertebral joints and ligaments of a backbone.
Instability at the nizhnesheyny level is connected with inborn inferiority of an intervertebral disk. Display of a dysplasia is the excentric provision of a pulpozny kernel, narrowing of an intervertebral disk, disturbance of integrity and parallelism of switching plates, and also a klinovidnost of bodies of vertebrae. At a dysplasia change of structure of collagenic fibers leads to disturbance of process of hydration of fabric of a pulpozny kernel that causes disturbance of mechanical properties of an intervertebral disk, decrease in rigidity of fixing of vertebrae, ratio distortion between a pulpozny kernel and a fibrous ring. These changes lead to development of instability of a backbone at the level from CI to CVII.
In atlantoaksialny department symptoms of a dysplasia are found in bodies of vertebras, intervertebral joints and all copular complex. Patients with kraniovertebralny pathology have a number of characteristic radiological changes: asymmetry and inclined provision of an odontoid shoot of a vertebra CI, hypoplasia of the Atlas and condyles of an occipital bone, asymmetry of an atlantoaksialny and atlantooktsipitalny joint, asymmetry of side mass of the Atlas, synostoses of vertebrae of CI and CII, basilar impressiya and platybasia, rotational and flexion and extensive instability of a backbone. Kraniovertebralny pathology is followed by multiple signs of dysplastic development in the form of a high hard palate, malocclusion, asymmetry of the person and nadplechiya, shovels, waist triangles, and also flat-footedness, dysplastic instability shoulder, elbow, metacarpophalangeal and knee joints. Inborn inferiority of the copular device in kraniovertebralny department leads to development of dekompensirovanny instability.
At inborn concrescense of vertebrae of CI and CII, and also at assimilation of the Atlas there is a restriction of the movement at the verkhnesheyny level with reduction of amplitude of movements that leads to compensatory development of hyper mobility in nizhnesheyny department of a backbone. The raised loading creates conditions for bystry wearability of intervertebral disks and development of instability at the level of CIV-CV and CV-CVI.
Dysplastic changes can strike any of backbone elements. The inborn underdevelopment of the sumochno-copular device creates the syndrome of a back basic complex described by A. V. Demchenko at teenagers. Dysplastic changes lead to a prematurity of degenerative process at young age with disturbance of stability of a backbone. Inborn asymmetry of intervertebral joints, or tropism, is shown in change of the sizes and the provision of joint facets. Change of the plane of intervertebral joints is the reason of change of rigidity of a back basic complex, redistribution of load of both basic complexes, an early degeneration of a vertebral segment which is complicated by its instability. The underdevelopment of joint shoots leads to joint capsule restretching, shift of joint surfaces, narrowing of intervertebral openings, looseness of intervertebral joints, reduction of rigidity of a back basic complex and increase in load of a front basic complex. Disproportionately big joint shoots lead to increase in rigidity of a back basic complex that promotes growth of load of this part of a backbone.
At mature age the dysplasia of intervertebral joints is the reason of development of dysplastic osteochondrosis which can result both in instability of a backbone, and to a spondylarthrosis.
Reasons of Dysplastic instability of cervical department of a backbone:
There are factors which contribute to excess mobility of vertebral segments. Normal for cervical department of a backbone excess mobility is defined by action of two factors: age and localization of a vertebra. Amplitude of mobility of a backbone at children exceeds mobility amplitude at adults. Amplitude of shift of vertebrae of SII CII when bending makes 4 mm, and at extension - 2 mm. Hypermotility of a segment CII-CIII is observed to age of 8 years. At children excess mobility is observed in verkhnesheyny department of a backbone in 65% of cases that it is connected with lack of an intervertebral disk at the level of CI-CII. At children the most mobile is the segment CII-CIII. Disturbances at this level are diagnosed in 52% of cases of instability of a backbone.
Treatment of Dysplastic instability of cervical department of a backbone:
Adjustable process of fibrosing of an intervertebral disk in an unstable segment of a backbone is the cornerstone of conservative treatment. Carrying a headholder promotes development of fibrosis of a disk and a stop of progressive shift of vertebrae. At the adult patient development of fibrosis can lead to gradual disposal of pain. As a rule, treatment of instability of a backbone begins with use of conservative methods. Conservative methods of treatment are shown at patients with instability of insignificant degree of manifestation which is not followed by a sharp pain syndrome and spinal symptomatology. The following belongs to conservative methods of treatment:
1) observance of the sparing mode;
2) carrying a soft or rigid headholder;
3) reception of non-steroidal anti-inflammatory drugs (NPVP);
4) novocainic blockade at an aggravation of a pain syndrome;
5) massage and physiotherapy exercises of muscles of a back;
6) physical therapy (electrophoresis, ultrasound).