Spondylosis

Description:

Spondylosis - failure of union of an arch of a vertebra (is more often than the 5th lumbar) in interarticular area or in an arch leg, arising owing to an arrest of development of back department of a backbone.

Spondylosis reasons:

On the etiology the spondylosis is divided into three look: inborn, acquired and mixed. The inborn spondylosis arises owing to not merge of two kernels of ossification of which this half of an arch is formed; the acquired spondylosis arises under the influence of excess exercise stresses against the background of disturbance of food of a bone tissue or a dysplasia of vertebrae. A spondylosis - a consequence of the cumulation of power impacts on an interarticular handle of a vertebra exceeding the module of elasticity of a bone tissue. In the beginning development of pathological process the spondylosis represents a zone of bone reorganization (Lozer's zone), then there is an ustalotny change of usually interarticular zone of a handle which is called "a critical zone". A spondylosis - reversible process. On condition of elimination excessive power influences the change zone union is possible. A spondylosis - an independent disease. At a part of patients (approximately at a half) the spondylosis is complicated by a spondylolisthesis.

Spondylosis symptoms:

Manifestations of a spondylosis happen different: from a resistant, but weak back pain to the severe pain changing gait or limiting ability to movement. Strengthening of pain at extension of a waist and easing is characteristic at an inclination forward. Athletes can complain that pain does not allow to sleep or lie on spin. Usually pain is limited to a waist, but can irradiate in a buttock or on the back surface of a hip. Also complaints to tension (spasticity) of back group of muscles of a hip and restriction of mobility of lumbar department of a backbone are possible. Radicular symptoms are possible, but are rare at a spondylosis.

Physical research:

The physical research usually finds few deviations. Restriction of movements in lumbar department of a backbone, preferential extensive is characteristic. Careful passive extension usually strengthens pain. There is a provocative test helping with diagnosis of a spondylosis: the patient has to cave in back, standing on one leg. At a spondylosis pain on the party of defeat amplifies. Cost the parties where pain is noted, it is often possible to find also morbidity at a palpation. If there is no spondylolisthesis, there should not be also a ledge-ugluleniya over acanthas. Provocative test for identification of a radiculopathy — a raising of the extended leg (symptom Lasega) — negative, and results of a neurologic research usually normal.

Treatment of a spondylosis:

The choice of treatment is influenced by several factors: age of the athlete, weight and prescription of symptoms and radiographic changes. To athletes with defect in an interarticular part of an arch according to a X-ray analysis, but without stings about treatment it is not required; they can continue to play sports. If displays of a disease come down to an insignificant back pain, strengthening of a muscular corset and maintenance of physical effeciency is necessary. If there are neurologic disturbances or other heavy manifestations, sports loadings it is necessary to limit and conduct additional examination. At athletes restriction of activity and an immobilization of a backbone with a corset happen to a dorsodynia and radiological signs of a spondylosis successful more than in 90% of cases.

Need of carrying a corset and the best kind of a corset — questions debatable. According to observation of seven athletes, rest and restriction of activity without immobilization of a backbone led to clinical recovery at all observable. Results of this research were recognized doubtful, and it was not succeeded to reproduce them. It is usually accepted to recommend a short-term immobilization of a backbone. For this purpose equally flexible and rigid, lordotic and anti-lordotic corsets approach. It is considered that the anti-lordotic corset (0 ° curvature) unloads back elements of vertebrae, and we give preference to it. Time of carrying a corset differed in different observations and, apparently, does not influence directly clinical performance. We recommend a constant immobilization of a backbone in the afternoon now (during wakefulness) and we allow to remove a corset during sleep. Duration of an immobilization makes generally 6 — 8 weeks in combination with restriction of sports occupations. The repeated X-ray analysis before maturing of a skeleton (growth termination) is recommended each 6 months to teenagers. The repeated X-ray analysis is shown to adult athletes only when resuming symptoms.

The purpose of treatment of athletes with fatigue changes of an interarticular part of an arch of a vertebra (accumulation of isotope at one-photon emission tomography for lack of radiological changes) — a change union. Reduction of accumulation of isotope can be observed after an immobilization (unloading) of a backbone. The probability of an union is maximum at unilateral changes and is minimum at bilateral. It is important that return to sports activity was not put into dependence on achievement of a bone union. It is considered that in the place of defect the strong fibrous (connective tissue) union providing disappearance of symptoms is formed. Most of doctors recommend to stop an immobilization of a backbone and to allow sports activity after disappearance of symptoms.

After an immobilization the athlete passes to the rehabilitation program paying special attention to exercises on bending and flexibility. Resuming of usual activity is possible during the subsequent 6 — 8 weeks.

Surgical treatment.
Thanks to efficiency of conservative treatment need for operation arises seldom. Candidates for it are athletes at whom complaints remain longer than 6 months despite restriction of activity and an immobilization (unloading) of a backbone.

Reference method of treatment of a spondylosis at the level of L5 vertebra at teenage athletes — a posterolateral spondylodesis of L5 — SI in situ. Operation is effective, the N mobility of a segment at the same time sharply decreases. In the last 20 years interest in the methods allowing to keep mobility of vertebrae increased. The following methods of an osteosynthesis of an interarticular part of an arch — fixing by a wire according to Scott were for this purpose offered; wire hooks; fixing by translaminar interfragmentary screws across Buck and fixing by the screw, a hook and a pin (considered as the most rigid) — added with use of a bone transplant. The plastics of defects of an interarticular part of an arch from L3 to L5 is described. According to several observations, both the interfragmentary method, and wire methods gave either good, or excellent results and provided return to sports activity and participation in competitions of the same level, as former, more than in 90% of cases. Possibly, success of complex methods is connected with defect closing use by a bone transplant.

At the athletes who underwent an operation it is necessary to confirm a defect union before starting rehabilitation. As soon as the union is reached, begin the rehabilitation program including exercises on bending, development of flexibility and strengthening of a muscular corset.