The complex problem of treating spinal osteochondrosis has not been finally resolved..

However, it is recognized that the main method of treating this disease is complex conservative therapy, while surgical treatment is used in a small part of cases..

This is due to the fact that when the spine is stabilized surgically or during decompression as a result of neurosurgical intervention at the level of one segment, decompensation gradually develops in the upper and lower intervertebral discs..

Along with this, there is often a widespread degenerative-dystrophic lesion of the spine, in which surgical intervention is not indicated..

It should be noted that there is no need to oppose surgical and conservative methods of treatment, since, if indicated, they complement each other in the overall complex of therapeutic measures..

However, as rightly pointed out by A. Korzh and co-authors (1980), "

As experience has shown, in advanced or severe acute disease accompanied by severe neurological changes, even in the case of effective manual therapy, residual phenomena remain in the form of sensitivity disorders, tendon reflexes, the presence of symptoms of tension, expressed in varying degrees, etc..

In this regard, it is necessary for a certain time (from 1 to 3 months) to recommend complex conservative therapy to patients, and, if indicated, sanatorium treatment in the future.. The terms of the recovery period depend on the stage and duration of the disease, the duration and severity of neurological disorders..

Clinic and pathogenesis Clinical manifestations of osteochondrosis of the spine are so diverse that in each case an individual choice of treatment methods is required, taking into account the stage of the pathological process, its severity, duration of the disease, the severity of pain, orthopedic, neurological manifestations and vascular disorders..

Without dwelling on the issues of patho- and mechanogenesis of the disease, it must be emphasized that in the area of \u200b\u200bthe affected disc, a local aseptic inflammatory process often develops, which occurs in the same way as an immunological conflict in the meninges of the brain such as arachnoiditis or epiduritis. The tissue of the nucleus pulposus, devoid of blood vessels and isolated from the immunological system of the blood, has autoimmune properties..

Local inflammatory process captures membranes, vessels and epidural tissues. Venous congestion and edema develop, which in itself can cause compression of nerve structures and regional ischemia. This must be remembered when prescribing treatment procedures..

Based on the pathogenesis of the disease, then the complex of conservative treatment should include measures aimed at restoring and relative normalization of intervertebral relationships, blood supply, reducing edema, eliminating reflex spasm and, therefore, normalizing the function of the peripheral nervous system, and most importantly, eliminating pain..

It is known that an intervertebral disc affected by a degenerative-destructive process sometimes cannot recover to normal.. However, one should not strive to create conditions favorable for reparative processes ending in fibrosis between the vertebral bodies, which leads to their stabilization with subsequent improvement in the patient's condition and gradual elimination of pain..

It is generally accepted that conservative treatment should be carried out in compliance with the following basic principles: unloading, immobilization, manual and drug therapy, acupuncture and physical methods of treatment..

The unloading of the spine, depending on the stage, severity and severity of the process, provides for a sparing regimen, which excludes certain physical efforts, excessive axial loads of the spinal column, forced, abrupt movements, etc.. and strict bed rest.

For immobilization of the affected vertebral segment, the wearing of fixing corsets of various designs is prescribed..

In drug therapy, biogenic stimulants, dehydration, hyposensitizing drugs, B vitamins, muscle relaxants, ganglionic blockers, anti-inflammatory, sedative, vascular drugs, various types of blockades with painkillers are used..

Physiotherapy.

Along with this, it is necessary to widely carry out physiotherapeutic measures, various types of traction, balneological treatment, therapeutic exercises, massage, as well as sanatorium treatment..

In recent years, acupuncture has become more widely used.. It is known that acupuncture has a mechanical, humoral, reflex and bioelectric effect.. Despite the fact that the theoretical issues of acupuncture continue to be studied, practical experience proves the great physiology of the method, its validity and effectiveness (B. Trufanova, E. G Dubenko, 1980; Tabeeva, 1982, etc..

Without dwelling in detail on the means of drug therapy, which are widely covered in domestic and foreign literature, it should be noted that most orthopedists divide patients with osteochondrosis into groups to facilitate the complex of medical procedures, distinguishing between acute pain syndrome, subacute and residual phenomena..

There are the following symptom complexes:.

1) syndrome of damage to intra- and extra-discal structures of the spine without involvement of radicular and vascular formations in the process: a) uncomplicated form; b) a complicated form with reflex manifestations of periarthritis, epicondylitis, neuroosteofibrosis, etc..

2) radicular syndrome: a) irritative type (pain and reflex static-topic), b) compression type (radicular paretic);

3) medullary and cerebral compression vascular syndromes.

By methods of conservative complex therapy, it is necessary to strive to transfer an acute process into a subacute one, against which it is easier and more efficient to perform manipulations on the vertebral segments in order to eliminate pain..

Mistakes and complications in manual therapy.

In the foreign literature, the issues of the occurrence of complications during manipulations on the spine are widely covered.. Korzh (1980) notes that " Such severe complications as paralysis, cerebral, vascular disorders, fractures, etc.. (AND. Dzyak, 1981, etc..

In medical practice, complications were also observed in the form of an overdose of a blow, shaking, which resulted in hemorrhages, tears and even concussions to some extent, which were mostly quickly stopped.. Along with this, during manipulations, especially in the region of the cervical spine, there was a short-term loss of consciousness..

It should be noted once again that, when starting to apply manual therapy methods, one should be careful, attentive, carefully study the clinical manifestations of the disease and radiographic data, differentiate the approach to manipulation taking into account the segment of the lesion, the individual characteristics of the patient, the stage of the pathological process, the severity and duration.

Manipulations must be carried out sparingly, if possible, dosed, so as not to cause hypermobility due to the use of excessive efforts..

As already noted, manual therapy is not indicated for excessive mobility of the spinal segment.. Performing manipulations with hypermobility leads to the activation of the pathological process and severe complications in the form of pain, the impossibility of movement due to the involvement of new nerve structures in the process, their compression and swelling.

Manipulations should not be carried out in spondylosis, especially in the lumbar and cervical spine, as this causes a breakdown of compensatory-adaptive mechanisms, the appearance of pathological mobility in the segment and, accordingly, exacerbation and pain.

In the cervical spine, it is possible to clamp the vertebral artery with bone growths with the development of complications in the form of fainting and collapse. In the cervical region, it is impossible to carry out manipulations in the position of maximum extension of the head backwards, since with sudden movements this can lead to clamping of the vertebral artery and loss of consciousness.

In acute lobar syndrome, dosed, careful manipulations can be carried out only with a short duration of exacerbation (7-10 days). With a pronounced pain syndrome lasting up to 1 month or more, when severe muscle contractures develop in the vicious position of the spinal segment, antalgic kyphosis and scoliosis, it is necessary to first create unloading, immobilization for the spine, carry out, according to indications, complex conservative therapy, including dehydration, hyposensitization, anti-inflammatory drugs with.

Only after stopping the acute process, you can carefully start manual therapy without causing complications in the form of an exacerbation of the process.. This makes it possible to achieve a gradual normalization of intervertebral relations against the background of complex therapy of the disease with unloading of the spine in the form of traction, the use of corsets of various designs, according to indications - magnetic therapy, etc..

Along with this, before carrying out manipulations, it is necessary to measure blood pressure, determine the pulse, lability of the patient's nervous system, etc.. This is necessary in order to provide timely assistance to the patient if any complications occur during manual therapy..

To provide urgent care to patients with complications, it is necessary to equip an ambulance cabinet equipped with a device for measuring blood pressure, as well as therapeutic agents (ammonia, cardiac, pain medications, etc.)..

Danilov, V. Naboychenko.

medbe. en.