DEGENERATIVE PROCESSES OF VERTEBRAE. PATHOLOGICAL PHYSIOLOGY. CERVICAL SPINE EXTENSION.

The degenerative-dystrophic-destructive pathological processes begins in fibrocartilaginous tissue of the intervertebral disc, which degenerates over age. This leads to loss of elasticity of the intervertebral disc and the reduction of intervertebral space, determined radiological. As a result, the disc loses ability to capture water and damping, therefore increases pressure on vertebral corpus, subsequent subchondral sclerosis and osteophyte formation at the periphery of the disc. It is a reaction of the body to stress and pathological mobility.

• 1 - Decrease of the C6-C7 intervertebral space;
• 2 - Sclerosis of the surface of the vertebral body;
• 3 - Anterior marginal osteophytes;

Herniated intervertebral disc

Disc herniation is a pathological condition in which fragments of nucleus pulposus penetrate through cracks in the annulus fibrosus, to induce rupture or prolapsing beyond physiological limits,extrusion of the nucleus pulposus in the spinal canal, or perforating the surface and penetrating the vertebral body (Schmorl hernia).

Depending on the degree of penetration of nucleus pulposus:

• A - Intrusion, intradiscal migration of nucleus pulposus;
• B - Bulging, entering through cracks of the nucleus pulposus in annulus fibrosus with prolapsing into the medullary space, without harming the integrity of the outer layer of the annulus fibrosus;
• C - Prolapse, damage the integrity of the outer layer of the annulus fibrosus, nucleus pulposus entering the medullary space;
• D - Sequestration, the nucleus pulposus content entering the medullary space and losing conection with core;

Types of hernia:

• 1 - Sub-ligamentar hernia;
• 2 - Trans-ligamentar hernia;

The direction of herniation denote location of hernia, and therefore neurological picture:

• 1 - Median;
• 2 - Paramedian;
• 3 - Lateral intraforaminal;

Conventional disc hernia manifestations can be divided into:

• 1 - Mechanical: irritative processe of the compressed tissue: ligaments, fascia, capsule, periosteum, annulus fibrosus;
• 2 - Reflector: edema, venous stasis, or immune inflammatory reactions;

In response to excitation of the posterior longitudinal ligament of hernia, pathological impulses are transmitted by segmentar nerve fibers, causing reflector paravertebralmuscle spasm and for inferior limbs, which represents reflector musculotonic syndromes. Also smooth muscles of blood vessels react through neurovascular reflector syndromes - spasm, causing circulatory disorders.

Diagnosis of cervical spine pathologies

Diagnosis is established after clinical examination and physical examination: standard radiography in two incidents and computer tomography (CT), when required to indicate additional MRI, Dopplerography, Electromyography.

Example of MRI of the patient with herniated intervertebral disc.

Differential diagnosis in cervicalgia

• - Discarthrosis, spondylarthrosis, herniated disc;
• - Fractures, vertebral dislocations;
• - Injury of muscles, ligaments, discs;
• - Spinal stenosis;
• - Fibromyalgia;
• - Greater occipital nerve syndrome (occipital neuritis);
• - Spinal instability;
• - Ankylosing Spondylitis Disease Behterev;
• - Rheumatoid arthritis;
• - Sindrom Reiter-Fiessinger-Leroy;
• - Forestier disease;
• - Spinal tumors;
• - Bleeding arachnoid;
• - Epidural hemangioma;

Indications for cervical spine extension

• 1 - Spine osteoarthritis with radicular, neurodystrophic, musculotonice, reflecto-vascular symptoms;
• 2 - Herniated intervertebral disc without seizure;
• 3 - Transitional circular disorders of vertebral artery;

Contraindications for cervical spine extension

• 1 - Tumors of the spinal cord, vertebral metastases;
• 2 - Severe cardiovascular disorders;
• 3 - Atherosclerosis with disorders of cerebral blood circulation;
• 4 - Spondylitis, inflammatory processes;
• 5 - Mental disorders (psychosis, psychopathy, insanity, hysteria);
• 6 - Epilepsy, convulsive states;
• 7 - Spinal tuberculosis;
• 8 - Recent craniocerebral trauma;
• 9 - Trauma, fractures of the vertebrae, ligaments injuries, intervertebral disc injuries;
• 10 - Spinal cord diseases (myelopathy, arachnoiditis);
• 11 - Postop intervertebral disc, not earlier than six months;
• 12 - Osteoporosis, age over 70 years;
• 13 - Developmental abnormalities of spine (Clippel-Feil, vertebral malformations, spinal cord malformations, Arnold-Chiari);
• 14 - Behterev disease, hyperostosis, ossification of longitudinal ligament;
• 15 - Fever, infectious diseases;
• 16 - Negative reaction to the procedure;
• 17 - Hormonal spondylopatie;
• 18 - Rheumatoid Arthritis;
• 19 - Spinal cord stenosis;
• 20 - Deforming spondylosis with osteophytes;
• 21 - Epidural hematoma;
• 22 - Subarachnoid haemorrhage;
• 23 - Paralysis;

Treatment

Combined treatment is recommended:

• 1 - Drug therapy, including decontracturant, condroprotector medications, and vitamines;
• 2 - Physiotherapy to combat painful syndrome, inflammation, edema, paravertebral muscles spasm, this treatment is indicated by physiotherapist;
• 3 - Relaxing massage of neck muscles;
• 4 - Cervical spine extension;
• 5 - Rehabilitation;

! An absolute indication for surgical treatment of herniated intervertebral disc, are spinal cord compression signs!

The performance of cervical spine extension method

Extension procedure we perform through the device proposed by Dinu Istrati, MD 3501G2 Patent 2008.02.29 "device for extension of cervical spine region". The invention relates to medical equipment. The essence of the invention consists in that the device includes a horizontal bar and a vertical bar, articulately joined at one end. Vertical bar is rigidly fixed on a stand with wheels. The free end of the horizontal bar is connected through two damping springs and a dynamometer, to a metallic halfring with Glisson loop. On the vertical bar is installed an electric adjustable engine, to change the position of the horizontal bar through a telescopic mechanism. The dynamometer records the effort on the spine and the dumping springs allow the extension to be slower, avoiding the bullying moments.

The device is used in the following manner: the patient sits in front of the device as shown in the picture, the head is fixed by Glisson loop. Through a transformer, the electric engine is turned on raising the horizontal bar, so performing extension through damping spring and dynamometer, same time recording the effort on the spine. Thus we achieved therapeutic effect on the cervical region of the spine, wich allows further physiotherapeutic treatment on the back(massage, ozokerite, magnitoterapie, ultrasound therapy, electrophoresis). The cervical spine extension performes the decrease of intradiscal pressure in discovertebral segment, and acts on intervertebral disc receptors, ligaments, joints and paravertebral muscles, diminishing muscle hypertonus. Extension normalizes space ratio between the facet joints, intervertebral space increases, and induce spinal artery decompression. After the procedure, is reduced and may disappear the neck pain, headaches, paresthesia of hands and functional kyphosis.

Vacuum effect leads to nucleus pulposus centering, and may return to its place of herniated nucleus pulposus, effect which is supported by the posterior longitudinal ligament tension during extension. During cervical spine extension, neck and shoulders massage can be performed. Massage procedure relaxes muscles and improves blood circulation. Extension procedure lasts from 15 to 25 minutes, increasing daily. Dosage effort is made according to individual structural and functional characteristics of body, under a permanent control of specialist. Effort applied from the first day is 3kg increase to 7.5kg until the last day of procedure. In total 10 procedures indicated.

© Dinu Istrati