Supporters of rheumatoid and autoimmune theory drew attention to the fact that the processes occurring in the joints in rheumatoid arthritis are identical processes in the intervertebral joints. The reliability of these views is confirmed, for example, by the similarity of biochemical changes in the main substance and the cellular elements of the disc, characteristic of diseases attributed to diseases including rheumatoid arthritis. These changes lead to the metabolism of the synovial membrane, which begins to produce less of the synovial fluid, resulting in disturbed nutrition of the cartilage and adjacent bone tissue. The emergence of the traumatic theory is connected with attempts to define the role of trauma (micro trauma) of mechanical factors in the etiopathogenesis of degenerative-dystrophic diseases of the spine.
The role of visceral pathology in the development of degenerative-dystrophic diseases of the spine is also proved. There are quite a number of theories and assumptions, which more or less repeat the above mentioned one.
Clinical syndromes are divided into vertebral and extra vertebral. Extra vertebral syndromes are divided into two broad categories: reflective and compression. Reflex syndromes are often preceded by compression. Reflex include syndromes caused by stimulation of nerve receptors of sinuvertebral nerve, which penetrates into the spinal canal through the intervertebral foramen and innervates the periosteum, ligaments, fibrous ring, vessels. Stimulation of the receptors is due to compression of the hernia, bone growths, in violation of fixation, vascular disorders (edema, worsening of blood flow), inflammation (reactive, immune). Pulse propagating along the sinuvertebral nerve comes on the posterior roots in the posterior horn of the spinal cord. Having switched on the front horn, they cause reflex-tonic disorders. By switching to sympathetic centers in the lateral horn, they cause vasomotor or dystrophic disorders. Such dystrophic changes are subject primarily of less vascular tissue (tendons, ligaments), especially in the field of attachment to bone protrusions. In some cases, these changes neurodystrophically cause intense pain, which occurs not only locally when touching the lessened section, but at a distance also. In the latter case, the pain is “reflected”, it can be reflected in the sometimes considerable distances. The reflected pain may be in the form of lightning “lumbago” or is prolonged. In Triggers zones and in the reflection of pain may vegetative disturbances.
In the origin of dorsalgia, functionally reversible blocking of the intervertebral joints is important, which may precede the development of degenerative-dystrophic diseases of the spine, but may also occur in already affected joints. The most common cause of blocking can be static or dynamic loads, not physiologic posture and microtrauma. Having been located in one area of the spine, it causes functional changes in the related fields in the form of compensatory hypermobility.
Myofascial pain (pain syndrome, muscular-fascial dysfunction) may occur in the reflected spondilosis pain. Myofascial pain is an intense, at times increasing pain, which leads to restriction of movements. The patient remembers what movements cause increasing pain and reflected the emergence of pain reaction, and tries to avoid these movements and the stimulation of trigger zones.
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