Dorsopathy

Dorsopathy – What is it in simple terms?

Dorsopathy is a clinical syndrome characterized by pain in the back area combined with other neurological disorders. The development of dorsopathy is associated with inflammatory or degenerative processes occurring in the spine or surrounding muscles.

About the Disease

Dorsopathy belongs to the category of commonly occurring conditions associated with disturbances in the anatomical and functional state of the musculoskeletal system. This condition is not only found in elderly patients but also in children and adolescents. The primary diagnosis is usually based on clinical symptoms. However, additional examinations are not always informative. It’s not uncommon for X-rays, CT scans, and MRI scans to fail to detect any pathognomonic changes. Often, only age-related features of the spine are found, which do not necessarily correlate with the severity of the pain syndrome.

Types

The classification of dorsopathy based on the mechanism of occurrence includes the following types:

• Vertebrogenic: pathological processes primarily develop in the spinal column.
• Myofascial: associated with muscle compartment involvement surrounding the spinal column.
• Unspecified: even thorough examination fails to detect organic changes in the musculoskeletal structures that could cause back pain or neck pain (cervical pain).

Symptoms of Dorsopathy

Symptoms of dorsopathy, in addition to general manifestations (pain and neurological disorders), have distinctive features determined by the primary pathology.
Spondylolisthesis may not be accompanied by clinical symptoms for a long time. In other cases, this condition is accompanied by the development of pain syndrome, symptoms of spinal cord compression, neurological disorders, and sometimes neurogenic claudication. The latter is associated with gradually developing narrowing of the spinal canal and intervertebral foramina.

Enthesitis is a typical manifestation of spondyloarthritis. Enthesitis is characterized by the development of an inflammatory process where the muscle bundle attaches to the bone. This condition manifests as sudden onset pain, which worsens during palpation and movement, and may include swelling at the inflamed site. Gradually, joint stiffness develops.

Facet joint involvement in the background of osteochondrosis with radicular syndrome leads to the appearance of pain, which is projected onto paraspinal points. Pain intensifies with extension and rotation of the spinal column, as well as palpation of paravertebral points.

Intervertebral disc herniation manifests as pain syndrome, sometimes extending to the leg; pain worsens when coughing, sneezing, laughing, standing, and when lifting the leg with the knee extended. Pain may persist for a long time. On the side of the pain, there is a reactive muscle spasm, leading to functional scoliosis.

The symptoms of idiopathic ankylosing hyperostosis are characterized by limited movement during body rotation and bending. Pain in the spinal area may be absent, but if present, it is of low intensity. The manifestations of the disease are particularly pronounced upon awakening and in the evening, as well as during prolonged monotonic posture. Symptoms are present constantly or appear episodically.

Dorsopathy associated with connective tissue dysplasia manifests as joint hypermobility. Signs of dorsopathy include:

• Hyperextension in the V metacarpophalangeal joint of the hand at a right angle.
• Bringing the first finger of the hand to the forearm.
• Excessive extension in the elbow joint of more than 10°.
• Excessive extension in the knee joint.
• Touching the palm surface to the floor with unbent knees.

In various forms of kyphoscoliosis, besides posture disturbance, discomfort in the back, rapid muscle fatigue, and tension along the spinal column muscles are noted.

Schmorl’s hernias in most cases are not accompanied by pain syndrome and are incidentally detected on X-rays. The process is characterized by multiple lesions.

Osteoporosis manifests as changes in posture, “back fatigue,” which usually develops in the elderly age group (osteoporosis in the young is rare).

Causes

In childhood, dorsopathies are not common. The main causal factors may include the following:

1. Genetically determined pathology – connective tissue dysplasia syndrome, manifested by pathological joint hypermobility (excessive body flexibility). A specific manifestation of connective tissue dysplasia is Scheuermann-Mau disease – progressive curvature of the thoracic spine backward, which occurs during the child’s active growth period.
2. Kyphoscoliosis – a disease characterized by vertebral rotation, resulting in lateral deviation of the spinal axis (scoliosis) in combination with anterior-posterior curvature (kyphosis). Kyphoscoliosis can develop from early childhood but externally debuts around 8-12 years old. Previously, the disease was associated with incorrect posture while sitting at a school desk, but now this condition is also explained by the inadequacy of connective tissue fibers.

In adults, the most common causes of dorsopathy may include the following factors:

Spondylolisthesis – slipping or displacement of the upper vertebra in any direction. This condition often affects the lumbar spine, which is subjected to the greatest load and weakness of the stabilizing ligamentous apparatus, creating conditions for easier anatomical abnormalities.

Schmorl’s hernia – a condition where the intervertebral disc protrudes into the vertebral body above or below (these areas have low strength due to developmental features). The pathology has a hereditary origin, and signs appear during the child’s active growth period.

Spondyloarthritis – a group of autoimmune diseases:

• Ankylosing spondylitis – a pathological process involving both right and left sacroiliac joints and spinal structures. Peripheral forms of the disease may also involve the hip joint. Deforming changes gradually lead to ankylosis (immobility).
• Other varieties – psoriatic arthritis (inflammation of the joint tissues associated with psoriasis), undifferentiated arthritis.

Spinal osteochondrosis – non-inflammatory damage to the structures of the spinal column. Facet joints, intervertebral discs with secondary vertebral body lesions (spondylosis) may be involved in the pathological process.

Intervertebral disc herniations are usually observed in elderly patients. This condition is characterized by a decrease in disc thickness and deterioration of structure.

Idiopathic diffuse skeletal hyperostosis (Forestier’s disease) – this pathology is characteristic of elderly people. It is characterized by stiffness due to calcium salt deposition in the tendon and ligament compartment. Ossification usually develops in the anterior longitudinal ligament.

Osteoporosis – a systemic pathology characterized by decreased bone mineralization and disruption of its structure, increasing the risk of fractures.

Involvement of spinal structures in a tumor process – bone metastases are more common than primary tumors.

Dorsopathy Diagnosis

According to clinical recommendations, the dorsopathy diagnostic program may include the following studies:

• X-ray of the suspicious spinal segment;
• Computed tomography;
• Magnetic resonance imaging, which allows a layered study of soft tissue structures, not just mineralized ones;
• Densitometry – to assess bone mineral strength;
• Laboratory determination of rheumatic pathology markers;
• Determination of calcium and vitamin D levels.

Treatment of dorsopathy

Treatment of dorsopathy is most often carried out using conservative methods, and reconstructive-plastic surgery may be indicated only for severe spinal deformities.

Conservative treatment

The nature and scope of conservative therapy are selected based on the established diagnosis:

• Non-steroidal anti-inflammatory drugs are used to relieve pain, with corticosteroids and paravertebral blocks indicated in severe cases.
• Neuroprotective agents and vitamin supplements are used to improve the metabolism of nervous tissue, whose roots may be compressed in spinal pathology.
• Bisphosphonates, calcium, and vitamin D are used to strengthen bone mineral density.

Surgical treatment

Surgical intervention is indicated for severe spinal deformities leading to persistent pain syndrome. Surgery is also applied for severe intervertebral disc herniations.

Prevention of dorsopathies

For the prevention of dorsopathies, it is recommended to maintain the health of the musculoskeletal system through regular physical exercises and prophylactic intake of vitamin D. Menopausal hormone therapy is recommended for women in menopause with indications, as it helps to strengthen bone tissue.