Degenerative Spine Disease and Homoeopathy

TABLE OF CONTENTS

Introduction

Degenerative spine disease (Syphilis/ Psora/ Sycosis) is a major cause of chronic disability in the adults. It is a normal part of aging. Neck and back pain are one of its most common outcomes.

Skiagram showing Degenerative spine disease

Normal and degenerated IVD

Origin of Pains

Pain can originate from bone, joints, ligaments, muscles, nerves and intervertebral disks, as well as other paravertebral tissues.

A- INTERVERTEBRAL DISK (IVD) DISEASE

Anatomy of IVD

Intervertebral disk consists of the nucleus pulposus surrounded by the anulus fibrosus. Both the anulus and the nucleus are composed of collagen and proteoglycans. The nucleus contains relatively more proteoglycans to give it a looser gelatinous texture. The anulus has more collagen, and the collagen becomes progressively more compact and tougher at the periphery. The outer anulus is attached to the adjacent vertebral bodies at the site of the fused epiphyseal ring.

Normal and degenerated disc

Function of IVD

Together with the cartilaginous end plates of the adjacent vertebral bodies, the intervertebral disk forms a disk complex that gives structural integrity to the interspace and cushions the mechanical forces applied to the spine.

Effects of Aging on IVD

• With aging, certain biochemical and structural changes occur in the intervertebral disks. There is an increase in the ratio of keratan sulfate to chondroitin sulfate, and the proteoglycans lose their close association with the disk collagen. The disk also loses its water-binding capacity and the water content decreases down to 70%.
• The vertebral end plates also become thinner and more hyalinized. This degree of disk degeneration is considered a normal part of aging.
• With more advanced degeneration (Syphilis), dense disorganized fibrous tissue replaces the normal fibrocartilaginous structure of the nucleus pulposus (Sycosis), leaving no distinction between the nucleus and anulus fibrosus.
• Development of anular tears weakens the anulus (Psora) and allows nucleus to protrude into the defect. Tears that extend through the outer anulus induce ingrowth of granulation tissue and accelerate the degenerative process (Sycosis/ Psora/ Syphilis).
• Advanced degeneration (Syphilis) can lead to gas formation or calcification within the disk (Psora/ Sycosis). Also, fissures develop in the cartilaginous end plates, and regenerating chondrocytes and granulation tissue form in the area (Sycosis/ Psora/ Syphilis).

B- Disk Degeneration

One of the earliest signs of disk degeneration is loss of water content or desiccation (Psora/ Syphilis), most noticeable in the nucleus pulposus. Calcification is not uncommon in chronic degenerative disk disease.

Types of Disc Degeneration

Desiccation - loss of disk water (Psora)

Disk bulge - circumferential enlargement of the disk contour in a symmetric fashion (Psora)

Protrusion - a bulging disk that is eccentric to one side but < 3 mm beyond vertebral margin (Psora/ Sycosis)

Herniation - disk protrusion that extends more than 3 mm beyond the vertebral margin (Psora/ Syphilis/ Sycosis)

Extruded disk - extension of nucleus pulposus through the anulus into the epidural space (Sycosis/ Syphilis)

Free fragment - epidural fragment of disk no longer attached to the parent disk (Psora/ Sycosis)

Effects of Disk Degeneration

• As a consequence of intervertebral disk degeneration, normal axial loading on the spine stretches and lengthens the anular fibers, resulting in rounded, symmetric bulging of the disk beyond the margins of the vertebral body (Psora/ Syphilis).
• A bulging disk encroaches on the ventral spinal canal and inferior portions of the neuroforamina but does not displace or impinge the nerve roots (Psora/ Sycosis).

Anular Tears

An anular disc tear occurs when the substance of the anulus fibrosus "rips" or "tears" and allows that highly pressurized and potentially "evil" nucleus pulposus to escape outward toward the periphery of the disc (Syphilis/ Sycosis).

Types of Anular Tears

There are three types of anular tears in degenerated disks:

Type I (Concentric tears) - These are caused by rupture of the short transverse fibers connecting the lamellae of the anulus.

Type II (Radial tears) – In these tears the longitudinal fibers are disrupted through all layers of the anulus, from the surface of the anulus to the nucleus. Radial tears tend to be more irregular and obliquely oriented.

Type III (Transverse tears) – These result from rupture of Sharpey's fibers near their attachments with the ring apophysis. Transverse tears are located at the periphery of the anulus adjacent to the vertebral margins.

Fate of Anular tears

Complete disruption of the anulus exposes the nuclear material to the epidural tissues (Syphilis), inducing a focal inflammatory reaction (Psora). Vascular granulation tissue forms and grows into the disk through the annular tear (Sycosis). Degeneration of the intervertebral disk (Syphilis) has secondary effects on the adjacent vertebral end plates and bone marrow. Fissures develop in the cartilaginous end plates in show with disk degeneration (Syphilis). Vascular granulation tissue grows into the fissures (Sycosis) and induces an oedematous reaction and vascular congestion in the adjacent bone marrow (Psora).