Osteochondrosis in the lumbar region occurs due to deformation and destruction of the cartilaginous tissue of the intervertebral discs.Without cartilaginous material, the vertebrae lose their elasticity and shift, causing pain.According to the WHO, the disease mainly affects people over the age of 30.Women get sick three times more often, which is also associated with age-related changes and a decrease in calcium levels in the body.
Osteochondrosis of the lower back
Of all diseases of the peripheral nervous system, osteochondrosis of the spine accounts for 80%, of which 60-80% affects the lumbar region, consisting of 5 vertebrae.In 40% of people the first signs of the disease appear at the age of 30-35 years.In old age, spinal osteochondrosis is diagnosed in 90% of people.Painful sensations are experienced by 7 out of 10 people, the exacerbation can last from 6 to 16 months.
Development phases
- 1st – the onset of degenerative disorders, which affect the nerve endings and interrupt the blood supply.The inflammatory process causes pain that radiates to the legs.The patient occasionally feels tingling in the back and buttocks.It appears after intense physical exertion.
- 2nd – the outer shell of the intervertebral disc (fibrous ring) is destroyed.The distance between the vertebrae is reduced, the nerve endings are compressed, causing severe, sharp pain.Symptoms are especially pronounced while walking.
- 3rd – due to excessive mobility of the vertebrae, the muscle fibers and nerve endings are compressed.Spasms, numbness, burning pain, hernias occur: displacement of the intervertebral disc in the spinal cord.
- 4th – growth of pathological exostoses on the bone structure.The spine literally “turns to stone.”Progressive arthrosis and lack of treatment immobilize the patient.
Reasons for development
The disease develops slowly, under the confluence of a number of circumstances, that is, the development of the disease depends on the influence of not one, but several factors:
- Sedentary lifestyle (physical inactivity), sedentary work, low level of physical activity.At first glance, they are not dangerous.However, with prolonged exposure, muscle tone, the so-called “muscle corset”, weakens.Supports the spine and internal organs.Therefore, physical inactivity causes disruption of the functioning of numerous systems: blood circulation, breathing, digestion.
- Overweight.With a BMI (Quetelet body mass index) above 25 kg/m2, excess weight creates additional stress on the body: it puts pressure on the spine, overloads the joints and compromises the blood supply.
- Endocrine pathological processes.Hormonal imbalance, disturbances in the functioning of the adrenal glands and thyroid “slow down” the body's metabolism.Frequent hormonal changes “wash away” calcium from bone tissue, making it weak and fragile.
- Unbalanced diet.Popular and cheap fast food fully satisfies the body's energy needs, while from the point of view of saturating the body with the necessary vitamins and microelements it is absolutely useless.
- Pathologies and genetic predisposition to diseases of the musculoskeletal system.
- Age-related degenerative changes.Under the influence of time, natural wear of the support system occurs.
In men whose profession involves significant physical activity, lumbar osteochondrosis occurs many times more often.
Symptoms of lumbar osteochondrosis
Pain is the main indicator of the onset of the disease and its localization.Based on the nature of the event, frequency and duration, a preliminary diagnosis can be made.Most often, patients with lumbar osteochondrosis experience aching pain radiating to the leg, groin area and coccyx.In a horizontal position the discomfort disappears.
Spinal nerves extend from the trunk of the spine to different parts of the body.Each nerve is responsible for a specific area.This is called "segmental innervation".It is for this reason that the affected nerve "responds" in a specific area: this is how "radicular syndrome" manifests itself.
The spinal nerve map allows you to identify pain with a specific area of the spine: C1-C8 - 8 cervical, T1-T12 - 12 thoracic, L1-L5 - 5 lumbar, S1-S5 - 5 sacral, C0 - 2 coccygeal.Signs of osteochondrosis dependent on segmental innervation:
- L3-L4 – weak knee reflex, partial numbness, episodic loss of sensation along the anterior surface of the thigh;
- L4-L5 – muscle weakness, the patient is unable to fix the body while standing on the heels, pain and sensitivity disorders extend to the area from the lower back to the buttock, as well as along the entire lateral surface of the thigh (from top to bottom).
- L5-S1 – tremors in the calf muscle, inability to stand on tiptoe, pain in the back of the thigh.
In rare cases, radicular arteries are also involved in the destructive process, causing a spinal stroke - a dangerous pathology in which the patient experiences paresis, paralysis and dysfunction of the pelvic organs.
Reflex symptoms of pain
- Lumbago or lumbago (in this case not sciatica!) – sharp pain.Any awkward movement, even sneezing and coughing, causes a spasm.The patient spontaneously changes the position of the body, moving it to the side.An attempt to assume a vertical position causes new low back pain.
- Lumbbodynia is a dull, aching pain that occurs on one side.Periods of remission are followed by an exacerbation, which gradually develops into severe pain.
- Lumboischialgia: painful sensations appear in the leg.
Side signs of the disease are not so typical and can easily be confused with the symptoms of another problem: reduced sweating (hypohidrosis), paleness of the skin of the affected area due to poor blood circulation, severe dryness and peeling.
Diagnostics
In the initial phase, the patient's complete medical history is collected.The general picture should be supplemented by the opinions of a surgeon, an orthopedist, a neurologist and a rheumatologist.Specialists subject the patient to a visual examination to evaluate changes in posture, muscle tone and skin sensitivity.
X-ray is performed for the primary diagnosis of 1st degree lumbar osteochondrosis;it is used to examine the condition of the intervertebral discs, pathologies of the spinal cord, and also to evaluate the general condition of the spine.However, this type of diagnosis does not provide complete information about the affected tissues.
Computed tomography (CT) is a highly sensitive test that uses a beam of ionizing rays.The CT scan records the degree of disc deformation, inflammatory processes in the spinal cord membrane and nerve endings in a layer-by-layer image.
Magnetic resonance imaging (MRI) informatively shows the general condition of the muscle mass, blood vessels and ligaments.Detects tumors and inflammatory processes.
Myelography is one of the ways to visually assess the condition of the spinal cord and nerve roots by injecting a contrast medium using a needle into the cavity between the pia mater and the arachnoid of the spinal cord, filled with cerebrospinal fluid.Similar to CT, MTP and x-ray, the procedure is performed in real time.
Neurological examination of sensitivity and reflexes for pathologies is a complex of studies that includes a screening method for studying the symmetry of the limbs, testing sensitivity to vibrations and evaluating Babinsky, Chaddock and Oppenheiman reflexes.
Treatment of lumbar osteochondrosis
The effectiveness of conservative treatment is achieved through a combination of drugs of various groups, massage and manual therapy.However, at stage 3, lumbar osteochondrosis can no longer be treated with conservative methods;surgery is required.One of the surgical methods for osteochondrosis is microdiscectomy.This is a neurosurgical procedure to remove a hernia without damaging the nerve structures.It is performed under general anesthesia.The patient can walk already on the 3rd day.
Drug therapy (for stages 1-2)
- Analgesics to relieve pain: local (ointments, gels), oral (tablets, suspensions), intramuscular (injectable solutions).
- Nonsteroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, removes swelling.Most often gels and tablets are used, in more severe cases (inflammation of the sciatic nerve) - injections.First Course - 7-14 days.
- Muscle relaxants.Prescribed in the acute period for muscle spasms, as well as during the period of remission to consolidate the effect.
- Chondroprotectors.Blocks destructive processes in intervertebral discs, promotes regeneration, improves metabolism in cartilaginous tissues.
- Vascular drugs.Helps normalize blood supply to the musculoskeletal system.
- Group B vitamin complexes. They improve nerve conduction.
- Diuretics.Reduces swelling.
As emergency help at the time of exacerbation, powerful injections are used: paravertebral blockade, which causes temporary loss of sensitivity.
It is also recommended to undergo a course of manual therapy twice a year, which relieves muscle tension and spasms, restores blood circulation, improves lymphatic circulation and increases the mobility of the musculoskeletal system.
Prevention
- Active lifestyle combined with moderate physical activity;
- Choose comfortable or, if indicated, orthopedic shoes;
- Good nutrition;
- Body weight control;
- Sleep only on an orthopedic mattress and pillow;
- Office furniture only with flat back;
- Refusal of heavy loads on the back and spine.When carrying heavy objects, the load should be distributed evenly across both hands.