Lumbar osteochondrosis is a chronic disease that develops as a result of a degenerative-dystrophic process in the intervertebral discs. The disease is widespread and affects most people between the ages of 25 and 40.
According to statistics, every second adult experiences back pain at least once in his life, while in 95% of cases it is caused by osteochondrosis of the spine.
Patients with a severe course of lumbar osteochondrosis, with persistent pain and other manifestations are recognized as temporarily disabled. If in four months his condition does not improve, the question of establishing a disability group is decided.
Lumbar osteochondrosis is a serious medical and social problem, since the disease mainly affects people of more working age, and also, in the absence of treatment, it can cause the formation of a herniated disc.
Causes and risk factors
The factors that predispose to the development of lumbar osteochondrosis are:
- column structure anomalies;
- lumbarization: congenital pathology of the spine, characterized by the separation of the first vertebra of the sacrum and its transformation into the sixth lumbar (additional);
- Sacralization is a congenital pathology in which the fifth lumbar vertebra fuses with the sacrum;
- asymmetric arrangement of the articular spaces of the intervertebral joints;
- pathological narrowing of the spinal canal;
- reflected spondiogenic pain (somatic and muscular);
- obesity;
- sedentary lifestyle;
- prolonged exposure to vibrations;
- systematic physical stress;
- smoking.
Unfavorable static-dynamic loads in combination with one or more risk factors cause a change in the physiological properties of the nucleus pulposus of the fibrous disc, which plays a cushioning role and ensures mobility of the spine. This process is based on the depolymerization of polysaccharides, which leads to the loss of moisture in the gelatinous core tissue. As a result, the nucleus pulposus and with it the fibrous disc lose their elastic properties. Additional mechanical stress causes the annulus fibrosus to bulge, which has lost its elasticity. This phenomenon is called protrusion. Cracks appear in the fibrous nucleus, through which fragments of the nucleus pulposus fall (prolapse, herniated disc).
Prolonged compression of the nerve roots that innervate certain organs of the abdominal cavity over time leads to impaired function.
Spinal segment instability is accompanied by reactive changes in the bodies of adjacent vertebrae, intervertebral joints, and concomitant spondyloarthrosis develops. A significant muscle contraction, for example, in the context of physical activity, leads to a displacement of the vertebral bodies and the entrapment of nerve roots with the development of radicular syndrome.
Another cause of pain and neurological symptoms in lumbar osteochondrosis can be osteophytes: bony outgrowths in vertebral bodies and processes that cause radicular syndrome or compression myelopathy (compression of the spinal cord).
Forms of the disease
Depending on the structures involved in the pathological process, lumbar osteochondrosis is clinically manifested by the following syndromes:
- reflex- lumbodynia, lumboishalgia, lumbago; develop against the background of reflex overexertion of the back muscles;
- compression (spinal, vascular, root): its development is caused by compression (compression) of the spinal cord, blood vessels or nerve roots. Some examples are lumbosacral radiculitis, radiculoischemia.
Symptoms of lumbar osteochondrosis
In lumbar osteochondrosis, symptoms are determined by the structures involved in the pathological process.
Low back pain occurs under the influence of hypothermia or physical overexertion, and sometimes for no apparent reason. The pain appears suddenly and is stabbing in nature. It is intensified by sneezing, coughing, turning the body, exercising, sitting, standing, walking. In the supine position, pain sensations are significantly weakened. Sensitivity and reflexes are preserved, the range of motion in the lumbar spine is reduced.
Observe on palpation:
- pain in the lumbar region;
- spasm of paravertebral muscles;
- flattening of the lumbar lordosis, which in many cases is combined with scoliosis.
The nerve root tension syndrome in low back pain is negative. When lifting a straight leg, patients notice increased pain in the lumbar region and not its appearance in an extended lower limb.
Often with lumbar osteochondrosis, there is a recurrence of attacks of pain, which become more intense and prolonged.
In low back pain, the clinical picture resembles low back pain, but the increase in pain intensity occurs over several days.
With lumboishalgia, patients complain of pain in the lumbar region that radiates to one or both lower extremities. The pain spreads to the buttocks and the back of the thigh and never reaches the feet.
Lumboishalgia is characterized by vasomotor disorders:
- changes in the temperature and color of the skin of the lower extremities;
- feeling hot or cold;
- violation of blood circulation.
The development of lumbar compression syndromes is clinically manifested by the following symptoms:
- Dermatomic hypalgesia;
- shooting pains;
- weakening or complete loss of deep reflexes;
- peripheral paresis.
With compression syndromes, pain is aggravated by bending the trunk, sneezing, and coughing.
Diagnosis
The diagnosis of lumbar osteochondrosis is made on the basis of data from the clinical picture of the disease, laboratory and instrumental research methods.
In blood tests in the context of lumbar osteochondrosis:
- decrease in calcium concentration;
- increased ESR;
- increased alkaline phosphatase levels.
In the diagnosis of lumbar osteochondrosis, great importance is attached to the X-ray examination of the spine.
Prolonged compression of the nerve roots that innervate certain organs of the abdominal cavity over time leads to impaired function.
The radiographic signs that confirm the diagnosis are:
- changes the configuration of the affected segment;
- pseudospondylolisthesis (displacement of adjacent vertebral bodies);
- deformation of the closing plates;
- flattening of the intervertebral disc;
- uneven intervertebral disc height (a symptom of a spacer), which is associated with asymmetric muscle tone.
Also in the diagnosis of lumbar osteochondrosis, if indicated, the following are used:
- myelography, magnetic resonance imaging or computed: are necessary for persistent symptoms, development of neurological deficits;
- scintigraphy (study of phosphorus accumulation by the bone system, marked with tech-99): performed if a tumor or infectious process, or a spinal injury is suspected.
The differential diagnosis of lumbar osteochondrosis is made with the following diseases:
- spondylolisthesis;
- dyshormonal spondylopathy;
- ankylosing spondylitis (ankylosing spondylitis);
- infectious processes (disc inflammation, spinal osteomyelitis);
- neoplastic processes (primary tumor of the spine or its metastatic lesions);
- rheumatoid arthritis;
- osteoarthritis deformation of the hip joint;
- reflected pain (diseases of the internal organs and large blood vessels).
Treatment of lumbar osteochondrosis
For lumbar osteochondrosis, the following treatment tactics are generally followed:
- bed rest for 2-3 days;
- traction of the affected segment of the spine;
- strengthen the back and abdominal muscles (creating the so-called muscular corset);
- impact on pathological myofascial and myotonic processes.
Low back pain occurs under the influence of hypothermia or physical overexertion, and sometimes for no apparent reason.
In most cases, conservative treatment of lumbar osteochondrosis is carried out, including the following measures:
- infiltration anesthesia of the muscles with a solution of local anesthetics;
- taking non-steroidal anti-inflammatory drugs;
- taking desensitizing agents;
- vitamin therapy;
- taking tranquilizers and antidepressants;
- manual therapy, massage;
- physical therapy exercises;
- acupuncture;
- post-isometric relaxation.
The absolute indications for the surgical treatment of lumbar osteochondrosis are:
- acute or subacute spinal cord compression;
- development of cauda equina syndrome, characterized by dysfunctions of the pelvic organs, sensory and movement disorders.
Therapeutic exercises for lumbar osteochondrosis
Physiotherapy plays an important role in the complex treatment of lumbar osteochondrosis. Regular exercises allow you to normalize the muscle tone of the paravertebral muscles, improve metabolic processes in the tissues affected by the pathological process, and, in addition, form a well-developed muscular corset that can support the spine in the correct position, eliminate unnecessary static loads.
For gymnastics with lumbar osteochondrosis to produce the greatest effect, it must adhere to the following principles:
- regularity of classes;
- gradual increase in intensity of physical activity;
- avoiding overwork during class.
Physiotherapy should be performed under the guidance of an experienced instructor, who will select the exercises that are most effective for a particular patient and monitor the accuracy of their implementation.
According to statistics, every second adult experiences back pain at least once in his life, while in 95% of cases it is caused by osteochondrosis of the spine.
In addition to classes with an instructor, you must perform a series of morning exercises daily, including special exercises for lumbar osteochondrosis.
- Relaxation and contraction of the abdominal muscles.The starting position is standing, with the feet shoulder-width apart and the arms toward the body. Breathe gently, relaxing the muscles of the anterior abdominal wall. During the exhale, pull your stomach in as much as possible, straining your abdominal muscles. The exercise should be repeated until mild fatigue appears.
- Head movements with flexion of the spine.The starting position is on your knees, resting on the floor with your arms extended and your back straight. Slowly raise your head and lean back. Hold this position for a few seconds and then gently return to the starting position. Repeat at least 10-12 times.
- "Pendulum".Starting position lying on your back, arms along the body, legs bent at right angles at the knee and hip joints. Twist your legs to the right and left in pendulous movements, trying to reach the ground. In this case, the shoulder blades cannot be pulled off the ground.
- Ship.Starting position lying face down, arms extended forward. Snatch your upper body and legs off the floor, bending your back. Hold this position for 5-6 seconds and slowly return to the starting position. Run 10 times.
Possible consequences and complications
The main complications of lumbar osteochondrosis are:
- formation of an intervertebral hernia;
- vegetative-vascular dystonia;
- spondylolysis, spondylolisthesis;
- osteophytosis;
- spondyloarthrosis;
- spinal canal stenosis, which results in compression of the spinal cord and can cause permanent disability and decreased quality of life.
Prolonged compression of the nerve roots that innervate certain organs of the abdominal cavity over time leads to impaired function. As a result, patients have intestinal dysfunctions (constipation, diarrhea, flatulence) and pelvic organs (urinary disorders, erectile dysfunction, frigidity, infertility).
Forecast
The pain syndrome in lumbar osteochondrosis presents in the form of remissions and exacerbations. Lumbago lasts 10-15 days, after which the patient's condition improves, the pain disappears. Associated secondary diseases can prevent a favorable outcome. Often with lumbar osteochondrosis, there is a recurrence of attacks of pain, which become more and more intense and prolonged.
Physiotherapy plays an important role in the complex treatment of lumbar osteochondrosis.
Patients with a severe course of lumbar osteochondrosis, with persistent pain and other manifestations are recognized as temporarily disabled. If in four months her condition does not improve, the question of establishing a disability group is decided.
Prevention
Prevention of the development of osteochondrosis of the spine consists of the following measures:
- quit smoking;
- normalization of body weight;
- improvement of general physical condition, active lifestyle;
- avoiding provocative conditions (lifting weights, sudden movements, twists, squats).