Back pain in the lumbar region.

About 40-80% of people complain that the spine hurts in the lumbar region, but no more than 25% of them seek medical help. In fact, such unpleasant sensations can be caused both by relatively harmless reasons and by pathological changes in the spine. Therefore, you should not treat them with disdain.

Causes of back pain

The spinal column consists of a whole complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves. Changes in any of them can be accompanied by painful sensations, and of a different nature. In addition, the spine is surrounded by the paravertebral muscles, a pain that patients often mistake for pain in the spine. Therefore, the causes of pain can be many. This can be overwork, a natural restructuring of the body during pregnancy, etc. But if the pain occurs regularly, it is worth contacting a vertebrologist or neurologist, since often the fact that the spine systematically hurts in the lumbar region indicates the development of certain diseases. .

Most often, in such situations, patients are diagnosed:

• pathology of the intervertebral discs (decreased disc height, protrusion, intervertebral hernia, discitis);
• pathologies of the facet joints (spondyloarthrosis, joint cysts);
• inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
• compression fractures of the vertebrae in the context of osteoporosis;
• Neoplastic lesions of the spine.

Intervertebral disc pathologies

Degenerative changes in intervertebral discs or osteochondrosis are very common, especially among young and middle-aged people. This is largely due to the need to sit for a long time or do heavy physical work. In old age, the disc dries out and the vertebrae grow together.

Already in the initial stages of the appearance of degenerative changes in the intervertebral discs, which are cartilage of a special configuration that divides the vertebral bodies, pain in the spine can occur. This is due to irritation of the pain receptors in the outer layers of the disc, as well as the posterior longitudinal ligament of the spine. Often osteochondrosis provokes an aseptic inflammatory process, which leads to a reflex spasm of the segmental muscles. As a result, the pain in the spine increases and there are also mobility restrictions.

Osteochondrosis tends to progress constantly, especially in the absence of proper treatment and lifestyle correction. Subsequently, it leads to the formation of protrusions, and subsequently to intervertebral hernias, which causes the aggravation of existing symptoms and the appearance of new ones.

The lumbar region, due to the fact that it supports the highest loads in daily activities, is most often affected.

Bumps are bumps on the disc that maintain the integrity of its outer layer, called the annulus fibrosus. Although they maintain the influence of the provoking factors over time, the fibers of the fibrous ring do not resist the load and pressure of the internal content of the disc (nucleus pulposus) and they rupture. As a result, the nucleus goes beyond the physiological position of the intervertebral disc. At the same time, the spine in the lumbar region always hurts or the pain radiates to the leg, and discomfort increases with sudden movements, bending over, lifting heavy objects, straining, coughing, sneezing, laughing, as well as prolonged sitting. weather. a position, walking, standing.

Often, patients with already formed lumps and hernias unconsciously assume a strained posture, leaning slightly to the healthy side. In this case, pain in the spine in the lumbar region can reach a high intensity, depriving a person of the ability to work. In such cases, he is forced to adhere to bed rest, and to relieve pain, he squeezes the bent leg and brought it to the stomach.

Most often, bumps and hernias form in the direction of the spinal canal, through which the spinal cord (cauda equina) and the nerve roots that branch from it pass. The latter pass through the natural openings of the vertebral bodies and branch into the lumbar plexus, which is responsible for the innervation of the lower extremities and various organs (including the genitalia).

Therefore, often with long-term osteochondrosis, the formation of hernias in the lumbar region, pain in the spine not only gradually intensifies, but is also supplemented by other disorders. If a deformed disc or swollen soft tissues as a result of the inflammatory process squeeze the spinal root that passes near them, neurological disorders occur. Therefore, spinal pain in the lumbar region can be supplemented by radiating to the buttocks, groin, front, inner, outer thigh, lower leg, and foot. It depends on what type of nerve root will be affected, that is, at the level of which segment of spinal movement pathological changes will be observed. In addition, in the corresponding areas of the lower extremities, sensitivity disorders in the form of a crawling sensation, numbness, changes in susceptibility to temperature, pain, tactile stimuli, and limited mobility can be observed.

Changes in the height and functionality of the discs that arise in osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as degeneration of the vertebral bodies themselves. The consequence of this is the development of spondylosis, that is, the calcification of the anterior longitudinal ligament and the formation of bone-cartilaginous growths on the surface of the vertebral bodies (osteophytes). Not only can they damage the surrounding tissue and squeeze the roots of the spine, causing severe pain in the spine, but they can also grow together. As a result, the adjacent vertebral bodies combine into a single whole, dramatically limiting mobility in the lower back.

Osteochondrosis can be accompanied by reactive changes in the vertebral bodies, in particular, reactive aseptic spondylitis, leading to osteosclerosis. This is accompanied by compaction of bone tissue and dramatically increases the likelihood of vertebral fractures.

Facet joint diseases

Pathologies of the facets or facet joints of the lumbar spine, in particular its osteoarthritis, can also cause pain in the spine in the lumbar region, including severe pain. Although more often the pain is painful and is located deep inside. Its appearance is due to the fact that its synovial capsule is richly innervated. In such situations, the pain is usually concentrated directly in the affected area and tends to increase with flexion, extension, twisting of the body, and prolonged position. Walking and sitting help reduce its severity. But in some cases, the pain can also occur in the groin area, the coccyx, as well as the back and outer thighs.

Inflammatory diseases of the spine.

Inflammatory diseases of the spine are less common than pathologies of the intervertebral discs and facet joints. However, they also hurt the spine. These include:

• ankylosing spondylitis or ankylosing spondylitis;
• reactive arthritis;
• psoriatic arthritis, etc.

Symptoms of these diseases generally occur before age 40 and most often by age 20. This distinguishes them from degenerative-dystrophic pathologies of the discs and joints of the spine, which often develop after the age of 40. In this case, the pain is characterized by a gradual increase in intensity. Also, its severity decreases after physical exertion, but does not decrease at rest. Therefore, in inflammatory diseases, the spine in the lumbar region often hurts at night and especially in the morning, immediately after sleeping.

The most difficult situation is observed with ankylosing spondylitis, and it is she who affects the lumbar region more often than other inflammatory diseases. This term means inflammation of the intervertebral joints with their subsequent immobilization due to the formation of dense bone, cartilaginous or fibrous fusion between the articulated bone structures.

At first, it is characterized by mild back pain, but over time it gradually spreads upward, covering the thoracic spine and then the cervical spine. This is associated with the development of limitation of the mobility of the spine in all planes, since the spinal column, as a consequence of the changes that are taking place, seems to be immersed in a specific case. He also observed:

• alignment of the lumbar lordosis (natural curvature of the spine in the lumbar region);
• worsening of thoracic kyphosis, leading to slouching;
• reflex tension of the back muscles;
• progressive worsening of mobility limitation due to the involvement of the facet joints in the pathological process and the ossification of the intervertebral discs;
• morning stiffness for an hour or more.

Inflammation of the iris (iritis), cornea (keratitis), mucosa (conjunctivitis), iris and ciliary body of the eyeball (iridocyclitis) is observed in 10-50% of patients.

The progression of ankylosing spondylitis leads to the fact that an increasing number of joints in the pathological process. As a result, patients are forced to acquire the so-called supplicating pose. It means pronounced kyphosis of the thoracic spine, inclination of the upper part of the body downwards, flexion of the knees with a strong limitation of the range of motion in the chest, which affects the depth of breathing.

The rate of disease progression depends on the adequacy and completeness of the treatment.

Compression fracture of the vertebra.

Compression fracture is the flattening of the vertebral body, as a result of which it becomes wedge-shaped. This leads to alteration of the anatomy of the spine, can cause trauma to the spinal cord and its roots, and also become a trigger for the rapid progression of degenerative-dystrophic changes.

Lumbar vertebrae 1 and 2 are more susceptible to injury, as they take on the greatest axial load.

Compression fractures of the spine often occur in the elderly due to the development of osteoporosis, that is, a decrease in bone density. In such cases, to injure yourself, it may be enough not only a slight fall, but also lifting weights - an unsuccessful movement.

The pathology is characterized by the presence of pain in the spine, which limits movement, increases when sitting, movement and attempts to lift a straight leg. It usually lasts 1 to 2 weeks and then gradually tapers over 2 to 3 months. In some cases, there is radiation of pain to the ridges of the iliac bones and hips. A decrease in the height of a broken vertebra causes an increase in lumbar lordosis, which also contributes to the appearance of painful sensations.

If a fracture is not diagnosed in a timely manner, a decrease in the height of the vertebra leads to changes in posture, a decrease in growth. This causes reflex tension and shortening of the spinal muscles, leading to chronic back pain and requiring prolonged rest.

Neoplastic spinal lesions

Neoplastic lesions of the spine mean the formation of benign and malignant tumors in it, as well as metastases, the source of which is neoplasms of other organs. This is much less common than pathologies of the intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, that is, only in 1-2% of patients with back pain. But such injuries require the earliest possible diagnosis and treatment.

The characteristic features of neoplastic lesions of the spine, in addition to pain in it, are:

• an increase in body temperature, even to subfebrile values;
• unreasonable weight loss;
• inability to find a comfortable body position;
• the presence of pain at night;
• severe pain in the spine;
• inability to relieve pain with conventional painkillers.

Even if you have 1 or 2 of these symptoms, you should make an appointment with your doctor right away.

Similarly, the following may appear:

• Chondroma is a malignant tumor that is diagnosed in 20% of patients with cancerous lesions of the spine. Most of the time it is formed in the sacrum and can occur in people of any age and sex.
• Young's sarcoma: occurs in 8% of patients with neoplastic lesions of the spine. More common in young men.
• Chondrosarcoma is a malignant neoplasm that represents 7 to 12% of cases. It is found most often in middle-aged men.
• The aneurysmal bone cyst is a benign neoplasm.
• Hemangioma is a benign vascular tumor that is present in 11% of people. It may not be detected throughout a person's life. But it increases the risk of vertebral fractures.
• Metastases from other tumors are secondary malignancies. Most commonly, cancer of the breast, prostate, lung, and, less commonly, kidney, thyroid, and skin cancer metastasize to the spine.

Diagnostics

If your spine hurts in your lower back, it is worth making an appointment with a neurologist or vertebrologist. At the appointment, the doctor initially collects an anamnesis, asking questions about the nature of the pain, the circumstances of its appearance, the duration of its persistence, the presence of other symptoms, lifestyle, etc.

Then the specialist performs an examination. As part of it, not only palpates the spine, determines the location of pain, evaluates the gait and posture that the patient takes unconsciously, but also performs functional tests. With the help of it, he can detect signs of ankylosing spondylitis, neurological deficit, assess the degree of mobility of the spine and obtain other diagnostic data.

Based on this, the doctor can already assume the possible causes of the pain syndrome. To clarify them, as well as to accurately determine the degree of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed. Most of the time they resort to help:

• X-ray in frontal and lateral projection, sometimes with functional radiological tests;
• CT: allows better visualization of bone structures, therefore it is used more frequently to diagnose spondylosis, fractures, bone tumors, etc. ;
• Magnetic resonance imaging: allows to assess the state of cartilaginous structures and soft tissues in the most scrupulous way possible, which is why it is often used to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord injuries, etc. ;
• electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of nerve damage;
• radioisotope bone scan - used to diagnose malignant tumors and metastases;
• X-ray densitometry is the best method to diagnose osteoporosis;
• myelography - used to detect signs of compression of the spinal cord and cauda equina nerves.

Treatment

For each patient, the treatment is selected strictly individually, and not only based on the diagnosis, but also on the nature of the existing concomitant pathologies. However, it is the cause of back pain that determines the tactics of therapy. It can be conservative or involve surgical intervention.

But the first step is always to direct efforts to relieve pain, especially if it is severe. For this, patients are prescribed NSAIDs, antispasmodics, painkillers. And in severe cases, spinal blocks are performed: injections of anesthetics and corticosteroids at specific points in the spine.

Bed rest is not shown to all patients. And with pathologies of the intervertebral discs, it can be completely contraindicated, since a decrease in physical activity contributes to the transformation of acute pain in the spine into chronic pain.

Exclusively conservative or non-surgical treatment is prescribed for:

• osteochondrosis;
• ankylosing spondyloarthritis;
• osteoarthritis of the facet joints;
• Mild compression fractures.

It is usually complex and consists of:

• drug therapy, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids,
• physiotherapy (UHF, magnet therapy, laser therapy, traction therapy, etc. );
• Exercise therapy;
• manual therapy.

If the cause of back pain is intervertebral hernias, bulges, spondylosis, severe vertebral fractures, tumors, surgery is often indicated. It is also necessary for:

• ineffectiveness of conservative therapy for degenerative-dystrophic changes;
• an increase in neurological deficit;
• spinal motion segment instability;
• the development of complications, in particular spinal canal stenosis.

Most modern spinal surgeries are minimally invasive. Thanks to this, intraoperative and postoperative risks are drastically reduced, the rehabilitation period is shortened and facilitated, and the effectiveness is not inferior to the most traumatic open operations. Depending on the disease detected, it may be recommended:

• Discectomy is an operation indicated mainly for hernias and protrusions, especially those that cause cauda equina syndrome. It can be performed using microsurgical instruments through an incision of the order of 3 cm (microdiscectomy) and using endoscopic equipment delivered to the spine through punctures with a diameter of approximately 1 cm (endoscopic discectomy). When the intervertebral disc is completely removed, it is usually replaced with implants.
• Vertebroplasty and kyphoplasty: indicated for compression fractures of the vertebrae, hemangiomas and some other diseases. The essence of the operation is to inject fast-setting bone cement through a thin cannula into the vertebral body, strengthening it. With kyphoplasty, it is also possible to restore the normal dimensions of the vertebral body, which is important in case of a severe decrease in its height as a result of a fracture.
• Fixation surgeries are used to stabilize the spine. For this, metallic structures of a different nature are used, which usually remain in the patient's body until the end of life.

Therefore, the spine in the lumbar region can hurt for a variety of reasons. Therefore, with the prolonged persistence of painful sensations, their regular appearance, increasing pain over time, and even more so the addition of other symptoms, it is imperative to contact a vertebrologist or neurologist. Early diagnosis will allow to detect pathological changes in the stages in which it is easier to cope with them and if the disease is not completely cured, at least stop its progression and maintain a high standard of living.