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What is lumbar osteochondrosis?

pain with lumbar osteochondrosis

Osteochondrosis in the lumbar region occurs due to deformation and destruction of the cartilage tissue of the intervertebral discs.Without the cartilage material, the vertebrae lose elasticity and shift, causing pain.According to the World Health Organization, the disease is mainly observed in people over 30 years old.Women get sick three times more often, which is associated with age-related changes and a decrease in the level of calcium 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 symptoms of the disease appear at the age of 30-35.Spinal osteochondrosis is diagnosed in 90% of people in old age.Painful sensations are experienced by 7 out of 10 people, exacerbation can last from 6 to 16 months.

Stages of development

  • 1st - the beginning of degenerative disorders affecting nerve endings and disrupting blood supply.The inflammatory process causes pain that spreads to the legs.The patient sometimes feels tingling in the back and buttocks.Appears after heavy physical exertion.
  • 2nd - the outer shell (fibrous ring) of the intervertebral disc is destroyed.The distance between the vertebrae decreases, the nerve endings are compressed, which causes severe, sharp pain.Symptoms are especially pronounced when walking.
  • 3rd - due to excessive mobility of the vertebrae, muscle fibers and nerve endings are compressed.Spasms, numbness, burning pain, ruptures occur - displacement of the intervertebral disc to the spinal cord.
  • 4th - the growth of pathological exostoses in 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, in a combination of a number of cases, that is, the development of the disease depends on the influence of several factors:

  • Sedentary lifestyle (physical inactivity), sedentary work, low level of physical activity.At first glance, they are not dangerous.However, with long-term exposure, the muscle tone of the so-called "muscle corset" weakens.Supports the spine and internal organs.Thus, physical inactivity causes disruption of a number of systems - blood circulation, breathing, digestive system.
  • Overweight.When the BMI (Quetelet body mass index) is above 25 kg/m2, excess weight creates additional stress on the body: it puts pressure on the spine, overloads the joints and disrupts the blood supply.
  • Endocrine pathological processes.Hormonal imbalance, disorders in the work of adrenal glands and thyroid gland "slow down" metabolism in the body.Often, hormonal changes "wash" calcium from bone tissue, making it weak and brittle.
  • Unbalanced diet.Popular and affordable fast food meals fully satisfy the body's energy needs, but are completely useless in terms of saturating the body with the necessary vitamins and trace elements.
  • 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.

Lumbar osteochondrosis occurs many times more often in men whose profession involves significant physical activity.

Symptoms of lumbar osteochondrosis

Pain is the main indicator of the onset and localization of the disease.A preliminary diagnosis can be made based on the nature, frequency and duration of the outbreak.Often, patients with lumbar osteochondrosis feel aching pain that spreads to the leg, groin, and tailbone.In the horizontal position, the discomfort disappears.

Spinal nerves extend from the trunk of the spine to various 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 certain area: "radicular syndrome" manifests itself in this way.

The map of the spinal nerve 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.Symptoms of osteochondrosis depending on segmental innervation:

  • L3-L4 – weak knee reflex, partial numbness, episodic loss of sensation are noted along the front surface of the thigh;
  • L4-L5 – muscle weakness, the patient cannot straighten the body while standing on the heel, pain and sensitivity disorders extend from the waist to the hip area, as well as along the entire lateral surface of the thigh (from top to bottom).
  • L5–S1 – trembling in the calf muscle, inability to stand on the toes, pain in the back of the thigh.

In rare cases, the radicular arteries are also involved in the destructive process, provoking a spinal stroke - a dangerous pathology in which the patient faces paresis and paralysis and dysfunction of the pelvic organs.

Pain reflex signs

  • Lumbago or lumbago (not sciatica in this case!) – sharp pain.Any awkward movement, even sneezing and coughing, provokes a spasm.The patient spontaneously changes the body position, moves it to the side.Attempting to maintain a vertical position provokes a new lumbago.
  • Lumbodynia is a dull and aching pain that occurs on one side.Periods of remission are accompanied by exacerbations, which gradually turn into severe pain.
  • Lumboischialgia - painful sensations appear in the leg.

Side symptoms of the disease are not very typical and can easily be mistaken for symptoms of another problem: disturbed sweating (hypohidrosis), paleness of the skin of the affected area due to poor blood circulation, severe dryness and peeling.

Diagnostics

At the initial stage, the complete medical history of the patient is collected.The general picture should be completed with the opinions of a surgeon, orthopedist, neurologist and rheumatologist.Specialists conduct a visual examination of the patient to assess changes in posture, muscle tone and skin sensitivity.

An X-ray examination is performed for the initial diagnosis of grade 1 lumbar osteochondrosis;it is used to examine the condition of the intervertebral discs, pathologies of the spinal cord, as well as to assess 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 very sensitive examination using ionizing rays.CT 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 muscle mass, blood vessels and ligaments.Detects tumors and inflammatory processes.

Myelography is one of the methods of visual evaluation of the condition of the spinal cord and nerve roots, the space between the pia mater of the spinal cord and the arachnoid part of the spinal cord is injected with a contrast agent using a needle, and it is filled with cerebrospinal fluid.Like 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 to study the symmetry of limbs, check vibration sensitivity and evaluate Babinsky, Chaddock and Oppenheimer reflexes.

Treatment of lumbar osteochondrosis

The effectiveness of conservative treatment is achieved by a combination of drugs of different groups, massage and manual therapy.However, lumbar osteochondrosis in the 3rd stage can no longer be treated with conservative methods;surgical intervention is required.One of the surgical methods for osteochondrosis is microdiscectomy.This is a neurosurgical operation performed to remove the hernia without damaging the nerve structures.It is performed under general anesthesia.The patient can walk on the 3rd day.

Drug therapy (for stages 1-2)

  • Analgesics for pain relief: local (ointments, gels), oral (tablets, suspensions), intramuscular (injection solutions).
  • Non-steroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, removes swelling.Gels and tablets are most often used, in more serious cases (inflammation of the sciatic nerve) - injections.Initial course - 7-14 days.
  • Muscle relaxants.It is prescribed in the acute period for muscle spasms, as well as in the remission period to strengthen the effect.
  • Chondroprotectors.Block destructive processes in intervertebral discs, promote regeneration, improve metabolism in cartilage tissues.
  • Intravenous drugs.Helps normalize blood supply to the musculoskeletal system.
  • B group vitamin complexes.Improve nerve conduction.
  • Diuretics.Reduces swelling.

During an exacerbation, strong injections are used as an emergency - paravertebral blockade, which causes a temporary loss of sensitivity.

It is also recommended to take a course of manual therapy twice a year, which relieves muscle tension and spasm, restores blood circulation, improves lymph circulation, and increases the mobility of the musculoskeletal system.

Prevention

  • Active lifestyle with moderate physical activity;
  • Choosing comfortable or orthopedic shoes if indicated;
  • Good nutrition;
  • Body weight control;
  • Sleep only on an orthopedic mattress and pillow;
  • Only office furniture with a straight back;
  • Rejection of heavy loads on the back and waist.When carrying heavy objects, the load should be evenly distributed in both hands.