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 25 and 40 years of age.
According to statistics, every second adult has back pain at least once in their 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 within four months your condition does not improve, the question of establishing a group of disabled people is decided.
Lumbar osteochondrosis is a serious medical and social problem, since the disease affects mainly people of working age and, in addition, in the absence of treatment, it can cause the formation of herniated discs.
Causes and risk factors
Factors that predispose to the development of lumbar osteochondrosis are:
- anomalies in the structure of the spine;
- lumbarization - congenital pathology of the spine, characterized by the separation of the first sacrum vertebra and its transformation into the sixth (additional) lumbar; Sacralization
- is a congenital pathology in which the fifth lumbar vertebra fuses with the sacrum;
- asymmetric arrangement of the joint spaces of the intervertebral joints;
- pathological narrowing of the spinal canal;
- reflected spondogenic pain (somatic and muscular);
- obesity;
- sedentary lifestyle;
- prolonged exposure to vibration;
- systematic physical stress;
- smoking.
Unfavorable static-dynamic loads in combination with one or more risk factors lead to an alteration in the physiological properties of the pulpal nucleus of the fibrous disc, which plays a shock-absorbing role and ensures mobility of the spine. This process is based on the depolymerization of the polysaccharides, which leads to the loss of moisture in the tissue of the gelatinous core. As a result, the pulpous nucleus and the fibrous disc lose their elastic properties. More mechanical tension causes protrusion of the fibrous ring that has lost its elasticity. This phenomenon is called protrusion. Cracks appear in the fibrous nucleus, where fragments of the pulpal nucleus fall (prolapse, herniated disc).
The prolonged compression of the nerve roots that innervate certain abdominal organs over time leads to the deterioration of their functioning.
The instability of the spinal segment is accompanied by reactive changes in the bodies of the adjacent vertebrae, intervertebral joints and the development of concomitant spondyloarthrosis. A significant muscle contraction, for example, in the context of physical activity, leads to a displacement of the vertebral bodies and compression of the nerve roots with the development of the root syndrome.
Another cause of pain and neurological symptoms in lumbar osteochondrosis can be osteophytes - bony protuberances in processes and vertebral bodies that cause root syndrome or compression myelopathy (spinal cord compression).
Forms of the disease
Depending on which structures are involved in the pathological process, lumbar osteochondrosis is clinically manifested by the following syndromes:
- reflex- lumbodynia, low back pain, lumbago; develop in the context of reflex overvoltage of the back muscles;
- compression (spinal, vascular, root)- its development is caused by compression (compression) of the spinal cord, blood vessels or nerve roots. Examples are lumbosacral radiculitis, radiculoischemia.
Symptoms of lumbar osteochondrosis
In lumbar osteochondrosis, symptoms are determined by the structures that are involved in the pathological process.
The lumbago occurs under the influence of hypothermia or excessive physical effort and, sometimes, for no apparent reason. The pain comes on suddenly and has a shooting character. She intensifies with sneezing, coughing, turning the body, exercising, sitting, standing, walking. In the supine position, the pain sensations are significantly weakened. Sensitivity and reflexes are preserved, the range of motion of the lumbar spine is reduced.
Observe the palpation:
- pain in the lower back;
- spasm of the paravertebral muscles;
- flattening of lumbar lordosis, which in many cases is associated with scoliosis.
The nerve root tension syndrome in the lumbago is negative. When lifting an extended leg, the patient notices an increase in pain in the lower back, not its appearance in an extended lower limb.
Often, in lumbar osteochondrosis, pain crises recur, increasingly intense and prolonged.
In lumbodynia, the clinical picture is similar to lumbago, but the increase in pain intensity occurs over several days.
In low back pain, patients complain of pain in the lower back that radiates to one or both lower limbs. The pain spreads to the buttocks and back of the thigh and never reaches the feet.
Vasomotor disorders are characteristic of low back pain:
- changes in temperature and skin color 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:
- dermatomal hipalgesia;
- sharp pains;
- weakening or complete loss of deep reflexes;
- peripheral paresis.
In compression syndromes, the pain is aggravated by trunk flexion, sneezing and coughing.
Diagnosis
The diagnosis of lumbar osteochondrosis is made based on data from the clinical picture of the disease, laboratory methods and instrumental investigation.
On blood tests in the context of lumbar osteochondrosis:
- decrease in calcium concentration;
- increased ESR;
- increased levels of alkaline phosphatase.
In the diagnosis of lumbar osteochondrosis, radiographic examination of the spine is of great importance.
The prolonged compression of the nerve roots that innervate certain abdominal organs over time leads to the deterioration of their functioning.
The X-ray 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 height of the intervertebral disc (a symptom of a spacer), which is associated with asymmetric muscle tone.
Also used in the diagnosis of lumbar osteochondrosis, if indicated, are used:
- myelography, computerized image or magnetic resonance imaging - are necessary for persistent symptoms, the development of neurological deficits;
- scintigraphy (study of the accumulation of phosphorus by the bone system, marked with tech-99) - is performed if a tumor or infectious process is suspected, spinal cord injury.
The differential diagnosis of lumbar osteochondrosis is carried out with the following diseases:
- spondylolisthesis; dysormonal spondylopathy
- ; ankylosing spondylitis (ankylosing spondylitis);
- infectious processes (inflammation of the disc, spinal osteomyelitis);
- neoplastic processes (primary tumor of the spine or its metastatic lesions);
- rheumatoid arthritis;
- deforming osteoarthritis of the hip joint;
- reflected pain (diseases of Organs internal organs and large blood vessels).
Treatment of lumbar osteochondrosis
For lumbar osteochondrosis, the following treatment tactics are generally followed:
- rest in bed for 2-3 days;
- traction of the affected spine segment;
- strengthening of the back and abdominal muscles (creating the so-called muscle corset);
- impact on myofascial and myotonic pathological processes.
The lumbago occurs under the influence of hypothermia or excessive physical effort and, sometimes, for no apparent reason.
In most cases, conservative treatment of lumbar osteochondrosis is performed, including the following measures:
- infiltration anesthesia of the muscles with a local anesthetic solution;
- taking non-steroidal anti-inflammatory drugs;
- taking desensitizing agents;
- vitamin therapy;
- taking tranquilizers and antidepressants;
- manual therapy, massage;
- physiotherapy 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 Organs pelvic organs, sensory and movement disorders.
Therapeutic exercises for lumbar osteochondrosis
Physiotherapy plays a significant role in the complex treatment of lumbar osteochondrosis. Regular exercises allow normalizing the muscle tone of paravertebral muscles, improving metabolic processes in the tissues affected by the pathological process and, in addition, forming a well-developed muscle corset that can support the spine in the correct position, removing unnecessary static loads from it.
For gymnastics with lumbar osteochondrosis to have the greatest effect, you must adhere to the following principles:
- regularity of classes;
- gradual increase in the intensity of physical activity;
- avoiding overwork during class.
Physiotherapy should be performed under the guidance of an experienced instructor, who will select the most effective exercises for a given patient and control the accuracy of their application.
According to statistics, every second adult has back pain at least once in their life, while in 95% of cases it is caused by osteochondrosis of the spine.
In addition to instructor-led classes, you must perform a series of morning exercises daily, which include special exercises for lumbar osteochondrosis.
- Relaxation and contraction of the abdominal muscles.The starting position is standing, feet shoulder-width apart, arms lowered to the body. Breathe gently, relaxing the muscles of the anterior abdominal wall. During exhalation, contract your stomach as much as possible, tightening your abdominal muscles. The exercise should be repeated until slight fatigue appears.
- Head movements with flexion of the spine.The starting position is on your knees, resting on the floor with your arms extended, your back straight. Slowly lift your head and bend your back. Hold in this position for a few seconds, then gently return to the starting position. Repeat at least 10-12 times.
- "Pendulum".Initial position lying on your back, arms along your body, legs bent at right angles at the knee and hip joints. Turn your legs to the right and to the left in pendulum movements, trying to reach the floor. In that case, the shoulder blades cannot be pulled off the floor.
- Boat.Initial position lying on your stomach, arms extended forward. Tear 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;
- stenosis of the spinal canal, which leads to compression of the spinal cord and can cause permanent disability and decreased quality of life.
The prolonged compression of the nerve roots that innervate certain abdominal organs over time leads to the deterioration of their functioning. As a result, patients experience intestinal disorders (constipation, diarrhea, flatulence) and pelvic organs (urinary disorders, erectile dysfunction, frigidity, infertility).
Forecasting
The pain syndrome in lumbar osteochondrosis occurs in the form of remissions and exacerbations. The lumbago lasts 10-15 days, after which the patient's condition improves and the pain decreases. A favorable result can be avoided by the associated secondary diseases. Often, in lumbar osteochondrosis, pain crises recur, which are increasingly intense and prolonged.
Physiotherapy plays a significant 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 within four months your condition does not improve, the question of establishing a group of disabled people is decided.
Prevention
The prevention of the development of osteochondrosis of the spine consists of the following measures:
- stop smoking;
- normalization of body weight;
- improvement in general physical condition, active lifestyle;
- avoiding provocative conditions (weight lifting, sudden movements, curves, curves).