Back pain in the lower back

About 40-80% of people complain that the spine in the lower back hurts, but no more than 25% of them seek medical help. In fact, these unpleasant sensations can be caused either by relatively harmless reasons or by pathological changes in the spine. Therefore, you must not treat them with disdain.

Back Pain Causes

The spine 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 paravertebral muscles, pain that patients often confuse with spinal pain. Thus, the causes of pain can be many. This could be overwork, a natural restructuring of the body during pregnancy, etc. But if the pain occurs regularly, it is worth getting in touch with a vertebrologist or neurologist, as the fact that the spine systematically aches in the lower back often indicates the development of certain diseases.

Most of the time, in such situations, patients are diagnosed with:

• pathology of intervertebral discs (reduced disc height, protrusion, intervertebral hernia, discitis);
• pathologies of the facet joint (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 perform heavy physical work. In old age, the disc dries up and the vertebrae grow together.

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

Osteochondrosis tends to progress constantly, especially in the absence of adequate treatment and lifestyle correction. Later, it leads to the formation of bumps and, later, intervertebral hernias, which worsen existing symptoms and cause new ones to appear.

The lumbar region, being the one that carries the most in daily activities, is the most affected.

The protrusions are protrusions on the disc, maintaining the integrity of its outer shell, called the fibrous ring. Despite maintaining the influence of provocative factors over time, the fibers of the annulus fibrosus do not support the load and pressure of the internal contents of the disc (nucleus pulposus) and rupture. As a result, the nucleus goes beyond the physiological position of the intervertebral disc. At the same time, the spine in the lower back always hurts or the pain radiates to the leg, and the discomfort increases with sudden movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well as sitting for a long time. a position, walking, standing.

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

Most often, protrusions and hernias form in the direction of the spinal canal, through which the spinal cord (equine tail) and the nerve roots that branch from it pass. The latter passes through the natural openings in the vertebral bodies and branches posteriorly into the lumbar plexus, which is responsible for innervating the lower extremities and various organs (including the genitals).

Therefore, often with long-term osteochondrosis, the formation of hernias in the lower back, spinal pain is gradually not only intensified but also complemented by other disorders. If a deformed disc or swollen soft tissue as a result of the inflammatory process compresses the spinal root passing close to them, neurological disorders occur. Therefore, spinal pain in the lower back can be supplemented by radiating to the buttocks, groin, front, inner, outer thigh, leg, and foot. It depends on what type of nerve root will be damaged, that is, at what level the pathological changes in the spinal movement segment will be observed. Furthermore, in the corresponding zones of the lower extremities, disturbances in sensitivity can be observed in the form of a crawling sensation, numbness, changes in temperature susceptibility, pain, tactile stimuli, and limited mobility.

Changes in the height and functionality of discs resulting from osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as to degeneration of the vertebral bodies themselves. The consequence of this is the development of spondylosis, that is, calcification of the anterior longitudinal ligament and the formation of bone-cartilaginous growths on the surface of the vertebral bodies (osteophytes). They can not only injure surrounding tissue and compress the roots of the spine, causing severe back pain, but they can also grow together. As a result, adjacent vertebral bodies are combined into a single whole, which drastically limits 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 facet or joints of the lumbar spine, in particular its arthrosis, can also cause spinal pain in the lower back, including severe pain. Though most often the pain is painful and located deep down. Its appearance is due to the fact that its synovial capsule is richly innervated. In these situations, the pain is usually concentrated directly in the affected area and tends to increase with flexion, extension, rotation of the body, prolonged standing. Walking and sitting help reduce its severity. But in some cases, pain can also be felt in the groin area, coccyx, as well as the back and outside of the 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 usually occur before age 40 and most often by age 20 years. This distinguishes them from degenerative-dystrophic pathologies of spinal discs and joints, which often develop after 40 years. In this case, the pain is characterized by a gradual increase in intensity. Furthermore, its severity decreases after physical exertion but does not decrease at rest. Therefore, in inflammatory diseases, the spine in the lumbar region usually hurts at night and, especially, in the morning, immediately after sleep.

The most difficult situation is seen with ankylosing spondylitis, and it is this that more often than other inflammatory diseases affects the lower back. 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 bone joint structures.

At first it is characterized by mild back pain, but over time it gradually spreads higher, covering the thoracic spine and then the cervical spine. This is associated with the development of limited mobility of the spine in all planes, since the spine, as a result of the changes that have taken place, seems to be immersed in a specific case. Also noted:

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

In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucous membrane (conjunctivitis), iris, and ciliary body of the eyeball (iridocyclitis) is seen.

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 supplicant pose. It means pronounced kyphosis of the thoracic spine, lowering of the upper body, bending of the knees with a marked limitation in the range of movement of the chest, which affects the depth of breathing.

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

Vertebrae compression fracture

A compression fracture is the flattening of the vertebral body, resulting in a wedge shape. This leads to disorganization of the spinal anatomy, can cause trauma to the spinal cord and its roots, in addition to becoming a triggering factor for the rapid progression of degenerative-dystrophic alterations.

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

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

The pathology is characterized by the presence of pain in the spine, which limits movement, increases with sitting, movement and attempts to lift the straight leg. It usually lasts 1 to 2 weeks and then tapers off over 2 to 3 months. In some cases, pain radiates to the crests of the hip bones and hips. Decreasing the height of a fractured vertebra causes an increase in lumbar lordosis, which also contributes to the occurrence 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, which causes chronic back pain and requires a long rest.

Neoplastic spinal injuries

Neoplastic lesions of the spine mean the formation of benign and malignant tumors in the spine, in addition to metastases, the origin of which is neoplasms of other organs. This is much less common than pathologies of intervertebral discs, facet joints, ankylosing spondylitis, and even compression fractures, particularly in 1-2% of patients with back pain. But these injuries require diagnosis and treatment as early as possible.

The characteristics of neoplastic spinal injuries, in addition to pain in the spine, are:

• an increase in body temperature, including even subfebrile values;
• irrational 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 analgesics.

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 diagnosed in 20% of patients with cancerous lesions in the spine. It most often forms in the sacrum and can occur in people of any age and gender.
• Young's sarcoma - occurs in 8% of patients with spinal neoplastic lesions. More common in young men.
• Chondrosarcoma is a malignant neoplasm, accounting for 7-12% of cases. It is most often found in middle-aged men.
• Aneurysmal bone cyst is a benign neoplasm.
• Hemangioma is a benign vascular tumor that is present in 11% of people. It may go undetected throughout a person's lifetime. But it increases the risk of vertebral fractures.
• Metastases from other tumors are secondary malignant neoplasms. More often, cancers of the breast, prostate, lung, and, less often, kidney, thyroid gland, and skin cancer metastasize to the spine.

Diagnosis

If the lumbar spine hurts, it's worth making an appointment with a neurologist or vertebrologist. During the consultation, the physician initially takes an anamnesis, asking about the nature of the pain, the circumstances of its occurrence, the duration of its persistence, the presence of other symptoms, lifestyle, etc.

Then the specialist performs an examination. In this context, he not only palpates the spine, determines the location of pain, assesses the patient's unconscious gait and posture, but also performs functional tests. With their help, you will be able to detect signs of ankylosing spondylitis, neurological deficit, assess the degree of spinal mobility and obtain other diagnostic data.

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

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

Treatment

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

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

Bed rest is not shown for all patients. And in intervertebral disc pathologies, it can be totally contraindicated, since the decrease in physical activity contributes to the transformation of acute back pain into chronic ones.

Exclusively conservative or non-surgical treatment is prescribed for:

• osteochondrosis;
• ankylosing spondylitis;
• joint arthrosis;
• mild compression fractures.

It is usually complex and consists of:

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

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

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

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

• Discectomy is an operation mainly indicated for hernias and protrusions, especially those that cause the cauda equina syndrome. It can be performed with microsurgical instruments through an incision of the order of 3 cm (microdiscectomy) and with endoscopic equipment supplied to the spine by puncture with a diameter of about 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 vertebrae, hemangiomas and some other diseases. The essence of the operation is to inject bone cement that hardens quickly through a thin cannula into the vertebral body, which strengthens it. With kyphoplasty, it is even possible to restore the normal dimensions of the vertebral body, which is important in the case of a marked decrease in height due to a fracture.
• Fixation surgeries are used to stabilize the spine. For this, metallic structures of a different nature are used, which generally remain in the patient's body until the end of life.

Therefore, the spine in the lower back can hurt for several reasons. Therefore, with the prolonged persistence of painful sensations, their regular occurrence, the pain increasing over time, and even more the addition of other symptoms, it is imperative to contact a vertebrologist or neurologist. Early diagnosis will allow detecting pathological changes in the phases when it is easier to face them and if the disease is not completely cured, at least stop its progression and maintain a high standard of living.