Osteochondrosis in the lumbar region occurs due to deformation and destruction of the cartilage tissue of the intervertebral discs.Without cartilage material, the vertebrae lose their elasticity and shift, causing pain.According to the WHO, the disease mainly affects people over 30 years of age.Women are three times more likely to get sick, which is also associated with age-related changes and a decrease in calcium levels 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% affect the lumbar spine, consisting of 5 vertebrae.In 40% of people, the first signs of the disease appear between the ages of 30 and 35.In old age, 90% of people are diagnosed with spinal osteochondrosis.Painful sensations occur in 7 out of 10 people; exacerbation can last from 6 to 16 months.
Stages of development
- 1. – the appearance of degenerative diseases that affect nerve endings and disrupt blood supply.The inflammatory process causes pain that radiates to the legs.The patient occasionally feels a tingling sensation in the back and buttocks.Appears after heavy physical exertion.
- 2. – The outer covering of the intervertebral disc (fibrous ring) is destroyed.The distance between the vertebrae decreases and the nerve endings are compressed, resulting in severe, acute pain.The symptoms are particularly pronounced when walking.
- 3. Due to excessive mobility of the vertebrae, muscle fibers and nerve endings are compressed.There are cramps, numbness, burning pain, hernia - displacement of the intervertebral disc into the spinal cord.
- 4. – Growth of pathological exostoses on the bone structure.The spine literally “petrifies”.Progressive osteoarthritis and lack of treatment lead to immobilization of the patient.
Reasons for development
The disease develops slowly and under the interaction of several circumstances, that is, the development of the disease depends not on one, but on several factors:
- Lack of exercise (physical inactivity), sedentary work, low physical activity.At first glance they are not dangerous.However, with prolonged exposure, the muscle tone, the so-called “muscle corset”, is weakened.It supports the spine and internal organs.Thus, physical inactivity leads to dysfunction of a number of systems - blood circulation, breathing, digestion.
- Overweight.With a BMI (Quetelet Body Mass Index) above 25 kg/m2, being overweight puts additional strain on the body: it puts pressure on the spine, overloads the joints and impairs the blood supply.
- Endocrine pathological processes.Hormonal imbalance, dysfunction of the adrenal glands and thyroid gland “slow down” the body's metabolism.Frequent hormonal changes “wash” calcium from bone tissue, making it weak and brittle.
- Unbalanced diet.Popular and affordable fast food fully covers the body's energy needs, but is absolutely useless in terms of saturating the body with the necessary vitamins and microelements.
- Pathologies and genetic predisposition to diseases of the musculoskeletal system.
- Degenerative age-related changes.Under the influence of time, the support system naturally wears out.
Men whose jobs involve significant physical activity are many times more likely to develop lumbar osteochondrosis.
Symptoms of lumbar osteochondrosis
Pain is the main marker of the onset of the disease and its localization.A preliminary diagnosis can be made based on the type of occurrence, frequency and duration.Most often, patients with lumbar osteochondrosis experience aching pain that radiates to the leg, groin and tailbone.In a horizontal position the symptoms disappear.
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.”For this reason, the affected nerve “reacts” in a certain area: This is how “radicular syndrome” manifests itself.
The spinal nerve map allows you to identify pain in a specific area of the spine: C1-C8 - 8 cervical spine, T1-T12 - 12 thoracic spine, L1-L5 - 5 lumbar spine, S1-S5 - 5 sacrum, C0 - 2 coccyx.Signs of osteochondrosis depending on segmental innervation:
- L3-L4 – weak knee reflex, partial numbness, episodic loss of sensation along the front of the thigh;
- L4-L5 – muscle weakness, the patient is unable to fix the body when standing on the heels, pain and loss of sensitivity extend to the area from the lower back to the buttocks, as well as along the entire lateral surface of the thigh (from top to bottom).
- L5-S1 – Tremor of calf muscles, inability to stand on toes, pain in back of thigh.
In rare cases, the root arteries are also involved in the destructive process, which triggers a stroke of the spine - a dangerous pathology in which the patient suffers from paresis and paralysis, as well as dysfunction of the pelvic organs.
Pain reflex symptoms
- Lumbago or lumbago (not sciatica in this case!) – acute pain.Any unpleasant movement, even sneezing and coughing, triggers a cramp.The patient spontaneously changes his posture and moves it to the side.Attempting to assume a vertical position triggers a new lumbago.
- Lumbodynia is a dull and aching pain that occurs on one side.Periods of remission are followed by an exacerbation that gradually develops into severe pain.
- Lumboischialgia – painful sensations occur in the leg.
Side effects of the disease are not so typical and can easily be confused with symptoms of another problem: decreased sweating (hypohidrosis), pallor of the skin in the affected area due to poor blood circulation, severe dryness and flaking.
diagnosis
In the initial stage, a complete medical history of the patient is taken.The overall picture should be supplemented by the opinions of a surgeon, orthopedist, neurologist and rheumatologist.Specialists subject the patient to a visual examination to assess changes in posture, muscle tone and skin sensitivity.
For the primary diagnosis of lumbar osteochondrosis of the 1st degree, an x-ray is performed;It is used to examine the condition of the intervertebral discs and pathologies of the spinal cord, and also 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 highly sensitive examination using a beam of ionizing radiation.The CT scan records the degree of disc deformation, inflammatory processes in the spinal cord membrane and nerve endings in a slice-by-slice image.
Magnetic resonance imaging (MRI) shows the general condition of muscle mass, blood vessels and ligaments.Detects tumors and inflammatory processes.
Myelography is a way to visually assess the condition of the spinal cord and nerve roots by injecting a contrast agent with a needle into the CSF-filled cavity between the pia mater and the arachnoid mater of the spinal cord.Similar to CT, MTP and X-ray, the procedure takes place in real time.
Neurological examination of sensitivity and reflexes for pathologies is a complex of studies that includes a screening method for studying the symmetry of the limbs, testing vibration sensitivity and assessing Babinsky, Chaddock and Oppenheiman reflexes.
Treatment of lumbar osteochondrosis
The effectiveness of conservative treatment is achieved through a combination of drugs of different groups, massage and manual therapy.However, stage 3 lumbar osteochondrosis can no longer be cured with conservative methods;surgical intervention is required.One of the surgical methods for osteochondrosis is microdiscectomy.This is a neurosurgical operation to remove a hernia without damaging the nerve structures.It is performed under general anesthesia.The patient can walk already on the 3rd day.
Drug therapy (for stages 1-2)
- Analgesics to relieve pain: local (ointments, gels), oral (tablets, suspensions), intramuscular (injection solutions).
- Nonsteroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, eliminates swelling.Gels and tablets are most often used, and in more serious cases (inflammation of the sciatic nerve) injections.Prima course – 7-14 days.
- Muscle relaxants.Prescribed in the acute phase for muscle cramps, as well as during the remission phase to consolidate the effect.
- Chondroprotectors.Block destructive processes in the intervertebral discs, promote regeneration and improve metabolism in the cartilage tissue.
- Vascular medications.Contributes to the normalization of blood supply to the musculoskeletal system.
- Vitamin complexes of group B. Improve nerve conduction.
- Diuretics.Reduces swelling.
As an emergency aid at the time of exacerbation, strong injections are used - a paravertebral blockade, which leads to a temporary loss of sensitivity.
It is also recommended to undergo manual therapy twice a year, which relieves muscle tension and spasms, restores blood circulation, improves lymphatic circulation and increases mobility of the musculoskeletal system.
Prevention
- Active lifestyle combined with moderate physical activity;
- choice of comfortable or, if necessary, orthopedic shoes;
- Good nutrition;
- control of body weight;
- Sleep only on an orthopedic mattress and pillow.
- Office furniture with flat back only;
- Rejection of heavy strain on the back and spine.When carrying heavy objects, the load should be distributed evenly between both hands.