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 experiences back pain at least once in his 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 their condition does not improve, the issue of establishing a disability group is decided.
Lumbar osteochondrosis is a serious medical and social problem, since the disease mainly affects people of the most working age, and in addition, in the absence of treatment, it can cause the formation of a herniated disc.
Causes and risk factors
Factors predisposing to the development of lumbar osteochondrosis are:
- anomalies of the structure of the spine;
- lumbarization - congenital pathology of the spine, characterized by the separation of the first vertebra from the sacrum and its transformation into the sixth (additional) lumbar;
- sacralization is a congenital pathology in which the fifth lumbar vertebra is fused with the sacrum;
- asymmetrical arrangement of the joint spaces of the intervertebral joints;
- pathological narrowing of the spinal canal;
- reflected spondiogenic pain (somatic and muscle);
- obesity;
- sedentary lifestyle;
- prolonged exposure to vibration;
- systematic physical stress;
- smoking.
Unfavorable static-dynamic loads in combination with one or several risk factors lead to a change in the physiological properties of the nucleus pulposus of the fibrous disc, which plays a shock-absorbing role and ensures the mobility of the spinal column. This process is based on the depolymerization of polysaccharides, which leads to the loss of moisture in the tissue of the gelatinous core. As a result, the nucleus pulposus, and with it the fibrous disc, lose their elastic properties. Further mechanical stress provokes protrusion of the annulus fibrosus that has lost its elasticity. This phenomenon is called protrusion. Cracks appear in the fibrous nucleus, through which fragments of the nucleus pulposus fall out (prolapse, herniated disc).
Prolonged compression of the nerve roots that innervate certain abdominal organs over time leads to a deterioration in their functioning.
Instability of the spinal segment is accompanied by reactive changes in the bodies of adjacent vertebrae, intervertebral joints, and concomitant spondyloarthrosis develops. A significant muscle contraction, for example, against the background of physical activity, leads to a displacement of the vertebral bodies and entrapment of the nerve roots with the development of radicular syndrome.
Another cause of pain and neurological symptoms in lumbar osteochondrosis can be osteophytes - bone outgrowths on processes and vertebral bodies that cause radicular 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, lumboishalgia, lumbago; develop against the background of reflex overstrain of the back muscles;
- compression (spinal, vascular, radicular)- compression (compression) of the spinal cord, blood vessels or nerve roots leads to their development. Examples are lumbosacral radiculitis, radiculoischemia.
Symptoms of lumbar osteochondrosis
In lumbar osteochondrosis, symptoms are determined by which structures are involved in the pathological process.
Lumbago occurs under the influence of hypothermia or physical overstrain, and sometimes for no apparent reason. The pain appears suddenly and is of a shooting character. It intensifies when 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 in the lumbar spine is reduced.
Observe on palpation:
- soreness in the lumbar region;
- spasm of the paravertebral muscles;
- flattening of the lumbar lordosis, which in many cases is combined with scoliosis.
Nerve root tension syndrome in lumbago is negative. When raising a straight leg, patients note an increase in pain in the lumbar region, and not their appearance in an extended lower limb.
Often, with lumbar osteochondrosis, there is a recurrence of pain attacks, which each time become more intense and prolonged.
In lumbodynia, the clinical picture resembles lumbago, but the increase in the intensity of pain occurs over several days.
With lumboishalgia, patients complain of pain in the lumbar region that radiates to one or both lower extremities. The pain spreads to the buttocks and back of the thigh and never reaches the feet.
Lumboishalgia is characterized by vasomotor disorders:
- changes in temperature and color of the skin of the lower extremities;
- feeling hot or chilly;
- violation of blood circulation.
The development of lumbar compression syndromes is clinically manifested by the following symptoms:
- dermatomal hypalgesia;
- shooting pains;
- weakening or complete loss of deep reflexes;
- peripheral paresis.
With compression syndromes, pain is aggravated by bending the trunk, sneezing and coughing.
Diagnostics
Diagnosis of lumbar osteochondrosis is carried out on the basis of data from the clinical picture of the disease, laboratory and instrumental research methods.
In blood tests against the background of lumbar osteochondrosis:
- decrease in calcium concentration;
- increased ESR;
- increased alkaline phosphatase levels.
In the diagnosis of lumbar osteochondrosis, X-ray examination of the spine is of great importance.
Prolonged compression of the nerve roots that innervate certain abdominal organs over time leads to a deterioration in their functioning.
X-ray signs that confirm the diagnosis are:
- change the configuration of the affected segment;
- pseudospondylolisthesis (displacement of adjacent vertebral bodies);
- deformation of the closing plates;
- flattening of the intervertebral disc;
- unequal height of the intervertebral disc (a symptom of a spacer), which is associated with asymmetric muscle tone.
Also in the diagnosis of lumbar osteochondrosis, if indicated, are used:
- myelography, computed or magnetic resonance imaging - are necessary for persistent symptoms, development of neurological deficits;
- scintigraphy (study of the accumulation of phosphorus in the bone system, labeled with tech-99) - is performed if a tumor or infectious process is suspected, or a spinal injury
Differential diagnosis of lumbar osteochondrosis is carried out with the following diseases:
- spondylolisthesis;
- dyshormonal spondylopathy;
- ankylosing spondylitis (ankylosing spondylitis);
- infectious processes (disc inflammation, 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 internal organs and large blood vessels).
Treatment of lumbar osteochondrosis
For lumbar osteochondrosis, the following treatment tactics are usually followed:
- bed rest for 2-3 days;
- traction of the affected segment of the spine;
- strengthening the back and abdominal muscles (creating the so-called muscle corset);
- impact on pathological myofascial and myotonic processes.
Lumbago occurs under the influence of hypothermia or physical overstrain, and sometimes for no apparent reason.
In most cases, conservative treatment of lumbar osteochondrosis is carried out, including the following measures:
- infiltration anesthesia of muscles with a solution of local anesthetics;
- 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 surgical treatment of lumbar osteochondrosis are:
- acute or subacute spinal cord compression;
- development of cauda equina syndrome, characterized by dysfunctions of the pelvic organs, sensory and motor disorders.
Therapeutic exercises for lumbar osteochondrosis
Physical therapy plays a significant role in the complex treatment of lumbar osteochondrosis. Regular exercises allow you to normalize the muscle tone of the paravertebral muscles, improve metabolic processes in the tissues affected by the pathological process, and, in addition, form a well-developed muscle corset that can support the spine in the correct position, remove unnecessary static loads from it.
For gymnastics with lumbar osteochondrosis to bring the greatest effect, you should adhere to the following principles:
- regularity of classes;
- gradual increase in the intensity of physical activity;
- avoiding overwork during class.
Physiotherapy should be done under the guidance of an experienced instructor, who will select the exercises that are most effective for a particular patient and control the correctness of their implementation.
According to statistics, every second adult experiences back pain at least once in his life, while in 95% of cases it is caused by osteochondrosis of the spine.
In addition to classes with an instructor, you should daily perform a set of morning exercises, which includes 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. Take a smooth breath, relaxing the muscles of the anterior abdominal wall. During exhalation, pull the stomach in as much as possible, straining the abdominal muscles. The exercise should be repeated until mild fatigue appears.
- Head movements with spinal flexion.The starting position is kneeling, resting on the floor with outstretched arms, back straight. Slowly raise your head and bend in your back. Hold in this position for a few seconds, and then smoothly return to the starting position. Repeat at least 10-12 times.
- "Pendulum".Starting position lying on your back, arms along the body, legs bent at right angles at the knee and hip joints. Turn your legs to the right and left in swinging pendulum movements, trying to reach the floor. In this case, the shoulder blades cannot be torn off the floor.
- Boat.Starting position lying on your stomach, arms extended forward. Tear off the upper body and legs from the floor, bending in the 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 reduced quality of life
Prolonged compression of the nerve roots that innervate certain abdominal organs over time leads to a deterioration in their functioning. As a result, patients have intestinal dysfunctions (constipation, diarrhea, flatulence) and pelvic organs (urinary disorders, erectile dysfunction, frigidity, infertility).
Forecast
Pain syndrome in lumbar osteochondrosis occurs in the form of remissions and exacerbations. Lumbago lasts 10-15 days, after which the patient's condition improves, the pain subsides. A favorable outcome can be prevented by the associated secondary diseases. Often, with lumbar osteochondrosis, there is a recurrence of pain attacks, which each time become more intense and prolonged.
Physical therapy 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 their condition does not improve, the issue of establishing a disability group is decided.
Prevention
Prevention of the development of osteochondrosis of the spine consists in the following measures:
- quitting smoking;
- normalization of body weight;
- improvement of general physical condition, active lifestyle;
- avoiding provocative conditions (lifting weights, sudden movements, turns, bends).