People with osteochondrosis of the lumbar spine always avoid sudden movements, gently bend and turn sideways, sit up and stand slowly. So they try to prevent a sharp and penetrating pain in the lower back, which forces them to freeze in one position of the body. Osteochondrosis is also manifested by crunches, clicks, limitation of mobility. Its treatment is usually conservative, but with severe damage to the discs and vertebrae, surgical intervention is required.
What is osteochondrosis of the lumbar spine?
Lumbar osteochondrosis is a degenerative-dystrophic pathology that initially affects the intervertebral discs. Due to insufficient supply of nutrients, they lose their ability to retain moisture. Regeneration processes slow down, the discs become flat and brittle. The distance between adjacent vertebrae decreases, therefore, to stabilize the lumbar segment affected by osteochondrosis, bone tissue grows. Osteophytes are formed - bone growths, when displaced, soft tissue structures, nerve roots and blood vessels are injured.
Stages of pathology
The osteochondrosis stage is a stage in the development of the disease, characterized by certain destructive changes in the discs and vertebral bodies. It is installed by X-ray examination. The images obtained clearly show specific signs of destruction of vertebral structures. Each stage corresponds to the severity of osteochondrosis, a set of symptoms. The higher it is, the more difficult the disease is amenable to conservative treatment.
|Stage of lumbar osteochondrosis||Radiographic signs and clinical manifestations|
|First (preclinical)||There are no signs of osteochondrosis on radiographs. Occasionally, there is discomfort in the lower back after exertion or being on the legs for a long time|
|Second||There is a straightening of the lordosis, less often: inclination of the vertebral bodies, deformation of the semilunar processes. The height of the discs is slightly reduced. Painful sensations appear more frequently, their duration increases|
|Third Party||There is subchondral sclerosis of the end plates, the defeat of a large number of semilunar processes, a moderate decrease in the height of the disc. In addition to pain in the lumbar spine, the clinic has a crunch, stiffness of movements|
|Fourth||The semilunar processes drift outward and backward. There is a compensatory growth of bone tissue, the formation of multiple osteophytes. Pain occurs when moving and at rest|
Causes of the disease
Increased loads on the lumbar spine often become the cause of osteochondrosis. The discs suffer constant micro-injuries and do not have time to recover in time. An important part of them is gradually damaged, which causes the deformation of the bony bodies of the vertebrae. Such pathological conditions can also provoke the destruction of the lumbar segment:
- congenital or acquired anomalies: flat feet, scoliosis, kyphosis, hallux valgus, hip dysplasia;
- systemic pathologies: rheumatoid arthritis, scleroderma, lupus erythematosus;
- endocrine and metabolic diseases: gout, diabetes mellitus, hypo and hyperthyroidism, obesity;
- previous injuries: subluxation of the vertebrae and their fractures, spinal cord injuries;
- circulatory disorders, even in the context of a sedentary lifestyle.
One of the main reasons for the development of osteochondrosis is the natural aging of the body. After 50 years, the recovery processes slow down, collagen production decreases, and the condition of the ligaments worsens.
Characteristic signs and symptoms of the disease
In the early stage of development, osteochondrosis does not manifest clinically. A person suffers a slight pain in the lower back due to muscle strain after a working day and does not go to the doctor. But the severity of the symptoms slowly increases: a crunch is soon added to the pains when the body bends and turns, sensory disturbances, stiffness.
This is the name of the spinal root injury, which leads to motor, autonomic and painful disorders. The radicular syndrome develops with osteochondrosis of 3-4 degrees of severity. In these stages, an intervertebral hernia forms that compresses the spinal roots. The pathology proceeds according to the type of lumbago, lumbodynia and lumbar ischialgia. In addition to severe pain, radicular syndrome is characterized by sensations of numbness, tingling, chills, decreased or total absence of sensation.
In the later stages of the course of lumbar osteochondrosis, compression of large blood vessels by hernia protrusion is possible. The pelvic organs stop receiving enough nutrients, which leads to disruption of their functioning. The trophism of the spinal cord is also disturbed, a neurological deficit develops - intermittent claudication appears, temperature and pain sensitivity disappear.
As a result of a decrease in the distance between adjacent vertebral bodies, the growth of bone tissue, the lumbar vertebral segments are gradually deformed. The situation is exacerbated by the constant compensatory strain on the back muscles with their subsequent atrophy. A person's gait and posture change pathologically, including due to improper load redistribution. The probability of participation of other parts of the spine and leg joints in the destructive-degenerative process increases significantly.
In the lower back there is a large sciatic nerve, formed by the roots of the sacral spine. When affected by a hernial bulge, bone growths, spasmodic muscles, sciatica occurs - a typical symptom of lumbar osteochondrosis. A sharp pain develops along the sciatic nerve to the thighs, knees, and legs (lumboischialgia). Another specific sign of pathology is lumbago, or "lumbago" in the lower back after a sharp tilt or turn, hypothermia.
When making a diagnosis, the most informative X-ray images are made in two projections. An MRI is done to examine the affected lumbar segment in more detail. The study allows you to assess the state of the spinal cord, soft tissue structures, blood vessels, nerve roots. It is possible to determine the degree of damage to the nerve trunks using evoked potentials, electroneurography, electromyography. Discography is used for the specific examination of the affected discs.
How is the treatment performed?
An integrated approach to the treatment of lumbar osteochondrosis is practiced. Treatment is aimed at eliminating pain, restoring range of motion, and preventing the spread of pathology to healthy discs and vertebrae.
The use of non-steroidal anti-inflammatory drugs, glucocorticosteroids, muscle relaxants allows to get rid of low back pain. In therapy, drugs are used to improve blood circulation. Patients should be prescribed B vitamins, chondroprotectors.
This is the most effective and affordable method of treating osteochondrosis. After 1-2 months of daily physical therapy, the muscles of not only the lower back, but also the entire back are strengthened, the posture improves, and the blood supply to the damaged connective tissue structures is accelerated. Exercise therapy physicians advise patients to perform slow, gentle twists and torso curls, shallow squats, and lunges.
Patients with lumbar osteochondrosis are shown all types of massage: vacuum, acupuncture, connective tissue, segmental. But the most popular is the classic. During the session, the masseur performs the basic movements of the massage: caress, rub, knead, vibrate. The goals of the procedures are to eliminate muscle spasms, improve blood circulation in the affected segment, and strengthen skeletal muscles.
In the acute and subacute period, patients are prescribed electrophoresis or phonophoresis with glucocorticosteroids, anesthetics, vitamins of group B. In the remission stage, sessions of laser therapy, magnet therapy, therapy are often carried outshock wave therapy, UHF therapy. Ozokerite, paraffin applications, hirudotherapy, mud therapy, radon baths and hydrogen sulfide are also used.
The main indication for surgical intervention is infringement of the spinal cord due to hernia protrusion. During the operation, the intervertebral hernia is removed and the spinal canal is decompressed. The most commonly used surgical methods for lumbar osteochondrosis are microdiscectomy, vaporization puncture or laser disc reconstruction, implant placement, and spinal segment stabilization.
After the main therapy, achieving a stable remission, homemade ointments, infusions, compresses, oils and rubbing with alcohol are used in the treatment. Folk remedies do not affect the cause of osteochondrosis, therefore, they are used to eliminate weak and painful aches, heaviness in the lower back after hypothermia, a sudden change in weather, or increased physical activity.
Consequences of not being treated
The development of almost all complications of lumbar osteochondrosis is caused by the resulting intervertebral hernia. Discogenic myelopathy is especially dangerous, which cannot always be eliminated even by surgical treatment. It manifests itself by pelvic disorders, including defecation and urination disorders. Complications of osteochondrosis also include radicular syndrome, a common cause of sharp, penetrating pain in the lower back.
Prevention and prognosis measures
The prognosis is favorable when a condition of severity 1-2 is diagnosed. It responds well to conservative treatment, and in young patients it is even possible to partially restore the tissues of the intervertebral discs. With the development of complications, the prognosis for complete recovery is less favorable.
Prevention of osteochondrosis of the lumbar spine is to control body weight, exclude excessive loads, timely treatment of endocrine and metabolic diseases. Neurologists and vertebrologists recommend visiting the pool, doing water aerobics, Pilates and Nordic walking.