Almost 80% of the residents of our country suffer from lumbar osteochondrosis, but only half of them seek medical help. The main symptom of the disease is pain in the back and lower back, which can radiate to the lower extremities.
Lumbar osteochondrosis is equally common in women and men. Among the patients, people over 30 years of age predominate.
What is lumbar osteochondrosis?
Osteochondrosis of the lumbar spine (lumbar osteochondrosis) is a degenerative-dystrophic lesion of the vertebrae and intervertebral discs, which has a long chronic course and can be complicated by intervertebral hernias, inflammation of the sciatic nerve and cauda equina syndrome.
Osteochondrosis of the spine often affects the lumbar spine, since it is under the greatest stress during movement, physical labor or sedentary work.
The lumbar spine lies between the thoracic and sacral spine. It consists of five massive vertebrae connected by intervertebral discs.
The intervertebral disc is disc-shaped and made up of cartilage. In the center of the disc is the nucleus pulposus, surrounded by the annulus fibrosus.
The intervertebral discs are the body's "shock absorbers", thanks to them the spine remains flexible and mobile.
Osteochondrosis leads to disruption of microcirculation and metabolism in the intervertebral discs, making them less elastic.
Degenerative-dystrophic processes of the spine lead to drying of the intervertebral discs and a decrease in their height.
Important!Over time, the stress on the fibrous ring increases and it breaks, pinching the roots of the spinal nerves, causing pain.
Untimely treatment of lumbar osteochondrosis leads to reduced mobility of the spine and disability of the patient.
What causes lumbar osteochondrosis?
It is impossible to identify a specific cause of lumbar osteochondrosis.
There are several theories about the origin of this disease:
- lumbar osteochondrosis occurs due to prolonged overload of the muscles of the lumbar girdle or their hypotonia. As a result, the load on the spine increases, microcirculation is disrupted, and degenerative-dystrophic changes in the bone and cartilage tissue of the vertebrae and intervertebral discs occur;
- endocrine theory implies the occurrence of osteochondrosis against the background of disruption of the endocrine glands;
- Exchange theory - metabolic disorders, especially calcium;
- hereditary theory - genetic predisposition to lumbar osteochondrosis;
- the autoimmune theory is that the body's own immune system destroys the bone and cartilage of the spine;
- The theory of systematic microtrauma.
Factors leading to degenerative-dystrophic changes in the lumbar spine can be:
- physical inactivity and sedentary, mostly sedentary lifestyle (office workers, drivers, programmers, cashiers);
- long stay in one position (needlewomen, waiters);
- pathology of the endocrine organs;
- diseases of the heart and blood vessels;
- diseases of the digestive system;
- heavy physical labor (loaders, construction workers);
- improper weight lifting and exercise in sports;
- autoimmune and inflammatory diseases of the joints;
- congenital anomalies in the development of the spine;
- flat feet and club feet;
- mechanical injury to the back;
- metabolic pathology;
- physiological aging of the body;
- improperly formed posture in childhood;
- overweight and obesity;
- wrong and unhealthy diet;
- genetic bias;
- sleeping in a hammock, on a water or air mattress, on a folding bed;
- chronic stress;
- frequent hypothermia of the lower back.
Pathogenetic classification of lumbar osteochondrosis
The course of lumbar osteochondrosis can be divided into the following stages:
- the stage of dystrophic changes in the intervertebral discs of the cartilage, characterized by narrowing of the intervertebral gaps;
- the stage of spondylosis is characterized by damage to several vertebrae of the lumbar spine;
- Stage of spondylarthrosis - the process extends to the intervertebral joints, which significantly reduces the mobility of the lumbar spine.
How does lumbar osteochondrosis manifest itself?
Interesting!The manifestations of lumbar osteochondrosis are diverse and are often perceived as diseases of the abdominal organs.
Therefore, a thorough examination of the body is required to exclude life-threatening conditions (acute appendicitis, acute pancreatitis, acute cholecystitis and others).
We can distinguish the following main signs of the disease:
- aching pain in the lower back, which increases with sudden movements, prolonged sitting. The pain is relieved by lying down;
- unilateral lancinating pain in the buttocks, which increases after movement, coughing, sneezing, intense laughter. A horizontal position on a healthy side or a knee-elbow position with a pillow under the stomach will help;
- a feeling of painful shooting in the lower back that comes on suddenly when lifting heavy objects or bending the upper body forward or backward sharply. The exacerbation can bother the patient for several days. For pain relief, the patient is in a constrained position;
- decrease in volume of one of the buttocks;
- Violation of the sensitivity of the skin of the lower back and buttocks (numbness, tingling, burning);
- dryness and discoloration of the skin (blue) of the lower back and buttocks;
- hypofunction of the sweat glands of the lower back and buttocks;
- Dysfunction of the genitourinary system (dysuria, enuresis, impotence).
Diagnosis of lumbar osteochondrosis
The patient should carefully collect complaints, anamnesis of the disease and life. Of great diagnostic value are the clinical syndromes characteristic of lumbar osteochondrosis, including the following:
- Vertebral syndrome consists of the following symptoms:
- the appearance of pathological bends in the spine or the strengthening and flattening of physiological bends (increased lordosis, scoliosis or lordoscoliosis);
- lumbar spine stiffness due to paravertebral muscle spasm;
- pain in the lumbar spine that may radiate to the buttocks or lower limbs;
- Pain on palpation of the paravertebral points.
- Reflex syndrome occurs due to pinching of the roots of the spinal nerves of the lumbar spine and is a combination of the following symptoms:
- severe pain in the lumbar region and areas innervating pinched nerves;
- "lumbago" in the lumbar region, which brings a lot of suffering to patients;
- Violation of sensitivity and paresthesia of areas of innervation from damaged nerves (numbness, tingling, goosebumps, burning);
- limited mobility of the lumbar spine;
- Compression syndrome is a clinical manifestation of compression, injury to the nerve roots of the spinal nerves and vessels of the spinal cord in the intervertebral foramen. Nerves and blood vessels can be compressed by bulging intervertebral discs, osteophytes (bone proliferation), herniated discs (Schmorl hernia):
- paresis and paralysis of the lower extremities;
- violations of the functions of the genitourinary system;
- chronic circulatory myelopathy;
- Ponytail Compression.
- X-ray of the lumbar spine in direct and lateral projection. On x-rays you can clearly see the narrowing of the intervertebral gaps and holes, Schmorl's hernia, the presence of osteophytes (bone overgrowths);
- magnetic resonance imaging of the lumbar spine, which allows you to accurately determine the localization and prevalence of the process, compression of the spinal cord and blood vessels, displacement of the intervertebral discs and their hernia;
- Computed tomography is performed for the same purpose as magnetic resonance imaging. With the help of computed tomography, soft tissue components (muscles, blood vessels, spinal cord) are perfectly displayed.
Diagnosis is not always possible only on the basis of a patient's complaints, so the examination algorithm must necessarily include additional instrumental diagnostic procedures:
Treatment of lumbar osteochondrosis
Important!Osteochondrosis of the lumbar spine is an incurable disease.
How and how to treat osteochondrosis? With the help of conservative and non-conservative methods, one can only relieve pain, slow down the development of degenerative-dystrophic processes and prevent complications. The earlier treatment is started, the greater the chance of remaining mobile and avoiding disabilities.
Algorithm for the treatment of lumbar osteochondrosis:
- Conservative methods:
- drug therapy;
- Physical therapy;
- massage and self-massage;
- manual therapy;
- Physical therapy.
- Surgical treatment.
- Nonsteroidal anti-inflammatory drugs have anti-inflammatory and analgesic effects. To eliminate the negative effect of drugs of this group on the gastric mucosa, they are combined with proton pump inhibitors;
- Muscle relaxants relieve cramps in the paravertebral muscles, thereby relieving pain and increasing mobility in the spine. These drugs can affect the respiratory muscles, so they are prescribed under medical supervision.
- Chondroprotectors, which contain components of cartilage tissue, restore intervertebral discs and joints of the spine, protecting them from negative factors;
- Glucocorticosteroid agents are administered paravertebrally. Thanks to glucocorticosteroids, a long-term anti-inflammatory effect occurs;
- vitamin therapy. A special place in the treatment of lumbar osteochondrosis is occupied by B vitamins (B1, B6, B12);
- local therapy.
- vibration massage;
- ultrasound therapy;
- sludge treatment;
- Treatment with ultraviolet radiation.
The main goal of drug therapy is to relieve pain and inflammation in the spine and lower back. For this, the following groups of drugs are prescribed:
Physiotherapeutic exercises and gymnastics are performed to relieve pain and eliminate muscle spasms.
Interesting!During the period of exacerbation of the process, relief is brought to the hip and knee joints by a forced position on the back with a small pillow under the head and bent legs. You must lie on a hard surface.
When the condition is relieved, you can begin to perform exercises with static and dynamic loads of various muscle groups of the back, trunk and lower extremities. During exercise therapy for lumbar osteochondrosis, you need to breathe freely, not holding your breath.
Spinal traction can be performed during the period of remission, which allows you to loosen the roots of the spinal nerves.
Manual therapy is a manual dosed effect on the muscles and vertebrae, aimed at correcting pathological processes in the spine.
With the help of manual therapy, you can treat the spine, restore the normal position of the vertebrae and intervertebral discs.
Important!To avoid spinal injuries, manual therapy should only be performed by a qualified and experienced chiropractor.
The acupuncture method consists of exposing the active points of thin needles, which release internal opiates and cortisol, which have anti-inflammatory and pain-relieving effects, into the blood.
Massage and self-massage
Techniques such as stroking, rubbing and kneading the back muscles, collar zone, pelvic muscles and lower extremities are used in the massage.
Physiotherapy methods include:
The decision about the surgical procedure is made last.
But with a persistent pain syndrome, which is stopped with medication for three months, as well as with the syndrome of cauda equina compression, dysfunction of the pelvic organs and progressive paresis of the feet, the operation is performed without fail .
Lumbar osteochondrosis should be taken seriously. Treatment should only be performed by qualified specialists such as neuropathologists, physical therapists, exercise therapists, chiropractors, and others.
Self-treatment of lumbar osteochondrosis can be not only useless, but also harmful to health.