People with osteochondrosis of the lumbar spine always avoid sudden movements, flex gently and turn sideways, sit down and get up slowly. Then, they try to avoid a sharp and penetrating pain in the lower back, forcing them to freeze in one position of the body. Osteochondrosis is also manifested by crushing, clicking, limiting mobility. Its treatment is usually conservative, but if the discs and vertebrae are severely damaged, surgical intervention is necessary.
What is osteochondrosis of the lumbar spine
Lumbar osteochondrosis is a degenerative dystrophic pathology that initially affects intervertebral discs. Due to insufficient supply of nutrients, they lose the ability to retain moisture. The regeneration processes are delayed, the discs become flat and brittle. The distance between the adjacent vertebrae decreases, therefore, to stabilize the lumbar segment affected by osteochondrosis, the bone tissue grows. Osteophytes are formed - bone growths, when dislocated, soft tissue structures, nerve roots and blood vessels are damaged.
Stages of pathology
The osteochondrosis stage is a stage in the development of the disease, which is characterized by certain destructive changes in the discs and vertebral bodies. It is installed using the X-ray scan. The images obtained clearly show specific signs of destruction of the vertebral structures. Each stage corresponds to the severity of osteochondrosis, a set of symptoms. The bigger it is, the more difficult the disease will be subject to conservative treatment.
|Stage of lumbar osteochondrosis||Radiographic signs and clinical manifestations|
|First (pre-clinical)||There are no signs of osteochondrosis on the radiographs. Occasionally, there is discomfort in the lower back after physical exertion or prolonged stay in the legs|
|Second||There is a straightening of the lordosis, less frequently - 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 compression, rigidity of movement|
|Bedroom||Semi-lunar processes are deflected out and back. Compensatory growth of bone tissue occurs, formation of multiple osteophytes. Pain occurs when moving and at rest|
Causes of the disease
The reasons for the development of osteochondrosis are often increased loads on the lumbar spine. The discs suffer micro-injuries constantly, not having time to recover in time. A significant part of them is gradually damaged, causing deformation of the bony bodies of the vertebrae. These pathological conditions can also cause 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, including 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, recovery processes slow down, collagen production decreases and the condition of ligaments worsens.
Signs and symptoms characteristic of the disease
In the early stage of development, osteochondrosis does not manifest clinically. After a day at work, a person feels mild pain in the lower back due to muscle tension and does not go to the doctor. But the severity of the symptoms increases slowly - soon a crack is added to the pain when the body tilts and turns, sensory disturbances, stiffness.
It is the name of the spinal root lesion, which leads to motor, autonomic and pain disorders. The root syndrome develops with osteochondrosis of 3-4 degrees of severity. In these stages, an intervertebral hernia forms, compressing the spinal roots. The pathology proceeds according to the type of lumbago, lumbodynia and lumbar ischialgia. In addition to severe pain, the root syndrome is characterized by sensations of numbness, tingling, chills, decreased or complete lack of sensitivity.
In the final stages of the course of lumbar osteochondrosis, compression of large blood vessels by hernial protrusion is possible. The pelvic organs stop receiving enough nutrients, which leads to disruption of their functioning. Spinal cord trophism is also disturbed, a neurological deficit develops - intermittent claudication, temperature, sensitivity to pain drops.
As a result of a decrease in the distance between the adjacent vertebral bodies, the growth of bone tissue, the lumbar vertebral segments are gradually deformed. The situation is aggravated by the constant compensatory tension of the back muscles with their subsequent atrophy. A person's gait and posture change pathologically, including due to inadequate load redistribution. The likelihood of other parts of the spine and leg joints being involved in the destructive-degenerative process is significantly increased.
In the lower back, there is a large sciatic nerve formed by the sacral spinal roots. When it is pinched by a hernial protrusion, bone growth, spasmodic muscles, sciatica occur - a typical symptom of lumbar osteochondrosis. Acute pain appears, spreading along the sciatic nerve to the thighs, knees and legs (low back pain). Another specific sign of pathology is lumbago, or "lumbago" in the lower back after a steep slope or curve, hypothermia.
When making a diagnosis, the most informative X-ray images taken in two projections. Magnetic resonance imaging is performed to examine the affected lumbar segment in more detail. The study allows 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 nerve trunks using evoked potentials, electroneurography, electromyography. Discography is used for targeted examination of affected discs.
How the treatment is done
An integrated approach to the treatment of lumbar osteochondrosis is practiced. Treatment aims to eliminate pain, restore range of motion and prevent the spread of pathology to healthy discs and vertebrae.
The use of non-steroidal anti-inflammatory drugs, glucocorticosteroids and muscle relaxants allows you to get rid of low back pain. In therapy, drugs are used to improve blood circulation. Patients should be prescribed chondroprotective B vitamins.
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 spine are strengthened, posture improves, and the blood supply to damaged connective tissue structures is accelerated. Physiotherapist doctors recommend to patients to decrease, smooth out the curves and curves of the trunk, superficial 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 masseuse performs the basic massage movements: stroking, rubbing, kneading, vibrating. The objectives 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, group B vitamins. In the remission phase, laser therapy sessions, magnetotherapy, shock wave therapy, UHF therapy are often performed. Ozokerite therapy, paraffin applications, hirudotherapy, mud, radon therapy and hydrogen sulfide baths are also used.
The main indication for surgical intervention is the violation of the spinal cord by hernial 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, puncture vaporization or laser disc reconstruction, implant placement and stabilization of the spinal segment.
After the main therapy, a stable remission is achieved, homemade ointments, herbal teas, compresses, rubbing with oil and alcohol are used in the treatment. Folk remedies do not affect the cause of osteochondrosis, so they are used to eliminate weak and painful pain, a feeling of heaviness in the lower back after hypothermia, sudden changes in the climate 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 is manifested by pelvic disorders, including defecation and urination disorders. Complications of osteochondrosis also include root syndrome - a common cause of acute, penetrating pain in the lower back.
Preventive and prognostic measures
The prognosis is favorable when diagnosing pathologies of severity 1-2. 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.
The prevention of osteochondrosis of the lumbar spine consists of controlling body weight, excluding excessive loads and treating endocrine and metabolic diseases in a timely manner. Neurologists and vertebrologists recommend visiting the pool, doing aqua aerobics, Pilates and Nordic walking.