People with osteochondrosis of the lumbar spine always avoid sudden movements, gently bend and turn to their sides, sit down and stand up slowly. They therefore try to avoid a sharp, piercing pain in the lower back, causing them to freeze in a body position. Osteochondrosis is also manifested by crackles, clicks, limited mobility. Its treatment is often conservative, but if the discs and vertebrae are severely damaged, surgery is necessary.
What is osteochondrosis of the lumbar spine
Lumbar osteochondrosis is a degenerative-dystrophic pathology that initially affects the intervertebral discs. Due to an insufficient supply of nutrients, they lose their ability to retain moisture. The regeneration processes are slowed 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 damaged.
Stages of pathology
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 an 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 the disease lends itself to conservative treatment.
|Stage of lumbar osteochondrosis||Radiographic signs and clinical manifestations|
|First (preclinical)||There is no sign of osteochondrosis on the x-rays. Sometimes there is discomfort in the lower back after physical exertion or prolonged stay on the legs|
|Second||There is a straightening of lordosis, less often - inclination of the vertebral bodies, deformation of the lunar processes. The height of the discs is slightly reduced. Painful sensations appear more often, their duration increases|
|Third||There is a subchondral sclerosis of the end plates, the defeat of a large number of lunar processes, a moderate decrease in the height of the disc. In addition to the pain in the lumbar spine, the clinic has tightening, stiffness of movements|
|Fourth||The lunar processes are deflected outwards and backwards. There is a compensatory growth of bone tissue, the formation of several osteophytes. Pain occurs in motion and at rest|
Causes of the disease
Increased loads on the lumbar spine often become the cause of osteochondrosis. The discs are constantly micro-injured, not having time to recover in time. A significant part of them is gradually damaged, causing 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, 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 the age of 50, recovery processes slow down, collagen production decreases, and the condition of the ligaments worsens.
Characteristic signs and symptoms of the disease
In the initial stage of development, osteochondrosis does not manifest clinically. A person takes a slight pain in the lower back for muscle tension after a day's work and does not go to the doctor. But the severity of symptoms slowly increases - soon a tightening is added to the pains when the body bends and turns, sensory disturbances, stiffness.
This is the name for the lesion of the spinal roots, which causes motor, autonomic and painful disorders. Radicular syndrome develops with osteochondrosis of 3 to 4 degrees of severity. At 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, radicular syndrome is characterized by sensations of numbness, tingling, crawling crawls, decreased or complete absence of sensitivity.
In the later stages of the development of lumbar osteochondrosis, compression of large blood vessels by hernial protrusion is possible. The pelvic organs stop receiving enough nutrients, which leads to disruption in their functioning. The trophism of the spinal cord is also upset, a neurological deficit develops - intermittent claudication appears, the temperature, sensitivity to pain falls.
Due to 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 constant compensatory tension of the back muscles with their subsequent atrophy. A person's gait and posture change pathologically, especially due to poor redistribution of loads. The likelihood of involvement of other parts of the spine and joints of the legs in the destructive-degenerative process is significantly increased.
In the lower back is a large sciatic nerve, formed by the sacral spinal roots. When infringed by hernial protrusion, bony growths, spasmodic muscles, sciatica occurs - a typical symptom of lumbar osteochondrosis. A sharp pain appears, spreading along the sciatic nerve to the thighs, knees, lower legs (lumboischialgia). Another specific sign of pathology is lumbago, or "lumbago" in the lower back after a sharp tilt or turn, hypothermia.
During diagnosis, the most informative x-ray images taken in two projections. MRI is done to examine the affected lumbar segment in more detail. The study allows you to assess the condition 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 a targeted examination of the affected discs.
How the treatment is carried out
An integrated approach to the treatment of lumbar osteochondrosis is practiced. Treatment is aimed at eliminating pain, restoring range of motion, preventing the spread of pathology to healthy discs and vertebrae.
The use of nonsteroidal anti-inflammatory drugs, glucocorticosteroids, muscle relaxers helps get rid of lower 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 physiotherapy, the muscles not only of the lower back, but also of the whole back are strengthened, posture improves, and blood supply to damaged connective tissue structures is accelerated. Doctors in exercise therapy recommend that patients slow down and smooth out twists and torso curls, shallow squats, and lunges.
Patients with lumbar osteochondrosis receive all types of massage - vacuum, acupuncture, connective tissue, segmental. But the most popular is the classic. During the session, the masseur performs the basic massage movements: caresses, rubbing, kneading, vibrations. The goals of the procedures are to eliminate muscle spasms, improve blood flow to 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. At the stage of remission, sessions of laser therapy, magnetotherapy, therapy withshock waves, UHF therapy are often performed. Ozokerite therapy, applications with paraffin, hirudotherapy, mud, radon and hydrogen sulfide baths are also used.
The main indication for surgery is involvement of the spinal cord by hernial protrusion. During the operation, the intervertebral hernia is removed and the spinal canal is decompressed. The most common surgical methods used for lumbar osteochondrosis are microdiscectomy, puncture vaporization or laser disc reconstruction, placement of implants, and stabilization of the spinal segment.
After the main therapy, to achieve stable remission in the treatment, homemade ointments, herbal teas, compresses, rubs with oil and alcohol are used. Folk remedies do not affect the cause of osteochondrosis, therefore, they are used to eliminate weak aching pain, 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. Especially dangerous is discogenic myelopathy, which cannot always be eliminated even with surgical treatment. It is manifested by pelvic disorders, including problems with defecation and urination. Complications of osteochondrosis also include radicular syndrome - a common cause of sharp, piercing pain in the lower back.
Preventive measures and prognosis
The prognosis is favorable when diagnosing a pathology 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.
Prevention of osteochondrosis of the lumbar spine is to control body weight, exclude excessive loads, timely treat endocrine and metabolic diseases. Neurologists and vertebrologists recommend visiting the pool, doing water aerobics, Pilates, and Nordic walking.