Lumbar osteochondrosis is a pathological process that develops in the lumbar intervertebral discs, accompanied by their destruction. The development of this disease is facilitated by a number of predisposing factors that worsen metabolic processes in the intervertebral discs. All the symptoms of the disease are divided into several groups, depending on the mechanism of their appearance. Treatment of lumbar osteochondrosis includes both conservative therapy methods and surgical interventions.
What is osteochondrosis of the lumbar spine
Osteochondrosis of the lumbosacral spine is a disease in which the intervertebral discs in this area undergo degenerative-dystrophic changes, which are subsequently associated with damage to the bone tissue of the vertebrae.
Usually, lumbar osteochondrosis develops at the age of 30-35, but under the influence of injuries, uneven loads on the back, symptoms of the disease may occur earlier.
Symptoms of pathology
Symptoms of osteochondrosis of the lumbar spine occur as a result of the impact of altered structures of the spine on surrounding vessels and nerve fibers. They are divided into several groups.
At the initial stage of the disease, there is a feeling of discomfort, fatigue in the lumbar region, combined with unpleasant sensations in the gluteal region. Sometimes with awkward movements, tight turns of the body in the lumbosacral region, pain occurs that passes on its own in a short time.
As the pathology progresses, a person worries about pain in the lumbosacral region, radiating to the buttock, hip joint, leg. If the pain occurs suddenly, is of a throbbing character, it is called lumbago. Most often, such a manifestation of osteochondrosis appears when trying to lift a weight, rolling with tremors, strong sneezing, coughing, changing the position of the body.
Long-term pain that gradually increases in intensity is called lumbodynia. They occur when you stay in an awkward position for a long time after physical exertion.
The pain is often accompanied by paresthesias (feeling of crawling, numbness), a burning sensation in the leg. There is stiffness in the lower back, which makes it difficult to move in this part of the spine. As I try to overcome this stiffness, the pain intensifies.
With the pathology of the 5th lumbar roots and 1st sacral roots, piriformis syndrome often develops. This condition is caused by the compression of the sciatic nerve by the spasmodic piriformis muscle, located between the sacrum and the upper femur. Localized tingling, numbness or pain occurs in the buttocks area.
In some, with osteochondrosis of the lower back, there is pelvic floor syndrome, which is manifested by coccygodynia - pain in the tailbone. There is also pain in the sacrum, perineum, passing to the gluteal region, internal, back of the thigh.
With psoas-iliac syndrome, against the background of excessive tension of the latter, a person experiences pain in the lower back, groin or buttock. In addition, unpleasant sensations, paresthesias are noted in the antero-external region of the thigh, less often on the lower leg.
These symptoms of lumbar osteochondrosis occur with mechanical damage to the spinal roots. The latter can be compressed by intervertebral hernias, osteophytes (bone growths), altered joint processes of the vertebrae, thickened yellow ligaments (ligaments connecting the arches of adjacent vertebrae).
An intervertebral hernia is a rupture of the fibrous ring of the intervertebral disc with subsequent exit of the nucleus pulposus. A hernia can form acutely, under the influence of a large load, or gradually, while the symptoms of lumbar osteochondrosis slowly increase.
The features of signs of an intervertebral hernia depend on its location, size. With the defeat of the spinal roots between:
- the third and fourth lumbar vertebrae hurt the antero-internal thigh area, lower leg, ankle from the inside, a decrease in sensitivity on the anterior side of the thigh is characteristic;
- through the fourth and fifth lumbar vertebrae, the pain from the gluteal region spreads to the outer part of the thigh, the lower leg, the back of the foot, and the skin sensitivity also decreases in these areas;
- the fifth lumbar vertebra and the first sacral vertebra, pain in the gluteal region is given on the back of the thigh, lower leg, heel, outer edge of the foot, which is accompanied by a violationsensitivity in these areas.
If the intervertebral hernia is large, the syndrome of compression of the roots of the cauda equina (the roots of the spinal nerves from the level of the second lumbar vertebra to the fifth sacral vertebra) may develop. Signs of this form of osteochondrosis of the lumbosacral region include pain syndrome, movement disorders of the lower limbs, which can lead to paralysis, decreased sensitivity, difficulty urinating.
There are blood vessels near the spinal roots, which are compressed as a result of degenerative changes. In the initial stages of the disease, compression of the arteries is rare, in later stages it persists for a long time.
Signs of ischemia in osteochondrosis of the lumbar spine - pain, weakness in the legs when walking for a long time, disappearing after stopping movement.
Causes of lumbar osteochondrosis
Lumbosacral osteochondrosis develops under the influence of the following factors:
- Hereditary predisposition. The presence of this disease in close relatives increases the likelihood of its development in humans.
- Hypodynamia, uneven load on the spine. Insufficient physical activity weakens the core muscles, and the lumbar spine takes the greatest load when a person sits. The forward curvature of the trunk creates additional stress on the anterior edges of the vertebrae.
- Excessive physical exertion, work associated with constant turns, flexion, extension of the trunk, jerky movements. These factors put undue stress on the back muscles and cause intervertebral hernias to form.
- Overweight, which creates additional load on the musculoskeletal system.
- Poor posture, which contributes to uneven load distribution on the spine.
- Congenital developmental disorders, trauma, diseases of the musculoskeletal system (eg, osteomyelitis, tuberculosis).
- Flat foot. In this condition, the arch of the foot does not perform a cushioning function, so the intervertebral discs experience increased stress.
- Inflammatory processes, diseases of internal organs. Lumbar osteochondrosis often develops against the background of endocrine disorders, pathologies of the cardiovascular system, inflammatory lesions of the joints of the spine.
- Frequent psycho-emotional stress.
All these factors contribute to the disruption of the blood supply to the intervertebral discs, the disruption of metabolic processes, a decrease in the elasticity of these structures and a slowing down of regenerative processes.
Lumbar osteochondrosis most often develops in athletes whose backs constantly experience heavy physical exertion, periodically - injuries. Another category of people at risk includes office workers, cooks, teachers, drivers, waiters, hairdressers. People in these professions spend a lot of time in one position during the day, which creates an excessive load on the intervertebral discs.
The degree of the disease
Depending on the severity of degenerative-dystrophic changes, lumbosacral osteochondrosis has 4 degrees.
The first one
Intervertebral discs lose elasticity, become less elastic, their height changes slightly or remains the same.
Small cracks form in the fibrous rings of the intervertebral discs. The intervals between the vertebrae are reduced, the latter are displaced relative to each other. This leads to compression of the nerve roots, a pain syndrome.
There is a rupture of the fibrous ring, the nucleus pulposus extends beyond its limits, as a result of which an intervertebral hernia is formed. . .The latter compresses nerve fibers, blood vessels.
The spine undergoes deformation, usually lordosis or scoliosis is formed. In lordosis, the anterior curvature of the spine becomes more pronounced; scoliosis is a lateral curvature of the spine.
There is a pronounced deformation of the spine, which together with the pain syndrome makes it difficult for a person to exercise motor skills. Osteophytes are formed - growths of bone tissue on the vertebrae, causing trauma to surrounding tissues, entrapment of nerve fibers. The vertebrae are as close together as possible, strongly deformed.
Stages of the disease
The symptomatology of osteochondrosis changes as the disease progresses, and therefore there are 4 stages of the pathological process. On the first of them, discomfort in the lumbar region periodically occurs. Usually, unpleasant sensations appear after physical exertion, weight lifting or awkward posture for a long time. This stage is characterized by a decrease in the elasticity of the intervertebral discs without a pronounced change in their height.
If the disease progresses to the second stage, the person experiences more severe and prolonged pain. During this period, cracks appear in the fibrous ring of the intervertebral disc, the intervals between the vertebrae decrease.
During the third stage, intervertebral hernias form, which often leads to damage to the spinal nerves. A person is worried about the constant pain radiating to the thigh, lower leg, the sensitivity of the skin in these areas is disturbed.
The fourth stage is characterized by constant pain, pronounced limitations in the movements of the lumbar spine due to a significant deformation of the vertebrae in this area.
Treatment of osteochondrosis of the lumbar spine
Before treating osteochondrosis of the lumbar spine, it is necessary to understand what links of the pathological process and symptoms it should influence. The activities carried out must contribute to:
- elimination of inflammation;
- reduce pain;
- strengthen muscles, eliminate their spasms;
- improved blood supply, metabolic processes in the spine;
- restoration of normal range of motion, restoration of sensitivity of the lower limbs.
One of the components of conservative treatment is drug treatment for osteochondrosis of the lumbosacral spine. For this disease, drugs of the following pharmacological groups are used:
- Nonsteroidal anti-inflammatory drugs. They suppress inflammation and reduce pain. Usually, in the acute period of the disease, injections are used for lumbar osteochondrosis, then, after reducing the pain syndrome, pills are used. In addition, for topical application, such gels and ointments are used.
- Muscle relaxants. These funds reduce the spasms of the muscles surrounding the spine, compressing nerve fibers, blood vessels, resulting in a decrease in pain.
- Chondroprotectors. These drugs prevent the destruction of cartilage tissue, normalizing metabolic processes in the intervertebral discs.
- Preparations containing vitamins improve metabolic processes in nerve fibers, which leads to the suppression of inflammatory reactions.
- Corticosteroids have a pronounced anti-inflammatory effect, they are used in short courses in cases where drugs from other groups are ineffective.
Massage for osteochondrosis of the lumbar spine helps improve blood circulation in the tissues, eliminate muscle spasms, reduce the severity of inflammatory reactions, which weakens the pain.
To eliminate the symptoms of osteochondrosis of the lumbar spine, physiotherapy is also used. The elimination of muscle spasms, pain, the restoration of metabolic processes in the intervertebral discs are facilitated by:
- diadynamic currents;
- laser therapy;
- vibration therapy.
Magnetotherapy promotes relaxation of spasmodic muscles, normalizes local blood circulation.
Balneotherapy, which is treatment with mineral water in the form of showers, baths, improves local metabolic processes, reduces pain.
Many are interested in when and how to surgically treat lumbar osteochondrosis. Surgery is performed when:
- compression of the spinal cord, vertebral artery;
- compression of the spinal nerves, accompanied by movement disorders;
- frequent and severe pain that is not relieved by medication;
- instability of the vertebrae.
During surgery, the damaged intervertebral disc is removed; this operation is called discetomy. The intervertebral disc is replaced by an artificial graft or a bone fragment obtained from the patient's pelvic bone. Sometimes with the intervertebral disc the vertebral body is removed, such an intervention is called a coprectomy.
In the next stage of the operation, the lumbar vertebrae are connected with each other so that they grow together in the future, which helps prevent their instability, the compression of the spinal nerves.
Therapeutic exercises for osteochondrosis of the lumbar spine
Therapeutic gymnastics for osteochondrosis of the lumbar spine is aimed at strengthening the muscles of the regions of the back, glutes and femur. Regular exercise improves blood circulation in these areas, as well as in the lumbosacral spine. Metabolic processes in the intervertebral discs are stimulated, muscle spasms and pain are reduced.
Before starting exercise therapy for osteochondrosis of the lumbar spine, it is necessary to choose comfortable clothes made of natural fabrics, which should not interfere with movement. However, it must be warm enough to avoid hypothermia of the back.
All exercises for lumbar osteochondrosis should be performed slowly, smoothly, with maximum concentration on muscle work. It is important to maintain deep, even breathing during exercise.
Gymnastics is performed no earlier than an hour after a meal.
When a person performs supine exercises for osteochondrosis of the lumbosacral spine, it is important to use a thick round roller, which is placed under the shins. This removes excess stress on the lower back.
It is recommended to record in the diary the plan, course results, changes in symptoms that occur. This information should be provided to the doctor for the subsequent correction of the performed gymnastic complex.
If during exercise therapy with lumbar osteochondrosis a person experiences pain when performing an exercise, it is necessary to reduce its amplitude, number of repetitions or exclude it from the complex.
All exercises for osteochondrosis of the lumbar spine are divided into:
- Performed in the acute period with severe pain. They aim at the general strengthening of the back muscles, facilitating breathing.
- Performed in the acute period when the pain subsides. These exercises are aimed at strengthening the abdominal muscles, the gluteal region.
- Performed during remission, when pain is absent or mild. Exercise allows you to use a large number of muscles, including active movements.
Recommended exercises for lumbar osteochondrosis in remission.
Prevention of lumbar osteochondrosis
To prevent the development of lumbar osteochondrosis, it is necessary to avoid excessive loads on the spine, to avoid prolonged stay in uncomfortable positions. To strengthen the muscles of the back and legs, regular exercise is important and swimming is considered to be the most beneficial for the spine. On the recommendation of a doctor, it is possible to use special orthopedic corsets, belts.
A balanced diet not only helps to reduce excess body weight and reduce the load on the spine, but also normalizes metabolic processes in the tissues. Timely treatment of chronic diseases, especially the pathology of the endocrine system, can prevent or slow down the development of degenerative changes in the spine.
Symptoms of lumbar osteochondrosis change with the progression of degenerative-dystrophic processes in the spine. Complex conservative treatment, including the use of drugs, massage, physiotherapy, therapeutic exercise, is aimed at reducing inflammation, muscle spasms and pain. Surgical treatment is used only with the ineffectiveness of conservative treatment, aimed at eliminating the intervertebral hernia, eliminating the complications of the disease.