It is one of the most common diseases todayosteochondrosis of the lumbar spine. Both men and women equally often turn to doctors with this disease.
At least once in our life, each of us has experienced pain in the lower back, lower back or lower limbs. We often unconsciously refer to this type of pain as "pinched nerve in the lower back".
Causes of lumbar osteochondrosis
According to the research of doctors and scientists, the main cause of osteochondrosis of the lumbar spine is the upright posture. But not all people suffer from osteochondrosis. Provocative factors that accelerate the development of the disease are: metabolic disorders, lack of physical activity, injuries, excess weight, incorrect weight lifting.
The source of pain in osteochondrosis is pinching of the nerve roots, which occurs after the protrusion of the intervertebral disc and narrowing of the intervertebral space. This deviation is formed when nutrition deteriorates, the natural processes of oxygen and lymph exchange in the tissues of the intervertebral discs are disturbed. As a result, the cushioning ability of the intervertebral discs decreases, and the nucleus pulposus of the disc gradually shrinks and dries up.
From an anatomical point of view, lumbar osteochondrosis is a process of transformation of cartilage into bone, which leads to excessive pressure on the nerve roots that extend from the spinal cord. This change causes pain. Overgrowth of bone tissue occurs due to deterioration of nutrition of the intervertebral discs, loss of fluid and disturbances in structure and function.
When the protrusion of the intervertebral disc during the development of osteochondrosis of the lumbar spine becomes more serious, it provokes the development of lumbar protrusion and lumbar disc herniation due to rupture of the fibrous ring.
The pain syndrome is formed due to pinching of the spinal nerve in lumbar osteochondrosis and is called lumboischialgia. This symptom is accompanied by numbness in the lower extremities. Depending on the nature and localization of the pain, the disease can be divided into sciatica and lumbago. Inflammation of a nerve due to its pinching is called sciatica. The methods of treating radiculitis with painkillers are actually only removing the symptoms and are ineffective, because such treatment does not affect the real cause of the disease, namely the degenerative processes in the intervertebral discs. To eliminate pain and take preventive measures to prevent complications, you need to undergo a comprehensive course of treatment to activate the recovery processes in the tissues of the discs, to normalize the height and physiological parameters of the intervertebral discs.
Symptoms of osteochondrosis of the lumbar spine
One of the signs of osteochondrosis is the compression of the spinal nerve roots by the bulging nucleus pulposus of the intervertebral disc. This compression occurs in the epidural space, which is a kind of container for the spinal roots. Osteochondrosis of the lumbar spine manifests itself with the following symptoms, which correspond to a compressed root:
- L1 and L2 - loss of sensation in the area of the "rider's pants", namely in the groin area and the inner part of the thighs. Pain can appear in both legs at once if lumbar osteochondrosis is complicated by the development of a hernia.
- L5 – shooting pain, decreased sensation in the lower back and sensation in the thumb, and decreased ability to flex the finger.
- S1 - shooting pain, decreased sensitivity of the lower leg and outer thigh, pain in the foot from the little to the fourth toe. Often, when this root is damaged, the Achilles and plantar reflexes are lost.
- Damage to the Deproge-Gotteron artery - in the chronic course of osteochondrosis, paralysis of the lower leg and buttocks may occur, and sensitivity in the anogenital area may disappear.
- Simultaneous damage to the L5, S roots and the Deproge-Gotteron artery causes the "paralyzing sciatica" syndrome, loss of pelvic and motor function.
Osteochondrosis of the lumbar spine can cause protrusions and hernias due to significant loads on this part of the spine. It is these complications that develop very quickly, so it is very important to treat them in time. Do not delay your visit to a vertebrologist, undergo a complete examination and seek qualified help at the first symptoms of lumbar osteochondrosis.
Complications of osteochondrosis of the lumbar spine
Compression-vascular ischemia can be considered a complication of lumbar osteochondrosis. This pathology develops due to impaired blood supply to the spinal cord, reduction of intervertebral openings for vessels and arteries, as well as narrowing of the peripheral structures of the vertebrae. The reason for the development of this pathology is the flattening of the discs, excessive mobility of the spine, weakened ligaments, formation of osteophytes and neoathrosis. Permanent injury and pressure on a pinched vessel or artery occurs due to any movement of the spine that affects the injured area. In addition, a reflex narrowing of the vessel that passes through the secured canal opening may develop. This effect is called "narrow bed".
Vertebrologists identify another serious complication of osteochondrosis of the lumbar spine. Compressive myelopathy is a disease of the spinal cord that occurs due to narrowing of the spinal canal. Depending on the location, the symptoms and severity of the pathology can vary. Most often, the course of the disease is characterized by episodicity - after an attack there is a period of remission.
Lumbar osteochondrosis can be complicated by disc herniation TXII-L1, which exerts pressure and provokes damage to the segments S1-S2, L2-L-4 of the spinal cord. A patient with this complication feels pain in the lower back, lower leg, back of the thigh, as well as weakness in the legs. The gluteal and calf muscles gradually become hypotonic and hypotrophic, the Achilles and plantar reflexes disappear, foot paresis is formed. The back and outer surface of the foot and lower leg are characterized by reduced sensitivity or complete absence.
If a disc herniation LI-II develops, in which excessive pressure on the coccygeal segment S3 increases, osteochondrosis of the lumbar spine has the following symptoms: disorder of the pelvic organs, fecal and urinary incontinence, constipation, loss or decrease in sensitivity of the anogenital area, development of bedsores, anal prolapse reflex.
"Cauda equina syndrome" develops when the nerve roots are compressed from the first lumbar vertebra and below. An experienced vertebrologist notes that this syndrome most often develops in patients with congenital narrowing of the spinal canal. "Cuda equina" is a bundleof nerve roots, which contains the terminal roots of the spinal cord from the first segment onwards. The name derives from its resemblance to a horse's tail. The diagnosis of this syndrome largely depends on the presence of excruciating pain of a radicular nature. It is this characteristic that distinguishes cauda equina syndromefrom other complications in which there is no acute pain.
Cauda equina syndrome is characterized by intense pain in the sacrum and lower back that radiates to the buttock, anogenital area, and the back of the thigh. In some cases, paresis, peripheral paralysis and sensory disturbances are observed. Severe cases are characterized by paralysis of the buttocks and both legs. A characteristic feature of the complication can be considered the asymmetry of sensory and motor disorders.
Lumbar osteochondrosis can cause the development of a myelogenous syndrome of "intermittent limping", in which there is weakness in the legs when walking, frequent urges to urinate and numbness in the lower part of the torso. The cause of this discomfort is poor blood supply to the lower parts of the spinal cord. After rest, these sensations disappear.
Caudogenic "intermittent claudication" occurs with ischemia of the roots of the cauda equina - goosebumps and numbness when walking. Over time, this symptom can increase, reaching the perineum, genitals and groin. Weakness in the legs disappears after a short rest.
Compression of the artery of Adamkiewicz can occur due to failed sudden movement, heavy lifting, or shaking. This complication of osteochondrosis of the lumbar spine manifests itself as disorders of the pelvic organs, loss of sensitivity, the appearance of bedsores and atrophy of the leg muscles.
Osteochondrosis of the lumbar spine is manifested by pain in the lower back. Due to prolonged stay in an uncomfortable position, the pain may increase. After sleeping or resting in a lying position, the pain subsides or disappears completely.
The occurrence of stressful situations for the body can cause the development of an acute condition. Most often this happens with hypothermia, heavy loads and sudden movements. Exacerbation is characterized by severe pain that can radiate from the lumbar region to the legs. The body can independently try to reduce the load on the affected part of the spine by strong tension in the muscles of the lower back. A patient with osteochondrosis of the lumbar spine tries to find a comfortable position in which the pain subsides.
Diagnosis of lumbar osteochondrosis
Diagnosis of osteochondrosis is carried out in several stages. The doctor should talk to the patient, ask about the complaints, understand the nature of the pain, where it is localized, when the painful sensations are felt, their duration, intensity, etc. In addition, the doctor will understand under what conditions the pain occurs, when it intensifies or subsides.
Then the vertebrologist examines the anamnesis, i. e. the history of the disease. The doctor will definitely clarify how long the painful condition lasts, what is the cause of the pain and how you feel during the period when the discomfort disappears. An important point is preliminary treatment, as well as the effectiveness of certain treatment methods. A qualified doctor will definitely ask the patient about living and working conditions, range of motion, well-being under certain loads and past illnesses. It is very important to find out if the patient has had spinal injuries, if he has played sports, and if he has direct relatives with spinal diseases.
The next step in the diagnosis will be the examination of the patient. The doctor will pay attention to the position of the head, legs and arms in relation to the body, the gait, the manner of holding, the symmetry of the areas of the body, the condition of the skin in the damaged area and the movements of the patient. The range of motion of the spine and the degree of impairment are then determined. To do this, the doctor will ask the patient to bend forward, sideways, backward, ask him to move different parts of his back and tilt his head. A healthy person should not experience crunch or joint pain during such a simple test.
If the patient does not suffer from osteochondrosis, then he can reach his chest and shoulder with his chin. Head movements in each direction are about 60 degrees. A 45-degree angle is formed by lateral bending between the head and upper cervical spine. The distance from the sacrum to the spinous process of the seventh cervical vertebra increases by 5-7 centimeters when bending forward. This distance is reduced by 5-6 cm when leaning back. An experienced vertebrologist will pay attention to how the knee and hip joints participate in bending and how the configuration of the spine changes.
Treatment of osteochondrosis of the lumbar spine
Lumbar osteochondrosis requires complex, intensive and long-term treatment. This is especially true for chronic cases with multiple intervertebral hernias and protrusions.
Effectivetreatment of osteochondrosis of the lumbar spineis achieved through reflex methods that do not cause side effects, but bring maximum benefit. Remember that recovery from such a serious illness cannot come quickly. In each case of lumbar osteochondrosis, the doctor prescribes an individual treatment regimen.
It is worth noting that manual therapy can be used only in cases where the patient's spine is not damaged by protrusions and intervertebral hernias. The integrated use of these techniques allows you to restore normal blood microcirculation, remove congestion, vascular edema, relieve muscle spasms, restore the balance of metabolic processes in the tissues of the vertebrae and intervertebral discs, as well as improve the nutrition of tissues in the lumbar region. As a result, the natural regeneration process is stimulated. It is worth noting that with lumbar osteochondrosis, manual therapy should be aimed at improving the functions of the spine.
Lumbar osteochondrosis treatment procedures are complemented by the use of herbal medicines that improve innervation in the body and also restore the balance of metabolic processes. The vertebrologist will recommend to patients correction of nutrition and a more active lifestyle. It is important to correct your body weight, because excess weight puts additional pressure on the lower back and also aggravates the development of osteochondrosis of the lumbar spine.
An experienced specialist who treats osteochondrosis allows the patient to achieve serious results, as well as to avoid surgery, improve motor activity, eliminate pain in the lower back and overall improve the body to prevent further exacerbations. Acute pain disappears after 1-3 sessions of manual therapy, and the positive effect of the treatment is achieved on average after 10-15 sessions. Remember that timely initiation of treatment is a guarantee of achieving positive results.
During the period of exacerbation of pain in the lower back, the patient is recommended to stay in bed for 2-3 days. For quick pain relief, non-steroidal anti-inflammatory drugs, pain relievers, venotonics, diuretics, nicotinic acid and vitamins of group B are prescribed. Walking with crutches, dry or underwater traction of the spine can also be prescribed to relieve the spine. If necessary, glucocorticoid blocks or paravertebral blocks with anesthetic are prescribed.
Physiotherapy treatment of osteochondrosis of the lumbar spine may also include electrophoresis, laser therapy and ultraviolet irradiation. Physical therapy is a mandatory component of a comprehensive treatment program. Some exercises can be used in the acute stage, but almost all exercises are recommended to be performed after the pain has subsided. Thanks to regular physical exercises, tissue nutrition is restored, blood supply and lymph supply to the intervertebral discs is improved, flexibility and elasticity of the joints and cartilages are gradually restored. In this way, the patient's condition improves and the interval between periods of exacerbation is extended.
Balneotherapy also has a good effect on health. In climatic resorts, iodine-bromine, hydrogen sulphide and radon baths are prescribed.
Surgical methods of treatment are used only if the patient's pain cannot be relieved by conservative methods for a long time, with paresis of the muscles of the lower limbs and disruption of the processes of natural urination and defecation. During the operation, the herniated disc is removed and the spinal segment is strengthened.
Prevention of lumbar osteochondrosis
Prevention of lumbar osteochondrosis consists in following simple rules recommended by a vertebrologist. Remember that the development of the disease can be prevented only by carefully following these rules, no matter what:
- Keep your lower back dry and warm, do not overcool the spine and avoid drafts.
- Do not lift heavy objects or carry them long distances.
- Try not to make sudden movements.
- Maintain proper posture during work and rest.
- Change your position as often as possible, trying not to stay in one position for a long time.
- Do physical therapy.
- Try not to stand in a bent position for a long time.
- When cleaning, use long mops, a broom and a vacuum cleaner with a long tube so you don't have to bend over.
- Lift weights correctly: bend over with a straight back or bend your knees, pick up the bags with a straight back and stand up. Keep your hands with the load as close to the body as possible.
- If you have to bend low to pick something up off the floor, such as under a table or bed, get down on one knee and keep your back straight.
- Distribute the weights equally between both hands.
- Strengthen your glutes, stretch your spine, walk every day.
- Balance your diet, enrich your diet with dairy and vegetable products.
- Observe the drinking regime - 1. 5-2 liters of water and herbal teas per day.
- Get rid of bad habits - alcohol, smoking, drugs.