The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is given to hereditary predisposition, age-related changes in intervertebral discs
Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is given to hereditary predisposition, age-related changes in intervertebral discs. Pain can be caused by awkward movements, prolonged forced position, lifting and carrying heavy loads, sports overload, excess weight.
Depending on the duration, there are acute pain lasting up to 4 weeks, subacute (from 4 to 12 weeks) and chronic (lasting longer than 12 weeks).
Neurological complications in osteochondrosis of the lumbar spine:
First step. Clinical manifestations are associated with reflex muscle tension.
Lumbago (low back pain). Sharp pain in the lower back starts suddenly, brought on by minimal movement in the back. The range of motion in the lumbar spine is quite limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with proper treatment and immobilization of the lumbar spine is not more than 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lower back, aggravated by movement or in a certain position, discomfort when standing or sitting for a long time. Onset is usually gradual. Clinically, limited mobility in the lumbar spine, tension and pain of the paraspinal muscles are often determined. In most cases, the pain goes away within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (low back pain that radiates to the leg). In the lumbar region, movements are limited, the paraspinal muscles are tense and painful on palpation.
In piriformis syndrome, the sciatic nerve is compressed, causing paresthesias and numbness in the leg and foot. positive Lasegue syndrome. But there are no signs of radicular syndrome.
second stageNeurological complications of osteochondrosis of the lumbar spine.
Disc herniation with radicular syndrome or radiculopathy. Root compression is accompanied by sharp, burning pains in the leg. The pain is aggravated by movement, by coughing, accompanied by numbness along the root, muscle weakness and loss of reflexes. Positive voltage symptoms.
In the lumbar region, the greatest load falls on the lower part, therefore, the L5 and S1 roots are most often involved in the pathological process. Each root has its own pain and numbness distribution zone for the limbs.
Root syndromes are detected by a neurologist during an objective examination.
The third stage of lumbar osteochondrosis neurological disorders.
Vascular-Rodicular Conflict. Paralyzing sciatica syndrome occurs when blood circulation is disturbed in the L5 radicular artery and less frequently in the S1. Radiculoischemia at other levels is diagnosed extremely rarely.
During awkward movement or heavy lifting, acute back pain develops radiating along the sciatic nerve. Then there is paresis or paralysis of the foot extensors and toes with the "tapping" of the foot when walking (steppage). The patient, while walking, lifts the leg very high, throws it forward and at the same time taps the toe on the floor.
In most cases, the paresis regresses safely within a few weeks.
The fourth stage of neurologic complications of osteochondrosis of the lumbar spine.
Violation of blood supply to the spinal cord and cauda equina. In spinal stenosis, several spinal nerve roots (cauda equina) are affected. The pain at rest is less, but when walking, there is an intermittent claudication syndrome. Pain when walking spreads along the roots of the lower back to the feet, is accompanied by weakness, paresthesia and numbness of the legs, disappears after rest or when the trunk is leaned forward.
Acute violation of spinal circulation is the most serious complication of lumbar osteochondrosis. Acutely develops inferior paraparesis or plegia. Weakness in the legs is accompanied by numbness of the lower extremities, dysfunction of Organs pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
Of great importance is the analysis of complaints and anamnesis to exclude a serious pathology. Neurological examination is performed to exclude damage to the roots and spinal cord. Manual examination makes it possible to determine the origin of pain, mobility limitation, muscle spasm.
Additional examination methods are indicated for suspected specific back pain.
An x-ray of the lumbar spine is prescribed to exclude tumors, spinal injuries, spondylolisthesis. The radiographic signs of osteochondrosis have no clinical value, as all the elderly and elderly have them. Functional radiographs are done to look for spinal instability. Photos are taken in the extreme flexion and extension position.
For radicular or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. On MRI, herniated discs and spinal cord are better visualized, and on CT, bony structures are better visualized. The clinical level of the lesion and the MRI findings must correspond with each other, as a herniated disc detected on MRI is not always the cause of pain.
In neurological deficits, electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis.
If somatic pathology is suspected, a thorough clinical examination is performed.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort appear in the lumbar spine, regular gymnastics are indicated to strengthen the muscular corset, swimming and massage courses.
The treatment of lumbar osteochondrosis is divided into 3 periods: treatment of the acute, subacute and chronic period.
In the acute period, the main task is to relieve the pain syndrome as early as possible and restore the patient's quality of life. In the presence of severe pain, immobilization of the lumbar spine with a special anti-radiculitis corset for 2-3 weeks is indicated. Bed rest should not last longer than 2-3 days. In many patients, it is possible to increase the pain syndrome in the context of the expansion of the motor regime. The patient should not limit himself to reasonable physical activity.
Of the non-drug therapy methods, interstitial electrical stimulation, acupuncture, hirudotherapy, and massage are effective. It is possible to use manual therapy, but only in competent hands.
Medical treatment. In acute pain, non-steroidal anti-inflammatory drugs are indicated. In combination with anti-inflammatory drugs, muscle relaxants can be prescribed in a short course.
In osteochondrosis of the lumbar spine, therapeutic blocks with local anesthetics, non-steroidal anti-inflammatory drugs, and corticosteroids are effective. Medicinal mixtures are administered as close as possible to the focus of pain (in the affected muscles, root exit points).
With radiculopathy with the presence of neuropathic pain, anti-inflammatory drugs are ineffective; in this case, antidepressants, anticonvulsants and a special therapeutic patch are prescribed.
With paresis, numbness, vascular preparations, vitamins of group B are prescribed.
With prolonged myofascial pain, introduction of non-steroidal anti-inflammatory drugs to trigger points, muscle relaxants, acupuncture, and post-isometric relaxation are effective.
For chronic pain, antidepressants, exercise therapy and other non-pharmacological treatments come first in treatment.
With spinal canal stenosis, weight loss, wearing a corset, NSAIDs and various venotonics are indicated.
Surgical treatment is performed with paralyzing sciatica (in the first three days) and cauda equina syndrome (paralysis of the extremities, impaired sensitivity, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
Preventionlumbar spine osteochondrosisreduced to avoid long and uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternate work and rest periods. Use a physical overload harness. Do exercises to strengthen your back muscles.