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Lumbar osteochondrosis

Causes of Lumbar Spine Osteochondrosis

Lumbar osteochondrosis is a chronic disease that develops as a result of a degenerative-dystrophic process in the intervertebral discs. The disease is widespread and affects most people between the ages of 25 and 40.

According to statistics, every second adult has back pain at least once in their life, while in 95% of cases it is caused by osteochondrosis of the spine.

Patients with a severe course of lumbar osteochondrosis with persistent pain and other manifestations are considered to be temporarily disabled. If their condition does not improve within four months, a decision is made to set up a group of disabled people.

Lumbar osteochondrosis is a serious medical and social problem as the disease mainly affects people of working age and can also lead to the formation of a herniated disc without treatment.

Causes and Risk Factors

Factors that predispose to the development of lumbar osteochondrosis are:

  • anomalies in the structure of the spine;
  • Lumbarization - congenital pathology of the spine, characterized by the separation of the first vertebra from the sacrum and its transformation into the sixth (additional) lumbar spine;
  • Sacralization is a congenital pathology in which the fifth lumbar vertebra is fused with the sacrum;
  • asymmetrical arrangement of the joint spaces of the intervertebral joints;
  • pathological narrowing of the spinal canal;
  • reflected spondiogenic pain (somatic and muscular);
  • obesity;
  • sedentary lifestyle;
  • longer exposure to vibration;
  • systematic physical exertion;
  • smoking.

Unfavorable static-dynamic loads in combination with one or more risk factors lead to a change in the physiological properties of the nucleus pulposus of the fiber disc, which plays a shock-absorbing role and ensures the mobility of the spine. This process is based on the depolymerization of polysaccharides, which leads to moisture loss in the tissue of the gelatin core. As a result, the nucleus pulposus and thus the fiber disc lose their elastic properties. Further mechanical stress leads to a protrusion of the annulus fibrosus, which has lost its elasticity. This phenomenon is called protrusion. Cracks appear in the fiber core, through which fragments of the nucleus pulposus fall out (prolapse, herniated disc).

Prolonged compression of the nerve roots that innervate certain organs of the abdominal cavity over time leads to a deterioration in their function.

The instability of the spinal segment is associated with reactive changes in the bodies of neighboring vertebrae, intervertebral joints and the associated development of spondyloarthrosis. A significant muscle contraction, for example, against the background of physical activity, leads to a dislocation of the vertebral bodies and entrapment of the nerve roots with the development of radicular syndrome.

Another cause of pain and neurological symptoms in lumbar osteochondrosis can be osteophytes - bone growth in processes and vertebral bodies that cause radicular syndrome or compression myelopathy (spinal cord compression).

Forms of the disease

Depending on which structures are involved in the pathological process, lumbar osteochondrosis manifests itself clinically through the following syndromes:

  • Reflex- Lumbodynia, Lumboishalgia, Lumbago; develop against the background of a reflex overload of the muscles of the back;
  • Compression (spinal, vascular, radicular)- Compression (compression) of the spinal cord, blood vessels or nerve roots leads to their development. Examples are lumbosacral radiculitis, radiculoic ischemia.

Symptoms of lumbar osteochondrosis

In lumbar osteochondrosis, the symptoms are determined by which structures are involved in the pathological process.

Lumbago occurs under the influence of hypothermia or physical overload, and sometimes for no apparent reason. The pain occurs suddenly and has a shooting character. It increases when sneezing, coughing, turning the body, exercising, sitting, standing, walking. In the supine position, the pain sensations are significantly weakened. Sensitivity and reflexes are retained, the range of motion in the lumbar spine is reduced.

Please note when scanning:

  • pain in the lumbar region;
  • spasm of the paravertebral muscles;
  • Flattening of the lordosis, which in many cases is associated with scoliosis.

The nerve root tension syndrome in lumbago is negative. When lifting a straight leg, patients note an increase in pain in the lumbar region, not its appearance in an elongated lower limb.

In lumbar osteochondrosis, pain attacks often recur, which become more intense and longer each time.

In lumbodynia, the clinical picture is similar to lumbago, but the increase in pain intensity occurs over several days.

With lumboishalgia, patients complain of pain in the lumbar region that radiates to one or both lower extremities. The pain spreads to the buttocks and back of the thigh and never reaches the feet.

Lumboishalgia is characterized by vasomotor disorders:

  • changes in the temperature and color of the skin of the lower extremities;
  • feeling hot or cold;
  • Circulatory disorder.

The development of lumbar compression syndromes is shown clinically in the following symptoms:

  • dermatomal hypalgesia;
  • stabbing pain;
  • weakening or complete loss of deep reflexes;
  • peripheral paresis.

With compression syndromes, the pain is aggravated by bending the trunk, sneezing, and coughing.

Diagnosis

The diagnosis of lumbar osteochondrosis is made on the basis of the data of the clinical picture, laboratory and instrumental research methods.

For blood tests against the background of lumbar osteochondrosis:

  • decrease in calcium concentration;
  • increased ESR;
  • increased alkaline phosphatase.

When diagnosing lumbar osteochondrosis, great importance is attached to the x-ray examination of the spine.

Prolonged compression of the nerve roots that innervate certain organs of the abdominal cavity over time leads to a deterioration in their function.

X-ray signs that confirm the diagnosis are:

  • changes the configuration of the affected segment;
  • pseudospondylolisthesis (displacement of neighboring vertebral bodies);
  • deformation of the locking plates;
  • flattening of the intervertebral disc;
  • unequal height of the intervertebral disc (a symptom of a spacer) associated with asymmetrical muscle tone.
how to recognize the presence of osteochondrosis of the lumbar spine

The following are also used in the diagnosis of lumbar osteochondrosis, if indicated:

  • Myelography, computed or magnetic resonance imaging - are necessary for persistent symptoms, the development of neurological deficits;
  • scintigraphy (examination of the accumulation of phosphorus in the bone system, marked with tech-99) - is carried out if there is a suspicion of a tumor or an infectious process or a spinal injury.

The differential diagnosis of lumbar osteochondrosis is carried out in the following diseases:

  • spondylolisthesis;
  • dyshormonal spondylopathy;
  • ankylosing spondylitis (ankylosing spondylitis);
  • infectious processes (inflammation of the intervertebral disc, osteomyelitis of the spine);
  • neoplastic processes (primary tumor of the spine or its metastatic lesions);
  • rheumatoid arthritis;
  • deforming osteoarthritis of the hip joint;
  • reflected pain (diseases of the internal organs and large blood vessels).

Treatment of lumbar osteochondrosis

The following treatment tactics are typically used for lumbar osteochondrosis:

  • bed rest for 2-3 days;
  • traction of the affected segment of the spine;
  • Strengthening the back and abdominal muscles (creation of the so-called muscle corset);
  • Effects on pathological myofascial and myotonic processes.

Lumbago occurs under the influence of hypothermia or physical overload, and sometimes for no apparent reason.

In most cases, conservative treatment for lumbar osteochondrosis is performed, including the following:

  • Infiltration anesthesia of the muscles with a solution of local anesthetics;
  • taking nonsteroidal anti-inflammatory drugs;
  • are taking desensitizers;
  • vitamin therapy;
  • take sedatives and antidepressants;
  • manual therapy, massage;
  • physical therapy exercises;
  • acupuncture;
  • post-isometric relaxation.

The absolute indications for the surgical treatment of lumbar osteochondrosis are:

  • acute or subacute compression of the spinal cord;
  • Development of the cauda equina syndrome, characterized by functional disorders of the pelvic organs, sensory and motor disorders.

Therapeutic exercises for lumbar osteochondrosis

physical exercise in lumbar osteochondrosis

Physical therapy plays an important role in the complex treatment of lumbar osteochondrosis. Regular exercises allow you to normalize the muscle tone of the paravertebral muscles, improve the metabolic processes in the tissues affected by the pathological process, and in addition to form a well-developed muscle corset that can support the spine in the correct position and remove unnecessary static loads from it.

In order for gymnastics with lumbar osteochondrosis to have the greatest effect, you should adhere to the following principles:

  • Regularity of the classes;
  • gradual increase in the intensity of physical activity;
  • Avoidance of overwork during class.

Physiotherapy should be carried out under the guidance of an experienced instructor who will select the exercises that will be most effective for a particular patient and check the correctness of their implementation.

According to statistics, every second adult has back pain at least once in their life, while in 95% of cases it is caused by osteochondrosis of the spine.

In addition to taking classes with an instructor, you should do a series of morning exercises every day, including specific exercises for lumbar osteochondrosis.

  1. Relaxation and contraction of the abdominal muscles.The starting position is standing, feet shoulder width apart, arms lowered onto the body. Take a deep breath and relax the muscles of the anterior abdominal wall. As you exhale, pull your stomach in as much as you can and strain your abdominal muscles. The exercise should be repeated until slight fatigue occurs.
  2. Head movements with spinal flexion.The starting position kneels and rests on the floor with outstretched arms. The back is straight. Slowly raise your head and bend in your back. Hold this position for a few seconds, then gently return to the starting position. Repeat at least 10-12 times.
  3. "pendulum".Starting position lying on your back, arms along your body, legs bent at right angles at the knee and hip joints. Rotate your legs in swinging pendulum-like movements to the right and left, trying to reach the floor. In this case, the shoulder blades cannot be torn off the floor.
  4. Boot.Starting position lying on your stomach, arms stretched forward. Tear your upper body and legs off the floor and bend backwards. Hold this position for 5-6 seconds and slowly return to the starting position. Run 10 times.

Possible consequences and complications

The main complications of lumbar osteochondrosis are:

  • Formation of an intervertebral hernia;
  • vegetative-vascular dystonia;
  • spondylolysis, spondylolisthesis;
  • osteophytosis;
  • spondyloarthrosis;
  • Stenosis of the spinal canal, which leads to compression of the spinal cord and can lead to permanent disabilities and a deterioration in quality of life.

Prolonged compression of the nerve roots that innervate certain organs of the abdominal cavity over time leads to a deterioration in their function. As a result, patients suffer from intestinal disorders (constipation, diarrhea, flatulence) and pelvic organs (urinary disorders, erectile dysfunction, frigidity, infertility).

Forecast

Pain syndrome in lumbar osteochondrosis occurs in the form of remissions and exacerbations. Lumbago lasts 10-15 days, after which the patient's condition improves, the pain subsides. A favorable result can be prevented by the associated complications. With lumbar osteochondrosis, pain attacks often recur, and each time they become more intense and longer.

Physical therapy plays an important role in the complex treatment of lumbar osteochondrosis.

Patients with a severe course of lumbar osteochondrosis with persistent pain and other manifestations are considered to be temporarily disabled. If their condition does not improve within four months, a decision is made to set up a group of disabled people.

Prevention

Preventing the development of osteochondrosis of the spine consists of the following measures:

  • stop smoking;
  • normalization of body weight;
  • Improvement of general physical condition, active lifestyle;
  • Avoidance of provocative conditions (lifting weights, sudden movements, twists, bends).