What is lumbar osteochondrosis

Osteochondrosis in the lumbar region is caused by deformation and destruction of the cartilage tissue of the intervertebral discs.Without cartilage material, the vertebrae lose their elasticity and move, causing pain.According to the WHO, the disease mainly affects people over 30 years old.Women get sick three times more often, which is also related to age changes and a decrease in the level of calcium in the body.

Osteochondrosis of the lower back

Of all diseases of the peripheral nervous system, osteochondrosis of the spinal column accounts for 80%, of which 60-80% affects the lumbar region, which consists of 5 vertebrae.In 40% of people, the first signs of the disease appear at the age of 30-35.In old age, osteochondrosis of the spine is diagnosed in 90% of people.Painful sensations are experienced by 7 out of 10 people, and the exacerbation can last from 6 to 16 months.

Stages of development

• 1. - the beginning of degenerative disorders that affect the nerve endings and disrupt the blood supply.The inflammatory process causes pain that radiates to the legs.The patient experiences occasional tingling in the back and buttocks.Appears after heavy physical exertion.
• 2. – the outer shell of the intervertebral disc (fibrous ring) is destroyed.The space between the vertebrae is reduced, the nerve endings are compressed, which causes severe, acute pain.Symptoms are especially pronounced while walking.
• 3. - due to excessive mobility of the vertebrae, muscle fibers and nerve endings are compressed.Spasms, numbness, burning pain, hernias occur - displacement of the intervertebral disc in the spinal cord.
• 4. - the growth of pathological exostoses on the bone structure.The spine literally "turns to stone".Progressive arthrosis and lack of treatment immobilize the patient.

Reasons for development

The disease develops slowly, under the confluence of a number of circumstances, that is, the development of the disease depends on the influence of not one, but several factors:

• Sedentary lifestyle (physical inactivity), sedentary work, low level of physical activity.At first glance, they are not dangerous.However, with prolonged exposure, muscle tone, the so-called "muscle corset", is weakened.It supports the spine and internal organs.Thus, physical inactivity causes disruption of numerous systems - blood circulation, breathing, digestion.
• Excessive weight.With a BMI (Quetelet's body mass index) above 25 kg/m2, excess weight creates additional stress for the body: it puts pressure on the spine, overloads the joints and hampers the blood supply.
• Endocrine pathological processes.Hormonal imbalance, disorders in the functioning of the adrenal gland and thyroid gland "slow down" the body's metabolism.Frequent hormonal changes "wash out" calcium from bone tissue, making it weak and brittle.
• Unbalanced diet.Popular and affordable fast food fully satisfies the body's energy needs, while from the point of view of saturating the body with the necessary vitamins and microelements, it is absolutely useless.
• Pathologies and genetic predisposition to diseases of the musculoskeletal system.
• Age-related degenerative changes.Under the influence of time, natural wear and tear of the support system occurs.

In men whose profession involves significant physical activity, lumbar osteochondrosis occurs many times more often.

Symptoms of lumbar osteochondrosis

Pain is the main marker of the onset of the disease and its localization.Based on the nature of the occurrence, frequency and duration, a preliminary diagnosis can be made.Most often, patients with lumbar osteochondrosis have excruciating pain that spreads to the leg, groin area and coccyx.In a horizontal position, the discomfort disappears.

Spinal nerves run from the trunk of the spine to different parts of the body.Each nerve is responsible for a specific area.This is called "segmental innervation".For this reason, the affected nerve "reacts" in a certain area: this is how "radicular syndrome" manifests itself.

The spinal nerve map allows you to identify pain with a specific area of the spine: C1-C8 - 8 cervical, T1-T12 - 12 thoracic, L1-L5 - 5 lumbar, S1-S5 - 5 sacral, C0 - 2 coccygeal.Signs of osteochondrosis depending on segmental innervation:

• L3-L4 – weak knee reflex, partial stiffness, episodic loss of sensation are observed along the front surface of the thigh;
• L4-L5 – muscle weakness, the patient cannot fix the body while standing on the heels, pain and sensitivity disorder extend to the area from the lower back to the buttocks, as well as along the entire lateral surface of the thigh (from top to bottom).
• L5–S1 – calf muscle tremors, inability to stand on tiptoes, pain in the back of the thigh.

In rare cases, the radicular arteries are also involved in the destructive process, causing spinal stroke - a dangerous pathology in which the patient experiences paresis and paralysis, as well as pelvic organ dysfunction.

Pain reflex symptoms

• Lumbago or lumbago (not sciatica in this case!) – acute pain.Any unpleasant movement, even sneezing and coughing, causes a spasm.The patient spontaneously changes the position of the body, moving it to the side.Attempting to assume a vertical position causes new lumbago.
• Lumbodynia is a dull and aching pain that occurs on one side.Periods of remission are followed by exacerbation, which gradually develops into severe pain.
• Lumboischialgia - painful sensations appear in the leg.

Secondary signs of the disease are not so typical and can easily be confused with symptoms of another problem: disturbed sweating (hypohidrosis), paleness of the skin of the affected area due to poor circulation, severe dryness and flaking.

Diagnostics

In the initial phase, the patient's complete medical history is collected.The overall picture should be supplemented with the opinions of surgeons, orthopedists, neurologists and rheumatologists.Specialists undergo a visual examination of the patient to assess changes in posture, muscle tone and skin sensitivity.

X-ray is done for the primary diagnosis of lumbar osteochondrosis of the 1st degree;it is used to examine the condition of the intervertebral discs, pathologies of the spinal cord, as well as to assess the general condition of the spine.However, this type of diagnosis does not provide complete information about the affected tissues.

Computed tomography (CT) is a highly sensitive examination using a beam of ionizing rays.The CT scanner records the degree of disc deformation, inflammatory processes in the membrane of the spinal cord and nerve endings in the image layer by layer.

Magnetic resonance imaging (MRI) informatively shows the general condition of muscle mass, blood vessels and ligaments.It detects tumors and inflammatory processes.

Myelography is one of the ways to visually assess the condition of the spinal cord and nerve roots by injecting a contrast medium with a needle into the cavity between the pia mater and the arachnoid of the spinal cord, filled with cerebrospinal fluid.Similar to CT, MTP and X-ray, the procedure is performed in real time.

Neurological examination of sensitivity and reflexes for pathologies is a complex of studies that includes a screening method for the study of limb symmetry, examination of sensitivity to vibrations and evaluation of the Babinski, Chaddock and Oppenheimer reflexes.

Treatment of lumbar osteochondrosis

The effectiveness of conservative treatment is achieved by combining drugs from different groups, massage and manual therapy.However, in stage 3, lumbar osteochondrosis can no longer be cured by conservative methods;surgical intervention is required.One of the methods of osteochondrosis surgery is microdiscectomy.This is a neurosurgical operation to remove the hernia without damaging the nerve structures.It is performed under general anesthesia.The patient can walk already on the third day.

Drug therapy (for stages 1-2)

• Analgesics for pain relief: local (ointments, gels), oral (tablets, suspensions), intramuscular (solutions for injections).
• Nonsteroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, removes swelling.Gels and tablets are most often used, in more severe cases (inflammation of the sciatic nerve) - injections.Receives a course - 7-14 days.
• Muscle relaxants.It is prescribed in the acute period for muscle spasms, as well as during the remission period to consolidate the effect.
• Chondroprotectors.They block destructive processes in intervertebral discs, promote regeneration, improve metabolism in cartilage tissues.
• Vascular drugs.It helps to normalize blood supply to the musculoskeletal system.
• Vitamin complexes of group B. They improve nerve conduction.
• Diuretics.Reduces swelling.

As an emergency aid during an exacerbation, strong injections are used - paravertebral blockade, which causes a temporary loss of sensitivity.

It is also recommended to undergo a course of manual therapy twice a year, which relieves muscle tension and spasms, restores blood circulation, improves lymph circulation and increases the mobility of the musculoskeletal system.

Prevention

• An active lifestyle combined with moderate physical activity;
• Selection of comfortable or, if indicated, orthopedic shoes;
• Good nutrition;
• Body weight control;
• Sleep only on an orthopedic mattress and pillow;
• Office furniture with straight backs only;
• Rejection of heavy loads on the back and spine.When carrying heavy objects, the load should be evenly distributed on both hands.