The causes of lumbar spine osteochondrosis are not well understood. The greatest importance is attached to hereditary predisposition, age-related changes in intervertebral discs
Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of lumbar spine osteochondrosis are not well understood. The greatest importance is attached to hereditary predisposition, age-related changes in intervertebral discs. Pain can be caused by awkward movement, prolonged forced position, heavy lifting and carrying, sports overload, overweight.
Depending on the duration, there are acute pain lasting up to 4 weeks, subacute (from 4 to 12 weeks) and chronic (lasting more than 12 weeks).
Neurological complications of osteochondrosis of the lumbar spine:
First stage. Clinical manifestations are associated with reflex muscle tension.
Lumbago (low back pain). Acute pain in the lumbar region begins suddenly, caused by minimal movements in the back. The range of motion of the lumbar spine is severely limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with adequate treatment and immobilization of the lumbar spine does not exceed 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lumbar region, aggravated by movement or in a certain position, discomfort when standing or sitting for a long time. The onset is usually gradual. Clinically, limited mobility of the lumbar spine, tension and pain of the paravertebral muscles are often determined. In most cases, the pain subsides within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (lower back pain radiating down the leg). In the lumbar region, movements are limited, the paravertebral 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 Lasègue syndrome. But there are no signs of radicular syndrome.
Second stepneurological complications of osteochondrosis of the lumbar spine.
Disc herniation with radicular syndrome or radiculopathy. Compression of the root is accompanied by shooting, burning pains in the leg. The pain is aggravated by movement, coughing, accompanied by numbness along the root, muscle weakness and loss of reflexes. Positive tension 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 area of distribution of limb pain and numbness.
Root syndromes are detected by a neurologist during an objective examination.
The third stage of neurological disorders of lumbar osteochondrosis.
Vascular-root conflict. Paralytic sciatica syndrome occurs when blood circulation is disturbed in the L5 and less often S1 root artery. Radiculoischemia at other levels is diagnosed extremely rarely.
During awkward movement or heavy lifting, acute low back pain develops with radiation along the sciatic nerve. Then there is paresis or paralysis of the extensors of the foot and fingers with the "spanking" of the foot when walking (stepping). The patient, while walking, raises his leg high, throws it forward and at the same time slaps his toe on the floor.
In most cases, the paresis regresses safely within a few weeks.
The fourth stage of neurological 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 minor, but when walking there is a syndrome of intermittent claudication. Pain when walking spreads along the roots from the lower back to the feet, is accompanied by weakness, paresthesia and numbness of the legs, disappears after rest or when the torso is tilted forward.
Acute violation of spinal circulation is the most serious complication of lumbar osteochondrosis. Acutely develops inferior paraparesis or plegia. Weakness of the legs is accompanied by numbness of the lower extremities, dysfunction of the pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
Analysis of complaints and anamnesis are of great importance to exclude serious pathology. A neurological examination is performed to rule out root and spinal cord damage. Manual examination allows you to determine the source of pain, limitation of mobility, muscle spasms.
Additional methods of examination are indicated if specific back pain is suspected.
An X-ray of the lumbar spine is prescribed to exclude tumors, spinal injuries, spondylolisthesis. X-ray signs of osteochondrosis are of no clinical value, since all old and elderly people have them. Functional x-rays are done to check for spinal instability. Photos are taken in the position of extreme flexion and extension.
For radicular or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. In MRI, herniated discs and the spinal cord are better seen, and in CT, bony structures are better seen. The clinical level of the lesion and the MRI findings should match, as a herniated disc detected on MRI is not always the cause of the 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 muscle corset, swimming and massage classes.
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 soon 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 last no more than 2-3 days. In many patients, it is possible to increase the pain syndrome against the background of the expansion of the motor regime. The patient should not limit himself to reasonable physical activity.
Among non-drug therapeutic 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, nonsteroidal anti-inflammatory drugs are indicated. In combination with anti-inflammatories, muscle relaxants can be prescribed as a short course.
In osteochondrosis of the lumbar spine, therapeutic blockades with local anesthetics, nonsteroidal anti-inflammatory drugs and corticosteroids are effective. Drug 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.
For prolonged myofascial pain, the introduction of trigger point nonsteroidal anti-inflammatory drugs, 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 stenosis, weight loss, wearing a corset, NSAIDs and various venotonics are indicated.
Surgical treatment is carried out with paralyzing sciatica (in the first three days) and cauda equina syndrome (paresis 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 workstation, to alternate periods of work and rest. Wear a fixation belt in case of physical overload. Do exercises to strengthen your back muscles.