What is lumbar osteochondrosis

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

Osteochondrosis of the lower back

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

Stages of development

• 1st – appearance of degenerative diseases affecting nerve endings and disrupting blood supply.The inflammatory process causes pain that radiates to the legs.The patient experiences intermittent tingling in the back and buttocks.Appears after heavy physical exertion.
• 2nd – the outer shell of the intervertebral disc (fibrous ring) is destroyed.The distance between the vertebrae is reduced, the nerve endings are compressed, which provokes strong, sharp pain.The symptoms are especially pronounced when walking.
• 3rd - due to the excessive mobility of the vertebrae, muscle fibers and nerve endings are pressed.Spasms, numbness, burning pain, hernia - displacement of the intervertebral disc in the spinal cord appear.
• 4th – growth of pathological exostoses on the bone structure.The spine literally "petrifies".Progressive arthrosis and lack of treatment immobilize the patient.

Reasons for development

The disease develops slowly, at 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 (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.Supports the spine and internal organs.In this way, the lack of physical activity provokes disruption of the work of a number of systems - blood circulation, breathing, digestion.
• Overweight.With a BMI (Quetelet body mass index) over 25 kg/m2, excess weight creates additional stress on the body: it puts pressure on the spine, overloads the joints and disrupts the blood supply.
• Endocrine pathological processes.Hormonal imbalance, disorders in the functioning of the adrenal glands and the thyroid gland "slow down" the body's metabolism.Frequent hormonal changes "wash" calcium from bone tissue, making it weak and brittle.
• An unbalanced diet.Popular and affordable fast food fully satisfies the energy needs of the body, but from the point of view of saturating the body with the necessary vitamins and trace elements, 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.

Lumbar osteochondrosis occurs many times more often in men whose occupation is associated with significant physical exertion.

Symptoms of lumbar osteochondrosis

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

Spinal nerves extend from the trunk of the spine to various 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 the "radicular syndrome" manifests itself.

The spinal nerve map allows you to identify pain with a specific region 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 the segmental innervation:

• L3-L4 – a weak knee reflex, partial numbness, episodic loss of sensitivity is noted on the front surface of the thigh;
• L4-L5 - muscle weakness, the patient cannot fix the body while standing on the heels, the pain and sensitivity disorder spread in the area from the lower back to the buttock, as well as over the entire lateral surface of the thigh (from top to bottom).
• L5–S1 – calf muscle tremors, inability to straighten toes, pain in back of thigh.

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

Pain reflex symptoms

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

Side signs of the disease are not so characteristic and can easily be mistaken for symptoms of another problem: impaired sweating (hypohidrosis), pallor of the skin of the affected area due to poor blood circulation, severe dryness and peeling.

Diagnosis

At the initial stage, a complete medical history of the patient is collected.The general picture should be supplemented by the opinions of a surgeon, orthopedist, neurologist and rheumatologist.Specialists subject the patient to a visual examination to assess changes in posture, muscle tone and skin sensitivity.

X-ray examination is performed 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.CT records the degree of disc deformation, inflammatory processes in the membrane of the spinal cord and nerve endings in a layer-by-layer image.

Magnetic resonance imaging (MRI) informatively shows the general condition of the muscle mass, blood vessels and ligaments.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 substance using a needle into the cavity between the pia mater and the arachnoid of the spinal cord, filled with cerebrospinal fluid.Like CT, MTP and X-ray, the procedure is performed in real time.

The neurological examination of sensitivity and reflexes for pathologies is a complex of studies that includes a screening method for examining the symmetry of the limbs, testing vibrational sensitivity and evaluating Babinski, Chadock and Oppenheim reflexes.

Treatment of lumbar osteochondrosis

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

Drug therapy (for stages 1-2)

• Analgesics for pain relief: local (ointments, gels), oral (tablets, suspensions), intramuscular (injection solutions).
• 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 serious cases (inflammation of the sciatic nerve) - injections.Primary course - 7-14 days.
• Muscle relaxants.It is prescribed in the acute period for muscle spasms, as well as in the remission period to consolidate the effect.
• Chondroprotectors.They block the destructive processes in the intervertebral discs, promote regeneration, improve metabolism in cartilaginous tissues.
• Vascular drugs.It helps to normalize blood supply to the musculoskeletal system.
• Vitamin complexes of group B. Improve nerve conduction.
• Diuretics.Reduces swelling.

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

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

Prevention

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