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Lumbar osteochondrosis

causes of osteochondrosis of the lumbar spine

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 experiences back pain at least once in their life, while in 95% of cases it is caused by osteochondrosis of the spine.

Patients with severe lumbar osteochondrosis, persistent pain and other manifestations are recognized as temporarily impaired. If their condition does not improve within four months, the issue of creating a disability group is resolved.

Lumbar osteochondrosis is a serious medical and social problem, as the disease mainly affects people of working age, and in the absence of treatment can cause the formation of disc herniation.

Causes and risk factors

Factors predisposing to the development of lumbar osteochondrosis are:

  • abnormalities in the structure of the spine;
  • lumbalization - congenital pathology of the spine, characterized by separation of the first vertebra from the sacrum and its transformation into the sixth (additional) lumbar;
  • sacralization is a congenital pathology in which the fifth lumbar vertebra is fused with the sacrum;
  • asymmetrical arrangement of the articular spaces of the intervertebral joints;
  • pathological narrowing of the spinal canal;
  • reflected spondygenic pain (somatic and muscular);
  • obesity;
  • sedentary lifestyle;
  • prolonged exposure to vibration;
  • systematic physical stress;
  • smoking

Adverse static-dynamic loads in combination with one or more risk factors lead to a change in the physiological properties of the pulpal nucleus of the fibrous disc, which plays a cushioning role and provides mobility of the spine. This process is based on the depolymerization of polysaccharides, which leads to a loss of moisture in the tissue of the gelatin core. As a result, the nucleus pulposus, and with it the fibrous disc, lose their elastic properties. Further mechanical stress provokes a protrusion of the annular fibrosis, which has lost its elasticity. This phenomenon is called bulging. Cracks appear in the fibrous nucleus, through which fragments of the pulposus nucleus (prolapse, disc herniation) fall off.

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

The instability of the spinal segment is accompanied by reactive changes in the bodies of adjacent vertebrae, intervertebral joints and concomitant spondyloarthritis develops. Significant muscle contraction, for example, against the background of physical activity, leads to displacement of the vertebral bodies and entrapment of nerve roots with the development of radicular syndrome.

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

Forms of the disease

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

  • reflex- lumbodinia, lumboisalgia, lumbago; develop against the background of reflex strain on 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, radiculoischemia.

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 exertion and sometimes for no apparent reason. The pain appears suddenly and is shooting in nature. Intensified by sneezing, coughing, turning the body, exercise, sitting, standing, walking. In the supine position, the pain sensations are significantly reduced. Sensitivity and reflexes are preserved, the range of motion in the lumbar spine is reduced.

Observe on palpation:

  • lumbar pain;
  • spasm of paravertebral muscles;
  • flattening of the lumbar lordosis, which in many cases is combined with scoliosis.

The nerve root tension syndrome in lumbago is negative. When lifting a straight leg, patients notice an increase in pain in the lumbar region, rather than their appearance in an elongated lower limb.

Often, in lumbar osteochondrosis, there is a recurrence of pain attacks, which each time become more intense and prolonged.

In lumbodinia, the clinical picture resembles lumbago, but the increase in pain intensity occurs over several days.

In lumboisalgia, patients complain of pain in the lumbar region, which radiates to one or both lower limbs. The pain spreads to the buttocks and back of the thigh and never reaches the legs.

Lumboisalgia is characterized by vasomotor disorders:

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

The development of lumbar compression syndromes is manifested clinically by the following symptoms:

  • dermatomal hypoalgesia;
  • shooting pain;
  • weakening or complete loss of deep reflexes;
  • peripheral paresis.

In compression syndromes, the pain is exacerbated by bending the trunk, sneezing and coughing.

Diagnostics

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

For blood tests for lumbar osteochondrosis:

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

In the diagnosis of lumbar osteochondrosis, X-ray examination of the spine is of great importance.

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

The X-ray signs that confirm the diagnosis are:

  • change the configuration of the affected segment;
  • pseudospondylolisthesis (displacement of adjacent vertebrae);
  • deformation of the closing plates;
  • alignment of the intervertebral disc;
  • uneven height of the intervertebral disc (symptom of a spacer), which is associated with asymmetric muscle tone.
how to recognize the presence of osteochondrosis of the lumbar spine

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

  • myelography, computed tomography or magnetic resonance imaging - are necessary for persistent symptoms, development of neurological deficits;
  • scintigraphy (examination of the accumulation of phosphorus in the bone system, designated tech-99) - is performed in case of suspicion of a tumor or infectious process, spinal cord injury.

The differential diagnosis of lumbar osteochondrosis is made with the following diseases:

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

Treatment of lumbar osteochondrosis

Lumbar osteochondrosis usually follows the following treatment tactics:

  • bed rest for 2-3 days;
  • adhesion of the affected segment of the spine;
  • strengthening the back and abdominal muscles (creating the so-called muscular corset);
  • effects on pathological myofascial and myotonic processes.

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

In most cases, conservative treatment of lumbar osteochondrosis is carried out, including the following measures:

  • infiltration anesthesia of the muscles with a solution of local anesthetics;
  • taking non-steroidal anti-inflammatory drugs;
  • intake of desensitizing agents;
  • vitamin therapy;
  • taking tranquilizers and antidepressants;
  • manual therapy, massage;
  • physiotherapy exercises;
  • acupuncture;
  • postisometric relaxation.

The absolute indications for surgical treatment of lumbar osteochondrosis are:

  • acute or subacute spinal cord compression;
  • development of cauda equina syndrome, characterized by pelvic dysfunction, sensory and motor disorders.

Therapeutic exercises for lumbar osteochondrosis

exercise for lumbar osteochondrosis

Physical therapy plays an essential role in the complex treatment of lumbar osteochondrosis. Regular exercise allows you to normalize the muscle tone of the paravertebral muscles, improve metabolic processes in the tissues affected by the pathological process, and also to form a well-developed muscular corset that can keep the spine in the correct position, relieve unnecessary static loads fromhim.

In order for gymnastics to bring the greatest effect in lumbar osteochondrosis, the following principles must be observed:

  • regularity of classes;
  • gradual increase in the intensity of physical activity;
  • Avoid fatigue during class.

Physiotherapy should be performed under the guidance of an experienced instructor who will select the exercises that are most effective for a given patient and will control the correctness of their performance.

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

In addition to classes with an instructor, you should perform a set of morning exercises daily, which includes special exercises for lumbar osteochondrosis.

  1. Relaxation and contraction of the abdominal muscles.The starting position is upright, the legs are shoulder-width apart, the arms are lowered to the body. Inhale smoothly, relaxing the muscles of the anterior abdominal wall. During exhalation, pull the stomach as far as possible, tensing the abdominal muscles. The exercise should be repeated until mild fatigue occurs.
  2. Movements of the head with folding of the spine.The starting position is kneeling, relaxed on the floor with outstretched arms, straight back. Slowly raise your head and bend over your back. Hold in this position for a few seconds and then gently return to the starting position. Repeat at least 10-12 times.
  3. "Mahalo".Starting position lying on your back, arms on your body, legs bent at right angles to the knee and hip joint. Rotate your legs to the right and left with swinging pendulum-like movements, trying to reach the floor. In this case, the blades cannot be detached from the floor.
  4. Boat.Starting position lying on your stomach, arms outstretched. Detach the upper body and legs from the floor, bending at the back. 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;
  • spondyloarthritis;
  • spinal stenosis, which leads to compression of the spinal cord and can cause permanent disability and reduced quality of life.

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

Forecast

The pain syndrome in lumbar osteochondrosis manifests itself in the form of remissions and exacerbations. Lumbago lasts 10-15 days, after which the patient's condition improves, the pain subsides. The favorable outcome can be prevented by the associated secondary diseases. Often in lumbar osteochondrosis there is a recurrence of pain attacks, which each time become more intense and prolonged.

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

Patients with severe lumbar osteochondrosis, persistent pain and other manifestations are recognized as temporarily impaired. If their condition does not improve within four months, the issue of creating a disability group is resolved.

Prevention

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

  • quitting smoking;
  • normalization of body weight;
  • improving general physical condition, active lifestyle;
  • avoid provocative conditions (lifting weights, sudden movements, turns, turns).