The causes of osteochondrosis of the lumbar spine are not well understood. Hereditary predisposition, age-related changes in the intervertebral discs are of the greatest importance
Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not well understood. Hereditary predisposition, age-related changes in the intervertebral discs are of the greatest importance. Pain can be caused by clumsy movements, prolonged forced posture, lifting and carrying heavy loads, overuse in sports, obesity.
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, provoked by minimal movements in the back. The range of motion in the lumbar spine is severely limited due to compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with adequate treatment and immobilisation of the lumbar spine is no more than 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 insidious. Clinically, limited mobility of the lumbar spine, tension and pain in the paravertebral muscles are often found. In most cases, the pain will subside within 2-3 weeks, but if left untreated, it can become chronic.
Lumbar sciatica (lower back pain radiating down the leg). In the lumbar region, movements are restricted, the paravertebral muscles are tense and painful on palpation.
In piriformis syndrome, the sciatic nerve becomes compressed, causing paresthesia and numbness in the leg and foot. Positive Lasegue Syndrome. But there are no signs of radicular syndrome.
Second floorNeurological complications of osteochondrosis of the lumbar spine.
Herniated disc with radicular syndrome or radiculopathy. Compression of the root is accompanied by shooting, burning pain in the leg. The pain is aggravated by movement, by 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 zone of pain and numbness distribution in the limbs.
Radicular syndromes are detected by a neurologist during an objective examination.
The third stage of neurological diseases of lumbar osteochondrosis.
Vascular-radicular conflict. The debilitating sciatica syndrome occurs when blood flow to the L5 and, less commonly, S1 radicular artery is disrupted. Radiculoischemia at other levels is diagnosed extremely rarely.
A clumsy movement or heavy lifting causes acute back pain when irradiated along the sciatic nerve. Then there is paresis or paralysis of the foot extensors and fingers with the "spanking" of the foot while walking (steppage). The patient raises his leg while walking, throws it forward and at the same time strikes the ground with his toe.
In most cases, the paresis will certainly resolve itself within a few weeks.
The fourth stage of neurological complications of osteochondrosis of the lumbar spine.
Violation of the blood supply to the spinal cord and cauda equina. Spinal canal stenosis affects several spinal nerve roots (cauda equina). 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 in the legs and disappears after rest or when the torso is tilted forward.
Acute violation of spinal blood flow is the most serious complication of lumbar osteochondrosis. Acutely develops lower paraparesis or plegia. Weakness in the legs is accompanied by numbness of the lower extremities, dysfunction of the pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
Of great importance is the analysis of complaints and anamnesis to exclude a serious pathology. A neurological exam is done to rule out damage to the roots and spinal cord. Manual examination allows you to determine the source of pain, limitation of movement and muscle spasms.
If specific back pain is suspected, additional examination methods are indicated.
An X-ray of the lumbar spine is prescribed to exclude tumors, spinal injuries, spondylolisthesis. X-ray signs of osteochondrosis have no clinical value, since all elderly and elderly people have them. Functional x-rays are taken to look for spinal instability. Images are taken in the position of extreme flexion and extension.
If there are radicular or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. Herniated discs and the spinal cord can be seen better on MRI, and bone structures better on CT. The clinical level of the lesion and the MRI findings should match, since a disc herniation detected on MRI is not always the cause of the pain.
In the case of neurological deficits, an electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis.
If a somatic pathology is suspected, a thorough clinical examination is carried out.
Osteochondrosis of the lumbar spine, treatment.
At the first signs of discomfort in the lumbar spine, regular gymnastics to strengthen the muscular corset, swimming and massage courses are revealed.
Treatment of lumbar osteochondrosis is divided into 3 periods: treatment of the acute, subacute and chronic periods.
In the acute phase, the primary task is to relieve the pain syndrome as early as possible and restore the patient's quality of life. If the pain is severe, immobilisation of the lumbar spine with a special anti-radiculitis corset for 2-3 weeks is indicated. Bed rest should not last more than 2-3 days. In many patients, it is possible to intensify the pain syndrome against the background of the expansion of the motor regime. The patient should not limit himself to adequate physical activity.
Of the non-drug therapy methods, interstitial electrostimulation, acupuncture, hirudotherapy and massage are effective. Manual therapy is possible, but only in competent hands.
Medical treatment. Nonsteroidal anti-inflammatory drugs are indicated for acute pain. In combination with anti-inflammatory drugs, muscle relaxants can be prescribed short-term.
With 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 source of pain (into the affected muscles, exit points of the roots).
With radiculopathy with neuropathic pain, anti-inflammatory drugs are ineffective, in this case antidepressants, anticonvulsants and a special therapeutic patch are prescribed.
With paresis, deafness, vascular preparations, vitamins of group B are prescribed.
With persistent myofascial pain, the introduction of nonsteroidal anti-inflammatory drugs at trigger points, muscle relaxants, acupuncture and postisometric relaxation is effective.
For chronic pain, antidepressants, exercise therapy, and other non-pharmacological treatments are the first line of treatment.
With stenosis of the spinal canal, weight loss, wearing a corset, NSAIDs, and various venotonics are indicated.
Surgical treatment is used for paralyzing sciatica (in the first three days) and cauda equina syndrome (paresis of the extremities, sensory disturbances, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
preventionOsteochondrosis of the lumbar spinereduced to avoiding long, uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternate work and rest periods. Wear a fixation belt if you are physically overexerted. Do exercises to strengthen your back muscles.