What is lumbar osteochondrosis

Osteochondrosis in the lumbar region occurs due to deformation and destruction of the cartilaginous tissue of the intervertebral discs.Without cartilaginous material, the vertebrae lose their elasticity and become dislocated, 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 associated with age-related changes and a decrease in calcium levels in the body.

Osteochondrosis of the lumbar region

Of all diseases of the peripheral nervous system, osteochondrosis of the spine accounts for 80%, of which 60-80% affect 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.Painful sensations are experienced by 7 out of 10 people, exacerbation can last from 6 to 16 months.

Development stages

• 1st – appearance of degenerative diseases, affecting nerve endings and interrupting blood supply.The inflammatory process causes pain that radiates to the legs.The patient feels occasional tingling in the back and buttocks.Appears after great physical exertion.
• 2nd – the outer layer of the intervertebral disc (fibrous ring) is destroyed.The distance between the vertebrae decreases, the nerve endings are compressed, which causes strong and sharp pain.Symptoms are especially pronounced when walking.
• 3rd – due to excessive mobility of the vertebrae, muscle fibers and nerve endings become compressed.Spasms, numbness, burning pain, hernias occur - displacement of the intervertebral disc into the spinal cord.
• 4th – growth of pathological exostoses in the bone structure.The column literally “turns to stone”.Progressive osteoarthritis 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 (sedentary lifestyle), 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”, becomes weakened.Supports the spine and internal organs.Thus, physical inactivity causes disruptions in the functioning of various systems - blood circulation, breathing, digestion.
• Overweight.With a BMI (Quetelet body mass index) above 25 kg/m2, excess weight creates additional stress on the body: it puts pressure on the spine, overloads the joints and impairs blood supply.
• Endocrine pathological processes.Hormonal imbalance, disturbances in the functioning of the adrenal glands and thyroid gland “slow down” the body's metabolism.Frequent hormonal changes “eliminate” calcium from bone tissue, making it weak and fragile.
• 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 much more often.

Symptoms of lumbar osteochondrosis

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

Spinal nerves extend 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."It is for this reason that the affected nerve “responds” in a specific area: this is how “radicular syndrome” manifests itself.

The spinal nerve map allows you to identify pain in 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 numbness, episodic loss of sensation are noted along the anterior surface of the thigh;
• L4-L5 – muscle weakness, the patient is unable to fix the body while standing on the heels, the pain and sensitivity disorders extend to the region from the lower back to the buttock, as well as along the entire lateral surface of the thigh (from top to bottom).
• L5–S1 – tremors in the calf muscle, inability to stand on tiptoe, pain in the back of the thigh.

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

Pain reflex symptoms

• Lumbago or low back pain (in this case not sciatica!) – sharp pain.Any strange 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 an upright position causes new low back pain.
• Lumbodynia is a dull, aching pain that occurs on one side.Periods of remission are followed by exacerbation, which gradually evolves into severe pain.
• Lumboischialgia - painful sensations appear in the leg.

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

Diagnosis

In the initial phase, a complete medical history of the patient is collected.The general picture must 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 is performed for the primary diagnosis of lumbar osteochondrosis of the 1st degree;is used to examine the condition of intervertebral discs, spinal cord pathologies, and also 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 exam that uses a beam of ionizing rays.Computed tomography records the degree of disc deformation, inflammatory processes in the spinal cord membrane and nerve endings in a layer-by-layer image.

Magnetic resonance imaging (MRI) informatively shows the general condition of 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 agent with a needle into the cavity between the pia mater and the arachnoid of the spinal cord, filled with cerebrospinal fluid.Similar to CT scan, 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 studying the symmetry of the limbs, testing vibration sensitivity and assessing Babinsky, Chaddock and Oppenheiman reflexes.

Treatment of lumbar osteochondrosis

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

Drug therapy (for stages 1-2)

• Analgesics for pain relief: local (ointments, gels), oral (tablets, suspensions), intramuscular (injectable solutions).
• Nonsteroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, removes swelling.Most often, gels and tablets are used, in more severe cases (inflammation of the sciatic nerve) - injections.Prima Course - 7 to 14 days.
• Muscle relaxants.Prescribed in the acute period of muscle spasms, as well as during the period of remission to consolidate the effect.
• Chondroprotectors.Blocks destructive processes in intervertebral discs, promotes regeneration, improves metabolism in cartilaginous tissues.
• Vascular drugs.Helps normalize blood supply to the musculoskeletal system.
• Group B vitamin complexes. Improve nerve conduction.
• Diuretics.Reduces swelling.

As emergency aid at the time of exacerbation, powerful injections are used - paravertebral blockade, which causes temporary loss of sensitivity.

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

Prevention

• Active lifestyle combined with moderate physical activity;
• Choose comfortable or, if indicated, orthopedic shoes;
• Good nutrition;
• Body weight control;
• Sleep only on an orthopedic mattress and pillow;
• Office furniture with flat backs only;
• Refusal of heavy loads on the back and spine.When carrying heavy items, the load must be evenly distributed between both hands.