Osteochondrosis of the lumbar spine

Osteochondrosis is a chronic degenerative-dystrophic disease that develops under the influence of many different factors. Initially, pathological changes occur in the pulpal nucleus (the inner contents of the intervertebral disc) and then spread to the fibrous ring (the outer shell of the disc) and other components of the spinal cord (SDS). This may be due to the natural aging process of the body or it may occur in the background of injuries, increased loads on the spine and other causes. In any case, osteochondrosis is only the first stage of destruction of the intervertebral disc and if left untreated, protrusions and hernias form, which often require surgical removal.

The intervertebral disc is a cartilage formation that separates the vertebral bodies and acts as a shock absorber.

Osteochondrosis of the lumbar spine: what it is

Osteochondrosis affects 48 to 52% of people. Osteochondrosis of the lumbar spine is more common. The disease can affect any of the lumbar intervertebral discs, several of them or even all of them. Most often, the discs L5-S1, L4-L5 suffer, less often L3-L4. The upper lumbar discs (L3-L2 and L2-L1) are affected much less frequently.

The prevalence of lumbar osteochondrosis is due to the fact that the greatest load in the performance of any physical work, especially in lifting and carrying weights, walking, running, sitting falls on the lower back. The lumbar spine consists of 5 vertebrae, which are much larger than the thoracic and cervical vertebrae. Correspondingly, the intervertebral discs that separate them are larger in size. Normally, the lumbar region has a slight anterior curvature (normal lordosis). It is the last mobile part of the spine and is adjacent to the fixed sacrum, so most often they talk about lumbar osteochondrosis.

If previously osteochondrosis was considered an age-related disease, today its first manifestations can already be observed at the age of 15-19 years. Among thirty-year-olds, already 1. 1% of people suffer from severe symptoms of degenerative-dystrophic changes in the intervertebral discs. And in representatives of the older age group (from 59 years), the clinical manifestations of the disease are already present in 82, 5%. At the same time, the incidence of the pathology continues to increase steadily, which is largely due not only to the increase in the average age of the country's population, but also to lifestyle changes that are not for the better.

Growth reasons

Today, there is still no consensus on the etiology of degenerative diseases of the spine. However, the main theory of their development is coherent. According to her, osteochondrosis is a consequence of previous damage to the intervertebral disc and the bone structures of the spine, as well as the appearance of inflammatory and other processes. The theory suggests that degenerative changes are genetically predetermined and, in fact, inevitable. And their clinical manifestation, especially in young and middle-aged people, is due to the influence of various endogenous and exogenous factors.

Thus, the development of osteochondrosis of the lumbar spine is facilitated by:

• heavy physical work, especially related to weight lifting.
• sedentary life, sedentary life.
• any back injuries, including bruises.
• overweight;
• metabolic disorders;
• violations of posture, deformity of the spine.
• flat feet and other foot pathologies.
• pregnancy, especially multiple pregnancy.

Pathogenesis

Regardless of the cause, intervertebral disc degeneration occurs when the intensity of the catabolic processes (breakdown and oxidation of molecules) of uterine proteins begins to exceed their rate of formation. One of the key points in this procedure is the malnutrition of the intervertebral discs.

Since, like most cartilages in an adult, they do not have a direct blood supply, as they lack blood vessels, the supply of nutrients to them and the removal of metabolic products is done by diffusion with successive compression and relaxation of the disc during movement. The main structure that provides power to the disk is the end plates located on the upper and lower surface.

By themselves, the end plates are a double layer formed by cartilage and bone cells. As a result, the cartilaginous side is next to the disc, and the bone - to the vertebral bodies. They are distinguished by sufficiently good permeability, which ensures the exchange of substances between the cells, the intercellular substance of the disc and the blood vessels that pass through the vertebral bodies. Over the years, especially with the negative effect of external and internal factors, the structure of the end plates changes and the blood supply decreases, which leads to a decrease in the intensity of metabolism in the intervertebral disc. As a result, its ability to produce a new uterus decreases, leading to a gradual decrease in its density with age.

At the molecular level, this is accompanied by:

• reducing the rate of diffusion of nutrients and metabolic products.
• reduction of cell viability.
• accumulation of cell degradation products and modified matrix molecules.
• reduction of proteoglycan production (high molecular weight compounds that are responsible for the formation of new cartilage cells and which are the main sources of chondroitin sulfate synthesis).
• damage to the collagen scaffold.

Possible consequences

As a result of the ongoing changes, the intervertebral disc becomes dehydrated and the pulpal nucleus loses its ability to adequately distribute the loads falling on it. Therefore, the pressure inside the disk becomes uneven and therefore the fibrous ring in many places is overloaded and compressed. As this happens with every movement of a person, the ring is regularly subjected to mechanical pressure. This leads to adverse changes in it.

Also, often the reduction of the height and elasticity of the disc leads to compensatory changes in the adjacent vertebral bodies. Bone growths called osteophytes form on their surface. They tend to increase in size over time and even merge with each other, ruling out the possibility of movement in the affected PDS.

Due to the fact that malnutrition causes damage to the collagen skeleton, under the influence of the pressure of the pulp nucleus in some places, the normal structure of the fibers that form the fibrous ring is disrupted. In the absence of surgery, this eventually leads to cracks and fractures in them. Gradually, more and more fibers of the fibrous ring at the point of application of pressure are torn, which leads to its protrusion. This is greatly facilitated by the increased loads on the spine. And since the lumbar region takes on the main load during movement and any physical activity, it suffers most of the time.

The protrusion of the intervertebral disc without the final rupture of the fibrous ring and with the size of its base more than the protruding part is called a protrusion. With its complete rupture at one point or another, an intervertebral hernia is diagnosed.

With the destruction of part of the fibers of the fibrous ring, the pressure in the disk is gradually reduced, which leads to a reduction of the voltage and the fibers themselves. This leads to a violation of its fixation and, as a result, abnormal mobility of the affected part of the spine.

The vertebral motor (SMS) is a structural and functional unit of the spine formed by the intervertebral disc, the adjacent vertebrae, their lateral joints, the ligaments, and the muscles associated with these bone structures.

Normal spinal function is possible only with proper PDS function.

Symptoms of osteochondrosis of the lumbar spine

The disease can be asymptomatic for a long time and then begin to manifest as a slight discomfort in the lumbar region, gradually gaining strength. But in some cases, lumbar osteochondrosis begins acutely, immediately causing a severe pain syndrome. In most cases, the signs of pathology appear for the first time after 35 years.

Back pain is the main symptom of the disease. It can have a different character and can be both painful and dull, and acute, constant or episodic. But basically for pathology, especially in the early stages of development, it is typical to alternate periods of ups and downs and both hypothermia or the lifting of a heavy object or an unsuccessful, sudden movement can cause another deterioration in well-being.

The pain is often accompanied by a feeling of numbness and tension in the back muscles. They are aggravated by physical exertion, sudden movements, weight lifting, crouching, and even coughing and sneezing.

If, due to the instability of the vertebral bodies, the nerve root extending from the spinal cord is tightened by one or the other anatomical structure, this will lead to the development of appropriate neurological disorders. Their main events are:

• shot, severe pain radiating to the sacrum, buttocks, lower extremities or perineum.
• Sensitivity disorders of varying severity.
• mobility restrictions, lameness.
• weakness in the muscles innervated by the pinched nerve.

In the lumbar spine, the spinal cord ends at the level of 1-2 vertebrae and passes to the so-called equine tail, which is formed by the accumulation of spinal roots. In addition, each of them is responsible not only for the innervation of the muscles, but also for specific organs of the small pelvis, so prolonged compression can cause disturbances in the work of the respective organ. This can lead to the development of impotence, infertility, gynecological diseases, hemorrhoids and other disorders.

The clinical picture of osteochondrosis of the lumbar spine, especially with a long course and the appearance of compression of the roots of the spine, depends to a large extent on the level of damage, ie which specific disc has undergone degenerative-dystrophic changes.

• Defeat of the L3-L4 disc - the pain is given to the front-inner parts of the thigh, the lower leg and the inner ankle. This is accompanied by a decrease in the sensitivity of the anterior surface of the thigh, a decrease in the severity or loss of the knee jerk, as well as a decrease in the strength of the quadriceps muscle.
• Defeat of the L4-L5 disc - the pain is given from the upper buttocks to the outer parts of the thigh and lower leg. Less often, this is accompanied by the spread of pain in the back of the legs, including 1-3 toes. In these areas there is a decrease in sensitivity and muscle weakness. Scholarships and incomplete extension of the big toe sometimes develop.
• L5-S1 disc damage - the pain starts in the middle of the buttocks and goes down to the heel along the back or back surface of the thigh and tibia and can grip the outer edge of the foot like 4-5 toes. In these areas of the lower extremities there is a decrease in sensitivity and the gastrocnemius and maxillary gluteus are often reduced in size, which is accompanied by their weakness. If the vertebral root passing at the level of this PDS is affected, a reduction or loss of Achilles and plantar reflexes may be observed.

Disks L1-L2 and L2-L3 are rarely affected.

The pain that accompanies the disease limits a person and significantly reduces his quality of life. Since they persist for a long time and reappear regularly, if not constantly, this can only affect the psycho-emotional state. As a result, more than half of the patients show signs of chronic emotional stress, depressive disorders, etc.

Diagnostics

If there are signs of osteochondrosis of the lumbar spine, you should contact a neurologist or spine specialist. First of all, the doctor collects a history, which consists in clarifying the nature of the complaints, the characteristics of the pain, the conditions of their appearance and reduction, the characteristics of a person's professional life, etc.

The second stage of diagnosis, which takes place as part of the first consultation with a doctor, is a physical examination. During this, the doctor evaluates the condition of the skin, the posture of the body, the depth of the normal curves of the spine, the presence of the curvature of the etc. The condition of the muscles surrounding the spine, called paravertebrates, is necessarily assessed, as they are often painful and overly tense, which is a reflex reaction of the body to inflammation and disc pain.

Already based on the data obtained during the examination and interrogation of the patient, the neurologist may suspect the presence of osteochondrosis of the lumbar spine. But to rule out possible concomitant pathologies, as well as to confirm the diagnosis and accurately determine the level of damage, the severity of degenerative-dystrophic changes in the intervertebral disc and the involvement of bone structures, laboratory and organic diagnostic methods are required.

Laboratory diagnosis

Analyzes of various kinds are not crucial for the diagnosis of osteochondrosis of the lumbar spine. They aim more at assessing the degree of the inflammatory process and at detecting concomitant disorders.

Thus, they can be assigned:

• UAC;
• I AM;
• blood test for blood sugar;
• blood chemistry.

Instrumental diagnosis

All patients with suspected lumbar spine osteochondrosis appear to have:

• X-ray of the lumbar spine in two views - allows you to determine the structure of bone structures, to detect abnormalities, formed osteophytes, changes in the joints of the face, etc.
• CT - allows you to detect changes in bone structures at an earlier stage of development than X-rays, as well as to detect indirect signs of osteochondrosis.
• MRI is the best method for diagnosing abnormal changes in cartilage formations and other soft tissue structures, which makes it possible to detect the slightest changes in the intervertebral discs, ligaments, blood vessels and spinal cord and its precision. and their potential risks.

In addition, it may be recommended:

• Densitometry - a method of determining bone density, which makes it possible to diagnose osteoporosis, which is particularly common in the elderly.
• myelography - allows you to assess the condition of the CNS pathways of the spinal cord and the degree of damage to the protruding disc, which is particularly important in the presence of an already formed lumbar intervertebral disc herniation.

Treatment of lumbar osteochondrosis

When osteochondrosis is diagnosed, as a rule, conservative treatment is initially prescribed to all patients, provided there is no severe and progressive neurological deficit. But her character is chosen strictly individually.

As the disease is chronic and the regenerative capacity of the intervertebral discs is extremely limited, especially with severe degenerative-dystrophic changes, the main goals of treatment are to stop their further progression and eliminate the symptoms that bother the patient. Therefore, treatment is always complex and includes:

• drug treatment;
• manual therapy;
• physiotherapy;
• exercise therapy.

In the acute period, patients appear to limit physical activity or even to observe bed rest for 1-2 days. This will help relax the muscles and reduce the pressure inside the disc. If you need to sit, walk or do physical work for a long time, you should wear a stabilizing lumbar corset.

After the end of the acute period and during the remission of the disease, on the other hand, it is important to move as much as possible, but with caution and excluding the increased pressure in the lower back. Patients will need to acquire the skills of proper sitting, lifting objects off the floor, carrying heavy loads, as all of these affect the course of the pathology. It is important to avoid sloping and abrupt movements, to lift something off the floor or low surfaces, after bending your knees and not bending down. You should only sit with your back straight in a chair that supports your back well. In addition, during sedentary work, it is important to take regular breaks for a short workout. It is important to avoid falls, jumps, jogging and hypothermia.

With osteochondrosis, it is important to keep the body weight within optimal limits and for obesity, diet and exercise appropriate to the patient's condition are indicated, as being overweight creates an increased load on the lower back and causes the pathological progression to progress faster. changes to disks.

On average, conservative treatment is usually planned for 1-3 months, although it may take longer. But even after completing the main course prescribed by your doctor, you will need to continue taking certain medications, exercise therapy and follow lifestyle recommendations.

Medical treatment

The main components of drug therapy are individually selected drugs from the NSAID group. When choosing them, the doctor takes into account not only the severity of the pain syndrome and the course of the inflammatory process, but also the nature of concomitant diseases, especially of the digestive system, as prolonged use NSAIDs can adversely affect the condition of the mucous membranes. and cause exacerbation of various pathologies of the digestive system.

It is necessary to use NSAIDs for acute pain in the lower back, and immediately after their appearance. Preferably in 1-2 days. Depending on the severity of the patient's condition, they can be administered intramuscularly, in the form of anal suppositories, topical agents and in oral forms. The duration of the introduction should not exceed 2 weeks. In the future, an individually selected drug is taken on demand, but trying to avoid frequent use.

Recently, drugs have become more commonly preferred as active ingredients, which include selective cyclooxygenase-2 inhibitors.

Patients are also prescribed drugs of the following groups:

• Muscle relaxants - help to relax excessively tense muscles and, therefore, reduce back pain.
• chondroprotectants - improve the course of metabolic processes in the intervertebral disc (especially effective when they begin in the early stages of lumbar osteochondrosis).
• B vitamins - help improve nerve conduction.
• Antidepressants and anxiolytics - used for long-term osteochondrosis, which has led to depression, chronic fatigue and other psychological disorders.

With very intense pain, especially of neurological origin, therapeutic exclusions are made. They involve the introduction of anesthetics in combination with corticosteroids in areas close to the compressed nerve, which leads to the rapid elimination of pain. But the procedure can only be performed in a medical institution by specially trained health professionals, as it is associated with a risk of complications.

Manual therapy

Manual therapy allows not only to improve the quality of blood circulation in the affected area, but also to significantly reduce the severity and duration of pain in osteochondrosis. It effectively relieves muscle tension and allows you to eliminate functional blocks, which significantly increases mobility in the affected SMS.

Also, through well-performed manual therapy, it is possible not only to increase the distance between the vertebrae, to return them to their anatomically correct position, but also to release the compressed nerve roots. As a result, the pain disappears quickly and the neurological disorders disappear. It also reduces the possibility of complications and disturbances in the work of internal organs.

Additional positive properties of manual therapy are the improvement of the mood, the strengthening of the immune system, the activation of the natural mechanisms of the body's recovery and the increase of the efficiency. Usually after the 1st session there is a noticeable improvement in well-being and in the future the result becomes more intense. As a rule, the course consists of 8-15 sessions and it is important to complete it by the end, even with a complete normalization of well-being.

Physiotherapy

After the acute inflammation subsides, physiotherapy courses are indicated, which not only help reduce pain, but also improve microcirculation, nutrition and the course of remedial processes in the area of degenerative-dystrophic changes. Most often, patients are prescribed:

• electrophoresis with the introduction of drugs.
• electrical neuromusculation?
• ultrasound treatment;
• laser treatment;
• magnetotherapy?
• UHF.

Which specific physiotherapy methods will give the best result, their frequency of application, the duration of the course and the possibility of combining with other types of exposure are determined separately for each patient.

Traction therapy gives very good results in osteochondrosis of the lumbar spine. Thanks to this, it is possible to achieve an increase in the distance between the vertebral bodies, which directly reduces the load on the affected discs. After the session, to consolidate the results, the patient must wear an orthopedic corset.

exercise therapy

After the elimination of the acute pain, the treatment program is necessarily supplemented with exercise therapy. Its main functions are to stretch the spine and relax the spasmodic muscles of the back. Therapeutic exercises also help strengthen the muscular corset, create reliable support for the spine and improve posture. In this process, the blood circulation is inevitably activated and the metabolic processes are improved, something that has a beneficial effect on the nutrition of the discs.

For each patient, a set of exercises is selected individually according to the degree of degenerative-dystrophic changes, the level of physical development of the patient, the nature of the concomitant disorders, age and other factors. Initially, the study is recommended under the guidance of an experienced exercise therapy instructor.

All patients with degenerative changes in the spine are advised to visit the pool 2-3 times a week, as swimming lessons minimize the load on the spine, but allow you to effectively strengthen the back muscles.

Thus, osteochondrosis of the lumbar spine is one of the most common diseases. At the same time, it can deprive a person of the ability to work for a long time and even lead to disability due to the development of complications. Therefore, it is important not to ignore the first symptoms of the disease when it is easier to treat. With the onset of pain and even more numbness, limited mobility, back pain, you should contact a neurologist as soon as possible, undergo the necessary examination and begin treatment. In this case, it will be possible to stop the pathological process and return to a normal, full life without pain and significant limitations.