The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is attached to hereditary predisposition, age-related changes in the intervertebral discs
Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is attached to hereditary predisposition, age-related changes in the intervertebral discs. Pain can be provoked by awkward movement, prolonged forced position, lifting and carrying heavy loads, sports overload, overweight.
Depending on the duration, there are acute pains lasting up to 4 weeks, subacute (from 4 to 12 weeks) and chronic (lasting more than 12 weeks).
Neurological complications in 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 sharply limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with adequate treatment and immobilization 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 with prolonged standing or sitting. The onset is usually gradual. Clinically, limited mobility in the lumbar spine, tension and soreness of the paravertebral muscles are often determined. In most cases, the pain subsides within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (lower back pain radiating to the leg). In the lumbar region, movements are limited, paravertebral muscles are tense and painful on palpation.
In piriformis syndrome, the sciatic nerve is compressed, causing paresthesias and numbness in the leg and foot. Positive Lasegue syndrome. But there are no signs of radicular syndrome.
Second stageneurological complications of osteochondrosis of the lumbar spine.
Herniated disc with radicular syndrome or radiculopathy. Compression of the root is accompanied by shooting, burning pains in the leg. 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, L5 and S1 roots are most often involved in the pathological process. Each root has its own zone of distribution of pain and numbness to the limbs.
Radicular syndromes are detected by a neurologist during an objective examination.
The third stage of neurological disorders of lumbar osteochondrosis.
Vascular-radicular conflict. Paralyzing sciatica syndrome occurs when blood circulation is disturbed in the radicular artery L5 and less often S1. Radiculoischemia at other levels is diagnosed extremely rarely.
During an awkward movement or heavy lifting, acute back pain develops with irradiation along the sciatic nerve. Then there is paresis or paralysis of the extensors of the foot and fingers with the "spanking" of the foot when walking (steppage). The patient, while walking, raises his leg high, throws it forward and at the same time slams his toe on the floor.
In most cases, paresis safely regresses 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. In spinal stenosis, several spinal nerve roots (cauda equina) are affected. 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 of the legs, disappears after rest or when the torso is tilted forward.
Acute violation of spinal circulation is the most severe 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. Neurological examination is carried out to exclude damage to the roots and spinal cord. Manual examination allows you to determine the source of pain, limitation of mobility, muscle spasm.
Additional examination methods are indicated for suspected specific back pain.
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 older and elderly people have them. Functional x-rays are done to look for spinal instability. Pictures are taken in the position of extreme flexion and extension.
For radicular or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. On MRI, herniated discs and the spinal cord are better seen, and on CT, bone structures are better seen. The clinical level of the lesion and the MRI findings should correspond to each other, since a disc herniation detected on MRI is not always the cause of pain.
In neurological deficits, electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis.
If somatic pathology is suspected, a thorough clinical examination is carried out.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort appear in the lumbar spine, regular gymnastics is shown to strengthen the muscular corset, swimming, and massage courses.
Treatment of lumbar osteochondrosis is divided into 3 periods: treatment of acute, subacute and chronic period.
In the acute period, the primary task is to relieve the pain syndrome as early as possible and restore the quality of life of the patient. In the presence of intense pain, immobilization 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 increase the pain syndrome against the background of the expansion of the motor regimen. The patient should not limit himself to reasonable physical activity.
Of the non-drug methods of therapy, interstitial electrical stimulation, acupuncture, hirudotherapy, and massage are effective. It is possible to use manual therapy, but only in competent hands.
Medical treatment. In acute pain, non-steroidal anti-inflammatory drugs are indicated. In combination with anti-inflammatory drugs, muscle relaxants can be prescribed in a short course.
In osteochondrosis of the lumbar spine, therapeutic blockades with local anesthetics, nonsteroidal anti-inflammatory drugs, and corticosteroids are effective. Medicinal mixtures are administered as close as possible to the focus of pain (into the affected muscles, exit points of the roots).
With radiculopathy with the presence of neuropathic pain, anti-inflammatory drugs are ineffective, in this case, antidepressants, anticonvulsants, and a special therapeutic patch are prescribed.
With paresis, numbness, vascular preparations, vitamins of group B are prescribed.
With prolonged myofascial pain, the introduction of non-steroidal anti-inflammatory drugs at trigger points, muscle relaxants, acupuncture, and post-isometric relaxation are effective.
For chronic pain, antidepressants, exercise therapy and other non-pharmacological treatments come first in the treatment.
With stenosis of the spinal canal, weight loss, wearing a corset, NSAIDs, and various venotonics are indicated.
Surgical treatment is carried out with paralyzing sciatica (in the first three days) and cauda equina syndrome (paresis of the extremities, impaired sensitivity, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
Preventionosteochondrosis of the lumbar spinereduced to the avoidance of long, uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternate periods of work and rest. Wear a fixing belt for physical overload. Do exercises to strengthen your back muscles.