Lumbar spine osteochondrosis

Osteochondrosis is a chronic degenerative-dystrophic disease that develops under the influence of many quite different factors. Initially, pathological changes occur in the pulposus nucleus (inner contents of the intervertebral disc), and then they spread to the fibrous ring (outer shell of the disc) and other elements of the spinal motion segment (SDS). This may be due to the natural aging process of the body, or it may occur against 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, extensions and hernias form, which often require surgical removal.

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

Lumbar osteochondrosis: what is it

From 48 to 52% of people suffer from osteochondrosis. And lumbar spine osteochondrosis is more common. The disease can affect any of the intervertebral discs of the lumbosacral spine, some of them, or even all of them. Most often, drives 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 performing any physical work, especially lifting and holding weights, walking, running, lowering falls on the lower back. The lumbar spine consists of 5 vertebrae, which are much larger than the thoracic and cervical vertebrae. Therefore, the intervertebral discs that separate them are larger in size. Normally, the lumbar region has a slight anterior curvature (physiological lordosis). It is the last mobile part of the spine and is adjacent to the fixed sacrum, so most often they talk about lumbosacral osteochondrosis.

If previously osteochondrosis was considered an age-related disease, today its first manifestations can be observed already at the age of 15-19 years. Among young people thirty years old, 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), clinical manifestations of the disease are already present in 82. 5%. At the same time, the incidence of pathology continues to increase steadily, which is mainly 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.

Reasons for development

Today, there is still no consensus on the etiology of degenerative spinal diseases. However, the main theory of their development is involutive. According to her, osteochondrosis is a consequence of previous damage to the intervertebral disc and bony structures of the spine, as well as the emergence of inflammatory and other processes. The theory suggests that degenerative changes are genetically predetermined and, in fact, are 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 lumbar spine osteochondrosis is facilitated by:

• heavy physical work, especially associated with heavy lifting;
• sedentary, sedentary lifestyle;
• any back injury, including bruising;
• overweight;
• metabolic disorders;
• postural disturbance, spinal deformity;
• flat feet and other foot pathologies;
• pregnancy, especially multiple pregnancy.

Pathogenesis

Regardless of the causes, degeneration of the intervertebral disc occurs when the intensity of the processes of catabolism (separation and oxidation of molecules) of matrix proteins begins to exceed the rate of their formation. One of the key points in this process is the malnutrition of the intervertebral discs.

Since they, like most cartilage in an adult, do not have a direct blood supply, as they do not have blood vessels, the supply of nutrients and the removal of metabolic products occurs through diffusion with compression and subsequent relaxation. of the disk during movement. The main structure that gives the disk power are the end plates placed on its upper and lower surfaces.

By themselves, the end plates are a double layer formed by cartilage and bone tissue cells. Therefore, on the cartilaginous side they are attached to the disc, and the bone - to the vertebral bodies. They are distinguished by fairly good permeability, which ensures the exchange of substances between cells, the intercellular substance of the disc, and the blood vessels that pass into the vertebral bodies. Over the years, especially with the negative impact of external and internal factors, the structure of the end plates changes and their blood supply decreases, which leads to a decrease in the intensity of metabolism in the intervertebral disc. As a result, its ability to produce new matrix decreases, which leads to a progressive decrease in its density with age.

At the molecular level, this is accompanied by:

• a decrease in the rate of diffusion of nutrients and metabolic products;
• decreased cell viability;
• accumulation of rotten products of altered matrix cells and molecules;
• a decrease in the production of proteoglycans (compounds with high molecular weight 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 constant changes, the intervertebral disc is dehydrated and the pulposus nucleus loses its ability to adequately distribute the loads falling on it. Therefore, the pressure inside the disc becomes uneven, and therefore the fibrous ring in some places experiences overload and compression. Since this happens with every movement of a person, the ring is regularly subjected to mechanical pressure. This leads to negative changes in it.

Also, often a decrease in disc height and elasticity leads to compensatory changes in adjacent vertebral bodies. Bone growths called osteophytes form on their surfaces. They tend to increase in size over time and even merge with each other, excluding the possibility of movements in the affected PDS.

Due to the fact that malnutrition provokes damage to the collagen skeleton, under the influence of pulposus nucleus pressure at certain points, the normal structure of the fibers that form the fibrous ring is disrupted. In the absence of intervention, this eventually leads to cracks and fractures in them. Gradually, more and more fibrous ring fibers at the site of pressure application are torn, leading to its elongation. This is especially facilitated by the increased load on the spine. And since the lumbar region receives the main load during movement and any physical activity, it suffers more often.

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 protrusion. With its complete rupture in one place or another, an intervertebral hernia is diagnosed.

With the destruction of a portion of the fibrous ring fibers, the pressure in the disc gradually decreases, which leads to a decrease in tension and the fibers themselves. This leads to a violation of its fixation and, as a result, pathological mobility of the affected segment of spinal movement.

The vertebral motor segment (SMS) is a structural and functional unit of the spine formed by the intervertebral disc, adjacent vertebral bodies, their aspect joints, ligaments, and muscles attached to these bony structures.

Normal functioning of the spine is possible only with proper functioning of the PDS.

Symptoms of lumbar spine osteochondrosis

The disease can be asymptomatic for a long time, and then begin to appear as a slight discomfort in the lumbar region, gradually gaining strength. But in some cases, lumbar osteochondrosis begins acutely, immediately provoking a powerful 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 be different in character and can be painful and dull, and acute, constant or episodic. But fundamentally for pathology, especially in the early stages of development, it is characteristic of alternating periods of deterioration and remission, and hypothermia or the lifting of a heavy object, or an unsuccessful, sudden movement can provoke another deterioration of 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, lifting weights, bending over, and even coughing and sneezing.

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

• shooting, severe pain radiating to the sacrum, buttocks, lower limbs or perineum;
• sensitivity disorders of varying severity;
• restrictions on movement, lameness;
• weakness in the muscles innervated by the oppressed nerve.

In the lumbar spine, the spinal cord ends at the level of 1-2 vertebrae and passes into the so-called cauda equina, formed by a cluster of spinal roots. Moreover, each of them is responsible not only for the innervation of the muscles, but also for the specific organs of the 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 spine, especially with a long course and the appearance of compression of the spinal roots, depends mainly on the level of the lesion, ie from which particular disc has undergone degenerative-dystrophic changes.

• L3-L4 disc loss - pain is given to the anterior-inner parts of the thigh, lower leg, and inner ankle. This is accompanied by a decrease in the sensitivity of the front surface of the thigh, a decrease in stiffness or loss of knee flexion, as well as a decrease in the strength of the quadriceps muscle.
• L4-L5 disc loss - pain is given by the upper buttocks to the outside of the thigh and lower leg. Rarely, this is accompanied by the spread of pain in the back of the feet, including 1-3 toes. In these areas there is a decrease in sensitivity and muscle weakness. Sometimes hypotrophy and incomplete extension of the big toe develop.
• L5-S1 disc injury - the pain starts in the middle area of the buttocks and goes down to the heel along the back or back surface of the thigh and lower leg and can grab the outer edge of the foot, like 4-5 toes. In these areas of the lower extremities there is a decrease in sensitivity and often the size of the gastrocnemius and gluteus maximus is reduced, which is associated with their weakening. If the spinal root passing at the level of this PDS is affected, a decrease or loss of Achilles and foot 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 are repeated regularly, if not constantly present, this can not but affect the psycho-emotional state. As a result, more than half of patients show signs of chronic emotional stress, depressive disorders, etc.

Diagnosing

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

The second stage of diagnosis, performed as part of the first consultation with a physician, is a physical examination. During it, the doctor assesses the condition of the skin, posture, depth of physiological curves of the spine, the presence of its curvature, etc. The condition of the muscles surrounding the spine, called the paravertebrals, is necessarily assessed, as they are often painful and overly tense, which is a reflex reaction of the body to inflammation and discogenic pain.

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

Laboratory diagnosis

Analyzes of different types are not crucial in the diagnosis of lumbar spine osteochondrosis. They aim more at assessing the extent of the inflammatory process and detecting concomitant disorders.

Thus, they can be assigned:

• UAC;
• OAM;
• blood test for sugar level;
• blood chemistry.

Instrumental diagnostics

All patients with suspected lumbar spine osteochondrosis are indicated to have:

• X-ray of the lumbar spine in two projections - allows you to determine the structure of bone structures, detect abnormalities, osteophytes formed, changes in the aspect joints, etc. ;
• CT - allows you to detect changes in bone structures in the earlier stages of development than x-rays, as well as to identify indirect signs of osteochondrosis;
• MRI is the best method for diagnosing pathological changes in cartilage formations and other soft tissue structures, which makes it possible to detect smaller changes in the intervertebral discs, ligaments, blood vessels and spinal cord and to evaluateaccurate of their severity and potential hazards.

Furthermore, it may be recommended that:

• densitometry - a method for determining bone density, which makes it possible to diagnose osteoporosis, which is especially common in the elderly;
• myelography - allows you to assess the condition of the CSF pathways of the spinal cord and the degree of elongated disc damage, which is especially important in the presence of an already formed intervertebral hernia of the spine.

Treatment of lumbar osteochondrosis

When diagnosing osteochondrosis, as a rule, all patients are initially prescribed conservative therapy, provided there is no pronounced and progressive neurological deficit. But her character is chosen strictly individually.

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

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

In the acute period, patients are shown to limit physical activity or even adhere to 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 contrary, it is important to move as much as possible, but carefully and excluding the increase of stress in the lower back. Patients will need to acquire the skills of proper lowering, lifting objects off the floor, carrying heavy loads, as all of this affects the course of the pathology. It is important to avoid tilting and sudden movements, to lift something off the floor or low surfaces, after you have bent your knees and not bend 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 maintain body weight within optimal limits, and for obesity, a diet and exercise appropriate to the patient's condition is indicated, as excess weight creates an added load on the lower back and causes progress. faster pathological changes in. disks.

On average, conservative therapy is usually designed for 1-3 months, though it may take longer. But even after completing the main course prescribed by the doctor, it will be necessary to continue taking a range of medications, exercise therapies and follow lifestyle recommendations.

Medical therapy

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 the concomitant diseases, especially of the digestive tract, as NSAIDs with prolonged use can adversely affect their condition. mucous membranes and provoke a worsening 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 rectal suppositories, local agents, and orally. The duration of admission should not exceed 2 weeks. In the future, an individually selected medication is taken on demand but trying to avoid frequent use.

Recently, drugs, as an active ingredient, which selectively select cyclooxygenase-2 inhibitors have been given priority.

Patients are also prescribed drugs of the following groups:

• muscle relaxants - help relax overly tense muscles and thus reduce back pain;
• chondroprotectors - improve the flow of metabolic processes in the intervertebral disc (especially effective when it begins in the earliest stages of development of lumbar osteochondrosis);
• B vitamins - contribute to improving nerve conduction;
• antidepressants and anxiolytics - used for long-term osteochondrosis, which led to depression, chronic fatigue and other psychological disorders.

With very severe pain, especially of neurological origin, therapeutic blockades are performed. They involve the introduction of anesthetics in combination with corticosteroids at points near 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 workers, 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 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 correct anatomical position, but also to release the compressed nerve roots. As a result, the pain is quickly eliminated and the neurological disorders disappear. It also reduces the possibility of complications and disorders in the work of internal organs.

Additional positive properties of manual therapy are improving mood, strengthening immunity, activating the body's natural recovery mechanisms and increasing efficiency. Usually after the first session there is a noticeable improvement in well-being and in the future the effect becomes more pronounced. As a rule, the course consists of 8-15 sessions, and it is important to finish by the end, even with the full normalization of well-being.

Physiotherapy

After the reduction of acute inflammation, courses of physiotherapeutic procedures are shown, which not only help reduce pain, but also improve microcirculation, nutrition and the course of repair processes in the area of degenerative-dystrophic changes. Most often, patients are prescribed:

• electrophoresis with drug introduction;
• electrical neuromyostimulation;
• ultrasound therapy;
• laser therapy;
• magnetotherapy;
• UHF.

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

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

exercise therapy

After eliminating the acute pain, the treatment program is necessarily supplemented with exercise therapy. Its main tasks are stretching the spine and relaxing the spasmodic muscles of the lower back. Therapeutic exercises also help strengthen the muscular corset, create reliable support for the spine, and improve posture. During this, blood circulation is inevitably activated and metabolic processes are improved, which has a beneficial effect on disc nutrition.

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

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

Thus, lumbar spine osteochondrosis is one of the most common diseases. At the same time, it is able to 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 deal with it. With the onset of pain, and even more so numbness, limited movement, back pain, you should contact a neurologist as soon as possible, undergo the necessary examination and start treatment. In this case, it will be possible to stop the pathological process and return to a normal, complete life without significant pain and limitations.