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
Lumbar spine osteochondrosis: 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 movements, 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 (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.
Low back pain (back pain). Sharp pain in the lower back starts suddenly, caused by minimal movement in the back. The range of motion in the lumbar spine is markedly limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of low back pain with adequate treatment and immobilization of the lumbar spine does not exceed 7-10 days.
Low back pain (back pain).Patients complain of moderate pain in the lower back, aggravated by movement or in a certain position, discomfort with standing or prolonged sitting. The onset is usually gradual. Clinically, limited mobility of the lumbar spine, tension and pain of the paravertebral muscles are often determined. In most cases, the pain goes away within 2-3 weeks, but if left untreated it can become chronic.
Lumboischialgia (back pain that radiates to the leg). In the lumbar region, movement is limited, the paravertebral muscles are tense and painful on palpation.
In piriformis syndrome, the sciatic nerve is compressed, causing paresthesia and numbness in the leg and foot. Positive Lasegue syndrome. But there are no signs of radicular syndrome.
Second phaseneurological complications of osteochondrosis of the lumbar spine.
Herniated disc with radicular syndrome or radiculopathy. Compression of the root is accompanied by shooting and burning pains in the leg. The pain is aggravated by movement, 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, so the L5 and S1 roots are more 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 a physical examination.
The third stage of the neurological disorders of lumbar osteochondrosis.
Vascular-root conflict. Paralyzing sciatica syndrome occurs when blood circulation is disturbed in the L5 and less often S1 radicular artery. Radiculoischemia at other levels is very rarely diagnosed.
During awkward movement or heavy lifting, acute back pain develops with irradiation along the sciatic nerve. Then there is paresis or paralysis of the extensor of the foot and toes 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 big toe on the floor.
In most cases, the paresis safely regresses within a few weeks.
The fourth stage of the 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 less, but when walking there is intermittent claudication syndrome. Pain when walking spreads along the roots from the lower back to the feet, is accompanied by weakness, paresthesia and numbness in the legs, disappears after rest or when the torso is tilted forward.
Acute violation of spinal circulation 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 limbs, 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 done to rule out damage to the roots and spinal cord. Manual examination allows you to determine the source of pain, limitation of mobility, muscle spasm.
Additional methods of examination are indicated for suspicion of specific back pain.
An x-ray of the lumbar spine is prescribed to exclude tumors, spinal injuries, spondylolisthesis. Radiographic signs of osteochondrosis have no clinical value, as all the elderly and the elderly have them. Functional radiographs are done to look for spinal instability. The photos are taken in the position of extreme flexion and extension.
For root or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. Herniated discs and spinal cord are better seen on MRI and bony structures are seen better on CT. The clinical level of the injury and the MRI results should match each other, since a herniated disc 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 done.
Lumbar spine osteochondrosis, treatment.
When the first signs of discomfort appear in the lumbar spine, regular gymnastics are shown to strengthen the muscle corset, swimming and massage courses.
Treatment of lumbar osteochondrosis is divided into 3 periods: treatment of the acute, subacute and chronic period.
In the acute period, the main task is to relieve the pain syndrome as soon as possible and restore the patient's quality of life. In the presence of intense pain, immobilization of the lumbar spine with a special anti-root brace 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 regime. The patient should not limit himself to reasonable physical activity.
Among non-drug therapeutic methods, interstitial electrical stimulation, acupuncture, hirudotherapy, and massage are effective. Manual therapy can be used, 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 blocks with local anesthetics, non-steroidal anti-inflammatory drugs and corticosteroids are effective. Medicinal mixtures are administered as close as possible to the center of pain (in the affected muscles, at the 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 into the trigger points, muscle relaxants, acupuncture and post-isometric relaxation are effective.
For chronic pain, antidepressants, physical therapy, and other non-drug treatments come first in treatment.
With stenosis of the spinal canal, weight loss, the use of a brace, 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, reduced sensitivity, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
Preventionosteochondrosis of the lumbar spinereduced to avoid long and uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternate periods of work and rest. Wear a restraint belt for physical overload. Do exercises to strengthen your back muscles.