What is lumbar osteochondrosis

Osteochondrosis in the lumbar region occurs due to deformation and destruction of the cartilage tissue of the intervertebral discs.Without cartilage material, the vertebrae lose their elasticity and become displaced, causing pain.According to 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 lower back

Of all diseases of the peripheral nervous system, osteochondrosis of the spinal column 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 years.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.

Stages of development

• 1st – the onset of degenerative disorders, affecting nerve endings and disrupting blood supply.The inflammatory process causes pain that radiates to the legs.The patient experiences occasional tingling in the back and buttocks.Appears after heavy physical exertion.
• 2nd – the outer shell of the intervertebral disc (fibrous ring) is destroyed.The distance between the vertebrae is reduced, the nerve endings are compressed, which provokes severe, acute pain.Symptoms are especially pronounced while walking.
• 3rd – due to excessive mobility of the vertebrae, muscle fibers and nerve endings are compressed.Spasms, numbness, burning pain, hernias occur - displacement of the intervertebral disc into the spinal cord.
• 4th – growth of pathological exostoses on the bone structure.The spine literally “turns to stone.”Progressive arthrosis 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 (physical inactivity), 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,” is weakened.It supports the spine and internal organs.Thus, physical inactivity provokes disruption of the functioning of a number of 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 “wash out” calcium from bone tissue, making it weak and fragile.
• Unbalanced diet.Popular and affordable fast food satisfies the body's energy needs in full, 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.
• Degenerative age-related 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 many times more often.

Symptoms of lumbar osteochondrosis

Pain is the main marker of the onset of the disease and its localization.Based on the nature of occurrence, frequency and duration, a preliminary diagnosis can be made.Most often, patients with lumbar osteochondrosis experience aching pain radiating to the leg, groin area, and tailbone.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 “responses” in a specific area: this is how “radicular syndrome” manifests itself.

The spinal nerve map allows you to identify pain with 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, pain and sensitivity disturbance extend to the area 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 the toes, pain in the back of the thigh.

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

Pain reflex symptoms

• Lumbago or lumbago (in this case not sciatica!) – acute pain.Any awkward movement, even sneezing and coughing, provokes a spasm.The patient spontaneously changes his body position, moving it to the side.An attempt to take a vertical position provokes a new lumbago.
• Lumbodynia is a dull and aching pain that occurs on one side.Periods of remission are followed by exacerbation, which gradually develops into severe pain.
• Lumboischialgia - painful sensations appear in the leg.

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

Diagnostics

At the initial stage, a complete medical history of the patient is collected.The overall picture should 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 carried out for the primary diagnosis of lumbar osteochondrosis of the 1st degree; it is used to examine the condition of the intervertebral discs, pathologies of the spinal cord, 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 examination using a beam of ionizing rays.CT scan records the degree of disc deformation, inflammatory processes in the membrane of the spinal cord 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 using a needle into the cavity between the pia mater and the arachnoid of the spinal cord, filled with cerebrospinal fluid.Similar to CT, MTP and X-ray, the procedure is carried out 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 the Babinsky, Chaddock and Oppenheiman reflexes.

Treatment of lumbar osteochondrosis

The effectiveness of conservative treatment is achieved through a combination of drugs of various groups, massage and manual therapy.However, at stage 3, lumbar osteochondrosis can no longer be cured using 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 the nerve structures.It is performed under general anesthesia.The patient can walk already on the 3rd day.

Drug therapy (for stages 1-2)

• Analgesics for pain relief: local (ointments, gels), oral (tablets, suspensions), intramuscular (injection solutions).
• Non-steroidal anti-inflammatory drugs to prevent the development of the inflammatory process.Reduces temperature, removes swelling.Most often, gels and tablets are used, in more serious cases (inflammation of the sciatic nerve) - injections.Prima course - 7-14 days.
• Muscle relaxants.Prescribed in the acute period for muscle spasms, as well as during the period of remission to consolidate the effect.
• Chondroprotectors.Block destructive processes in intervertebral discs, promote regeneration, improve metabolism in cartilage tissues.
• Vascular drugs.Helps normalize blood supply to the musculoskeletal system.
• Vitamin complexes of group B. Improve nerve conduction.
• Diuretics.Reduces swelling.

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

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

Prevention

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