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 movements, prolonged forced position, lifting and carrying heavy loads, sports overload, overweight.
Depending on the duration, there are acute pains that last 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 (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 very limited, there is a compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with proper treatment and immobilization of the lumbar spine does not exceed 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lumbar region, aggravated by movement or in a certain position, discomfort when standing or sitting for a long time. The onset is usually gradual. Clinically, limited mobility in the lumbar spine, tension and pain of the paravertebral muscles are often determined. In most cases, the pain goes away in 2 to 3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (low back pain that radiates to the leg). In the lumbar region, movements are limited, the 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.
Disc herniation with radicular syndrome or radiculopathy. Root compression is accompanied by shooting, burning pains in the leg. The pain is aggravated by movement, with coughing, accompanied by numbness along the root, muscle weakness and loss of reflexes. Positive stress symptoms.
In the lumbar region, the greatest load falls on the lower part, therefore the L5 and S1 roots are more often involved in the pathological process. Each root has its own zone of distribution of pain and numbness of the extremities.
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 in the radicular artery L5, and less often S1, is disturbed. Radiculoischemia at other levels is diagnosed very rarely.
During an awkward movement or lifting heavy objects, 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 "slapping" of the foot when walking (steppage). The patient, while walking, raises his leg high, throws it forward and at the same time hits the ground with his toe.
In most cases, the paresis regresses safely 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. The pain at rest is less, but when walking there is a syndrome of intermittent claudication. Pain when walking extends 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 serious complication of lumbar osteochondrosis. He acutely develops inferior 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 in order to exclude 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 are of no clinical value, since all elderly and elderly people have them. Functional radiographs are done to look for spinal instability. Images 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. Herniated discs and spinal cord are better seen on MRI, and bony structures are better seen on CT. The clinical level of the injury and the MRI findings should correspond to each other, since a disc herniation detected on MRI is not always the cause of the pain.
In neurological deficits, electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis.
If somatic pathology is suspected, a full clinical examination is performed.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort appear in the lumbar spine, regular gymnastic exercises to strengthen the muscle corset, swimming courses and massage are shown.
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 severe 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 be limited to reasonable physical activity.
Of the non-pharmacological methods of therapy, interstitial electrical stimulation, acupuncture, hirudotherapy, and massage are effective. Manual therapy is possible, but only in competent hands.
Medical treatment. In acute pain, nonsteroidal 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, nonsteroidal anti-inflammatory drugs, and corticosteroids are effective. Medicinal mixtures are administered as close as possible to the focus of pain (in the affected muscles, exit points of the roots).
With radiculopathy with the presence of neuropathic pain, anti-inflammatory drugs are not effective, 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 nonsteroidal anti-inflammatory drugs to the trigger points, muscle relaxants, acupuncture and post-isometric relaxation are effective.
For chronic pain, antidepressants, exercise therapy, and other non-drug treatments come first in treatment.
With stenosis of the spinal canal, weight loss, wearing a corset, NSAIDs and various venotonics are indicated.
Surgical treatment is performed 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 and uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternate periods of work and rest. Wear a restraint belt due to physical overload. Do exercises to strengthen your back muscles.