Osteochondrosis of the lumbar region is a chronic degenerative-dystrophic disease of the lumbar spine that affects the structure of the intervertebral discs and a number of located lumbar vertebrae.It affects people of predominantly working age.It manifests itself in various symptoms, the main of which are pain in the lower back and legs, limiting movements in the lower back.For diagnostics, research methods such as radiography, computed tomography or magnetic resonance tomography of the lumbar spine are used.In this article, you can more in more detail with the causes, symptoms and methods of diagnosing osteochondrosis of the lumbar spine.
Osteochondrosis is the result of aging of the body.These or other signs of this disease can be found in almost every person (!), Starting from 25 years old.But here is the severity of these changes, the rate of their progression, the degree of clinical manifestations depends on many causes, primarily on how a healthy lifestyle leads a specific person.Moderate physical activity, compulsory morning gymnastics, the right pose of the body when performing a number of work (garden, construction, banal cleaning of the house and so on), the orthopedic mattress is those moments that prevent the development of osteochondrosis of the lumbar spine.
According to statistics, osteochondrosis of the spine in 80% of cases is the cause of back pain.
How does osteochondrosis develop?
The entire spine consists of separate vertebrae, between the bodies of which there are intervertebral discs.That is, between the two vertebrae is one disk.The disk consists of a gelatinous (pulpic) nucleus and a fibrous ring.The core contains a lot of water and provides depreciation and flexibility of the spine.The fibrous ring is located along the periphery of the jacket nucleus, as if holding it inside itself.
With a prolonged increased load on the jetty core, it changes its physiological properties, loses water and dries, and eventually sequences: the disk is flattened, and the vertebral bodies come close to each other.Along with such processes, in the jacket of the nucleus, the fibrous ring loses its elasticity and, under the influence of mechanical loads, begins to protrude.This is called protrusion.Then the fibrous ring cracks, and a gelatinous nucleus falls through the resulting gaps: a hernia of the disk occurs.A plot of two adjacent vertebrae and a disk located between them, called the vertebral segment, acquires excess mobility, thereby increasing the load on the nearby segments.The overload of neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bone growths are formed along the edges of the vertebral bodies, increasing the area of the support.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondylo arthrosis.Usually all three pathologies - osteochondrosis, spondylosis, spondyl arthrosis - walk nearby.
Reasons
Why does osteochondrosis occur?To date, there are several theories of the occurrence:
- Mechanical theory: Perhaps the main reason should be considered a regular increased load on the spine.That is why osteochondrosis is an almost obligatory destiny of movers, miners, builders and people of such professions.The occurrence of osteochondrosis of the lumbar region is mainly associated with the slopes and lifting of severity, forced an uncomfortable work pose;
- Another factor in development is incorrect posture, sitting in the wrong pose, which is especially relevant for mental workers;
- Sometimes the role is played by hereditary features of the structure of the spine and the nutrition of its individual structures;
- Traumatic theory: any trauma to the spine (even the most insignificant) is able to launch a degenerative process;
- Hormonal metabolic disorders and endocrine diseases can adversely affect metabolism in the tissues of the spinal column and contribute to the development of osteochondrosis;
- Age theory implies the natural wear of the discs in the process of life.
Rarely, only one of these theories can explain the occurrence of osteochondrosis in each case.More often at the same time, several factors are “to blame”.
In the occurrence of osteochondrosis of the lumbar spine, overweight plays an important role, since it itself is an overload for the spinal column.The higher the body mass index (degree of obesity), the more pronounced changes in the spine are usually.Among other reasons provoking the appearance of osteochondrosis, one can note:
- sedentary lifestyle;
- Imorly nutrition (fast food, excess sweet, semi -finished products: all this leads to an imbalance of trace elements) and a lack of fluid;
- anomalies of the structure of the spine (for example, the presence of an additional lumbar vertebra);
- constant wearing of high -heeled shoes;
- pregnancy (due to the excess load on the lumbar spine);
- sudden termination of training in people professionally involved in sports;
- Smoking and abuse of alcohol: as factors that accelerate the aging process in the body.
Symptoms
The main manifestation of osteochondrosis of the lumbar spine is pain.The nature of the pain, the place of occurrence and the direction of distribution depend on which receptors are irritated, that is, how rough changes in the disk and surrounding tissues, there is protrusion or hernia, in which direction the protrusion was formed and so on.
Reflex and compression syndromes are distinguished with osteochondrosis of the lumbar spine.
Reflex syndromes develop in cases where the receptors of the fibrous ring of the affected disk, ligaments and joint capsules located nearby are irritated.They are reflexive because in addition to pains are accompanied by muscle-tonic, vegetative-vascular or neurodistrophic reflex changes, that is, irritation with reflexes is transmitted to other structures, causing symptoms mainly from the side of the soft tissues.
Compression syndromes occur as a result of compression (compression) of nerve roots, blood vessels or spinal cord formed by osteochondrosis by changes.
Reflex syndromes of the lumbar spine
Lumbago(Feeling): Acute sudden pain in the lower back, which occurs with an awkward movement or at the time of physical tension (much less often - for no apparent reason).It is believed that the occurrence of lumbago is associated with the movement of a jacket nucleus within the fibrous ring, that is, it develops in the initial stages of osteochondrosis.Often the pain is described as "Feeling", "The stake was stuck in the lower back."Patients freeze in the pose in which pain caught them.The slightest move causes an increase in pain (sneezing, coughing, an attempt to turn in bed, to move your foot).If a person was in an inclined position at the time of the development of Lumbago (which happens most often), then he cannot straighten up.A pronounced muscle voltage in the lumbar spine occurs reflexively.Along the vertebrae in this area, a muscle roller is felt, which is sometimes visible to the naked eye without touch, and muscle tension is so pronounced.Feeling painful for the patient.Such an increased muscle tone performs an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can provoke a deterioration in the state.The natural bend of the spinal column in the lower back (lordosis) is flattened, perhaps curvature (scoliosis) is possible due to muscle tension.
Lumbalgia- Another reflex syndrome of the lumbar level.This term also means the presence of pain in the lumbar region.But, unlike lumbago, the pain does not arise acutely, but gradually, within a few hours or even days.The pain is stupid, moderate intensity, intensifies during movements, in a sitting or standing position, when moving from one position to another.A little relief brings the position of lying down or the back with a roller under the lower back, but the passive rise of the straightened leg in this position causes increased pain in the lower back (Lassa Symptom).Palpation of the lumbar spine is painful, but the reflex tension of the muscles is less pronounced than with lumbago, and sometimes absent at all.Movements in the lumbar spine are limited, but possible.This means that the patient can bend down and to the sides to a certain level (and then the pain intensifies).
Sciatica- Another variety of reflex syndrome of the lumbar level.By this term is meant pain in the lower back, which gives to the buttock and in the leg (on the back surface).The pain is different, mostly aching, but can periodically intensify by the type of “fireplace” in the leg.Just as with lumbalgia, it intensifies with any movements, walking, straining, decreases in the lying on the back.The symptom of Lassa is usually positive.Palpation of the lumbar spine is painful, as well as pressing on some points (for example, in the middle of the line separating the buttock from the thigh, in the middle of the back of the thigh, in the middle of the popliteal fossa).There is tension of the lower back muscles.The inclinations forward and to the sides are limited.
Compression syndromes of the lumbar spine
The clinical characteristic depends on which structure is subject to compression.
Between the vertebrae in each intervertebral hole are nerve roots (spinal nerves): left and right.If pathological formations for osteochondrosis of the lumbar spine (mainly discs of the discs) squeeze the roots, then radiculopathy develops, the symptoms of which differ for each root.Common to all radiculopathies of the lumbar region is the increase in pain during sneezing, coughing, movement in the lower back (especially tilting forward), the presence of muscle tension in the lower back, restriction of movements in the lumbar spine.The following types of radiculopathies of the lumbar spine are most common:
- Radiculopathy L1, L2, L3: pain occurs in the lower back, give to the anticipated thigh.In the same area, the occurrence of paresthesia (a sense of crawling goosebumps, numbness) is possible, superficial sensitivity is disturbed (an acute touch from the usual is not distinguished, the feeling of cold and hot) is lost.The knee reflex decreases, the weakness of the quadriceps of the thigh is revealed;
- Radiculopathy L4: the pain from the lower back gives to the front -line part of the thigh, the inner surface of the knee joint and slightly lower along the inner surface of the lower leg.In the same areas, paresthesia is felt, and surface sensitivity is lost (reduced).Weakness in the quadriceps muscle of the thigh also develops, the knee reflex decreases;
- radiculopathy L5: one of the frequent localizations.The pain gives to the buttock, along the outer edge of the thigh, along the front surface of the lower leg to the inner edge of the foot and thumb.Paresthesia is felt here, superficial sensitivity is disturbed, and a pain is given here when sneezing and coughing.In addition, there is a difficulty in extension of the thumb of the foot, since the muscle that performs this action is innervated by the Kine L5.It is sometimes difficult to stand on a heel with an exposed foot;
- S1 radiculopathy is also often found with osteochondrosis of the lumbar spine.The pain gives to the buttock, along the outer edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and the 5th finger, heels.These zones are characterized by a feeling of paresthesia, a decrease in surface sensitivity.Achilles reflex is reduced.With the damage to this spine, the weakness of the muscles of the lower leg and flexors of the foot develops, so standing and walking on the socks are difficult.
The simultaneous development of radiculopathies of several roots is possible, this is especially characteristic of L5, S1.It happens that one hernia squeezes several roots.
If the disc herd sticks back, then it can squeeze the spinal cord.This is possible only when the hernia is localized in the upper reference point, since there are no spinal cord vertebrae below the II lumbar vertebra (the spinal cord roots are subjected to compression, and the horse tail syndrome develops).
If the vessels of the lumbar region are subjected to squeezing, which carry out blood flow to the spinal cord, then in the case of an acute circulatory disorder, a spinal stroke develops, and with prolonged compression - myelopathy.Myelopathy is manifested by bilateral weakness of the muscles of the legs, starting from the foot and gradually progressing up.The sensitivity in the legs is disturbed, Achilles reflex is lost, and later knee.It is possible to emerge urination disorders (frequent, “imperative” urge, requiring immediate satisfaction, urinary incontinence).
Diagnostic methods
Diagnosis of osteochondrosis of the lumbar spine is based on clinical data and data of additional research methods.The key role belongs to such methods as:
- radiography of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance tomography of the lumbar spine.
The radiography of the lumbar spine is necessarily performed in 2 mutually perpendicular projections-the straight rear and side.Such pictures allow you to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, the abnormalities of the spine, and natural bends.To display the intervertebral joints and intervertebral holes, radiograms are produced in oblique projections.To identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed under the conditions of functional trial, that is, in the flexion and extension of the spine.Normally, you can clearly see the change in the height of the intervertebral discs in the front or rear sections in accordance with the direction of the body inclination, with osteochondrosis due to the functional block of one of the segments, the height of the disk does not change either when bending or extensing.With pathological mobility, the displacement of the vertebrae forward or backwards is determined.The main X -ray signs of osteochondrosis include narrowing of the intervertebral slit, pathological mobility and displacement of vertebral bodies, deposition of salts in the disk tissue (calcification), the formation of regional growths of vertebral bodies, compaction of the vertebrae at the border with the affected disk (subchondral sclerosis).The radiography of the lumbar spine is a routine of research, which gradually loses its significance against the background of the active implementation of new and more informative research methods (CT and MRI).The radiography of the lumbar department is today used as a screening diagnostic method.
CT of the lumbar spine is also carried out using x -ray radiation, but the radial load on the body is much less than with x -ray.The study is carried out lying on the table of a special device - a computer tomograph, it is absolutely painless.The resulting pictures are processed using a computer and allow you to see significantly more structures than with spine radiography.
MRI is a method in which electromagnetic radiation is used to create images.The study is also carried out in the position of lying on the table, which calls into the chamber of the tomograph.MRI is harmless and painless.
CT or MRI of the lumbar spine allow you to see all the structures of the spine, carefully examine the intervertebral discs (and the jacket and fibrous ring) and the intervertebral holes, the contents of the spinal canal.Even a slight protrusion of the intervertebral disc will not go unnoticed.These methods (especially MRI) allow you to determine the direction of the disk hernia if any, the degree of compression of nerve roots, spinal cord.Thus, these research methods are much more informative in the diagnosis of osteochondrosis of the lumbar spine than radiography.In addition, they allow you to diagnose not only osteochondrosis, but also other diseases (tumors, circulatory disorders in the spinal cord, abscesses, congenital defects of the structure of the spine and spinal cord), which is important during the differential diagnosis of causes of pain in the back.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.It is, in fact, the destruction of the intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses working capacity, since, in addition to pain, the disease can lead to a violation of the mobility of the spine, the inability to sit, stand and walk.The symptoms of this disease are non -specific and require additional research methods to accurately confirm the diagnosis.The most informative and safe of modern methods of diagnosis of osteochondrosis is MRI of the spine.