Lumbar osteochondrosis is a pathological process that develops in the lumbar intervertebral discs, accompanied by their destruction. The development of this disease is facilitated by a number of predisposing factors that impair metabolic processes in the intervertebral discs. All symptoms of the disease are divided into several groups, depending on the mechanism of their occurrence. Treatment of lumbar osteochondrosis includes both methods of conservative therapy and surgical interventions.
What is osteochondrosis of the lumbar spine
Osteochondrosis of the lumbosacral spine is a disease in which the intervertebral discs in this area undergo degenerative-dystrophic changes, which are subsequently combined with damage to the bone tissue of the vertebrae.
Usually, lumbar osteochondrosis develops at the age of 30–35 years, but under the influence of injuries, uneven loads on the back, symptoms of the disease may occur earlier.
Symptoms of pathology
Symptoms of osteochondrosis of the lumbar spine occur as a result of the impact of altered structures of the spine on the nearby vessels and nerve fibers. They are divided into several groups.
At the initial stage of the disease, there is a feeling of discomfort, fatigue in the lumbar region, which is combined with discomfort in the gluteal region. Sometimes, with awkward movements, sharp turns of the body in the lumbosacral region, pain occurs that passes on its own within a short time.
As the pathology progresses, a person is concerned about pain in the lumbosacral region, radiating to the buttock, hip joint, leg. If the pain occurs suddenly, is of a shooting character, it is called lumbago. Most often, such a manifestation of osteochondrosis appears when trying to lift any weight, while riding with shaking, strong sneezing, coughing, changing the position of the body.
Long-term pain with gradually increasing intensity is called lumbodynia. They occur when you stay in an uncomfortable position for a long time, after physical exertion.
Pain is often accompanied by paresthesias (a feeling of crawling, numbness), a burning sensation in the leg. There is stiffness in the lower back, making it difficult to move in this part of the spine. When trying to overcome this stiffness, the pain intensifies.
With the pathology of the 5th lumbar and 1st sacral roots, piriformis syndrome often develops. This condition occurs due to compression of the sciatic nerve by the spasmodic piriformis muscle, which is located between the sacrum and the upper femur. Localized tingling, numbness, or pain occurs in the buttock area.
In some, with osteochondrosis of the lower back, there is a pelvic floor syndrome, manifested by coccygodynia - pain in the coccyx. There are also pains in the sacrum, perineum, passing to the gluteal region, inner, back of the thigh.
With iliopsoas syndrome, against the background of excessive tension of the latter, a person experiences pain in the lower back, groin or buttock. Also, discomfort, paresthesias are noted in the antero-outer region of the thigh, less often on the lower leg.
These symptoms of lumbar osteochondrosis occur with mechanical damage to the spinal roots. The latter can be compressed by intervertebral hernias, osteophytes (bony outgrowths), altered articular processes of the vertebrae, thickened yellow ligaments (ligaments connecting the arcs of adjacent vertebrae).
An intervertebral hernia is a rupture of the fibrous ring of the intervertebral disc with subsequent exit from the nucleus pulposus. A hernia can form sharply, under the influence of a significant load, or gradually, while the symptoms of lumbar osteochondrosis increase slowly.
Features of the signs of an intervertebral hernia depends on its location, size. With the defeat of the spinal roots between:
- the third and fourth lumbar vertebrae give pain to the region of the antero-inner thighs, to the lower leg, ankle from the inside, a decrease in sensitivity on the front surface of the thigh is characteristic;
- by the fourth and fifth lumbar vertebrae, pain from the gluteal region extends to the outer part of the thigh, lower leg, the back of the foot, and the sensitivity of the skin also decreases in these zones;
- the fifth lumbar and first sacral vertebrae, pain from the gluteal region is given to the back of the thigh, lower leg, heel, outer edge of the foot, which is accompanied by a violation of sensitivity in these zones.
If the intervertebral hernia is large, then the syndrome of compression of the cauda equina roots (the roots of the spinal nerves from the level of the second lumbar vertebra to the fifth sacral vertebra) may develop. Signs of this form of osteochondrosis of the lumbosacral region include pain syndrome, movement disorders of the lower extremities, up to paralysis, decreased sensitivity, difficulty urinating.
There are blood vessels near the spinal roots, which are compressed as a result of degenerative changes. In the initial stages of the disease, compression of the arteries is rare, at later stages it persists for a long time.
Signs of ischemia in osteochondrosis of the lumbar spine - pain, weakness in the legs with prolonged walking, disappearing after stopping movement.
Causes of lumbar osteochondrosis
Lumbosacral osteochondrosis develops under the influence of the following factors:
- Hereditary predisposition. The presence of this disease in close relatives increases the likelihood of its development in humans.
- Hypodynamia, uneven load on the spinal column. Insufficient physical activity weakens the muscles of the trunk, and the lumbar spine experiences the greatest load when a person is sitting. The forward bending of the trunk creates additional stress on the anterior edges of the vertebrae.
- Excessive physical exertion, work associated with constant turns, flexion, extension of the trunk, jerking movements. These factors create excessive stress on the back muscles and provoke the formation of intervertebral hernias.
- Overweight, which creates an additional load on the musculoskeletal system.
- Poor posture, which contributes to an uneven distribution of the load on the spine.
- Congenital developmental disorders, trauma, diseases of the musculoskeletal system (for example, osteomyelitis, tuberculosis).
- Flat feet. In this condition, the arch of the foot does not perform a shock-absorbing function, as a result of which the intervertebral discs experience increased stress.
- Inflammatory processes, diseases of internal organs. Lumbar osteochondrosis often develops against the background of endocrine disorders, pathology of the cardiovascular system, inflammatory lesions of the joints of the spine.
- Frequent psycho-emotional stress.
All these factors contribute to the disruption of the blood supply to the intervertebral discs, the disruption of metabolic processes in them, a decrease in the elasticity of these structures, and a slowdown in the regeneration processes in them.
Lumbar osteochondrosis most often develops in athletes whose back is constantly experiencing great physical exertion, periodically - injuries. Another category of people at risk includes office workers, cooks, teachers, drivers, waiters, hairdressers. People of these professions spend a lot of time in one position during the day, which creates an excessive load on the intervertebral discs.
The degree of the disease
Depending on the severity of degenerative-dystrophic changes, lumbosacral osteochondrosis has 4 degrees.
Intervertebral discs lose elasticity, become less elastic, their height changes slightly or remains the same.
Small cracks form in the fibrous rings of the intervertebral discs. The intervals between the vertebrae are reduced, the latter are displaced relative to each other. This leads to compression of the nerve roots, pain syndrome.
There is a rupture of the annulus fibrosus, the nucleus pulposus extends beyond its limits, as a result of which an intervertebral hernia forms. . .The latter compresses the nerve fibers, blood vessels.
The spine undergoes deformation, usually lordosis or scoliosis is formed. In lordosis, the anteriorly-facing curvature of the spinal column becomes more pronounced; scoliosis is a lateral curvature of the spine.
There is a pronounced deformity of the spine, which, in combination with pain syndrome, complicates the motor activity of a person. Osteophytes are formed - growths of bone tissue on the vertebrae, causing trauma to the surrounding tissues, entrapment of nerve fibers. The vertebrae are as close together as possible, pronouncedly deformed.
Stages of the disease
The symptomatology of osteochondrosis changes as the disease progresses, and therefore there are 4 stages of the pathological process. On the first of them, discomfort in the lumbar region occurs periodically. Usually, unpleasant sensations appear after physical exertion, lifting weights, or being in an uncomfortable position for a long time. This stage is characterized by a decrease in the elasticity of the intervertebral discs without a pronounced change in their height.
If the disease progresses to the second stage, the person experiences more severe, prolonged pain. During this period, cracks appear in the fibrous ring of the intervertebral disc, the intervals between the vertebrae decrease.
During the third stage, intervertebral hernias form, which often lead to infringement of the spinal nerves. A person is worried about constant pain radiating to the thigh, lower leg, the sensitivity of the skin in these areas is disturbed.
The fourth stage is characterized by constant pain, pronounced limitations of movement in the lumbar spine due to significant deformation of the vertebrae in this area.
Treatment of osteochondrosis of the lumbar spine
Before treating osteochondrosis of the lumbar spine, it is necessary to understand which links of the pathological process and symptoms it should influence. The activities carried out should contribute to:
- elimination of inflammation;
- reducing pain;
- strengthening muscles, eliminating their spasm;
- improving blood supply, metabolic processes in the spine;
- restoration of normal range of motion, restoration of sensitivity of the lower extremities.
Drug treatment of osteochondrosis of the lumbosacral spine is one of the components of conservative therapy. For this disease, drugs of the following pharmacological groups are used:
- Non-steroidal anti-inflammatory drugs. They suppress inflammation and reduce pain. Usually, in the acute period of the disease, injections are used for lumbar osteochondrosis, then, after reducing the pain syndrome, pills are used. Also, for topical application, such gels and ointments are used.
- Muscle relaxants. These funds reduce the spasm of the muscles surrounding the spine, squeezing nerve fibers, blood vessels, resulting in reduced pain.
- Chondroprotectors. These drugs prevent the destruction of cartilage tissue, normalizing metabolic processes in the intervertebral discs.
- Vitamin-containing preparations improve metabolic processes in nerve fibers, which leads to suppression of inflammatory reactions.
- Corticosteroids have a pronounced anti-inflammatory effect, they are used in short courses in cases where drugs from other groups are ineffective.
Massage for osteochondrosis of the lumbar spine helps to improve blood circulation in the tissues, eliminate muscle spasm, reduce the severity of inflammatory reactions, as a result of which pain becomes weaker.
Physiotherapy is also used to eliminate the symptoms of osteochondrosis of the lumbar spine. Elimination of muscle spasm, pain, restoration of metabolic processes in the intervertebral discs are facilitated by:
- diadynamic currents;
- laser therapy;
- vibration therapy.
Magnetotherapy promotes relaxation of spasmodic muscles, normalizes local blood circulation.
Balneotherapy, which is a treatment with mineral waters in the form of showers, baths, improves local metabolic processes, reduces pain.
Many are interested in when and how to treat lumbar osteochondrosis surgically. Surgical intervention is carried out when:
- compression of the spinal cord, vertebral artery;
- compression of the spinal nerves, accompanied by movement disorders;
- frequent, severe pain that is not relieved by medication;
- instability of the vertebrae.
During surgery, the damaged intervertebral disc is removed; this operation is called discetomy. The intervertebral disc is replaced with an artificial graft or bone fragment obtained from the patient's own pelvic bone. Sometimes, together with the intervertebral disc, the vertebral body is removed, such an intervention is called coprectomy.
At the next stage of the operation, the lumbar vertebrae are connected to each other so that they grow together in the future, this helps to prevent their instability, compression of the spinal nerves.
Therapeutic exercises for osteochondrosis of the lumbar spine
Therapeutic gymnastics for osteochondrosis of the lumbar spine is aimed at strengthening the muscles of the back, gluteal, and femoral regions. Regular exercise improves blood circulation in these areas, as well as in the lumbosacral spine. Metabolic processes in the intervertebral discs are stimulated, muscle spasm and soreness are reduced.
Before starting exercise therapy for osteochondrosis of the lumbar spine, it is necessary to choose comfortable clothes made from natural fabrics, which should not impede movement. However, it should be warm enough to avoid hypothermia of the back.
All exercises for lumbar osteochondrosis should be performed slowly, smoothly, with maximum concentration on muscle work. It is important to maintain deep, even breathing during exercise.
Gymnastics is carried out no earlier than an hour after a meal.
When a person performs exercises in the supine position for osteochondrosis of the lumbosacral spine, it is important to use a thick round roller, which is placed under the shins. This eliminates excess stress on the lower back.
It is recommended to record in the diary the plan, the results of the classes, the changes in symptoms that arise. This information must be provided to the doctor for the subsequent correction of the performed gymnastics complex.
If, during exercise therapy with lumbar osteochondrosis, a person experiences pain while performing any exercise, it is necessary to reduce its amplitude, the number of repetitions, or exclude it from the complex.
All exercises for osteochondrosis of the lumbar spine are divided into:
- Performed in the acute period with severe pain. They are aimed at general strengthening of the back muscles, facilitating breathing.
- Performed in the acute period when pain subsides. Such exercises are aimed at strengthening the abdominal muscles, gluteal region.
- Performed during remission, when pain is absent or mild. Exercise allows you to use a large number of muscles, includes active movements.
Exercises that are recommended for lumbar osteochondrosis in remission.
Prevention of lumbar osteochondrosis
To prevent the development of lumbar osteochondrosis, it is necessary to avoid excessive loads on the spinal column, to avoid prolonged stay in uncomfortable positions. To strengthen the muscles of the back and legs, regular exercise is important, and swimming is considered the most beneficial for the spine. On the recommendation of a doctor, it is possible to use special orthopedic corsets, belts.
A balanced diet not only helps to reduce excess body weight and reduce the load on the spine, but also normalizes metabolic processes in tissues. Timely treatment of chronic diseases, especially the pathology of the endocrine system, can prevent or slow down the development of degenerative changes in the spine.
The symptoms of lumbar osteochondrosis change with the progression of degenerative-dystrophic processes in the spine. Complex conservative treatment, including the use of medications, massage, physiotherapy, therapeutic exercises, is aimed at reducing inflammation, muscle spasm, and pain. Surgical treatment is used only with the ineffectiveness of conservative therapy, aimed at removing the intervertebral hernia, eliminating complications of the disease.