Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the spine, affecting the structures of the intervertebral discs and adjacent lumbar vertebrae.It mainly affects people of working age.It is manifested by various symptoms, the main of which is pain in the back and legs, limitation of movements in the lumbar region.For diagnosis, research methods such as radiography, computed tomography or magnetic resonance imaging of the spine are used.In this article, you can learn more about the causes, symptoms and diagnosis methods of osteochondrosis of the back.
Osteochondrosis is the result of aging of the body.Some symptoms of this disease can be found in almost every person (!) starting from the age of 25. However, the severity of these changes, the rate of development and the degree of clinical manifestations depend on many reasons, first of all, how healthy a particular person leads a lifestyle.Moderate physical activity, mandatory morning exercises, correct body posture when performing a number of tasks (gardening, construction, banal house cleaning, etc.), orthopedic mattress - these are points that prevent the development of lumbar osteochondrosis.
According to statistics, the cause of back pain in 80% of cases is spinal osteochondrosis.
How does osteochondrosis develop?
The entire spine is made up of individual vertebrae with intervertebral discs between their bodies.That is, there is a disc between two vertebrae.The disc consists of a pulpous nucleus and a fibrous annulus.The core contains a lot of water and provides cushioning and elasticity to the spine.The annulus fibrosus is located along the periphery of the nucleus pulposus, as if containing it.
With a long-term increased load on the nucleus pulposus, it changes its physiological properties, loses water and dries up, and becomes sequestered over time: the disc flattens and the vertebral bodies come closer to each other.Along with such processes, the fibrous ring in the pulpous nucleus loses its elasticity and begins to bulge under the influence of mechanical loads.This is called an overhang.Then the fibrous ring cracks and the nucleus pulposus falls out of the resulting cracks: a herniated disc is formed.A part of two adjacent vertebrae, called a spinal segment, and a disc located between them acquire excessive mobility, thereby increasing the load on the adjacent segments.Overloading of neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spinal column, increasing the area of support, bone growths occur along the edges of the vertebral bodies.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondyloarthrosis.Usually all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - go side by side.
Reasons
What causes osteochondrosis?Today there are several theories of its formation:
- mechanical theory: perhaps the main reason should be considered the regular increased load on the spine.Therefore, osteochondrosis is an almost inevitable fate of loaders, miners, builders and similar professions.The occurrence of osteochondrosis of the lumbar region is mainly associated with bending and lifting heavy objects forced by an uncomfortable work posture;
- Another developmental factor may be poor posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes the hereditary characteristics of the structure of the spine and nutrition of its separate structures play a role;
- traumatic theory: any damage to the spine (even the smallest) can cause a degenerative process;
- hormonal metabolic disorders and endocrine diseases can negatively affect metabolism in the tissues of the spine and contribute to the development of osteochondrosis;
- The age theory assumes natural wear and tear of the discs throughout life.
In rare cases, only one of these theories can explain the occurrence of osteochondrosis in each specific case.More often than not, several factors are to blame at the same time.
Excess weight plays an important role in the occurrence of osteochondrosis of the lumbar spine, since it itself is an overload for the spinal column.The higher the body mass index (adiposity), the more pronounced the changes in the spine.Other reasons that provoke the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excess sweets, processed food: all this leads to an imbalance of micronutrients) and lack of fluid;
- abnormalities in the structure of the spine (for example, the presence of an additional lumbar vertebra);
- constant wearing of high-heeled shoes;
- pregnancy (due to excessive load on the lower back);
- sudden cessation of training in persons engaged in sports professionally;
- smoking and alcohol abuse: as factors that accelerate the aging process in the body.
Symptoms
The main manifestation of lumbar osteochondrosis is pain.The nature of the pain, the place of origin and the direction of spread depend on which receptors receive irritation, that is, how severe the changes are in the disc and surrounding tissues, whether there is a protrusion or a hernia, in which direction the protrusion has formed, and so on.
Osteochondrosis of the back has reflex and compression syndromes.
Reflex syndromes develop in cases where the receptors of the fibrous ring of the affected disc, ligaments and joint capsules located nearby are irritated.They are called reflex because, in addition to pain, they are accompanied by muscular-tonic, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly from soft tissues.
Compression syndromes occur as a result of compression (squeezing) of nerve roots, blood vessels or the spinal cord as a result of the changes that occur during osteochondrosis.
Lumbar reflex syndromes
Lumbago(lumbago): sharp, sudden pain in the lower back that occurs during an awkward movement or at a moment of physical stress (less often - without any reason).It is believed that the formation of lumbago is related to the movement of the nucleus pulposus within the fibrous ring, that is, it develops in the early stages of osteochondrosis.The pain is often described as "lumbago" or "a stake stuck in the lower back."Patients freeze in the position where the pain takes them.The slightest movement causes an increase in pain (sneezing, coughing, trying to turn over in bed, moving the leg).If a person was in a prone position during the development of lumbago (this happens most often), he cannot straighten it.Severe muscle tension occurs reflexively in the lumbar region.Along the vertebra in this region, sometimes visible to the naked eye without touch, a muscle ridge is felt, the muscle tension is so obvious.Palpation is painful for the patient.This increased muscle tone acts as an immobilizer that protects the affected lumbar segment from pathological mobility that can worsen the condition.In the lumbar region, the natural curve of the spine (lordosis) is flattened, lateral curvature (scoliosis) is possible due to muscle tension.
Lumbodynia- another reflex syndrome of the lumbar level.This term also means pain in the lower back.However, unlike lumbago, the pain is not acute, but occurs gradually, over several hours or even days.The pain is dull and aching, of moderate intensity, aggravated by movement, sitting or standing, or moving from one position to another.Lying on the back with a support under the waist provides some relief, but passively raising the straightened leg in this position causes increased pain in the lumbar region (Lassegue's symptom).Palpation of the back is painful, but reflex muscle tension is less pronounced than in lumbago and sometimes completely disappears.Movement in the lumbar spine is limited, but possible.This means that the patient can bend down and to the sides up to a certain level (then the pain intensifies).
Lumboschialgia- another reflex syndrome of the lumbar level.This term refers to pain that spreads to the lower back, hips and legs (along the back surface).The pain varies in nature, mainly aching, but from time to time it can intensify as a "shooting" in the leg.As in lumbodynia, it increases during any movement, walking, tension, and decreases when lying on the back.Lassegue's sign is usually positive.Palpation of the back is painful, as well as pressure on certain points (for example, in the middle of the line separating the hip from the thigh, in the middle of the back of the thigh, in the middle of the popliteal fossa).There is tension in the lower back muscles.Forward and side bends are limited.
Lumbar compression syndromes
Clinical features depend on which structure is subjected to compression.
In each intervertebral foramen there are nerve roots (spinal nerves) between the vertebrae: left and right.If pathological formations (mainly disc herniations) compress the roots in osteochondrosis of the lumbar spine, then radiculopathy develops, the symptoms of which are different for each root.Common to all lumbar radiculopathies are increased pain during sneezing, coughing, lumbar motion (especially forward bending), lumbar muscle strain, and limitation of lumbar motion.The most common types of radiculopathy of the lumbar spine are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, spreads to the anterior inner thigh.In the same area, paresthesia may occur (a feeling of crawling, numbness), surface sensitivity is disturbed (sharp touch does not differ from ordinary touch, cold and hot sensations are lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is detected;
- radiculopathy L4: pain from the lower back radiates to the anterior lower part of the thigh, the inner surface of the knee joint and slightly lower along the inner surface of the lower leg.Paresthesia is felt in the same areas and surface sensitivity is lost (decreased).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- radiculopathy L5: one of the common localizations.The pain spreads to the hip, along the outer edge of the thigh, along the front outer surface of the lower leg to the inner edge of the foot and big toe.Paresthesia is felt here, superficial sensitivity is impaired, pain is transmitted here during sneezing and coughing.In addition, it becomes difficult to extend the thumb, because the muscle that performs this movement is innervated by the L5 root.Sometimes it is difficult to stand on the heel with the leg extended;
- radiculopathy S1: is also common in lumbar osteochondrosis.The pain spreads to the hip, along the outer back edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and the 5th toe, heel.These areas are characterized by a sense of paresthesia and a decrease in superficial sensitivity.The Achilles reflex decreases.When this root is damaged, weakness of the lower leg muscles and leg bends develop, making it difficult to stand on the toes and walk.
Simultaneous development of radiculopathy of several roots is possible, which is especially characteristic of L5, S1.It happens that one tear squeezes several roots.
If a herniated disc bulges backwards, it can put pressure on the spinal cord.This is possible only if the hernia is localized in the upper lumbar region, because there is no spinal cord under the second lumbar vertebra (there the roots of the spinal cord are compressed and cauda equina syndrome develops).
If the vessels of the lumbar region, which supply blood to the spinal cord, are subjected to compression, in the case of acute circulatory disorders, spinal stroke develops, and with long-term compression, myelopathy develops.Myelopathy manifests itself as bilateral weakness of the leg muscles, starting from the leg and gradually moving upwards.Sensation in the legs is impaired, the Achilles reflex is lost, and then the knee reflex is lost.Urinary disorders may occur (frequent, "imperative" urges requiring immediate satisfaction, urinary incontinence).
Diagnostic methods
The diagnosis of osteochondrosis of the lumbar spine is based on clinical data and data from additional research methods.The main role refers to methods such as:
- X-ray of the spine;
- computed tomography of the spine;
- Magnetic resonance imaging of the spine.
X-ray of the lumbar spine should be done in 2 mutually perpendicular projections - directly behind and laterally.Such images allow to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, anomalies in the structure of the spine, and natural curves.Radiographs are taken in oblique projections to show the intervertebral joints and intervertebral foramina.In order to determine the pathological mobility of individual lumbar segments (this is a sign of osteochondrosis), radiography is performed under functional tests, that is, in the position of bending and extension of the spine.Normally, the change in the height of the intervertebral discs in the front or back parts is clearly visible according to the direction of bending of the body;with osteochondrosis, due to the functional block of one of the segments, the height of the disc does not change either during flexion or during extension.With pathological mobility, forward or backward displacement of the vertebra is determined.The main X-ray signs of osteochondrosis include narrowing of the intervertebral space, pathological mobility and displacement of the vertebral bodies, deposition of salts in the disc tissue (calcification), formation of marginal growths of the vertebral bodies, compression of the vertebra at the border with the affected disc (subchondral sclerosis).X-ray of the spine is a common research method that is gradually losing its importance against the background of the active application of new and more informative research methods (CT and MRI).X-ray of the spine is now used as a screening diagnostic method.
A CT scan of the spine is also done using X-rays, but the radiation exposure to the body is much less than X-rays.The examination is carried out lying on the table of a special device - computer tomography;completely painless.The resulting images are processed using a computer and allow you to see significantly more structures than an X-ray of the spine.
MRI is a technique that uses electromagnetic radiation to create an image.The examination is also performed lying on a table that slides into the tomograph camera.MRI is harmless and painless.
CT or MRI of the spine allows you to see all the structures of the spine, carefully examine the intervertebral discs (both nucleus pulposus and annulus fibrosus) and intervertebral foramina, the contents of the spinal canal.Even a small protrusion of the intervertebral disc will not go unnoticed.These methods (especially MRI) allow determining the direction of the disc herniation, if any, and the degree of compression of the nerve roots and spinal cord.Thus, these research methods are more informative in the diagnosis of lumbar osteochondrosis than radiography.In addition, they make it possible to diagnose not only osteochondrosis, but also other diseases (tumors, circulatory disorders in the spinal cord, abscesses, congenital defects in the structure of the spine and spinal cord), which is important when conducting a differential diagnosis of the causes of back pain.
Osteochondrosis of the back is a disease that most often causes back pain.This is, in fact, the destruction of the intervertebral discs.Due to osteochondrosis of the spine, a person often loses his ability to work, because in addition to pain, the disease can cause a violation of the mobility of the spine, the ability to sit, stand and walk.The symptoms of this disease are non-specific and require additional research methods to confirm the diagnosis.The most informative and safe of the modern methods for the diagnosis of osteochondrosis is MRI of the spine.