Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine, affecting the structures of the intervertebral discs and adjacent lumbar vertebrae.It mainly affects people of working age.It appears with various symptoms, the main of which are pains in the lower back and legs, limitation of movements in the lower back.For the diagnosis, research methods such as radiography, computed tomography or magnetic resonance imaging of the lumbar spine are used.In this article you can learn more about the causes, symptoms and diagnostic methods of osteochondrosis of the lumbar spine.
Osteochondrosis is the result of aging of the body.Some signs of this disease can be found in almost every person (!), starting from the age of 25. But the severity of these changes, the speed of their progress and the degree of clinical manifestations depend on many reasons, first of all on how healthy a certain person leads a lifestyle.Moderate physical activity, mandatory exercises in the morning, correct body posture while performing a variety of work (gardening, construction, banal house cleaning, etc.), orthopedic mattress - these are the points that prevent the development of osteochondrosis of the lumbar spine.
According to statistics, osteochondrosis of the spine is the cause of back pain in 80% of cases.
How does osteochondrosis develop?
The entire spine is made up of individual vertebrae, between the bodies of which intervertebral discs are located.That is, there is a disc between the two vertebrae.The disc consists of a nucleus pulposus and a fibrous annulus.The core contains a lot of water and provides relaxation and flexibility to the spine.The fibrous ring is located along the periphery of the nucleus pulposus, as if holding it within itself.
With a prolonged increase in the load on the nucleus pulposus, it changes its physiological properties, loses water and dries up, and over time becomes sequestered: the disc flattens and the vertebral bodies come closer to each other.Together with such processes, in the nucleus pulposus the fibrous ring loses its elasticity and begins to swell under the influence of mechanical loads.This is called extension.Then the annulus fibrosus ruptures and the nucleus pulposus falls out through the resulting fissures: a disc herniation occurs.A part of two adjacent vertebrae and a disc located between them, called a spinal segment, acquires excessive mobility, thus increasing the load on the adjacent segments.The overload of neighboring segments causes a similar pathological process in them.These changes are called osteochondrosis.
To somehow ensure the stability of the spine, bony growths are formed along the edges of the vertebral bodies, increasing the support area.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondyloarthrosis.Usually all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - go hand in hand.
reason
What causes osteochondrosis?Today there are several theories about its appearance:
- mechanical theory: perhaps the main reason should be considered the regular load added to the spine.That is why osteochondrosis is an almost obligatory fate of loaders, miners, builders and people of similar professions.The appearance of osteochondrosis of the lumbar region is mainly associated with bending and lifting heavy objects, forced by an uncomfortable working posture;
- Another development factor can be the wrong posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes the hereditary features of the structure of the spine and the nutrition of its individual 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 the metabolism in the tissues of the spine and contribute to the development of osteochondrosis;
- The age theory implies the natural wear and tear of the discs during life.
Rarely, only one of these theories is able to 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 spine, as it itself is an overload for the spine.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine are usually.Other reasons that provoke the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excessive sweets, processed foods: all this leads to an imbalance of micronutrients) and lack of fluids;
- 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 lumbar spine);
- sudden interruption of training for persons professionally involved in sports;
- smoking and alcohol abuse: 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 origin and the direction of propagation depend on the receptors that receive irritation, that is, how severe are the changes in the disc and the surrounding tissues, if there is a protrusion or a hernia, in which direction the protrusion is formed, etc.
There are reflex and compression syndromes in osteochondrosis of the lumbar spine.
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 muscle-tonic, vegetative-vascular or neurodystrophic reflex changes, so irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly from soft tissues.
Compression syndromes arise as a result of compression (compression) of nerve roots, blood vessels or spinal cord due to changes formed during osteochondrosis.
Reflex syndromes of the lumbar spine
Lumbago(lumbago): acute, sudden pain in the lumbar region that occurs during a difficult movement or at a moment of physical stress (much less often - for no apparent reason).It is believed that the appearance of lumbago is associated with the movement of the nucleus pulposus within the fibrous ring, that is, it develops in the initial stages of osteochondrosis.The pain is often described as a "lumbago" or "a stick stuck in the lower back."Patients freeze in the position in which the pain gripped them.The slightest movement causes increased pain (sneezing, coughing, trying to turn over in bed, moving the leg).If a person was in a prone position at the time of the development of lumbago (which happens more often), then he cannot stand up.Heavy muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, a muscle ridge is felt, which is sometimes visible with the naked eye without touching, the muscle tension is so pronounced.Palpation is painful for the patient.This increased muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can provoke a worsening of the condition.The natural curve of the spine in the lumbar region (lordosis) is flattened, and lateral curvature (scoliosis) is possible due to muscle tension.
Lumbodynia– another mid-level reflex syndrome.This term also means the presence of pain in the lumbar region.But, unlike lumbago, the pain does not appear acutely, but gradually, over several hours and even days.The pain is dull and aching in nature, of medium intensity, intensifies with movements, while sitting or standing, or when moving from one position to another.Lying on the back with a support under the lower back brings some relief, but passively raising the straightened leg in this position causes increased pain in the lower back (Lassegue's symptom).Palpation of the lumbar spine is painful, but reflex muscle tension is less pronounced than with lumbago, and sometimes it is completely absent.Movement in the lumbar spine is limited, but possible.This means that the patient can bend down and sideways to a certain level (and then the pain intensifies).
Lumboischialgia– another type of mid-level reflex syndrome.This term refers to pain in the lumbar region, radiating to the buttocks and legs (along the back surface).The pain varies in nature, mainly aches, but can periodically intensify as "shooting" in the leg.As with lumbodynia, it increases with any movement, walking, straining, and decreases when you lie on your back.Lassegue's sign is usually positive.Palpation of the lumbar spine is painful, as well as pressure at certain points (for example, in the middle of the line that separates the back from the thigh, in the middle of the back of the thigh, in the middle of the popliteal fossa).There is tension in the muscles of the lower back.Forward and lateral turns are limited.
Compression syndromes of the lumbar spine
Clinical features depend on the structure that undergoes compression.
Between the vertebrae in each intervertebral foramen there are nerve roots (spinal nerves): left and right.If pathological formations in osteochondrosis of the lumbar spine (mainly disc herniations) compress the roots, then radiculopathy develops, the symptoms of which differ for each root.Common to all lumbar radiculopathies is increased pain during sneezing, coughing, movements in the lower back (especially bending forward), the presence of muscle tension in the lumbar region and limitation of movements in the lumbar spine.The most common types of radiculopathy of the lumbar spine are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the front of the inner thigh.In the same area, paresthesia (crawling sensation, numbness) may appear, surface sensitivity is impaired (sharp touch does not differ from ordinary touch, the sensation of cold and heat is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is detected;
- L4 radiculopathy: pain from the lower back radiates to the front of the lower thigh, on 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 (decreased).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- L5 radiculopathy: one of the common localizations.The pain radiates to the buttocks, along the outer edge of the thigh, along the outer front surface of the lower leg to the inner edge of the foot and big toe.Paresthesia is felt here, surface sensitivity is impaired, and pain during sneezing and coughing is transmitted here.In addition, it becomes difficult to extend the thumb, since the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on the heel with the leg extended;
- S1 radiculopathy: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttocks, 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, the heel.These areas are characterized by a feeling of paresthesia and decreased surface sensitivity.Achilles reflex decreases.When this root is damaged, weakness of the muscles of the lower leg and plantar flexors develops, making standing and tiptoeing difficult.
Simultaneous development of radiculopathy of several roots is possible, this is especially typical for L5, S1.It happens that a hernia compresses several roots.
If a herniated disc bulges backwards, it can put pressure on the spinal cord.This is possible only if the hernia is located in the upper lumbar region, since 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, undergo compression, then in the case of an acute blood circulation disorder, a spinal stroke develops in them, and with prolonged compression - myelopathy.Myelopathy manifests as bilateral leg muscle weakness, starting from the feet and gradually progressing upwards.Sensation in the legs is impaired, the Achilles reflex is lost and later the knee reflex.Urinary disorders may occur (frequent, "urgent" urges requiring immediate gratification, 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 belongs to methods such as:
- X-ray of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
X-rays of the lumbar spine should be performed in 2 mutually perpendicular projections - direct posterior and lateral.Such images allow you to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, abnormalities in the structure of the spine and natural curves.To show the intervertebral joints and intervertebral foramina, radiographs are taken in oblique projections.To identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed under functional tests, that is, in the position of flexion and extension of the spine.Normally, the difference in the height of the intervertebral discs in the front or back sections is clearly visible in accordance with the direction of the tilt of the body;with osteochondrosis, due to the functional blockage of one of the segments, the disc height does not change even during bending or stretching.With pathological mobility, the displacement of the vertebrae forward or backward is determined.The main radiological 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), the formation of marginal growths of the vertebral bodies, compression of the vertebra at the border with the affected disc (subchondral).X-ray of the lumbar spine is a routine research method, which is gradually losing its importance against the background of the active introduction of new and more informative research methods (CT and MRI).X-rays of the lumbar region are now used as a screening diagnostic method.
A CT scan of the lumbar spine is also performed using X-rays, but the radiation exposure to the body is significantly less than with X-rays. The examination is performed lying on the table of a special device - a computed tomography;it is absolutely painless.The resulting images are processed using a computer and allow you to see significantly more structures than with an X-ray of the spine.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also performed in a lying position on a sliding table in the tomography room.MRI is harmless and painless.
CT or MRI of the lumbar spine allows you to see all the structures of the spine, carefully examine the intervertebral discs (both nucleus pulposus and anulus fibrosus) and intervertebral foramina, the contents of the spinal canal.Even a slight protrusion of the intervertebral disc will not go unnoticed.These methods (especially MRI) make it possible to determine the direction of the disc herniation, if present, and the degree of compression of the nerve roots and spinal cord.Thus, these research methods are much more informative in the diagnosis of osteochondrosis of the lumbar spine than radiography.In addition, they make it possible to diagnose not only osteochondrosis, but also other diseases (tumors, blood circulation disorders in the spinal cord, abscesses, congenital defects in the structure of the spine and spinal cord), which is important when performing a differential diagnosis of the causes of back pain.
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 spine, a person often loses his ability to work, since, in addition to pain, the disease can lead to impaired mobility of the spine, 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 safest of the modern methods for diagnosing osteochondrosis is MRI of the spine.