Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine, which affects the structures of the intervertebral discs and adjacent lumbar vertebrae.It mainly affects people of working age.It manifests itself with various symptoms, the main of which are pain in the lower back and legs, limitation of movement in the lower back.For diagnosis, research methods such as x-ray, computed tomography or magnetic resonance imaging of the lumbar spine are used.In this article you can learn more about the causes, symptoms and methods of diagnosing osteochondrosis of the lumbar spine.
Osteochondrosis is the result of aging of the body.Some signs of this disease can be found in almost all people (!), starting from the age of 25.But the severity of these changes, the speed of their progression and the degree of clinical manifestations depend on many reasons, primarily on how healthy a lifestyle a particular person leads.Moderate physical activity, mandatory morning exercises, correct body posture when performing a variety of work (gardening, construction, banal housekeeping, etc.), orthopedic mattress - these are the points that prevent the development of osteochondrosis of the lumbar spine.
According to statistics, spinal osteochondrosis is the cause of back pain in 80% of cases.
How does osteochondrosis develop?
The entire spinal column consists of individual vertebrae, between the bodies of which the intervertebral discs are located.That is, there is a disk between two vertebrae.The disc is made up of a nucleus pulposus and a fibrous ring.The core contains a lot of water and provides cushioning and flexibility to the spine.The fibrous ring is located along the periphery of the nucleus pulposus, as if holding it inside.
With a prolonged increase in the load on the nucleus pulposus, it changes its physiological properties, loses water and dries out, and over time it sequesters: the disc flattens and the vertebral bodies move closer to each other.Along 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 protrusion.Then the fibrous ring breaks, and the nucleus pulposus falls through the resulting cracks - a herniated disc occurs.A section of two adjacent vertebrae and a disk located between them, called the spinal segment, acquires excessive mobility, thereby increasing the load on adjacent segments.Overloading neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
To somehow ensure the stability of the spine, bony outgrowths are formed along the edges of the vertebral bodies, which increase 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 - walk side by side.
Reasons
What causes osteochondrosis?Today there are several theories about its presence:
- mechanical theory: perhaps the main reason should be considered the regular increase in load on the spine.That is why osteochondrosis is an almost inevitable fate for loaders, miners, builders and people of similar professions.The onset of osteochondrosis of the lumbar region is associated mainly with bending and lifting heavy objects, forced by an uncomfortable working posture;
- Another development factor can be poor posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes hereditary characteristics of the structure of the spine and the nutrition of its individual structures play a role;
- traumatic theory: any injury to the spine (even the slightest) can trigger 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 throughout life.
Rarely only one of these theories is able to explain the appearance of osteochondrosis in each specific case.In most cases, several factors are to blame at the same time.
Excess weight plays an important role in the onset of osteochondrosis of the lumbar spine, since it itself constitutes an overload for the spine.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine usually are.Other reasons that provoke the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excess sweets, processed foods: all this leads to an imbalance of microelements) and lack of fluids;
- anomalies in the structure of the spine (for example, the presence of an additional lumbar vertebra);
- constantly wearing high-heeled shoes;
- pregnancy (due to excessive load on the lumbar spine);
- sudden cessation of training in people professionally involved in sports;
- smoking and alcohol abuse: as factors that accelerate the aging process of the organism.
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 spread depend on which receptors receive the irritation, that is, how severe the changes are in the disc and surrounding tissues, whether there is a protrusion or hernia, in which direction the protrusion was formed, and so on.
There are reflex and compressive 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 reflexes because, in addition to pain, they are accompanied by changes in the musculo-tonic, vegetative-vascular or neurodystrophic reflex, that is, irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly from soft tissues.
Compression syndromes arise due to compression (compression) of the nerve roots, blood vessels or spinal cord due to changes formed during osteochondrosis.
Reflex syndromes of the lumbar spine
Low back pain(low back pain): sharp, sudden pain in the lumbar region that occurs during awkward movement or at a time of physical stress (much less often - for no apparent reason).It is believed that the onset of low back pain 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 “low back pain” or “a stake stuck in the lower back”.Patients freeze in the position where the pain gripped them.The slightest movement causes an increase in pain (sneezing, coughing, trying to turn over in bed, moving a leg).If a person was in an inclined position at the time of the development of low back pain (which happens most often), he will not be able to straighten himself.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, a muscle ridge is felt, which is sometimes visible to the naked eye without touching it, the muscle tension is so pronounced.Palpation is painful for the patient.This increase in muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can cause a worsening of the condition.The natural curve of the spine in the lumbar region (lordosis) is flattened, while muscle tension can cause a lateral curvature (scoliosis).
Lumbonia– another reflex syndrome of the lumbar level.This term also refers to the presence of pain in the lumbar region.But, unlike low back pain, the pain does not appear acutely, but gradually, over several hours and even days.The pain is dull and aching in nature, of moderate intensity, intensifies with movements, sitting or standing, or when moving from one position to another.Lying on your back with a pillow under your lower back brings some relief, but passively raising your leg straight in this position causes increased pain in your lower back (Lassegue's symptom).Palpation of the lumbar spine is painful, but the reflex muscle tension is less pronounced than in low back pain and is sometimes completely absent.Movement in the lumbar spine is limited, but possible.This means that the patient can bend down and to the side to a certain level (and then the pain intensifies).
Lumboischialgia– another type of lumbar reflex syndrome.This term refers to pain in the lumbar region, radiating to the buttock and leg (along the back surface).The pain is of a different nature, mostly aching, but can periodically intensify like a "shot" in the leg.Just as with low back pain, it increases with any movement, walking, straining, and decreases when lying on your back.Lassegue's sign is usually positive.Palpation of the lumbar spine is painful, as is pressure on some points (for example, in the center of the line separating the buttock from the thigh, in the center of the back of the thigh, in the center of the popliteal fossa).There is tension in the muscles of the lower back.Forward and side bends are limited.
Compression syndromes of the lumbar spine
The clinical characteristics depend on which structure is subjected to compression.
Between the vertebrae in each intervertebral hole are nerve roots (spinal nerves): left and right.If pathological formations in osteochondrosis of the lumbar spine (mainly herniated discs) compress the roots, radiculopathy develops, the symptoms of which differ for each root.Common to all lumbar radiculopathies is increased pain when sneezing, coughing, movements of the lower back (especially forward bends), presence of muscle tension in the lumbar region and limitation of movement in the lumbar spine.The most common types of radiculopathies of the lumbar spine are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the anterior inner thigh.In the same area, paresthesia (crawling sensation, numbness), impaired superficial sensitivity (sharp touch does not differ from ordinary touch, the sensation of cold and heat is lost) may occur.The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- L4 radiculopathy: Pain from the lower back radiates to the lower front of the thigh, the inner surface of the knee joint, and slightly further down the inner surface of the lower leg.In these same areas, paresthesia is felt and superficial sensitivity is lost (decreased).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- L5 radiculopathy: one of the most common localizations.The pain radiates to the buttock, 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.Here paraesthesia is felt, superficial sensitivity is impaired, and pain is transmitted here when sneezing and coughing.Furthermore, it becomes difficult to extend the big toe, since the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on the heel with the foot extended;
- S1 radiculopathy: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttock, along the rear outer 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 sensation of paresthesia and a decrease in superficial sensitivity.The Achilles reflex decreases.When this root is damaged, weakness of the lower leg muscles and foot flexors develops, making it difficult to stand and walk on tiptoes.
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 protrudes backwards, it can put pressure on the spinal cord.This is possible only if the hernia is localized in the upper lumbar region, since there is no spinal cord under the second lumbar vertebra (here 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 an acute circulatory disorder, a spinal stroke develops, and with prolonged compression - myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, starting in the foot and gradually progressing upward.Sensitivity in the legs is impaired, the Achilles reflex is lost and subsequently the knee reflex.Urinary disorders (frequent, “imperative” urges requiring immediate gratification, urinary incontinence) may occur.
Diagnostic methods
The diagnosis of osteochondrosis of the lumbar spine is based on clinical data and data from additional research methods.The key role belongs to methods such as:
- Radiography of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
Radiographs of the lumbar spine must 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, anomalies in the structure of the spine and natural curves.To visualize the intervertebral joints and intervertebral holes, 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 variation in the height of the intervertebral discs in the anterior or posterior sections is clearly visible according to the direction of inclination of the body;in 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, 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 outgrowths of the vertebral bodies, compaction of the vertebra at the border with the affected disc (subchondral sclerosis).X-ray of the lumbar spine is a routine research method, which is gradually losing its significance against the background of the active introduction of new, more informative research methods (CT and MRI).X-rays of the lumbar region are now used as a diagnostic screening method.
A CT scan of the lumbar spine is also performed using X-rays, but the radiation exposure of the body is significantly lower than with X-rays. The examination is carried out lying on the table of a special device - a computed tomography scan;it is absolutely painless.The resulting images are processed using a computer and allow you to see many more structures than with an x-ray of the spine.
Magnetic resonance imaging is a technique that uses electromagnetic radiation to create images.The examination is also carried out in a lying position on a table that slides into the tomograph chamber.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 the nucleus pulposus and the 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 herniated disc, if any, and the degree of compression of the nerve roots and spinal cord.Therefore, these research methods are much more informative in the diagnosis of osteochondrosis of the lumbar spine than x-ray.In addition, they allow you 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 carrying out differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that very 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 the ability to work, since, in addition to pain, the disease can lead to reduced mobility of the spine, the inability to sit, stand and walk.The symptoms of this disease are nonspecific and require additional research methods to accurately confirm the diagnosis.The most informative and safe modern method of diagnosing osteochondrosis is MRI of the spine.