lumbar osteochondrosis

14 September 2022

Lumbar osteochondrosis is a degenerative-dystrophic lesion of the spine in the lumbar region. Pain syndrome is caused by damage to the intervertebral discs, spinal roots, nerve fibers and cartilaginous tissues. For the treatment of lumbosacral osteochondrosis, you need to contact a neurologist.

Symptoms of lumbar osteochondrosis

severe pain syndrome that may radiate to the leg and pelvic organs
pain in the kidneys and sacrum
numbness of the extremities
rigidity
tension in the lumbar region
fatigue, weakness
dizziness

Lumbar osteochondrosis has gender characteristics of the course. Vertebrogenic pain, which occurs due to compression of the nerve roots by the altered cartilage of the intervertebral discs, is much more difficult for women than for men. The intensity of the pain is directly related to the level of estrogen. The lower its indicators, the more pronounced the pain.

Also, reflected lumbosacral pain syndrome may be associated with concomitant diseases of internal organs. In women, diseases of the genitourinary sphere prevail, for men, disorders of the gastrointestinal tract are more characteristic.

Treatment of osteochondrosis of the lumbosacral region

Treatment of patients with neurological manifestations of lumbosacral osteochondrosis should be comprehensive and staged. At the first medical appointment, a clinical and functional examination (clarification of complaints and anamnesis) and a clinical examination are carried out. A neurologist examines the dynamic and static function of the spine, assesses the posture and paravertebral muscle tone parameters, determines the degree of mobility of various parts of the spine and limbs. The standard treatment regimen for osteochondrosis includes:

exclusion of adverse loads
immobilization (use of corsets, orthoses, orthopedic style)
drug therapy
physical therapy procedures
gentle acupressure massage
exercise therapy
acupuncture
mud therapy
pulling techniques (traction)

If conservative methods do not give the desired effect, surgical intervention may be necessary.

Physiotherapy for lumbar osteochondrosis

To eliminate pain, reduce swelling, normalize the tone of the back muscles, activate recovery processes, resolve fibrous foci and increase the mobility of damaged segments, a set of physiotherapy procedures is used:

pulsed diadynamic currents
darsonvalization
magnetotherapy (exposure to a static or alternating magnetic field)
laser treatment
medicinal electrophoresis
ultraviolet irradiation
local cryotherapy
ultrasound
transcutaneous electrical nerve stimulation

Thanks to physiotherapy combined with the simultaneous use of several methods, the effectiveness of therapy for lumbar osteochondrosis increases by 30%.

Physiotherapy

A special role in the conservative treatment of degenerative pathologies of the musculoskeletal system is assigned to recreational physical education. The instructors-rehabilitators of the rehabilitation center develop individual complexes of stretching and dynamic exercise therapy exercises for osteochondrosis of the spine. This takes into account the sex, age and physical abilities of the patient.

Optimized therapeutic exercises aim to strengthen the muscles of the back, abdominals, pelvic region and lower extremities. Thanks to training therapy, pathological muscle tension is eliminated, pressure on the intervertebral discs is reduced, swelling and pain are eliminated, the spine is stabilized and posture is improved.

Surgical intervention

An absolute indication for decompressive surgery is disabling radiculomyeloishemia. This dangerous pathological condition is caused by herniated compression of the nerve roots and impaired blood flow in the sacrococcygeal area. It produces intermittent excruciating pain, pelvic organ dysfunction, intermittent claudication, and other motor, reflex, or sensory disturbances. A relative indication for operative stabilization is the lack of effect of long-term conservative therapy (more than 1. 5-2 months).

Endoscopic methods of osteoplasty are recognized as the most optimal: installation of interbody implants and fixation cages made of biocompatible materials. Minimally invasive interventions quickly return the ability to support the operated department and allow early rehabilitation to begin.

Injection treatment (injections for lumbar osteochondrosis)

The main manifestation of osteochondrosis of the lumbosacral region is pain. This complex, multi-component symptom is associated with local inflammation, pathologic muscle strain, ligament damage, biomechanical causes, and dysfunction of the pain perception system. Therefore, the treatment must be carried out in a complex. For faster pharmacological action and reduction of gastrointestinal and cardiovascular risks, injection therapy drugs are prescribed:

anti-inflammatories (NSAIDs)
analgesics (analgesics)
muscle relaxants (relaxants, which reduce muscle tone)
vasodilator (improves blood microcirculation)
chondroprotectors (which stimulate the regeneration of intervertebral discs, slowing down the destruction of cartilage tissue).

On the recommendation of a doctor, homeopathic injections for the treatment of osteochondrosis and vitamins can be used. For the rapid and effective elimination of severe pain syndrome, therapeutic paravertebral blocks (injections into the lumbosacral nerve plexus) are prescribed.

medical therapy

Traditionally, complex therapy for degenerative diseases of the spine includes treatment with tablets and capsules, similar to the injection method:

NSAIDs (non-steroidal anti-inflammatory drugs)
analgesics
myotropic antispasmodics (drugs to relieve muscle spasms)
vegetative correctors (autonomic nervous system tone stabilizers)
vasodilators (to improve blood flow and tissue trophism)
chondroitin and glucosamine dosage forms
sedatives and antidepressants (to relieve emotional tension and chronic stress)
vitamin and mineral complexes

Tablet preparations for the treatment of osteochondrosis of the lumbosacral spine are prescribed for a long period (up to 2 months or more).

How does this disease manifest clinically?

Osteochondrosis of the lumbar spine in the early stages is characterized by very general symptoms, which are very difficult to recognize without the intervention of an experienced specialist. Usually, patients begin to complain of pain and other discomfort only when the second stage occurs.

The main clinical symptom of this disease, as everyone probably knows, is pain in the lower back. The severity of this symptom increases significantly after lifting and carrying weights, or even after simple movements of the limbs or torso. After a while, the pains become aching, annoying, but can periodically worsen.

Another common complaint of patients at a vertebrologist's appointment is stiffness, limitation of movement in the lumbosacral joint. It becomes difficult for patients to bend over, turn around. It should also be noted that pain can often radiate to the posterior surface of the lower extremities.

As a result of compression of the nerve roots by the enlarged intervertebral discs, alterations in skin pain and temperature sensitivity occur. It should be said that these violations can mean both a weakening and an increase in the sensitivity threshold. With untimely treatment, the disease is further complicated by muscle hypotension, as well as hyporeflexia.

How can you get rid of this serious disease?

Treatment of the problem of osteochondrosis is divided into two main groups of methods: conservative and surgical. The basis of the first method is the impact on the human body with the help of drugs, which include nonsteroidal anti-inflammatory drugs, analgesics, biogenic immunostimulants, and drugs that relax peripheral muscles. Before taking any of the groups of these drugs, you should definitely visit your doctor, who will make a full diagnosis and draw up your individual treatment plan. This is very important because the medications described above can have some serious side effects that can be avoided if taken correctly.

Chondroprotective and anti-inflammatory ointments, B vitamins are also widely used.

Manual therapy, physiotherapy and acupuncture methods have proven themselves in the treatment of osteochondrosis, which help to improve the local blood supply and relax the back muscles.

Treatment of osteochondrosis of the lumbar spine.

According to statistics, one in two people aged 25-55 years has experienced at least once in his life manifestations of lumbar osteochondrosis of varying severity: from discomfort in the lumbar region to severe pain with limited mobility.

The lumbar skeleton is subjected to maximum loads, so a high percentage of osteochondrosis in this particular area of the spine is not accidental.

The disease is based on the degeneration of the disc with the gradual involvement of the adjacent vertebrae, intervertebral joints and the ligamentous apparatus in the pathological process.

When the diagnosis is confirmed, treatment of lumbar osteochondrosis should be started immediately, without waiting for the appearance of complications.

The mechanism of development of osteochondrosis.

In the cartilaginous structure of the intervertebral disc there is a nucleus pulposus surrounded by a dense annulus fibrosus, the collagen fibers of which firmly fix the disc to the vertebral body.

The intervertebral discs act as shock absorbers that ease the pressure on the spine during stress. With age, as a consequence of malnutrition, the cartilaginous tissue of the discs undergoes dystrophic processes. The core dries out, loses its shock-absorbing properties, followed by the destruction of the fibrous ring. In its structure appear microcracks, fiber breaks. Due to the increased load, the disc nucleus is displaced outside the spinal column; the initial stage of hernia formation develops - protrusion. This leads to irritation of the nerve roots and the appearance of pain in the patient.

If the annulus fibrosus ruptures completely, an intervertebral hernia forms.

Factors provoking the development and exacerbation of lumbar osteochondrosis.

Occupational hazards: intense dynamic loads, work associated with frequent changes in body position: flexion, extension, turns, lifting heavy loads, vibration.
A genetic predisposition in which the tissues of the spinal column have structural changes that accelerate their degeneration.
Incorrect posture, in which an uneven distribution of the load on the axial skeleton occurs.
Orthopedic pathologies: flat feet, curvature of the spine.
Hypodynamia, sedentary lifestyle.
Obesity.
Congenital and acquired pathologies of the spine.
Consequences of injuries to the structures of the spine (fall from a height, transport accidents, and others).
Occupations in sports with a large physical load on the spine: skiing, tennis, horse riding, weightlifting.
Irrational nutrition, imbalance of the diet for the main nutrients: proteins, fats, carbohydrates, vitamins, microelements.
Hormonal imbalance in women during pregnancy and menopause.
Bad habits: alcohol, smoking.
Age changes.
Inflammatory processes of the spine (Bekhterev's disease).
Pathologies associated with impaired metabolic processes in the body (diabetes, hypothyroidism).

Stages of lumbar osteochondrosis.

Depending on the degree of damage to the intervertebral discs and the clinical picture, there are four stages of osteochondrosis of the lumbar spine:

1 stageThere is a gradual decrease in the elasticity of the intervertebral discs. Microcracks appear in the annulus fibrosus. Due to reflex spasm of the muscles surrounding the affected segment of the spine, there is stiffness and discomfort in the back in the morning.

2 stage. The destruction of the fibrous ring continues, the disc flattens, which leads to a decrease in the distance between the adjacent vertebrae. Pathological mobility develops when the vertebrae can move relative to each other. The nutrition of the vertebral tissues is disturbed. The pain is regular.

3 stage. The semi-destroyed annulus fibrosus can no longer contain the nucleus pulposus, a bulge (bulge) appears - the beginning of the formation of a hernia. The pain worsens and becomes constant. There is a spinal deformity.

4 stage. The intervertebral discs are replaced by scar tissue. There are many complications up to the complete loss of motor activity. It is possible to treat this stage of lumbar osteochondrosis only with the help of a complex operation to replace the destroyed vertebrae with artificial implants.

Diagnosis

Anamnesis collection.
Neurological examination of reflexes, sensitivity.
functional testing.
X-ray, MRI, computed tomography.

treatment methods

Traditional treatment of lumbar osteochondrosis includes the following methods:

Drug therapy: nonsteroidal anti-inflammatory drugs, glucocorticoids, muscle relaxants, sedatives, and a complex of vitamins with trace elements.

Physiotherapy procedures: electro, phonophoresis, exposure to magnetic fields, hydrotherapy.

Surgical treatment of lumbar osteochondrosis is carried out according to strict medical indications in severe cases, if the patient fails to stop severe pain with conservative methods or is threatened with a complication in the form of paralysis of the lower extremities or dysfunction of the the internal organs.

Osteochondrosis of the lumbar spine: diagnosis and treatment.

Back pain often occurs in a person due to the formation of incorrect posture when walking and sitting at a desk. But it is also one of the consequences of damage to the intervertebral discs, cartilaginous tissues and nerve fibers, resulting in the development of osteochondrosis of the lumbar spine.

With lumbar osteochondrosis, degenerative changes occur in the lumbosacral spine. If the disease is left untreated for a long time, the general well-being of the patient worsens: constant back pain, numbness of the extremities, spasms and cramps in the muscles, general weakness and loss of strength.

How does the pathology develop?

During the development of the disease, degenerative-dystrophic and destructive disorders occur in the skeleton of the patient's spine. As a result, the anatomy and physiology of the articular elements of the spine change. The lumbar spine of a person takes on the main load in the form of weight of the upper body of a person, loads during movement, training or performing any physical activity. As a result of all of the above, the following changes occur:

the axis of the spine is distorted;
posture changes;
the bones press on the internal organs. This leads to the development of diseases of the cardiovascular system;
coordination is disturbed due to infringement of nerve endings;
the structure of the spine changes;
cartilage thins;
the structure of the synovial fluid is filled with third-party components;
the vertebrae are worn, due to which the distance between them is reduced;
when the vertebrae come into contact, the nerves are pinched, causing sharp pain.

At risk of developing lumbar osteochondrosis are athletes who lead an overly active lifestyle, people with a sedentary lifestyle (being in an unchanged state for a long time, they create an increased load on the spine), representatives of manual labor professions working with heavy tools, the elderly, pregnant women, hyperactive children.

Symptoms of osteochondrosis of the lumbar area

sharp pain in the lower back after a night's sleep;
pain during sharp turns of the body or when lifting heavy things;
the first signs of scoliosis appear;
frequent urination;
pain radiates to the legs, internal organs of the abdomen and pelvis;
sharp pain in the kidneys and sacrum;
difficulty moving, walking, bending and turning the body;
fatigue after light load;
limb numbness;
spasms and cramps in the muscles;
dizziness;
Decreased muscle tone and sensitivity.

Causes of osteochondrosis of the lumbosacral spine

poorly distributed load on the back;
sedentary lifestyle;
stooped posture;
stay in the same position for a long time;
congenital curvature of the spine;
too frequent physical training;
excess body weight;
violation of blood flow in the spine;
injuries, bruises, fractures of extremities or vertebrae;
infections of the internal organs.

Stages of development of osteochondrosis of the lumbar area.

Stage 1: All degenerative disorders are just beginning to develop in the patient's skeleton. But at the same time, the roots of the nerve endings are already affected. The blood supply worsens and the inflammatory process begins. It is manifested by back pain after increased exertion, which often radiates to the legs.

Stage 2 - the annulus fibrosus of the spine is destroyed, the cartilage becomes thinner, and the distance between the vertebrae is reduced. The pain in the second stage is sharper and sharper.

Stage 3 - there is a strong compression of muscle fibers and nerve endings. There are burning pains and spasms in the muscles, as well as frequent numbness.

Stage 4 - the period of growth of neoplasms (osteophytes) in the bone structure. Osteoarthritis appears in the spine and joints. The back becomes inactive and, in the absence of correct treatment, completely immobile.

How is osteochondrosis of the lumbar spine diagnosed?

Diagnosis of pathology begins with a consultation with a specialist. At the first manifestations of osteochondrosis, consult a rheumatologist, neuropathologist, orthopedic surgeon or traumatologist. If it is difficult for you to choose a doctor, you should first consult with a therapist. Depending on the symptoms and the suspected causes of the pathology, he will refer you to one of the highly specialized specialists.

The doctor will study your medical history and the frequency of its manifestations, it is necessary that you provide the specialist with a complete medical history and the results of the first studies (if any). The specialist will perform a visual examination and palpation.
During the examination, the doctor pays special attention to changes in posture, muscle tone, skin sensitivity, and identifies the most painful areas. The purpose of the conversation is to find out the degree of development of the disease. If you have any questions, a specialist will advise you and conduct an examination.
He will refer you for tests, because it is a complete diagnosis that will allow him to make the correct diagnosis.
Based on the test results, the doctor will prescribe an individual treatment plan.

To identify the state of the muscles, ligaments, blood vessels, to detect inflammatory processes or tumors, an informative and safe diagnostic method is prescribed - MRI of the lumbar spine. During an osteochondrosis MRI, the patient lies on his back on a special retractable table. Rollers are placed on the patient's head to eliminate muscle tension, and the limbs are secured with straps. Any slight movement during the procedure can affect the quality of the result. The table is then moved into the scanner area. The procedure does not cause pain. The scanner makes a lot of noise during the scan, so you can use headphones to avoid discomfort.

If MRI is contraindicated, there are other diagnostic methods, such as computed tomography and radiography. Radiography is only suitable for primary diagnosis and does not provide a layered image of the affected tissues. However, this study is the simplest and cheapest, since it allows to examine the patient's body in various projections. Due to the body's high radiation exposure, x-rays cannot be taken frequently.

Treatment of osteochondrosis of the lumbar area

Depending on the stage of lumbosacral osteochondrosis, different methods of treatment can be prescribed. One of these methods is exercise therapy. It is carried out in a specially equipped room under the close supervision of a doctor. Classes are held when the patient is not experiencing pain. But if during physical education the patient began to feel worse, the doctor corrects or cancels the exercise altogether.

Another method of treating lumbar osteochondrosis is physiotherapy. It improves blood circulation and tissue nutrition, reduces inflammation and reduces pain. Physiotherapy treatments include:

Electrophoresis - analgesics, anti-inflammatory drugs are used, the procedure reduces the neurological manifestations of the disease.
Magnetic therapy: an alternating magnetic field relieves inflammation.
Ultrasound therapy: acts along the affected spine.
Diadynamic therapy - the effect on the affected areas occurs with the help of currents of different intensities.
Hirudotherapy - treatment with leeches. Its impact improves microcirculation, the exchange of nutrients in the tissues of the back.
Kinesiotaping is a treatment that uses a cotton patch.

Drug treatment - prescribed in extreme cases with the use of analgesics (has an additional analgesic or anti-inflammatory effect), antispasmodics (relieves muscle spasms), vasodilators (improves blood microcirculation).