Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine, affecting the structure of the intervertebral disc and adjacent lumbar vertebrae.It affects people mostly of working age.It presents itself with various symptoms, the main ones being pain in the lower back and legs, limitation of movement in the lower back.For 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 methods of diagnosing osteochondrosis of the lumbar spine.
Osteochondrosis is a result of the aging of the body.Some signs of this disease can be found in almost everyone (!), starting from the age of 25.But the severity of these changes, the speed of their development, and the level of clinical manifestations depend on many reasons, especially on how healthy a particular person leads a lifestyle.Moderate physical activity, mandatory morning exercises, correct body posture when doing some work (gardening, construction, shallow house cleaning, etc.), orthopedic mattresses - 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 the intervertebral discs are located.That is, there is a disc between two vertebrae.The disc consists of a pulpy nucleus and a fibrous ring.The core contains a lot of water and provides cushion and flexibility to the spine.A fibrous ring lies 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 isolated: the disc becomes flat, and the vertebral bodies move closer to each other.Along with such a process, in the nucleus pulposus the fibrous ring loses its elasticity and begins to bulge under the influence of mechanical loads.This is called a protrusion.Then the fibrous ring cracks, and the nucleus pulposus falls through the resulting crack: a herniated disc occurs.A part of two adjacent vertebrae and the disc located between them, called a spinal segment, acquires excessive mobility, thereby increasing the load on the adjacent segment.The excess of neighboring segments triggers similar pathological processes in them.This change is called osteochondrosis.
To ensure the stability of the spine, bone growth forms along the edges of the vertebral body, increasing the area of support.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondyloarthrosis.Usually all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - run side by side.
Reason
What causes osteochondrosis?Today there are several theories about its occurrence:
- mechanical theory: probably the main reason should be considered the usual increased load on the spine.That is why osteochondrosis is an almost obligatory fate for loaders, miners, builders and people with 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 development factor can be wrong posture, sitting in the wrong position, which is very important for mental workers;
- sometimes hereditary characteristics of the structure of the spine and nutrition of its individual structure play a role;
- traumatic theory: any injury to the spine (even the smallest) can trigger a degenerative process;
- hormonal metabolic disorders and endocrine diseases can affect the metabolism in the spinal tissue and contribute to the development of osteochondrosis;
- The age theory implies the natural wear and tear of the disc during life.
Rarely, 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 body weight plays an important role in the occurrence of osteochondrosis of the lumbar spine, because it itself is an excessive load for the spinal column.The higher the body mass index (obesity level), the more pronounced the changes in the spine usually are.Other causes that trigger the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excessive sweets, processed food: all this leads to an imbalance of microelements) 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 cessation 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 receiving the irritation, that is, how severe the changes in the disc and surrounding tissue are, whether there is a protrusion or a hernia, in which direction the protrusion has formed, and so on.
There is a reflex and compression syndrome in osteochondrosis of the lumbar spine.
Reflex syndrome develops in cases where the receptors of the fibrous ring of the disc, ligaments and capsule of the affected joint located nearby are irritated.They are called reflexes because, in addition to pain, they are accompanied by muscle-tonic, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is sent to other structures, causing symptoms mainly from soft tissues.
Compression syndrome arises due to compression (compression) of nerve roots, blood vessels or spinal cord due to changes formed during osteochondrosis.
Lumbar spinal reflex syndrome
Lumbago(lumbago): acute and sudden pain in the lumbar region that occurs during awkward movements or at a moment of physical stress (less often - for no apparent reason).It is believed that the occurrence of lumbago is associated with the movement of the nucleus pulposus in the fibrous ring, that is, it develops in the early stages of osteochondrosis.The pain is often described as "lumbago" or "a spike stuck in the lower back."The patient freezes in the position where the pain seizes them.The slightest movement causes increased pain (sneezing, coughing, trying to turn over in bed, moving the legs).If a person is in an inclined position at the time of the development of lumbago (which happens most often), then he cannot straighten.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, muscle ridges are felt, which are sometimes visible to the naked eye without touching, the muscle tension is so noticeable.Palpation is painful for the patient.This increased muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can trigger a deterioration of the condition.The natural curve of the spinal column in the lumbar region (lordosis) is flattened, and lateral curvature (scoliosis) may be caused by muscle tension.
Lumbodynia– another lumbar level reflex syndrome.This term also means the presence of pain in the lumbar region.But, unlike lumbago, the pain does not occur acutely, but gradually, over several hours and even days.The pain is dull and aching in nature, of moderate intensity, increases with movement, when sitting or standing, or when moving from one position to another.Lying on the back with a bolster 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 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 to the side to a certain extent (and then the pain increases).
Lumboschialgia– another type of lumbar level reflex syndrome.This term refers to pain in the lumbar region, radiating to the back and legs (along the back surface).The pain varies in nature, mostly aching, but periodically can intensify like "shooting" in the leg.Just like lumbodynia, 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 well as pressure at certain points (for example, in the middle of the line separating 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 lower back muscles.Forward and side bends are limited.
Lumbar spinal compression syndrome
Clinical features depend on which structure is subject to 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 (especially disc herniation) compress the root, then radiculopathy develops, the symptoms of which are different for each root.Common to all lumbar radiculopathies is increased pain when sneezing, coughing, movement in the lower back (especially bending forward), the presence of muscle tension in the lumbar region, and limitation of movement in the lumbar spine.The most common types of lumbar spine radiculopathies are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the anterior inner thigh.In the same area, paresthesia may occur (crawling sensation, numbness), superficial sensitivity is affected (sharp touch does not differ from normal touch, cold and hot sensations disappear).The knee reflex is reduced, the weakness of the quadriceps femoris muscle is lowered;
- L4 radiculopathy: pain from the lower back radiates to the anterior part of the lower thigh, the inner surface of the knee joint and slightly lower along the inner surface of the lower leg.In this same area, 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 common localizations.Pain radiates to the back, along the outer edge of the thigh, along the anterior outer surface of the lower leg to the inner edge of the foot and big toe.Here paresthesia is felt, superficial sensitivity is affected, and pain when sneezing and coughing is sent here.In addition, it becomes difficult to extend the big toe, because the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on the heels with the legs extended;
- S1 radiculopathy: also common in osteochondrosis of the lumbar spine.Pain radiates to the back, along the posterior outer 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.This area is characterized by feelings of paresthesia and reduced superficial sensitivity.Decreased Achilles reflexes.When this root is damaged, weakness of the lower leg muscles and foot flexors develops, making it difficult to stand and walk on the toes.
Simultaneous development of radiculopathy of several roots is possible, this is typical for L5, S1.It happens that one hernia compresses several roots.
If a herniated disc bulges backwards, it can put pressure on the spinal cord.This is only possible if the hernia is localized in the upper lumbar region, because there is no spinal cord below the second lumbar vertebra (there the root of the spinal cord is compressed, and cauda equina syndrome develops).
If the vessels of the lumbar region, which supply blood to the spinal cord, are subject to compression, then in the case of acute circulatory disorders, spinal strokes develop in them, and with prolonged compression - myelopathy.Myelopathy manifests itself as bilateral weakness of the leg muscles, starting in the legs and gradually increasing upwards.Sensation in the legs is affected, the Achilles reflex is lost, and then the knee reflex.Urinary disturbances may occur (frequent, "imperative" urges that require 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 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-ray of the lumbar spine must be done in 2 mutually perpendicular projections - direct posterior and lateral.Such images allow you to see the shape, contour 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 display the intervertebral joints and intervertebral foramina, radiographs are taken in an oblique projection.To identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiographs are performed under functional tests, that is, in the position of flexion and extension of the spine.Usually, changes in the height of the intervertebral disc in the anterior or posterior part are clearly visible according to the direction of body tilt;with osteochondrosis, due to the functional block of one of the segments, the disc height does not change either during flexion or 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 body, salt deposition in the disc tissue (calcification), the formation of marginal growth of the vertebral body, compaction of the vertebrae 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 importance against the background of the active introduction of new and more informative research methods (CT and MRI).X-ray of the lumbar region is now used as a diagnostic method of examination.
CT scans of the lumbar spine are also performed using X-rays, but the radiation exposure to the body is much lower than X-rays.The examination is carried out on the table of a special device - a computed tomograph;it doesn't hurt at all.The resulting images are processed using a computer and allow you to see more structures than a spinal radiograph.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also carried out lying on a table that slides into the tomograph room.MRI is harmless and painless.
CT or MRI of the lumbar spine allows you to see all the structures of the spine, carefully examining the intervertebral discs (both nucleus pulposus and annulus fibrosus) and intervertebral foramina, the contents of the spinal canal.Even a slight protrusion of the intervertebral disc will not be noticed.This method (mainly MRI) makes it possible to determine the direction of disc herniation, if any, and the degree of compression of the nerve roots and spinal cord.Therefore, this research method is 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, circulatory disorders in the spinal cord, abscesses, congenital defects in the structure of the spine and spinal cord), which is important when carrying out a differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is the most common cause of back pain.It is, in fact, the destruction of the intervertebral disc.Due to osteochondrosis of the lumbar spine, a person often loses his ability to work, because, in addition to pain, this disease can cause impaired movement of the spine, the inability to sit, stand and walk.The symptoms of this disease are non-specific and require additional research methods to confirm the diagnosis accurately.The most informative and safe modern method for diagnosing osteochondrosis is MRI of the spine.