Osteochondrosis of the lumbar spine - treatment and symptoms

In the medical literature, the term "osteochondrosis of the spine" means degenerative processes in the centers of ossification in children. A disease common to medicine, which is considered the most common of all musculoskeletal problems, lies behind the words sciatica, disc herniation, dorsalgia (back pain). The lower back, according to official statistics, suffers more often than other parts, leading to severe complications for the whole body. Why does this happen and how to treat osteochondrosis?

What is osteochondrosis of the lumbar spine

Degenerative neuro-orthopedic disease affecting the intervertebral discs and leading to secondary compensatory and reactive changes in the osteo-ligament apparatus and the nervous system - this is the definition given by doctors for osteochondrosis. It mainly affects the lumbar region, which is located between the thoracic and sacral and consists of five vertebrae. Between them there are discs - fibro-cartilage formations formed by the following elements:

• cartilage tissue (the membrane involved in feeding the discs from the vessels of the spinal body);
• nucleus pulposus (gelatinous mass in the center with nucleus pulpus);
• annular fibrosis (protects the liquid part).

Against the background of circulatory problems, changes in the composition of cartilage tissue, dehydration of the pulpal nucleus, the elasticity and resilience of the intervertebral disc deteriorate, its fixative properties suffer. Under the influence of adverse factors, muscle fixation weakens and the vertebrae become excessively mobile. Then the degenerative and destructive processes affect the bone surfaces of adjacent vertebrae, dystrophy (tissue malnutrition) of the spine occurs.

The next process looks like this:

1. Microcracks appear in the loosened rings. The nucleus pulposus begins to penetrate it, gradually pierces through the annular fibrosis and is damaged, leading to a disc herniation or bulge (initial stage).
2. Hernia compresses the spinal canal, can compress the nerve roots and blood vessels, causing pain and movement problems.
3. Due to the increased pressure on the vertebrae (from the thinning of the disc) accelerated production of bone tissue begins and spinous processes (osteophytes) are formed.

Causes

Some experts tend to call intervertebral osteochondrosis of the lumbar spine and others "a disease of civilization, " mainly because of the upright posture that has increased the strain on the back of modern man. The disease mainly begins in people over 30 years of age, in men it is diagnosed more often than in women.

Lumbar osteochondrosis may develop:

• excessive loads on the spine (household, professional, sports);
• weak back muscles;
• incorrect distribution of household load on the spine (for the lumbar spine - the most common cause);
• frequent tension in the muscles of the back;
• overweight, especially against the background of diabetes mellitus;
• spinal injuries;
• metabolic disorders;
• improperly fitted shoes, flat feet;
• posture problems, giving an uneven distribution of the load on the spine;
• hypothermia of the lumbar spine;
• sedentary lifestyle, long-term driving;
• hormonal disorders (mainly in women);
• congenital pathologies of the musculoskeletal system;
• age (natural changes in fibro-cartilage tissue are observed in people over 50 years);
• frequent stress, emotional stress.

Stages of development

The course of the disease is slow and gradual, with most patients recognizing a serious problem only in stage 2 or later. In the absence of appropriate treatment, osteochondrosis progresses and can lead to damage.

Basic medical classification:

1. The initial stage is characterized by initiating the process of destruction of the intervertebral discs, reducing their elasticity, resilience. The disease is felt mainly with a load on the spine.
2. Destructive processes affect the fibrous ring, the distance between the vertebrae decreases (the disc becomes thinner), the amortization suffers, protrusions appear (protrusion of the intervertebral disc without breaking the ring). Nerve root pinching and tissue inflammation occur, which increases the pain syndrome.
3. The fibrous ring ruptures, a hernia occurs. The vessels, the nerve endings are compressed. Changes in the lumbar spine lead to a general deformity of the spine.
4. In the last stage, the muscles of the affected area atrophy, motor activity and performance suffer. The spine is noticeably curved - there is a pronounced scoliosis (3-plane deformity), lordosis (hypertrophied forward deviation in the lower back).

Symptoms of lumbar osteochondrosis

The clinical manifestations of the disease depend on the stage of severity. The main symptom is a local pain syndrome, which occurs in response to physical activity, heavy lifting, hypothermia of the lower back, prolonged awkward posture (in a sitting position the load is higher than in an upright position). It is caused by irritation of the sinuvertebral nerve.

The stages of osteochondrosis of the lumbar spine look like this:

• In the initial stage there is discomfort in the lumbar region, the pain is rare, mainly with a heavy load on the back. They pass quickly.
• In stage 2, the mobility of the lumbar spine deteriorates, the pain occurs after exercise and without it (with a strong cough, change in posture), gradually increases, lasts a long time. Malfunctions of the internal organs are possible.
• With the development of osteochondrosis, the pain becomes permanent (permanent) and the vertebrae become deformed. The nerve defenses are compressed, so the pain can be attributed to the sacrum, legs, become sharp, shooting. Loss of sensitivity of the limbs, buttocks, thighs, stiffness, paresthesia (burning, tingling, "chills"). Pelvic dysfunction occurs.
• At the last stage, motor function is impaired or becomes completely impossible, there is a curvature of the spine. The pain is constant, one unconsciously takes an unnatural position to reduce it.

Reflex syndromes of the disease in official medicine are understood in 3 groups: muscular-tonic, neurodystrophic, vegetative-vascular. The last 2 categories appear live in 3 stages of the disease and later.

The clinical picture may include:

• weakened or disappeared Achilles tendon reflexes, flexion of the fingers (if osteochondrosis of the sacral region is added);
• dry skin, blue discoloration;
• urination disorders (urinary retention or incontinence), bladder pain;
• cramps and pain in the thigh on the background of eating and circulatory disorders;
• tense, unstable gait, lameness;
• increased sweating, fever with increased back pain;
• pain syndrome radiating to the heart area (if the thoracolumbar region is affected).

Complications

If osteochondrosis of the lumbar spine is diagnosed, treatment should be started immediately, as the patient may be completely disabled at the last stage. Against the background of compression (squeezing) of the spinal cord from the vertebrae, between which there is no space left, paralysis of the lower extremities may develop.

In addition, osteochondrosis can cause:

• disorders of the pelvic organs (men suffer from erectile function, women - ovarian activity);
• lumbago (acute lower back pain), sciatica (pinching and inflammation of the sciatic nerve);
• intervertebral disc prolapse, stenosis (narrowing of the spinal canal);
• Damage to the lining of the spinal cord, which is fatal.

Diagnostics

In order to make the correct diagnosis and assess the severity of the disease, the doctor collects data from the anamnesis (study of the patient's complaints, lifestyle, hereditary factors). A physiological examination is then performed to assess the patient's motor abilities, posture, sensitivity level, muscle tone and size, and their spasm. Beating with a hammer marks areas of radiation (where it gives) pain in osteochondrosis of the lumbar region.

Once the patient is assigned:

• Radiographyis ​​the most accessible way to study the anatomical parameters of the vertebrae, assess the tendency to narrow the holes between their bases and identify bone growths.
• MRI(magnetic resonance imaging) - helps to assess the condition of the vessels supplying the spine, nerve processes, discs.
• CT(computed tomography) - is prescribed only to check for changes in blood vessels, the lining of the spinal cord and to examine the marginal growths.

Treatment of osteochondrosis of the lumbar spine

Surgery is considered a last resort, mainly prescribed for patients who have significant neurological disorders and a high risk of disability. These problems are characterized by advanced osteochondrosis of the lumbar spine - doctors try to carry out treatment in stages 1 and 2 by a conservative method.

Therapeutic measures are aimed at:

• elimination of the pain syndrome;
• elimination of muscle spasm, hypertension;
• elimination of the inflammatory process;
• improving blood circulation in the affected areas and metabolic processes;
• normalization of lumbar spine mobility;
• restoration of lumbar sensitivity.

There is no universal method of treatment: each case of osteochondrosis requires an individual scheme. It is especially important to consider the form of the disease: acute or chronic. The therapy is mandatory of a combined nature, involving the use of drugs (internal and external) together with physical manipulations - massage, gymnastics, physiotherapy. The scheme of treatment of osteochondrosis of the lumbar spine can be supplemented with acupuncture, hirudotherapy.

The effectiveness of the treatment will increase if you follow the following rules:

• A special belt or corset should be worn during treatment to reduce spinal stress.
• Physical activity is excluded (only those recommended by the doctor remain), so as not to add provoking factors.
• It is important to follow the diet closely: cartilage needs sources of collagen (gelatin, aspic, jelly meat), and the whole body needs plant foods, fish, nuts. It is advisable to give up salted, smoked, marinated products, as well as spicy cheeses, fatty meats.
• The schedule prescribed by your doctor should be followed to the very end: do not interrupt treatment when the main symptoms disappear, do not change the set of medications and procedures yourself.
• Along with the doctor it is worth choosing an orthopedic mattress that will help relax the waist during sleep, and special shoes. Women are completely forbidden to wear heels.

Acute osteochondrosis of the lumbar spine requires special attention - its treatment begins with the appointment of the patient to rest in bed for several days. Pain is reduced by injections of analgesics, novocaine blockade and glucocorticoids are not excluded. Spinal traction (using a traction table or vertical apparatus), walking on crutches, electrophoresis and laser therapy help to improve the condition.

Drug therapy

Drugs for the treatment of osteochondrosis of the lumbar spine are used internally and topically. Topical gels and ointments are symptomatic therapy: relieving inflammation and pain, relieving muscle spasm and swelling, improving blood circulation. In acute conditions, injections are indicated, which have an immediate anti-inflammatory effect, antipyretic, analgesic.

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Mostly doctors prescribe home remedies for osteochondrosis:

• Chondroprotectors- protect cartilage tissue and promote its recovery, are indicated for long-term use (from six months or more).
• Means that improve blood circulation and metabolic processes in tissues- tablets that are taken for several months because the effect is cumulative.
• Muscle relaxants- relieve muscle spasm, used orally in a short course.
• Non-steroidal anti-inflammatory drugs- quickly block pain, suppress the production of prostaglandins involved in the inflammatory process. Ointments and gels are applied to the affected area 1-2 times a day, unless otherwise indicated in the instructions. In the initial stages, the external forms can be removed, after which they are duplicated with tablets.
• corticosteroids- injections to relieve pain are prescribed only in the absence of a significant effect of non-steroidal drugs.
• Ointments that have a warming effect- help relieve pain and improve blood circulation in the tissues, are safer than non-steroidal drugs, but are prohibited in the inflammatory process.
• B vitaminsand multivitamin complexes are prescribed in a long course to increase the overall effectiveness of treatment.

Physiotherapy procedures

Physiotherapy courses may be prescribed to enhance the effect of medication and speed recovery. You can alternate them or go through several options at once. The specific technique is chosen according to the stage and form of the disease.

Osteochondrosis of the lumbar spine - treatment includes effective methods:

• Electrotherapy (electrophoresis)- suggests the effect of low-power electric currents to improve blood circulation in the affected areas.
• Laser therapy- activates biological processes in the nerve endings, relieves the symptoms of neuro-dystrophic syndrome.
• UHF- local impact on the lumbar region with a high-frequency magnetic field to stop the inflammatory process, stimulate cell regeneration (recovery) of tissues and reduce pain.
• Phonophoresis and electrophoresis- helps deliver drugs to the area that needs them, which increases the effectiveness of drug treatment. The result depends on the specific agent used during the procedure.
• Darsonvalization- therapeutic effect of high-frequency alternating current in order to dilate blood vessels, improve blood circulation and tissue nutrition. The procedure affects the symptoms less than the others.
• Amplipulse- local effect of sinusoidally modulated currents, due to which the severity of pain is reduced. The procedure has an analgesic effect, vasodilator, neurostimulant, improves tissue trophism.

Therapeutic gymnastics

Physical activity - especially when it comes to early (initial) osteochondrosis of the lumbar spine - should be included in the treatment: they help relax muscles and strengthen them and have a beneficial effect on tissue nutrition. For people with grade 2 or more severe disease, your doctor will choose it. In case of exacerbation, gymnastics, swimming, yoga are prohibited (the most effective instructions).

The following exercises show good results:

• Emphasize your knees and palms, keeping your back straight (parallel to the floor). On the exhale, slowly bend the lumbar region, tilt your head back slightly. Count to 5-8 (depending on how you feel), inhale and bend your back with a wheel. Count to 5-8 again and take the starting position. The exercise is performed 10-12 times at a slow pace. If necessary, they are divided into 2-3 approaches.
• Lie on your stomach. On the exhale, slowly pull your chest off the floor, bending at the lower back and trying to rise as high as possible. The arms are stretched forward, the legs do not move. Hold in this position for 5-10 seconds and gradually lower. Repeat the exercise 8-10 times, gradually increasing the duration of the delay at the above point.

Massage

Massage is an effective method of treating each stage of osteochondrosis, which helps to relieve unpleasant symptoms, eliminate muscle spasm, normalize lymph flow and blood supply to the affected areas. In addition, this procedure stimulates the recovery of atrophied muscles and removes the restriction of the mobility of the vertebrae, strengthens the ligament apparatus. The massage is performed by a medical specialist in courses of 10-12 sessions, when the symptoms of the acute stage subside.

Surgery

If the patient is diagnosed with significant neurological disorders, loss of control over urination, there is a strong hernial protrusion, surgery is required. In addition, the indication for it is the lack of a positive effect of conservative treatment (lasting more than a month). Before receiving a referral for surgery, the doctor must weigh all the risks, especially if the traditional technology is chosen instead of microdiscectomy.

During the procedure, the surgeon can:

• remove pathologically altered areas by placing local implants (discectomy), which are developed individually for each patient;
• for aligning the spine with a special rod - this helps to properly distribute the load and prevent new deformities.

The discectomy is performed under general anesthesia, the surgeon's access is from behind. During the operation, the skin is cut to a length of 10 cm, the muscles are removed and the affected disc is removed. At the end of the procedure, the wound is sutured in layers. The duration of the surgery is about 2 hours, the next day the patient should lie on his back. The rehabilitation period is 2 months. In microdiscectomy, the procedure lasts 1. 5 hours, the incision is made 3 cm and you can get up after leaving anesthesia.

Treatment of osteochondrosis of the lumbar spine with folk remedies

After consultation with a doctor who can properly assess the patient's condition, it is allowed to use prescriptions from traditional medicine. They do not give the same pronounced effect as drug therapy, do not replace physiotherapy, massage and gymnastics, but increase the likelihood of a positive result from the main treatment.

Some simple options:

• Grate the peeled black radish (350 g), combine with liquid honey (250 g) and vodka (100 ml). Use to rub the waist with light massage movements for 10 minutes in the morning and evening. Then it is advisable to wrap this area with woolen cloth and lie down for an hour under a blanket. The procedure is performed for 8-10 days, after which they take a break.
• In severe lumbar pain you can take 100 g of cottage cheese with medium fat, add 1 tsp apple cider vinegar, place on a cotton cloth or cheesecloth. The dressing is kept for 2 hours, the procedure, if necessary, is repeated 2 times a day. The duration of treatment is not limited.
• Collect fresh lilac flowers, fill a liter jar with them without crushing them. Pour a liter of vodka, leave in a cool place for 3 weeks. Use to rub the affected area once a day for a month. It is not required to cover the lower back with anything after treatment.

Prevention of lumbar spine osteochondrosis

Doctors say that most back ailments can be prevented through regular physical activity, which strengthens muscles, improves blood circulation and tissue nutrition. Osteochondrosis of the lumbar spine is no exception - treatment will not be necessary if you regularly engage in gymnastics, yoga and swimming.

Additional prevention measures:

• diet control (more plant foods, less animal fats, pickles, marinades: as in treatment);
• limiting heavy loads on the spine;
• monitoring of the endocrine system;
• elimination of bad habits (alcohol, smoking);
• use of orthopedic mattress;
• posture tracking;
• Avoid high heels (from 7 cm) for women.