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 manifests itself with various symptoms, the main of which are pain in the lower back and legs, limitation of movements in the lower back.Research methods such as radiography, computed tomography or nuclear magnetic resonance of the lumbar spine are used for diagnosis.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 every person (!), 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, mainly on how healthy a lifestyle a particular person leads.Moderate physical activity, mandatory morning gymnastics, correct body posture when performing a number of activities (gardening, construction, banal cleaning of the house, 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 vertebral column consists of individual vertebrae, between the bodies of which intervertebral discs are located.That is, there is one disc between two vertebrae.The disc consists of a nucleus pulposus and an annulus fibrosus.The core contains a lot of water and provides cushioning and flexibility to the spine.The fibrous ring is located on the periphery of the nucleus pulposus, as if holding it inside itself.
With prolonged increased load on the nucleus pulposus, it changes its physiological properties, loses water and dries up, and over time sequesters: the disc flattens and the vertebral bodies move closer to each other.Together with these processes in the nucleus pulposus, the fibrous ring loses its elasticity and begins to protrude under the influence of mechanical loads.This is called a protrusion.Then the fibrous ring cracks and the nucleus pulposus falls out through the resulting cracks: a disc herniation occurs.A part of two adjacent vertebrae and a disc located between them, called a vertebral segment, acquires excessive mobility, thereby increasing the load on the adjacent segments.Overloading adjacent segments unlocks a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bony outgrowths are formed along the edges of the vertebral bodies, 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 - go hand in hand.
Reasons
What causes osteochondrosis?Today there are several theories about its origin:
- mechanical theory: perhaps the main reason should be considered the regular increased load on the spine.That is why osteochondrosis is almost a mandatory fate of loaders, miners, builders and people with 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 incorrect posture, sitting in an incorrect 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 injury to the spine (even the smallest) can cause a degenerative process;
- hormonal metabolic disorders and endocrine diseases can adversely affect the metabolism in the tissues of the spine and contribute to the development of osteochondrosis;
- The age theory suggests natural wear and tear on the discs during life.
Rarely, only one of these theories is able to explain the occurrence of osteochondrosis in each individual 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 lumbar spine, since 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, excess sweets, processed foods: 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 in persons engaged in professional sports;
- smoking and alcohol abuse: as factors accelerating 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 depends on which receptors receive irritation, that is, how severe the changes in the disc and surrounding tissues are, whether there is a protrusion or hernia, in which direction the protrusion was 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, autonomic-vascular or neurodystrophic reflex changes, i.e.irritation by means of reflexes is transmitted to other structures, causing symptoms mainly from the soft tissues.
Compression syndromes occur as a result of compression (compression) of nerve roots, blood vessels or the spinal cord due to changes formed during osteochondrosis.
Reflex syndromes of the lumbar spine
Lumbago(lumbago): sharp, sudden pain in the lumbar region, which appears during an uncomfortable movement or at a time of physical exertion (much less often - for no apparent reason).It is believed that the appearance of lumbago is associated with the movement of the pulpous nucleus in the fibrous ring, i.e.develops in the initial stages of osteochondrosis.The pain is often described as "lumbago" or "a stake in the lower back."Patients freeze in the position in which the pain has caught them.The slightest movement causes an increase in pain (sneezing, coughing, trying to turn over in bed, moving the leg).If a person was in an inclined position during the development of lumbago (which happens most often), then he cannot stand up.Reflexively, a strong muscular tension occurs in the lumbar spine.Along the length of the vertebrae in this area, a muscular edge is felt, which is sometimes visible to the naked eye without touching it, so pronounced is the muscular tension.Palpation is painful for the patient.This increased muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility that can provoke a worsening of the condition.The natural curve of the spine in the lumbar region (lordosis) is leveled, and due to muscle tension, it can be twisted to the side (scoliosis).
Lumbodynia– another reflex syndrome at the lumbar level.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, of moderate intensity, intensifies during movements, when sitting or standing, when moving from one position to another.Lying on the back with support under the lower back brings some relief, but passively raising the straight leg in this position causes an increase in pain in the lower back (Lassegue's symptom).Palpation of the lumbar spine is painful, but the reflex muscle tension is less pronounced than in 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 level (and then the pain increases).
Lumboschialgia– another type of reflex syndrome at the lumbar level.This term refers to pain in the lumbar region radiating to the buttock and leg (on the back surface).The pain is different in nature, mostly aching, but it can periodically intensify as a "shooting" in the leg.Just like lumbodynia, it increases with any movement, walking, tension 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 on certain points (for example, in the middle of the line separating the buttock 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.Front and side turns are limited.
Lumbar spine compression syndromes
Clinical features depend on which structure is being compressed.
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 are different for each root.Common to all lumbar radiculopathies is increased pain when sneezing, coughing, movements in the lower back (especially bending forward), 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 vertebrae are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the anterior inner thigh.In the same area, paresthesia (crawling sensation, tingling) may appear, surface sensitivity is impaired (a sharp touch does not differ from an ordinary touch, the sensation of cold and hot is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- L4 radiculopathy: pain from the lower back radiates to the front of the lower thigh, the inner surface of the knee joint and a little further down the inner surface of the lower leg.In these same areas, paresthesia is felt and surface sensitivity is lost (reduced).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- L5 radiculopathy: one of the frequent locations.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.Paresthesia is felt here, surface sensitivity is impaired, and pain when sneezing and coughing is transmitted here.It also 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 your heel with your leg extended;
- S1 radiculopathy: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttock, 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 sensation of paresthesia and reduced surface sensitivity.The Achilles reflex decreases.When this root is damaged, weakness develops in the muscles of the lower leg and plantar flexors, making it difficult to stand and walk on tiptoes.
Simultaneous development of radiculopathy of several roots is possible, this is especially characteristic of L5, S1.It happens that a hernia compresses several roots.
If the herniated disc is bulging 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, are subjected to compression, then in the case of an acute violation of blood circulation, a spinal stroke develops in them, and in case of prolonged compression, myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, starting at the foot and gradually progressing upwards.Sensation in the legs is impaired, the Achilles reflex is lost, and later the knee reflex.Urinary disturbances may occur (frequent, "imperative" 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 key role belongs to methods such as:
- X-ray of the lumbar vertebrae;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
X-ray of the lumbar vertebrae 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.Oblique x-rays are taken to show the intervertebral joints and intervertebral foramina.In order to identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed during functional tests, i.e.in a position of flexion and extension of the spine.Usually, the change in the height of the intervertebral discs in the front or back is clearly visible in accordance with the direction of the inclination of the body;with osteochondrosis, due to the functional block of one of the segments, the disc height does not change either during flexion or during extension.In case of 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), formation of marginal outgrowths of the vertebral bodies, compaction of the vertebrae at the border with the affected disc (subchondral sclerosis).X-ray of the lumbar spine is a routine examination method, which is gradually losing its importance against the background of the active introduction of new and more informative examination methods (CT and MRI).X-rays of the lumbar region are now used as a screening diagnostic method.
Computed tomography of the lumbar spine is also performed with the help of X-rays, but the irradiation of the body is significantly less than with X-ray radiation.The examination is carried out in a lying position on the table on a special apparatus - computer tomograph;it is absolutely painless.The resulting images are processed with 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 table that slides into the tomograph camera.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 annulus fibrosus) and intervertebral openings, 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 any, 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, circulatory disorders in the spinal cord, abscesses, congenital defects in the structure of the spine and spinal cord), which is important when making a differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.In fact, it is a rupture of the intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses his ability to work, because 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 safe of the modern methods for diagnosing osteochondrosis is MRI of the spine.