In the medical literature, the term "osteochondrosis of the spine" means degenerative processes in the centers of ossification in children. A disease habitual to medicine, which is considered the most common among all problems of the musculoskeletal system, is hidden behind the words sciatica, disc herniation, dorsalgia (back pain). The lower back, according to official statistics, suffers more often than other parts, which leads 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-ligamentous apparatus and the nervous system - this is the definition given by the doctors of osteochondrosis. It mainly affects the lumbar region, which is located between the thoracic and sacral and consists of five vertebrae. There are discs between them - fibro-cartilaginous formations, formed from the following elements:
- cartilaginous tissue (the membrane involved in the nutrition of the discs from the vessels of the vertebral body);
- nucleus pulposus (gelatinous mass in the center with a nucleus pulposus);
- annulus fibrosus (protects the fluid part).
Against the background of problems with blood circulation, changes in the composition of cartilage tissue, dehydration of the nucleus pulposus, the elasticity and elasticity of the intervertebral disc deteriorates, its fixing properties suffer. Under the influence of unfavorable factors, muscle fixation weakens and the vertebrae acquire excessive mobility. Next, degenerative and destructive processes affect the bony surfaces of adjacent vertebrae, dystrophy (tissue malnutrition) of the spine occurs.
The further process looks like this:
- Microcracks appear in the loosened annulus. The nucleus pulposus begins to penetrate into it, gradually breaks through the annulus fibrosus and is damaged, which leads to disc herniation or protrusion (initial stage).
- A hernia compresses the spinal canal, can pinch nerve roots and blood vessels, causing pain and problems with movement.
- 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.
Some experts are inclined to call intervertebral osteochondrosis of the lumbar spine and others a "disease of civilization", primarily caused by upright posture, which has increased the load on the back of a modern person. Mostly the disease begins in persons over 30 years old, in men it is diagnosed more often than in women.
Lumbar osteochondrosis may develop:
- excessive loads on the spinal column (household, professional, sports);
- weak back muscles;
- incorrect distribution of household load on the spine (for the lumbar spine - the most common reason);
- frequent tension of the back muscles;
- being overweight, especially against the background of diabetes mellitus;
- spinal injuries;
- violation of metabolic processes;
- incorrectly fitted shoes, flat feet;
- problems with posture, giving an uneven distribution of load along 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 fibrocartilaginous tissue occur in people over 50);
- frequent stress, emotional stress.
Degrees of development
The course of the disease is slow and gradual, with most patients only recognizing a serious problem at stage 2 or later. In the absence of proper treatment, osteochondrosis progresses and can lead to disability.
Main Medical Classification:
- The initial stage is characterized by the initiation of the process of destruction of intervertebral discs, a decrease in their elasticity, elasticity. The disease makes itself felt mainly with stress on the spine.
- Destructive processes affect the annulus fibrosus, the distance between the vertebrae decreases (the disc becomes thinner), depreciation suffers, protrusions appear (protrusion of the intervertebral disc without breaking the ring). Pinching of the nerve roots and tissue inflammation occur, which increases the pain syndrome.
- The annulus fibrosus ruptures, a hernia occurs. Vessels, nerve endings are compressed. Changes in the lumbar spine lead to a general deformity of the spine.
- At the last stage, the muscles of the affected area atrophy, motor activity and ability to work suffer. The vertebral column is noticeably curved - pronounced scoliosis (3-plane deformity), lordosis (hypertrophied forward deflection of the lower back) appear.
Symptoms of lumbar osteochondrosis
Clinical manifestations of the disease depend on the stage of severity. The main symptom is a local pain syndrome that occurs in response to physical activity, heavy lifting, hypothermia of the lower back, prolonged preservation of an uncomfortable posture (in a sitting position, the load is higher than in an upright position). It is caused by irritation of the sinuvertebral (recurrent) nerve.
The stages of osteochondrosis of the lumbar spine look like this:
- At the initial stage, there is discomfort in the lumbar region, pain is rare, mainly with a high load on the back. They pass quickly.
- At stage 2, the mobility of the lumbar spine deteriorates, pain occurs after physical exertion and without it (with a strong cough, change in posture), gradually intensifies, persists for a long time. Malfunctions in the work of internal organs are possible.
- With the development of osteochondrosis, the pain becomes permanent (permanent), and the vertebrae are deformed. Nerve endings are pinched, so the pain can be given to the sacrum, leg, become sharp, shooting. Loss of sensitivity of the limbs, buttocks, thighs, numbness, paresthesia (burning, tingling, "chills") occur. Dysfunctions of the pelvic organs appear.
- At the last stage, the motor function is impaired or becomes completely impossible, the curvature of the spine occurs. The pain is permanent, the person unconsciously takes an unnatural position to reduce it.
Reflex syndromes of the disease in official medicine are meant into 3 groups: muscle-tonic, neurodystrophic, vegetative-vascular. The last 2 categories manifest themselves clearly at 3 stages of the disease and later.
The clinical picture may include:
- weakened or disappeared reflexes of the Achilles tendon, flexion of the fingers (if osteochondrosis of the sacral region has been added);
- dry skin, blue discoloration;
- urinary disorders (urinary retention or incontinence), pain in the bladder;
- cramps and pains in the thigh area on the background of nutritional and circulatory disorders;
- tense, unsteady gait, lameness;
- increased sweating, fever with increased back pain;
- pain syndrome radiating to the region of the heart (if the thoracic-lumbar region is affected).
If osteochondrosis of the lumbar spine has been diagnosed, treatment should be started immediately, since at the last stage the patient may be completely disabled. Against the background of compression (squeezing) of the spinal cord by the vertebrae, between which there is no space left, paralysis of the lower extremities can 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);
- prolapse of the intervertebral disc, stenosis (narrowing of the spinal canal);
- damage to the lining of the spinal cord, which is fatal.
In order to make the correct diagnosis and assess the severity of the disease, the doctor collects anamnesis data (study of patient complaints, lifestyle, hereditary factors). After that, a physiological examination is carried out, where the patient's motor capabilities, posture, sensitivity level, muscle tone and size, and their spasm are assessed. By tapping with a hammer, zones of irradiation (where it gives) pain in osteochondrosis of the lumbar are marked.
After the patient is assigned:
- Radiographyis the most accessible way of examining the anatomical parameters of the vertebrae, assessing the tendency to narrowing of the holes between their bases, and identifying 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 changes in the vessels, the lining of the spinal cord and to study the marginal growths.
Treatment for osteochondrosis of the lumbar spine
Surgical intervention is considered a last resort, predominantly 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 of stages 1 and 2 according to a conservative method.
Therapeutic measures are aimed at:
- elimination of pain syndrome;
- removal of muscle spasm, hypertonicity;
- elimination of the inflammatory process;
- improvement of blood circulation in the affected areas and metabolic processes;
- normalization of mobility of the lumbar vertebrae;
- restoration of lumbar sensitivity.
There is no universal method of treatment: each specific case of osteochondrosis requires an individual scheme. It is especially important to consider the form of the disease: acute or chronic. Therapy is necessarily of a combined nature, implying the use of medications (internally and externally) along with physical manipulations - massage, gymnastics, physiotherapy. The treatment regimen for osteochondrosis of the lumbar spine can be supplemented with acupuncture, hirudotherapy.
The effectiveness of treatment will increase if you follow these rules:
- A special belt or corset should be worn during treatment to reduce stress on the spinal column.
- Physical activity is excluded (only those recommended by the doctor remain) in order not to add provoking factors.
- It is important to closely monitor the diet: the cartilaginous tissue needs sources of collagen (gelatin, aspic, aspic), and the whole body needs plant foods, fish, nuts. It is advisable to refuse salted, smoked, pickled products, as well as from sharp cheeses, fatty meat.
- The scheme prescribed by the doctor must be followed to the very end: do not interrupt treatment when the main symptoms have subsided, do not change the set of drugs and procedures yourself.
- Together with the doctor, it is worth choosing an orthopedic mattress that will help relax the lower back during sleep, and special shoes. Women are completely prohibited from heels.
Acute osteochondrosis of the lumbar spine requires special attention - its treatment begins with the appointment of the patient to bed rest for several days. Pain sensations are reduced by injections of analgesics, novocaine blockade and glucocorticoid are not excluded. Spinal traction (using a traction table or vertical apparatus), walking on crutches, electrophoresis and laser therapy help to improve the condition.
Drugs for the treatment of osteochondrosis of the lumbar spine are used internally and topically. Local gels and ointments are symptomatic therapy: relieving inflammation and pain, relieving muscle spasm and edema, improving blood circulation. In acute conditions, injections are shown that have an immediate anti-inflammatory effect, antipyretic, analgesic.:
Mostly doctors prescribe for home medication for osteochondrosis:
- Chondroprotectors- protect cartilaginous tissue and promote its recovery, are indicated for long-term use (from six months or longer).
- Means that improve blood circulation and metabolic processes in tissues- tablets that are taken for several months, since the effect is cumulative.
- Muscle relaxants- relieve muscle spasm, are used orally in a short course.
- Non-steroidal anti-inflammatory- 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, external forms can be dispensed with, after which they are duplicated with tablets.
- Corticosteroids- pain-relieving injections are prescribed only in the absence of a significant effect from non-steroidal drugs.
- Ointments that have a warming effect- help relieve pain and improve blood circulation in tissues, are safer than non-steroidal drugs, but are prohibited in the inflammatory process.
- Vitamins of group Band multivitamin complexes are prescribed in a long course to increase the overall effectiveness of the treatment.
In order to enhance the effect of drug treatment and accelerate recovery, the patient may be prescribed courses of physiotherapy. You can alternate them or go through several options at the same time. The specific technique is selected according to the stage and form of the disease.
Osteochondrosis of the lumbar spine - treatment includes effective methods:
- Electrotherapy (electrophoresis)- implies the effect of low-power electric currents to improve blood circulation in the affected areas.
- Laser therapy- activates biological processes in nerve endings, relieves symptoms of neuro-dystrophic syndrome.
- UHF- local impact on the lumbar region with a high-frequency magnetic field to stop the inflammatory process, stimulate cellular regeneration (restoration) of tissues, and reduce pain.
- Phonophoresis and electrophoresis- helps to 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- a therapeutic effect of high frequency alternating current in order to expand blood vessels, improve blood circulation and tissue nutrition. The procedure affects the symptoms less than others.
- Amplipulse- local effect of sinusoidally modulated currents, due to which the severity of pain is reduced. The procedure has an analgesic effect, vasodilator, neurostimulating, improves tissue trophism.
Physical activity - especially when it comes to the early (initial stage) osteochondrosis of the lumbar spine - must be included in treatment: they help to relax the muscles and strengthen them, have a beneficial effect on tissue nutrition. For people with grade 2 disease and more severe exercise, the doctor will select it. With exacerbation, gymnastics, swimming, yoga (the most effective directions) are prohibited.
The following exercises show good results:
- Take an emphasis on your knees and palms, keep your back straight (parallel to the floor). On exhalation, slowly bend the lumbar region, tilt your head back slightly. Count to 5-8 (depending on how you feel), inhale and arch your back with a wheel. Again count to 5-8 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 exhalation, slowly tear the chest off the floor, bending in the lower back and trying to rise as high as possible. The arms are extended forward, the legs do not move. Hold in this position for 5-10 seconds and gradually descend. Repeat the exercise 8-10 times, gradually increasing the duration of the delay at the top point.
Massage is an effective method of treating any stage of osteochondrosis, which helps relieve unpleasant symptoms, remove muscle spasms, and normalize lymph outflow and blood supply to the affected areas. Additionally, this procedure stimulates the restoration of atrophied muscles and removes the limitation of mobility of the vertebrae, strengthens the ligamentous apparatus. The massage is performed by a medical specialist in courses of 10-12 sessions, when the symptoms of the acute stage have subsided.
If the patient is diagnosed with significant neurological disorders, loss of control over urination, there is a severe hernial protrusion, surgery is necessary. In addition, the indication for it is the lack of a positive effect from conservative treatment (lasting longer than a month). Before receiving a referral for surgery, the physician should assess all the risks, especially if traditional technology is chosen over microdiscectomy.
During the procedure, the surgeon may:
- remove pathologically altered areas by placing local implants (discectomy) on them, which are developed individually for each patient;
- to align the spinal column with a special rod - this helps to correctly distribute the load and prevent new deformation.
Discectomy is performed under general anesthesia, access for the surgeon is posterior. During the operation, the skin is cut to a length of 10 cm, the muscles are moved apart, and the affected disc is removed. At the end of the procedure, the wound is sutured in layers. The duration of the surgical intervention is about 2 hours, the next day the patient should lie on his back. The rehabilitation period is 2 months. With microdiscectomy, the procedure lasts 1. 5 hours, the incision is made 3 cm, and you can get up after you have left anesthesia.
Treatment of osteochondrosis of the lumbar spine with folk remedies
After consultation with a doctor who can competently assess the patient's condition, it is allowed to use traditional medicine recipes. 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 peeled black radish (350 g), combine with liquid honey (250 g) and vodka (100 ml). Use to rub the lower back with light massage movements for 10 minutes in the morning and evening. After that, it is advisable to wrap this area with a woolen cloth and lie down for an hour under a blanket. The procedure is carried out for 8-10 days, after which they take a break.
- With severe lumbar pain, you can take 100 g of medium fat cottage cheese, add 1 tsp. apple cider vinegar, place on cotton cloth or cheesecloth. The bandage 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. Pour a liter of vodka, leave in a cold place for 3 weeks. Use for rubbing the affected area once a day for a month. It is not required to cover the lower back with anything after processing.
Prevention of osteochondrosis of the lumbar spine
Doctors say that most back diseases 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 have to be carried out if you systematically engage in gymnastics, yoga, and swimming.
Additional Prevention Measures:
- control over the diet (more plant foods, less animal fats, pickles, marinades: as in the treatment);
- limiting heavy loads on the spinal column;
- monitoring the state of the endocrine system;
- elimination of bad habits (alcohol, smoking);
- use of an orthopedic mattress;
- posture tracking;
- avoiding high heels (from 7 cm) for women.