Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine, affecting the structures of the intervertebral discs and adjacent lumbar vertebrae.It affects people predominantly 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.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 the result of 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, primarily on how healthy a particular person leads a lifestyle.Moderate physical activity, mandatory morning exercises, correct body posture when performing a number of works (gardening, construction, banal house cleaning, etc.), orthopedic mattress - these are the points that prevent the development of osteochondrosis of the lumbar spine.
According to statistics, spinal osteochondrosis is the cause of back pain in 80% of cases.
How does osteochondrosis develop?
The entire spine 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 pulpous nucleus and a fibrous ring.The core contains a lot of water and provides cushioning and flexibility to the spine.The fibrous ring is located along 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 out, and over time becomes sequestered: the disc flattens, and the vertebral bodies move closer to each other.Along with such processes, in the nucleus pulposus the fibrous ring loses its elasticity and begins to bulge under the influence of mechanical loads.This is called protrusion.Then the fibrous ring cracks, and the nucleus pulposus falls out through the resulting cracks: a herniated disc occurs.A section of two adjacent vertebrae and a disc located between them, called a spinal segment, acquires excessive mobility, thereby increasing the load on adjacent segments.Overload of neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bone growths form 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 - walk side by side.
Reasons
What causes osteochondrosis?Today there are several theories of its occurrence:
- mechanical theory: perhaps the main reason should be considered the regular increased load on the spine.That is why osteochondrosis is an almost obligatory fate of loaders, miners, builders and people of similar professions.The occurrence of osteochondrosis of the lumbar region is associated mainly with bending and lifting heavy objects, forced by an uncomfortable working posture;
- Another development factor can be incorrect posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes 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 most minor) can trigger a degenerative process;
- hormonal metabolic disorders and endocrine diseases can adversely affect metabolism in the tissues of the spinal column and contribute to the development of osteochondrosis;
- The age theory implies natural wear and tear of discs during life.
Rarely, only one of these theories is able to explain the occurrence of osteochondrosis in each specific 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 spinal column.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine usually are.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 fluid;
- 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 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 spread depend on which receptors receive irritation, that is, how severe the changes are in the disc and surrounding tissues, whether there is a protrusion or a hernia, in which direction the protrusion has formed, and so on.
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 muscular-tonic, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly from soft tissues.
Compression syndromes arise 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): acute, sudden pain in the lumbar region that occurs during an awkward movement or at a moment of physical stress (much less often - for no apparent reason).It is believed that the occurrence of lumbago is associated with the movement of the nucleus pulposus within the fibrous ring, that is, it develops in the initial stages of osteochondrosis.The pain is often described as a “lumbago” or “a stake stuck in the lower back.”Patients freeze in the position in which the pain caught them.The slightest movement causes increased pain (sneezing, coughing, trying to turn over in bed, moving a leg).If a person was in an inclined position at the time of development of lumbago (which happens most often), then he cannot straighten up.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, a muscle ridge is felt, which is sometimes visible to the naked eye without touching, the muscle tension is so pronounced.The palpation is painful for the patient.This increased muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can provoke a deterioration of the condition.The natural curve of the spinal column in the lumbar region (lordosis) is flattened, and curvature to the side (scoliosis) is possible due to muscle tension.
Lumbodynia– another reflex syndrome of the lumbar level.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, intensifies with movements, while sitting or standing, or when moving from one position to another.Lying on your 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 with lumbago, and sometimes is completely absent.Movement in the lumbar spine is limited, but possible.This means that the patient can bend down and to the sides to a certain level (and then the pain intensifies).
Sciatica– another type of reflex syndrome of the lumbar level.This term refers to pain in the lumbar region, radiating to the buttock and leg (along the back surface).The pain varies in nature, mostly aching, but can periodically intensify like “shooting” in the leg.Just like with 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 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 lower back muscles.Forward and side bends are limited.
Compression syndromes of the lumbar spine
The clinical characteristics depend on which structure is subjected 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 (mainly disc herniations) compress the roots, then radiculopathy develops, the symptoms of which differ for each root.Common to all lumbar radiculopathies is increased pain when sneezing, coughing, movements in the lower back (especially bending forward), the presence of muscle tension in the lumbar region, and limitation of movements in the lumbar spine.The most common types of radiculopathies of the lumbar spine are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the anterior inner thigh.In the same area, paresthesia may occur (feelings of crawling, numbness), superficial sensitivity is impaired (sharp touch does not differ from ordinary touch, the sensation of cold and hot is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- radiculopathy L4: pain from the lower back radiates to the anterior lower part of the thigh, the inner surface of the knee joint and slightly lower along the inner surface of the lower leg.In these same areas, paresthesia is felt, and superficial sensitivity is lost (decreased).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- radiculopathy L5: one of the common localizations.The pain radiates to the buttock, 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 impaired, and pain when sneezing and coughing is transmitted here.In addition, it becomes difficult to extend the big toe, since the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on your heel with your foot extended;
- radiculopathy S1: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttock, along the outer posterior edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and the 5th toe, heel.These areas are characterized by a feeling of paresthesia and decreased superficial sensitivity.The Achilles reflex decreases.When this root is damaged, weakness of the lower leg muscles and foot flexors develops, making it difficult to stand and walk on toes.
The simultaneous development of radiculopathy of several roots is possible, this is especially typical for L5, S1.It happens that one hernia compresses several roots.
If a herniated disc bulges backward, it can put pressure on the spinal cord.This is only possible if the hernia is localized in the upper lumbar region, since there is no spinal cord below 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 circulatory disorder, a spinal stroke develops in them, and with prolonged compression - myelopathy.Myelopathy manifests itself as bilateral weakness of the leg muscles, starting at the foot and gradually progressing upward.Sensation in the legs is impaired, the Achilles reflex is lost, and later the knee reflex.Urinary disorders may occur (frequent, “imperative” urges requiring immediate gratification, urinary incontinence).
Diagnostic methods
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 spine;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
X-rays of the lumbar spine must 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, anomalies in the structure of the spine, and natural curves.To display the intervertebral joints and intervertebral foramina, radiographs are taken in oblique projections.To identify pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed under functional tests, that is, in the position of flexion and extension of the spine.Normally, the change in the height of the intervertebral discs in the anterior or posterior sections is clearly visible in accordance with the direction of the tilt of the body; with osteochondrosis, due to the functional block of one of the segments, the height of the disc 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 bodies, deposition of salts in the disc tissue (calcification), the formation of marginal growths of the vertebral bodies, compaction of the vertebra 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 significance against the backdrop of the active introduction of new and more informative research methods (CT and MRI).X-rays of the lumbar region are now used as a screening diagnostic method.
A CT scan of the lumbar spine is also performed using X-rays, but the radiation exposure to the body is significantly less than with X-rays.The examination is carried out lying on the table of a special device - a computed tomograph; it is absolutely painless.The resulting images are processed using a computer and allow you to see significantly more structures than with radiography of the spine.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also carried out in a lying position on a table that slides into the tomograph chamber.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 the nucleus pulposus and the annulus fibrosus) and the intervertebral foramina, 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 present, 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 carrying out differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.It is, in fact, the destruction of intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses his ability to work, since, in addition to pain, the disease can lead to impaired mobility of the spine, the inability to sit, stand and walk.The symptoms of this disease are nonspecific and require additional research methods to accurately confirm the diagnosis.The most informative and safe of modern methods for diagnosing osteochondrosis is MRI of the spine.