Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is attached to hereditary predisposition, age-related changes in the intervertebral discs. Pain can be caused by uncomfortable movement, prolonged forced posture, lifting and carrying heavy loads, sports overload, excess weight.
Depending on the duration, there are acute pains that last up to 4 weeks, subacute (from 4 to 12 weeks) and chronic (lasting more than 12 weeks).
Neurological complications in osteochondrosis of the lumbar spine:
Lumbago (lower back pain). Acute pain in the lumbar region begins suddenly, caused by minimal movements in the back. The range of motion in the lumbar spine is severely limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with adequate treatment and immobilization of the lumbar spine is no longer than 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lumbar region, aggravated by movement or in a certain position, discomfort when standing or sitting for a long time. The onset is usually gradual. Clinically, limited mobility in the lumbar spine, tension and pain in the paravertebral muscles are often determined. In most cases, the pain goes away within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (pain in the lower back that radiates into the leg). In the lumbar region, movements are limited, the paravertebral muscles are tense and painful on palpation.
In piriformis syndrome, the sciatic nerve is compressed, which causes paresthesias and numbness in the leg and foot. Positive Lasegue syndrome. But there are no signs of radicular syndrome.
Disc herniation with radicular syndrome or radiculopathy. Root compression is accompanied by cracking, burning pains in the leg. The pain increases with movement, coughing, accompanied by numbness along the root, muscle weakness and loss of reflexes. Symptoms of positive tension.
In the lumbar region, the greatest load falls on the lower part, therefore the roots of L5 and S1 are most often involved in the pathological process. Each root has its own zone of distribution of pain and numbness of the limbs.
Radicular syndromes are discovered by a neurologist during an objective examination.
Vascular-radicular conflict. Paralyzing sciatica syndrome occurs when the blood circulation in the radicular artery L5 and less often S1 is disturbed. Radiculoischemia at other levels is diagnosed extremely rarely.
During an awkward movement or lifting a heavy load, acute back pain develops with radiation along the sciatic nerve. Then there is paresis or paralysis of the extensors of the feet and toes with "stepping" of the foot when walking (steppage). While walking, the patient raises his leg high, throws it forward and at the same time hits the floor with his toe.
In most cases, the paresis is sure to resolve within a few weeks.
Disorder of the blood supply of the spinal cord and cauda equina. In spinal stenosis, several roots of the spinal nerve (cauda equina) are affected. Pain at rest is less, but intermittent claudication syndrome occurs when walking. Pain when walking spreads along the roots from the lower back to the feet, is accompanied by weakness, paresthesia and numbness of the legs, disappears after rest or when the torso is bent forward.
Acute spinal circulation disorder is the most serious complication of lumbar osteochondrosis. Lower paraparesis or plegia develops acutely. Weakness in the legs is accompanied by numbness of the lower extremities, dysfunction of the pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
It is very important to analyze the complaints and history in order to rule out serious pathology. A neurological examination is performed to rule out root and spinal cord damage. By manual examination, you can determine the source of pain, limitation of mobility, muscle spasm.
Additional testing methods are indicated for suspected specific back pain.
X-ray of the lumbar spine is prescribed to rule out tumors, spinal injuries, spondylolisthesis. X-ray signs of osteochondrosis have no clinical value, because all older and older people have them. Functional X-rays are taken to determine spinal instability. Images are taken in the position of extreme flexion and extension.
For radicular or spinal symptoms, MRI or CT of the lumbar spine is indicated. Magnetic resonance imaging shows herniated discs and spinal cord better, and CT shows bone structures better. The clinical level of the lesion and the magnetic resonance findings should correspond to each other, because a disc herniation detected on magnetic resonance is not always the cause of pain.
Electroneuromyography (ENMG) is sometimes prescribed for neurological deficits to clarify the diagnosis.
If somatic pathology is suspected, a thorough clinical examination is performed.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort in the lumbar spine appear, regular gymnastics to strengthen the muscle corset, swimming and massage courses are indicated.
Treatment of lumbar osteochondrosis is divided into 3 periods: acute, subacute and chronic treatment.
In the acute period, the primary task is to remove the pain syndrome as soon as possible and restore the patient's quality of life. In the presence of intense pain, immobilization of the lumbar part of the spine with a special antiradiculitis corset for 2-3 weeks is indicated. Bed rest should not last longer than 2-3 days. In many patients, it is possible to increase the pain syndrome against the background of the expansion of the motor regime. The patient should not limit himself to reasonable physical activity.
Non-drug therapy methods include interstitial electrical stimulation, acupuncture, hirudotherapy and massage. It is possible to use manual therapy, but only in expert hands.
Treatment. Nonsteroidal anti-inflammatory drugs are indicated for acute pain. In combination with anti-inflammatory drugs, muscle relaxants can be prescribed in a short course.
In osteochondrosis of the lumbar spine, therapeutic blockades with local anesthetics, non-steroidal anti-inflammatory drugs and corticosteroids are effective. Medicinal mixtures are administered as close as possible to the focus of pain (into the affected muscles, root exit points).
With radiculopathy with the presence of neuropathic pain, anti-inflammatory drugs are ineffective, in this case antidepressants, anticonvulsants and a special therapeutic patch are prescribed.
With paresis, numbness, vascular preparations, group B vitamins are prescribed.
In the case of prolonged myofascial pain, the introduction of non-steroidal anti-inflammatory drugs on trigger points, muscle relaxants, acupuncture and postisometric relaxation is effective.
For chronic pain, antidepressants, exercise therapy and other non-pharmacological treatments are the first line of treatment.
In the case of stenosis of the spinal canal, weight loss, wearing a corset, NSAIDs and various venotonics are indicated.
Surgical treatment is performed for paralyzing sciatica (in the first three days) and cauda equina syndrome (extremity paresis, impaired sensitivity, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
Preventionosteochondrosis of the lumbar spinereduced to avoiding long, uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternating periods of work and rest. Wear a fixation belt for physical overload. Do exercises to strengthen your back muscles.