Osteochondrosis is the most severe form of degenerative -dystrophic lesion of the spine, which is based on the defeat of the pulpic nucleus of the intervertebral disk, with subsequent deformations of the bodies of adjacent vertebrae, intervertebral joints, impaired ligamentous apparatus, and involving the pathological process of the nervous system and blood vessels.
One of the most common forms of osteochondrosis is osteochondrosis of the lumbar region, or, more precisely, the lumbosacral spine.To a lot - both men and women - are familiar with back pain in the lower back, sacrum, lower extremities, caused by various types of lumbar osteochondrosis and its complications.Among the reasons for temporary disability and disability, this disease occupies one of the first places.
The course of the disease is chronic, usually with periods of exacerbations.Most often, the exacerbations of osteochondrosis of the lumbar linema lift and transfer of weights, hypothermia, stress, and injury are provoked.
Osteochondrosis of the lumbar spine - causes, mechanism of occurrence and development
There was no unambiguous cause of osteochondrosis, the disease is considered polyfaver.The most popular theory is, according to which the cause of osteochondrosis of the spine is the constant overwhelming of the muscles or hypotension of muscles, nonphysiological muscle tension, which leads to overloading the vertebral segments, the deterioration of their blood supply and, ultimately, to the degeneration of the intervertebral discs and joints, the result of which is the result of which is the resultosteochondrosis.
The cause of premature aging of the intervertebral discs can also be endocrine and metabolic disorders, a hereditary predisposition to the development of osteochondrosis, autoimmune disorders, and microtrauma.The negative role of visceral, that is, related to internal organs, pathologies in the development of osteochondrosis of the spine, has also been proven.A significant role in the development of the disease belongs to adverse heredity.The contribution of hereditary factors to the appearance of lumbar osteochondrosis is about 60%, the rest refers to the factors of adverse external influence on the spine.
Factors that contribute to the development of osteochondrosis both in the lumbar and other parts of the spine are very numerous.The main of them: improper posture, hypodynamia, muscle overvoltage in the lumbar region as a result of the constant wearing of weights or a sharp excessive load, hormonal restructuring, endocrine and somatic diseases, violation of normal blood supply to the tissue of the spine, emotional stress, age -related changes, poor nutrition.Under the influence of these factors in the structures of the spine, the processes of dehydration and circulatory disorders, arthrosis and subluxation in small joints, bone growths, and disks - hernias are gradually increasing.
The most obvious causes of lumbar osteochondrosis are most often considered a sedentary lifestyle and back injury.Therefore, the risk group primarily includes those people whose profession is directly related to the loads on the back.This is a very wide range of professions - seller and waiters, surgeons and teachers - all who are forced to spend most of the working time standing.The risk group includes builders and movers, as well as athletes who, who, in the nature of the activity, arise large loads on the spine.In addition, drivers, various office workers, programmers - that is, those who have the work mostly sedentary, and who suffer from hypodynamia, suffer from osteochondrosis of the lumbar.
Symptoms of osteochondrosis of the lumbar spine
Atlumbar osteochondrosisPainful sensations of various nature are possible.This one can be either aching pain that occurs with a prolonged seat or after sleep, as well as sharp shooting, causing in the most uncomfortable pose and not allowing the opportunity to straighten up.The pain is pinched by the nerve roots, the irritation of the own nerves of the spinal column, edema and irritation of the muscles and ligaments located in the innervation zone of the lumbar spine.
The pain syndrome can be caused by the compression of radicemic structures (radiculopathy), compression of the spinal cord (compression myelopathy), damage to the spinal cord due to impaired blood supply due to pushing, narrowing (stenosis) of the supply arteries and veins (compression-vascular myelohemia).
The reason for the compression may be: protrusion and hernia of the intervertebral discs, spondylolistz (slipping the vertebra forward in relation to the underlying), the growth of osteophytes and cartilaginous tissue in the vertebral segment.As a resultOsteochondrosis of the lumbar regionThe spine leads to a narrowing of the canal through which the cerebrospinal nerves or vascular structures pass, and under certain conditions (awkward movement, physical activity, an unsuccessful turn of the body, etc.), compression (squeezing) may occur.Compression of nervous structures leads to various pain syndromes, muscle spasms.The compression of blood vessels causes a violation of blood supply - the ischemia of the organ that feeds from this vessel or artery begins.
Clinical syndromes of osteochondrosis of the lumbar spine
The clinical picture for lumbar osteochondrosis is determined by a complex of vertebral symptoms (a change in the statics and dynamics of the lumbar spine) and the escorted symptoms, which are understood as a violation of the function of neurological and vascular structures in the lumbosacral region of the spine.
Vertebral syndromes of lumbar osteochondrosis
With lumbar osteochondrosis, the vertebral syndrome is characterized by the following complex of symptoms:
- Violation of the configuration of the spinal functional-anatomical segment: a flattening or (less often) increase in lordosis, scoliosis or lordoscoliosis is observed;
- violation of mobility in the lumbar region, a decrease in the volume of movements, the muscle-tonic imbalance caused by the tension of both deep and superficial multi-human muscles;
- local pain and soreness with active and passive movements, which causes reflex tonic muscle tension;
- violation of the spring-motor functions of both the intervertebral disc and, in general, the vertebral-motor segment;
- Local soreness (increased sensitivity) of the bone-ligamentous structures of the spine in the affected area (pain during palpation, local (regional) vertebral and/or vertebrosonal pain syndrome).
It is important to note that with osteochondrosis of the lumbar department, vertebral pathologies are always observed.The presence of signs of myelopathy, radiculopathy and myeloradiculopathy without obvious clinical and morphological signs of the vertebral syndrome requires, as a rule, a more in -depth examination of the patient for the primary ("non -sorester") damage to the nervous system.
Extrovertebral (reflex and compression) syndromes for osteochondrosis of the lumbar spine
Extrovertebral syndromes are divided into two large groups: reflex and compression.
Reflex syndromesThey precede compression and are caused by irritation of the receptors of the roots of nerves emerging from the spinal canal through the intervertebral holes.Irritation can be caused by intervertebral hernia, bone growths, as well as vascular disorders (edema, blood circulation worsening), and inflammation.In some cases, this leads to intensive pain, which occurs not only locally, but also in the course of the nerve at a distance from the place of irritation - the so -called “reflected pains”, reflected pain can be short and acute (“shift”) or stupid long -term.In the innervation zone of the damaged nerve, vegetative disorders (burning, goosebumps, impaired sensitivity) are possible.Myofascial pains are possible - muscle spasm, which leads to limiting movements.
Reflex syndromes include lumbago (“shift”) in the acute development of the disease and lumbalgia with subacute or chronic course.
Compression syndromes are syndromes that occur as a result of compression, infringement of nerves, blood vessels, spinal cord in the area of the lumbar spinal segments.Compression syndromes for osteochondrosis of the lumbosacral department are divided into radicular and vascular-brown.A special case of compression syndrome is myelopathy - infringement of the spinal cord.
Remedy syndromes (radiculopathy) are usually due to protrusions of the disk, causing infringement of cerebrospinal roots.The radicular symptoms arising in this case correspond to the level of the affected vertebral segment.Most often, the roots of L4-S1 are affected.
Vascular-brown neurological disorders are caused by the compression of the hernia on the spine and the root artery passing with it.At the same time, “paralytic ishias” can develop catastrophically, characterized by peripheral paresis or paralysis of the muscle of the foot extensors.In such cases, the appearance of motor disorders is accompanied by the disappearance of pain.
Even more severe neurological manifestations are caused by a violation of the blood supply to the spinal cord due to damage to the radicular-spinal arteries.At the same time, chronic discirculatory myelopathy develops, usually at the level of lumbar thickening of the spinal cord.
The most unfavorable version of the lumbar vertical radicular syndromes is the compression of the “horse tail” - the so -called caudal syndrome.Most often, it is caused by the falling medinal hernia of the disk, which squeezes all the roots at the level of the affected segment.
What is osteochondrosis of the lumbar spine?What are its symptoms?How to treat osteochondrosis of the lumbar?
Clinical classification of osteochondrosis of the lumbar region.Degree of osteochondrosis
The classification of lumbar osteochondrosis according to degrees is used for the systematic characteristics of the clinical manifestations of the disease.This classification systematically describes the symptoms of the disease and begins from the moment the patient has pain.
1 degree of osteochondrosis
It occurs when the intervertebral disk caused by a sharp movement or overvoltage occurs.It is manifested by a sudden pain, in the spine a feeling of passage of electric current arises, the muscles are reflexively tense.
2 degree of osteochondrosis
The second degree can manifest itself in the form of symptoms of intervertebral protrusion and instability of the spine.Chronic pain increasing at loads.The intervals of remission and exacerbations alternate.The cervical region is characterized by pain in the neck, increasing after a long stay in one position, headaches, pain in the hand, shoulder pain, periodic discomfort or numbness in the fingers.For the lumbar region - lower back pain, pain in the gluteal region, periodic pain in the sacrum, frequent fatigue in the legs.
3 degree of osteochondrosis
It manifests itself in the form of symptoms of the hernia of the intervertebral disc (pain along the affected nerve, numbness of the arms or legs, a change in gait, headaches) or distant symptoms of the intervertebral hernia (in the cervical spine: frequent headaches, noise in the ears, dizziness, decrease in vision, muscle strength in the hands of the thoracic: violation of the cordial region: Violation of the heartrhythm, difficulty breathing; in the lumbar region: kidney disease, gastrointestinal tract, violations in the genital area, numbness or weakness in the legs).
4 degree of osteochondrosis
It is generally accepted that the fourth degree of osteochondrosis begins from the moment when the hernia no longer manifests itself, the manifestations of the disease can decrease, but the symptoms of the spinal instability, slipping or twisting the vertebrae, or their complete fixation are still relative to each other.The manifestations of the growths of the vertebral bodies (osteophytes) can join them, which can also squeeze the spinal nerves or overlap the spinal canal (secondary stenosis of the spinal canal) and squeeze the spinal cord (spinal cord ischemia).In addition, the fourth degree include the consequences of surgical intervention if the hernia was removed promptly (various kinds of innervation, paresis, inflammation).
Treatment of osteochondrosis of the lumbar spine
With the first acute lower back pain, it is necessary to consult a doctor to establish a diagnosis in order to exclude an attack of renal colic, appendicitis, or any other disease requiring emergency medical care.
If the cause of the back pain is known, and this exacerbation of osteochondrosis of the lumbar spine, first of all, it is necessary to maximize the load on the spine.It is necessary to observe bed rest for 3 to 7 days - sometimes only this can significantly reduce the pain.But in order to accelerate recovery, it is necessary correct, that is, effective, treatment.It should stimulate its own protective and health processes in the human body.Treatment should take into account the localization of the lesion, the stage of the disease, the functional state of the body and its individual systems.Surgical treatment of this disease is indicated only in very severe cases.Most often, various methods of conservative treatment of osteochondrosis are used.
Conservative treatment of lumbar osteochondrosis
Conservative methods of treatment are, first of all, drug treatment.In order to reduce pain, as well as to reduce inflammation, which is often the cause of the vertebral syndrome, non -steroidal anti -inflammatory drugs (NSAIDs) in the form of tablets or - in acute cases - in the form of injections are prescribed.Sometimes, after injection, an analgesic, the pain calms down and does not resume even when the duration of the medicinal substance ends.This means that it was possible to break the vicious circle in which the pain leads to muscle cramps, and muscle tension, in turn, enhances pain.However, if the pain lasts a long time, it is important to remember that NSAIDs usually have various side effects and with prolonged use can cause unwanted complications - a decrease in the number of leukocytes in the blood, complications from the gastrointestinal tract.
Often, sedative (soothing) agents are prescribed to improve the general condition of patients within 1-3 weeks, as well as small doses of antidepressants.With osteochondrosis of the lumbar spine, if necessary, novocaine blockade is produced.Recently, drugs of the anticonvulsants began to be successfully used to relieve pain.
To reduce compression syndromes, manual therapy, traction treatment (spinal traction) and in special cases are used - surgery.
When weakening the fixation properties of the ligamentous and consistency apparatus of the spine, it is recommended to use fixing devices - corsets, collars, dressings, etc.However, only limited time can be used fixing devices, since when they are used, weakening of the muscles is observed.And patients with spinal osteochondrosis are extremely important in the future to strengthen their own muscle corset.
After removing acute symptoms, the task of creating muscle fixation comes first in the first place, and then stimulating the regeneration processes of damaged structures.To do this, use therapeutic gymnastics, reflexology, massage.To do this, use chondroprotectors (drugs to restore cartilage tissue).As well as drugs that improve the condition of blood vessels (angioprotectors), vitamins, primarily group B, calcium preparations that improve the condition of bone tissue.
For the treatment of osteochondrosis of the spine, physiotherapeutic procedures are widely used.They reduce tissue pain and edema, improve blood circulation, and stimulate muscle fixation.Procedures can be combined, alternate.Such methods of physiotherapeutic treatment as:
- darsonvalization of the affected area of the back and affected limbs;
- electrophoresis;
- low -energy laser radiation;
- ultrasound;
- exposure to the magnetic field;
- Thermal procedures.
In the conditions of the sanatorium, mud, ozokeritic, paraffin applications, radon, sulfide, hydrogen sulfide, turpentine and other baths are successfully used;
It must be remembered that for the development of full regeneration, it takes a fairly long period of time, under favorable circumstances it occurs in the sixth month.Therefore, treatment should be long.It should be carried out with a combined manner, that is, combined drugs with physiotherapy and physiotherapy exercises.