Osteochondrosis of the lumbar spine: treatment and symptoms

In the medical literature, the term "osteochondrosis of the spine" means degenerative processes in the ossification centers in children. A common disease in medicine, which is considered the most common among all problems of the musculoskeletal system, hides behind the words sciatica, herniated disc, dorsalgia (back pain). The lower back, according to official statistics, suffers more often than the other parts, which leads to serious 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 that affects the intervertebral discs and leads to compensatory and reactive secondary changes in the osteo-ligamentous apparatus and the nervous system: this is the definition given by doctors in osteochondrosis. It mainly affects the lumbar region, which is located between the thoracic and the sacral and consists of five vertebrae. There are discs between them: fibrocartilaginous formations, formed by the following elements:

• cartilaginous tissue (the membrane involved in nourishing the discs of the vessels of the vertebral body);
• nucleus pulposus (gelatinous mass in the center with a nucleus pulposus);
• fibrous ring (protects the liquid 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 bone surfaces of the adjacent vertebrae, dystrophy (tissue malnutrition) of the spine occurs.

The post process looks like this:

1. Microcracks appear in the loosened ring. The nucleus pulposus begins to penetrate it, gradually ruptures through the fibrous annulus and becomes damaged, leading to a herniated disc or bulge (initial stage).
2. A hernia compresses the spinal canal, it can pinch nerve roots and blood vessels, causing pain and movement problems.
3. Due to increased pressure on the vertebrae (due to thinning of the disc), accelerated production of bone tissue begins, and spinous processes (osteophytes) are formed.

Reasons

Some experts are inclined to call intervertebral osteochondrosis of the lumbar spine and others a "disease of civilization", mainly due to the upright posture, which has increased the load on the back of a modern person. The disease begins mainly in people over 30 years old, in men it is diagnosed more often than in women.

Lumbar osteochondrosis can develop:

• excessive loads on the spine (domestic, 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 in the context of diabetes mellitus;
• spinal injuries;
• violation of metabolic processes;
• ill-fitting shoes, flat feet;
• problems with posture, giving an uneven distribution of the load along the spine;
• hypothermia of the lumbar spine;
• sedentary lifestyle, prolonged driving;
• hormonal disorders (mainly in women);
• congenital pathologies of the musculoskeletal system;
• age (natural changes in fibrocartilaginous tissue occur in people over 50 years of age);
• 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:

1. The initial stage is characterized by the beginning of the process of destruction of the intervertebral discs, a decrease in their elasticity, elasticity. The disease manifests itself mainly with stress on the spine.
2. Destructive processes affect the fibrous ring, the distance between the vertebrae decreases (the disc becomes thinner), depreciation suffers, bulges appear (protrusion of the intervertebral disc without breaking the ring). Pinching of the nerve roots and inflammation of the tissues occur, increasing the pain syndrome.
3. The annulus fibrosus ruptures and a hernia occurs. The vessels, the nerve endings are compressed. Changes in the lumbar spine lead to a general deformity of the spine.
4. In the last stage, the muscles in the affected area atrophy, motor activity and work capacity suffer. The spine is noticeably bent: there is pronounced scoliosis (deformity in 3 planes), lordosis (hypertrophied forward deviation of the lower back).

Lumbar osteochondrosis symptoms

The 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 greater 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:

• In the initial stage, there is discomfort in the lumbar region, pain is rare, mainly with a large load on the back. Pass fast.
• At stage 2, the mobility of the lumbar spine deteriorates, the pain occurs after physical exertion and without it (with a strong cough, change of posture), gradually intensifies, persists for a long time. Failures in the work of internal organs are possible.
• With the development of osteochondrosis, the pains become permanent (permanent), and the vertebrae deform. The nerve endings are pinched, so the pain can be given to the sacrum, leg, become sharp, stabbing. Loss of sensation occurs in the extremities, buttocks, thighs, numbness, paraesthesia (burning, tingling, "goose bumps"). Pelvic organ dysfunctions appear.
• In the last stage, motor function deteriorates or becomes completely impossible, curvature of the spine occurs. The pain is permanent, the person unconsciously takes an unnatural position to reduce it.

The reflex syndromes of the disease in official medicine are classified into 3 groups: muscle tonic, neurodystrophic, vegetative-vascular. The last 2 categories are clearly shown in 3 disease stages and later.

The clinical picture may include:

• weakened or missing Achilles tendon reflexes, flexion of the fingers (if osteochondrosis of the sacral region is added);
• dry skin, blue discoloration;
• urinary disorders (urinary retention or incontinence), bladder pain;
• cramps and pains in the thigh area in the context of nutritional and circulatory disorders;
• tense gait, unsteady, limp;
• increased sweating, fever with increased back pain;
• pain syndrome radiating to the heart region (if the thoracic-lumbar region is affected).

Complications

If osteochondrosis of the lumbar spine has been diagnosed, treatment should be started immediately, since in the last stage the patient can be completely disabled. Against the background of compression (squeezing) of the spinal cord by the vertebrae, between which there is no space, paralysis of the lower extremities may develop.

Additionally, osteochondrosis can cause:

• disorders of the pelvic organs (men suffer from erectile function, women - ovarian activity);
• lumbago (acute low back pain), sciatica (pinching and inflammation of the sciatic nerve);
• intervertebral disc prolapse, stenosis (narrowing of the spinal canal);
• damage to the lining of the spinal cord, which is fatal.

Diagnosis

To make the correct diagnosis and assess the severity of the disease, the doctor collects anamnesis data (study of the patient's complaints, lifestyle, hereditary factors). Subsequently, a physiological examination is performed, where the patient's motor skills, posture, level of sensitivity, muscle tone and size and its spasm are evaluated. By striking with a hammer, the irradiation zones (where it emits) are marked for pain in osteochondrosis of the lumbar spine.

After assigning the patient:

• Radiographyis ​​the most accessible way to examine the anatomical parameters of the vertebrae, evaluating the tendency to narrow the holes between their bases, identifying bony growths.
• MRI(magnetic resonance imaging): helps to assess the condition of the vessels that supply the spine, the nervous processes, and the discs.
• CT(computed tomography) - Prescribed only to check for changes in the vessels, the lining of the spinal cord, and to study marginal growths.

Treatment for osteochondrosis of the lumbar spine

Surgical intervention is considered a last resort and is prescribed primarily 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 the treatment of stages 1 and 2 according to a conservative method.

The therapeutic measures are aimed at:

• elimination of pain syndrome;
• elimination of muscle spasms, hypertonicity;
• elimination of the inflammatory process;
• improvement of blood circulation in affected areas and metabolic processes;
• normalization of mobility of the lumbar vertebrae;
• restoration of lumbar sensation.

There is no universal treatment method: 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, which involves the use of drugs (internal and external) in conjunction with physical manipulations: massage, gymnastics, physiotherapy. The treatment regimen for osteochondrosis of the lumbar spine can be supplemented with acupuncture, hirudotherapy.

The effectiveness of the treatment will increase if you follow the following rules:

• A special belt or corset should be worn during treatment to reduce stress on the spine.
• Physical activity is excluded (only those recommended by the doctor remain), so as not to add provoking factors.
• It is important to closely monitor the diet: cartilage needs sources of collagen (gelatin, aspic, jellied meat) and the whole body needs plant foods, fish, nuts. It is advisable to refuse salty, smoked, pickled products, as well as spicy cheeses, fatty meats.
• The scheme prescribed by the doctor should be followed to the end: do not stop treatment when the main symptoms have disappeared, do not change the set of drugs and procedures yourself.
• Together with the doctor, it is worth choosing an orthopedic mattress that helps to relax the lower back during sleep, and special shoes. Women are completely forbidden to wear heels.

Acute osteochondrosis of the lumbar spine requires special attention: its treatment begins with the appointment of the patient in bed rest for several days. Pain sensations are reduced with injections of analgesics, blockade of novocaine and glucocorticoids is not excluded. Spinal traction (using a traction table or vertical appliance), walking on crutches, electrophoresis, and laser therapy help improve the condition.

Drug therapy

Medications for the treatment of osteochondrosis of the lumbar spine are used internally and topically. Local gels and ointments are symptomatic therapy: relieves inflammation and pain, relieves muscle spasm and edema, improves blood circulation. In acute conditions, injections are shown that have an immediate anti-inflammatory, antipyretic, analgesic effect.

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Most doctors prescribe home remedies for osteochondrosis:

• Chondroprotectors: they protect the cartilage tissue and promote its recovery, they are indicated for prolonged use (from six months or more).
• 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 spasms, are used orally in a short course.
• Non-steroidal anti-inflammatory: quickly blocks pain, suppresses 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 doubled with tablets.
• Corticosteroids: Injections for pain relief are prescribed only in the absence of a significant effect of 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.
• Group B vitaminsand multivitamin complexes are prescribed in a long cycle to increase the overall effectiveness of the treatment.

Physiotherapy procedures

To enhance the effect of drug treatment and accelerate recovery, physical therapy courses may be prescribed to the patient. You can toggle them or go through multiple options simultaneously. 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): involves the effect of low-power electrical currents to improve blood circulation in the affected areas.
• Laser therapy: activates biological processes in nerve endings and relieves symptoms of neurodystrophic syndrome.
• UHF: local impact on the lumbar region with a high frequency magnetic field to stop the inflammatory process, stimulate cell regeneration (restoration) of tissues and reduce pain.
• Phonophoresis and Electrophoresis- Helps deliver medications to the area that needs them, increasing the effectiveness of drug treatment. The result depends on the specific agent used during the procedure.
• Darsonvalization: Therapeutic effect of high-frequency alternating current to expand blood vessels, improve blood circulation and nutrition of tissues. The procedure affects symptoms less than others.
• Amplipulse- local effect of sinusoidally modulated currents, due to which pain severity is reduced. The procedure has an analgesic, vasodilator, neurostimulating effect, improves tissue trophism.

Recovery gymnastics

Physical activity, especially when it comes to early (initial stage) osteochondrosis of the lumbar spine, should be included in the treatment: they help to relax and strengthen muscles, have a beneficial effect on the nutrition of tissues. For people with grade 2 disease and more intense exercise, a doctor will select it. With an exacerbation, gymnastics, swimming, yoga (the most effective directions) are prohibited.

The following exercises show good results:

• Emphasize your knees and palms, keep your back straight (parallel to the floor). As you exhale, slowly bend your lower back and tilt your head slightly back. Count to 5-8 (depending on how you sit), inhale and arch your back with a wheel. Count to 5-8 again and take the starting position. The exercise is done 10 to 12 times at a slow pace. If necessary, they are divided into 2-3 approaches.
• Lie face down. As you exhale, slowly lift your chest off the floor, bending your lower back and trying to rise as high as possible. Arms are extended forward, legs do not move. Hold this position for 5-10 seconds and gradually lower yourself. Repeat the exercise 8 to 10 times, gradually increasing the duration of the delay at the top point.

Massage

Massage is an effective method of treating any stage of osteochondrosis, helping to relieve unpleasant symptoms, eliminate muscle spasm, and normalize lymphatic flow and blood supply to affected areas. In addition, this procedure stimulates the restoration of atrophied muscles and eliminates the limitation of mobility of the vertebrae, strengthens the ligamentous apparatus. The massage is performed by a specialist doctor in courses of 10-12 sessions, when the symptoms of the acute stage have subsided.

Surgery

If a patient is diagnosed with major neurological disorders, loss of urination control, there is a severe hernial bulge, surgery is necessary. Also, the indication is the lack of a positive effect of conservative treatment (lasting more than a month). Before receiving a referral for surgery, the doctor must evaluate all risks, especially if traditional technology is chosen over microdiscectomy.

During the procedure, the surgeon can:

• remove pathologically altered areas by placing local implants (discectomy) on them, which are developed individually for each patient;
• to align the spine with a special rod; This helps to correctly distribute the load and prevent further deformation.

The discectomy is performed under general anesthesia, with a posterior access for the surgeon. During the operation, the skin is cut to a length of 10 cm, the muscles are separated, 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 must lie on his back. The rehabilitation period is 2 months. With microdiscectomy, the procedure takes 1. 5 hours, a 3-cm incision is made, and it can be lifted after leaving anesthesia.

Treatment of osteochondrosis of the lumbar spine with home remedies

After consultation with a doctor who can competently assess the patient's condition, it is allowed to use recipes of traditional medicine. They do not give the same pronounced effect as drug therapy, they do not replace physical therapy, massage and gymnastics, but they increase the probability of a positive result of the main treatment.

Some simple options:

• Grate peeled black radish (350 g), combine with liquid honey (250 g) and vodka (100 ml). Use it to gently massage the lower back for 10 minutes in the morning and at night. 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 low back pain, you can take 100 g of medium-fat cottage cheese, add 1 tsp. apple cider vinegar, place on a cotton cloth or gauze. 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 without crushing them. Pour a liter of vodka, leave it in a cold place for 3 weeks. Use it to rub the affected area once a day for a month. It is not necessary 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 by regular physical activity, which strengthens muscles, improves blood circulation and nutrition of tissues. Osteochondrosis of the lumbar spine is no exception: treatment will not have to take place if you systematically participate in gymnastics, yoga and swimming.

Additional prevention measures:

• control over diet (more plant foods, less animal fats, pickles, marinades: as in the treatment);
• limit heavy loads on the spine;
• 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.