Lumbar osteochondrosis is a chronic degenerative dystrophic disease of the lumbar spine that affects the structures of the intervertebral discs and adjacent lumbar vertebrae.It mainly affects people of working age.It manifests itself with several symptoms, the main of which are pain in the lower back and legs, limitation of movement in the lower back.Research methods such as x-ray, computed tomography or magnetic resonance imaging of the lumbar spine are used for diagnosis.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 all people (!), 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 the lifestyle of a particular person is.Moderate physical activity, mandatory morning exercises, correct body posture when performing a series of works (gardening, construction, banal house cleaning, etc.), orthopedic mattresses - 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 are intervertebral discs.That is, there is a disc between two vertebrae.The disc consists of a nucleus pulposus and an annulus fibrosus.The core contains a lot of water and provides cushioning and flexibility to the spine.The annulus fibrosus is located along the periphery of the nucleus pulposus, as if holding it within itself.
With a prolonged increase in the load on the nucleus pulposus, it changes its physiological properties, loses water and dries out, and over time it becomes sequestered: the disc flattens and the vertebral bodies become closer to each other.Along with these processes, in the nucleus pulposus the annulus fibrosus loses its elasticity and begins to bulge under the influence of mechanical loads.This is called protrusion.The annulus fibrosus then 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 the spinal segment, acquires excessive mobility, thereby increasing the load on adjacent segments.The overload of neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
To somehow ensure the stability of the spine, bone growths form along the edges of the vertebral bodies, increasing the support area.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 about its appearance:
- Mechanical theory: perhaps the main reason should be considered the regular increase in load on the spine.That is why osteochondrosis is an almost obligatory fate for loaders, miners, builders and people in similar professions.The appearance of osteochondrosis of the lumbar region is mainly associated with bending and lifting heavy objects, forced by an uncomfortable working posture;
- Another development factor may be incorrect posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes the hereditary characteristics of the structure of the spine and the nutrition of its individual structures influence;
- traumatic theory: any injury to the spine (even the slightest) can trigger a degenerative process;
- hormonal metabolic disorders and endocrine diseases can negatively affect the metabolism in the tissues of the spine and contribute to the development of osteochondrosis;
- The aging theory implies the natural wear and tear of discs during life.
In rare cases, only one of these theories is able to explain the appearance of osteochondrosis in each specific case.Most of the time, several factors are to blame at the same time.
Excess weight plays an important role in the appearance of osteochondrosis of the lumbar spine, since it in itself is an overload for the spine.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine tend to be.Other reasons that provoke the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excess sweets, processed foods - all this causes an imbalance of microelements) and lack of fluids;
- abnormalities in the structure of the spine (for example, the presence of an additional lumbar vertebra);
- constant use of high-heeled shoes;
- pregnancy (due to excessive load on the lumbar spine);
- sudden cessation of training in people professionally dedicated to sports;
- Smoking and alcohol abuse: as factors that accelerate the aging process of 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 the irritation, that is, on the severity of the changes in the disc and surrounding tissues, whether there is a bulge or hernia, in which direction the bulge has formed, etc.
There are reflex and compression syndromes in osteochondrosis of the lumbar spine.
Reflex syndromes develop in cases where the receptors of the annulus fibrosus of the affected disc, ligaments and joint capsules located nearby are irritated.They are called reflexes because, in addition to pain, they are accompanied by tonic-muscular, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly in soft tissues.
Compression syndromes arise as a result of compression (compression) of nerve roots, blood vessels or spinal cord due to changes formed during osteochondrosis.
Reflex syndromes of the lumbar spine.
low back pain(lumbago): sharp, sudden pain in the lumbar region that occurs during an uncomfortable movement or at a time of physical stress (much less common, for no apparent reason).It is believed that the appearance of lumbago is associated with the movement of the nucleus pulposus within the annulus fibrosus, that is, it develops in the initial stages of osteochondrosis.The pain is often described as “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 roll over in bed, moving a leg).If a person was in a bent position at the time of the 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 muscular ridge is felt, which is sometimes visible to the naked eye without touching it, which is why muscle tension is so pronounced.Palpation is painful for the patient.This increased muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can lead to deterioration of the condition.The natural curvature of the spine in the lumbar region (lordosis) is flattened and a curvature to one 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 low back pain, the pain does not appear acutely, but rather gradually, over several hours and even days.The pain is dull and painful, of moderate intensity, it intensifies with movements, when sitting or standing, or when moving from one position to another.Lying on your back with a cushion under your lower back provides some relief, but passively raising your straight leg in this position causes increased pain in your lower back (Lassegue's symptom).Palpation of the lumbar spine is painful, but reflex muscle tension is less pronounced than in lumbago and sometimes completely absent.Movement of the lumbar spine is limited, but possible.This means that the patient can lean down and sideways to a certain level (and then the pain intensifies).
lumboischialgia– another type of reflex syndrome of the lumbar level.This term refers to pain in the lumbar region, which radiates to the buttocks and legs (along the back surface).The pain varies in nature, mainly aching, but may periodically intensify like a "shot" in the leg.As with lumbodynia, it increases with any movement, walking, exertion, and decreases when lying on your back.Lassegue's sign is usually positive.Palpation of the lumbar spine is painful, as is pressure at 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 features depend on which structure is subjected to compression.
Between the vertebrae of each intervertebral foramen there are nerve roots (spinal nerves): left and right.If pathological formations in osteochondrosis of the lumbar spine (mainly herniated discs) compress the roots, radiculopathy develops, the symptoms of which differ for each root.All lumbar radiculopathies have in common increased pain when sneezing, coughing, movements of the lumbar area (especially when 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:
- L1, L2, L3 radiculopathy: pain occurs in the lower back and radiates to the anterior inner thigh.In the same area, paresthesia (tingling sensation, numbness) may appear, superficial sensitivity is disturbed (sharp touch does not differ from normal touch, the sensation of cold and heat is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- L4 radiculopathy: Low back pain radiates to the anterior lower 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;
- L5 radiculopathy: one of the common locations.The pain radiates to the buttocks, along the outer edge of the thigh, along the anterior outer surface of the leg to the inner edge of the foot and big toe.Here, paresthesia is felt, superficial sensitivity is altered, and pain is transmitted when sneezing and coughing.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 the heel with the foot extended;
- S1 radiculopathy: 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 leg to the outer edge of the foot and the fifth finger, the heel.These areas are characterized by a sensation of paresthesia and decreased surface 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 your toes.
Simultaneous development of radiculopathy in several roots is possible, this is especially typical for L5, S1.It happens that a hernia compresses several roots.
If a herniated disc protrudes backwards, it can put pressure on the spinal cord.This is only possible if the hernia is located in the upper lumbar region, since there is no spinal cord under 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 subject to compression, in the case of an acute circulatory disorder, a stroke develops in them, and with prolonged compression - myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, starting in the foot and gradually progressing upward.Sensitivity in the legs is altered, the Achilles reflex is lost and, subsequently, the knee reflex.Urinary disorders may occur (frequent and “imperative” needs requiring immediate gratification, urinary incontinence).
Diagnostic methods
The 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 should be performed in 2 mutually perpendicular projections: direct posterior and lateral.These images allow you to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, abnormalities in the structure of the spine and natural curves.To show 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 testing, 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 according to the direction of body tilt;with osteochondrosis, due to functional blockage 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), formation of marginal growths of the vertebral bodies, compaction of the vertebra on the edge with the affected disc (subchondral sclerosis).X-ray of the lumbar spine is a routine research method that is gradually losing its importance against the background of the active introduction of new, 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-ray, but the exposure of the body to radiation is significantly less than with X-ray. The examination is performed lying on the table of a special device - a CT scan;It is absolutely painless.The resulting images are processed by a computer and allow many more structures to be seen than with spinal x-rays.
MRI is a technique that uses electromagnetic radiation to create images.The exam is also performed in a lying position on a table that slides into the CT scanner camera.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 herniated disc, if present, and the degree of compression of the nerve roots and spinal cord.Therefore, 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 making a differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.In fact, it is the destruction of the 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 problems with mobility of the spine, inability to sit, stand and walk.The symptoms of this disease are non-specific and require additional research methods to accurately confirm the diagnosis.The most informative and safest modern method for diagnosing osteochondrosis is MRI of the spine.