Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not fully understood. The greatest importance is attributed to the hereditary tendency, the age-related changes of the intervertebral discs. Pain can be caused by uncomfortable movement, long-term forced position, lifting and carrying heavy loads, sports overload, overweight.
Depending on the duration, acute pain lasts up to 4 weeks, subacute (4-12 weeks) and chronic (more than 12 weeks).
Neurological complications in osteochondrosis of the lumbar spine:
Lumbago (back pain). Acute pain in the lumbar region begins suddenly, triggered by minimal movement of the back. The range of motion of the lumbar spine is sharply limited, there is compensatory scoliosis. "Stone" density paravertebral muscles. With proper treatment and immobilization of the lumbar spine, the duration of lumbago is a maximum of 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lumbar region, which is aggravated by movement or in a certain position, discomfort due to prolonged standing or sitting. The onset is usually gradual. Clinically, the limitation of movement of the lumbar spine, the tension and pain of the paravertebral muscles are often determined. In most cases, the pain subsides within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (lower back pain that radiates to the leg). Movements in the lumbar region are limited, the paravertebral muscles are tense and painful to the touch.
In piriformis syndrome, the sciatic nerve is compressed, causing paresthesia 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. Compression of the root is accompanied by shooting, burning pains in the leg. The pain is aggravated by movement, accompanied by coughing, root numbness, muscle weakness and loss of reflexes. Symptoms of positive tension.
In the lumbar region, the greatest load falls on the lower part, therefore the L5 and S1 roots are most often involved in the pathological process. Each root has its own zone for the distribution of pain and numbness in the limbs.
Radicular syndromes are detected by a neurologist during an objective examination.
Vascular-radicular conflict. Paralyzing sciatica syndrome occurs when blood circulation is disturbed in the L5 radicular artery, less often in the S1 artery. Radiculoischaemia of another level is extremely rarely diagnosed.
During awkward movement or heavy lifting, acute back pain develops along the sciatic nerve. Then there is paresis or paralysis of the extensors of the foot and fingers with "spanning" of the foot while walking (stepping). While walking, the patient raises his leg high, throws it forward, and at the same time taps his toe on the floor.
In most cases, paresis resolves safely within a few weeks.
Violation of blood supply to the spinal cord and cauda equina. In spinal stenosis, several spinal nerve roots (cauda equina) are affected. At rest, the pain is slight, but intermittent claudication syndrome occurs when walking. The pain that occurs during walking spreads along the roots from the lower back to the feet, is associated with weakness, paresthesia and numbness of the legs, and disappears after rest or when the trunk is tilted forward.
Acute violation of spinal circulation is the most serious complication of lumbar osteochondrosis. Acute lower paraparesis or plegia develops. Weakness of the legs is accompanied by numbness of the lower limbs and dysfunction of the pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
It is very important to analyze complaints and anamnesis in order to rule out serious pathology. A neurological examination is performed to rule out damage to the roots and spinal cord. Manual examination allows to determine the source of pain, limitation of mobility, muscle spasms.
Additional examination methods are recommended in case of suspicion of specific back pain.
X-rays of the lumbar spine are prescribed to rule out tumors, spinal injuries, and spondylolisthesis. X-ray signs of osteochondrosis have no clinical significance, since all old and elderly people have them. Functional X-rays are taken to look for spinal instability. The images are taken in extreme bending and stretching positions.
In case of radicular or spinal cord symptoms, an MRI or CT examination of the lumbar spine is recommended. The herniated disc and the spinal cord can be seen better on MRI, and the bone structures on CT. The clinical level of the lesion and the MRI findings must match each other, as a herniated disc detected on MRI does not always cause the pain.
Electroneuromyography (ENMG) is sometimes prescribed for neurological deficits to clarify the diagnosis.
If somatic pathology is suspected, a thorough clinical examination should be performed.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort appear in the lumbar spine, they are shown regular gymnastics to strengthen the ligament, swimming and massage courses.
Treatment of lumbar osteochondrosis is divided into 3 periods: treatment of acute, subacute and chronic periods.
In the acute period, the primary task is to alleviate the pain syndrome as soon as possible and to restore the patient's quality of life. In case of severe pain, immobilization of the lumbar spine with a special brace against radiculitis is recommended for 2-3 weeks. 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 treatment regimen. The patient cannot limit himself to reasonable physical activity.
Among the non-drug methods of therapy, interstitial electrical stimulation, acupuncture, hirudotherapy and massage are effective. It is possible to use manual therapy, but only in competent hands.
Medical treatment. In case of acute pain, non-steroidal anti-inflammatory drugs are prescribed. In combination with anti-inflammatory drugs, muscle relaxants can also 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. Drug mixtures should be administered as close as possible to the focus of pain (into the affected muscles, the exit points of the roots).
With radiculopathy accompanied by 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 case of long-lasting myofascial pain, the introduction of non-steroidal anti-inflammatory drugs at trigger points, muscle relaxants, acupuncture and postisometric relaxation are effective.
Antidepressants, exercise therapy, and other non-pharmacological treatments are the first lines of treatment for chronic pain.
In case of narrowing of the spinal canal, weight loss, corset wearing, NSAIDs and various venotonics are indicated.
Surgical treatment is performed in case of crippling sciatica (in the first three days) and cauda equina syndrome (paresis of limbs, sensitivity, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
Preventionosteochondrosis of the lumbar spineit is reduced to avoid long, uncomfortable positions and excessive loads. It is important to properly equip the workplace and alternate work and rest periods. In case of physical overload, wear a restraint belt. Do exercises to strengthen your back muscles.