Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is given to hereditary predisposition, age-related changes in the intervertebral discs. Pain can be provoked by difficult movements, prolonged forced position, lifting and carrying heavy loads, sports overload, overweight.
Depending on the duration, acute pain lasting up to 4 weeks, subacute (from 4 to 12 weeks) and chronic (lasting more than 12 weeks) are distinguished.
Neurological complications in osteochondrosis of the lumbar spine:
Lumbago (back pain). Acute pain in the lumbar region begins suddenly, provoked by minimal movements in the back. The range of motion in the lumbar spine is severely limited, there is compensatory scoliosis. "Stone" dense paravertebral muscles. The duration of lumbago with adequate treatment and immobilization of the spine is no more 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 with prolonged standing or sitting. The onset is usually gradual. Clinically, limited mobility in the spine, tension and pain in 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 (pain in the lower back that radiates to the leg). In the lumbar region, movements are limited, paravertebral muscles are tense and painful to palpation.
In piriformis syndrome, the sciatic nerve is compressed, causing paresthesia and numbness in the legs and feet. 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 legs. The pain is aggravated by movement, by coughing, accompanied by numbness along the root, muscle weakness and loss of reflexes. Positive symptoms of tension.
In the lumbar region, the greatest load falls on the lower part, therefore, the roots L5 and S1 are more often involved in the pathological process. Each root has its own area of distribution of pain and numbness in the limb.
Radicular syndromes are detected by a neurologist during an objective examination.
Vascular-radicular conflict. Paralyzing sciatic nerve syndrome occurs when blood flow is disturbed in the L5 and less commonly S1 radicular artery. Radiculoischemia at other levels is diagnosed extremely rarely.
During a difficult movement or heavy lifting, acute back pain develops with radiation along the sciatic nerve. Then there is paresis or paralysis of the extensors of the foot and toes with the "explosion" of the foot during walking (stair). While walking, the patient lifts the leg up, throws it forward and at the same time hits the toe on the floor.
In most cases, the paresis regresses 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. The pain at rest is minor, but when walking, there is an intermittent claudication syndrome. Pain during walking spreads along the roots from the lower back to the legs, is accompanied by weakness, paresthesia and numbness of the legs, disappears after rest or when the torso is tilted forward.
Acute violation of the circulation of the spine is the most serious complication of lumbar osteochondrosis. Lower paraparesis or plegia develops acutely. Weakness in the legs is associated with numbness of the lower extremities, dysfunction of the pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
Of great importance is the analysis of complaints and anamnesis to rule out a serious pathology. Neurological examination is performed to exclude damage to the roots and spinal cord. Manual examination allows you to determine the source of pain, limitation of mobility, muscle spasm.
Additional examination methods are indicated for specific suspected back pain.
An x-ray of the lumbar spine is prescribed to rule out tumors, spinal injuries, spondylolisthesis. X-ray signs of osteochondrosis have no clinical value, since all the elderly and the elderly have them. Functional x-rays are done to look for spinal instability. Photographs were taken in the position of extreme flexion and extension.
For radicular or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. In MRI, the herniated discs and spinal cord are better seen, and in CT, the bony structures. The clinical level of the lesion and the MRI findings must correspond to each other, as a disc herniation detected on MRI is not always the cause of pain.
In neurological deficits, electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis.
If somatic pathology is suspected, a complete clinical examination is performed.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort appear in the lumbar spine, regular gymnastics to strengthen the muscular corset, swimming and massage courses are indicated.
The treatment of lumbar osteochondrosis is divided into 3 periods: the treatment of the acute, subacute and chronic period.
In the acute period, the main task is to relieve the pain syndrome as soon as possible and restore the patient's quality of life. In the presence of intense pain, immobilization of the spine with a special corset against radiculitis is indicated for 2-3 weeks. Bed rest should not last more 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 be limited in reasonable physical activity.
Of the methods of therapy without drugs, interstitial electrical stimulation, acupuncture, hirudotherapy and massage are effective. It is possible to use manual therapy, but only in competent hands.
Medical treatment. In acute pain, non-steroidal anti-inflammatory drugs are indicated. 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 (in the affected muscles, root exit points).
With radiculopathy in 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 preparation, vitamins of group B are prescribed.
With prolonged myofascial pain, the introduction of non-steroidal anti-inflammatory drugs into trigger points, muscle relaxants, acupuncture and post-isometric relaxation are effective.
For chronic pain, antidepressants, exercise therapy and other non-pharmacological treatments are the first lines of treatment.
With stenosis of the spinal canal, weight loss, wearing a corset, NSAIDs and various venotonics are indicated.
Surgical treatment is performed with paralyzing sciatic nerve pain (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 spineis reduced to avoiding long, uncomfortable positions, excessive loads. It is important to properly equip your workplace, change the periods of work and rest. Wear a fixation belt for physical overload. Do exercises to strengthen your back muscles.