Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine that affects the structure of the intervertebral discs and adjacent lumbar vertebrae.It primarily affects people of working age.It manifests itself with various symptoms, the main of which is pain in the lower back and legs, and limited 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 diagnosis of osteochondrosis of the lumbar spine.
Osteochondrosis is a consequence 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 progress and the degree of clinical manifestations depend on many factors, primarily on how healthy a person leads a healthy lifestyle.Moderate physical activity, mandatory morning exercises, correct posture when performing many jobs (gardening, construction, banal house cleaning, etc.), orthopedic mattress - these are the points that prevent the development of osteochondrosis of the lumbar spine.
According to statistics, osteochondrosis of the spine is the cause of back pain in 80% of cases.
How does osteochondrosis develop?
The entire spine consists of individual vertebrae with intervertebral discs between their bodies.In other words, there is a disc between two vertebrae.The disc consists of a pulpy core and a fibrous annulus.The core contains a lot of water and provides cushioning and flexibility to the spine.The fibrous ring is located on the periphery of the nucleus pulposus, as if it holds it in itself.
As a result of the long-term increased load on the nucleus pulposus, its physiological properties change, it loses water and dries out, and over time it becomes isolated: the disc flattens, the vertebral bodies become closer to each other.Along with such processes, the fibrous ring in the nucleus pulposus loses its elasticity and begins to bulge under mechanical stress.This is called prominence.Then the fibrous ring cracks and the nucleus pulposus falls out through the resulting cracks: a disc herniation occurs.A section consisting of two adjacent vertebrae and the disc located between them, called a spinal segment, acquires excessive mobility, thereby increasing the load on the adjacent segments.Overloading of adjacent segments initiates a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bone growth is formed along the edges of the vertebral bodies, increasing the area of support.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondyloarthrosis.Usually, all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - go hand in hand.
Reasons
What causes osteochondrosis?Today, there are several theories about its occurrence:
- mechanical theory: the main reason may be the regular increased load on the spine.That is why osteochondrosis is an almost inevitable fate for loaders, miners, builders and similar professions.The occurrence of osteochondrosis of the lumbar region is mainly associated with bending and lifting heavy objects, which is forced by the uncomfortable working position;
- Another developmental factor can be incorrect posture, incorrect sitting, which is particularly important for white-collar workers;
- sometimes the hereditary characteristics of the structure of the spine and the nutrition of some of its structures play a role;
- traumatic theory: any injury to the spine (even the smallest) can trigger a degenerative process;
- hormonal metabolic disorders and endocrine diseases can adversely affect the metabolism in the tissues of the spinal column and contribute to the development of osteochondrosis;
- The age theory assumes the natural wear and tear of the discs during life.
Rarely, only one of these theories can explain the occurrence of osteochondrosis in each case.More often than not, several factors are to blame at the same time.
Excess weight plays an important role in the occurrence of osteochondrosis of the lumbar spine, as it is an overload of the spinal column itself.The higher the body mass index (a measure of obesity), the more pronounced the changes in the spine.Other causes of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, unnecessary sweets, processed foods: all this leads to 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 wearing of high-heeled shoes;
- pregnancy (due to excessive load on the lumbar spine);
- sudden cessation of training for persons engaged in sports professionally;
- smoking and alcohol consumption: as factors that accelerate the body's aging process.
Symptoms
The main manifestation of osteochondrosis of the lumbar spine is pain.The nature, origin and direction of the pain depends on which receptors are irritated, i.e. how severe the changes are in the disc and surrounding tissues, whether there is a protrusion or hernia, in which direction the protrusion developed, etc.
In osteochondrosis of the lumbar spine, there are reflex and compression syndromes.
Reflex syndromes develop in cases where the receptors of the fibrous annulus of the affected disc, ligaments and nearby joint capsules are irritated.They are called reflex because, in addition to pain, muscle tone, vegetative-vascular or neurodystrophic reflex changes are also associated with them, i.e. the irritation caused by reflexes also spreads to other structures, mainly causing symptoms from the soft tissues.
Compression syndromes develop as a result of compression (compression) of nerve roots, blood vessels or the spinal cord, as a result of the changes developed during osteochondrosis.
Reflex syndromes of the lumbar spine
Lumbago(lumbago): sharp, sudden pain in the lumbar region, which occurs during uncomfortable movement or at a moment of physical stress (much less often - for no apparent reason).It is believed that the occurrence of lumbago is related to the movement of the nucleus pulposus within the fibrous ring, that is, it develops at the initial stage of osteochondrosis.The pain is often referred to 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 turn over in bed, moving the legs).If a person was in an inclined 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.In this area, muscle ridges can be felt along the vertebrae, which can sometimes be seen with the naked eye without touching, the muscle tension is so pronounced.Palpation is painful for the patient.This increased muscle tone plays an immobilizing role, protecting the affected lumbar region from abnormal mobility, which can cause the condition to worsen.The natural curvature of the spine is flattened in the lumbar region (lordosis), lateral curvature (scoliosis) is possible due to muscle tension.
Lumbodynia– the lumbar level is another reflex syndrome.This term also means the presence of pain in the lumbar region.But unlike lumbago, the pain does not appear acutely, but gradually, over several hours or even days.The pain is dull and aching, of moderate intensity, intensifies with movement, sitting or standing, or when moving from one position to another.Lying on the back with the lower back supported brings some relief, but passively raising the straightened leg in this position causes increased pain in the lower back (Lassegue's symptom).Palpation of the lumbar spine is painful, but the reflex muscle tension is less pronounced than in the case of lumbago, and sometimes it is completely absent.Movement of the lumbar spine is limited, but possible.This means that the patient can bend down and to the side to a certain level (and then the pain intensifies).
Lumboschialgia– another type of lumbar reflex syndrome.This term refers to pain in the lumbar region that radiates to the buttocks and legs (along the back surface).The nature of the pain is variable, mostly it hurts, but sometimes it can intensify like a "shot" in the leg.Just as in the case of lumbodynia, it increases with every movement, walking, exertion, and decreases when lying on the back.Lassegue's sign is usually positive.Palpation of the lumbar spine is painful, as well as pressure on certain points (for example, in the middle of the line separating the buttocks 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 lateral bends are limited.
Compression syndromes of the lumbar spine
Clinical features depend on which structure is compressed.
There are nerve roots (spinal nerves) in each intervertebral cavity between the vertebrae: left and right.If in osteochondrosis of the lumbar spine pathological formations (mainly disc herniation) compress the roots, then radiculopathy develops, the symptoms of which differ from root to root.All lumbar radiculopathy is characterized by increased pain when sneezing, coughing, moving the lower back (especially when bending forward), muscle tension in the lumbar region and limited movement in the lumbar spine.The most common types of radiculopathy of the lumbar spine:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the front inner thigh.Paresthesia may occur in the same area (crawling sensation, numbness), surface sensitivity deteriorates (sharp touch does not differ from ordinary touch, the sensation of hot and cold is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- radiculopathy L4: the pain radiates from the lower back to the front lower part of the thigh, to the inner surface of the knee joint and slightly lower to the inner surface of the lower leg.Paresthesia is felt in the same areas and surface sensitivity is lost (decreased).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- radiculopathy L5: one of the common localizations.The pain radiates into the buttocks, along the outer edge of the thigh, along the front outer surface of the lower leg to the inner edge of the foot and big toe.Paresthesia is felt here, surface sensitivity is impaired, and pain during sneezing and coughing spreads here.Also, it becomes difficult to extend the big toe because the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on your heels with your legs outstretched;
- radiculopathy S1: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttocks, along the outer back edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and towards the 5th toe, heel.These areas are characterized by paresthesia and reduced surface sensitivity.The Achilles reflex decreases.If this root is damaged, weakness of the lower leg muscles and leg flexors develops, making it difficult to stand up and walk on the toes.
It is possible to develop radiculopathy of several roots at the same time, this is especially characteristic of L5, S1.It happens that a hernia compresses several roots.
If the herniated disc bulges backwards, it can put pressure on the spinal cord.This is possible only if the hernia is localized in the upper lumbar region, since there is no spinal cord under the second lumbar vertebra (here the roots of the spinal cord are compressed and cauda equina syndrome develops).
If the vessels of the lumbar region, which supply the spinal cord with blood, are subjected to compression, then in the case of acute circulatory disorders, a spinal cord develops in them, and with long-term compression - myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, which begins at the foot and gradually progresses upward.The sensation of the legs deteriorates, the Achilles reflex and later the knee reflex disappear.Urinary disorders may occur (frequent, "urgent" urge that requires immediate satisfaction, 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 is played by methods such as:
- X-ray of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
The X-ray of the lumbar spine should be taken in 2 mutually perpendicular projections - directly behind and laterally.Such images allow viewing the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, anomalies of the spine structure and natural curves.X-rays are taken in oblique projections to visualize the intervertebral joints and intervertebral openings.To identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed during functional tests, that is, in the flexion and extension position of the spine.Normally, the change in the height of the intervertebral discs in the anterior or posterior section is clearly visible according to the direction of inclination of the body;in the case of osteochondrosis, due to the functional block of one segment, the height of the disc does not change either during bending or stretching.In the case of pathological mobility, the movement of the vertebrae forward or backward is determined.The main radiological signs of osteochondrosis include the narrowing of the intervertebral space, the pathological mobility and displacement of the vertebral bodies, the deposition of salts in the disc tissue (calcification), the formation of marginal growths of the vertebral bodies, the compression of the vertebra at the border of the affected disc (subchondral sclerosis).X-ray examination of the lumbar spine is a routine research method, which is gradually losing its importance due to the active introduction of new and more informative research methods (CT and MRI).X-rays of the lumbar region are now used as a screening diagnostic method.
A CT examination of the lumbar spine is also performed using X-rays, but the radiation exposure to the body is significantly lower than with X-rays.The examination is performed lying on the table of a special device - computer tomograph;completely painless.The resulting images are processed with a computer, and we can see significantly more structures than with spine radiography.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also performed lying down, on a table that can be slid into the tomograph chamber.MRI is harmless and painless.
CT or MRI of the lumbar spine allows you to see all the structures of the spine, carefully examining the intervertebral discs (both nucleus pulposus and annulus fibrosus) and intervertebral openings, the contents of the spinal canal.Even a slight protrusion of the intervertebral disc does not go unnoticed.These methods (especially MRI) make it possible to determine the direction of the herniated disc, if any, and the degree of compression of the nerve roots and spinal cord.Thus, these research methods are much more informative in diagnosing 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 abnormalities of the structure of the spine and spinal cord), which is important in the differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.In fact, this is the destruction of the intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses his ability to work, because in addition to pain, the disease can lead to damage to the mobility of the spine, inability to sit, stand and walk.The symptoms of this disease are non-specific and require additional research methods to confirm the diagnosis accurately.Among the modern methods of diagnosing osteochondrosis, the most informative and safe is MRI of the spine.