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 disease common to medicine, which is considered the most common among all problems of the musculoskeletal system, hides behind the words sciatica, disc herniation, dorsalgia (back pain). The lower back, according to official statistics, suffers more often than other parts, leading to severe complications for the whole body. Why does this happen and how to treat osteochondrosis?

What is lumbar osteochondrosis

Degenerative neuro-orthopedic disease that affects the intervertebral discs and leads to secondary compensatory and reactive changes in the osteo-ligament apparatus and the nervous system - these are the definitions given by doctors of osteochondrosis. It mainly affects the lumbar part which is located between the thoracic and sacral part and consists of five vertebrae. Between them are discs - fibro-cartilage formations, formed from the following elements:

• cartilaginous tissue (membrane involved in the nutrition of discs from the vessels of the vertebral body);
• nucleus pulposus (gelatinous mass centered with nucleus pulposus);
• annular fibrosus (protects the fluid part).

Against the background of problems with blood circulation, changes in the composition of cartilage tissue, dehydration of the pulpal nucleus, the elasticity and resilience of the intervertebral disc deteriorates, and the fixation properties suffer. Under the influence of unfavorable factors, muscle fixation weakens and the vertebrae acquire excessive mobility. Further, degenerative and destructive processes affect the bone surfaces of adjacent vertebrae, dystrophy (malnutrition of the tissue) of the spine occurs.

The further procedure looks like this:

1. Microcracks appear in the loosened ring. The nucleus pulposus begins to penetrate it, gradually penetrates the annular fibrosus and is damaged, leading to a herniated disc or protrusion (initial stage).
2. Hernia compresses the spinal canal, can constrict mercury roots and blood vessels, causing pain and movement problems.
3. Due to the increased pressure on the vertebrae (from the thinning of the disc), the accelerated production of bone tissue begins and spinous processes (osteophytes) are created.

Reasons

Some experts are prone to intervertebral osteochondrosis of the lumbar spine, while others call it a "civilization disease", primarily an upright posture, which has increased the load on the back of a modern person. The disease usually begins in people over the age of 30, and is diagnosed more often in men than in women.

Lumbar osteochondrosis can develop:

• excessive spinal loads (household, professionals, sports);
• weak back muscles;
• incorrect distribution of household load on the spine (for lumbar spine - the most common reason);
• frequent back muscle tension;
• overweight, especially in the background of diabetes mellitus;
• spinal injuries;
• violation of metabolic processes;
• incorrectly fitted shoes, flat feet;
• problems with posture, which gives an uneven distribution of the load along the spine;
• lumbar spine hypothermia;
• sedentary lifestyle, prolonged driving;
• hormonal disorders (mainly in women);
• congenital pathologies of the musculoskeletal system;
• age (natural changes in fibro-cartilage tissue occur in people older than 50 years);
• frequent stress, emotional stress.

Level of development

The course of the disease is slow and gradual, and most patients recognize a serious problem only in phase 2 or later. In the absence of proper treatment, osteochondrosis progresses and can lead to disability.

Main medical classification:

1. The initial phase is characterized by initiating the process of destruction of intervertebral discs, reducing their elasticity, resilience. The disease is felt mainly by stress on the spine.
2. Destructive processes affect the annular fibrosus, the distance between the vertebrae decreases (the disc becomes thinner), amortization suffers, protrusions appear (protrusion of the intervertebral disc without ring rupture). Nerve root pinching and tissue inflammation occur, which increases the pain syndrome.
3. Annular fibrosus ruptures, hernia occurs. Vessels, nerve endings are compressed. Changes in the lumbar spine lead to general spinal deformity.
4. In the last stage, the muscles of the affected part, motor activity and working ability suffer. The vertebral column is noticeably bent - there is a pronounced scoliosis (deformation in three planes), lordosis (hypertrophied deviation of the lower back).

Symptoms of lumbar osteochondrosis

The clinical manifestations of the disease depend on the severity. The main symptom is a local pain syndrome that occurs in response to physical exertion, lifting heavy loads, hypothermia of the lower back, long-term preservation of uncomfortable posture (in a sitting position, the load is greater than in the vertical position). It is caused by irritation of the sinuvertebral (return) nerve.

The stages of lumbar osteochondrosis look like this:

• In the initial stage there is discomfort in the lumbar region, pain is rare, mostly with a large load on the back. They pass quickly.
• In phase 2, the mobility of the lumbar spine worsens, the pain occurs after physical exertion and without it (with a strong cough, change of posture), it gradually increases, it lasts for a long time. Malfunctions of internal organs are possible.
• With the development of osteochondrosis, the pain becomes permanent (permanent) and the vertebrae are deformed. The nerve endings are compressed so that the pain can get to the sacrum, leg, become sharp, shooting. There is a loss of sensitivity of the limbs, buttocks, thighs, numbness, paraesthesia (tingling, tingling, "chills"). Pelvic dysfunction occurs.
• In the last phase, motor function is impaired or becomes completely impossible, a curvature of the spine occurs. The pain is permanent, the person unconsciously takes an unnatural position to reduce it.

Reflex syndromes of the disease in official medicine are understood in 3 groups: muscular-tonic, neurodystrophic, vegetative-vascular. The last 2 categories are clearly manifested in 3 stages of the disease and later.

The clinical picture may include:

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

Complications

If osteochondrosis of the lumbar spine is diagnosed, treatment should begin immediately, as the patient may be completely disabled in the final stage. In the background of compression (contraction) of the spinal cord with vertebrae, between which there is no more space, paralysis of the lower extremities can develop.

In addition, osteochondrosis can cause:

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

Diagnostics

To make a correct diagnosis and assess the severity of the disease, the doctor collects data on the anamnesis (study of patient complaints, lifestyle, hereditary factors). After that, a physiological examination is performed, where the patient's motor abilities, posture, sensitivity level, muscle tone and size and their spasm are assessed. Knocking with a hammer marks the areas of radiation (where it radiates) due to pain in osteochondrosis of the lumbar spine.

After assigning to the patient:

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

Treatment of lumbar osteochondrosis

Surgical intervention is considered the last resort, mostly prescribed 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 are trying to carry out treatment of stages 1 and 2 by a conservative method.

Therapeutic measures are aimed at:

• removal of pain syndrome;
• removal of muscle spasms, hypertension;
• removal of the inflammatory process;
• improving blood circulation in the affected areas and metabolic processes;
• normalization of lumbar spine mobility;
• restoration of lumbar sensitivity.

There is no universal method of treatment: 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 implies the use of drugs (internally and externally) together with physical manipulations - massage, gymnastics, physiotherapy. The treatment regimen for osteochondrosis of the lumbar spine can be supplemented with acupuncture and hirudotherapy.

Treatment effectiveness will increase if you follow these rules:

• During treatment, a special strap or corset should be worn 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 follow the diet carefully: cartilage tissue needs sources of collagen (gelatin, aspic, aspic), and the whole body needs plant foods, fish, nuts. It is recommended to refuse salty, smoked, sour products, as well as sharp cheeses, fatty meat.
• The scheme prescribed by the doctor must be followed to the very end: do not stop treatment when the main symptoms subside, do not change the set of medications and procedures yourself.
• Together with the doctor it is worth choosing an orthopedic mattress that will help you relax your lower back during sleep and special shoes. Women are completely forbidden to heels.

Acute osteochondrosis of the lumbar spine requires special attention - its treatment begins with appointing the patient to bed rest for a few days. Feelings of pain are reduced by analgesic injections, novocaine blockade and glucocorticoid are not excluded. Spinal traction (using a traction table or vertical apparatus), walking on crutches, electrophoresis and laser therapy help to improve the condition.

Drug Therapy

Drugs for the treatment of osteochondrosis of the lumbar spine are used internally and locally. Topical gels and ointments are symptomatic therapy: relieving inflammation and pain, relieving cramps and muscle edema, improving blood circulation. In acute conditions, injections that have an immediate anti-inflammatory effect, antipyretic, analgesic are shown.

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Doctors generally prescribe home remedies for osteochondrosis:

• Chondroprotectors- protect cartilage tissue and promote its recovery, are indicated for long-term use (from six months or longer).
• Means that improve blood circulation and metabolic processes in tissues- tablets that are taken for several months, as the effect is cumulative.
• Muscle relaxants- relieve muscle cramps, used orally in a short course.
• Nonsteroidal anti-inflammatory drugs- quickly block pain, suppress 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, the external forms can be released, after which they are duplicated by tablets.
• Corticosteroids- injections to relieve pain are prescribed only in the absence of a significant effect of nonsteroidal drugs.
• Warming fats- 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 over a long period of time to increase the overall effectiveness of treatment.

Physiotherapy procedures

In order to enhance the effect of drug treatment and speed up recovery, the patient may be prescribed courses of physiotherapy. You can alternate them or go through several options at the same time. 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 electric currents to improve blood circulation in the affected areas.
• Laser therapy- activates biological processes in nerve endings, relieves symptoms of neuro-dystrophic syndrome.
• UHF- local impact on the lumbar region with a high-frequency magnetic field to stop the inflammatory process, stimulate cell regeneration (renewal) of tissues and reduce pain.
• Phonophoresis and electrophoresis- helps deliver drugs to the area where they are needed, which increases the effectiveness of drug treatment. The result depends on the particular agent used during the procedure.
• Darsonvalization- therapeutic effect of high-frequency alternating current in order to dilate blood vessels, improve blood circulation and tissue nutrition. The procedure affects the symptoms less than the others.
• Amplipulse- local effect of sinusoidal modulated currents, which reduces the intensity of pain. The procedure has an analgesic effect, vasodilator, neurostimulating, improves tissue trophism.

Rehabilitation gymnastics

Physical activity - especially when it comes to early (initial stage) osteochondrosis of the lumbar spine - must be included in the treatment: they help relax muscles and strengthen, have a beneficial effect on tissue nutrition. For people with stage 2 disease and more difficult exercise, a doctor will choose this. With the worsening, gymnastics, swimming, yoga (the most effective instructions) are forbidden.

The following exercises show good results:

• Emphasize your knees and palms, keeping your back straight (parallel to the floor). On the exhale, bend your lower back slightly, tilt your head back slightly. Count to 5-8 (depending on how you feel), inhale and bend your back with the wheel. Count to 5-8 again and take the starting position. The exercise is performed 10-12 times at a light pace. If necessary, they are divided into 2-3 approaches.
• Lie on your stomach. On the exhale, slowly pull your chest off the floor, bending at the lower back and trying to lift yourself as high as possible. The arms are outstretched forward, the legs do not move. Hold this position for 5-10 seconds and gradually lower yourself. Repeat the exercise 8-10 times, gradually increasing the duration of the delay at the upper point.

Massage

Massage is an effective method of treating any stage of osteochondrosis, which helps alleviate unpleasant symptoms, eliminate muscle cramps and normalize lymph outflow and supply blood to the affected areas. In addition, this procedure stimulates the regeneration of atrophied muscles and removes the limitation of vertebral mobility, strengthens the ligament apparatus. The massage is performed by a medical specialist in courses of 10-12 sessions when the symptoms of the acute phase subside.

Surgery

If the patient is diagnosed with significant neurological disorders, loss of control over urination, there is a strong hernial protrusion, surgical intervention is necessary. In addition, the indication for this is the lack of a positive effect of conservative treatment (which lasts longer than a month). Before receiving instructions for surgery, the doctor should assess all the risks, especially if traditional technology is chosen instead of microdiscectomy.

During the procedure, the surgeon can:

• remove pathologically altered areas by placing local implants (discectomy) on them that develop individually for each patient;
• for aligning the spine with a special bar - this helps to properly distribute the load and prevent new deformations.

Discectomy is performed under general anesthesia, access to the surgeon is from behind. 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 operative intervention is about 2 hours, the next day the patient should lie on his back. The rehabilitation period is 2 months. In microdiscectomy, the procedure takes 1. 5 hours, the incision is made in 3 cm and you can get up after leaving the anesthetic.

Treatment of osteochondrosis of the lumbar spine with folk remedies

After consulting a doctor who can properly assess the patient's condition, it is allowed to use prescriptions of traditional medicine. They do not give the same pronounced effect as drug therapy, do not replace physiotherapy, massage and gymnastics, but increase the likelihood of a positive outcome of the main treatment.

Some simple options:

• Grate the peeled black radish (350 g), combine with liquid honey (250 g) and vodka (100 ml). Use to rub the lower back with light massage movements for 10 minutes in the morning and evening. After that, it is desirable to wrap this area with a woolen cloth and lie for an hour under a blanket. The procedure is performed for 8-10 days, after which a break is made.
• With severe lumbar pain you can take 100 g of fresh cheese of medium fat, add 1 tsp. apple cider vinegar, place on a cotton cloth or gauze. The bandage is kept for 2 hours, the procedure is repeated, if necessary, 2 times a day. The duration of treatment is not limited.
• Collect fresh lilac flowers, fill a liter jar without crushing. Pour a liter of vodka, leave in a cool place for 3 weeks. Use to rub the affected area once a day for a month. After treatment, it is not necessary to cover the lower back with anything.

Prevention of lumbar osteochondrosis

Doctors say that most back diseases can be prevented by regular physical activities, which strengthen muscles, improve blood circulation and tissue nutrition. Osteochondrosis of the lumbar spine is no exception - treatment will not be necessary if you systematically do gymnastics, yoga and swimming.

Additional prevention measures:

• diet control (more plant foods, less animal fats, pickles, marinades: as in treatment);
• limiting large loads on the spine;
• monitoring of the endocrine system;
• elimination of bad habits (alcohol, smoking);
• use of orthopedic mattress;
• tracking posture;
• avoiding high heels (from 7 cm) for women.