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 mostly affects people of working age.It is manifested by various symptoms, the main of which are pain in the lower back and legs, limitation of movement in the lower back.Research methods such as radiography, computer 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 the aging of the organism.Some signs of this disease can be found in almost every person (!), starting 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 reasons, primarily on how healthy a person leads a lifestyle.Moderate physical activity, mandatory morning exercises, proper body posture when performing a series of works (pottery, 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 occur?
The entire spine consists of individual vertebrae, between whose bodies are intervertebral discs.That is, there is one disc between two vertebrae.The disc consists of a pulpous nucleus and a fibrous annulus.The core contains a lot of water and provides cushioning and flexibility to the spine.A fibrous ring is located along the periphery of the nucleus pulposus, as if holding it inside.
With long-term increased load on the nucleus pulposus, it changes its physiological properties, loses water and dries out, and over time becomes sequestered: the disc flattens, and the vertebral bodies move closer to each other.With such processes, the fibrous ring in the nucleus pulposus loses its elasticity and begins to protrude under the influence of mechanical loads.This is called a bulge.Then the fibrous ring breaks, and the nucleus pulposus falls out through the resulting cracks: a disc herniation occurs.The part of the two adjacent vertebrae and the disc located between them, called the spinal segment, acquires excessive mobility, thereby increasing the load on the adjacent segments.Overloading of adjacent segments causes a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bony growths are 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 - walk side by side.
Reasons
What causes osteochondrosis?Today, there are several theories about its origin:
- mechanical theory: perhaps the main reason should be considered the regular increased load on the spine.That is why osteochondrosis is an almost inevitable fate of loaders, miners, builders and people in similar occupations.The occurrence of osteochondrosis of the lumbar region is mainly associated with bending and lifting heavy objects, caused by an uncomfortable working position;
- Another development factor can be improper posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes hereditary characteristics of the structure of the spine and nutrition of its individual structures play a role;
- traumatic theory: any injury to the spine (even the smallest) can cause a degenerative process;
- hormonal metabolic disorders and endocrine diseases can negatively affect the metabolism in the tissues of the spinal column and contribute to the development of osteochondrosis;
- The age theory implies the natural wear and tear of discs during life.
Rarely, only one of these theories can explain the occurrence of osteochondrosis in each specific case.Several factors are often to blame at the same time.
Excess weight plays an important role in the development of osteochondrosis of the lumbar spine, because it is itself an overload of the spinal column.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine.Other causes of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excess sweets, processed food: 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 termination of training of persons who are professionally engaged in sports;
- smoking and alcohol abuse: as factors that accelerate the aging process in 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, i.e. how pronounced the changes are on the disc and surrounding tissues, whether there is a protrusion or hernia, in which direction the protrusion has appeared, etc.
In osteochondrosis of the lumbar spine, there are reflex and compression syndromes.
Reflex syndromes develop in cases where the receptors of the fibrous ring of the affected disc, ligaments and joint capsules located nearby are irritated.They are called reflex because, in addition to pain, they are accompanied by muscle-tonic, vegetative-vascular or neurodystrophic reflex changes, i.e. irritation is transmitted to other structures with the help of reflexes, causing symptoms mainly from soft tissues.
Compression syndromes occur as a result of compression (compression) of nerve roots, blood vessels or spinal cord due to changes that occur during osteochondrosis.
Reflex syndromes of the lumbar spine
Lumbago(lumbago): acute, sudden pain in the lumbar region that occurs during an unpleasant 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 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 found them.The slightest movement causes increased pain (sneezing, coughing, trying to roll over in bed, moving the leg).If a person was in an inclined position at the time of the development of lumbago (which happens most often), then he cannot stand up.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, you can feel the muscle ridge, which is sometimes visible with the naked eye without touching it, so the tension of the muscles is pronounced.Palpation is painful for the patient.This increased muscle tone has an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can cause the condition to worsen.The natural curvature of the spinal column in the lumbar region (lordosis) is flattened, and it can be curved to the side (scoliosis) due to muscle tension.
Lumbodynia– another reflex syndrome of the lumbar level.This term also indicates the presence of pain in the lumbar region.But, unlike lumbago, the pain does not occur acutely, but gradually, over several hours and even days.The pain is of a dull and aching nature, of moderate intensity, intensifies during movement, when sitting or standing, or when moving from one position to another.Lying on the back with a support under the lower back provides some relief, but passively raising the straight leg in this position causes increased pain in the lower back (Lassegue's symptom).Palpation of the lumbar part of the spine is painful, but the reflex muscle tension is less pronounced than in lumbago, and sometimes it is completely absent.Movement in the lumbar spine is limited, but possible.This means that the patient can also bend to the side 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 spreads to the buttocks and leg (along the back surface).The pain is of a different nature, mostly painful, but occasionally it can intensify like "shooting" in the leg.As with lumbodynia, it increases with any movement, walking, straining, and decreases when you lie on your back.Lassegue's sign is usually positive.Palpation of the lumbar spine is painful, as well as pressure on certain points (eg in the middle of the line that separates 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 muscles of the lower back.Front and side turns are limited.
Compression syndromes of the lumbar spine
Clinical features depend on which structure is subjected to compression.
Between the vertebrae in each intervertebral foramen there are nerve roots (spinal nerves): left and right.If pathological formations in osteochondrosis of the lumbar spine (mainly disc herniations) compress the roots, then radiculopathy develops, the symptoms of which differ for each root.Common to all lumbar radiculopathy is increased pain when sneezing, coughing, movements in the lower back (especially bending forward), the presence of muscle tension in the lumbar region and limitation of movement in the lumbar spine.The most common types of radiculopathy of the lumbar spine are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the front inner thigh.In the same area, paresthesia (crawling sensation, numbness) may occur, surface sensitivity is disturbed (a sharp touch does not differ from an ordinary touch, the sensation of cold and hot is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- L4 radiculopathy: pain from the lower back radiates to the front of the lower thigh, the inner surface of the knee joint and slightly lower along the inner surface of the lower leg.Paresthesia is felt in these same areas, and surface sensitivity is lost (reduced).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- L5 radiculopathy: one of the common localizations.The pain spreads to the buttocks, along the outer edge of the upper leg, 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 disturbed, and pain during sneezing and coughing is transmitted here.In addition, 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 the heel with the foot extended;
- radiculopathy S1: it is also common in osteochondrosis of the lumbar spine.The pain spreads to the buttocks, along the outer back edge of the upper leg, along the outer edge of the lower leg to the outer edge of the foot and the 5th toe, the heel.These areas are characterized by a feeling of paresthesia and reduced surface sensitivity.Achilles reflex decreases.When this root is damaged, weakness of the calf muscles and foot flexors develops, making it difficult to stand and walk on tiptoes.
Simultaneous development of radiculopathy of several roots is possible, which is especially typical for L5, S1.It happens that one hernia squeezes several roots.
If a 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 part, because there is no spinal cord under the second lumbar vertebra (there the roots of the spinal cord are compressed and the cauda equina syndrome occurs).
If the vessels of the lumbar region, which supply the spinal cord with blood, are subjected to compression, then in the case of an acute circulatory disorder, a spinal stroke develops in them, and with prolonged compression - myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, which starts at the feet and gradually progresses upwards.Sensation in the legs is disturbed, the Achilles reflex is lost, and later the knee reflex.Urination disorders may occur (frequent, "imperative" urges that require 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.Methods such as:
- x-ray of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance of the lumbar spine.
X-ray of the lumbar spine must be performed in 2 mutually perpendicular projections - direct posterior and lateral.Such images allow you to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, anomalies in the structure of the spine and natural curves.In order to show the intervertebral joints and intervertebral openings, radiography is done in oblique projections.In order to determine the pathological mobility of certain lumbar segments (which is a sign of osteochondrosis), radiography is done under functional tests, that is, in the position of flexion and extension of the spine.Normally, the change in the height of the intervertebral discs in the front or back part is clearly visible in accordance with the direction of the inclination of the body;in osteochondrosis, due to the functional block of one of the segments, the disc height does not change during flexion or extension.In the case of pathological mobility, the movement 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 body, deposition of salt in the disc tissue (calcification), formation of marginal outgrowths of the vertebral body, compaction of the vertebra at the border with the affected disc (subchondral sclerosis).X-ray of the lumbar spine is a routine research method that is gradually losing its importance in the context of the active introduction of new and more informative research methods (CT and MRI).X-ray of the lumbar region is now used as a screening diagnostic method.
CT of the lumbar spine is also done using X-rays, but the body's exposure to radiation is significantly less than with X-rays.The examination is performed lying on the table of a special device - a computerized tomograph;it is absolutely painless.The resulting images are processed using a computer and allow you to see significantly more structures than with an X-ray of the spine.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also performed in the supine position on a table that slides 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 examine 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 will not go unnoticed.These methods (especially MRI) make it possible to determine the direction of the disc herniation, 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 conducting a differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.It is, in fact, 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, the inability to sit, stand and walk.The symptoms of this disease are non-specific and require additional research methods to confirm the correct diagnosis.The most informative and safest of the modern methods for diagnosing osteochondrosis is MRI of the spine.