Lumbar osteochondrosis: causes, symptoms, diagnosis

Osteochondrosis of the lumbar region is a chronic degenerative-dystrophic disease of the lumbar department of the spine, affecting the structure of intervertebral discs and a number of located lumbar vertebrae. It affects people mostly of working age. It manifests itself by various symptoms, the main ones being pain in the lower back and legs, limitation of movements in the lower back. For diagnosis, methods such as radiography, computed tomography or magnetic resonance imaging of the lumbar spine are used. 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 aging. Some signs of this disease can be found almost every person (!), Since 25 years. But here is the severity of these changes, the rate of their progression, the degree of clinical manifestations depends on a variety of reasons, primarily on how healthy a lifestyle leads to a specific human. Moderate exercise, mandatory morning exercises, the correct body posture in the performance of a number of works (garden, construction, banal house cleaning and so on), orthopedic mattress - these are the moments that prevent the development of osteochondrosis of the lumbar region the spine.

According to statistics, osteochondrosis of the spine in 80% of cases is the cause of back pain.

How does osteochondrosis develop?

The entire vertebral column consists of separate vertebrae, between the bodies of which intervertebral disks are located. That is, between the two vertebrae is located one disc. The disk consists of a gelatinous (pulpous) nucleus and a fibrous ring. The core contains a lot of water and provides amortization and flexibility of the spine. The fibrous ring is located along the periphery of the gelatinous nucleus, as if holding it within itself.

With prolonged increased stress on the gelatinous nucleus, it changes its physiological properties, Loses water and dries up, and eventually becomes sequestered: the disk is flattened, and the bodies of the vertebrae approach to each other. Along with such processes, in the gelatinous nucleus the fibrous ring loses its elasticity and, under the influence of mechanical loads, begins to bulge. This is called protrusion. Then the fibrous ring cracks, and through the formed slits the gelatinous nucleus drops out: a disc hernia arises. A segment of two adjacent vertebrae and a disk located between them, called the vertebral segment, acquires excess mobility, thereby increasing the load on the adjacent segments. Overload of neighboring segments triggers a similar pathological process in them. These changes are called osteochondrosis.

In order to somehow ensure the stability of the spine, on the edges of the vertebral bodies, bone growths are formed, increasing the area of ​​the support. This phenomenon is called spondylosis. Changes in the joints between the vertebrae are called spondyloarthrosis. Usually all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - step alongside.

Causes

Because of what there is an osteochondrosis? To date, there are several theories of origin:

• mechanical theory: perhaps the main reason should be considered a regular increased strain on the spine. That is why osteochondrosis is almost an obligatory destiny of loaders, miners, builders and people of similar professions. The appearance of the osteochondrosis of the lumbar region is associated mainly with the slopes and lifting of the gravity, forced by an uncomfortable working posture;
• another factor of development can serve as a wrong posture, sitting in the wrong posture, which is especially important for workers of intellectual work;
• sometimes the hereditary features of the structure of the spine and the nutrition of its individual structures play a role;
• traumatic theory: any trauma of the spine (even the most insignificant) is capable of triggering a degenerative process;
• hormonal metabolic disorders and endocrine diseases can adversely affect metabolism in the tissues of the spinal column and contribute to the development of osteochondrosis;
• age theory implies the natural wear of disks in the process of life.

Rarely, only one of these theories can explain the occurrence of osteochondrosis in each specific case. More often, several factors are "to blame" at the same time.

In the occurrence of osteochondrosis of the lumbar spine, excessive weight plays an important role, since it itself is an overload for the spinal column. The higher the body mass index (the degree of obesity), the more pronounced are usually the changes in the spine. Among other reasons provoking the appearance of osteochondrosis, we can note:

• passive lifestyle;
• improper diet (fast food, excess sweet, semi-finished products: all this leads to an imbalance of microelements) and lack of liquid;
• anomalies in the structure of the spine (eg, the presence of an additional lumbar vertebra);
• constant wearing of shoes with high heels;
• pregnancy (due to excessive load on the lumbar spine);
• sudden termination of training for persons 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 the propagation depend on which receptors get irritated, that is how gross changes in the disk and surrounding tissues, there is a protrusion or already a hernia, in which direction did protrusion develop and etc.

Define reflex and compression syndromes in osteochondrosis of the lumbar spine.

Reflex syndromes develop in cases where the receptors of the fibrous ring of the affected disc, ligaments and capsules of joints that are located side by side are irritated. They are called reflexive because they are accompanied by muscular-tonic, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is transferred to other structures, causing symptoms mainly from the soft tissues.

Compression syndromes arise as a result of compression (compression) of nerve roots, vessels or spinal cord formed during osteochondrosis changes.

Reflex lumbar spine syndromes

Lumbago(lumbago): acute sudden pain in the lumbar region, which occurs with awkward movement or at the time of physical stress (much less often - for no apparent reason). It is believed that the appearance of lumbago is associated with the movement of the gelatinous nucleus within the fibrous ring, that is, it develops in the initial stages of osteochondrosis. Often the pain is described as a "chamber "the count was stuck in the lower back". Patients freeze in the position in which they were caught by pain. The slightest stirring causes an increase in pain (sneezing, coughing, trying to turn in the bed, move the leg). If a person was in a tilted position at the time of lumbago development (which happens most often), then he can not straighten. Reflexively, there is a pronounced muscular tension in the lumbar spine. Along the vertebrae in this area, a muscular cushion is palpated, which is sometimes visible to the naked eye without touch, so much muscle tension is expressed. Feeling is painful for the patient. This increased muscle tone fulfills an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can cause deterioration of the condition. The natural curvature of the vertebral column in the lumbar region (lordosis) is flattening, possibly curving aside (scoliosis) due to muscle tension.

Lumbalia- Another reflex syndrome of the lumbar level. This term also means the presence of pain in the lumbar region. But, unlike lumbago, with this pain does not appear acutely, but gradually, for several hours and even days. The pain is aching stupid in nature, of moderate intensity, increases with movement, in sitting or standing position, when changing from one position to another. A little relief comes from lying on the back with the bolster under the waist, but the passive lifting of the straightened leg in this position causes increased pain in the lower back (Lassega's symptom). Palpation of the lumbar spine is painful, but the reflex muscle tension is less pronounced than with lumbago, and sometimes it is absent altogether. Movement in the lumbar spine is limited, but possible. This means that the patient can bend down and sideways to a certain level (and then the pain intensifies).

Sciatica- Another type of reflex syndrome of the lumbar level. By this term is meant pain in the lumbar region, giving off in the buttock and in the leg (on the back surface). The pain has a different character, mostly aching, but can periodically increase in the type of "lumbago" in the leg. Just like with lumbargia, it increases with any movement, walking, straining, decreases in the supine position on the back. Usually the symptom of Lasseg is positive. Painful palpation of the lumbar spine, as well as pressure on some points (for example, In the middle of the line separating the buttock from the hip, in the middle of the hamstrings, in the middle of the popliteal pits). There is tension in the muscles of the waist. Slopes forward and to the sides are limited.

Compression syndromes of the lumbar spine

The clinical characteristic depends 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 with osteochondrosis of the lumbar spine (mainly hernia disks) squeeze the roots, then develops radiculopathy, the symptoms of which differ for each spine. Common to all the radiculopathy of the lumbar region is increased pain when sneezing, coughing, back movements (especially the slopes forward), the presence of muscle tension in the lumbar region, the limitation of movements in the lumbar region the spine. The most common types of radiculopathy of the lumbar spine are:

• radiculopathy L1, L2, L3: pains arise in the lower back, they are given to the antero-internal part of the thigh. In the same area, the emergence of paresthesias (feelings of crawling, numbness), is broken surface sensitivity (there is no sharp touch from the usual, the feeling of cold and hot). The knee reflex decreases, the weakness of the quadriceps femoris is revealed;
• radiculopathy L4: pain from the waist gives into the anterior part of the thigh, the inner surface of the knee joint and slightly lower along the inner surface of the shin. Paresthesia is felt in these areas, and surface sensitivity is lost (reduced). Also, weakness develops in the quadriceps muscle of the thigh, the knee reflex decreases;
• radiculopathy L5: one of the frequent localizations. The pain gives to the buttock, along the outer edge of the thigh, along the anterior antrum of the lower leg to the inner edge of the foot and thumb. Paresthesia is felt here, surface sensitivity is disturbed, it gives pain when sneezing and coughing. In addition, there is difficulty in unbending the big toe, since the muscle that performs this action is innervated by the spine L5. Sometimes it is difficult to stand on the heel with an unbent foot;
• radiculopathy S1: also often occurs with osteochondrosis of the lumbar spine. The pain gives to the buttock, along the outer and posterior margin of the thigh, along the outer edge of the shin to the outer edge of the foot and the fifth finger, the heel. These zones are characterized by a feeling of paresthesias, a decrease in surface sensitivity. Decreased Achilles reflex. When this root is damaged, the weakness of the leg muscles and the flexors of the foot develops, so it is difficult to stand and walk on your toes.

It is possible to develop several radiculopathies simultaneously, especially in L5, S1. It happens that one hernia squeezes several roots.

If the disc herniation protrudes back, then it can squeeze the spinal cord. This is possible only with the localization of a hernia in the upper lumbar region, since below the II lumbar vertebra There is no spinal cord (the roots of the spinal cord are subjected to compression, and horse syndrome develops tail).

If the lumbar vessels carrying blood flow to the spinal cord are subjected to compression, then In case of acute circulatory disturbance, spinal stroke develops in them, and with prolonged compression, myelopathy. Myelopathy is manifested by the bilateral weakness of the muscles of the legs, beginning with the foot and gradually progressing upwards. The sensation in the legs is broken, the Achilles reflex is lost, and later the knee. Perhaps the appearance of disorders of urination (frequent, "imperative" urges, requiring immediate satisfaction, urinary incontinence).

Diagnostic Methods

Diagnosis of osteochondrosis of the lumbar spine is based on clinical data and

data of additional research methods. A key role belongs to such methods as:

• radiography of the lumbar spine;
• computer tomography of the lumbar spine;
• magnetic resonance imaging of the lumbar spine.

Radiography of the lumbar spine is necessarily performed in 2 mutually perpendicular projections - a straight line 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, the anomalies of the spine structure, natural curves. To display the intervertebral joints and intervertebral openings, X-rays are made in oblique projections. To identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis) X-rays are performed in conditions of functional tests, that is, in the position of flexion and extension the spine. Normally, the change in the height of the intervertebral discs in the anterior or posterior parts is clearly visible in accordance with the direction of inclination body, with osteochondrosis due to the functional block of one of the segments, the height of the disc does not change either when bending, or when extension. With pathological mobility, the displacement of the vertebrae is determined forward or backward. The main radiographic signs of osteochondrosis include the narrowing of the intervertebral space, pathological mobility and displacement of the vertebral bodies, deposition salts in the disc tissue (calcification), the formation of marginal sprouting of the vertebral bodies, compaction of the vertebra at the border with the affected disc (subchondral sclerosis). Radiography of the lumbar spine is a routine research method that gradually loses its significance against the background of active introduction of new and more informative methods of research (CT and MRI). Radiography of the lumbar region is now used as a screening diagnostic method.

CT of the lumbar spine is also carried out using X-rays, but the radiation load on the body is much less than in radiography. The study is carried out on the table of a special device - a computer tomograph, it is absolutely painless. The received pictures are processed by means of the computer and allow to see much more structures, than at a roentgenography of a backbone.

MRI is a method in which electromagnetic radiation is used to create images. The study is also carried out in the supine position on the table, which rides 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 consider intervertebral discs (with both nucleus pulposus and fibrous ring) and intervertebral foramen, contents vertebral canal. Even a slight protrusion of the intervertebral disc will not go unnoticed. These methods (especially MRI) allow to determine the direction of the hernia of the disc if it is present, the degree of compression of the nerve roots, the spinal cord. Thus, these methods of investigation 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 defects in the structure of the spine and spinal cord), which is important in the differential diagnosis of the causes of pain in back.

Osteochondrosis of the lumbar spine is a disease that most often causes back pain. Represents, in fact, the destruction of intervertebral discs. Because of osteochondrosis of the lumbar spine, a person often loses his ability to work, because, except for pain, the disease can lead to impaired mobility of the spine, the inability to sit, stand and walk. Symptoms of this disease are nonspecific and require additional research methods to accurately confirm the diagnosis. The most informative and safe of modern diagnostic methods for osteochondrosis is the MRI of the spine.

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