In the medical literature, the term "osteochondrosis of the spine" means degenerative processes in the ossification centers in children. A common illness in medicine, considered the most common among all musculoskeletal system problems, is hidden behind the words sciatica, herniated disc, back pain (back pain). The lower back, according to official statistics, suffers more than the other parts, which causes serious complications for the entire body. Why does this happen and how to treat osteochondrosis?
What is lumbar spine osteochondrosis
Degenerative neuro-orthopedic disease that affects intervertebral discs and leads to secondary compensatory and reactive changes in the osteoligamentous system and the nervous system - this is the definition given by doctors in osteochondrosis. It mainly affects the lumbar region, which is located between the thoracic and sacral parts and consists of five vertebrae. There are disks between them - fibro-cartilaginous formations, formed from the following elements:
- cartilaginous tissue (the membrane involved in nourishing the discs of the vessels in the vertebral body);
- pulposus nucleus (gelatinous mass in the center with pulposus nucleus);
- annulus fibrosus (protects the fluid part).
In the context of problems with blood circulation, changes in the composition of cartilage tissue, dehydration of the pulpous nucleus, the elasticity and elasticity of the intervertebral disc deteriorate, its fixation properties suffer. Under the influence of unfavorable factors, muscle fixation weakens and the vertebrae acquire excessive mobility. Then, the degenerative and destructive processes affect the bone surfaces of the adjacent vertebrae, dystrophy (tissue malnutrition) of the spine occurs.
The later process looks like this:
- Microfissures appear in the loose ring. The pulpy nucleus begins to penetrate it, gradually breaks the fibrous ring and is damaged, which leads to a herniated disc or protrusion (initial stage).
- A hernia compresses the spinal canal, it can compress nerve roots and blood vessels, causing pain and movement problems.
- Due to the increased pressure in the vertebrae (due to the thinning of the disc), the accelerated production of bone tissue begins and spinous processes (osteophytes) are formed.
Some experts tend to call intervertebral osteochondrosis of the lumbar spine and others "a disease of civilization", mainly due to the upright posture, which increases the load on a modern person's back. The disease starts mainly in people over 30; in men, it is diagnosed more often than in women.
Lumbar osteochondrosis can develop:
- excessive loads on the spine (domestic, professional, sports);
- weak back muscles;
- incorrect distribution of domestic load on the spine (for the lumbar spine - the most common reason);
- frequent tension in the back muscles;
- being overweight, especially in the context of diabetes mellitus;
- spinal injuries;
- violation of metabolic processes;
- poorly adjusted shoes, flat feet;
- problems with posture, giving an unequal load distribution along the spine;
- hypothermia of the lumbar spine;
- sedentary lifestyle, long-term driving;
- hormonal disorders (mainly in women);
- congenital pathologies of the musculoskeletal system;
- age (natural changes in fibrocartilaginous tissue occur in people over 50);
- frequent stress, emotional tension.
Degrees of development
The course of the disease is slow and gradual, with most patients only recognizing a serious problem in stage 2 or later. In the absence of adequate treatment, osteochondrosis progresses and can lead to disability.
Main medical classification:
- The initial phase is characterized by the beginning of the process of destruction of the intervertebral discs, a decrease in their elasticity, elasticity. The disease is felt mainly with stress on the spine.
- Destructive processes affect the fibrous ring, the distance between the vertebrae decreases (the disc gets thinner), depreciation suffers, protrusions appear (protrusion of the intervertebral disc without breaking the ring). Nerve root clamping and tissue inflammation occurs, which increases the pain syndrome.
- A rupture of the fibrous ring occurs, a hernia occurs. Vessels, compressed nerve endings. Changes in the lumbar spine lead to a general spinal deformity.
- In the last stage, the muscles of the affected section atrophy, motor activity and the ability to work suffer. The spine is visibly curved - there is pronounced scoliosis (3-plane deformity), lordosis (deflection hypertrophied in front of the lower back).
Symptoms of lumbar osteochondrosis
The clinical manifestations of the disease depend on the stage of severity. The main symptom is a local pain syndrome that occurs in response to physical activity, weight lifting, hypothermia of the lower back, prolonged preservation of an uncomfortable posture (in the sitting position, the load is greater than in the upright position). It is caused by irritation of the sinuvertebral (recurrent) nerve.
The stages of lumbar spine osteochondrosis look like this:
- In the initial phase, there is discomfort in the lower back, pain is rare, especially with a high load on the back. They pass quickly.
- In stage 2, the mobility of the lumbar spine deteriorates, the pain occurs after physical effort and without it (with a strong cough, change of posture), it gradually intensifies, persists for a long time. Dysfunctions in the functioning 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 pain can be given to the sacrum, leg, it becomes acute, acute. Loss of sensation occurs in the limbs, buttocks, thighs, numbness, paresthesia (burning, tingling, "chills"). Dysfunctions of Organs pelvic organs appear.
- In the last stage, motor function is impaired or becomes completely impossible, curvature of the spine occurs. The pain is permanent, the person unconsciously takes an unnatural position to reduce it.
The reflex syndromes of the disease in official medicine are divided into 3 groups: muscle-tonic, neurodistrophic, 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 reflexes of the Achilles tendon, flexion of the fingers (if osteochondrosis of the sacral region is added);
- dry skin, blue discoloration;
- urinary disorders (urinary retention or incontinence), pain in the bladder;
- cramps and pain in the thigh region due to nutritional and circulatory disorders;
- tense, unsteady gait, lameness;
- increased sweating, fever with increased back pain;
- pain syndrome with radiation to the heart region (if the thoracic-lumbar region is affected).
If osteochondrosis of the lumbar spine is diagnosed, treatment should be started immediately, as in the last stage the patient may be completely disabled. In the context of compression (compression) of the spinal cord by the vertebrae, between which there is no space left, paralysis of the lower extremities may occur.
In addition, osteochondrosis can cause:
- disorders of Organs pelvic organs (men suffer from erectile function, women - ovarian activity);
- lumbago (acute low back pain), sciatica (pinching and inflammation of the sciatic nerve);
- prolapse of the intervertebral disc, stenosis (narrowing of the vertebral canal);
- damage to the lining of the spinal cord, which is fatal.
In order to make the correct diagnosis and evaluate the severity of the disease, the doctor collects anamnesis data (study of the patient's complaints, lifestyle, hereditary factors). Then, a physiological examination is performed, where the patient's motor capacity, posture, sensitivity level, muscle tone and size and their spasms are evaluated. When hitting with a hammer, the irradiation zones (where it occurs) are marked for pain in osteochondrosis of the lumbar spine.
After the patient is assigned:
- Radiographyis the most accessible way to examine the anatomical parameters of the vertebrae, assessing the tendency of the orifices to narrow between their bases and identifying bone growth.
- MRI(magnetic resonance imaging) - helps to assess the condition of the vessels that feed the spine, nervous processes, discs.
- CT(computed tomography) - it is prescribed only to check for changes in the vessels, in the lining of the spinal cord and to study marginal growths.
Treatment for lumbar spine osteochondrosis
Surgical intervention is considered the last resort, predominantly prescribed for patients with significant neurological disorders and high risk of disability. These problems are characterized by advanced osteochondrosis of the lumbar spine - doctors try to carry out the treatment of stages 1 and 2 according to a conservative method.
Therapeutic measures are aimed at:
- elimination of pain syndrome;
- removal of muscle spasm, hypertonicity;
- elimination of the inflammatory process;
- improved blood circulation in the affected areas and metabolic processes;
- normalization of lumbar vertebrae mobility;
- restoration of lumbar sensitivity.
There is no universal method of treatment: each specific case of osteochondrosis requires an individual regimen. It is especially important to consider the form of the disease: acute or chronic. Therapy is necessarily of a combined nature, implying the use of medications (internally and externally) together with physical manipulations - massage, gymnastics, physiotherapy. The treatment regimen for osteochondrosis of the lumbar spine can be complemented with acupuncture, hirudotherapy.
The effectiveness of the treatment will increase if you follow the following rules:
- A special belt or corset should be worn during treatment to reduce stress on the spine.
- Physical activity is excluded (only those recommended by the doctor remain), so as not to add provocative factors.
- It is important to monitor the diet closely: cartilage needs sources of collagen (gelatin, gelatin, cold meat) and the whole body needs plant foods, fish, nuts. It is advisable to refuse salty, smoked, preserved products, as well as spicy cheeses, fatty meats.
- The schedule prescribed by the doctor must be followed until the end: do not interrupt treatment when the main symptoms have subsided, do not change the set of drugs and procedures on your own.
- Along with the doctor, it is worth choosing an orthopedic mattress that helps to relax the lower back during sleep and special shoes. Women are completely prohibited from wearing heels.
Acute osteochondrosis of the lumbar spine requires special attention - its treatment begins with the indication of the patient to rest in bed for several days. Pain sensations are reduced by injections of painkillers, novocaine block and glucocorticoid are not excluded. Traction of the spine (using a traction table or vertical device), walking with crutches, electrophoresis and laser therapy help to improve the condition.
Medicines for the treatment of osteochondrosis of the lumbar spine are used internally and topically. Local gels and ointments are symptomatic therapy: they relieve inflammation and pain, relieve muscle spasm and edema and improve blood circulation. In acute conditions, injections have an immediate anti-inflammatory, antipyretic, analgesic effect.:
Mostly doctors prescribe home medicines for osteochondrosis:
- Chondroprotectors- protect cartilaginous tissue and promote its recovery, are indicated for long-term use (from six months or more).
- Means that improve blood circulation and metabolic processes in tissues- pills that are taken for several months, as the effect is cumulative.
- Muscle relaxants- relieve muscle spasm, are used orally in a short course.
- Non-steroidal anti-inflammatory- quickly blocks pain, suppresses 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 early stages, external forms can be dispensed, after which they are duplicated with tablets.
- Corticosteroids- injections to relieve pain are prescribed only in the absence of a significant effect of non-steroidal drugs.
- Ointments that have a warming effect- help to 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 course to increase the overall effectiveness of the treatment.
To increase the effect of drug treatment and accelerate recovery, physiotherapy courses may be prescribed for the patient. You can switch between 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)- implies the effect of low-power electrical currents to improve blood circulation in the affected areas.
- Laser therapy- activates biological processes in nerve endings, relieves symptoms of neurodystrophic syndrome.
- UHF- local impact on the lower back with a high-frequency magnetic field to interrupt the inflammatory process, stimulate cell regeneration (restoration) of the tissues and reduce pain.
- Phonophoresis and electrophoresis- helps to distribute medicines to the area that needs them, which increases the effectiveness of drug treatment. The result depends on the specific agent used during the procedure.
- Darsonvalization- therapeutic effect of high frequency alternating current to expand blood vessels, improve blood circulation and tissue nutrition. The procedure affects symptoms less than others.
- Amplipulse- local effect of sinusoidally modulated currents, due to which the pain intensity is reduced. The procedure has an analgesic, vasodilatory, neurostimulant effect, improves tissue trophism.
Physical activity - especially when it comes to early (early stage) osteochondrosis of the lumbar spine - should be included in the treatment: they help to relax and strengthen muscles, have a beneficial effect on tissue nutrition. For people with grade 2 disease and more intense exercise, the doctor will select you. With an exacerbation, gymnastics, swimming, yoga (the most effective directions) are prohibited.
The following exercises show good results:
- Emphasize your knees and palms, keep your back straight (parallel to the floor). As you exhale, slowly bend your lower back, slightly tilt your head back. Count to 5-8 (depending on how you feel), take a deep breath and arch your back with a wheel. Again count to 5-8 and take the starting position. The exercise is performed 10-12 times at a slow pace. If necessary, they are divided into 2-3 approaches.
- Lie on your stomach. As you exhale, slowly pull your chest off the floor, bending your lower back and trying to climb as high as possible. The arms are extended forward, the legs do not move. Hold in this position for 5-10 seconds and descend gradually. Repeat the exercise 8 to 10 times, gradually increasing the duration of the delay at the upper point.
Massage is an effective method to treat any stage of osteochondrosis, which helps to relieve unpleasant symptoms, remove muscle spasm, normalize the flow of lymph and the blood supply to the affected areas. In addition, this procedure stimulates the restoration of atrophied muscles and removes the limitation of mobility of the vertebrae, strengthening the ligamentous apparatus. The massage is performed by a doctor who specializes in courses of 10 to 12 sessions, when the symptoms of the acute phase subside.
If a patient is diagnosed with significant neurological disorders, loss of control over urination, strong hernia protrusion, surgical intervention is required. In addition, the indication for this is the absence of a positive effect of conservative treatment (lasting more than one month). Before receiving a referral for surgery, the doctor must assess all risks, especially if traditional technology is chosen instead of microdiscectomy.
During the procedure, the surgeon can:
- remove pathologically altered areas, placing in them local implants (discectomy), which are developed individually for each patient;
- to align the spine with a special rod - this helps to properly distribute the load and prevent further deformation.
The discectomy is performed under general anesthesia, the surgeon's access is posterior. During the operation, the skin is cut to a length of 10 cm, the muscles are pulled apart and the affected disc is removed. At the end of the procedure, the wound is sutured in layers. The duration of the surgical intervention is about 2 hours, the next day the patient must lie on his back. The rehabilitation period is 2 months. With microdiscectomy, the procedure lasts 1. 5 hours, an incision is made by 3 cm, and you can get up after leaving anesthesia.
Treatment of lumbar spine osteochondrosis with folk remedies
After consultation with a doctor who can correctly assess the patient's condition, it is permitted to use traditional medicine prescriptions. They do not produce the same pronounced effect as drug therapy, they do not replace physiotherapy, massage and gymnastics, but they increase the likelihood of a positive outcome of the main treatment.
Some simple options:
- Grate the peeled black radish (350 g), mix with liquid honey (250 g) and vodka (100 ml). Use to rub your lower back with light massage movements for 10 minutes in the morning and evening. After that, it is advisable to wrap this area with a woolen cloth and lie down for an hour under a blanket. The procedure is carried out for 8 to 10 days, after which they take a break.
- With severe low back pain, you can take 100 g of medium cottage cheese, add 1 tsp. apple cider vinegar, place on a cotton cloth or gauze. The dressing is kept for 2 hours, the procedure, if necessary, is repeated 2 times a day. The duration of treatment is not limited.
- Collect fresh lilac flowers, fill a liter jar with them without crushing. Pour a liter of vodka, leave in a cold place for 3 weeks. Use to rub the affected area once a day for a month. It is not necessary to cover your lower back with anything after processing.
Prevention of osteochondrosis of the lumbar spine
Doctors say that most back diseases can be prevented through regular physical activity, which strengthens muscles, improves blood circulation and tissue nutrition. Osteochondrosis of the lumbar spine is no exception - treatment will not have to be performed if you practice gymnastics, yoga and swimming systematically.
Additional preventive measures:
- control over the diet (more plant foods, less animal fats, pickles, marinades: as in the treatment);
- limit heavy loads on the spine;
- monitor the state of the endocrine system;
- elimination of bad habits (alcohol, smoking);
- use of orthopedic mattress;
- posture tracking;
- avoiding high heels (from 7 cm) for women.