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 predominantly affects people of working age.It manifests itself with several symptoms, the main ones being pain in the lower back and legs, and limited movement in the lower back.For diagnosis, research 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 diagnostic methods of osteochondrosis of the lumbar spine.
Osteochondrosis is the result of the aging of the body.Some signs of this disease can be found in almost everyone (!), from the age of 25.But the severity of these changes, the speed of their progression and the degree of clinical manifestations depend on many reasons, primarily on how healthy a particular person leads a lifestyle.Moderate physical activity, mandatory morning exercises, correct body posture when carrying out various work (gardening, construction, banal cleaning of the house, etc.), orthopedic mattress - these are the points that prevent the development of osteochondrosis of the lumbar spine.
According to statistics, spinal osteochondrosis is the cause of back pain in 80% of cases.
How does osteochondrosis develop?
The entire spine consists of individual vertebrae, between whose bodies intervertebral discs are located.In other words, there is a disc between two vertebrae.The disc consists of a nucleus pulposus and an annulus fibrosus.The core contains a lot of water and provides cushioning and flexibility to the spine.The fibrous ring is located along the periphery of the nucleus pulposus, as if holding it inside itself.
With a prolonged increase in the 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.Along with these processes, in the nucleus pulposus, the fibrous ring loses its elasticity and begins to swell under the influence of mechanical loads.This is called protrusion.Then, the fibrous ring cracks and the nucleus pulposus falls through the resulting fissures: a herniated disc occurs.A section of two adjacent vertebrae and a disc located between them, called the spinal segment, acquires excessive mobility, thereby increasing the load on adjacent segments.Overloading neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
To somehow ensure the stability of the spine, bone growths are formed along the edges of the vertebral bodies, increasing the support area.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondyloarthrosis.Generally, all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - go hand in hand.
Reasons
What causes osteochondrosis?Today there are several theories about its occurrence:
- mechanical theory: perhaps the main reason should be considered the regular increase in the load on the spine.That is why osteochondrosis is an almost obligatory fate of loaders, miners, builders and people of similar professions.The occurrence of osteochondrosis of the lumbar region is mainly associated with bending and lifting heavy objects, forced by an uncomfortable working posture;
- Another development factor may be incorrect posture, sitting in the wrong position, which is especially important for mental workers;
- sometimes hereditary features of the structure of the spine and the nutrition of its individual 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 spine and contribute to the development of osteochondrosis;
- The aging theory implies natural wear and tear on the discs throughout life.
Rarely, only one of these theories can explain the occurrence of osteochondrosis in each specific case.Most of the time, 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 in itself represents an overload on the spine.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine generally are.Other reasons that provoke the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excess sweets, processed foods: all of this leads to an imbalance of microelements) and lack of fluids;
- anomalies in the structure of the spine (for example, the presence of an additional lumbar vertebra);
- constant use of high-heeled shoes;
- pregnancy (due to excessive load on the lumbar spine);
- sudden cessation of training in people professionally involved in sport;
- smoking and alcohol abuse: as factors that accelerate the body's aging process.
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 propagation depend on which receptors receive irritation, that is, on the severity of changes in the disc and surrounding tissues, whether there is a protrusion or a hernia, in which direction the protrusion formed, and so on.
There are 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 joint capsules located nearby are irritated.They are called reflexes because, in addition to pain, they are accompanied by muscular-tonic, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly in soft tissues.
Compression syndromes arise as a result of compression (squeezing) of nerve roots, blood vessels or spinal cord due to changes formed during osteochondrosis.
Reflex syndromes of the lumbar spine
Lumbago(lumbago): sharp and sudden pain in the lower back that occurs during a strange movement or in a moment of physical stress (much less often - for no apparent reason).It is believed that the occurrence of low back pain is associated with 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 they were struck by pain.The slightest movement causes increased pain (sneezing, coughing, trying to turn over in bed, moving a leg).If a person was bent over when low back pain developed (which happens most often), they cannot straighten up.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, a muscular ridge is felt, which is sometimes visible to the naked eye without touching, the muscle tension is so pronounced.Palpation is painful for the patient.This increase in muscle tone plays an immobilizing role, protecting the affected lumbar segment from pathological mobility, which can worsen the condition.The natural curve of the spine in the lower back (lordosis) is flat and lateral curvature (scoliosis) is possible due to muscle tension.
Lumbodínia– another reflex syndrome at the lumbar level.This term also means the presence of pain in the lower back.But, unlike low back pain, the pain does not occur acutely, but gradually, over several hours and even days.The pain is dull and aching in nature, of moderate intensity, intensifies with movement, when sitting or standing, or when moving from one position to another.Lying on your back with a pillow under your lower back brings some relief, but passively lifting your straight leg in this position causes increased pain in the lower back (Lassegue's symptom).Palpation of the lumbar spine is painful, but reflex muscle tension is less pronounced than with low back pain and is sometimes completely absent.Movement of the lumbar spine is limited but possible.This means that the patient can bend sideways to a certain level (and then the pain intensifies).
Lumboischialgia– another type of reflex syndrome at the lumbar level.This term refers to pain in the lower back, radiating to the buttocks and legs (along the posterior surface).The pain varies in nature, mainly aching, but may periodically intensify like a “shot” in the leg.Just like lumbodynia, it increases with any movement, walking, exertion and decreases when you are lying on your back.The Lassegue sign is usually positive.Palpation of the lumbar spine is painful, as is pressure at certain points (for example, 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 in the lower back.Forward and sideways bends are limited.
Lumbar spine compression syndromes
Clinical features depend on which structure is subject 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 (primarily herniated discs) compress the roots, radiculopathy develops, the symptoms of which differ for each root.Common to all lumbar radiculopathies is increased pain when sneezing, coughing, movements in the lumbar region (especially leaning forward), the presence of muscle tension in the lumbar region and limited movement in the lumbar spine.The most common types of radiculopathies of the lumbar spine are:
- radiculopathy L1, L2, L3: pain occurs in the lower back, radiating to the anterior inner part of the thigh.In the same area, paresthesia may occur (crawling sensation, numbness), superficial sensitivity is impaired (sharp touch does not differ from normal touch, the sensation of cold and heat is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- L4 radiculopathy: pain in the lower back radiates to the lower anterior part of the thigh, the inner surface of the knee joint and slightly lower along the inner surface of the leg.In these same areas, paresthesia is felt and superficial sensitivity is lost (decreased).Weakness also develops in the quadriceps femoris muscle, the knee reflex decreases;
- L5 radiculopathy: one of the common locations.The pain radiates to the buttock, along the outer edge of the thigh, along the anterior outer surface of the leg to the inner edge of the foot and big toe.Paresthesia is felt here, superficial sensitivity is impaired, and pain when sneezing and coughing is transmitted here.Furthermore, it becomes difficult to extend the big toe, as the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand with your foot extended;
- S1 radiculopathy: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttock, along the outer back edge of the thigh, along the outer edge of the leg to the outer edge of the foot and to the 5th toe, heel.These areas are characterized by a sensation of paresthesia and decreased surface sensitivity.The Achilles reflex decreases.When this root is damaged, weakness develops in the leg muscles and foot flexors, making it difficult to stand and walk on toes.
The simultaneous development of radiculopathy of several roots is possible, this is especially typical for L5, S1.It happens that a hernia compresses several roots.
If a herniated disc protrudes backwards, it can put pressure on the spinal cord.This is only possible if the hernia is located in the upper lumbar region, since there is no spinal cord below the second lumbar vertebra (there the roots of the spinal cord are compressed and cauda equina syndrome develops).
If the vessels in the lumbar region, which supply blood to the spinal cord, are subjected to compression, then in the case of an acute circulatory disorder, a stroke develops in them, and with prolonged compression, myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, starting at the foot and gradually progressing upward.Sensitivity in the legs is impaired, the Achilles reflex is lost, and later the knee reflex.Urinary disorders may occur (frequent and “imperative” urges that require immediate gratification, urinary incontinence).
Diagnostic methods
Diagnosis of osteochondrosis of the lumbar spine is based on clinical data and data from additional research methods.The main role belongs to methods such as:
- X-ray of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
Radiographs of the lumbar spine must be taken in 2 mutually perpendicular projections - direct posterior and lateral.These 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.To display the intervertebral joints and intervertebral foramina, radiographs are taken in oblique projections.To identify pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed 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 anterior or posterior sections is clearly visible according to the direction of inclination of the body;in osteochondrosis, due to functional blockage of one of the segments, the height of the disc does not change during flexion or extension.With pathological mobility, the displacement 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 bodies, deposition of salts in the disc tissue (calcification), formation of marginal growths of the vertebral bodies, compaction of the vertebra on the border with the affected disc (subchondral sclerosis).Lumbar spine radiography is a routine research method, which is gradually losing its significance in the context of the active introduction of new and more informative research methods (CT and MRI).X-rays of the lower back are now used as a screening diagnostic method.
A computed tomography of the lumbar spine is also performed using X-rays, but the radiation exposure to the body is significantly less than with X-rays. The examination is carried out lying on the table of a special apparatus - a computed tomograph;It is absolutely painless.The resulting images are processed on a computer and allow you to see significantly more structures than on spinal x-rays.
Magnetic resonance imaging is a technique that uses electromagnetic radiation to create images.The exam is also performed in the supine position on a table that slides into the tomographic chamber.MRI is harmless and painless.
Computed tomography or magnetic resonance imaging of the lumbar spine allows you to see all structures of the spine, carefully examine the intervertebral discs (both the nucleus pulposus and the fibrous ring) and the intervertebral foramina, 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 herniated disc, if present, 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 defects in 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, it is the destruction of the intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses the ability to work, since, in addition to pain, the disease can lead to impaired mobility of the spine, 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 methods for diagnosing osteochondrosis is MRI of the spine.