Osteochondrosis of the lumbar spine: symptoms and treatment
The cause of osteochondrosis of the lumbar spine is not well understood. The greatest importance is attached to hereditary predisposition, age-related changes in the intervertebral disc. Pain can be provoked by awkward movements, prolonged forced positions, lifting and carrying heavy loads, sports loads, overweight.
Depending on the duration, there is acute pain that lasts up to 4 weeks, subacute (from 4 to 12 weeks) and chronic (lasting more than 12 weeks).
Neurological complications in osteochondrosis of the lumbar spine:
Lumbago (back pain). Acute pain in the lumbar region begins suddenly, provoked by minimal movement in the back. The range of motion in the lumbar spine is very limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. The duration of lumbago with adequate treatment and immobilization of the lumbar spine is no more than 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lumbar region, aggravated by movement or in certain positions, discomfort with prolonged standing or sitting. Onset is usually gradual. Clinically, limited mobility in the lumbar spine, paravertebral muscle tension and pain are often determined. In most cases, the pain subsides within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (back pain that spreads to the legs). In the lumbar region, movement is limited, the paravertebral muscles are tense and painful on palpation.
In piriformis syndrome, the sciatic nerve is compressed, causing paresthesia and numbness in the legs and feet. Lasegue syndrome positive. But there are no signs of radicular syndrome.
Herniated disc with radicular syndrome or radiculopathy. Root compression is accompanied by shooting, burning pain in the legs. The pain is aggravated by movement, with coughing, accompanied by numbness along the roots, muscle weakness and loss of reflexes. Symptoms of positive tension.
In the lumbar region, the greatest load falls on the lower part, therefore, the roots of L5 and S1 are most often involved in the pathological process. Each root has its own zone of distribution of pain and numbness in the limbs.
Radicular syndrome is detected by a neurologist during an objective examination.
Vascular-radicular conflict. Paralytic sciatica syndrome occurs when blood circulation is interrupted in the radicular artery L5 and less often S1. Radiculoischemia at other levels is diagnosed very rarely.
During awkward movements or heavy lifting, acute back pain develops with irradiation along the sciatic nerve. Then there is paresis or paralysis of the extensors of the legs and fingers with "spanking" of the legs when walking (steppage). The patient, while walking, lifts his leg high, throws it forward and at the same time taps his toe on the floor.
In most cases, the paresis resolves within a few weeks.
Violation of blood supply to the spinal cord and cauda equina. In spinal stenosis, several spinal nerve roots (cauda equina) are affected. The pain at rest is minor, but when walking, there is an intermittent claudication syndrome. Pain when walking spreads along the roots from the lower back to the legs, accompanied by weakness, paresthesia, and numbness of the legs, disappears after rest or when the trunk is tilted forward.
Acute violation of spinal circulation is the most severe complication of lumbar osteochondrosis. Acutely developing paraparesis or lower plegia. Weakness in the legs is accompanied by numbness in the lower part of the legs, dysfunction of the pelvic organs.
Examination of patients with osteochondrosis of the lumbar spine.
Very important is the analysis of complaints and anamnesis to exclude serious pathology. A neurological examination is carried out to exclude damage to the roots and spinal cord. Manual examination allows you to determine the source of pain, mobility limitations, muscle spasms.
Additional examination methods are indicated for suspected specific back pain.
X-ray of the lumbar spine is prescribed to exclude tumors, spinal injuries, spondylolisthesis. X-ray signs of osteochondrosis have no clinical value, because all older and older people have them. Functional X-rays are performed to look for spinal instability. Photographs are taken in extreme flexion and extension positions.
For radicular or spinal symptoms, an MRI or CT scan of the lumbar spine is indicated. On MRI, the herniated disc and spinal cord are better seen, and on CT, the bone structure is better seen. The clinical level of the lesion and the MRI findings should match each other, because a disc herniation detected on MRI is not always the cause of pain.
In neurological deficits, electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis.
If somatic pathology is suspected, a thorough clinical examination is carried out.
Osteochondrosis of the lumbar spine, treatment.
When the first signs of discomfort appear in the lumbar spine, regular gymnastics is shown to strengthen the muscle corset, swimming, and massage courses.
Treatment of lumbar osteochondrosis is divided into 3 periods: treatment of acute, subacute and chronic periods.
In the acute period, the main task is to relieve the pain syndrome as early as possible and restore the patient's quality of life. In the presence of severe pain, immobilization of the lumbar spine with a special anti-radiculitis corset for 2-3 weeks is indicated. Bed rest should not last more than 2-3 days. In many patients, it is possible to increase the pain syndrome against the background of the development of the motor regimen. The patient should not limit himself to reasonable physical activity.
Of the non-drug therapy methods, interstitial electrical stimulation, acupuncture, hirudotherapy, and massage are effective. It is possible to use manual therapy, but only in competent hands.
Medical treatment. In acute pain, nonsteroidal anti-inflammatory drugs are indicated. In combination with anti-inflammatory drugs, muscle relaxants can be prescribed in short courses.
In osteochondrosis of the lumbar spine, therapeutic restrictions with local anesthetics, nonsteroidal anti-inflammatory drugs, and corticosteroids are effective. The drug mixture is administered as close as possible to the focus of pain (into the affected muscle, root exit point).
With radiculopathy in the presence of neuropathic pain, anti-inflammatory drugs are ineffective, in this case, antidepressants, anticonvulsants, and special therapeutic patches are prescribed.
With paresis, numbness, vascular preparations, group B vitamins are prescribed.
With prolonged myofascial pain, the introduction of non-steroidal anti-inflammatory drugs at trigger points, muscle relaxants, acupuncture, and post-isometric relaxation are effective.
For chronic pain, antidepressants, exercise therapy and other non-pharmacological treatments are preferred in treatment.
With stenosis of the spinal canal, weight loss, wearing a corset, NSAIDs, and various venotonics are indicated.
Surgical treatment is carried out with paralytic sciatica (in the first three days) and cauda equina syndrome (limb paresis, impaired sensitivity, urinary and fecal incontinence).
Prevention of lumbar osteochondrosis
Preventionosteochondrosis of the lumbar spinereduced to avoid long positions, uncomfortable, excessive load. It is important to properly equip your workplace, alternating periods of work and rest. Wear a fixation belt for excessive physical loads. Do exercises to strengthen your back muscles.