Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine, affecting the structures of the intervertebral discs and adjacent lumbar vertebrae.It mainly affects people 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, research methods such as x-ray, computed tomography or magnetic resonance imaging of the lumbar spine are used.In this article you can learn about the causes, symptoms and diagnostic methods of osteochondrosis of the lumbar spine.
Osteochondrosis is the result of aging of the body.Some signs of this disease can be found in almost all people (!), starting from 25 years old.But the severity of these changes, the speed of their progression and the degree of clinical manifestations depend on many reasons, primarily on the health of a particular person.Moderate physical activity, obligatory morning exercises, correct body posture when performing numerous works (gardening, construction, banal housekeeping, 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 develop?
The entire spine consists of individual vertebrae, between the bodies of which there are intervertebral discs.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 annulus fibrosus is located along the periphery of the nucleus pulposus, as if holding it inside itself.
With increased and prolonged load on the nucleus pulposus, it changes its physiological properties, loses water, dries up and, over time, sequesters: the disc flattens and the vertebral bodies move closer to each other.Along with such processes, in the nucleus pulposus, the annulus fibrosus loses its elasticity and begins to swell under the influence of mechanical loads.This is called protrusion.Then the annulus fibrosus cracks and the nucleus pulposus falls through the resulting cracks: 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.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bony outgrowths are formed along the edges of the vertebral bodies, thereby increasing the support area.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 are the causes of osteochondrosis?Today there are several theories about its appearance:
- mechanical theory: perhaps the main reason should be considered the regular increased load on the spine.That is why osteochondrosis is an almost obligatory fate for loaders, miners, builders and people engaged in 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 developmental factor can be poor posture, incorrect sitting 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 spinal injury (even the most minor) can trigger a degenerative process;
- hormonal metabolic disorders and endocrine diseases can adversely affect the metabolism of spinal tissues and contribute to the development of osteochondrosis;
- The age theory implies natural wear and tear of the discs over the course of life.
Rarely, only one of these theories is able to explain the occurrence of osteochondrosis in each specific case.Most often, several factors are involved simultaneously.
Excess weight plays an important role in the occurrence of osteochondrosis of the lumbar spine, since it itself constitutes an overload for the spine.The higher the body mass index (degree of obesity), the more pronounced the spinal changes usually are.Other reasons that provoke the appearance of osteochondrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excess sweets, processed foods: all this leads to an imbalance of microelements) and a lack of fluid;
- abnormalities in the structure of the spine (for example, presence of an extra lumbar vertebra);
- constant wearing of high-heeled shoes;
- pregnancy (due to excessive load on the lumbar spine);
- abrupt cessation of training among people professionally involved in sports;
- smoking and alcohol abuse: as factors that accelerate the aging process of 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 propagation depend on which receptors receive the irritation, that is, on the severity of changes in the disc and surrounding tissues, the existence of a protrusion or herniation, the direction in which the protrusion was formed, etc.
There are reflex and compression syndromes in osteochondrosis of the lumbar spine.
Reflex syndromes develop in cases where the receptors of the annulus fibrosus of the affected disc, nearby ligaments and joint capsules are irritated.They are called reflexes because, in addition to pain, they are accompanied by musculo-tonic, vegetative-vascular or neurodystrophic reflex changes, that is, irritation with the help of reflexes is transmitted to other structures, causing symptoms mainly from soft tissues.
Compression syndromes result from 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, sudden pain in the lumbar region that occurs during an awkward movement or during a moment 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 nucleus pulposus within the annulus fibrosus, that is, it develops in the early stages of osteochondrosis.The pain is often described as “lumbago” or “a stuck stake in the lower back.”Patients freeze in the position in which the pain seized them.The slightest movement causes increased pain (sneezing, coughing, trying to turn over in bed, moving a leg).If a person was in a tilted position when lumbago developed (which happens most often), he or she cannot straighten up.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, we feel a muscular ridge, sometimes visible to the naked eye without touching, as the muscular 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 cause deterioration of the condition.The natural curvature of the spine in the lumbar region (lordosis) is flattened and a lateral curvature (scoliosis) is possible due to muscle tension.
Lumbodynie– another reflex syndrome of the lumbar level.This term also refers to the presence of pain in the lumbar region.But unlike lumbago, the pain does not appear acutely, but gradually, over several hours or even days.The pain is dull and aching, of moderate intensity, intensifies with movements, when sitting or standing, or when moving from one position to another.Lying on your back with a bolster under your lower back provides some relief, but passively raising your straight leg in this position causes increased lower back pain (Lassegue's symptom).Palpation of the lumbar spine is painful, but reflex muscle tension is less pronounced than with lumbago, and sometimes completely absent.Movements of the lumbar spine are limited, but possible.This means that the patient can bend to the sides to a certain level (and the pain then intensifies).
Lumboischialgia– another type of reflex syndrome of the lumbar level.This term refers to pain in the lumbar region, radiating towards the buttock and leg (along the back side).The pain is variable in nature, mainly aching, but can periodically intensify like a "tightening" in the leg.As with lumbodynia, it increases with any movement, walking, effort and decreases when lying on the back.The Lassegue sign is generally positive.Palpation of the lumbar spine is painful, as is pressure on certain points (for example, in the middle of the line separating 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 lower back muscles.Forward and sideways turns are limited.
Lumbar spine compression syndromes
Clinical characteristics depend on the structure subjected to compression.
Between the vertebrae of each intervertebral foramen there are nerve roots (spinal nerves): left and right.If the pathological formations of osteochondrosis of the lumbar spine (mainly herniated discs) compress the roots, radiculopathy develops, the symptoms of which differ for each root.What all lumbar radiculopathies have in common is increased pain when sneezing, coughing, movements of the lower back (especially when bending forward), the presence of muscle tension in the lumbar region and limitation of movement of 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 anterior inner thigh.In the same area, paresthesias may occur (creeping sensation, numbness), superficial sensitivity is impaired (sharp touch does not differ from ordinary touch, the sensation of cold and hot is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle is revealed;
- L4 radiculopathy: Lower back pain radiates to the lower anterior portion of the thigh, the inner aspect of the knee joint, and slightly lower along the inner aspect of the lower leg.In these same areas, paresthesias are felt, and superficial sensitivity is lost (diminished).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 lower leg to the inner edge of the foot and big toe.Here paresthesias are felt, superficial sensitivity is impaired, and pain when sneezing and coughing is transmitted here.In addition, it becomes difficult to extend the big toe, since 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;
- S1 radiculopathy: also common in osteochondrosis of the lumbar spine.The pain radiates to the buttock, along the outer posterior edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and 5th toe, heel.These areas are characterized by a feeling of paresthesia and a decrease in superficial sensitivity.The Achilles reflex decreases.When this root is damaged, weakness in the lower leg muscles and foot flexors develops, making it difficult to stand and walk on tiptoes.
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 bulges backward, it can put pressure on the spinal cord.This is possible only if the hernia is localized 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 of the lumbar region, which supply the spinal cord with blood, are subjected to compression, then in case of an acute circulatory disorder, a stroke develops there, and with prolonged compression, myelopathy.Myelopathy manifests as bilateral weakness of the leg muscles, starting at the foot and gradually progressing upward.Sensation in the legs is impaired, the Achilles reflex is lost, then the knee reflex.Urinary problems may occur (frequent, “imperative” urges requiring 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.The key role belongs to methods such as:
- X-ray of the lumbar spine;
- CT scan of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
Radiographs of the lumbar spine should be taken 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, abnormalities in the structure of the spine and natural curves.To visualize the intervertebral joints and intervertebral foramens, radiographs are taken in oblique projections.To identify pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is carried out under functional tests, that is, in the position of flexion and extension of the spine.Normally, the change in height of the intervertebral discs in the anterior or posterior parts is clearly visible depending on the direction of body tilt;with osteochondrosis, due to the functional block of one of the segments, the height of the disc does not change either in flexion or extension.With 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 bodies, deposition of salts in the disc tissue (calcification), the formation of marginal outgrowths 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 is gradually losing its importance against the background of the active introduction of new, more informative research methods (CT and MRI).X-rays of the lumbar region are now used as a screening diagnostic method.
A CT scan of the lumbar spine is also carried out using X-rays, but the body's exposure to radiation is significantly less than with X-rays. The examination is carried out lying on the table of a special device - a CT scanner;it's absolutely painless.The images obtained are processed using a computer and allow many more structures to be seen than with spinal x-rays.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also carried out in a lying position on a table which slides into the tomograph chamber.MRI is harmless and painless.
Computed tomography or MRI of the lumbar spine allows you to see all the structures of the spine, carefully examine the intervertebral discs (both the nucleus pulposus and the annulus fibrosus) and the intervertebral foramina, the contents of the spinal canal.Even a slight protrusion of the intervertebral disc will not go unnoticed.These methods (notably 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 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 of the spinal cord, abscesses, congenital malformations of the structure of the spine and spinal cord), which is important when carrying out a differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.This is in fact the destruction of the intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses the ability to work because, in addition to pain, the disease can lead to reduced 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.MRI of the spine is the most informative and safe modern method for diagnosing osteochondrosis.