Osteochondrosis of the lumbar spine: symptoms and treatment
The causes of osteochondrosis of the lumbar spine are not well understood. The greatest importance is given to hereditary predisposition, age-related changes in intervertebral discs. Pain can be provoked by awkward movement, long-term forced position, lifting and carrying heavy loads, sports overload, excess weight.
Depending on the duration, there are acute, subacute (from 4 weeks to 12 weeks) and chronic (lasting more than 12 weeks) pains that last up to 4 weeks.
Neurological complications in lumbar osteochondrosis:
Lumbago (back pain). Sharp pain in the lower back begins suddenly, provoked by minimal movements in the back. The range of motion in the waist is sharply limited, there is compensatory scoliosis. Paravertebral muscles of "stone" density. With adequate treatment and immobilization of the back, the duration of lumbago does not exceed 7-10 days.
Lumbodynia (back pain).Patients complain of moderate pain in the lower back, aggravated by movement or in a certain position, feel discomfort when standing or sitting for a long time. Onset is usually gradual. Clinically, limited mobility in the lumbar region, paravertebral muscle tension and pain are often identified. In most cases, the pain subsides within 2-3 weeks, but if left untreated, it can become chronic.
Lumboischialgia (back pain radiating to the leg). Movements in the lumbar region are limited, paravertebral muscles are tense and painful during palpation.
In piriformis syndrome, the sciatic nerve is compressed and causes paresthesia and numbness in the foot and leg. Positive Lasegue syndrome. But there are no signs of radicular syndrome.
Herniated disc with radicular syndrome or radiculopathy. Compression of the root is accompanied by burning pains in the leg. The pain is aggravated by movement, coughing, accompanied by numbness along the root, muscle weakness and loss of reflexes. Signs of positive tension.
In the lumbar region, the greatest load falls on the lower part, so the L5 and S1 roots are most often involved in the pathological process. Each root has a distribution zone of pain and numbness to the limbs.
Radicular syndromes are detected during an objective examination by a neurologist.
Vascular-radicular conflict. Paralytic sciatica syndrome occurs when the blood circulation in the radicular artery L5 and to a lesser extent S1 is impaired. Radiculoischemia at other levels is rarely diagnosed.
During an awkward movement or heavy lifting, acute back pain develops with radiation along the sciatic nerve. Then there is paresis or paralysis of the extensors of the foot and toes with a "snap" of the foot when walking (step). The patient, while walking, raises the leg high, throws it forward and at the same time taps the toe on the ground.
In most cases, paresis resolves safely within a few weeks.
Disruption of blood supply to the spinal cord and cauda equina. In spinal stenosis, several spinal nerve roots (cauda equina) are affected. There is little pain at rest, but there is a syndrome of intermittent claudication when walking. When walking, the pain spreads along the roots from the lower back to the leg, accompanied by weakness, paresthesia and numbness of the legs, disappears after rest or when the trunk is bent forward.
Acute disruption of spinal circulation is the most severe complication of lumbar osteochondrosis. Lower paraparesis or plegia develops sharply. Weakness in the legs is accompanied by numbness of the lower limbs, dysfunction of the pelvic organs.
Examination of patients with lumbar spine osteochondrosis.
The analysis of complaints and anamnesis is of great importance to rule out a serious pathology. A neurological examination is performed to avoid damage to the roots and spinal cord. Manual examination allows determining the source of pain, limitation of mobility, muscle spasm.
Additional examination methods are indicated for suspected specific back pain.
An x-ray of the lumbar spine is prescribed to rule out tumors, spinal injuries, and spondylolisthesis. X-ray signs of osteochondrosis do not have clinical significance, because they are present in all old and elderly people. Functional X-rays are taken to look for spinal instability. Pictures are taken in extreme flexion and extension.
An MRI or CT scan of the spine is indicated for radicular or spinal symptoms. Herniated discs and spinal cord are better seen on MRI, and bone structures are better seen on CT. The clinical level of the lesion and the MRI results should be consistent with each other, as a disc herniation detected on MRI does not always cause pain.
Electroneuromyography (ENMG) is sometimes prescribed to clarify the diagnosis in neurological deficits.
If somatic pathology is suspected, a comprehensive clinical examination is performed.
Osteochondrosis of the back, treatment.
When the first signs of discomfort appear in the waist, regular gymnastics, swimming and massage courses are indicated to strengthen the muscle corset.
Treatment of lumbar osteochondrosis is divided into 3 periods: treatment of acute, subacute and chronic period.
In the acute period, the main task is to eliminate the pain syndrome as soon as possible and restore the patient's quality of life. In case of severe pain, immobilization of the lower back with a special corset against radiculitis is indicated for 2-3 weeks. Bed rest should not exceed 2-3 days. In many patients, it is possible to increase the pain syndrome against the background of the expansion of the motor mode. The patient should not limit himself to acceptable physical activity.
Among the non-drug methods of treatment, interstitial electrical stimulation, acupuncture, hirudotherapy and massage are effective. It is possible to use manual therapy, but only in competent hands.
Treatment. Nonsteroidal anti-inflammatory drugs are indicated for acute pain. Along with anti-inflammatory drugs, muscle relaxants can be prescribed in a short course.
Local anesthetics, non-steroidal anti-inflammatory drugs and therapeutic blockades with corticosteroids are effective in lumbar osteochondrosis. Medicinal mixtures are applied as close as possible to the pain center (affected muscles, root exit points).
In the presence of neuropathic pain, anti-inflammatory drugs with radiculopathy are ineffective, in this case, antidepressants, anticonvulsants and a special therapeutic patch are prescribed.
It is prescribed with paresis, numbness, vascular preparations, vitamins of group B.
With long-lasting myofascial pain, the application of non-steroidal anti-inflammatory drugs, muscle relaxants, acupuncture and post-isometric relaxation at trigger points are effective.
Antidepressants, exercise therapy, and other non-pharmacological treatments are the mainstays of treatment for chronic pain.
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 (paresis of the surroundings, impaired sensation, incontinence of urine and feces).
Prevention of lumbar osteochondrosis
Preventionosteochondrosis of the backreduced to avoid long, uncomfortable positions, excessive loads. It is important to properly equip your workplace, alternate work and rest periods. Wear a restraint belt for physical loading. Do exercises to strengthen your back muscles.