Many of us are familiar with back pain, which interferes with normal life in the long run. Although the cause may be trauma, neurological disease or spinal malformations, osteochondrosis of the lumbar spine is often a provocateur of unpleasant sensations. This degenerative disease can occur even at a young age, the initial manifestations can be detected even in adolescents and school children, but the majority of patients are people after 40 years. Changes in the spinal space associated with osteochondrosis can occur in any part, from the cervix to the lumbar and sacrococcygeal. But the most common form that brings patients a lot of unpleasant and painful sensations is osteochondrosis of the lumbar spine. What kind of pathology is this, what is special for it and does the pain in the lower back always mention this disease.
Osteochondrosis of the lumbar spine: what is the essence of the pathology?
Osteochondrosis is a term derived from two words: Greek osteon, which means bone, and chondron, which is cartilage. Thus, osteochondrosis of the lumbar spine (and all others as well) is initiated by changes in the disc cartilage, which is the natural "layer" between the vertebrae and the shock absorber during movement. Changes in the structure of the disc and its function are accompanied by natural responses in the vertebral body. With this disease, gradual degenerative changes occur in the body of the disc. The height of the disc decreases, as its physiological function is lost, causing instability and changes in the vertebral joints. As the disease progresses, reactions occur at the ends of the vertebral body. These reactions can be divided into three stages: edema due to malnutrition and dystrophic changes, fat degeneration and, in the last stage, sclerosis.
Causes of spinal osteochondrosis
Our vertebral discs begin to change gradually and change when we are around 20 years old. The gradual decrease of fluid in the body of the disc causes a decrease in the size of the space between the vertebrae (chondrosis). This means that the disc can no longer function as a shock absorber and tension on the anterior and posterior longitudinal ligaments of the altered vertebrae. As a result, a much greater load is imposed on the vertebral joints, which increases from year to year. The spinal ligaments are not positioned correctly and are stretched unevenly, and the moving segments of the spine gradually become unstable. The dorsal segment usually consists of two adjacent vertebral bodies and a disc between them. The upper and lower plates in the vertebral body experience higher pressure, zones of thickening (sclerosis) and ridges at the border (spondylophytes) gradually develop. Because of these changes, the overall clinical picture of the disease is formed in the future.
What are the symptoms of lumbar spine osteochondrosis?
Almost all forms of the disease manifest themselves in the form of unusual back pain, which is difficult to control and which affects certain segments of the spine (from the neck to the lower back and sacrum). Symptoms of lumbar spine osteochondrosis may be limited to the spine (in the lumbar region) or spread to the legs if originating from the lumbar spine, or the arms if originating from the cervical spine.
Symptoms can occur while resting, exercising, or doing routine activities. There may be radicular symptoms caused by compression, irritation in the nerve root area, or pseudo-radicular symptoms if the cause is at a nearby facet joint or muscle. Often, osteochondrosis of the lumbar spine is combined with lesions in other areas - the cervical spine, cervix - then the symptoms will be more widespread. In other words, discomfort and pain give rise to not just one damaged segment, but several areas of osteochondrosis at once. The disease has a non -bumpy path with periods of exacerbation (serious symptoms can interfere with normal life) and a temporary reduction, when manifestations diminish or almost disappear. But any factor, physical or mental, can cause a sudden relapse.
How is spinal osteochondrosis diagnosed?
Diagnosis is made based on the study of medical history and complaints of the patient, physical examination with the identification of special symptoms and neurological examination. Today, doctors are increasingly inclined to perform instrumental diagnostics, as other pathologies are often disguised as osteochondrosis.
For example, among patients who suffer from persistent back pain and plan surgery to relieve the pain, bone health is an important factor. If a patient is found to have low bone density before surgery, this can affect the osteochondrosis treatment plan before, during and after the procedure. Studies from the Hospital for Special Surgery (HSS) in New York showed that computed tomography of the lumbar spine before surgery showed that a large number of patients had low bone density that had never been previously diagnosed.
Nearly half of the nearly 300 patients tested were diagnosed with osteoporosis, or its predecessor, osteopenia. It is very important to take this into account at the age of over 50 years. The prevalence of low bone mineral density in this group was 44%, and 10. 3% were diagnosed with osteoporosis. Low bone density is a known risk factor for vertebral fractures, and this condition can be an exacerbating factor in the treatment of osteochondrosis.
Treatment of spinal osteochondrosis
Treatment options depend on the severity of your symptoms. Physical therapy is the main method of relieving pain in the early stages. Ultrasound, electrotherapy, heat treatment are used. Treatment is complemented by appropriate pain management such as NSAIDs, muscle relaxers, and steroids. Injection practices can be used - blockade, trigger point injection. Shown are manual therapy, osteopathy, exercise therapy.
Surgical treatment is always a last resort. There are situations when surgery is needed. Examples are paralysis of the bladder or rectum caused by narrowing of the spinal canal or a prolapsed disc, a large herniated disc. The option for surgery is chosen together with the doctor. But after surgical treatment, the problem cannot be completely eliminated, requiring long -term rehabilitation and lifelong treatment. This is due to the fact that osteochondrosis does not disappear anywhere, it can develop in other departments.