In the medical literature, the term "osteochondrosis of the spine" means degenerative processes in the ossification centers in children. A common disease in medicine, which is considered the most common of all musculoskeletal problems, is hidden behind the words sciatica, herniated disc, dorsalgia (back pain). According to official statistics, the lower back suffers more often than the other parts, causing serious complications for the entire body. Why does this happen and how to treat osteochondrosis
What is osteochondrosis of the lumbar spine?
Degenerative neuroorthopedic disease that affects the intervertebral discs and leads to secondary compensatory and reactive changes in the osteobandic apparatus and nervous system - this is the doctors definition of osteochondrosis. It mainly affects the lumbar region, which is located between the chest and sacral and consists of five vertebrae. Between them are disks - fibro-cartilaginous formations, which are formed from the following elements:
- cartilage tissue (the membrane that helps nourish the intervertebral discs from the vessels of the vertebral body);
- Nucleus Pulposus (a gelatinous mass in the middle with a nucleus pulposus);
- Annulus Fibrosus (protects the fluid part).
Against the background of circulatory disorders, changes in the composition of cartilage tissue, dehydration of the nucleus pulposus, deterioration in the elasticity and elasticity of the intervertebral disc, their fixing properties suffer. Under the influence of unfavorable factors, muscle fixation weakens and the vertebrae become excessively mobile. Next, degenerative and destructive processes affect the bone surfaces of adjacent vertebrae, causing dystrophy (tissue malnutrition) of the spine.
The rest of the process looks like this:
- Micro cracks appear in the loosened ring. The nucleus pulposus begins to penetrate into it, gradually breaking through the annulus fibrosus and becoming damaged, resulting in a herniated disc or protrusion (initial stage).
- An inguinal hernia compresses the spinal canal, can pinch nerve roots and blood vessels, and cause pain and problems with motor activity.
- Due to the increased pressure on the vertebrae (through thinning of the intervertebral disc), the accelerated production of bone tissue begins and spinous processes (osteophytes) are formed.
Some experts tend to refer to intervertebral osteochondrosis of the lumbar spine as the "disease of civilization", mainly caused by an upright posture, which has increased the stress on the back of a modern person. Most often, the disease begins in people over the age of 30, and it is diagnosed more often in men than in women.
Lumbar osteochondrosis can occur:
- excessive load on the spine (household, job, sport);
- weak back muscles;
- incorrect distribution of the household burden on the spine (for the lumbar spine - the most common reason);
- frequent tensioning of the back muscles;
- being overweight, especially against the background of diabetes mellitus;
- spinal injuries;
- violation of metabolic processes;
- incorrectly fitting shoes, flat feet;
- problems with posture, which lead to an uneven load distribution along the spine;
- hypothermia of the lumbar spine;
- sedentary lifestyle, long-term driving;
- hormonal disorders (mainly in women);
- congenital pathologies of the musculoskeletal system;
- age (natural changes in fibrocartilaginous tissue occur in people over 50);
- frequent stress, emotional stress.
Degree of development
The disease process is slow and gradual, with most patients not realizing a serious problem until stage 2 or later. Without adequate treatment, osteochondrosis progresses and can become disabling.
Main medical classification:
- The initial stage is characterized by the initiation of the process of destruction of intervertebral discs, a decrease in their elasticity and elasticity. The disease is mainly noticeable through stress on the spine.
- Destructive processes affect the annulus fibrosus, the distance between the vertebrae decreases (the intervertebral disc becomes thinner), devaluation suffers, protrusions appear (protrusion of the intervertebral disc without ring break). Pinching of the nerve roots and inflammation of the tissues occur, increasing the pain syndrome.
- The annulus fibrosus ruptures, an inguinal hernia occurs. Vessels and nerve endings are compressed. Changes in the lumbar spine lead to a general deformity of the spine.
- In the final stage, the muscles of the affected area suffer, atrophy, motor activity and work ability. The spine is noticeably curved - there is pronounced scoliosis (3-level deformity), lordosis (hypertrophied forward deflection of the lower back).
Symptoms of lumbar osteochondrosis
Clinical manifestations of the disease depend on the severity. The main symptom is a local pain syndrome that occurs in response to physical activity, heavy lifting, hypothermia of the lower back, and prolonged maintenance of an uncomfortable posture (the load is higher in a sitting position than in an upright position). It is caused by irritation of the sinuvertebral nerve (recurring).
The stages of osteochondrosis of the lumbar spine are as follows:
- In the initial stage there are complaints in the lumbar region, pain is rare, mainly with a high load on the back. They pass quickly.
- In stage 2, the mobility of the lumbar spine deteriorates, pain occurs after physical exertion, and without it (with a strong cough, change in posture) it gradually intensifies, persists for a long time. Malfunctions in the work of internal organs are possible.
- With the development of osteochondrosis, the pain becomes permanent (permanent) and the vertebrae become deformed. Nerve endings become pinched, allowing the pain to sharpen and shoot on the sacrum, leg. There is a loss of sensitivity of the limbs, the buttocks, the thighs, numbness and paresthesia (burning, tingling, "chills"). Functional disorders of the pelvic organs occur.
- In the last stage the motor function is impaired or becomes completely impossible, the curvature of the spine occurs. The pain is permanent, the person unconsciously takes an unnatural position to reduce it.
Reflex syndromes of the disease in official medicine are divided into three groups: muscle-strengthening, neurodystrophic, vegetative-vascular. The last two categories are vividly manifested in three stages of the disease and later.
The clinical picture can include:
- weakened or disappeared reflexes of the Achilles tendon, flexion of the fingers (if osteochondrosis was added to the sacral region);
- dry skin, blue discoloration;
- Urinary tract disease (urinary retention or incontinence), pain in the bladder;
- cramps and pain in the thigh area against the background of malnutrition and blood circulation;
- tense, unsteady gait, lameness;
- increased sweating, fever with increased back pain;
- pain syndrome that radiates to the heart region (when the chest-lumbar region is affected).
If osteochondrosis of the lumbar spine has been diagnosed, treatment should be started immediately as the patient may be completely disabled in the latter stage. Against the background of the compression (squeezing) of the spinal cord by the vertebrae, between which there is no more space, paralysis of the lower extremities can occur.
In addition, osteochondrosis can cause:
- disorders of the pelvic organs (men suffer from erectile function, women - ovarian activity);
- lumbago (acute lower back pain), sciatica (pinching and inflammation of the sciatic nerve);
- prolapse of the intervertebral disc, stenosis (narrowing of the spinal canal);
- damage to the lining of the spinal cord that is fatal.
In order to make the correct diagnosis and assess the severity of the disease, the doctor collects anamnesis data (examination of patient complaints, lifestyle, hereditary factors). After this, a physiological examination is carried out, which assesses the motor skills, posture, level of sensitivity, muscle tone and size of the patient, as well as their cramp. Tapping with a hammer marks radiation areas (where it causes pain) in osteochondrosis of the lumbar spine.
After the patient has been assigned:
- Radiographyis the most accessible method to study the anatomical parameters of the vertebrae, assess the tendency for the holes between their bases to narrow, and identify bone growth.
- MRI(magnetic resonance imaging) - helps assess the condition of the vessels that supply the spine, nerve processes and intervertebral discs.
- CT(computed tomography) - is only prescribed to examine changes in the blood vessels, the lining of the spinal cord, and the growth of the margins.
Treatment of osteochondrosis of the lumbar spine
Surgical interventions are considered a last resort and are primarily prescribed to patients with significant neurological disorders and a high risk of disability. These problems are characterized by advanced osteochondrosis of the lumbar spine - doctors try to conduct treatment of stages 1 and 2 according to a conservative method.
Therapeutic measures are aimed at:
- Elimination of the pain syndrome;
- removal of muscle spasms, hypertonicity;
- elimination of the inflammatory process;
- Improvement of blood circulation in the affected areas and metabolic processes;
- normalization of the mobility of the lumbar vertebrae;
- Restoration of lumbar sensitivity.
There is no universal treatment method: each specific case of osteochondrosis requires an individual scheme. It is especially important to consider the form of the disease: acute or chronic. Therapy is necessarily of a combined nature and involves the use of drugs (internal and external) along with physical manipulations - massage, gymnastics, physiotherapy. The treatment regimen for osteochondrosis of the lumbar spine can be supplemented with acupuncture, hirudotherapy.
The effectiveness of the treatment increases if you follow the following rules:
- A special belt or corset should be worn during treatment to reduce the stress on the spine.
- Physical activity is excluded (only those recommended by the doctor remain) so as not to add provoking factors.
- It is important to closely monitor diet: cartilage tissue needs sources of collagen (gelatin, aspic, aspic), and the whole body needs plant foods, fish, nuts. It is advisable to refuse salted, smoked, pickled products, as well as sharp cheeses and fatty meats.
- The scheme prescribed by the doctor must be followed to the end: do not interrupt treatment when the main symptoms have subsided, and do not change medications and procedures yourself.
- It is worthwhile to work with your doctor to choose an orthopedic mattress that relaxes your lower back while you sleep, as well as special shoes. Women are completely prohibited from the heels.
Acute osteochondrosis of the lumbar spine requires special attention - its treatment begins with the appointment of the patient to bed rest for several days. Pain sensations are reduced by injections of analgesics, novocaine blockade and glucocorticoid are not excluded. Spinal traction (using a traction table or vertical device), walking on crutches, electrophoresis, and laser therapy all help improve the condition.
Medicines for the treatment of osteochondrosis of the lumbar spine are used internally and topically. Local gels and ointments are symptomatic therapies: relieve inflammation and pain, relieve muscle spasms and edema, improve blood circulation. In acute conditions, injections are shown that have an immediate anti-inflammatory effect, antipyretic, analgesic.:
Most often, doctors prescribe medication for osteochondrosis at home:
- Chondroprotectors- protect cartilage tissue and promote its recovery, are indicated for long-term use (from six months or longer).
- Means to improve blood circulation and metabolic processes in tissues- tablets that are taken over several months, as the effect is cumulative.
- Muscle relaxants- relieve muscle cramps, are used orally in a short time.
- Non-steroidal anti-inflammatory agent- quickly blocks pain and suppresses the production of prostaglandins, which are involved in the inflammatory process. Ointments and gels are applied to the affected area 1-2 times a day, unless otherwise specified in the instructions. At the initial stage, it is possible to do without external forms, after which they are duplicated with tablets.
- Corticosteroids- Pain relieving injections are only prescribed when there is no significant effect of nonsteroidal drugs.
- Ointments with a warming effect- relieve pain and improve blood circulation in tissues, are safer than non-steroidal drugs, but prohibited in the inflammatory process.
- Group B vitaminsand multivitamin complexes are prescribed over a long period of time to increase the overall effectiveness of the treatment.
In order to enhance the effect of drug treatment and speed recovery, the patient can be prescribed physiotherapy. You can alternate them or go through several options at the same time. The specific technique is selected depending on the stage and form of the disease.
Lumbar spine osteochondrosis - Treatment includes effective methods:
- Electrotherapy (electrophoresis)- implies the effect of low-power electrical currents to improve blood circulation in the affected areas.
- Laser therapy- activates biological processes in nerve endings and alleviates symptoms of neurodystrophic syndrome.
- UHF- local influence on the lumbar region with a high-frequency magnetic field to stop the inflammatory process, stimulate cell regeneration (restoration) of the tissue and relieve pain.
- Phonophoresis and Electrophoresis- helps deliver drugs to the area where they are needed, increasing the effectiveness of drug treatment. The result will depend on the specific agent used during the procedure.
- Darsonvalization- a therapeutic effect of high frequency alternating current to expand blood vessels, improve blood circulation and improve tissue nutrition. The procedure affects symptoms less than others.
- Amplipulse- local effect of sinusoidally modulated currents, which reduces the severity of the pain. The procedure has an analgesic effect, vasodilator, neurostimulating, improves tissue trophism.
Physical activity - especially in early osteochondrosis of the lumbar spine (in the initial stage) - must be included in the treatment: it helps to relax and strengthen the muscles, has a positive effect on tissue nutrition. For people with degree 2 disease and more heavy physical activity, a doctor will select this. With an exacerbation, gymnastics, swimming, yoga (the most effective directions) are prohibited.
The following exercises show good results:
- Focus on your knees and palms and keep your back straight (parallel to the floor). As you exhale, slowly bend your lumbar spine and tilt your head back slightly. Count to 5-8 (depending on how you are feeling), inhale and arch your back with a wheel. Count to 5-8 again and take the starting position. The exercise is performed 10-12 times at a slow pace. If necessary, they are divided into 2-3 approaches.
- Lie on your stomach. As you exhale, slowly tear your chest off the floor, bend your lower back, trying to get up as high as you can. The arms are stretched forward, the legs do not move. Hold this position for 5-10 seconds and gradually descend. Repeat the exercise 8-10 times, gradually increasing the duration of the delay at the top point.
Massage is an effective method of treating any stage of osteochondrosis, helping to relieve unpleasant symptoms, relieve muscle spasms, and normalize lymphatic drainage and blood supply to the affected areas. In addition, this procedure stimulates the restoration of atrophied muscles and removes the restriction of the mobility of the vertebrae, strengthens the ligamentous system. The massage is carried out by a specialist doctor in courses of 10-12 sessions, when the symptoms of the acute stage have subsided.
When a patient is diagnosed with significant neurological disorders, loses control of urination, has a severe protrusion of the hernia, and requires surgery. In addition, the indication for it is the lack of a positive effect of conservative treatment (lasting more than a month). Before receiving a referral for surgery, the doctor should evaluate all risks, especially if traditional technology is preferred to microdiscectomy.
During the procedure, the surgeon can:
- remove pathologically changed areas by placing local implants (discectomy), which are developed individually for each patient;
- , to align the spine with a special rod - this will help correctly distribute the load and prevent new deformations.
The discectomy is performed under general anesthesia with a posterior approach for the surgeon. During the operation, the skin is cut to a length of 10 cm, the muscles are moved apart and the affected intervertebral disc is removed. At the end of the procedure, the wound is sewn in layers. The duration of the surgical intervention is about 2 hours, the next day the patient should lie on his back. The rehabilitation period is 2 months. With microdisectomy, the procedure takes 1. 5 hours, a 3 cm incision is made, and you can get up after leaving the anesthetic.
Treatment of osteochondrosis of the lumbar spine with folk remedies
After consulting a doctor who can correctly assess the patient's condition, traditional medical prescriptions may be used. They do not have the same pronounced effect as drug therapy, do not replace physical therapy, massage and gymnastics, but increase the likelihood of a positive result from the main treatment.
Some simple options:
- Grate peeled black radish (350 g), combine with liquid honey (250 g) and vodka (100 ml). Use to rub the lower back with light massage movements in the morning and evening for 10 minutes. After that, it is advisable to wrap this area with a woolen cloth and lie under a blanket for an hour. The procedure is carried out for 8-10 days, after which they take a break.
- If there is severe pain in the lumbar spine, you can take 100 g of medium-fat cottage cheese and add 1 tsp. Place apple cider vinegar on a cotton cloth or cheesecloth. The bandage is kept for 2 hours, the process is repeated twice a day if necessary. The duration of treatment is not limited.
- Collect fresh purple flowers and fill a liter glass with them without crushing them. Pour a liter of vodka and leave in a cold place for 3 weeks. Use to rub the affected area once a day for a month. It is not necessary to cover the lower back with anything after processing.
Prevention of osteochondrosis of the lumbar spine
Doctors say that most back disorders can be prevented with regular physical activity that strengthens muscles, improves blood circulation, and improves tissue nutrition. Lumbar spine osteochondrosis is no exception - there is no need to go through treatment if you are systematically doing gymnastics, yoga and swimming.
Additional preventive measures:
- Control of the diet (more vegetable foods, less animal fats, cucumbers, marinades: as with the treatment);
- Limitation of heavy loads on the spine;
- monitoring the condition of the endocrine system;
- elimination of bad habits (alcohol, smoking);
- using an orthopedic mattress;
- posture tracking;
- Avoid high heels (from 7 cm) for women.