Lumbar osteochondrosis is a chronic degenerative-dystrophic disease of the lumbar spine that affects the structures of the intervertebral discs and adjacent lumbar vertebrae.The majority of those affected are people of working age.It is manifested by various symptoms, the main of which are pain in the lower back and legs, as well as limitation of movement in the lower back.Examination methods such as X-rays, computer tomography or magnetic resonance imaging of the lumbar spine are used for diagnosis.In this article you will learn about the causes, symptoms and methods for diagnosing osteochondrosis of the lumbar spine.
Osteochondrosis is a consequence of aging of the body.Some signs of this disease can be found in almost every person (!) from the age of 25.However, the severity of these changes, the speed of their progression and the degree of clinical manifestations depend on many reasons, primarily on how healthy a particular person leads a lifestyle.Moderate physical activity, mandatory morning exercises, correct posture when performing various work (gardening, construction work, banal house cleaning, etc.), orthopedic mattresses - 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, with intervertebral discs between their bodies.This means that there is an intervertebral disc between two vertebrae.The intervertebral disc consists of a pulp core and a fibrous ring.The core contains a lot of water and provides cushioning and flexibility to the spine.The fibrous ring is located along the periphery of the nucleus pulposus, as if holding it within itself.
If the nucleus pulposus is subjected to prolonged increased stress, it changes its physiological properties, loses water and dries out and becomes sequestered over time: the intervertebral disc becomes flatter and the vertebral bodies move closer together.Accompanying such processes, the fibrous ring in the nucleus pulposus loses its elasticity and begins to bulge under the influence of mechanical stress.This is called a lead.Then the fibrous ring tears and the nucleus pulposus falls out through the resulting cracks: a herniated disc occurs.A section of two adjacent vertebrae and an intervertebral disc between them, called a spinal segment, is given excessive mobility, increasing stress on adjacent segments.Overloading neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bone growths form on the edges of the vertebral bodies, which increase the supporting surface.This phenomenon is called spondylosis.Changes in the joints between the vertebrae are called spondyloarthrosis.Usually all three pathologies - osteochondrosis, spondylosis, spondyloarthrosis - occur side by side.
Reasons
What causes osteochondrosis?Today there are several theories about its appearance:
- Mechanical theory: The main reason should perhaps be seen as the regularly increased load on the spine.That is why osteochondrosis is an almost obligatory fate of loaders, miners, builders and people of similar professions.The occurrence of osteochondrosis of the lumbar region is mainly associated with bending over and lifting heavy objects, forced by an uncomfortable working posture;
- Another development factor can be incorrect posture, sitting in the wrong 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 injury to the spine (even the smallest) can trigger a degenerative process;
- hormonal metabolic disorders and endocrine diseases can affect metabolism in the tissues of the spine and contribute to the development of osteochondrosis;
- The aging theory assumes that the intervertebral discs wear down naturally over the course of life.
Rarely, only one of these theories can explain the occurrence of osteochondrosis in an individual case.Most of the time, several factors are to blame at the same time.
Excess weight plays an important role in the development of osteochondrosis of the lumbar spine, as it itself represents an overload on the spine.The higher the body mass index (degree of obesity), the more pronounced the changes to the spine tend to be.Other reasons provoking the appearance of osteochondrosis are:
- sedentary lifestyle;
- unhealthy diet (fast food, excessive sweets, processed foods: all this leads to an imbalance of microelements) and lack of fluids;
- Abnormalities in the structure of the spine (e.g. the presence of an additional lumbar vertebra);
- constant wearing of high-heeled shoes;
- Pregnancy (due to excessive load on the lumbar spine);
- sudden termination of training in people who do sports professionally;
- Smoking and alcohol abuse: as factors that accelerate the aging process in the body.
Symptoms
The main manifestation of osteochondrosis of the lumbar spine is pain.The type of pain, the place of origin and the direction of spread depend on which receptors are irritated, i.e.h.how severe the changes are in the intervertebral disc and the surrounding tissue, whether there is a bulge or a hernia, in which direction the bulge formed, and so on.
In osteochondrosis of the lumbar spine there are reflex and compression syndromes.
Reflex syndromes arise when the receptors of the fibrous ring of the affected intervertebral disc, ligaments and nearby joint capsules are irritated.They are called reflexes because, in addition to pain, they are accompanied by muscular-tonic, vegetative-vascular or neurodystrophic reflex changes, i.e.
Compression syndromes arise from compression (compression) of nerve roots, blood vessels or the spinal cord due to changes that arise in osteochondrosis.
Reflex syndromes of the lumbar spine
Lumbago(lumbago): acute, sudden pain in the lumbar region that occurs when making an awkward movement or at a moment of physical stress (much rarer - for no apparent reason).It is believed that the appearance of lumbago is associated with the movement of the nucleus pulposus within the fibrous ring, that is, it develops at the initial stage of osteochondrosis.The pain is often described as “lumbago” or “a stake stuck in the lower back.”Patients freeze in the position in which the pain grips them.The slightest movement causes increased pain (sneezing, coughing, trying to turn over in bed, moving a leg).If a person was in an oblique position at the time of developing lumbago (which is most common), he or she will not be able to sit up.Reflexively, strong muscle tension occurs in the lumbar spine.A muscle ridge can be felt along the vertebrae in this area, which is sometimes visible to the naked eye even without touching it, so pronounced is the muscle tension.Palpation is painful for the patient.This increased muscle tone has an immobilizing function and protects the affected lumbar segment from pathological mobility that can lead to a worsening of the condition.The natural curvature of the spine in the lumbar region (lordosis) is flattened; a lateral curvature (scoliosis) is possible due to muscle tension.
Lumbodynia– another reflex syndrome of the lumbar spine.This term also refers to the presence of pain in the lumbar region.In contrast to lumbago, the pain does not occur acutely, but gradually over several hours and even days.The pain is dull and aching, of moderate intensity and increases with movement, sitting or standing, or when changing from one position to another.Lying on your back with a pad under the lower back provides some relief, but passively raising the straight leg in this position leads to increased lower back pain (Lassegue symptom).Palpation of the lumbar spine is painful, but reflex muscle tension is less pronounced than in lumbago and is sometimes completely absent.Movement of the lumbar spine is limited but possible.This means that the patient may bend down and to the side to a certain extent (and then increase the pain).
Lumbar sciatica– another type of lumbar spine reflex syndrome.This term refers to pain in the lumbar region that radiates to the buttocks and leg (along the back surface).The pain varies in nature and is usually painful, but can periodically increase and appear in the form of a “shooting” sensation in the leg.Just like lumbodynia, it increases with every movement, when walking, with exertion and decreases when you lie on your back.The Lassegue sign is usually positive.Palpation of the lumbar spine is painful, as is pressure on certain points (e.g. in the middle of the dividing line between the buttocks and thighs, in the middle of the back of the thigh, in the middle of the back of the knee).Tension occurs in the lower back muscles.Forward and side bends are limited.
Compression syndromes of the lumbar spine
The clinical features depend on which structure is subjected to compression.
Between the vertebrae in each intervertebral foramen there are nerve roots (spinal nerves): left and right.When pathological formations in osteochondrosis of the lumbar spine (mainly herniated discs) compress the roots, radiculopathy develops, the symptoms of which are different for each root.What all lumbar radiculopathies have in common are increased pain when sneezing, coughing, movements in the lower back (especially when bending forward), the presence of muscle tension in the lumbar region and restricted movement in the lumbar spine.The most common types of lumbar radiculopathies are:
- Radiculopathy L1, L2, L3: Pain occurs in the lower back and radiates to the front inner thigh.In the same area, paresthesia may occur (crawling sensation, numbness), superficial sensitivity is impaired (sharp touches do not differ from ordinary touches, the feeling of cold and heat is lost).The knee reflex decreases, weakness of the quadriceps femoris muscle appears;
- Radiculopathy L4: Pain from the lower back radiates to the anterior lower part of the thigh, the inner surface of the knee joint and slightly deeper along the inner surface of the lower leg.Paresthesia is felt in the same areas and superficial sensitivity is lost (reduced).Weakness also develops in the quadriceps femoris muscle and the knee reflex decreases;
- Radiculopathy L5: one of the most common localizations.The pain radiates to the buttocks, along the outer edge of the thigh, along the front outer surface of the lower leg to the inner edge of the foot and big toe.This is where abnormal sensations can be felt, superficial sensitivity is impaired and pain when sneezing and coughing is transferred here.In addition, it becomes difficult to straighten the big toe because the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on your heel with your foot extended;
- Radiculopathy S1: also common in osteochondrosis of the lumbar spine.The pain radiates into the buttocks, along the outer posterior edge of the thigh, along the outer edge of the lower leg to the outer edge of the foot and the 5th toe, heel.These areas are characterized by a feeling of paresthesia and reduced superficial sensitivity.The Achilles reflex decreases.When this root is damaged, weakness occurs in the lower leg muscles and foot flexors, making it difficult to stand and walk on tiptoes.
The simultaneous development of multi-root radiculopathy is possible, this is especially typical for L5, S1.It happens that a hernia compresses several roots.
When a herniated disc bulges backwards, it can put pressure on the spinal cord.This is only possible if the hernia is located 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 occurs).
When the vessels of the lumbar region supplying blood to the spinal cord are subjected to compression, spinal stroke occurs with an acute circulatory disorder, and myelopathy with prolonged compression.Myelopathy manifests itself as weakness of the leg muscles on both sides, starting at the foot and gradually progressing upwards.Sensitivity in the legs is impaired, the Achilles tendon reflex is lost, and later also the knee reflex.Urinary disorders may occur (frequent, “compelling” urges requiring immediate gratification, 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 is played by methods such as:
- X-ray of the lumbar spine;
- Computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
X-rays of the lumbar spine must be performed in 2 mutually perpendicular projections - directly 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, anomalies in the structure of the spine and natural curvatures.To visualize the intervertebral joints and intervertebral foramina, x-rays are taken in oblique projection.To detect the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), an X-ray is carried out under functional tests, that is, in the flexion and extension positions of the spine.Normally, the change in height of the intervertebral discs is clearly visible in the front or back according to the direction of inclination of the body;With osteochondrosis, the height of the intervertebral disc does not change either during flexion or extension due to the functional blockage of one of the segments.With pathological mobility, the displacement of the vertebrae forward or backward is noted.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 intervertebral disc tissue (calcification), the formation of peripheral growths of the vertebral bodies, compaction of the vertebra at the border with the affected intervertebral disc (subchondral sclerosis).X-ray of the lumbar spine is a routine examination method that is gradually losing its importance against the background of the active introduction of new and more informative examination methods (CT and MRI).Lumbar spine x-rays are now used as a screening diagnostic method.
A CT examination of the lumbar spine is also carried out using X-rays, but the radiation exposure to the body is significantly lower than with X-rays.The examination is carried out lying on the table of a special device - a computer tomograph;it is absolutely painless.The resulting images are processed on a computer and allow you to see significantly more structures than with an X-ray of the spine.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also carried out while lying down on a table that can be inserted into the tomograph chamber.The MRI is harmless and painless.
CT 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 bulging of the intervertebral disc does not go unnoticed.These methods (especially MRI) make it possible to determine the direction of the herniated disc, if any, as well as the degree of compression of the nerve roots and spinal cord.Thus, these research methods are much more informative than radiography in the diagnosis of osteochondrosis of the lumbar spine.In addition, they make it possible to diagnose not only osteochondrosis, but also other diseases (tumors, circulatory disorders of the spinal cord, abscesses, congenital defects in the structure of the spine and spinal cord), which is important for the differential diagnosis of the causes of back pain.
Osteochondrosis of the lumbar spine is a disease that most often causes back pain.It is actually the destruction of the intervertebral discs.Due to osteochondrosis of the lumbar spine, a person often loses the ability to work, since, in addition to pain, the disease can also lead to impaired mobility of the spine, the inability to sit, stand and walk.The symptoms of this disease are nonspecific and require additional research methods to accurately confirm the diagnosis.The most informative and safe modern method for diagnosing osteochondrosis is MRI of the spine.