Lumbar osteochondrosis is a chronic disease that develops as a result of a degenerative-dystrophic process in intervertebral discs.The disease is widespread and affects in most cases people from 25 to 40 years old.
According to the statistics of back pain, at least once in his life every second adult is experiencing, while in 95% of cases they are due to osteochondrosis of the spine.
Patients with a severe course of lumbar osteochondrosis, with persistent pain and other manifestations are recognized as temporarily disabled.If within four months their condition does not improve, the issue of establishing a disability group is resolved.
Lumbar osteochondrosis is a serious medical and social problem, since the disease mainly affects people of the most working age, and in addition, in the absence of treatment, it can cause the formation of hernia of the intervertebral disc.
Causes and risk factors
The factors predisposing to the development of lumbar osteochondrosis are:
- abnormalities of the structure of the spine;
- lumbalization is a congenital pathology of the spine, characterized by the separation from the sacrum of the first vertebra and its transformation in the sixth (additional) lumbar;
- sacralization is an innate pathology, in which the fifth lumbar vertebra is fed with the sacrum;
- the asymmetric location of the articular cracks of the intervertebral joints;
- pathological narrowing of the spinal canal;
- reflected spondiogenic pains (somatic and muscle);
- obesity;
- sedentary lifestyle;
- prolonged exposure to vibration;
- systematic physical strain;
- smoking.
Adverse statodynamic loads combined with one or more risk factors lead to a change in the physiological properties of the jacket nucleus of a fibrous disc, playing a shock -absorbing role and providing the mobility of the spinal column.The basis of this process is the depolymerization of polysaccharides, which leads to the loss of moisture with a fabric of the jet nucleus.As a result, the jacket nucleus, and with it, the fibrous disk loses their elastic properties.Further mechanical loads provoke the protrusion of the fibrous ring that has lost the elasticity.This phenomenon is called protrusion.Cracks appear in the fibrous core, through which fragments of the jacket nucleus (prolapse, hernia of the intervertebral disc) fall out.
A long compression of the nerve roots innervating certain organs of the abdominal cavity over time leads to a deterioration in their functioning.
The instability of the spinal segment is accompanied by reactive changes in the bodies of adjacent vertebrae, intervertebral joints, and concomitant spondyl arthrosis develops.A significant muscle contraction, for example, against the background of physical activity, leads to a shift in the vertebral bodies and infringement of nerve roots with the development of radicular syndrome.
Osteophytes can be another cause of pain and neurological symptoms with lumbar osteochondrosis - bone outgrowths on processes and bodies of vertebrae that cause royshold syndrome or compression myelopathy (compression of the spinal cord).
Forms of the disease
Depending on which structures are drawn into the pathological process, lumbar osteochondrosis is clinically manifested by the following syndromes:
- Reflex- Lumbalgia, Lumboichachalia, Lumbago;develop against the background of reflex overvoltage of the muscles of the back;
- compression (spinal, vascular, radicular)- Their development is leading to the compression (compression) of the spinal cord, blood vessels or nerve roots.Examples are lumbosacral radiculitis, radiculoichemia.
Symptoms of lumbar osteochondrosis
With lumbar osteochondrosis, symptoms are determined by which structures are drawn into the pathological process.
Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.The pain appears suddenly and is firing.It intensifies when sneezing, coughing, body turns, physical exertion, seat, standing, walking.In the lying position, pain is significantly weakening.Sensitivity and reflexes are preserved, the volume of movements in the lumbar region is reduced.
On palpation, they observe:
- soreness in the lumbar region;
- spasm of paravertebral muscles;
- The flattening of lumbar lordosis, which in many cases is combined with scoliosis.
The tension syndrome of nerve roots with lumbar is negative.When raising a straight leg, patients note the increase in pain in the lower back, and not their appearance in an elongated lower limb.
Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which each time become increasingly intense and long.
With lumbalia, the clinical picture resembles a lumbago, however, an increase in the intensity of pain occurs within a few days.
In lumbar -shaped, patients complain of pain in the lower back, which radiate to one or both lower limbs.The pain spreads over the buttocks and the back of the thigh and never reaches the feet.
Vasomotor disorders are characteristic of lumbar -shaking:
- changes in the temperature and color of the skin of the lower extremities;
- feeling of heat or chillness;
- Violation of blood supply.
The development of lumbar compression syndromes is clinically manifested by the following symptoms:
- dermatomic gipalgesia;
- shooting pains;
- weakening or complete loss of deep reflexes;
- Peripheral paresis.
With compression syndromes, pain intensifies when tilting the body, sneezing and coughing.
Diagnostics
Diagnosis of lumbar osteochondrosis is carried out on the basis of the clinical picture of the disease, laboratory and instrumental research methods.
In blood tests against the background of lumbar osteochondrosis, it can be noted:
- decrease in calcium concentration;
- increase in ESR;
- Increasing the level of alkaline phosphatase.
In the diagnosis of lumbar osteochondrosis, the radiological examination of the spine is given great importance.
A long compression of the nerve roots innervating certain organs of the abdominal cavity over time leads to a deterioration in their functioning.
X -ray features confirming the diagnosis are:
- change in the configuration of the affected segment;
- pseudospondylastez (shift of related vertebral bodies);
- deformation of closing plates;
- flattening of the intervertebral disc;
- The unequal height of the intervertebral disc (symptom of the spacer), which is associated with the asymmetric muscle tone.
Also in the diagnosis of lumbar osteochondrosis in the presence of indications are used:
- Myelography, computed or magnetic refusal tomography - are necessary for persistent symptoms, the development of neurological deficiency;
- Scintigraphy (the study of the accumulation of a bone system of phosphorus, a molten technology-99)-is performed in case of suspicion of a tumor or infectious process, a spinal injury.
Differential diagnosis of lumbar osteochondrosis is carried out with the following diseases:
- spondylolistz;
- disgormonal spondylopathy;
- ankylosing spondylitis (ankylosing spondel);
- Infectious processes (disks inflammation, osteomyelitis of the spine);
- non -plastic processes (primary tumor of the spine or its metastatic lesions);
- rheumatoid arthritis;
- deforming osteoarthrosis of the hip joint;
- Reflected pains (diseases of internal organs and large blood vessels).
Treatment of lumbar osteochondrosis
With lumbar osteochondrosis, they usually adhere to the following treatment tactics:
- bed rest for 2-3 days;
- the traction of the affected segment of the spine;
- strengthening the muscles of the back and abdominal press (the creation of the so -called muscle corset);
- impact on pathological myofascial and myotonic processes.
Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.
In most cases, conservative treatment of lumbar osteochondrosis is performed, including the following measures:
- muscle infiltration with a solution of local anesthetics;
- taking non -steroidal anti -inflammatory drugs;
- reception of desensitizing agents;
- vitamin therapy;
- reception of tranquilizers and antidepressants;
- manual therapy, massage;
- physiotherapy physical education;
- acupuncture;
- Postisometric relaxation.
Absolute indications for the surgical treatment of lumbar osteochondrosis are:
- acute or subacute compression of the spinal cord;
- The development of the horse tail syndrome, characterized by impaired function of the pelvic organs, sensitive and motor disorders.
Medical gymnastics for lumbar osteochondrosis
In the complex treatment of lumbar osteochondrosis, a significant role belongs to physiotherapy exercises.Regular classes make it possible to normalize the muscle tone of the paravertebral muscles, improve metabolic processes in the tissues affected by the pathological process, and in addition to form a well -developed muscle corset, which can maintain the spine in the correct position, remove excess static loads from it.
In order for gymnastics with lumbar osteochondrosis to bring the greatest effect to adhere to the following principles:
- regularity of classes;
- gradual increase in the intensity of physical exertion;
- Avoiding overwork during the lesson.
Physical education should be engaged in the leadership of an experienced instructor, who will select the most effective exercises for a particular patient and control the correctness of their implementation.
According to the statistics of back pain, at least once in his life every second adult is experiencing, while in 95% of cases they are due to osteochondrosis of the spine.
In addition to classes with an instructor, you should daily perform a complex of morning gymnastics, which includes special exercises with lumbar osteochondrosis.
- Relaxation and contractions of the abdominal muscles.The starting position is standing, the legs are shoulder -width apart, the hands of the body are lowered.Make a smooth breath, relaxing the muscles of the anterior abdominal wall.During exhalation, draw into yourself as much as possible, straining the muscles of the press.The exercise should be repeated before the appearance of light fatigue.
- Movement of the head with the bending of the spine.The starting position of the knees, resting on the floor out of the back, the back is straight.Slowly raise your head and bend in the back.To linger in this position for a few seconds, and then smoothly return to its original position.Repeat at least 10-12 times.
- "Pendulum".The starting position lying on the back, arms along the body, the legs are bent at right angles in the knee and hip joints.Turn the legs to the right and left with swaying pendulum -shaped movements, trying to get the floor.At the same time, the shoulder blades cannot be torn from the floor.
- "Boat".The starting position of lying on the stomach, the hands are extended forward.Tear off the upper body and legs from the floor, bending in the back.To linger in this position for 5-6 seconds and slowly return to the starting position.Perform 10 times.
Possible consequences and complications
The main complications of lumbar osteochondrosis are:
- the formation of intervertebral hernia;
- vegetovascular dystonia;
- spondylolis, spondylolistz;
- osteophytosis;
- spondylarthrosis;
- Stenosis of the spinal canal, leading to compression of the spinal cord and capable of causing persistent loss of working capacity and reducing the quality of life.
A long compression of the nerve roots innervating certain organs of the abdominal cavity over time leads to a deterioration in their functioning.As a result, patients have intestinal dysfunctions (constipation, diarrhea, flatulence) and pelvic organs (urination disorders, erectile dysfunction, frigidity, infertility).
Forecast
Pain syndrome for lumbar osteochondrosis proceeds in the form of remissions and exacerbations.Lumbago lasts 10-15 days, after which the patient's condition improves, the pain subsides.Aparticular secondary diseases may interfere with a favorable outcome.Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which each time become increasingly intense and long.
In the complex treatment of lumbar osteochondrosis, a significant role belongs to physiotherapy exercises.
Patients with a severe course of lumbar osteochondrosis, with persistent pain and other manifestations are recognized as temporarily disabled.If within four months their condition does not improve, the issue of establishing a disability group is resolved.
Prevention
Prevention of the development of osteochondrosis of the spine is the following measures:
- Refusal of smoking;
- normalization of body weight;
- improvement of general physical condition, active lifestyle;
- Avoiding provoking conditions (weight lifting, sharp movements, turns, inclinations).