The osteochondrosis of the lumbar region is a chronic degenerative-dystophical disease of the lumbar column that affects the structure of the intervertebral discs and a series of lumbar vertebrae located.It affects people of predominantly labor age.It manifests itself in several symptoms, the main one of which is the pain in the lower back and legs, which limits the movements in the lower back.For diagnosis, research methods such as radiography, computerized tomography or magnetic resonance tomography of the lumbar spine are used.In this article, it can more detail with the causes, symptoms and methods to diagnose the osteochondrosis of the lumbar column.
Osteochondrosis is the result of body aging.These or other signs of this disease can be found in almost all people (!), From 25 years.But here is the seriousness of these changes, the rate of their progression, the degree of clinical manifestations depends on many causes, mainly on how a healthy lifestyle leads to a specific person.Moderate physical activity, compulsory morning gymnastics, the correct possession of the body when performing a series of works (garden, construction, banal cleaning of the house, etc.), the orthopedic mattress are those moments that prevent the development of osteocondrosis of the lumbar spine.
According to statistics, the osteochondrosis of the column in 80% of cases is the cause of back pain.
How does osteochondrosis develop?
The entire column consists of separate vertebrae, among the bodies of which there are intervertebral discs.That is, between the two vertebrae there is an album.The disc consists of a gelatinous nucleus (pulpp) and a fibrous ring.The nucleus contains a lot of water and provides depreciation and flexibility of the spine.The fibrous ring is found along the periphery of the jacket core, as if holding it within itself.
With a prolonged increase in loading in the spring core, it changes its physiological properties, loses water and dry, and eventually sequences: the disc is flattened and the backbone bodies approach each other.Together with such processes, in the core jacket, the fibrous ring loses its elasticity and, under the influence of mechanical loads, begins to excel.This is called protrusion.Then, the fibrous ring cracks, and a gelatinous nucleus falls through the resulting spaces: there is a hernia of the disc.A two adjacent vertebrae plot and an album located between them, called vertebral segment, acquires an excess of mobility, thus increasing the load in the nearby segments.The overload of neighboring segments triggers a similar pathological process in them.These changes are called osteochondrosis.
To somehow guarantee the stability of the spine, bone growth is formed along the edges of the vertebral bodies, increasing the support area.This phenomenon is called spondyosis.Changes in the joints between the vertebrae are called spondylo osteoarthritis.Usually, the three pathologies (osteochondrosis, spondyosis, spondy osteoarthritis - walk close.
Reasons
Why does osteochondrosis occur?To date, there are several theories of the occurrence:
- Mechanical theory: Perhaps the main reason should be considered a regular increase in a load in the spine.That is why osteochondrosis is an almost mandatory destination for engines, miners, builders and people from such professions.The appearance of osteochondrosis of the lumbar region is mainly associated with the slopes and the lifting of gravity, forced an uncomfortable work;
- Another factor in development is the incorrect posture, sitting in the mistaken, which is especially relevant to mental workers;
- Sometimes, the paper is played by the hereditary characteristics of the structure of the spine and the nutrition of its individual structures;
- Traumatic theory: any trauma to the column (even the most insignificant) is capable of launching a degenerative process;
- Hormonal metabolic disorders and endocrine diseases can negatively affect metabolism in the tissues of the spinal column and contribute to the development of osteochondrosis;
- Age theory implies natural wear of discs in the life process.
Rarely, only one of these theories can explain the appearance of osteochondrosis in each case.More often, at the same time, several factors are "guilty."
In the appearance of osteochondrosis of the lumbar column, overweight plays an important role, since it is an overload for the spine.The higher the body mass index (degree of obesity), the most pronounced changes in the column are generally.Among other reasons that cause the appearance of osteochondrosis, you can notice:
- sedentary lifestyle;
- Nutrition Imore (fast food, excess sweet, semi -ends: all this leads to an imbalance of trace elements) and a lack of liquid;
- abnormalities of the structure of the column (for example, the presence of an additional lumbar vertebra);
- constant use of high heel shoes;
- pregnancy (due to excess load in the lumbar column);
- Sudden training termination in professionals professionally involved in sports;
- Smoking and alcohol abuse: as factors that accelerate the aging process in the body.
Symptoms
The main manifestation of the osteochondrosis of the lumbar column is pain.The nature of pain, the place of occurrence and the distribution direction depend on which receptors are irritated, that is, how the rough changes in the disc and the surrounding tissues, there is protuberance or hernia, in which direction the protuberance was formed and so on.
Reflex and compression syndromes are distinguished with osteochondrosis from the lumbar column.
The reflex syndromes are developed in cases where the fibrous ring receptors of the affected disk, the ligaments and the joint capsules located nearby are irritated.They are reflective because in addition to the pains are accompanied by changes muscle, vegetative-vascular or neurodistrophic reflexes, that is, irritation with reflexes is transmitted to other structures, causing symptoms mainly from the side of soft tissues.
Compression syndromes occur as a result of compression (compression) of nerve roots, blood vessels or spinal cord formed by osteochondrosis by changes.
Reflex syndromes of the lumbar column
Lumbago(Feeling): Sudden pain acute in the lower back, which occurs with an awkward movement or at the time of physical tension (much less frequently, without apparent reason).It is believed that the appearance of Lumbago is associated with the movement of a core of the jacket inside the fibrous ring, that is, it develops in the initial stages of osteochondrosis.Often, the pain is described as "feeling", "The stake was stuck in the lower back."Patients freeze in the pose in which pain caught them.The slightest movement causes an increase in pain (sneezing, cough, an attempt to turn in bed, to move the foot).If a person was in an inclined position at the time of the development of Lumbago (which happens more frequently), then he cannot straighten.A muscle voltage pronounced in the lumbar column occurs reflexively.Throughout the vertebrae in this area, it feels a muscular roller, which is sometimes visible to the naked eye without contact, and muscle tension is so pronounced.Feel painful for the patient.Such an increased muscle tone plays an immobilizer role, protecting the lumbar segment affected from pathological mobility, which can cause deterioration in the state.The natural spine curve in the lower back (lordosis) is flattened, perhaps curvature (scoliosis) is possible due to muscle tension.
Lumbalgia- Another syndrome reflex of the lumbar level.This term also means the presence of pain in the lumbar region.But, unlike Lumbago, pain does not arise acutely, but gradually, within a few hours or even days.The pain is stupid, moderate intensity, intensifies during the movements, in a position to be sitting or standing, when it moves from one position to another.A little relief brings to bed or back with a roller under the lower back, but the passive increase in the straight leg in this position causes greater pain in the lower back (Lassa symptom).The palpation of the lumbar column is painful, but the reflex tension of the muscles is less pronounced than with lumbago, and sometimes absent at all.The movements in the lumbar column are limited, but possible.This means that the patient can bend down and to the sides at a certain level (and then the pain intensifies).
Sciatica- Another variety of syndrome reflex of the lumbar level.By this term the pain is understood in the lower back, which gives the buttock and in the leg (on the surface of the back).The pain is different, mostly sore, but can be periodically intensified by the type of "chimney" in the leg.As with low back pain, it intensifies with any movement, walking, tensioned, decreases in the back on the back.Lassa's symptom is usually positive.The palpation of the lumbar column is painful, in addition to pressing some points (for example, in the middle of the line that separates the buttock from the thigh, in the middle of the back of the thigh, in the middle of the popliteal grave).There is voltage of the lower back muscles.The forward and sides are limited.
Compression syndromes of the lumbar column
The clinical characteristic depends on which structure is subject to compression.
Among the vertebrae in each intervertebral hole are nerve roots (spinal nerves): left and right.If the pathological formations for the osteochondrosis of the lumbar column (mainly disc discs) squeeze the roots, then the ladiculopathy develops, whose symptoms differ for each root.Common to all the lumbar region's radiculopathies is the increase in pain during sneeze, cough, movement in the lower back (especially the forward inclination), the presence of muscle tension in the lower back, restriction of movements in the lumbar spine.The following types of lumbar column radicles are more common:
- L1, L2, L3 Radiculopathy: Pain occurs in the lower back, gives the anticipated thigh.In the same area, the appearance of paresthesia (a feeling of chicken skin, numbness) is possible, superficial sensitivity is altered (an acute touch is not distinguished from the usual, the sensation of cold and heat is lost).The knee reflex decreases, the weakness of the quadriceps of the thigh is revealed;
- L4 Radiculopathy: The pain of the lower back gives the front of the thigh, the internal surface of the knee joint and slightly lower along the internal surface of the lower leg.In the same areas, it feels parstesty and surface sensitivity (reduced) is lost.The weakness in the quadriceps muscle of the thigh also develops, the knee reflex decreases;
- L5 Radiculopathy: One of the frequent locations.The pain gives the buttock, along the outer edge of the thigh, along the front surface of the lower leg to the inner edge of the foot and the thumb.Paresthesia is felt here, superficial sensitivity is altered and pain is given here when sneezing and coughing.In addition, there is a difficulty in the extent of the thumb of the foot, since the muscle that performs this action is innervated by the Kine L5.Sometimes it is difficult to stand on a heel with an exposed foot;
- S1 radicle is also often found with osteochondrosis of the lumbar column.The pain gives the buttock, along the outer edge of the thigh, along the outer edge of the bottom of the leg to the outer edge of the foot and the fifth finger, heels.These areas are characterized by a sensation of paresthesia, a decrease in surface sensitivity.The Achilles reflection is reduced.With the damage to this spine, the weakness of the muscles at the bottom of the leg and the flexors of the foot is developed, so standing and walking on the socks are difficult.
The simultaneous development of several roots of several roots is possible, this is especially characteristic of L5, S1.It happens that a hernia squeezes several roots.
If the album's flock adheres, then you can press the spinal cord.This is possible only when the hernia is located in the superior reference point, since there are no vertebrae of the spinal cord under the lumbar vertebra II (the roots of the spinal cord are subject to compression and develops the horse's tail syndrome).
If the glasses of the lumbar region are subject to tightening, which carry out the blood flow to the spinal cord, then in the case of an acute circulatory disorder, a spinal race is developed and with prolonged compression: myelopathy.Myelopathy is manifested by the bilateral weakness of the leg muscles, starting from the foot and gradually progressing.The leg sensitivity is disturbed, the Achilles reflection is lost and then the knee.It is possible to emerge from urination disorders (frequent, "imperative" urgency, which requires immediate satisfaction, urinary incontinence).
Diagnostic methods
The diagnosis of lumbar column osteochondrosis is based on clinical data and additional research methods.The key role belongs to methods such as:
- Radiography of the lumbar column;
- computerized tomography of the lumbar column;
- Magnetic resonance tomography of the lumbar column.
The lumbar column radiography is necessarily performed in 2 mutually perpendicular projections, the back and lateral part.These images allow you to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, the abnormalities of the column and the natural curves.To show the intervertebral joints and intervertebral holes, radiograms occur in oblique projections.To identify the pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), the radiography is performed in functional test conditions, that is, in the flexion and extension of the spine.Normally, you can clearly see the change in the height of the intervertebral discs in the front or rear sections according to the direction of the body's inclination, with osteochondrosis due to the functional block of one of the segments, the height of the disc does not change or when it is extended or extended.With pathological mobility, the displacement of vertebrae forward or backwards is determined.The main X -ray signs of osteochondrosis include the narrowing of intervertebral cleft, pathological mobility and displacement of vertebral bodies, the deposition of salts in the disc tissue (calcification), the formation of regional growth of vertebral bodies, compaction of the vertebra on the edge with the affected disc (subcondral sclerosis).The radiography of the lumbar column is a research routine, which gradually loses its importance in the context of the active implementation of new and more informative research methods (TC and MRI).The lumbar department radiography is used today as a detection diagnosis method.
The Lumbar column TC is also carried out using X -ray radiation, but the radial load in the body is much less than with x -ray.The study is carried out at the table of a special device: a computer tomograph, is absolutely painless.The resulting images are processed using a computer and allow it to see significantly more structures than with column radiography.
Magnetic resonance is a method in which electromagnetic radiation is used to create images.The study is also carried out in the position of bedtime on the table, which calls the tomograph camera.Magnetic resonance is harmless and painless.
The CT or the magnetic resonance of the lumbar column allow it to see all the structures of the spine, carefully examine the intervertebral discs (and the jacket and the fibrous ring) and the intervertebral holes, the content of the spinal channel.Even a slight protuberance of the intervertebral album will not go unnoticed.These methods (especially MRI) allow you to determine the direction of disc herniation, if any, the degree of compression of nerve roots, the spinal cord.Therefore, these research methods are much more informative in the diagnosis of osteochondrosis of the lumbar column than the radiography.In addition, they allow it to diagnose not only osteochondrosis, but also other diseases (tumors, circulatory disorders in the spinal cord, abscesses, congenital defects of the structure of the spine and the spinal cord), which is important during the differential diagnosis of the causes of pain in the back.
Lumbar column osteochondrosis is a disease that often causes back pain.It is, in fact, the destruction of intervertebral discs.Due to the osteochondrosis of the lumbar column, a person often loses the ability to work, since, in addition to pain, the disease can lead to a violation of the mobility of the spine, the inability to sit, stop and walk.The symptoms of this disease are not specific and require additional research methods to accurately confirm the diagnosis.The most informative and safe of modern diagnostic methods of osteochondrosis is the magnetic resonance of the spine.