The lumbar region has more load than all other parts of the spine. Osteochondrosis develops as a result of degenerative-dystrophic processes due to a decrease in disc height. Marginal osteophytes develop along the edges of the vertebra. At the same time, the intervertebral foramen narrows, the root is compressed, and symptoms of osteochondrosis appear. Treatment of lumbar osteochondrosis depends on the stage of the disease.
Osteochondrosis sometimes manifests itself in such a way that its symptoms "simulate" damage to other organs. You have been assigned a code in the ICD - 10. We will try to understand all the intricacies in more detail.
International classification
According to ICD-10, osteochondrosis has the code M42 and is divided into subspecies. The code M42. 0, according to ICD-10, indicates that it is a juvenile variant, osteochondrosis is manifested by Scheuermann-Mao or Calve disease. The code M42. 1 according to ICD-10 gives an idea of the disease in adults.
If the variant of the disease is not specified, in ICD-10 the code will be M42. 9. There are also complications of childhood osteochondrosis, the ICD-10 code is completely different for them. A complication occurs in the form of juvenile kyphosis, which gives Scheuermann-Mao disease. Your code according to ICD-10 M40. 0.
Reasons for the appearance
Why everything appears is still not fully understood, one thing has been established for sure: a violation of the structure of the intervertebral disc develops, which leads to further changes in the spine. Symptoms can be clearly seen after 35 years, accelerate the injury process, a long stay in a static position, due to load. But not only the load is to blame, often the disease is genetic in nature. The cause may be flat feet, especially grades 3 or 4.
Symptoms
The insidiousness of this spinal disease is undeniable, and over time it only progresses. In total, doctors distinguish four degrees of development of this pathology.
The first degree does not give any pain, a person can sit calmly and without pain, but changes characteristic of the disease are already taking place in the nucleus of the intervertebral disc. The ligaments that strengthen the vertebrae can also suffer. Locally, discomfort can be noted, which can move away from the problem area. As a result of violations of the innervation of the vessels of the lower extremities, they become cold.
In the second degree, the destruction of the fibrous ring of the intervertebral disc occurs. Instability appears in the lumbar spine, increased mobility and local tension of the lumbar muscles can be noted. A person feels constant fatigue, a feeling of a certain discomfort in the back and insecurity.
In the third degree, osteochondrosis leads to the fact that the fibrous ring completely loses its strength and bursts, the nucleus pulposus, in turn, overcomes it, due to which a hernia is formed. There is compression of the roots of the spinal nerves, symptoms develop, mainly pain. In the zone of innervation of the compressed nerve root, sensitivity completely or partially disappears. Morning or daily exercise brings significant pain. In the initial stages, burning sensation, tingling sensation bother, then comes the turn of numbness. A decrease or lack of sensation can be considered the cause of the paralysis, resulting in muscle atrophy.
According to the characteristic zones of sensitivity deterioration, it can be assumed in which segment the failure occurred. If the fibers of the sciatic nerve (the thickest in the body) are affected, the Lasègue symptom will be positive, it is easy to check at home. It is necessary to lie on your back, a stranger helps to raise a straight leg to the knee. With a positive symptom, the pain will increase if the leg is bent at the knee joint, it completely disappears.
With a significant size of the hernia, the function of the spinal cord may be impaired. Symptoms of compression of the "horse tail" can often be observed, so osteochondrosis often manifests itself, this is a bundle of nerves, leaving the spinal cord, passing through the lumbar and sacral spine. Symptoms are manifested by mobility and sensitivity problems in the lower extremities. In addition, disorders of the function of the pelvic organs are added, very often this is the bladder.
In the fourth stage, the intervertebral joints and ligaments are involved in the degenerative process and symptoms of spinal instability appear. Arthrosis of the joints between the vertebrae develops, spondyloarthrosis. There is practically no pain at this stage, but along with this, the ability to move, exercises or gymnastics for a person almost completely disappears and becomes a real problem.
Due to the defeat of various nerves innervating the internal organs, their function may be impaired. Sometimes for a long time a person struggles with a problem, but actually the cause is osteochondrosis. In addition to the fact that there are characteristic symptoms, osteochondrosis of the spine must be established instrumentally.
Diagnostics
Symptoms are important, but further confirmation of osteochondrosis makes it possible to image the lumbar spine. It shows damage to the joints of the vertebrae, a decrease in the height of the disc, narrowing of the intervertebral foramen. A snapshot of the spine is taken in two projections, additional functional tests may be required.
You can confirm the presence of a herniated disc with an MRI, the image will show characteristic changes. CT will more clearly show the structure of the tissue, it is especially convenient because the techniques are performed in different planes and sections. It is possible to consider the place where the symptoms arise and are disturbed.
Treatment
Before treating lumbar osteochondrosis, a consultation with a neurologist is necessary. Medicines have always been effective in helping to get rid of the disease. They are prescribed in courses for about 10 days, complement all physiotherapy, daily exercises, gymnastics, massage.
With the help of medication, you can effectively get rid of severe pain caused by inflammation and swelling. After treatment in a hospital, you can continue to take your medications and follow your doctor's prescriptions at home.
They all start with nonsteroidal anti-inflammatory drugs, or NSAIDs. Due to the fact that they reduce the inflammatory process in osteochondrosis, swelling and pain disappear. The doctor is engaged in the selection of drugs - they have many contraindications. But along with this, they allow to quickly alleviate the condition, after a couple of days the person will get rid of pain and sit normally, osteochondrosis will recede.
The treatment will be inferior if you do not use drugs aimed at restoring the cartilage structure. They are called chondroprotectors and contribute to better cartilage nutrition, restoration of disc tissue in the initial stages. You need to take them for a long time, including at home.
Muscle relaxants allow to eliminate the spasm of the muscles of the lower back. This condition is a response to root compression.
Medications that improve microcirculation are needed. All this will eliminate the swelling in the place where the compression occurred, give more oxygen and nutrients to the nerve cells. Exercise and massage have a similar effect, which can be done at home to relieve pain.
If your back hurts a lot and sitting becomes a real problem, painkillers will be required. This group of drugs will quickly eliminate the manifestations of the disease.
Vitamins improve the nutrition of the nerve roots, strengthen them. With the use of this group of drugs, treatment is much more effective. It perfectly overcomes the symptoms of pain ointment, which must be smeared on the place of maximum pain.
The doctor prescribes an ointment if the back hurts a lot and it is impossible to sit. Penetrating into the tissues, the ointment has an anti-inflammatory effect on the roots. You can apply the ointment in the form of compresses at night. Apply the ointment to the sore areas three times a day.
Physiotherapy
A complete rehabilitation treatment consists of:
- physical therapy exercises;
- physiotherapy;
- massage;
- traction;
- manual therapy;
- reflexology.
Therapeutic gymnastics consists of applying a dosed load on the lumbar spine. With its help, the clamped roots are released, the muscles are strengthened, the correct posture is established, which is then supported by the load. Gymnastics allows you to increase the range of motion, make the ligaments more elastic. Gymnastics is selected individually for each person.
The technique, like loading, is easy to perform, contributes to the normalization of blood circulation and improves metabolism. Gymnastics helps improve the nutrition of the intervertebral disc, increasing the space between the vertebrae. Due to the formation of a corset, pain and load on the spine are reduced. Gymnastics is performed under the supervision of a specialist, and loading is needed every morning to prevent osteochondrosis.
Physiotherapeutic methods are used, in addition to loading, very widely. Especially low-frequency currents, alternating current, ultrasound, laser and much more help. With ultrasound, you can also use an ointment. Methods relieve the inflammatory process, pain and swelling. More popular:
- ultrahigh frequency;
- diodynamic;
- magnet;
- shock wave therapy;
- ultrasound;
- electrophoresis
Massage is very often used at the stage when it was possible to eliminate pain. Massage, like exercise, promotes cartilage nutrition, improves metabolic processes. It is a massage a combination of special techniques: rubbing, kneading, stroking and shock vibrations.
Correctly performed massage is the key to successful treatment and subsequent recovery. Massage should only be performed by a specialist. Also, you can use an ointment with an anti-inflammatory effect. Massage allows you to relieve muscle spasm, improves blood flow and strengthens the back.
Manual therapy is also a massage, only using a special technique. Its effect is the same as that of a massage.
With the help of specially selected weights and techniques, traction is carried out. The procedure helps to increase the space between the vertebrae, relieves pain, restores the anatomical axis of the spine.
Acupuncture is based on the effect of a needle prick on the active points of the human body. The technique is especially indicated for severe pain syndrome.