Lumbar osteochondrosis is a chronic degenerative dystrophic disease of the lumbar spine that affects the intervertebral discs and structures adjacent to the lumbar spine.It mainly affects people of working age.It presents with a variety of symptoms, mainly pain in the waist and legs and limited waist movement.For diagnosis, studies such as lumbar spine radiography, computed tomography, or magnetic resonance imaging are used.In this article, you can learn more about the causes, symptoms, and diagnosis of lumbar osteochondrosis.
Osteochondrosis is a result of the aging body.Starting at the age of 25, almost everyone (!) will experience some symptoms of this disease.But the severity, speed of progression, and extent of clinical manifestations of these changes depend on a variety of reasons, primarily on the healthiness of a given person's lifestyle.Moderate physical activity, obligatory morning exercises, correct body posture when performing multiple tasks (gardening, construction, general house cleaning, etc.), orthopedic mattresses - these are all points in preventing the development of osteochondrosis of the lumbar spine.
According to statistics, 80% of back pain cases are caused by spinal osteochondrosis.
How does osteochondrosis develop?
The entire spine is made up of individual vertebrae, with intervertebral discs located between them.That is, there is an intervertebral disc between the two vertebrae.The intervertebral disc is composed of the nucleus pulposus and the annulus fibrosus.The core contains a large amount of water, which provides cushioning and flexibility to the spine.The annulus fibrosus is located on the periphery of the nucleus pulposus, as if anchoring it within itself.
As the load on the nucleus pulposus increases over time, its physiological properties change, it loses water and dries out, and over time it becomes isolated: the discs flatten and the vertebral bodies move closer to each other.As these processes proceed, the annulus fibrosus in the nucleus pulposus loses elasticity and begins to bulge under the influence of mechanical loading.This is called protrusion.The annulus fibrosus then ruptures and the nucleus pulposus falls off through the resulting crack: a disc herniation occurs.Two adjacent vertebrae and a portion of the disc between them (called a spinal segment) acquire excessive mobility, thereby increasing the load on the adjacent segment.Overloading of adjacent segments can trigger similar pathological processes.These changes are called osteochondrosis.
In order to somehow ensure the stability of the spine, bone growth forms along the edges of the vertebral bodies, increasing the area of support.This phenomenon is called spondylosis.Changes in the joints between vertebrae are called spondyloarthropathy.Often, all three conditions—osteochondrosis, spondylosis, spondyloarthropathy—coexist.
reason
What causes osteochondrosis?There are several theories today about how it happened:
- Mechanical theory: Perhaps the main reason should be considered as the regular increase in spinal load.This is why osteochondrosis is an almost inevitable fate for loaders, miners, builders and people in similar occupations.The occurrence of lumbar osteochondrosis is mainly related to uncomfortable working postures that force bending and lifting heavy objects;
- Another developmental factor may be incorrect posture, sitting in the wrong position, which is especially important for mental workers;
- Sometimes the genetic characteristics of the spinal structure and the nutrition of its individual structures play a role;
- Trauma Theory: Any injury to the spine, even the most minor, can trigger a degenerative process;
- Hormone metabolism disorders and endocrine diseases can adversely affect the metabolism of spinal tissues and lead to the development of osteochondrosis;
- The age theory means that the discs wear down naturally over the course of life.
Rarely does only one of these theories explain the occurrence of osteochondrosis in each specific case.Many times, several factors are responsible at the same time.
Excess weight plays an important role in the development of lumbar osteochondrosis, as it is itself an overload of the spine.The higher the body mass index (degree of obesity), the more pronounced the changes in the spine are.Other causes of osteochondrosis include:
- sedentary lifestyle;
- Unhealthy diet (fast food, excess sweets, processed foods: all of these can lead to micronutrient imbalances) and lack of fluids;
- Structural abnormalities of the spine (e.g., presence of additional lumbar vertebrae);
- often wear high heels;
- Pregnancy (due to overloading of the lumbar spine);
- Professionals involved in sports suddenly stop training;
- Smoking and alcohol abuse: as factors that accelerate the aging process in the body.
symptom
The main symptom of lumbar osteochondrosis is pain.The nature, location of origin and direction of pain depend on which receptors are stimulated, how severe the changes are to the disc and surrounding tissue, whether there is a herniation or hernia, the direction in which the herniation forms, etc.
Lumbar osteochondrosis has reflex syndrome and compression syndrome.
Reflex syndrome occurs when the annulus fibrosus receptors in the affected disc, ligaments, and nearby joint capsules are irritated.They are called reflexes because, in addition to pain, they are accompanied by reflex changes in muscle tone, vegetative vasculature or neurodystrophies, that is, stimuli are transmitted with the help of reflexes to other structures, causing symptoms mainly from soft tissues.
Compression syndrome is caused by changes that develop during osteochondrosis that compress nerve roots, blood vessels, or the spinal cord.
lumbar reflex syndrome
low back pain(low back pain): Acute, sudden pain in the lower back (less common - no apparent cause) that occurs during awkward movements or moments of physical stress.It is believed that the occurrence of low back pain is related to the movement of the nucleus pulposus within the annulus fibrosus, which occurs in the early stages of osteochondrosis.The pain is often described as "low back pain" or "a stake in the lower back."The patient freezes in place in pain.The slightest movement can cause the pain to worsen (sneezing, coughing, trying to turn over in bed, moving legs).If a person is in a reclined position when low back pain occurs (which is most common), he or she will be unable to stand upright.Severe muscle tension occurs reflexively in the lumbar spine.A ridge of muscle can be felt along the vertebrae in this area, sometimes visible to the naked eye without touching it, and the tension in the muscle is very noticeable.Palpation is painful for the patient.This increased muscle tone acts as an anchor, protecting the affected lumbar segment from pathological activities that may worsen the condition.The natural curve of the spine in the lower back (lordosis) is flattened and may curve sideways (scoliosis) due to muscle tension.
Lombardinha– Another lumbar reflex syndrome.The term also means the presence of pain in the lumbar area.However, unlike low back pain, the pain does not occur sharply but rather gradually, lasting for hours or even days.The pain is dull in nature, of moderate intensity, and worsens with movement while sitting or standing or moving from one position to another.Lying on your back with a cushion under your lower back can relieve some symptoms, but passively raising your straight legs can cause worsening of lower back pain (La Seger syndrome).Lumbar spine palpation will feel painful, but the reflex muscle tone is not as obvious as in low back pain, and sometimes even disappears completely.Movement of the lumbar spine is limited, but possible.This means the patient can bend down and to the sides to a certain extent (and then the pain worsens).
Lumbar pain– Another type of lumbar reflex syndrome.This term refers to pain in the lower back area that radiates into the buttocks and legs (along the back).The nature of the pain varies, mostly aching, but may also periodically intensify, as if "shooting" in the leg.Just like lower back pain, it increases with any movement, walking, exertion and decreases when lying on your back.Lassegue's sign is usually positive.The lumbar spine will be painful to palpation, and there will be pressure at certain points (eg, midway between the buttocks and thighs, midway up the back of the thigh, midway into the popliteal fossa).Tense lower back muscles.Forward and side bending are restricted.
lumbar compression syndrome
Clinical features depend on which structure is compressed.
There are nerve roots (spinal nerves) between the vertebrae in each foramen: left and right.If the pathological form of lumbar osteochondrosis (mainly disc herniation) compresses the root, radiculopathy will occur, and the symptoms of each root are different.Common to all lumbar radiculopathies are sneezing, coughing, increased pain with lower back movement (especially forward bending), tightness of the lumbar muscles, and limited movement of the lumbar spine.The most common types of lumbar radiculopathy are:
- Radiculopathy L1, L2, L3: Pain occurs in the lower back and radiates to the inner front of the thigh.In the same area, paresthesia may occur (crawling sensation, numbness), surface sensitivity is impaired (sharp touch is indistinguishable from ordinary touch, hot and cold sensations are lost).Decreased knee reflexes and quadriceps weakness;
- Radiculopathy L4: Pain radiates from the waist to the front and lower part of the thigh, the inner surface of the knee joint and slightly downward along the inner surface of the calf.In these same areas, paresthesia is abnormal and surface sensitivity is lost (reduced).There is also weakness in the quadriceps and decreased knee reflexes;
- Radiculopathy L5: one of the common localizations.The pain radiates to the buttocks, along the outer edge of the thigh, and along the front outer surface of the calf to the inner edge of the foot and big toe.Paresthesia is abnormal here, surface sensitivity is impaired, and pain during sneezing and coughing is also transmitted from here.Additionally, extending the big toe becomes difficult because the muscles that perform this action are innervated by the L5 root.Sometimes it is difficult to stand with your heels straight;
- Radiculopathy S1: Also common in lumbar osteochondrosis.The pain radiates to the buttocks, along the outer posterior edge of the thigh, and along the outer edge of the calf to the outer edge of the foot, the fifth toe, and the heel.These areas are characterized by paresthesias and decreased surface sensitivity.Achilles tendon reflexes are weakened.When this root is damaged, the calf muscles and foot flexors become weak, making it difficult to stand and walk on your toes.
Radiculopathy of multiple roots may occur simultaneously, which is particularly typical of L5 and S1.Sometimes a hernia compresses multiple roots.
If a herniated disc bulges backward, it can put pressure on the spinal cord.This condition is possible only if the hernia is located in the upper lumbar area, since there is no spinal cord below the second lumbar vertebra (the root of the spinal cord is compressed, cauda equina syndrome occurs).
If the lumbar blood vessels supplying blood to the spinal cord are compressed, then in the case of acute circulatory disorders, they can develop spinal strokes, and long-term compression - myelopathy.Myelopathy presents with bilateral leg muscle weakness, starting in the feet and progressing upward.Sensation in the legs is impaired, with loss of Achilles tendon reflexes and subsequently loss of knee reflexes.Urinary tract disorders (frequent, "urgent" urges requiring immediate gratification, urinary incontinence) may occur.
diagnostic methods
The diagnosis of lumbar osteochondrosis is based on clinical data and data from other research methods.The key role belongs to 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 taken in 2 mutually perpendicular projections - the direct posterior projection and the lateral projection.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 curves. To show the intervertebral joints and intervertebral foramina, radiographs are taken in oblique projection.To identify pathological mobility of individual lumbar segments (which is a sign of osteochondrosis), radiography is performed under functional tests, that is, in the position of flexion and extension of the spine. Normally, the change in the height of the intervertebral discs in the anterior or posterior sections is clearly visible in accordance with the direction of the tilt of the body; with osteochondrosis, due to the functional block of one of the segments, the height of the disc does not change either during flexion orextension. To determine the forward or backward displacement of the vertebrae through pathological movement.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 disc tissue (calcification), the formation of marginal growths of the vertebral bodies, compaction of the vertebra at the border with the affected disc (subchondral sclerosis). X-ray of the lumbar spine is a routine research method, which is gradually losing its significance against the backdrop of the active introduction of newand more informative research methods (CT and MRI). X-rays of the lumbar region are now used as screening diagnostic methods.
Lumbar spine CT scans are also performed using X-rays, but the radiation exposure to the body is significantly less than X-rays.The examination is performed on a table with special equipment - a computed tomography scanner; it is absolutely painless. The resulting images are processed using a computer, allowing you to see more structures than with spinal radiography.
MRI is a technology that uses electromagnetic radiation to create images.The exam is also performed on a table that slides into the tomography room.MRI is harmless and painless.
A lumbar spine CT or MRI allows you to see all the structures of the spine, carefully examining the intervertebral discs (including the nucleus pulposus and annulus fibrosus) and the intervertebral foramina, the contents of the spinal canal.Even a slightly herniated disc does not go unnoticed.These methods, especially MRI, can determine the direction of the disc herniation (if present) and the degree of compression of the nerve roots and spinal cord.Therefore, these investigational methods are much more informative than radiography in diagnosing lumbar osteochondrosis.In addition, they allow the diagnosis not only of osteochondrosis, but also of other diseases (tumors, spinal circulatory disorders, abscesses, congenital defects of the spine and spinal cord structures), which is very important in the differential diagnosis of causes of back pain.
Lumbar osteochondrosis is a disease that most commonly causes back pain.In fact, it is destruction of the intervertebral disc.A person is often incapacitated due to lumbar osteochondrosis because, in addition to pain, the disease causes impaired spinal mobility and the inability to sit, stand, and walk.The symptoms of this disease are nonspecific and require additional research methods to accurately diagnose it.The most informative and safe of the modern methods for diagnosing osteochondrosis is spinal MRI.