Osteochondrosis of the 2nd degree of the lumbosacral region: causes and treatment

Spinal osteochondrosis (intervertebral osteochondrosis) is a multifactorial disease. This means that its development can be influenced not only by external factors, but also by hereditary predisposition. With osteochondrosis, degeneration (weakening of the basic functions) of the intervertebral discs occurs, which can lead to damage to the musculoskeletal segment, nervous system and other parts of the spinal tube. Osteochondrosis of the lumbar region of the 2nd degree is manifested by instability of the clinical picture and disruption of metabolic processes in the nucleus pulposus - a gelatinous substance that fills the space between the two connective tissue plates of the intervertebral disc.

Osteochondrosis of the lumbar region 2 degrees

Mechanism of disease development

Osteochondrosis is a deformation of the intervertebral discs. The discs located between the vertebrae are a kind of shock absorption that provides the spinal column with mobility and flexibility. When intervertebral discs are deformed, the distance between the vertebrae is reduced, resulting in compression of the nerve roots and pain. Osteochondrosis of the lumbar spine passes from stage 1 to stage 2 in a fairly short period - within a month. The development of the disease is accelerated under the influence of unfavorable factors.

Risk factors

Factors contributing to the faster development of degenerative changes include:

• Unbalanced diet with a deficiency of minerals and an excess of fast carbohydrates.
• Spinal injuries.
• Congenital anomalies of vertebral development.
• Hormonal disorders (diabetes mellitus, dysfunction of the thyroid gland and ovaries).
• Excess body weight.
• Poor posture.
• Infectious diseases of the spine.
• Lack of regular and adequate physical activity.

These factors contribute to the development of degenerative processes not only in the cartilage of the spine, but also in the joints. Osteoarthritis most often occurs in the hip and knee joints, as they bear the greatest load.

Causes

Osteochondrosis of the lumbar spine of the 2nd degree develops for a number of reasons.

2.1. Metabolic disease

When metabolic processes in the body are disrupted, nutrition of the intervertebral discs stops, and as a result, degenerative processes begin in the intervertebral space. The fibrous membranes are damaged, the vertebral disc gradually takes on a flat shape, which causes the development of osteochondrosis of the lumbar spine of degrees 1 and 2.

2.2. Physical inactivity

With a sedentary lifestyle, the muscles that support the spinal column atrophy, displacement of the vertebrae and deformation of the intervertebral discs occur.

2.3. Excess weight

A common cause of grade 2 lumbar spine osteochondrosis is increased load on it, which is caused by the patient’s excess weight.

2.4. Backbreaking work

If work involves lifting weights and other physical activity, there is a risk of developing grade 1 and 2 osteochondrosis of the lumbar spine due to excessive stress on it.

What is osteochondrosis?

Osteochondrosis is a progressive disease of a chronic nature . The disease is accompanied by degeneration of the bone and connective tissues of the spine. The pathological process of tissue change originates in the intervertebral disc. Its structure is a fibrous ring with a nucleus pulposus inside.

With osteochondrosis, changes in the spine begin with the intervertebral discs

When metabolism is disrupted, the kernel gradually dries out. Yes, and changes occur in the ring: breaks appear in the tissues, which can cause the nucleus to escape. This process begins to affect the vertebral bones, as the vertebrae withstand extreme loads.

In addition to discs, joints and ligaments are involved in the negative process. If left untreated, the disease can lead to serious complications.

Main symptoms

The main manifestation of the disease is pain. Also, degree 2 osteochondrosis of the lumbar spine is associated with serious dysfunctions of the body and is manifested by various symptoms.

3.1. Increased level of fatigue

Chronic fatigue of the patient is associated with constant pain, which can disturb at night and prevent sleep. Also, grade 2 osteochondrosis of the lumbar spine limits movement and forces you to exert more effort to perform normal actions.

3.2. Problematic urination process

With osteochondrosis of the lumbar spine of the 2nd degree, important nerve roots that are responsible for various functions of the body are pinched. The result of such pinching can be urination problems.

3.3. Pain in the kidney area

Kidney pain with osteochondrosis can be disguised as other diseases. It occurs as a result of pinching of the nerve roots that are responsible for the functioning of the kidneys.

Widespread or polysegmental

The disease develops in 12% of cases of osteochondrosis (5). This is the most severe type of disease, when degenerative processes occur in several segments (a segment is two vertebrae, upper and lower, surrounding the intervertebral disc affected by the disease) of the spine. Both segments of one department can be affected (for example, osteochondrosis of the disc between the 4th and 5th and 6-7th cervical vertebrae) and unrelated segments of different departments. For example, osteochondrosis of the disc between the 4-5 cervical vertebrae (C4-C5) and the disc between the 4th and 5th lumbar vertebrae (L4-L5) may develop.

Symptoms of common osteochondrosis consist of those that are characteristic of each lesion individually.

If osteochondrosis of all parts of the spine develops, this is called generalized osteochondrosis. Usually it develops in people whose genes “dictate” to them a special structure of the musculoskeletal system and connective tissue, and against this background the person overloads his spine.

Because with polysegmental osteochondrosis, it does not happen that an exacerbation develops simultaneously in all departments. Most often, exacerbation develops in one department, then in another. This led to the emergence of such a “everyday” diagnosis as wandering osteochondrosis. Official medicine does not recognize it and prescribes additional research for a person who has made such a “diagnosis” in order to understand the cause of his symptoms.

Youthful or juvenile

Juvenile osteochondrosis is a group of diseases that develop in children under 20 years of age. In this case, there is a violation of the blood supply in one or more cartilages located near the joints, from which bones develop (elongate) (these areas are called ossification centers).

Juvenile osteochondrosis is divided according to localization into osteochondrosis (9), which affects:

• brush;
• shoulder joint;
• tibia and fibula;
• radius and ulna bones;
• patella;
• metatarsus of the foot;
• hip joint;
• tarsus of the foot;
• hip and pelvis;
• femur (this is called Perthes disease).
• juvenile osteochondrosis after healing of congenital hip dislocation.

Juvenile spinal osteochondrosis is also called Scheuermann-Mau disease. It is based on a violation of the blood supply to the plates of cartilage that lines the vertebral body and is adjacent to the intervertebral disc. But not all of them suffer, but only some of the vertebrae. The severity of the disease depends on the angle at which the thoracic spine is concave, on the number of affected vertebrae, and the degree of their deformation. Most often it develops in boys, aged 11-18 years.

Stages (periods)

Modern literature describes spinal osteochondrosis as a chronic process prone to relapses. Developing at a young age (mainly as a result of injuries or improper movements, heavy lifting), it progresses at different rates, can slow down (remission of osteochondrosis occurs), or can proceed continuously. In old age, on the contrary, a slow course of the disease is observed.

Neurologists distinguish several stages (periods) depending on how much the intervertebral disc structures are changed:

1. I period. Here, the amount of water in the nucleus pulposus, the shock-absorbing center of the intervertebral disc, decreases, and cracks appear in its fibrous ring. The nucleus pulposus is deformed and shifted to the posterior side (towards the posterior longitudinal ligament, which runs along the posterior surface of the vertebral bodies). This intradiscal movement of the nucleus pulposus causes irritation of the passing nerves (in the cervical region - sinuvertebral). This is manifested by minor pain in the neck or the corresponding part of the back, stiffness of movements, adoption of a special position in which some pain relief occurs. If osteochondrosis develops in the lumbar region, the lumbar lordosis is smoothed.
2. The second period is characterized by the formation of subluxations and pathological mobility in the affected segment of the spine. This is due to the fact that the cartilage-like tissue of the disc (fibrous ring), which lies around the nucleus pulposus, begins to gradually dry out - the height of the disc decreases. Where the annulus fibrosus delaminates more, the nucleus pulposus rushes, helping to further disintegrate it (usually this happens towards the weaker posterior longitudinal ligament). This period of osteochondrosis is manifested by pain at the level of the affected segment; the muscles above and below the segment are constantly tense, trying to hold the vertebrae so as not to damage the spinal cord.
3. III period is characterized by a complete rupture of the fibrous ring, so the nucleus pulposus moves through it and protrudes between the vertebrae (an intervertebral hernia is formed). The nucleus pulposus may even prolapse into the lumen of the spinal canal (disc sequestration). The cartilage covering the vertebrae becomes thinner due to the fact that the layer between them becomes smaller. Symptoms of the stage depend on which direction the intervertebral disc is displaced:
   if in the direction of the hole through which the spinal root exits, pain is felt that spreads along the nerve fibers (that is, if osteochondrosis develops in the lower cervical or upper thoracic segments, they will be felt in the arm, and if in the lumbar, then in the leg ), the sensitivity of innervated organs suffers;
4. if towards the spinal canal along the midline, back pain becomes constant, mobility and sensitivity of the limbs are impaired, the function of internal organs receiving innervation from the affected segment suffers,
5. if the nucleus pulposus penetrates the vertebra located above or below, the disease will be asymptomatic;
6. IV period. The tissue of the affected intervertebral discs is replaced by scar tissue, due to which mobility in this spinal segment is limited or lost. In neighboring segments, the vertebrae are forced to shift, and inflammation and arthrosis develop between their processes. Osteophytes - bone outgrowths - begin to appear from the bones. The longitudinal ligament may ossify. The edges of the vertebrae deformed by osteophytes and the ossified ligaments next to them form a kind of bone brackets. This is spondyloarthrosis.

In the domestic literature you can see another classification of osteochondrosis. She distinguishes between acute, subacute and remission.

the initial stage of osteochondrosis. In rare cases, pain periodically occurs in the affected area of ​​the spine, which quickly passes.

When the muscles trying to stabilize the spine are involved in the process, a spasm occurs in them and local vessels are compressed. Because of this, swelling develops, which compresses the nerve roots. Pain occurs. This is an acute period of the disease. If treatment is started during this period - limiting physical activity in the damaged area, using painkillers (also known as anti-inflammatory drugs), then the attack of osteochondrosis will pass in 5-7 days. Subacute or 2nd period of the disease begins.

The subacute period lasts approximately 12-14 days. If at this stage you do not overcool, do not lift heavy objects, or make sudden movements, osteochondrosis goes into remission.

Exacerbation of osteochondrosis rarely develops “on its own” if a person takes care of replenishing the microvibration deficiency in the body (this is achieved through high physical activity and/or phonation procedures) and maintaining sufficient blood supply to the affected area.

Exacerbation of osteochondrosis can be caused by:

• hypothermia;
• lifting weights;
• severe stress;
• sudden movements;
• unprofessional massage;
• drinking alcohol;
• cold;
• sudden changes in heat and cold (for example, diving into cold water after a bath or sauna);
• frequent bending;
• long stay in a bent position.

Degrees of osteochondrosis

In its development, osteochondrosis goes through certain stages. These are called grades, and depending on the grade, the doctor plans treatment.

To understand how much the disease affects work, the ability to self-care, and the adequacy of a person, domestic neurologists distinguish 5 degrees of osteochondrosis:

Osteochondrosis of the spine, no matter in what part it forms and no matter what degree it reaches, needs to be identified and prescribed adequate timely treatment. In this case, treatment should be comprehensive, and include not only taking medications to relieve symptoms, but also other (main) treatment methods aimed at eliminating the causes of the disease. Read more about treatment here: “Treatment of osteochondrosis at home.”

List of used literature:

1. Neurology and neurosurgery / ed. A.N. Konovalova, A.V. Kozlova; E.I. Gusev, A.N. Konovalov, V.I. Skvortsova, textbook: vol. 1 – 2009
2. Osteocondritis of the spine. V.A. Epifanov, A.V. Epifanov. – M, 2008
3. Osteochondrosis. Yakushin M.A., Gilinskaya N.Yu., Yakushina T.N., Maratkanova T.V. Moscow Regional Research Clinical Institute. Almanac of Clinical Medicine, 2001, No. 4, Pages: 285-292.
4. Clinical radiology. Guide in five volumes / ed. G.A. Zedgenidze. Volume 3. “X-ray diagnosis of injuries and diseases of bones and joints.
5. Osteocondritis of the spine. Guide for doctors. N.M. Zhulev, Yu.D. Badzgaradze, S.N. Zhulev. – St. Petersburg, 1999
6. Traumatology and orthopedics. Kornilov N.V.
7. Orthopedics. National leadership. Mironov S.P., Kotelnikov G.P., 2008
8. Traumatology and orthopedics. Kavalersky G.M.
9. International Classification of Diseases, 10th Revision (ICD-10).
10. Stenosis of the lumbar vertebral canal and sciatica. Verbiest H. Neurosurg Rev. 3: 75 - 89. 1988.
11. Cervical osteochondrosis. Popelyansky Ya.Yu. M, 1966
12. Wikipedia.
13. Body resources – immunity, health, longevity. Vasiliev A.E., Kovelenov A.Yu., Kovlen D.V., Ryabchuk F.N., Fedorov V.A., St. Petersburg, 2004

Author of the article: doctor Krivega M.S. (Regional Infectious Diseases Clinical Hospital, Zaporozhye)

You can ask questions (below) on the topic of the article and we will try to answer them competently!

Diagnosis of the disease

Osteochondrosis of the lumbar spine, degree 2, requires immediate treatment, which can only be prescribed after a medical examination. The following methods are used to diagnose the disease:

• medical examination: allows you to preliminarily determine the area of ​​damage to the spine;
• X-ray: confirms the diagnosis and gives a detailed idea of ​​the location of the disease;
• MRI: may be prescribed as an additional research method.

Before definitively diagnosing grade 2 osteochondrosis of the lumbar spine, a neurologist
may prescribe other studies to exclude diseases with similar symptoms.

Do they take you into the army?

Conscripts with osteochondrosis are rarely not drafted into the army. It all depends on the degree of deformation and degradation of the spinal discs.

If the pathology interferes with normal life, the question of calling up for military service is left to the decision of the military draft commission. If there is an intervertebral hernia, the young man will most likely be declared unfit for military service. Sometimes, with second-degree osteochondrosis, they give a deferral for a year for treatment. A year later, the young man is called back to the military registration and enlistment office to undergo a commission and determine the degree of suitability for military service.

Possible complications

Grade 2 osteochondrosis of the lumbosacral spine in the absence of therapy can result in the following complications:

• sciatica: inflammation of the sciatic nerve, causing numbness of the limbs, curvature of the spinal column and even more rapid destruction of the intervertebral discs;
• vertebral instability: a dangerous condition in which the lumbar region begins to “slide” from the sacrum and disrupt the functioning of internal organs.

It is easier to prevent complications of osteochondrosis of the lumbar spine at stage 2 of the disease than to treat them in the future. Therefore, timely diagnosis and treatment are extremely important.

Diagnosis of second degree osteochondrosis

If you experience pain and lumbago in any area of ​​the spinal column, you must make an appointment with a doctor.

Often with this problem they turn to a therapist at a local clinic.

If a patient is suspected of having osteochondrosis, he gives a referral to a specialized specialist.

Spinal pathologies are usually dealt with by a neurologist.

Treatment most often comes down to prescribing NSAIDs.

Effective comprehensive treatment is possible only in specialized centers where a whole team of doctors cares for the patient. But, this is quite an expensive pleasure.

At the initial visit, the doctor will collect anamnesis:

• When and after what did the pain appear?
• In what part of the spine is it located?
• Does it increase with load?
• Is there numbness in the limbs?
• Do you have breathing problems?
• Are movements constrained?

Next, the doctor begins a visual examination of the spine.

Tests ordered:

• Blood chemistry;
• X-ray of the affected area;
• CT scan;
• MRI.

Using an x-ray, the doctor will be able to determine the causes of the pathology.

Computed tomography will allow you to visualize the condition of bone tissue. Magnetic resonance imaging allows you to see the condition of the spinal discs, connective and cartilage tissue.

Only after receiving the examination results, the doctor will be able to diagnose the patient with second-degree osteochondrosis and prescribe comprehensive treatment for the pathology.

Methods of treating the disease

Grade 2 osteochondrosis of the lumbar spine is more difficult to treat than the first, but in the vast majority of cases it is possible to manage with conservative methods.

6.1 Drug treatment

Medicines are necessary to relieve symptoms that have a negative impact on the patient's quality of life. For grade 2 osteochondrosis of the lumbar spine, the following groups of drugs can be prescribed:

• anti-inflammatory drugs: relieve pain, stop the inflammatory process and swelling;
• chondoprotectors: restore cartilage tissue – intervertebral discs;
• B vitamins: improve the general condition of the body and contribute to the nutrition of intervertebral discs.

In the acute stage of the disease, the doctor prescribes injections to block the pain syndrome.

6.2 Physiotherapeutic and manual therapy methods

Physiotherapy and manual manipulation can be prescribed as effective treatments once the pain is relieved. For osteochondrosis of the lumbar spine of the 2nd degree, these types of therapy provoke blood flow to the affected area and improve the functioning of the vertebral muscles. However, these treatment methods can only be used on the recommendation of a doctor. Manual therapy for osteochondrosis of the lumbar spine of the 2nd degree is effective, provided that it is performed by a qualified physician.

6.3 Therapeutic gymnastics and physical education

Exercise therapy is a set of exercises that is selected individually for each patient, depending on the severity of the disease. With lumbar osteochondrosis of the 2nd degree, the vertebral muscles are strengthened, which means that with regular exercise the general condition of the spine will improve. However, exercise therapy is effective only if it is performed consistently.

6.4 Surgical treatment

Surgical intervention for grade 2 osteochondrosis of the lumbar spine is prescribed as a last resort. It is indicated in the absence of a positive effect after long-term conservative therapy. Surgical treatment is aimed at restoring damaged vertebrae and eliminating intervertebral hernias.

6.5 Alternative therapy

Alternative therapy can provide positive results. This does not mean that you can treat osteochondrosis yourself. However, on the recommendation of a doctor, it is worth using methods of alternative therapy for osteochondrosis of the 2nd degree of the lumbar spine. Alternative therapy can act as an additional treatment method.

Medications

Pharmaceuticals are used in the treatment of second-degree osteochondrosis for:

• elimination of pain (including mild and moderate severity) and spasms;
• prevention of disease progression;
• restoration of tissue nutrition;
• relieving inflammation;
• returning the patient to normal life.

Some medications have an immediate effect (for example, glucocorticoids), and some (for example, chondroprotectors) have a cumulative effect, and noticeable results from taking them appear no earlier than after 3 months.

Medicines are an obligatory aspect in the treatment of second degree osteochondrosis

Chondroprotectors

Chondroprotectors for second-degree osteochondrosis come in 3 types: with glucosamine, with chondroitin, and combined.

Chondroitin drugs include mucosate, alflutop, structum, chondroxide. Dona, Elbona and Artiflex are produced with glucosamine. Most doctors and patients choose modern combined chondroprotectors - such as artracam, teraflex, rheumoxicam, movex active, chondroitin complex and others. Some of them already contain anti-inflammatory components.

Nonsteroidal anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs are used during exacerbation of symptoms to achieve remission. NSAIDs can be prescribed for both systemic and local treatment of grade 2 osteochondrosis. Systemically (in the form of tablets or injections) patients are recommended to take artradol, nurofen, methindol, voltaren, nimesil, revmoxib, movalis.

Compresses and wraps, ointments and creams with diclofenac, heparin and dimexide are applied locally. Indomethacin ointment, rheumoxicam and other drugs in this group help relieve discomfort.

Please note that NSAIDs in tablets and injections should not be taken on a regular basis - this can lead to stomach ulcers. The dosage and schedule for taking medications should be determined by a doctor. To accelerate and consolidate remission, NSAIDs are best combined with physiotherapy.

Glucocorticoids

Glucocorticosteroids are hormonal drugs that are used in cases where the treatment of second-degree osteochondrosis with NSAIDs has proven ineffective. GK is prescribed in short courses no more than 2-3 times a year (in the absence of contraindications). Because these drugs have serious side effects, avoid self-medication! Glucocorticoids include hydrocortisone, diprospan, kenalog, prednisolone and methylprednisolone, dexamethasone and others. Relief of symptoms after taking GC (usually in the form of injections into the area of ​​the affected joint or directly into the joint cavity) occurs within the first hour.

Antispasmodics

Muscle spasm that occurs due to back pain is a complication of osteochondrosis. Most often it is observed in the esophagus and abdominal cavity. Spasm occurs as a basic reaction to dorsalgia. However, by spasming, the muscle irritates the receptors even more, which increases the pain.

For painful spasms that interfere with sleep and daily activities, antispasmodic medications are recommended. Such as mydocalm, tolperisone, paparin.

Prevention

Contrary to popular belief, grade 2 osteochondrosis of the lumbar spine can be completely cured. It will not appear in the future if you change your lifestyle and follow the following recommendations:

• rational nutrition: a sufficient amount of vitamins and microelements in the daily diet will prevent depletion of intervertebral discs;
• physical activity: morning exercises, warm-up during breaks between work - this is an effective preventive measure against osteochondrosis, allowing you to maintain muscle elasticity;
• comfortable conditions: for osteochondrosis of the lumbar spine of the 2nd degree, it is worth acquiring an orthopedic mattress for sleeping, as well as taking care of comfortable sitting at the workplace;
• reasonable loads: do not overload the spine with excessively heavy objects; for the same reasons, monitor your body weight.

You must understand that self-medication of grade 2 osteochondrosis of the lumbosacral spine is strictly contraindicated, since each case is individual.

Alternative therapy

The first thing to note is that self-medication for osteochondrosis is strictly contraindicated, however, on the recommendation of a doctor, you can resort to an additional method of treatment. Traditional recipes are not able to cure the disease or get rid of inflammation, but they help the body fight pathology.

Recommendations for home implementation

1. Buy an orthopedic mattress. It is necessary that the patient's sleeping place be rigid so that the spine has proper support during sleep.
2. Dieting. With osteochondrosis, when it has entered the second stage, it is important to adhere to dietary nutrition. Particular attention is paid to diet if the root cause of the disease is a metabolic disorder. The basis of the diet should be vegetables and fruits, dried fruits, nuts, and seafood. In this way, recovery can be significantly brought closer.
3. Use herbal medicine. To increase immunity, the use of herbal infusions (mint, licorice root, chamomile) is recommended.

You can watch a commentary on osteochondrosis from a specialist in the video.