Degrees of lumbar osteochondrosis: features of development and treatment

Osteochondrosis of the lumbar spine is the main cause of lower back pain in 3 out of 4 cases. If left untreated, it often leads to a herniated disc, causing patients to have difficulty walking and significant limitations in mobility. The disease is widespread - more than 50% of people complain of its manifestations in various stages. And no wonder, the entire lower back is the lower part of the spine, and it bears the heaviest load.

Is it possible to avoid the “price for upright walking,” what is needed for its early diagnosis, and how to stop or slow down the course of the disease? Let's look at it in the article.

What is lumbosacral osteochondrosis

In addition to the 33 bones that make up the vertebral column, the human spinal cord also includes cartilaginous intervertebral discs. They provide stability to the spine against vertical loads, and also play the role of a spring, softening movements - it is thanks to them that our bones do not rub against each other, and our back bends. Together with muscles and ligaments, they are involved in the human body adopting various positions. Without these cartilage "spacers", we would not be able to run, jump and walk without suffering from excruciating headaches and injuries. However, over time, they tend to wear out - this is facilitated by the genetic “weakness” of cartilage tissue, and uneven distribution of load (for example, with poor posture), and poor nutrition, and many other factors that relate to the lifestyle of a modern person. The disease is characterized by a chronic course with periodic relapses. A complete cure is impossible, but timely treatment of osteochondrosis of the lumbar spine gives an almost 100% effect and returns to normal life.

Degenerative changes in the cartilage tissue of the spine lead to degeneration of the intervertebral discs. It is expressed in discomfort when moving, muscle hypertonicity, sharp shooting or constant aching pain. The consequence of abrasion of the intervertebral discs is deterioration of tissue trophism, the appearance of microcracks in the bones and osteophytes, protrusion of the spinal cord, and compression of internal organs. For this reason, lumbar osteochondrosis is called a disease of the whole body - it is capable of triggering a chain of metabolic disorders that affect the abdominal and pelvic organs (primarily the gastrointestinal tract and genitourinary system), the spinal cord and brain, and so on. Radicular syndrome, or radiculopathy, caused by this disease can cause neuralgic pain in the heart and even the stomach. Sometimes leg paresis and other severe symptoms of osteochondrosis of the lumbar spine are observed.

When the disease is localized in the lumbar region, vertebral displacements often occur due to sudden everyday movements. In this case, it becomes difficult for patients to walk and sit, an inflammatory process begins, the relief of which requires drug treatment, physiotherapy, a special exercise therapy program for osteochondrosis of the lumbar spine and observation by an orthopedist. In some cases, realignment of the vertebrae is required - a rather painful procedure, after which significant relief occurs after 1-2 days. It can only be carried out by a chiropractor - an osteopath and a vertebroneurologist.

Symptoms of spinal osteochondrosis

Symptoms of spinal osteochondrosis can vary in the degree of pain and depend on the stage of the disease.

The most common symptoms of osteochondrosis include:

• headache;
• dizziness;
• pain in the spine, when bending over, lifting weights;
• violation of freedom of movement (difficulty straightening your back, bending over);
• flashing spots before the eyes;
• loss of sensitivity in the problem area;
• blood pressure disorders;
• pain when exhaling or inhaling;
• stitching pain in the chest area.

Only a specialist can correctly identify the symptoms of osteochondrosis and make the correct diagnosis. Thus, very often some symptoms are confused with diseases of the cardiovascular system. The Yusupov Hospital has assembled a team of highly qualified specialists with many years of experience, whose activities are aimed at identifying causes, symptoms and conducting successful rehabilitation.

Signs of lumbar osteochondrosis

Having felt pain in the back, older - and sometimes young - people who do not know how lumbar osteochondrosis manifests itself often look for completely rational explanations for this. Got a cold, pulled, lay down... In fact, pain and pain syndrome often indicate that compression of a nerve, root or even a segment of the spinal cord has already occurred, which means that the disease has passed the first stage and requires not only symptomatic, but also supportive treatment.

1. Osteochondrosis of the 1st degree
   of the lumbar region is characterized by mild pain in the sacrum and above, which feels like a kind of echo and does not attract special attention. Discomfort can only occur after sleep or prolonged sitting in an uncomfortable position or significant physical activity. In this case, patients attribute the unpleasant sensations to “numbness” of the limbs, but hardware examination and modern diagnostics help to identify even a slight displacement of the spinal disc and the appearance of a crack in the fibrous ring of the spine.
2. Osteochondrosis of the 2nd degree
   of the lumbar spine manifests itself through a feeling of chronic fatigue and discomfort, and a decrease in load-bearing capacity. Pain and discomfort (“pins and needles”, sensitivity to cold, etc.) in the lumbar region become constant companions of patients; sometimes spasmodic contractions of the muscles located below the affected area appear - the gluteal, femoral, and spinal. There may also be a partial decrease in sensitivity or, on the contrary, the appearance of neuralgia, which is difficult to relieve with conventional painkillers due to its neurogenic nature. When exercising, sharp pain is observed, the so-called. "shots". A feeling of stiffness appears in cases where you need to sit in one position for at least 10-15 minutes, and is especially pronounced after sleep or a working day. For this stage, conservative treatment is still effective - the disease responds well to therapy, stable remission without acute periods of illness can be achieved for many months.
3. Osteochondrosis of the 3rd degree
   of the lumbar region is already a complicated disease, which is characterized by gradual destruction of the tissue of nearby fibrous rings and intractable pain. Signs of osteochondrosis of the lumbar spine reach their peak, reducing ability to work and leading to disability. This stage is dangerous due to the appearance of intervertebral hernias and other irreversible changes in the spinal column, which can affect large nerves and vessels. At this stage, severe functional disorders of the musculoskeletal system and significant limitation of mobility, up to paralysis and paresis, may already appear. Stage 3 of lumbar osteochondrosis significantly affects the quality and life expectancy and may require additional support when walking (for example, a cane).

A number of experts also distinguish stages 4 and 5, where in the 4th there is scarring of the cartilage, and the 5th is considered incompatible with life, however, with timely treatment and lifestyle changes, such cases are rare in practice.

Classification by clinical manifestations

This type of classification is based on clinical studies of the patient. It has four stages:

• Stage 1. The spine continues to function as usual, but the person feels slight pain at the site of the disease.
• Stage 2. Pinched nerves, protrusion, and subluxation of the vertebrae begin, and the pain becomes stronger.
• Stage 3. The pain intensifies, spinal deformation occurs, and vertebral disc herniation occurs.
• Stage 4. The spine loses mobility, pain occurs with any movement, the patient walks with great difficulty.

After diagnosing the fourth stage, the patient receives disability.

Prevention of lumbar osteochondrosis

Exacerbation of the disease can be triggered by infectious or colds, stress, hormonal disorders, weight gain, pregnancy, age-related changes, intoxication of the body, overwork, dehydration, hypovitaminosis, smoking, high physical activity, unbalanced nutrition, uncomfortable workplace or bed, injury. At the same time, osteochondrosis is characterized by constant microtraumatization - sometimes damage to the lower back does not require a bruise, but an excessively sharp bend, turn, or lifting of the leg is sufficient.

Therefore, chondroprotectors for lumbar osteochondrosis are included in the mandatory preventive course, in addition to taking multivitamin complexes, immunomodulators, and gymnastic exercises. It is also advisable, if possible, to eliminate or compensate for the above-mentioned factors.

Treatment methods for osteochondrosis

The degree and type of osteochondrosis determines which treatment methods the doctor will choose. In particularly advanced cases, surgical intervention will be required. However, the disease is usually successfully managed with medication. Additionally, magnetic and ultrasound physiotherapy, electrophoresis, massages, therapeutic exercises and much more are used.

In our clinic you can undergo a rehabilitation course for osteochondrosis under the supervision of experienced doctors. We will do everything possible to cure osteochondrosis without surgery.

How to treat lumbar osteochondrosis

The question of how to treat osteochondrosis of the lumbar spine - with drugs or non-drug therapy - cannot be answered unambiguously. Treatment of the disease is carried out in several directions:

• elimination of symptoms
  that reduce the patient’s quality of life;
• partial regeneration of connective tissue
  ;
• implementation of a preventive program
  that prevents the progression of destructive processes in cartilage and bone tissues (maintaining a muscle corset, general tone, etc.).

Cartilage is devoid of nerve endings and blood vessels - this determines the specifics of diagnosis and treatment of osteochondrosis. Firstly, cartilage cannot hurt, and therefore self-diagnosis of the disease is difficult and the vast majority of patients turn to an orthopedist or vertebroneurologist already with lumbar osteochondrosis of the 2nd or 3rd degree. The further the destruction of cartilage goes, the more stress the already worn out discs experience, the faster the disease progresses, and the more difficult it is to achieve positive changes. The reason for this lies in the fact that the cellular restoration of cartilage occurs very slowly - tissue nutrition occurs mainly in a diffuse manner. Therefore, a general improvement in the patient’s condition plays an important role on the path to remission. The treatment of lumbar osteochondrosis necessarily includes diet, maintenance medications for 1-3 months, as well as special gymnastic exercises. In exercise, separate time is allocated for warm-ups, which stimulate the nutrition of adjacent tissues, and therefore cartilage. Warm-ups must alternate between episodes of exercise, be it sitting at the computer or long walking.

Sometimes the doctor may prescribe the wearing of compression devices - for example, corsets, bandages to support the spine in the correct position. This measure is effective for concomitant postural disorders.

Drug treatment of osteochondrosis of the lumbar spine

Drugs for the treatment of osteochondrosis of the lumbar spine include oral and external anti-inflammatory drugs, muscle relaxants, analgesics, chondroprotectors, as well as drugs to improve metabolism (B vitamins and others) and blood circulation, glucocorticosteroids, neurotransmitters, enzymes. With reduced immunity and susceptibility to infectious diseases, immunomodulators are used. Constant pain can lead to depression, which also requires treatment. If the patient suffers from convulsions or swelling, anticonvulsants and diuretics are also prescribed. Tablets for lumbar osteochondrosis, suspensions, injections, gels and applicators do not need to be used constantly - usually the doctor prescribes an individual maintenance course at significant intervals. In the acute phase, with extremely severe pain, a specialist can place the so-called. paravertebral blockade - an injection of an anesthetic into the place where the nerve root exits the spine.

Features of therapy at each stage of the disease

Treatment of lumbar osteochondrosis is a long process with an integrated approach. Depending on the severity of the pathology, its characteristics and the patient’s tolerance, various methods of therapy are prescribed. Treatment with drugs only relieves pain; the disease itself cannot be cured with drugs.

Therefore, additional techniques are used:

• Massage.
• Acupuncture.
• Hirudotherapy.
• Vacuum effect.
• Spinal traction.

Depending on the stage of the disease, the types of therapy differ radically.

Treatment of lumbar osteochondrosis of the 1st degree

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Therapy, although easier than at other stages, will still take a long time. The doctor determines a comprehensive treatment regimen that will eliminate many of the symptoms. Medicines are prescribed to relieve inflammation and improve blood flow in the damaged tissue.

Required funds:

Naturally, there must be auxiliary therapy, which involves:

• A massage that relaxes and warms up the muscles. It takes no more than 2 weeks.
• Physiotherapy (electrophoresis, magnetotherapy, ultrasound, laser). The procedures relieve pain, stimulate biochemical reactions and improve blood circulation.
• Physical therapy is definitely recommended, the exercises of which are selected individually. It is advisable to visit the pool.

It should be noted that the disease, even in the first stage of development, is not always cured. Therefore, prevention of the development of subsequent degrees of pathology comes to the fore, which is possible with proper treatment.

Treatment of lumbar osteochondrosis of 2-3 degrees

We can talk about the presence of this disease when pain in the lumbar region appears 3-5 times a week .

To treat stages 2-3 of osteochondrosis, the use of medications is required. At this stage you need:

• Eliminate all causes that contribute to the disease.
• Stop the inflammatory process.
• Normalize metabolism in the lower back.
• Activate the production of cartilage cells.
• Naturally, it is necessary to relieve pain.
• Restore mobility, which is done partly due to the complexity of the problem.

Only a set of all necessary measures will ensure a favorable prognosis.

Treatment begins with the use of medications that are intended to improve the patient's condition.

Non-steroidal drugs. Relieves pain and relieves inflammation. Taking medications should not exceed 10 days, then take a break. This is due to the presence of negative reactions with prolonged use.

The most common drugs in this group are:

• Diclofenac. It has an anti-inflammatory effect and also blocks the synthesis of prostaglandins.
• Nimesil. It comes in the form of a powder from which the drink is prepared. Relieves fever and eliminates pain.
• Nurofen. Reduces swelling and prevents inflammation of soft tissues.

Analgesics. For this disease, drugs containing several components are used that enhance the pain relief effect. You should not get carried away with them, as they become addictive.

Most often used:

• Pentalgin. Provides lasting pain relief, as the product contains 5 active ingredients.
• Tramal. It is a narcotic analgesic and is highly effective.
• Ketanov. It is an excellent pain reliever, but the drug is contraindicated for kidney and liver disease.

Chondroprotectors. Stimulates the restoration of cartilage tissue.

The most popular means:

• Teraflex. Regulates metabolism in cartilage tissue and restores lower back mobility. It will take a very long time to take it.
• Chondroxide. Available in the form of a solution for injection and gel for external use.
• Artra. Stimulates the synthesis of cartilage tissue.

You can't do without physiotherapy. For lumbar osteochondrosis of the 2nd degree, the following procedures are used :

• Magnetotherapy.
• Sharko's shower.
• Electrophoresis.
• Paraffin therapy.
• Electromyostimulation.
• Laser therapy.
• UHF.
• Vibration therapy.

The effectiveness of these procedures has been proven by scientific research, but not everyone can use them. Not every clinic has specialized equipment, and the price of the procedures is quite high. The problem can be solved by using portable devices. Their efficiency is quite high, and operation is very simple.

Treatment of lumbar osteochondrosis of 3-4 degrees

For pathology of the 3rd degree there are certain therapeutic methods. The disease is very serious and requires great attention. The same drugs are used that are used in the treatment of the disease in previous stages , but glucocorticoid hormones are necessarily added. It is also necessary to use vitamins from groups B, B1, B6, B12.

Since protrusions and hernias of the spine often occur with osteochondrosis of the lower back, spinal traction will be relevant. Novocaine blockades are also widely used, turning off peripheral nerves, thereby relieving pain.

Novocaine is a mild irritant that improves tissue nutrition and helps slow inflammation.

For stage 3 disease, traction is often prescribed.

A properly performed procedure increases the distance between the vertebrae and relieves pinched nerve endings. But to perform traction, a highly qualified doctor is required.

If surgical treatment is necessary, then minimally invasive intervention is usually used , which consists of administering an injection into the damaged disc. Its removal or connection of the vertebrae is prescribed in a neglected state.

Surgery is absolutely necessary if:

• Within 4 months, acute pain syndrome does not relieve.
• Pinching of a bundle of nerve endings, that is, a “horse tail”.
• There is severe compression of the spinal nerves.

Physiotherapy with therapeutic exercises will not be superfluous either . The main thing is no self-medication, so as not to aggravate the situation.

Find out about the possible consequences of osteochondrosis:

• Why do osteophytes form on the spine in the lumbar region?
• You can learn more about osteophytes in various parts of the spine here
• To find out what salt deposition in the spine means, follow the link