Osteochondrosis of the lumbar spine. Symptoms and treatment of lumbar osteochondrosis

Osteochondrosis is the most severe form of degenerative-dystrophic damage to the spine, which is based on damage to the nucleus pulposus of the intervertebral disc, with subsequent deformations of the bodies of adjacent vertebrae, intervertebral joints, disorders of the ligamentous apparatus, and involvement of the nervous system and blood vessels in the pathological process.

One of the most common forms of osteochondrosis is lumbar osteochondrosis , or, more precisely, the lumbosacral spine. Many people - both men and women - are familiar with back pain in the lumbar region, sacrum, and lower extremities, caused by various types of lumbar osteochondrosis and its complications. Among the causes of temporary loss of ability to work and disability, this disease occupies one of the first places.

The course of the disease is chronic, usually with periods of exacerbations. Most often, exacerbations of lumbar osteochondrosis are provoked by lifting and carrying heavy objects, hypothermia, stress, and injury.

Osteochondrosis of the lumbar spine - causes, mechanism of occurrence and development

No clear cause of osteochondrosis has been identified; the disease is considered multifactorial. The most popular theory is that the cause of spinal osteochondrosis is considered to be constant muscle overstrain or muscle hypotension, non-physiological muscle tension, which leads to overload of the vertebral segments, deterioration of their blood supply and, ultimately, to degeneration of the intervertebral discs and joints, which results in osteochondrosis.

The cause of premature aging of intervertebral discs can also be endocrine and metabolic disorders, hereditary predisposition to the development of osteochondrosis, autoimmune disorders, and microtraumas. The negative role of visceral, that is, associated with internal organs, pathologies in the development of spinal osteochondrosis has also been proven. Unfavorable heredity plays a significant role in the development of the disease. The contribution of hereditary factors to the appearance of lumbar osteochondrosis is about 60%, the rest is attributed to factors of adverse external influences on the spine.

Factors contributing to the development of osteochondrosis in both the lumbar and other parts of the spine are very numerous. The main ones are: incorrect posture, physical inactivity, muscle strain in the lumbar region as a result of constant carrying of heavy objects or sudden excessive load, hormonal changes, endocrine and somatic diseases, disruption of the normal blood supply to spinal tissues, emotional stress, age-related changes, poor nutrition. Under the influence of these factors, the processes of dehydration and circulatory disorders, arthrosis and subluxations in small joints, bone growths, prolapsed discs - hernias, gradually increase in the structures of the spine.

The most obvious causes of lumbar osteochondrosis are most often considered to be a sedentary lifestyle and back injuries. Therefore, the risk group primarily includes those people whose profession is directly related to stress on the back. This is a very wide range of professions - salespeople and waiters, surgeons and teachers - everyone who is forced to spend most of their working time standing. The risk group includes builders and loaders, as well as athletes whose occupation places heavy stress on the spine. In addition, drivers, various office workers, programmers suffer from osteochondrosis of the lumbar region - that is, those who have a mostly sedentary job and who suffer from physical inactivity.

Massage and self-massage

Self-massage for osteochondrosis is an alternative to therapeutic massage.
As part of the treatment of lumbar osteochondrosis, massage and self-massage are used at home. It is not recommended for use if the patient has pain; open wounds and skin diseases are also contraindications. Manual massage is highly effective in helping to relieve muscle tension and pain.

The procedure helps strengthen the body's defenses and activate metabolic processes. It is worth noting that a full course of massage will be very expensive; self-massage is considered an excellent alternative in this case. It is recommended that it be carried out very carefully; the rules must be followed.

Massagers

Massagers also provide the necessary massage effect on the affected area. There are a large number of devices; your doctor will help you choose the most suitable option. The specialist will determine the frequency of the procedure.

Symptoms of osteochondrosis of the lumbar spine

With lumbar osteochondrosis, pain of a different nature is possible. This can be either aching pain that occurs during prolonged sitting or after sleep, or sharp shooting pain that catches you in the most uncomfortable position and does not allow you to straighten up. Pain is caused by pinched nerve roots, irritation of the spinal column's own nerves, swelling and irritation of the muscles and ligaments located in the innervation zone of the lumbar spine.

Pain syndrome can be caused by compression of the radicular structures (radiculopathy), compression of the spinal cord (compressive myelopathy), damage to the spinal cord due to impaired blood supply due to compression, narrowing (stenosis) of the supply arteries and veins (compression-vascular myelischemia).

The cause of compression may be: protrusion and herniation of intervertebral discs, spondylolisthesis (sliding of the vertebra forward in relation to the underlying one), proliferation of osteophytes and cartilage tissue in the spinal segment. As a result, osteochondrosis of the lumbar spine leads to a narrowing of the canal through which spinal nerves or vascular structures pass, and under certain conditions (awkward movement, physical activity, unsuccessful rotation of the body, etc.) compression (squeezing) may occur. Compression of nerve structures leads to various pain syndromes and muscle spasms. Compression of blood vessels causes disruption of blood supply - ischemia of the organ that is supplied by this vessel or artery begins.

Clinical syndromes of osteochondrosis of the lumbar spine

The clinical picture of lumbar osteochondrosis is determined by a complex of vertebral symptoms (changes in the statics and dynamics of the lumbar spine) and extravertebral symptoms, which mean dysfunction of neurological and vascular structures in the lumbosacral region of the spine.

Vertebral syndromes of lumbar osteochondrosis

In lumbar osteochondrosis, vertebral syndrome is characterized by the following set of symptoms:

violation of the configuration of the vertebral functional-anatomical segment: flattening or (less often) increased lordosis, scoliosis or lordoscoliosis is observed;
impaired mobility in the lumbar region, decreased range of motion, muscle-tonic imbalance caused by tension in both deep and superficial multi-joint muscles.
local pain and tenderness during active and passive movements, which causes reflex tonic muscle tension
violation of the spring-motor functions of both the intervertebral disc and the vertebral-motor segment as a whole.
local pain (increased sensitivity) of the osteoligamentous structures of the spine in the affected area (pain on palpation, local (regional) vertebral and/or vertebral pain syndrome).

It is important to note that with osteochondrosis of the lumbar region, vertebral pathologies are always observed. The presence of signs of myelopathy, radiculopathy and myeloradiculopathy without obvious clinical and morphological signs of vertebral syndrome requires, as a rule, a more in-depth examination of the patient for primary (“non-vertebrogenic”) damage to the nervous system.

Extravertebral (reflex and compression) syndromes in osteochondrosis of the lumbar spine

Extravertebral syndromes are divided into two large groups: reflex and compression.

Reflex syndromes precede compression syndromes and are caused by irritation of the receptors of the nerve roots emerging from the spinal canal through the intervertebral foramina. Irritation can be caused by intervertebral hernia, bone growths, as well as vascular disorders (swelling, poor circulation), inflammation. In some cases, this leads to intense pain, which occurs not only locally, but also along the nerve at a distance from the site of irritation - the so-called “referred pain.” Referred pain can be short and sharp (“lumbago”) or dull and prolonged. In the area of innervation of the damaged nerve, autonomic disturbances (burning, goosebumps, impaired sensitivity) are possible. Possible myofascial pain - muscle spasm, which leads to limitation of movements.

Reflex syndromes include lumbago (“lumbago”) in the acute development of the disease and lumbodynia in the subacute or chronic course.

Compression syndromes are syndromes that occur as a result of compression, pinching of nerves, blood vessels, and the spinal cord in the area of the lumbar spinal motion segments. Compression syndromes in osteochondrosis of the lumbosacral region are divided into radicular and vascular-radicular. A special case of compression syndrome is myelopathy—infringement of the spinal cord.

Radicular syndromes (radiculopathy) are usually caused by disc protrusions, causing pinching of the spinal roots. The radicular symptoms that arise correspond to the level of the affected spinal segment. The L4-S1 roots are most often affected.

Vascular-radicular neurological disorders are caused by compression of the hernia on the root and the radicular artery passing along with it. In this case, “paralytic sciatica” can develop catastrophically quickly, characterized by peripheral paresis or paralysis of the extensor muscles of the foot. In such cases, the appearance of motor disorders is accompanied by the disappearance of pain.

Even more severe neurological manifestations are caused by disruption of the blood supply to the spinal cord due to damage to the radicular arteries. In this case, chronic discirculatory myelopathy develops, usually at the level of the lumbar enlargement of the spinal cord.

The most unfavorable variant of lumbar vertebrogenic radicular syndromes is compression of the cauda equina - the so-called caudal syndrome. Most often it is caused by a prolapsed median disc herniation, which compresses all the roots at the level of the affected segment.

Diagnostics.

Most often, the diagnosis of “osteochondrosis” is made by a neurologist. At the initial examination, the doctor conducts an examination in connection with the patient's complaints of pain or limited mobility of the spine. The patient's spine is examined in standing, sitting and lying positions, in states of rest and movement.

Feeling the spine allows you to supplement the examination data (presence or absence of deformation), determine the location, degree and nature of pain. When palpated, tension in the muscles located next to the spine is noted. The patient is asked to bend or squat to determine the range of motion in various parts.

The final diagnosis is made by a neurologist based on a physical examination, as well as the results of radiography, CT or MRI. With the help of these examinations, the level of damage is determined, the diagnosis is specified, and hidden pathologies are revealed. After diagnosis, the attending physician determines treatment tactics and selects the most effective treatment method.

Clinical classification of lumbar osteochondrosis. Degrees of osteochondrosis

Classification of lumbar osteochondrosis by degree is used to systematically characterize the clinical manifestations of the disease. This classification systemically describes the symptoms of the disease and begins from the moment the patient experiences pain.

1st degree of osteochondrosis

Occurs when an intervertebral disc ruptures, caused by sudden movement or overexertion. It manifests itself as sudden pain, a feeling of electric current passing in the spine, and the muscles are reflexively tense.

2nd degree osteochondrosis

The second degree can manifest itself in the form of symptoms of intervertebral protrusion and spinal instability. Chronic pain that worsens with exercise. Intervals of remission and exacerbation alternate. The cervical spine is characterized by neck pain that worsens after a long stay in one position, headaches, arm pain, shoulder pain, periodic discomfort or numbness in the fingers. For the lumbar region - pain in the lower back, pain in the gluteal region, periodic pain in the sacrum, frequent fatigue in the legs.

3rd degree osteochondrosis

Manifests itself in the form of symptoms of a herniated disc (pain along the affected nerve, numbness in the arms or legs, changes in gait, headaches) or long-term symptoms of a herniated disc (in the cervical region: frequent headaches, tinnitus, dizziness, decreased vision, hearing , muscle strength in the arms; in the thoracic region: irregular heart rhythm, difficulty breathing; in the lumbar region: kidney disease, gastrointestinal tract, sexual dysfunction, numbness or weakness in the legs).

4 degree osteochondrosis

It is generally accepted that the fourth degree of osteochondrosis begins from the moment when the hernia no longer manifests itself, the manifestations of the disease may decrease, but the symptoms of spinal instability, slipping or twisting of the vertebrae, or their complete fixation relative to each other still remain. They may be joined by manifestations of proliferation of the vertebral bodies (osteophytes), which can also compress the spinal nerves or block the spinal canal (secondary spinal canal stenosis) and compress the spinal cord (spinal cord ischemia). In addition, the fourth degree includes the consequences of surgical intervention if the hernia was removed promptly (various types of innervation disorders, paresis, inflammation).

Literature:

Biktimirov R.G., Kedrov A.V., Kiselev A.M., Kachkov I.A., Osteochondrosis of the spine - Almanac of Clinical Medicine - 2004. P.329,330,333,334, https://cyberleninka.ru/article/n/osteohondroz-pozvonochnika/viewer
Human anatomy: textbook. -method. manual / M. V. Ulitko, I. M. Petrova, A. A. Yakimov; [under general ed. M. V. Ulitko]; Ministry of Science and Higher Education education Ros. Federation, Ural. federal n-t. - Ekaterinburg: Ural Publishing House. University, 2021. - 88 p. ISBN 978-5-7996-2447-7
Oleynik A.D., Kovalev S.A. // Criteria for a comprehensive assessment of foci of lumbar osteochondrosis // Bulletin of the International Scientific Surgical Association - 2008 P. 84 https://cyberleninka.ru/article/n/kriterii-kompleksnoy-otsenki-ochagov-poyasnichnogo-osteohondroza/viewer
Nikiforov A.S., Avakyan G.N., Mendel O.I., Modern approaches to the treatment of complications of spinal osteochondrosis - RMZh No. 26 from November 26, 2010 - P.1633 https://www.rmj.ru/articles/nevrologiya /Sovremennye_podhody_k_lecheniyu_osloghneniy_osteohondroza_pozvonochnika/
Velichko T.I., Loskutov V.A., Loskutova I.V. // Exercise therapy and therapeutic swimming in orthopedics // 2014 -2.5 — Osteochondrosis https://monographies.ru/en/book/section?id=7270
Gushcha A.O., Konovalov N.A., Dreval O.N., Grin A.A., Dzhindzhikhadze R.S., Arestov S.O., Dreval M.D., Kashcheev A.A., Vershinin A. V.V., Asyutin D.S., Korolishin V.S., Clinical guidelines for the diagnosis and treatment of herniated intervertebral discs of the lumbosacral spine. - 2014 - pp.4,7,8 https://www.mst.ru/information/manual/lumbar_disc_herniation.pdf
Pilipovich A.A., Treatment and prevention of osteochondrosis - 2015. — S.1,17,18,19 https://cyberleninka.ru/article/n/lechenie-i-profilaktika-osteohondroza/viewer
Rodichkin P.V., Shalamanov N.S. Pathophysiological rationale for complex therapy of intervertebral hernias -2012-P.32 https://www.vmeda.org/wp-content/uploads/2016/pdf/31-36.pdf
Instructions for medical use of the drug Motrin ® tablets, Reg. number P N002874/01 ///o-motrin
Buchakchiyskaya N.M., Maramukha V.I., Maramukha A.A., Maramukha I.V., Non-drug treatment of patients with neurological manifestations of osteochondrosis of the lumbar spine - Science of Life and Health - 2013. P.104 https://cyberleninka.ru/article/n/nemedicamentoznoe-lechenie-bolnyh-s-nevrologicheskimi-proyavleniyami-osteohondroza-poyasnichnogo-otdela-pozvonochnika-sovremennyy/viewer
Therapeutic physical education for spinal osteochondrosis: textbook / O. V. Bezrukova, G. I. Bulnaeva; GBOU VPO IGMU of the Ministry of Health of Russia. – Irkutsk: IGMU, 2013. – 58 p.
Frick et al. Efficacy and safety of naproxen sodium and ibuprofen for pain relief after oral surgery. Current Therapeutic Research. 1993;54(6):619-27.
Clinical recommendations. Diagnosis and treatment of musculoskeletal (nonspecific) pain in the lower back. Russian Interregional Society for the Study of Pain. 2021
Cochrane Database of Systematic Reviews. (2010.) “Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica.” https://pubmed.ncbi.nlm.nih.gov/20556780/
Svetoslav Nikolaev Stoev, Stanislav Radoslavov Gueоrguiev, Vasil Georgiev Madzharov, Hristina Viktorova Lebanova (2021). “Naproxen in Pain and Inflammation – A Review”, International Journal of Pharmaceutical and Phytopharmacological Research, 11(1), pp.142-148.

Treatment of osteochondrosis of the lumbar spine

If you experience acute lower back pain for the first time, you should definitely consult a doctor to establish a diagnosis in order to rule out an attack of renal colic, appendicitis, or any other disease that requires emergency medical care.

If the cause of back pain is known, and this is an exacerbation of osteochondrosis of the lumbar spine, first of all it is necessary to reduce the load on the spine as much as possible. You need to stay in bed for 3-7 days - sometimes this is the only way to significantly reduce pain. But to speed up recovery, proper, that is, effective, treatment is necessary. It should stimulate the human body’s own protective and healing processes. Treatment should take into account the localization of the lesion, the stage of the disease, the functional state of the body and its individual systems. Surgical treatment of this disease is indicated only in very severe cases. Most often, various methods of conservative treatment of osteochondrosis are used.

Conservative treatment of lumbar osteochondrosis

Conservative treatment methods are primarily drug treatment. In order to reduce pain, as well as to reduce inflammation, which is often the cause of vertebral syndrome, nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed in the form of tablets or, in acute cases, in the form of injections. Sometimes after an injection of an analgesic, the pain subsides and does not return even when the drug expires. This means that the vicious circle in which pain leads to muscle spasm, and muscle tension, in turn, increases pain, has been broken. However, if the pain continues for a long time, it is important to remember that NSAIDs usually have various side effects and, when taken for a long time, can cause unwanted complications - a decrease in the number of leukocytes in the blood, complications from the gastrointestinal tract.

Often, to improve the general condition of patients, sedatives (calming) drugs are prescribed for 1-3 weeks, as well as small doses of antidepressants. For osteochondrosis of the lumbar spine, novocaine blockades are performed if necessary. Recently, anticonvulsant drugs have been successfully used to relieve pain.

To reduce compression syndromes, manual therapy, traction treatment (spinal traction) and, in special cases, surgery are used.

When the fixation properties of the ligamentous-articular apparatus of the spine are weakened, it is recommended to use fixation devices - corsets, collars, bandages, etc. However, fixation devices can only be used for a limited time, since muscle weakening is observed when using them. And for patients with spinal osteochondrosis, it is extremely important to strengthen their own muscle corset in the future.

After relieving acute symptoms, the task of creating muscle fixation comes first, and then stimulating the processes of regeneration of damaged structures. For this purpose, therapeutic exercises, reflexology, and massage are used. For this purpose, chondroprotectors are used (drugs for restoring cartilage tissue). As well as drugs that improve the condition of blood vessels (angioprotectors), vitamins, primarily group B, calcium preparations that improve the condition of bone tissue.

Physiotherapeutic procedures are widely used to treat spinal osteochondrosis. They reduce pain and swelling of tissues, improve blood circulation, and stimulate muscle fixation. Procedures can be combined and alternated. Physiotherapeutic treatment methods that can be used include:

darsonvalization of the affected area of the back and affected limbs;
electrophoresis;
low-energy laser radiation;
ultrasound;
exposure to a magnetic field;
thermal procedures

In sanatorium conditions, mud, ozokerite, paraffin baths, radon, sulfide, hydrogen sulfide, turpentine and other baths are successfully used;

It must be remembered that the development of full regeneration requires a fairly long period of time; under favorable circumstances, it occurs in the sixth month. Therefore, treatment must be long-term. It should be carried out in combination, that is, combine medications with physiotherapy and exercise therapy.

Orthopedic correction

A lumbar corset will help alleviate the patient’s condition.
Special orthopedic designs will help alleviate the condition during the acute period of the disease; if the lumbar region is affected, it is recommended to wear corsets. In their manufacture, a special breathable elastic material is used. All structures are reinforced with plastic or metal inserts, due to which the required level of rigidity is achieved.

Functions of corsets:

unloading of muscles, reducing the load on the vertebrae;
fixation of the spinal column in the correct position, correction of postural defects, restoration of the functioning of internal organs;
reduction of pain syndrome.

Treatment of lumbar osteochondrosis with therapeutic anti-inflammatory patch NANOPLAST forte

The therapeutic analgesic anti-inflammatory patch NANOPLAST forte has shown high effectiveness in the treatment of many types of osteochondrosis, including lumbar osteochondrosis.

Thanks to the simultaneous influence of two physiotherapeutic factors - deep soft warming heat of infrared radiation and the influence of a magnetic field with specially selected characteristics - this innovative drug allows you to relieve pain and inflammation, improve blood circulation in the affected area, and reduce the dose of painkillers and anti-inflammatory drugs.

Therapeutic pain-relieving anti-inflammatory patch NANOPLAST forte can be used both in the complex treatment of lumbar osteochondrosis and in monotherapy. The patch is applied to the lumbar spine, to the buttocks, depending on the type of disease and location of pain.

To relieve acute symptoms in the treatment of lumbar osteochondrosis, a therapeutic patch is used for 3 to 5 days. The duration of the course of treatment is from 9 days. It is usually recommended to use the treatment patch in the morning for 12 hours, but it can also be used at night.

High efficiency, unique composition, long-term (up to 12 hours!) therapeutic effects, ease of use and affordable price make NANOPLAST forte the drug of choice in the treatment of osteochondrosis of the lumbar spine.

Nutrition

It is best to steam food.
Maintaining a diet plays an important role in osteochondrosis. Meals should be fractional, portions should be small. You should eat 5-6 times a day. It is necessary to give up spicy, salty, smoked, canned foods, fast food, alcohol, carbonated drinks, and confectionery. Preference should be given to fish, seafood, fresh vegetables and fruits; fried foods should be replaced with boiled, stewed, steamed ones.