Vertebrogenic pain syndrome (back pain due to problems with the spine): why it occurs and how it manifests itself

Anyone who experiences constant pain in the back and joints knows how pain hinders movement and normal human activities are limited.

The pain is repeated day after day, the use of all kinds of ointments and tablets brings relief for a while or does not give at all.

It's time to go to a medical facility, undergo an examination, establish an accurate diagnosis and begin the correct treatment.

If you have been diagnosed with vertebrogenic pain syndrome, know that pain occurs not only due to problems in the back, it is a problem of the whole body. This is not a separate disease, but a consequence of disorders in the spine, surrounding tissues and ligaments. It is necessary to identify the cause of the disease and then begin treatment.

Classification and causes

Vertebrogenic pain syndrome is not common; it affects about 10% of patients with disorders of the spinal trunk.

Types of classification of vertebrogenic pain:

• Non-mechanical pain. These pains are associated with immobility, the joints seem to be stiff and move poorly. Pain can also occur at rest. These are algic and dysgemic types.
• Pain of a mechanical nature occurs when a nerve root is compressed, muscle spasm, this is a compression type.
• The defixation type of pain is caused by an unstable joint in the segment responsible for movement. The pain may increase with bending and movement.

Risk factors for the occurrence of vertebrogenic pain syndrome include:

• osteochondrosis in the development stage;
• the patient is overweight;
• presence of metabolic diseases;
• being in stressful situations and overexertion;
• abuse of physical activity, alcohol, smoking;
• heredity.

Men and women aged 30-50 years, whose work involves stress on the spine, are at risk.

The reasons can be divided into three groups:

• If there are congenital pathologies: bends of the vertebral trunk, tortuosity.
• Acquired diseases that reduce the lumen in blood vessels: atherosclerosis, thrombosis.
• If external pressure is applied to the blood artery: stage III-IV osteochondrosis, curvature of the spine, muscle spasms, spinal injuries, neoplasms in the spinal column.

Many experts attribute predisposing factors to the causes of the development of pain syndrome: diseases of the throat and nose organs of the chronic stage, bronchi and lungs, injuries to the skull and brain, poor blood clotting if blood circulation is impaired.

And yet, the first place in the causes of pain is occupied by diseases and inflammation of the spine.

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).

Mechanism of occurrence and development options

Our spine consists of vertebrae, intervertebral discs, joints and ligaments. It is surrounded by blood vessels, muscles and nerve endings.

With osteochondrosis, when the discs wear out and destroy, the vertebrae shift away from the main trunk, protrusions and hernias form, blood vessels and nerve roots are compressed.

This is how vertebrogenic pain syndrome arises, characterized by acute pain at the site of injury.

There are two variants of the development of the syndrome:

• Compression of the nerve trunk. It occurs when the cervical and thoracic regions are affected; pain in this case is of low or medium intensity and can spread to the upper limbs or encircle the torso. When the cervical spine is affected, the upper limbs become numb and may even become atrophied.
• Compression of the nerve roots. These pains are observed with pathologies in the lumbar and sacral regions; they are more intense and cutting. Localization of these pains occurs in the lower extremities and perineum. Venous and arterial blood flow worsens.

Vertebrogenic syndrome occurs most often in the last stages of osteochondrosis, when an intervertebral hernia forms.

Accurate diagnosis is the key to successful treatment

The arsenal of modern medicine includes non-destructive neuroimaging methods that allow us to obtain a complete picture of the processes taking place. When it comes to neurological pathologies, the most important method is MRI. Magnetic tomography clearly visualizes the spinal cord roots, vessels and soft tissues, joints, discs and vertebrae. You can choose a clinic with a powerful device, suitable opening hours and low prices on our website.

You can find out whether the clinic does MRI with contrast, whether they accept children, whether you can consult with a specialist after the examination, whether it is possible to undergo the procedure with sedation, etc.

Symptoms of vertebrogenic syndrome

The main sign that changes are occurring in the spine is pain.

Symptoms of the development of vertebrogenic pain syndrome depend on the location where the destruction of the vertebrae and discs and pinching of the nerve roots occurred.

An attack of vertebrogenic pain syndrome can last from 30 minutes and not subside for several hours. After using medicinal drugs, the pain subsides after 5-7 days.

Acute pain can last from one and a half to three months, after this period the chronic stage of the disease begins.

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.

Diagnosis of vertebrogenic syndrome.

To make a diagnosis and prescribe treatment, you must contact a neurologist.

The doctor will ask you in detail about the type and nature of pain, study your medical history, and ask about genetic abnormalities, lifestyle and work activity.

The doctor can determine the displacement of the vertebrae by feeling the spinal column.

Afterwards he will prescribe tests on the devices.

Criteria for diagnosis:

• pain in the cervical, thoracic, lumbar and sacral regions;
• if the pain intensifies with movement;
• if using a corset or lying down the pain decreases;
• if you have to provide support with your hands when standing up;
• if when walking the gait becomes swaying;

The studies that give the most effective results are considered to be computed tomography (CT), which studies the affected area in detail, and magnetic resonance imaging (MRI), which helps to detect the cause of blood flow disturbances.

If the case is not advanced, sometimes it is enough to take an x-ray.

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.

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Treatment and prevention of vertebrogenic pain syndrome

Experts advise treating pain syndrome in a comprehensive manner:

• Preventive methods . In the first few days it is better to stay in bed. Eliminate physical activity, sit less. Use orthopedic mattresses and pillows, wear special corsets and a collar.
• Medication methods. Use analgesics, non-steroidal and anti-inflammatory drugs: diclofenac, relanium, ketorol, ketoprofen, nimesulide, piroxicam. To block prolonged pain, nerve blockades are prescribed using lidocaine, novocaine, diprospan, hydrocortisone.
• Unconventional methods. These methods include the use of:

1. manual therapy for realignment of vertebrae;
2. osteopathy to correct and suppress the symptoms of pain and eliminate it;
3. reflexology to relieve nerve tension;
4. hirudotherapy, which relieves swelling;
5. homeopathy to eliminate disturbances in the functioning of internal organs.

Physiotherapy, magnet and ultrasound therapy help prevent the development of exacerbation of pain syndrome.

If after using all treatment methods the pain does not go away, experts recommend surgery.

Remember that timely contact with specialists will help not only get rid of vertebrogenic pain syndrome, but also prevent its consequences, which may be irreversible.

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.

Lumbar compression syndromes

Upper lumbar compression syndromes are a relatively rare location.

Compression of the LII root (LI-LII disc) is manifested by pain and loss of sensitivity along the inner and anterior surfaces of the thigh, and decreased knee reflexes.

Compression of the LIV root (LII-LIV disc) is manifested by pain along the anterior inner surface of the thigh, decreased strength and subsequent atrophy of the quadriceps femoris muscle, loss of the knee reflex.

Compression of the LV root (LIV-LV disc) is a common location. It manifests itself as pain in the lower back with irradiation along the outer surface of the thigh, the anterior surface of the leg, the inner surface of the foot and big toe. Hypotonia and wasting of the tibialis muscle and decreased strength of the dorsal flexors of the thumb are noted.

Compression of the SI root (LV-SI disc) is the most common location. It manifests itself as pain in the buttock, radiating along the outer edge of the thigh, lower leg and foot. The strength of the triceps surae muscle decreases, sensitivity in the areas of pain irradiation is impaired, and the Achilles reflex fades.

Cervical reflex syndromes

Clinically manifested by lumbago or chronic pain in the neck area with irradiation to the back of the head and shoulder girdle. On palpation, pain is detected in the area of ​​the facet joints on the affected side. Sensitivity disorders, as a rule, do not occur.

It should be noted that the cause of pain in the neck, shoulder girdle, and scapula can be a combination of several factors, for example, reflex pain syndrome due to spinal osteochondrosis in combination with microtrauma of the tissues of the joints, tendons and other structures of the musculoskeletal system. Thus, with glenohumeral periarthrosis, many researchers note in such patients damage to the C5-C6 discs, as well as injury to the shoulder joint, or myocardial infarction, or other diseases that play the role of triggers.

Clinically, with glenohumeral periarthrosis, pain in the periarticular tissues of the shoulder joint and limitation of movements in it are noted. Only pendulum-like movements of the shoulder in the sagittal plane are possible (frozen shoulder syndrome). The adductor muscles of the shoulder and periarticular tissues are painful on palpation, especially in the area of ​​the coracoid process and the subacromial zone. Sensory disorders are not determined, tendon reflexes are preserved, sometimes somewhat animated.

Reflex cervical syndromes include the anterior scalene muscle syndrome. The anterior scalene muscle connects the transverse processes of the middle and lower cervical vertebrae with the first rib. When this muscle is involved in the process, pain occurs along the anterior outer surface of the neck, radiating along the ulnar edge of the forearm and hand. When palpating the anterior scalene muscle (at the level of the middle of the sternocleidomastoid muscle, somewhat laterally), its tension is determined, and in the presence of muscle trigger points, pain distribution zones are reproduced in it - shoulder, chest, scapula, hand.

Vertebrogenic neurological complications in the thoracic spine with osteochondrosis are rare, since the bone frame of the chest limits displacement and compression. Pain in the thoracic region more often occurs in inflammatory (including specific) and inflammatory-degenerative diseases (ankylosing spondylitis, spondylitis, etc.).

In medical practice, the first place in terms of treatment is taken by lesions of the lumbar and lumbosacral spine.