Treatment of dorsopathy of the lumbosacral spine in Moscow at the Dikul clinic: prices, making an appointment

Dorsopathy is not an independent disease, but only a generalized term for back diseases, such as osteochondrosis, trauma, tumors, spinal infections (tuberculosis, syphilis, osteomyelitis). With dorsopathy, the pathological process involves not only bones, but also cartilage tissue, intervertebral discs, as well as nerves, ligaments, vessels and muscles that are located next to the spine. Treatment of lumbosacral dorsopathy is associated with the genesis, severity of symptoms and duration of the disease.

Features of dorsopathy of the lumbosacral spine

With dorsopathy, there can be pathology in any part of the spine. A combined form of dorsopathy is often encountered, when pathological changes are noted in several parts of the spine. However, the lumbosacral region is the most vulnerable department for the development of dorsopathy, since this department bears the greatest vector loads.

Despite the fact that this part of the spine contains the largest vertebrae, discs and muscles, nevertheless, systematic loads lead to damage to the structures of the lumbar spine (muscles, discs, nerves) and the development of degenerative changes, such as disc herniation, protrusion. As the integrity of the fibrous ring of the discs is destroyed, conditions arise for compression of the nerve roots and the development of corresponding radicular symptoms

Causes of dorsopathy of the lumbar sacral spine

The pathological process can be caused by various factors:

Excess weight, especially if a person has low physical activity
A harmful diet that leads to dystrophic changes in the intervertebral discs
If you have frequent episodes of hypothermia
Weakened immune system (frequent colds).
Professional need to carry heavy loads
Incorrect stereotype of body position during sleep
Sedentary lifestyle typical of office workers
History of spinal injuries
Serious diseases of the central nervous system, heart, blood vessels, digestive system disorders
Complications of infectious diseases (syphilis, tuberculosis) or tumors (for example, cancer metastases)

Symptoms of dorsopathy

Dorsopathy of the lumbar spine at the initial stage is characterized by minor morphological changes in the cartilage tissue. At this stage, there are few or no symptoms and patients generally do not seek medical help. When bone tissue joins the degeneration process, the structures of the motor segments of the spine shift, and the flattened intervertebral disc begins to affect the nerve endings, which leads to the appearance of symptoms - the patient may experience discomfort or pain.

Further morphological changes in the discs are often irreversible and pain can already occur with any sudden movement or axial load on the lumbar region. With severe compression of the nerve structures, the pain becomes unbearable.

Dorsopathy of the lumbosacral region has 4 stages of development:

Dystrophic processes in the lumbosacral spine are caused by disturbances in metabolic processes at the tissue level. Cartilage tissue has no morphological changes. At this stage, the pain may have the character of discomfort.
At this stage, problems arise with the bone tissue in the vertebrae, displacement of the structures of the motor segments occurs, because of this, compression of the roots occurs, and severe pain occurs.
At this stage, there is significant damage to the integrity of the structure of the intervertebral discs, and when lifting heavy objects, conditions arise for rupture of the fibrous ring of the disc and hernial protrusion. A compensatory reaction may be the formation of hyperlordosis in the lumbar region, since bending forward sharply increases pain.
At the last stage of the disease, the muscles are very tense, problems with posture arise because the vertebrae are displaced. A lot of fibrous tissue appears in the spaces of the vertebrae, followed by the formation of salt deposits.

Causes of pathology

The onset of the disease is provoked by an unhealthy lifestyle with poor diet and low mobility or excessive stress on the back.

Hereditary predisposition

People with abnormalities in the constitution are more at risk of the disease. If you are predisposed, you must adhere to restrictions on the load on the spinal column.

Prolonged stay in uncomfortable positions and non-compliance with ergonomic techniques

Incorrect position of the spine during work, being in an uncomfortable position for a long time lead to increased stress. It is necessary to adhere to special techniques when performing manipulations so as not to load the spine.

Hypodynamia – sedentary lifestyle

Sitting in one place for a long time and low mobility weaken the muscle corset and cause pathology.

Periodic excessive stress in people who do not engage in physical work

In the absence of physical activity, a weak muscle corset, sudden movements, changing a sedentary lifestyle to an active one lead to overload. If you have led a sedentary lifestyle for a long time, a sudden transition to active exercise in the gym can have adverse consequences.

Spinal pathologies (osteochondrosis, spondyloarthrosis, osteomyelitis)

People with spinal disorders are predisposed to developing back problems. Injuries and injuries (subluxations, fractures, sprains) have a negative impact.

How does dorsopathy of the lumbosacral spine manifest?

Dull pain in the lumbar region, which only increases when walking
Frequent muscle cramps in the lower leg
Sharp pain and discomfort when moving
Lameness associated with a person’s reluctance to load the leg or forced postures associated with impaired biomechanics due to significant pain.
Pain in the buttocks that does not go away even after taking medication
Constant intense pain, mostly localized in the center of the lumbosacral spine
Increased pain during sudden movements, when straining, sneezing, coughing
Increased pain when standing
Feeling of numbness, pain in the legs
Muscle weakness, paresis
Lumbodynia (dull pain)
Low back pain that radiates to the muscles of the buttocks and thighs
Bowel and bladder problems (occurs when cauda equina syndrome develops, and this condition requires emergency surgery)

Diagnosis of dorsopathy of the lumbosacral spine

When patients complain of pain in the lumbosacral region, the doctor finds out the following details:

localization and presence of irradiation of pain;
dependence of pain on movement and body position;
the presence or absence of previous injuries and diseases of the spine;
emotional and psychological state of the patient.

Based on the examination, the patient’s posture, the presence of muscle spasms, and the range of movements in the torso are determined.

When diagnosing dorsopathy of the lumbosacral spine, it is necessary to exclude diseases of the internal organs, which can manifest as lower back pain.

The following diagnostic methods can be used to make a diagnosis:

X-ray of the lumbar spine.

Pros: it is carried out quickly, visualizes bone structures well, allows you to diagnose bone tissue degeneration and determine the presence of deformities
Cons: poor visualization of soft tissues, radiation exposure.

CT (MSCT)

Pros: fast, high-quality visualization of bone anatomy, especially areas of calcification (osteophytes), diagnosis of degenerative changes and injuries of the lumbar spine, possibility of use in cases where MRI is contraindicated.
Cons: poor differentiation of soft tissues in the spine, radiation exposure

Magnetic resonance imaging (MRI)

Pros: excellent visualization of soft tissue morphology, no radiation exposure, the most sensitive method for diagnosing spinal diseases
Disadvantages: The method is less sensitive for assessing bone anatomy and calcification, and is contraindicated in patients with metal devices in the body.
PAT. Scanning using radionuclides is necessary to clarify the genesis of formations in the lumbosacral spine
Laboratory diagnostics. Blood (urine) tests are necessary to diagnose both diseases of the internal organs and to diagnose systemic diseases or infections.

Diagnosis of lumbar osteochondrosis

Today, there are a number of modern methods for hardware diagnostics of osteochondrosis. The most accurate of them are MRI and CT. But the main method is still clinical diagnosis - this is when an experienced doctor compares data from at least three sources - from the patient’s complaints, MRI results and the symptoms that were identified during the examination. This allows you to make a diagnosis as accurately as possible and create an effective individual treatment program.

Let's find out what causes the symptoms. We will make the correct diagnosis to solve the problem at the cause level.
Diagnostic duration is 30 minutes. This is a full-fledged examination, and not a 2-minute “feeling” for show.
The diagnosis is carried out personally by Dr. Vlasenko A.A., a doctor with 30 years of experience, an expert in the treatment of osteochondrosis and muscle pain syndromes.

Dr. Vlasenko Alexander Adolfovich, neurologist, manual therapy doctor

Treatment of dorsopathy of the lumbosacral spine

Basic principles of treatment

The American College of Physicians (ACP) recently published its guidelines for treating different types of low back pain, from short-term attacks of pain to debilitating chronic pain. The focus is primarily on exercise, stress reduction, and integrative therapy, with medications recommended only when conservative therapy does not relieve pain.

Based on long-term clinical observations, the basic principles for the treatment of dorsopathy of the lumbosacral spine were formed:

Reducing or eliminating back pain
Improved spinal function
Improving health-related quality of life
Increased ability to work
Managing the number of episodes of back pain
Improved patient satisfaction

Treatment recommendations:

Different types of pain may require different treatments. The medical community has developed a treatment system of 3 recommendations that address 3 different types of back pain: acute, subacute and chronic back pain.
Acute back pain: pain that lasts less than 4 weeks.
Subacute back pain: pain that lasts 4 to 12 weeks.
Chronic back pain: pain that lasts more than 12 weeks.

Recommendation
#1
: Patients with acute or subacute low back pain often experience a decrease in symptoms over time, so ACV recommends that doctors first treat with massage, acupuncture, or manual therapy before prescribing medications. If drug therapy is necessary, AKV recommends the use of non-steroidal anti-inflammatory drugs (NSAIDs) and/or muscle relaxants.

Recommendation№2:

For patients with chronic lower back pain, AKV recommends comprehensive rehabilitation, including exercise therapy, tai chi exercises, physical therapy (laser therapy), acupuncture, cognitive behavioral therapy or manual therapy (osteopathy).

Recommendation #3:

When non-drug treatments do not help patients with chronic low back pain, then drug therapy is an option. The first-line treatment should be an NSAID, followed by tramadol or duloxetine as second-line therapy. Opioids should only be used if the potential benefits outweigh the risks, and doctors should discuss all risks and benefits with patients before starting treatment.

Surgery

Unfortunately, conservative treatment of dorsopathy of the lumbosacral spine is not always very effective. In the absence of effect from conservative treatment and resistant, in the presence of persistent neurological symptoms or with the development of progressive symptoms, surgical treatment is recommended.

Treatment methods

In acute cases of lumbar dorsopathy, treatment is aimed at stopping pain, reducing inflammation and relaxing muscle mass. The doctor prescribes bed rest for up to 5 days. Physical activity is excluded; the bed should preferably have a solid base. Diet and light exercises are recommended.

Taking medications

Pain is relieved with the help of non-steroidal drugs, they reduce inflammation. Muscle relaxants are used to relieve muscle spasms. As a result, the corset relaxes and the pain subsides. Constant pain causes mental fatigue, so sedatives are prescribed.

Physiotherapy

The procedures are indicated in combination with drug therapy for lumbar dorsopathy. To reduce pain, ultrasound and laser exposure are recommended; they show the best results in relieving painful sensations. To reduce inflammatory processes and relieve muscle spasms, electro- and phonophoresis and darsonvalization are used. Hardware procedures and reflexology are used when the exacerbation goes away. The impact of the devices can reduce pain, improve microcirculation in tissues and trophic processes (relieve vascular spasms). Pulsed currents of low frequency and voltage, laser, and ultrasonic influence have proven themselves well. They also use therapeutic mud, climatotherapy methods and baths.

Acupuncture

To start the recovery process, the area of tissue destruction is impacted using special needles.

Manual methods

Appointment with a chiropractor

allows you to effectively treat dorsopathy (in the absence of contraindications). Methods are used during the rehabilitation period. A massage is also indicated, which is performed to relieve excessive tension in the muscles and joints. The procedure helps improve blood flow.