Degenerative-dystrophic changes in the lumbosacral region

Degenerative-dystrophic changes in the lumbosacral region are a set of pathologies in the intervertebral disc or, alternatively, in the lumbar vertebrae. This disease can mainly be recognized by lower back pain.

Degenerative-dystrophic changes in the lumbosacral region

In most cases, able-bodied people suffer from such problems, and gender does not play a role here. Statistics say the following: there are now an extremely large number of people with this diagnosis, and this number is growing, with no intention of slowing down the pace of development, which is not encouraging.

What are these pathologies?

The body of any person is an extremely delicate and well-functioning system. And it is not surprising that changes in the activity of at least one of its components inevitably entail disruptions in the functioning of all other parts of the body. In recent years, cases of diseases of the musculoskeletal system have increased greatly among the population. Because of this, people's ability to meet their needs has decreased.

The spine is a component of the human skeleton. This organ plays a certain number of vital functions:

• support;
• participation in the movement;
• giving the body flexibility;
• distribution of nerve fibers throughout the body.

Due to the high complexity of the structure of the body, it is not so rare for its organs and tissues to age earlier than the time allotted by nature. Degenerative dystrophic changes begin to appear in the spine, which necessarily cause osteochondrosis, coupled with extremely severe pain.

Without such changes in the spine, none of its known diseases is possible. Any osteochondrosis, spondyloarthrosis, intervertebral disc herniation and the like are precisely the results of untreated degenerative dystrophic pathologies of the intervertebral disc, which can be detected by doing the necessary examination by a specialist. However, an examination is not so necessary when the disease can be indicated by the most common symptoms of pathology, which can be detected during the first examination.

All diseases of the spine begin their development with minor degenerative-dystrophic changes

Despite the fact that a person may not have a very strong tendency towards this pathology, inherited to him, in reality its root lies in the combination of many genes. Degenerative processes are also possible due to the aging process or due to any injury. And yet, extensive injuries like the same car accident do not often lead to this. In most cases, they occur due to a slow traumatic process that damages the intervertebral disc. Moreover, this damage gradually becomes more pronounced, which leads to the disease.

The intervertebral disc does not receive blood, and therefore, in case of damage, it will not be able to “patch” them in the same way as other organs and tissues. For this reason, any, even the slightest, damage to this tissue can lead to the most serious consequences, starting the so-called “degenerative cascade.” This inevitably leads to the destruction of the intervertebral disc. And this severe pathology has a very high “popularity”. According to modern statistics, almost a third of the world's population who have reached the age of four to six decades has this problem, at least to the smallest extent. This means that almost every elderly patient has such a diagnosis or pain, if not both.

Degenerative-dystrophic lesions of the spine: diagnosis, clinical picture and treatment

About the article

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Regular issues of "RMZh" No. 26 dated November 11, 2008 p. 1739

Category: Neurology

Author: Tyurnikov V.M.

For quotation:

Tyurnikov V.M. Degenerative-dystrophic lesions of the spine: diagnosis, clinical picture and treatment. RMJ. 2008;26:1739.

It is currently generally accepted that degenerative diseases of the spine are the most common chronic diseases, characterized by progressive degenerative changes in the tissues of the vertebral segments—degradation of the tissues of the intervertebral discs, joints, ligaments, bone tissue of the spine, in advanced cases manifested by severe orthopedic, neurological and visceral disorders and often leading to loss of ability to work.

Acute back pain of varying intensity is observed in 80–100% of the population. About 40% of sick people seek medical help. It is known that after 30 years, every fifth person in the world suffers from discogenic radiculitis, which is one of the syndromes of degenerative-dystrophic diseases of the spine. According to the Central Institute of Traumatology and Orthopedics and the Moscow Main Health Department, in the capital, for every 1000 adults, there are 122 patients with spinal dysfunction. Among the structural changes in the spine that cause back pain are the following: herniation of the nucleus pulposus; narrow spinal canal; instability due to disc or extradiscal pathology; muscular-tonic or myofascial syndrome. It is no coincidence that in recent years, numerous symposiums and conferences devoted to this problem have been held both in our country and abroad. Numerous statistical data indicate not only the high frequency of degenerative diseases of the spine, but also the absence of a tendency to reduce the frequency of these diseases. Most often affecting people of working age, degenerative-dystrophic diseases of the spine lead to significant loss of work, and often to disability. Of the total number of sick leaves issued only by neurologists, more than 70% are for various clinical manifestations of degenerative diseases of the spine. Among the causes of temporary loss of ability to work and disability, this disease still occupies one of the first places. The level of disability among patients with degenerative diseases of the spine is 4 people per 10 thousand of the population and ranks first in terms of this indicator in the group of diseases of the musculoskeletal system. The problem of preventing the development of degenerative-dystrophic diseases of the spine and eliminating pain syndrome is becoming increasingly urgent and requires its solution both in terms of developing an effective physical rehabilitation program and in terms of its accessibility for all categories of the population. In the era of total computerization, a sharp transition from physical to mental labor, a decrease in human motor activity occurs. Sedentary work and driving in a car lead to a decrease in muscle tone. Studies have shown that 80% of the time the spine is in a forced half-bent position. Prolonged stay in this position causes stretching of the back flexor muscles and a decrease in their tone. This is one of the main factors that lead to the occurrence of degenerative diseases of the spine. A brief history of the study of compression syndromes of degenerative-dystrophic diseases of the spine: • Cotugno (1794) – infectious theory of sciatica; • Virchov (1857) – described a herniated cervical intervertebral disc (IC) called extradural chondroma; • Babinsky (1888), Bekhterev (1913) – described the clinical picture of damage to the spinal cord (SC) roots when they are compressed in the spinal canal; • Dandy (1929) – suggested that compressed cartilage fragments could come from the disc; • Schmorl (1932) – classic work on cartilaginous nodules and degenerative lesions of MD; • Hildenbrandt (1933) – characteristics of degenerative changes in MD, the concept of “osteochondrosis” was introduced; • Mixter and Barr (1934) – first used the term “disc herniation”; • Margulis (1940) – introduced the term “lumbosacral radiculitis”; • Popelyansky Y.Yu., Osna A.I., Lutsik A.A. a school for the study of spinal osteochondrosis was created (1970–1980). In 1984, in the collective monograph “Osteochondrosis of the Spine,” Academician of the Academy of Medical Sciences, Professor GS. Yumashev and Professor M.E. Furman gave a definition of this disease: “Osteochondrosis is the most severe form of degenerative-dystrophic damage to the spine, which is based on disc degeneration with subsequent involvement of adjacent vertebral bodies, intervertebral joints and ligaments. In each part of the spinal column, osteochondrosis has a typical location and characteristics.” In the 1980–90s, the theory of the predominant myogenic origin of dorsalgia began to prevail. Many clinicians believe that in almost 90% of cases, back pain is a manifestation of myofascial syndrome. However, the vertebrogenic factor in the development of dorsalgia should not be underestimated. Vertebrogenic causes of dorsalgia [Voznesenskaya T.G., 2004]: – degenerative-dystrophic diseases of the spine and their manifestations – disc herniations, deforming spondylosis, spondyloarthrosis. To a greater extent, pain syndrome is associated with diseases not associated with degenerative-dystrophic diseases of the spine: sacralization, lumbarization, ankylosing spondylitis, osteoporosis, ankylosing spondylitis. The nucleus pulposus of an unchanged intervertebral disc is a gelatin-like, homogeneous mass bounded by the fibrous ring and terminal cartilaginous plates of adjacent vertebral bodies above and below (Fig. 1 and 2). With age, a decrease in the amount of mucopolysaccharides and a change in their qualitative composition leads to a decrease in the fluid content in the core. The core loses its gel properties, the disc itself becomes thinner and loses its elastic body functions. In addition, the adhesion forces between the collagen plates of the annulus fibrosus are weakened, the ring is stretched and cavities appear in it. These processes occur against the background of gradual atrophy of the vessels supplying the intervertebral discs. Replacing the blood supply with a diffusion mechanism, the efficiency of which is much lower, leads to serious changes in the nucleus pulposus. Cracks and tears appear in the fibrous ring, and intervertebral hernias form (Fig. 3 and 4). The vertebrae consist of an internal spongy substance and a compact external substance. Spongy substance in the form of bone bars provides strength to the vertebrae. The outer compact substance consists of bony lamellar tissue, which provides the hardness of the outer layer and the ability of the vertebral body to absorb loads, for example, compression during walking. Inside the vertebra, in addition to the bone crossbars, there is red bone marrow, which has the function of hematopoiesis. The bone structure is constantly renewed: cells of one type are engaged in the decomposition of bone tissue, while another type is engaged in its renewal. Mechanical forces and loads to which the vertebra is exposed stimulate the formation of new cells. Increasing the impact on the vertebra leads to accelerated formation of denser bone tissue and vice versa. To explain the etiopathogenesis of degenerative diseases of the spine, various theories have been put forward. The involution theory is based on the assumption that the cause of degenerative-dystrophic diseases of the spine is premature aging and wear of the intervertebral discs. At the heart of the muscle theory, the cause of the appearance and development of degenerative-dystrophic diseases of the spine was considered to be constant muscle tension or muscle hypotension, inflammation of muscles and ligaments. A number of authors believe that the development of degenerative-dystrophic diseases of the spine is based on the creation of an incorrect muscle motor stereotype, which leads to mechanical overload of the corresponding components of the intervertebral segment and, ultimately, to the appearance of processes of degeneration and involution. Proponents of the endocrine and metabolic theories tried to link the occurrence and development of degenerative diseases of the spine with endocrine and metabolic disorders. The theory of heredity assumes a hereditary predisposition to the development of degenerative diseases of the spine. Proponents of the rheumatoid and autoimmune theory have drawn attention to the fact that the processes occurring in the joints with rheumatoid arthritis are identical to the processes occurring in the intervertebral joints. The reliability of these views is confirmed, for example, by the similarity of biochemical changes in the main substance and cellular elements of the disc, characteristic of diseases classified as “collagenoses,” including rheumatoid polyarthritis. These changes lead to disruption of the metabolism of the synovial membrane, which begins to produce less synovial fluid, as a result of which the nutrition of the cartilage and adjacent bone tissue is disrupted. The emergence of the traumatic theory is associated with attempts to determine the role of the traumatic (microtrauma) mechanical factor in the etiopathogenesis of the development of degenerative-dystrophic diseases of the spine. The role of visceral pathology in the development of degenerative diseases of the spine has also been proven. There are still quite a large number of theories and assumptions that, to one degree or another, repeat the above. Clinical syndromes are divided into vertebral and extravertebral. Extravertebral syndromes are divided into two large groups: reflex and compression. Reflex syndromes often precede compression syndromes. Reflex syndromes include syndromes caused by irritation of the receptors of the Luschka sinuvertebral nerve, which penetrates the spinal canal through the intervertebral foramina and innervates the periosteum, ligaments, fibrous ring, and blood vessels. Irritation of the receptors occurs as a result of compression by a hernia, bone growths, in case of impaired fixation, vascular disorders (edema, poor circulation), inflammation (reactive, immune). Impulses traveling along the Luschka nerve enter the dorsal root into the dorsal horn of the spinal cord. Switching to the anterior horns, they cause reflex-tonic disorders. Switching to the sympathetic centers of the lateral horn, they cause vasomotor or dystrophic disorders. These types of dystrophic changes primarily affect poorly vascularized tissues (tendons, ligaments), especially in places of attachment to bony protrusions. In some cases, these neurodystrophic changes cause intense pain, which occurs not only locally when touching the affected area (trigger zone), but also at a distance. In the latter case, the pain is “reflected”; it can sometimes be reflected over considerable distances. Referred pain can be in the form of a lightning-fast “lumbago” or it can be long-lasting. In the trigger zones and in the area where pain is reflected, autonomic disorders are possible. In the origin of dorsalgia, functionally reversible blocking of intervertebral joints is of great importance, which can precede the development of degenerative diseases of the spine, but can also occur in already affected joints. The most common cause of blocking can be static or dynamic loads, antiphysiological postures and microtraumas. Blocking in one area of ​​the spine causes functional changes in adjacent areas in the form of the formation of compensatory hypermobility [Vorobeva O.V., 2003]. Myofascial pain (painful musculofascial dysfunction syndrome) can occur as part of referred spondylogenic pain. Myofascial pain is intense, sometimes intensifying pain that leads to limitation of movements. The patient remembers which movements cause increased pain and the occurrence of a reflected pain reaction, and tries to avoid these movements and irritation of trigger zones. Muscle spasm can be associated with many painful conditions of the spine and internal organs. In some cases, localized muscle spasm may be a protective physiological mechanism that limits the mobility of the affected parts of the spine. However, then the spasmed muscles become a secondary source of pain, which triggers a vicious circle of “pain-muscle spasm-pain”, which contributes to the formation of myofascial pain syndrome MFPS. The leading pathogenetic mechanisms of MFPS include local vasomotor dysfunction and reflex tonic changes in the entire muscle or its limited area [Popelyansky Ya.Yu., 1989]. Reflex syndromes include lumbago in the acute development of the disease and lumbodynia in the subacute or chronic course. These pains are characterized by flattening of the lumbar lordosis. This is the first stage of neurological complications. Of the compression syndromes, the most common are radiculopathies, which account for 40% of all extravertebral syndromes. Due to the physiological characteristics of the structure of the spine, the lumbar region is most often affected. When the spinal motion segment is damaged at the level of the lumbar region, sanogenetic reactions begin in the body in order to limit movement in the affected segment, which leads to a change in the motor stereotype, which is formed due to the close interaction of the pyramidal and extrapyramidal systems. The second (radicular) stage, or stage of discogenic radiculitis, is caused by increased disc prolapse and penetration of disc tissue into the epidural space, where the spinal roots are located. The radicular symptoms that arise correspond to the level of the affected spinal segment. The L5 and S1 roots are most often affected. The third (vascular-radicular) stage of neurological disorders is caused by ongoing 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. The fourth stage of neurological manifestations is caused by impaired blood supply to the spinal cord due to damage to the radicular-spinal arteries. More often, blood flow is disrupted in the artery of Adamkiewicz and the accessory artery of Deproge-Hutteron. In this case, chronic discirculatory myelopathy develops, usually at the level of the lumbar enlargement of the spinal cord. In case of damage to the Adamkiewicz artery, a patient develops intermittent spinal cord claudication syndrome. When the Deproge-Hutteron artery is damaged, intermittent cauda equina claudication syndrome develops. An 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. Degenerative-dystrophic diseases of the spine (often in combination with disc prolapse or herniation) lead to the development of segmental stenosis of the spinal cord and radicular canals. The most common cause of narrowing of the spinal canal is a combination of a progressive degenerative process in the discs, joints and ligaments of the spine with a pre-existing relatively small capacity of the canal as a result of congenital or constitutional features of the structure of the vertebral bodies. Instability of the spinal motion segment (SMS) is a condition characterized by the inability to tolerate physiological loads and accompanied by clinical and radiological manifestations. The origin of PDS instability: trauma, tumor lesions, degenerative-dystrophic lesions, congenital pathology (spondylolisthesis). X-ray signs: displacement of the vertebral bodies more than 3.5 mm; the angle of inclination between the vertebral bodies during flexion–extension is greater than 12 (Fig. 5). Diagnosis of degenerative-dystrophic diseases of the lumbar spine is based on the clinical picture of the disease and data from additional examination methods (radiography, computed tomography, magnetic resonance imaging). MRI is especially informative (Fig. 6 and 7). Syndromes of damage to individual lumbar roots: L3: pain and paresthesia in the L3 dermatome, paresis of the quadriceps femoris muscle, decrease or loss of the tendon reflex from the quadriceps muscle (patellar reflex). L4: pain, possible paresthesia or hypalgesia in the L4 dermatome, paresis of the quadriceps femoris and tibialis anterior muscles, decreased knee reflex. L5: pain, possible paresthesia or hypalgesia in the L5 dermatome, paresis, possible atrophy of the extensor pollicis longus and extensor toes brevis, absence of the posterior tibial reflex. S1: pain, possible paresthesia or hypalgesia in the S1 dermatome, paresis of the triceps surae muscle, loss of the Achilles reflex (Fig. 8). The complexity of the interaction of compensatory and pathogenic mechanisms in vertebrogenic pathology largely explains the lack of clear correlations between the severity of clinical symptoms and the degree of morphological changes in vertebral and neural structures according to radiography, computed tomography, and MRI, which is well known to practicing physicians (especially neurosurgeons operating on herniated discs). Therefore, the doctor’s tactics when choosing treatment are determined primarily by clinical data, although the results of additional examination methods are important. Treatment of degenerative-dystrophic diseases of the spine The current opinion in most medical institutions is that surgical treatment of discogenic disease is indicated only in 10-12% of patients. All other patients with degenerative-dystrophic diseases of the spine and complications can and should receive conservative treatment. Conservative treatment methods include the mandatory use of drugs with chondroprotective, chondrostimulating effects. These requirements are fully met by the domestic drug chondroxide containing the active substance chondroitin sulfate. Chondroitin is a sour mucopolysaccharide from the cartilage fabric of the cattle trachea. Chondroxide, presented in pharmacies with ointment. gel for external use and pills. Chondroxide stimulates the regeneration of cartilage, has an anti -inflammatory, analgesic effect. Chondroxide is involved in the construction of the main substance of cartilage and bone tissue; It affects metabolic processes in hyalin and fibrous cartilage. Inhibits the processes of degeneration of cartilage and connective tissue; Inhibits enzymes that cause cartilage tissue. Chondroxide stimulates the biosynthesis of glucosaminoglycans, promotes the regeneration of the joint bag and cartilage surfaces of the joints, and increases the products of intraarticular fluid. This leads to a decrease in inflammation, an increase in the mobility of the affected joints. Chondroxide in a tablet form is taken at 0.5 g (2 tablets) 2 times a day, washed down with a small amount of water. Recommended initial treatment course 6 months. Chondroxide ointment or gel is applied to the skin and is easily rubbed (in the lesion) until completely absorbed. The course of treatment is at least 2-3 weeks. In addition, the use of medical blockade, muscle relaxants, physiotherapeutic procedures, kinesotherapy, reflexology, massage, and manual therapy is common. From physiotherapeutic procedures, electrophoresis with proteolytic enzyme caripazim is currently widely used. It is known that therapeutic physical culture and massage are inalienable parts of the complex treatment of patients with damage to the spine. Therapeutic gymnastics pursues the goals of the general strengthening of the body, increase performance, improve coordination of movements, and increase training. At the same time, special exercises are aimed at restoring certain motor functions. Despite the presence of effective means of conservative treatment, the existence of dozens of methods, some patients need surgical treatment. To date, 0.3% of all patients are operated on. Indications for surgical treatment are divided into relative and absolute. An absolute indication for surgical treatment is the development of a caudal syndrome, the presence of a sequestered hernia of the intervertebral disc, a pronounced royal pain syndrome, not decreasing, despite the treatment. The development of radiculomilohemia also requires emergency surgery, however, after the first 12–24 hours, the indications for surgery in this kind of cases become relative, first, due to the formation of irreversible changes in the roots, and, secondly, because in most cases it is in most cases In the course of medical and rehabilitation measures, the process regresses for about 6 months. The same period of regression is observed with delayed operations. Relative indications include the inefficiency of conservative treatment, recurrent Ishias. Conservative therapy for the duration should not exceed 3 months and lasts at least 6 weeks. It is assumed that the surgical approach in the case of acute radicular syndrome and the inefficiency of conservative treatment is justified within the first 3 months after the appearance of pain to prevent chronic pathological changes in the spine. The relative indication is cases of extremely pronounced pain syndrome, when a change in the pain component of a neurological deficiency occurs. The main goal of surgical intervention is not a disk surgery, but a decompression of a spine that should remain mobile and not damaged. A neurosurgeon should, if possible, minimize the formation of cicatricial fabric, not create additional conditions of instability in the operated segment of the spine. A prerequisite is an accurate diagnosis when the clinical manifestations correlate with the data of additional examination methods. Currently, minimally invasive methods of endoscopic nucleotomy under the control of CT, laser vaporization of intervertebral discs are increasingly used. For the past 5 years, a new method of minimally invasive plasma disk nucleoplasty has appeared, based on the controlled supply to the disc in the disc in the disc with ablation and coagulation. The reassuring results of the use of Prodis prostheses demonstrated South Korean orthopedists at the 24th International Conference on Minor Technologies. The “golden” standard is currently microdiscectomy, which minimizes the trauma of epidural tissues that do not cause impaired normal anatomy of the bone -articular apparatus of the spine, which significantly reduces the danger of the development of postoperative complications.

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Why does the disease begin?

In more than half of the cases, this problem occurs for at least one of the following reasons:

• inflammatory processes that begin due to the fact that the nerve roots are irritated by the protein located in the disc space during the appearance of a hernia;
• microscopic damage that occurs if the annulus fibrosus wears out, completely losing any ability to bear load. The consequence is excess mobility in the affected area.

Most often, the combination of these two factors occurs when an intervertebral hernia begins to develop, which is a complication of the pathological process in the intervertebral discs. When it appears, the neurovascular bundle passing through the spinal canal is compressed by mechanical action. Because of this factor, lower back pain becomes much stronger and does not stop.

Treatment of spinal stenosis

Many factors go into determining the optimal way to perform surgery. We are talking about the location of the pathologically narrowed area on the spine, the cause of root compression, concomitant diseases of the patient, etc. Most often the problem is solved by:

• Endoscopic surgery.
• One-stage or two-stage operation with thoractomy.
• Operations involving the installation of implants – metal or from a person’s own bone tissue.

What can happen due to this pathology

Once you start degenerative changes in the spine, severe complications in the lumbar region cannot be ruled out:

• hernias;
• osteochondropathy;
• numbness and partial paralysis of the lower extremities;
• complete paralysis of the legs;
• difficulty going to the toilet;
• decrease/loss of libido.

If degenerative changes are not treated, complications will not keep you waiting.

To avoid such problems, you should promptly and wisely choose what and how to cure the pathology. This way you can most effectively keep the intervertebral discs intact.

How to recognize the disease

More than half of the patients who have degenerative-dystrophic pathologies in the lower back complain of ongoing pain, which, however, can be tolerated. But sometimes they become stronger for a long time. For the most part, each patient has his own symptoms of the disease, but there are several common signs:

• the back hurts, and pain in the hips and legs is possible;
• pain in the lumbar region lasting over one and a half months;
• the pain is dull/aching in the lower back, and burning in the hips and legs;
• when the patient sits, the pain becomes stronger. Standing, walking or lying down, he feels less pain. Standing for too long, bending forward or lifting something heavy, the patient feels a more “bright” pain;
• If a person has a herniated disc, his legs may go numb and their legs may tingle. In addition, he may have trouble walking;
• if the hernia turns out to be medium in size, it is possible that the nerve root that exits the spinal cord at the affected level will be compressed (foraminal stenosis), and this will already provoke pain in the legs (sciatica);

The main symptom of the onset of degenerative changes is severe pain, which can radiate to the legs

• symptoms of neuralgia, such as weakened legs, as well as various problems in the functioning of organs in the pelvic area (difficulty going to the toilet) can quite eloquently “hint” at the appearance of cauda equina syndrome. Then you need to urgently consult a doctor;
• inflammation caused by proteins trapped in the disc causes the nerves to react more sharply to stimuli. This is what makes your legs go numb and tingling. Moreover, in most cases, such sensations are localized in the knee or higher.

If you want to learn in more detail how to treat aching lower back pain, and also consider symptoms, diagnosis and alternative treatment methods, you can read an article about this on our portal.

Symptoms and diagnostic methods

Unfortunately, a person is unaware of the disease until low back pain appears , which limits the ability to work. The degenerative process does not manifest itself; symptoms indicate its complications.

You should definitely visit a neurologist if the following sensations appear::

• Dull or stabbing pain in the lumbar region.
• Pain after being in an uncomfortable position for a long time.
• Painful sensations after physical activity.
• The appearance of weakness in the lower extremities.
• Difficulty bending and turning.
• Stiffness of the spine in the morning.
• Constipation and problems with urination.
• Cold skin in the lower back area.
• The symmetry of the body is broken.
• Swelling and redness of the skin in the lower spine.

Symptoms intensify depending on the stage of development of the pathology:

Symptoms appear most clearly during an exacerbation . When degenerative processes take a chronic form, the signs of the disease are characterized by muted discomfort.

Symptoms at the initial stages of development of degenerative disorders in the spine do not appear. It is very difficult to determine the degenerative process in the initial stage of development. It is usually only discovered during a routine medical examination. But if a visit to the clinic is caused by lower back pain, then the disease is already progressing.

It is important to detect the problem before the first complications appear. To do this, various diagnostic methods are used, covering a wide range of stimuli. But initially an examination is carried out by a neurologist. Then the doctor will prescribe additional tests to clarify the diagnosis.

The following procedures are usually performed : radiography, computed tomography, MRI.

X-ray is the most accessible method, but not very informative. It detects the disease at a late stage. and MRI are higher priority. They allow you to more accurately determine the location, as well as the degree of damage.

MRI most reliably indicates the presence of degenerative changes.

MRI results about the presence of dystrophic processes:

• The disk is destroyed more than 50%.
• Disc dehydration. It looks darker on MRI.
• Accurately determines the presence of protrusions and hernias.
• Detects erosion of the cartilage plate through which the cells inside the disc receive nutrition.

Sometimes it is necessary to conduct electroneuromyography to understand where and how the nerve is affected. Naturally, blood is given for analysis to detect endocrine disorders and possible infections.

Video: “Degenerative-dystrophic changes in the spine: lecture”

Degenerative-dystrophic changes in the lumbosacral region

Lower back pain can easily appear not only due to pathological processes in the discs, but also from the following:

• narrowing (stenosis) of the spinal canal, osteoarthritis, any other spinal pathology that worsens over time, caused by deterioration of the discs. However, this does not mean that such diseases cannot be combined;
• hernia caused by disc pathology.

Moreover, with the development of the disease, as well as the transition from one stage to another caused by it, its symptoms become increasingly stronger:

• stage No. 1 . The disease rarely manifests itself in any way. Perhaps after physical work you may feel a dull pain, but in most cases it is mistaken for normal fatigue;
• stage No. 2 . You can clearly distinguish symptoms from normal phenomena. From time to time there is a “shoot” in the back. It's also hard to bend sometimes. The reason lies in the nerve endings: they are compressed, and therefore the pelvic area “tingles”;
• stage No. 3 . Spicy. At this time, metabolism in the lower back is disrupted because the blood vessels are damaged. Ischemia, cramps, and numbness of the legs appear. The pain becomes stronger;
• stage No. 4 . Due to deformation of the spinal cord, the legs may become paralyzed. This pathology has exacerbations - the time of greatest severity of symptoms. If dystrophy becomes chronic, the symptoms weaken to a state of tolerable discomfort.

Prices for lumbosacral corset

Diagnostics

It is very important that the disease is diagnosed before the first complications appear. For this purpose, diagnostics are made using a variety of methods so that they capture many types of stimuli. However, the patient must first be examined by a neurologist. After the examination, the specialist will definitely prescribe additional examinations to make the diagnosis more accurate.

In most cases, the following methods are used: x-rays, computed tomography (CT), and MRI.

X-rays are the most accessible, but at the same time they are the least useful. This technique allows you to diagnose pathology when it has already reached one of the fairly late stages. MRI and CT are much more useful. Using these methods, it is possible to more reliably determine both where the focus of the disease is and how far it has developed.

How to treat

First of all, conservative therapy procedures are carried out. Among them are the use of painkillers, warming ointments, therapeutic exercises, massage, and physiotherapy. If there is no benefit from these treatment methods, surgery is performed.

Medicines

First of all, the pain should be relieved so that the patient can walk normally. For this purpose, the doctor prescribes the necessary painkillers (for example, Ketanov and Ketonal), as well as anti-inflammatory drugs (Movalis and Diclofenac).

Next, to relax the lower back muscles, muscle relaxants (Mydocalm and Sirdalud) are used. These drugs are not used constantly, but with periodic breaks, since otherwise they make the muscular system less strong.

Medicines will help relieve symptoms and influence the cause of the disease

Chondroprotectors are also used in treatment. With their help, you can quickly restore cartilage and joints.

But with all the miraculousness of the complex of drugs, it is necessary to remember that they can easily cause an unpleasant “side effect”, disrupting the functioning of the gastrointestinal tract.

Exercise therapy

Of course, therapeutic exercises should be done both during treatment and rehabilitation. Properly selected and planned exercises are very useful for any symptoms of degenerative-dystrophic pathologies in the lower back. When selecting and planning exercises, it is necessary to look at the causes, severity and main signs of the disease.

Treatment

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Next fact

First, conservative therapy is carried out: various medications for pain relief, warming ointments, therapeutic exercises, massage and physiotherapeutic procedures. If these methods do not help, then a decision is made on surgical intervention. .

Drugs

First of all, it is necessary to relieve the pain syndrome, which will allow the person to move normally. For this purpose, painkillers (Ketanov, Ketonal) and anti-inflammatory drugs (Movalis, Diclofenac) are prescribed. These medications are used topically, orally, and by injection.

To relax the lumbar muscles, muscle relaxants (Mydocalm, Sirdalud) are used. They are used intermittently due to weakening muscles.

Chondroprotectors are also used to help speed up the regeneration of cartilage and joints.

Treatment with drugs gives a positive effect, but one should not forget about adverse reactions, since drugs often disrupt the functioning of the gastrointestinal tract.

Surgical intervention

Typically, conservative treatment improves the patient's condition. Surgery is necessary if the pathology continues to progress and drug therapy is powerless . The surgeon installs special devices to support the lumbar spine. This relieves pressure and prevents further deformation of the intervertebral discs in the lumbar region.

Exercise therapy

Therapeutic exercises are necessary both during treatment and during the rehabilitation period . Physical exercises are indicated for any manifestations of degenerative-dystrophic changes in the lumbar region. Naturally, the causes, severity of the process and the main symptoms of the disease should be taken into account.

In the acute phase of the disease, exercise therapy, of course, is not performed . First, you need to achieve pain reduction using other methods: absolute rest, NSAIDs, blockades, local cooling and other procedures.

For intense manifestations, low-amplitude and static exercises are recommended, performed very carefully and slowly. During the rehabilitation period, dynamic complexes are preferable.

In the future, the complexes become more complicated, and exercises with weights are added.

Massage and physiotherapy

Massage and other physical procedures are allowed only during the period of remission of the disease. Carrying out this procedure for dystrophic changes in the lumbar region causes controversy in the medical community. Mechanical impact on the discs also harms the healthy spine. Massage can be allowed if the soft tissues are massaged by an experienced specialist and in the initial stage of the disease.

Massage is prohibited during the acute period , since manipulation causes blood flow, and this provokes increased inflammation and swelling.

During remission, when there is no inflammation and acute pain, physiotherapy is also used. Electrophoresis, acupuncture and magnetic therapy speed up recovery. Manual therapy will restore the normal position of the vertebrae.

Self-treatment at home is best avoided. Without knowing the cause and exact diagnosis of the disease that caused dystrophic changes in the lumbar region, you can only harm your health.

Prevention

To prevent degenerative-dystrophic changes, much effort is not required. But even simple preventive measures will help maintain mobility and health. The aging of cartilage and bones cannot be stopped, but everyone has the power to slow down the degeneration of any part of the spine.

What is needed for this:

• It is necessary to strengthen the back muscles. To develop a muscular corset, strength exercises are necessary, and swimming will also be beneficial.
• You always need to be active. Lack of movement leads to muscle atrophy and loss of ligament elasticity. To keep your back healthy, you just need to do daily exercises.
• It is advisable to avoid excessive physical activity.
• You should pay attention to your posture; your back should always be straight.
• It is better to sleep on an orthopedic mattress, which allows you to fully relax.

Compliance with these rules will prevent degenerative changes and prolong activity into old age.

Prevention

You can prevent such pathologies in the spine by following simple rules. First of all, greater physical activity is required. You should start your morning with exercise. Moreover, it is worth choosing exactly the kind of exercises that would help make your back muscles stronger. Those who are forced to sit for long periods of time while working should sometimes pause to stretch their muscles.

Prevention of degenerative-dystrophic changes in the lumbosacral region can be done by daily morning exercises

Also, to maintain the health of the spine, it is useful to know how to choose a mattress: it should be firm, but in moderation. It is best to also use orthopedic pillows. It is important that the width of such a pillow is suitable for the distance of the shoulders. If you are obese, you should lose weight: it puts extra strain on the spine.

Orthopedic mattresses

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.

Bottom line

Regular back pain is a reason to consult a doctor. Alas, any organism is not eternal, and with aging, the spine suffers first. If a person begins to feel the first signs of the disease, he should immediately be examined by a doctor. Many serious illnesses first signal themselves with completely minor discomfort, but if you miss the moment, you can forget about normal life for a long time. Degenerative-dystrophic pathologies cannot always be cured, but it is quite possible to stop their development and maintain health.