Spondyloarthrosis (osteoarthritis) is a common pathology of the lumbar spine. Spondyloarthritis of the lumbosacral spine is more common in older people, but it can also develop in people who do heavy physical work, are obese, or in anyone who has had a previous spinal injury.
Osteoarthritis of the lumbar spine develops in the joints that connect the segments of the spine. Each vertebra is connected to another vertebra in three places. In front of the spinal cord, the vertebrae are separated by the spinal disc. Behind the spinal cord, the vertebrae are connected by two small joints called facet joints. These joints, along with the intervertebral disc, allow the spine to move and perform movements such as bending and extension or rotation of the back.
Treatment of spondyloarthrosis of the lumbar-sacral spine can be either conservative or surgical, and the choice of treatment tactics depends mainly on the clinical picture.
Causes
Common causes of osteoarthritis of the facet joints of the lumbar spine are:
- Degenerative changes in joints and wear and tear of joints over time.
- Disc degeneration can cause the distance between vertebrae to decrease, which will increase stress on the facet joints, accelerating wear and tear on these joints.
- Backward movements of the trunk (extensions) can put pressure on the facet joints, which can lead to degenerative changes.
- A sudden fall or injury, such as a car accident, can damage the facet joints, increasing and accelerating wear and tear on the joints.
- Genetic factors may influence your likelihood of developing degenerative joint disease.
- Repetitive stress injuries, such as lifting or carrying heavy objects, can cause joint irritation and degeneration.
Prevention
As preventive measures, you should definitely carry out:
- medical examinations and examinations of the spine to monitor the stage of the process and the effectiveness of treatment;
- maintaining optimal body weight;
- optimization of motor mode and physical activity;
- regular attendance at fitness programs;
- treatment of inflammatory diseases in a timely and qualified manner.
Symptoms
Symptoms of spondyloarthrosis of the lumbar spine will depend on which motor segment is most damaged and the degree of impact on nearby nerve structures.
Symptoms can range from mild to severe and can mimic those of disc disease:
- Back pain or radicular pain radiating into the buttock, into the leg and extending down to the back of the knee, less commonly to the front of the leg or foot.
- Pain and tenderness are localized at the level of the facet joint involved in the pathological process.
- Muscle spasm and forced changes in posture.
- Loss of movement, such as the inability to straighten, bend the body to the side, or maintain an upright position for long periods of time.
- There may be disturbances in walking and standing in cases of severe pathological process
- Sitting is usually more comfortable.
- Change in normal lumbar curvature or lordosis.
- Development of stenosis-like symptoms.
- Stiffness in the joints after a period of rest.
- Pain after excessive activity and pain relief after rest.
- There may be some swelling at the level of the pathologically changed facet joints.
- Muscle weakness in the lower extremities or symptoms of cauda equina syndrome due to the development of spinal stenosis
Training complex for thoracic localization
Exercise therapy warm-ups will allow you to strengthen this part of the spinal column, increase and maintain its mobility, forget for a long time about excruciating pain in the shoulder blades, sternum and ribs, and restore the functionality of the internal organs.
- Stand straight, feet together. As you inhale, raise your arms up and slowly bend back; as you exhale, lower your arms and at the same time bend forward, rounding your back. Repeat 10 times.
- Sit on a chair, cross your arms behind your head. Inhaling, bend your back backwards, spreading your elbows as far apart as possible. As you exhale, we return back, relaxing our elbows (8 repetitions).
- Kneel down, rest on the palms of your straightened arms. Arch your back downwards, opening your chest as much as possible, and hold in this position for 3 seconds. Then bend your back upward, holding for the same amount of time. Perform alternate bending-bending 7 times for each task.
- Lie on your stomach, arms bent, palms at shoulder level. Straightening your upper limbs, raise your body. Standing on straight arms, smoothly arch the spine, pulling your chest forward (5-7 times).
- Starting position – lying on your stomach, upper limbs located along the body. We tear our shoulders off the surface, raise them to such a distance from the floor as your physical fitness allows (5-7 repetitions).
Diagnostics
A patient who has been experiencing back pain or stiffness for more than two weeks should see a doctor for a physical examination.
Disease history
The physician must evaluate the patient's medical history, examine symptoms, pain characteristics, and joint function, how and when symptoms began, and how they have changed over time.
The doctor also needs to find out the presence of concomitant pathology, previous treatment, family history and bad habits (for example, alcohol consumption, smoking, etc.),
Physical examination. The doctor will need to perform a physical examination to evaluate the patient's general health, muscle and bone condition, nerve conduction, reflexes, and spinal joint mobility.
The doctor also needs to obtain information about the patient's muscle strength, flexibility, and ability to perform activities of daily living, such as walking, bending, and standing.
The patient may need to perform some movements so that the doctor can understand the range of motion and determine which movements increase symptoms.
Instrumental diagnostic methods
Radiography
- a doctor may order an x-ray to see if there is injury to the spinal joints and how extensive it is. X-rays can show cartilage loss, bone changes, and the location of possible bone growths (osteophytes).
Additional diagnostic methods that may be required to exclude other causes of pain or confirm the presence of spondyloarthrosis:
PAT.
A bone scan is used to rule out inflammation, cancer, infection or a small fracture.
CT scan
can be performed to more accurately measure the degree of narrowing of the spinal canal and morphological changes in surrounding structures.
MRI.
Magnetic resonance imaging is a method that can provide a very detailed morphological picture of the spinal cord, nerve roots, intervertebral discs, ligaments and surrounding tissues.
Stages and classification
Spondylosis and its variety - spondyloarthrosis, as well as osteochondrosis, can manifest themselves in different parts of the spine. These diseases are characterized by stages, so the clinical picture does not develop immediately, which interferes with the early diagnosis of diseases.
Important! Staging is determined using instrumental methods. The criteria are the size, nature of the growth, and the height of the intervertebral disc.
Table No. 1. Stages of diseases.
| Stage | Description |
| Stage 1 | On an x-ray you can see many bone growths that do not leave the vertebrae. Intervertebral discs are intact. Their height is unchanged. |
| Stage 2 | Osteophytes extend beyond the vertebrae and grow together. But at the second stage this process remains incomplete. |
| Stage 3 | Osteophytes are completely fused and form brackets. The affected part of the spine loses its mobility. Stenosis of the vertebral canal is observed. |
According to the rate of progression, spondylosis can be classified into:
Treatment
Treatment of spondyloarthrosis of the lumbosacral spine is aimed at both reducing symptoms and stopping the progression of pathological processes in the joints or bones.
Most doctors take a conservative approach in the initial phase of treatment, and only then consider invasive options, but only if symptoms do not respond to conservative therapy or severe neurological signs develop.
Some of the most common treatments for lumbar spondyloarthrosis are:
- Physical therapy (PT)
is used to strengthen the muscles of the lumbar spine. Stronger muscles support the spine better and thus reduce stress on the facet joints. - Losing weight
improves symptoms simply by reducing the stress on the lumbar spine. Although weight loss can be difficult for some patients, low-impact exercise (such as swimming) combined with a low-calorie diet can often achieve the results needed to relieve pain. - Drug treatment
. Anti-inflammatory medications can reduce swelling and inflammation in the facet joint area. While over-the-counter medications such as Aleve (naproxen) or Advil (ibuprofen) can often provide sufficient symptom relief, stronger prescription medications such as Voltaren (diclofenac) and Arthrotec (diclofenac/misoprostol) are sometimes required. - The use of cold and heat
can also be effective in relieving pain in the lumbar spine. Heat can help loosen the spine before physical activity, while ice is best used after activity to reduce inflammation. - Manual therapy
. Manipulation is widely used to treat spinal diseases. Although manual therapy does not allow you to restore the full range of motion in the motor segments of the spine and restore the structure of the spine, nevertheless, manipulations can reduce pain and improve mobility. - Epidural injections
include: Injecting a steroid (cortisone or analogues) into the area of the pinched nerve. Cortisone may affect the immune system, thereby reducing localized inflammation and radicular pain.
Additional treatments include acupuncture, massage, magnetic therapy
, naturopathic remedies and other direct or indirect forms of posterior those. Although scientific evidence supporting these alternative treatments is largely lacking, most have few side effects and are reasonable options when used in conjunction with standard medical treatments.
Costotransverse type of arthrosis
In the thoracic region there are costotransverse and costovertebral joints, which form the connections of the thoracic vertebrae with the ribs. These two types of formations are mechanically interconnected and therefore cannot work without each other. The costovertebral joint and the transverse costal joint perform the same function: raising and lowering the symmetrical arcuate bones that form the rib cage. This specificity of the articular apparatus of the spinal column is characteristic specifically of the thoracic region.
A little anatomy.
Each of the presented joints can suffer from degenerative-dystrophic pathogenesis. Although it is worth noting that articular lesions in this spinal region are very rare, since the thoracic segment is powerfully strengthened by the muscular-ligamentous complex. They develop more often in older people, mainly women.
As for clinical manifestations, in the previous paragraph we have already talked about the nature of the dorsal type of the disease. Let us recall one distinctive feature: pathological signs are predominantly concentrated in the region of the ribs and the upper part of the abdominal wall. If the disease is severely neglected, dangerous complications may follow: severe depression of the respiratory center and serious disorders of the functioning of the cardiovascular system.
Complications of spondyloarthrosis of the lumbosacral spine
Osteoarthritis rarely causes severe neurological dysfunction due to compression of nerve structures.
However, over time, degenerative changes can cause spinal stenosis, which means that narrowing of the spinal canal can cause compression of the spinal cord and nerve roots.
Spinal stenosis can be a complication of spondyloarthrosis.
Cauda equina syndrome is a disorder caused by compression of the nerves in the lower spinal cord by a tissue overgrowth or intervertebral disc, a rare complication of osteoarthritis that can cause serious neurological problems.
Osteoarthritis of the facet joints
Destruction of the matrix of the cartilaginous surfaces of the cervical joints is the most common type of spinal arthrosis, and one of the most severe. This subtype of the disease is also called uncoarthrosis or cervical osteoarthritis. The pathology develops over a long period of time and may not manifest itself at first. But a progressive osteochondral deformation, causing compression of the cervical-vertebral nerve roots, veins and arteries, and autonomic plexuses, will certainly show itself as a variety of neurological symptoms. So, destructive processes in the articular cartilages of the neck may be indicated by:
- limited mobility of the head and painful condition in the cervical region with an uncomfortable posture, prolonged immobility, turns and tilts of the head;
- the appearance of a specific sound when moving the head (crunching, clicking);
- local muscle tension in the projection of the damaged element;
- tinnitus and a feeling of loss of balance;
- shooting into the scapuloclavicular triangle;
- deterioration of vision, hearing;
- feeling of a lump in the throat;
- arterial hypertension;
- numbness in various parts of the upper extremities and other types of paresthesia;
- pain in the neck, head, shoulder girdle, arms, less often in the sternum (sometimes the pain imitates a heart attack).
Naturally, each person will have their own set of symptoms, but all patients will have one common problem - loss of mobility of the cervical segment. The worst thing is that without adequate and timely therapy, the deformed bone bodies can grow together, and the motor abilities of the neck will then be completely blocked. Among other things, due to an illness that affects any level of this department, blood supply and nutrition to the brain can be seriously disrupted.
Surgery
In cases of severe spondyloarthrosis that cannot be treated conservatively, surgery may be indicated.
Generally, surgery is considered if the patient experiences some of the following symptoms:
- Increased radicular pain
- Increased pain or nerve irritation
- Associated disk damage
- If degenerative changes in the facet joints lead to compression of the nerve roots, then radicular syndrome occurs. This causes radicular pain, weakness, and stenosis-like symptoms. In this case, surgery may be indicated to release the nerve root and remove excess degenerative tissue that is putting pressure on the root. One such procedure is called a foraminotomy. In addition, an operation such as vertebral fusion (spinal fusion) is used.
- Vertebral fusion is a surgical procedure used to eliminate movement between adjacent vertebrae. When all other treatments fail to provide relief, spinal fusion may be a reasonable option for treating severe spondyloarthritis.
Two tips to make your workouts more effective
Take a professional exercise therapy course
It is highly advisable to take a professional exercise therapy course at least once a year. Physical therapy for spondyloarthrosis, performed in medical institutions, has a number of advantages over home gymnastics:
- it is safe because it is carried out under the supervision of a doctor;
- gives quick results due to the use of the most effective and individually adjusted exercises;
- there is the possibility of using gymnastic apparatus and special equipment;
- As a rule, such physical education is combined with other therapeutic measures (manual therapy, massage, physical therapy).
Sign up for the pool
Some of the most effective options for therapeutic exercises are swimming and exercises in water. While in the water, the spine experiences virtually no stress, and you can exercise quite intensely, which strengthens the muscles well without creating a feeling of fatigue and overwork.
Self help
- Self-medication is important for pain caused by spondyloarthritis because pain may increase or decrease over several days.
- Experts have found that even if there is pain, staying in bed for a long time is not advisable. Therefore, it is recommended to continue normal physical activity.
- However, you should avoid anything that could aggravate the condition, such as lifting heavy loads.
- Some people benefit from applying heat or ice to treat back pain.
- Sleeping with a pillow between your legs can be beneficial for lower back pain. An orthopedic mattress can also provide good support.
How to prepare for lumbar exercise therapy
Physical therapy may be prescribed by a doctor after the results of the examination. Don't forget about the rules that will help you make it effective:
- The best time for classes is before lunch. The last meal should take place 1.5 hours before they start.
- Every workout should start with a warm-up. It helps warm up muscles and ligaments, prepares the heart for stress.
- During the exercise, use a roller under your knees at the correct height (the thigh and shin are perpendicular to each other).
- Record the exercises you perform in your diary and monitor the results.
For osteochondrosis, there is a whole complex of gymnastics. Exercises vary in difficulty and stages. Follow the lesson plan without combining them with each other.
The lumbar exercise therapy program is divided into blocks that are intended for a specific stage.
The first stage is carrying out exercise therapy in the acute period . As simple and slow movements as possible.
The second stage is the subacute period . If the pain has decreased, you can increase the load, but gradually.
The third stage is remission . The pain has stopped, complex exercises are included.
Choose loose clothing that will not interfere with your workout. We recommend paying attention to a cotton T-shirt or tank top, shorts or sweatpants. If you exercise outside in cold weather, use woolen items.
Inventory you will need:
- Gymnastic ball.
- Swedish wall.
- Pillow for the knees.
- Fitness mat.