Many of us are familiar with back pain, which disrupts normal life for a long time. Although the cause can be trauma, neurological diseases or malformations of the spine, osteochondrosis of the lumbar spine often becomes a provocateur of unpleasant sensations. This degenerative disease can occur even in youth, its initial manifestations can be detected even in adolescents and school children, but most patients are people after the age of 40. Changes in the spine associated with osteochondrosis can occur in any part, from the cervical to the lumbar and sacrococcygeal. But the most common form that brings patients a lot of unpleasant and painful sensations is osteochondrosis of the lumbar spine. What kind of pathology is it, what is typical for it and whether lower back pain always speaks about this disease.
Osteochondrosis of the lumbar spine: what is the essence of the pathology?
Osteochondrosis is a term derived from two words: Greek osteon, meaning bone, and chondron, or cartilage. Thus, osteochondrosis of the lumbar spine (as well as all others) is triggered by changes in the cartilage of the discs, which are the natural "lining" between the vertebrae and the shock absorber during movement. Changes in the structure of the disc and its functionality are accompanied by a natural reaction in the vertebral body. In this disease, degenerative changes gradually occur in the body of the discs. The height of the disc decreases, due to which its physiological function is lost, which causes instability and changes in the spinal joints. As the disease progresses, a reaction occurs on the end plate of the vertebral body. This reaction can be divided into three stages: edema due to malnutrition and dystrophic changes, fatty degeneration, and, in the latter stage, sclerosis.
Causes of osteochondrosis of the spine
Our spinal discs begin to gradually deform and change when we are about 20 years old. Gradual reduction of fluid in the body of the disc leads to a reduction in the size of the space between the vertebrae (chondrosis). This means that the disc can no longer function as a shock absorber and the tension in the anterior and posterior longitudinal ligaments of the vertebrae changes. As a result, a much higher load is imposed on the spinal joints, which increases from year to year. The spinal ligaments are not correctly placed and are unevenly stretched, and the moving segments of the spine gradually become unstable. The dorsal segment usually consists of two adjacent vertebral bodies and a disc between them. The upper and lower end plates in the vertebral body are exposed to greater stress, zones of thickening (sclerosis) and ridges at the borders (spondylophytes) gradually develop. Due to such changes, the overall clinical picture of the disease in the future is formed.
What are the symptoms of lumbar spine osteochondrosis?
Almost any form of the disease manifests itself in the form of excruciating back pain, which is difficult to control and which affects a certain segment of the spine (from the neck to the lower back and sacrum). Symptoms of lumbar spine osteochondrosis may remain limited to the spine (in the lumbar region) or extend to the legs if they originate from the lumbar spine or the arms if they come from the cervical spine.
Symptoms may occur during rest, exertion, or normal activities. There may be radicular symptoms caused by compression, irritation in the area of the nerve root, or pseudo-radicular symptoms if the cause is in the facet joint or adjacent muscles. Often, osteochondrosis of the lumbar spine is combined with lesions in other areas - the thoracic, cervical spine - then the symptoms will be wider. In other words, discomfort and pain provoke not only one segment that is damaged, but also several areas of osteochondrosis at once. The disease has a wavy course with periods of worsening (symptoms can seriously interfere with normal life) and temporary remissions, when the manifestations are reduced or almost disappear. But any factors, physical or mental, can lead to sudden relapse.
How is osteochondrosis of the spine diagnosed?
Diagnosis is based on a study of the patient's medical history and complaints, a physical examination to identify typical symptoms, and a neurological examination. Today, doctors are increasingly inclined to perform instrumental diagnostics, as other pathologies are often hidden under the guise of osteochondrosis.
For example, among patients who suffer from persistent back pain and are planning surgery to relieve pain, bone health is an important factor. If a patient is found to have low bone density before surgery, this may affect the osteochondrosis treatment plan before, during, and after the procedure. A study from the Special Surgery Hospital (HSS) in New York showed that computed tomography of the lumbar spine before surgery showed that a significant number of patients had low bone density that had not been previously diagnosed.
Nearly half of the nearly 300 patients tested were diagnosed with osteoporosis or its precursor osteopenia. It is especially important to consider this at the age of over 50 years. The prevalence of low bone mineral density in this group was 44%, and 10. 3% were diagnosed with osteoporosis. Low bone density is a known risk factor for vertebral fractures and this condition can be an aggravating factor in the treatment of osteochondrosis.
Treatment of osteochondrosis of the spine
Treatment options depend on the severity of your symptoms. Physical therapy is the main method of relieving pain in the early stages. Ultrasound, electrotherapy, heat treatment are used. Treatment is supplemented by an appropriate way of managing pain such as NSAIDs, muscle relaxants and steroids. Injections can be used - blockades, trigger point injections. Manual therapy, osteopathy, exercise therapy are presented.
Surgical treatment is always the last resort. There are situations when surgery is needed. An example could be paralysis of the bladder or rectum caused by narrowing of the spinal canal or a prolapsed disc, a large herniated disc. The options for surgery are selected together with the doctor. But after surgical treatment the problem is not completely eliminated, long-term rehabilitation and lifelong supportive treatment is needed. This is due to the fact that osteochondrosis does not disappear anywhere, it can progress in other departments.