Many of us are familiar with back pain, which disrupts normal life for a long time. Although the cause may be trauma, neurological diseases, or spinal malformations, osteochondrosis of the lumbar spine often becomes provocative of uncomfortable sensations. This degenerative disease can occur even at a young age, its initial manifestations can also be detected in adolescents and school children, but most patients are people after 40 years. Spinal changes associated with osteochondrosis can occur in any part, from the cervix to the lumbar and sacrococcygeal. But the most common form that brings patients a lot of uncomfortable and painful sensations is osteochondrosis of the lumbar spine. What kind of pathology is this, what is typical for it and does the pain in the lower back always speak for this disease.
Osteochondrosis of the lumbar spine: what is the essence of the pathology?
Osteochondrosis is a term derived from two words: the Greek osteon, meaning bone, and the chondron, which is cartilage. Thus, osteochondrosis of the lumbar spine (and everyone else, too) begins with changes in the disc cartilage, 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. With this disease, degenerative changes gradually occur in the body of the discs. The height of the disc decreases, due to which it loses its physiological function, causing instability and changes in the vertebral joints. As the disease progresses, a reaction occurs in 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 last stage, sclerosis.
Causes of osteochondrosis of the spine
Our vertebral discs begin to deform and gradually change when we are about 20 years old. Gradual reduction of fluid within 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 longitudinal anterior and posterior vertebral ligaments varies. As a result, a much greater load is imposed on the vertebral joints, which increases from year to year. The spinal ligaments are not positioned correctly and are unevenly stretched, and the movable 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 more subject to stress, the areas of obesity (sclerosis) and the ridges at the borders (spondylophytes) develop gradually. Due to such changes, the whole clinical picture of the disease is formed in the future.
What are the symptoms of lumbar spine osteochondrosis?
Almost every form of the disease manifests itself in the form of excruciating back pain, which is difficult to control and affects a specific segment of the spine (from the neck to the lower back and sacrum). Symptoms of lumbar spine osteochondrosis may be limited to the spine (lumbar region) or spread to the legs if they come from the lumbar spine, or the arms if they come from the cervical spine.
Symptoms may occur during rest, strain, or normal activity. There may be radicular symptoms caused by compression, irritation in the nerve root area or pseudo-radicular symptoms if the cause is in the facial joint or adjacent muscles. Often, osteochondrosis of the lumbar spine is combined with lesions in other areas - thoracic spine, cervix - then the symptoms will be more extensive. In other words, discomfort and pain provoke not only one segment that is damaged, but several areas of osteochondrosis at the same time. The disease has a wavy course with periods of exacerbations (symptoms can seriously interfere with normal life) and temporary remission, when manifestations diminish or almost disappear. But any factor, physical or mental, can lead to a sudden relapse.
How is spinal osteochondrosis diagnosed?
Diagnosis is based on the study of the patient's medical history and complaints, physical examination with identification of typical symptoms, and 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 suffering from persistent back pain and 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 by 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.
Almost 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 complemented by proper pain management, such as NSAIDs, muscle relaxants and steroids. Injection practices can be used - blockades, injection point injections. Manual therapy, osteopathy, exercise therapy are indicated.
Surgical treatment is always the last resort. There are situations when surgery is needed. An example would be paralysis of the bladder or rectum caused by narrowing of the spinal canal or prolapsed disc, a large herniated disc. Options for surgery are chosen together with the doctor. But after surgical treatment, the problem is not completely eliminated, long-term rehabilitation and lifelong supportive treatment is required. This is due to the fact that osteochondrosis does not disappear anywhere, it can progress to other departments.