Lumbar osteochondrosis is a chronic disease that develops as a result of a degenerative-district process in the intervertebral discs.The disease is widespread and affects in most cases people from 25 to 40 years of age.
According to back pain statistics, at least once in his life every second adult is experiencing, while in 95% of cases they are due to spinal osteochondrosis.
Patients with a severe course of lumbar osteochondrosis, with persistent pain and other manifestations are known as temporarily disabled.If their situation does not improve within four months, the issue of creating a disability group is resolved.
Lumbar osteochondrosis is a serious medical and social problem, as the disease mainly affects people of the most working age, and in addition, in the absence of treatment, it can cause the formation of intervertebral disc hernia.
Causes and risk factors
The factors that predisposition to the development of lumbar osteochondrosis are:
- abnormalities of the spine structure;
- Lumbarization is a congenital pathology of the spine, characterized by separation from the first vertebra sacrum and its transformation into the sixth lumbar (additional);
- Sacralization is an innate pathology, in which the fifth lumbar vertebra is fed by sacrum;
- the asymmetric location of the articular cracks of the intervertebral joints;
- pathological narrowing of the spinal canal;
- spondiogenic reflected pain (somatic and muscle);
- Obesity;
- sedentary lifestyle;
- prolonged exposure to vibrations;
- systematic physical exertion;
- smoking.
The unfavorable statodynamic loads combined with one or more risk factors lead to a change in the physiological properties of the nucleus of a fibrous disc, playing a role to remove a shock and ensuring the mobility of the spinal column.The basis of this process is the depolimerization of polysaccharides, which leads to the loss of moisture with a jet core fabric.As a result, the nucleus of the jacket, and with it, the fibrous disk loses their elastic properties.Further mechanical loads provoke the extension of the fibrous ring that has lost elasticity.This phenomenon is called extension.Ackes appear in the fibrous nucleus, through which fragments of the jacket nucleus (prolapse, intervertebral disc hernia fall).
A long compression of the nerve roots by innovating certain organs of the abdominal cavity over time leads to a deterioration in their function.
Spinal segment instability is associated with reactive changes in adjacent vertebrae bodies, intervertebral joints and simultaneous spondy arthrosis.An important contraction of the muscles, for example, against the backdrop of physical activity, leads to a displacement in vertebral bodies and violation of nerve roots with the development of radicular syndrome.
Osteophytes can be another cause of pain and neurological symptoms with lumbar osteochondrosis - bone output to processes and vertebrae bodies that cause ROYSHOLD syndrome or compression myelopathy (compression of the spinal cord).
Forms of illness
Depending on which structures are attracted to the pathological process, lumbar osteochondrosis is clinically manifested by the following syndromes:
- Reflective- Lumbalgia, Lumbochachacalia, Lumbago;develop against the background of reflex overlap of the back muscles;
- compression (spinal, vascular, radical)- Their development is leading to compression (compression) of the spinal cord, blood vessels or nerve roots.Examples are lumbosakral radiculus, radiculochemia.
Symptoms of lumbar osteochondrosis
With lumbar osteochondrosis, the symptoms are determined by which the structures are attracted to the pathological process.
Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.Pain appears suddenly and is shooting.It intensifies when sneezing, coughing, body curves, physical exercise, place, attitude, walking.In the lie, the pain is significantly weakening.Sensitivity and reflexes increase, the volume of movements in the lumbar region is reduced.
In palpation, they observe:
- pain in the lumbar region;
- preverstebral muscle spasm;
- Flashing the lumbar lordosis, which in many cases is combined with scoliosis.
Lumbar nerve tension syndrome is negative.When they grow a straight leg, patients mark increased pain in the lower back, not their appearance in an elongated lower limb.
Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which always become increasingly intense and long.
With lumbalia, clinical photography resembles a lumbago, however, an increase in pain intensity occurs within days.
In lumbar form, patients complain of pain in the lower back, which radiate to one or both limbs.The pain spreads over the buttocks and the back of the thigh and never reaches the legs.
Disordishes Vasomotor disorders are characteristic of lumbar jackaling:
- changes in the temperature and color of the skin of the lower extremities;
- feeling of heat or cooling;
- Violation of blood supply.
The development of lumbar compression syndromes is clinically manifested by the following symptoms:
- dermatomic gipalgesia;
- shooting pain;
- Weakening or complete loss of deep reflexes;
- Suburban paresis.
With compression syndromes, the pain intensifies when bending your body, sneezing and coughing.
Troubleshooting
The diagnosis of lumbar osteochondrosis is performed on the basis of the clinical image of the disease, laboratory and instrumental research methods.
In the blood tests on the background of lumbar osteochondrosis, it can be noted:
- decreased calcium concentration;
- increase in ESR;
- Increasing the level of alkaline phosphatase.
In the diagnosis of lumbar osteochondrosis, radiological examination of the spine is given great importance.
A long compression of the nerve roots by innovating certain organs of the abdominal cavity over time leads to a deterioration in their function.
The X -Ray features that confirm the diagnosis are:
- change in configuration of the affected segment;
- Pseudospondylastz (displacement of associated vertebral bodies);
- deformation of closing plates;
- flattening of the intervertebral disc;
- The uneven height of the intervertebral disc (Spacer symptom), which is associated with asymmetrical muscle tone.
Also in the diagnosis of lumbar osteochondrosis in the presence of indications they are used:
- Myelography, rejected tomography or calculated magnetic - are indispensable for persistent symptoms, development of neurological deficiency;
- Scintigraphy (the study of the accumulation of a phosphorus bone system, a melted technology-99)-is performed in the event of a suspicion of a tumor or an infectious process, a spinal cord.
Differential diagnosis of lumbar osteochondrosis is performed with the following diseases:
- Spondylolistz;
- Strusideronal spondylopathy;
- ankylosing spondylitis (ankylosing spondylitis);
- Infectious processes (inflammation of the discs, osteomyelitis of the spine);
- Neoplastic processes (primary spine tumor or its metastatic lesions);
- rheumatoid arthritis;
- deformity of hip osteoarthrosis;
- Mirrored pain (diseases of the internal organs and large blood vessels).
The treatment of lumbar osteochondrosis
With lumbar osteochondrosis, they usually adhere to the following treatment tactics:
- Bed rest for 2-3 days;
- withdrawal of the affected segment of the spine;
- strengthening of the back muscles and abdominal press (the creation of so -called muscle corsets);
- Impact on myophassic and myotonic pathological processes.
Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.
In most cases, conservative treatment of lumbar osteochondrosis is performed, including the following measures:
- infiltration of muscles with a solution of local anesthesia;
- taking non -steroidal anti -inflammatory drugs;
- reception of desensitizing agents;
- Vitamin therapy;
- reception of sedatives and antidepressants;
- manual therapy, massage;
- Physical education of physiotherapy;
- acupuncture;
- Postisometric relaxation.
Absolute indications for surgical treatment of lumbar osteochondrosis are:
- acute or subacute compression of the spinal cord;
- The development of horse tail syndrome, characterized by impaired pelvic organs function, sensitive and motor disorders.
Medical gymnastics for lumbar osteochondrosis
In the complex treatment of lumbar osteochondrosis, an important role belongs to the exercises of physiotherapy.Regular classes make it possible to normalize the tone of the preverstebral muscle muscle, improve metabolic processes in the tissues affected by the pathological process, and in addition to forming a well -developed muscle corset, which could store the spine in the right position, remove excess static loads from it.
In order that gymnastics with lumbar osteochondrosis to bring the greatest effect to adhere to the following principles:
- regularity of classes;
- gradual increase in the intensity of physical exercise;
- Avoiding work during the lesson.
Physical education should be engaged in leading an experienced instructor who will choose the most effective exercises for a particular patient and control the correctness of their implementation.
According to back pain statistics, at least once in his life every second adult is experiencing, while in 95% of cases they are due to spinal osteochondrosis.
In addition to classes with an instructor, you need to perform a morning gymnastics complex daily, which includes special exercises with lumbar osteochondrosis.
- Relaxation and abdominal muscle contractions.The starting position is standing, the legs are in shoulder width, the hands of the body sit.Do a calm breath, relaxing the muscles of the anterior abdominal wall.When extracting, draw yourself as much as possible, straining the press muscles.Exercise should be repeated before the light of light appears.
- The movement of the head with the bending of the spine.The initial position of the knees, resting on the floor from the back, the back is straight.Slowly raise your head and bend on your back.Remain in this position for a few seconds, and then return smoothly to its original position.Repeat at least 10-12 times.
- "Pendulum".The starting position lying on the back, the arms along the body, the legs are bent at right angles to the knee joints and hip.Turn your legs to the right and left with the swinging movements of the pendulum, trying to get the floor.At the same time, the shoulder blade cannot be chopped off the floor.
- "Boat".The initial position lying in the stomach, the hands extend forward.Wash the upper body and legs from the floor, bending to the back.Remain in this position for 5-6 seconds and slowly return to the starting position.Perform 10 times.
Possible consequences and complications
The main complications of lumbar osteochondrosis are:
- formation of intervertebral hernia;
- vegetovascular dystonia;
- Spondylolis, spondylolistz;
- osteophytosis;
- spondylarthrosis;
- Spinal canal stenosis, leading to compression of the spinal cord and capable of causing constant loss of working capacity and reduce the quality of life.
A long compression of the nerve roots by innovating certain organs of the abdominal cavity over time leads to a deterioration in their function.As a result, patients have intestinal dysfunctions (constipation, diarrhea, flat) and pelvic organs (urination disorders, erectile dysfunction, frigidity, infertility).
Predict
Pain syndrome for lumbar osteochondrosis continues in the form of remissions and irritation.Lumbago lasts 10-15 days, after which the patient's condition improves, the pain decreases.Distant secondary diseases can interfere with a favorable outcome.Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which always become increasingly intense and long.
In the complex treatment of lumbar osteochondrosis, an important role belongs to the exercises of physiotherapy.
Patients with a severe course of lumbar osteochondrosis, with persistent pain and other manifestations are known as temporarily disabled.If their situation does not improve within four months, the issue of creating a disability group is resolved.
PREVENTION
Preventing the development of osteochondrosis of the spine is the following measures:
- Refusal of smoking;
- normalization of body weight;
- improving the general physical condition, active lifestyle;
- Avoiding provocation conditions (weight lifting, sharp movements, curves, tendencies).