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 source of unpleasant sensations. This degenerative disease can occur even at a young age, its initial manifestations can be detected even in adolescents and school children, but most patients are people after 40 years. Spinal changes associated with osteochondrosis can occur anywhere, from the cervical to the lumbar and sacrococcygeal. But the most common form that brings the patient many unpleasant and painful sensations is osteochondrosis of the lumbar spine. What kind of pathology is this, what is typical of it and the pains in the lower back always speak of this disease.
Osteochondrosis of the lumbar spine: what is the essence of pathology?
Osteochondrosis is a term derived from two words: the Greek osteon, which means bone, and chondron, which is cartilage. Thus, osteochondrosis of the lumbar spine (and all others too) is initiated 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 in its functionality are accompanied by a natural reaction of the vertebral body. With this disease, degenerative changes occur gradually in the body of the discs. The height of the disc decreases, causing the loss of its physiological function, causing instability and changes in the vertebral joints. As the disease progresses, a reaction occurs at the vertebral body's end plate. 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 spinal osteochondrosis
Our vertebral discs begin to deform and change gradually when we are about 20 years old. The gradual decrease of the liquid inside the disc body leads to a decrease 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 greater load is imposed on the vertebral joints, which increases each year. Spinal ligaments are not positioned correctly and are unevenly stretched, and the moving spine segments gradually become unstable. The dorsal segment usually consists of two adjacent vertebral bodies and a disc between them. The plates of the upper and lower extremities of the vertebral body are subject to more stress, thickening zones (sclerosis) and ridges on the edges (spondylophytes) gradually develop. Due to these changes, the entire clinical picture of the disease is formed in the future.
What are the symptoms of osteochondrosis of the lumbar spine?
Almost all forms of the disease are manifested in the form of excruciating low back pain, difficult to control and affecting a specific segment of the spine (from the neck to the lumbar region and the sacrum). Symptoms of osteochondrosis of the lumbar spine may remain limited only to the spine (in the lumbar region) or spread to the legs, if they come from the lumbar spine, or to the arms, if they come from the cervical spine.
Symptoms can occur during rest, exertion, or habitual activity. There may be root symptoms caused by compression, irritation in the nerve root area, or pseudo-root symptoms if the cause is in the facet joint or in the adjacent muscles. Often, osteochondrosis of the lumbar spine is combined with lesions in other areas - the thoracic, cervical spine - so the symptoms will be more extensive. In other words, discomfort and pain cause not only an injured segment, but several areas of osteochondrosis at the same time. The disease has a wavy course with periods of exacerbations (the symptoms can seriously interfere with normal life) and temporary remissions, when the manifestations diminish or almost disappear. But any factors, physical or mental, can lead to a sudden relapse.
How is spinal osteochondrosis diagnosed?
The diagnosis is based on the study of the patient's clinical history and complaints, physical examination with identification of typical symptoms and neurological examination. Today, doctors are increasingly inclined to perform instrumental diagnoses, since other pathologies often hide 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 has low bone density before surgery, it can affect the treatment plan for osteochondrosis before, during and after the procedure. A study by the Hospital for Special Surgery (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 take this into account at the age of over 50. 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. Physiotherapy is the main method of pain relief in the early stages. Ultrasound, electrotherapy and heat treatment are used. Treatment is complemented by adequate pain control, such as NSAIDs, muscle relaxants and steroids. Injection practices can be used - blockages, trigger point injections. Manual therapy, osteopathy and exercise therapy are shown.
Surgical treatment is always the last resort. There are situations where surgery is necessary. An example would be bladder or rectal paralysis caused by narrowing of the spinal canal or disc prolapse, a large herniated disc. The options for the operation are selected in conjunction with the doctor. But, after surgical treatment, the problem is not completely eliminated, long-term rehabilitation and lifelong support treatment are needed. This is because osteochondrosis does not disappear anywhere, it can progress in other departments.