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 spinal malformations, osteochondrosis of the lumbar spine often becomes a provocateur of unpleasant sensations. This degenerative disease can manifest itself even at a young age, its initial manifestations can also be detected in adolescents and schoolchildren, but most of the patients are people after 40 years of age. Changes in the spine associated with osteochondrosis can occur anywhere from cervical to 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 this, what is typical, and pain in the lower back always speaks of 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, which means bone, and chondron, which is cartilage. Thus, osteochondrosis of the lumbar spine (and all others as well) 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 its function are accompanied by a natural reaction in the vertebral body. With this disease, degenerative changes in the body of the discs gradually occur. The height of the disc decreases, as a result of which its physiological function is lost, causing instability and changes in the vertebral joints. As the disease progresses, a reaction occurs in the endplate of the vertebral body. This reaction can be divided into three phases: edema due to malnutrition and dystrophic changes, fatty degeneration and, at the last stage, sclerosis.
Causes of osteochondrosis of the spine
Our vertebral discs begin to deform and gradually change when we are in our 20s. The gradual decrease of fluid 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 from year to year. The spinal ligaments are not positioned correctly and are stretched unevenly, and the mobile 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 endplates in the vertebral body are subject to greater strain, gradually developing thickened areas (sclerosis) and ridges at the edges (spondylophytes). Due to such changes, the entire clinical picture of the disease will form in the future.
What are the symptoms of osteochondrosis of the lumbar spine?
Almost every form of the disease manifests itself in the form of excruciating back pain that is difficult to control and affects a specific segment of the spine (from the neck to the lower back and sacrum). Symptoms of osteochondrosis of the lumbar spine may remain limited to the spine only (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-radicular symptoms if the cause is in the facet joint or adjacent muscles. Often, osteochondrosis of the lumbar spine is combined with injuries in other areas - the thoracic and cervical spine - so the symptoms will be wider. In other words, discomfort and pain provoke not only one damaged segment, 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 remissions, when the 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 studying the patient's medical history and complaints, physical examination with identification of typical symptoms, and neurological examination. Today, doctors are increasingly inclined to carry out 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 has low bone density before surgery, this can affect the treatment plan for osteochondrosis before, during, and after the procedure. A study from 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 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 may be an aggravating factor in the treatment of osteochondrosis.
Treatment of osteochondrosis of the spine
Treatment options depend on the severity of the symptoms. Physical therapy is the main method of relieving pain in the early stages. Ultrasound, electrotherapy, heat treatment are used. Treatment is complemented by properly matched pain management such as NSAIDs, muscle relaxants and steroids. Injection practices can be used: blockages, trigger point injections. Manual therapy, osteopathy, physical therapy are shown.
Surgical treatment is always a last resort. There are situations when surgery is needed. An example would be bladder or rectal paralysis caused by narrowing of the spinal canal or disc prolapse, a large herniated disc. Options for the operation are selected together with the doctor. But after surgical treatment, the problem is not completely eliminated, long-term rehabilitation and life-long supportive treatment are required. This is due to the fact that osteochondrosis does not go away anywhere, it can progress in other departments.