Lumbar osteochondrosis

Lumbar osteochondosis is a chronic disease that develops following a dystrophic degenerative process in intervertebral discs.The disease is widespread and in most cases affects people aged 25 to 40.

According to statistics of back pain, at least once in their life, each second adult knows, while in 95% of cases, they are due to osteochondrosis of the spine.

Patients with a severe course in lumbar osteochondosis, with persistent pain and other manifestations are recognized as temporarily disabled.If within four months, their condition does not improve, the question of establishing a disability group is resolved.

Lumbar osteochondosis is a serious medical and social problem, as the disease mainly affects people of the most worked age, and moreover, in the absence of treatment, it can cause the formation of hernia of the intervertebral disc.

Causes and risk factors

The factors predisposing to the development of lumbar osteochondosis are:

• anomalies of the structure of the spine;
• Lomination is a congenital pathology of the spine, characterized by the separation of the sacrum from the first vertebra and its transformation in the lumbar sixth (additional);
• Sacralization is an innate pathology, in which the fifth lumbar vertebra is nourished by the sacrum;
• the asymmetrical location of the joint cracks of the intervertebral joints;
• pathological narrowing of the vertebral canal;
• reflected spondiogenic pain (somatic and muscular);
• obesity;
• sedentary lifestyle;
• prolonged exposure to vibrations;
• systematic physical constraint;
• smoking.

The unfavorable statistical loads combined with one or more risk factors lead to a change in the physiological properties of the nucleus of the jacket of a fibrous disc, playing a shock absorption role and providing the mobility of the spine.The basis of this process is the depolymerization of polysaccharides, which leads to the loss of humidity with a tissue of the jet nucleus.Consequently, the core of the jacket and with it, the fibrous disc loses their elastic properties.Other mechanical charges cause the fibrous ring protrusion that has lost elasticity.This phenomenon is called protruding.The cracks appear in the fibrous nucleus, through which the fragments of the nucleus of the jacket (prolapse, hernia of the intervertebral disc) fall.

A long compression of the nerve roots innervating certain organs of the abdominal cavity over time leads to a deterioration of their operation.

The instability of the vertebral segment is accompanied by reactive changes in the bodies of adjacent vertebrae, intervertebral joints and concomitant spondyl osteoarthritis.Significant muscular contraction, for example, in the context of physical activity, leads to a change in vertebral bodies and to the violation of nerve roots with the development of root syndrome.

Osteophytes can be another cause of pain and neurological symptoms with lumbar osteochondosis - bone growths on processes and bodies of vertebrae which cause Royshold syndrome or compression myelopathy (compression of spinal cord).

Forms of the disease

According to the structures trained in the pathological process, lumbar osteochondosis manifests itself clinically by the following syndromes:

• Reflex- Lumbalgia, Lumbohachalia, Lumbago;develop in the context of the reflex overvoltage of back muscles;
• Compression (spine, vascular, radicular)- Their development leads to the compression (compression) of the spinal cord, blood vessels or nerve roots.The examples are lombo-sacular radiculitis, radiculismochichemia.

Lumbar osteochondrosis symptoms

With lumbar osteochondosis, symptoms are determined by the structures that are driven in the pathological process.

Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.The pain suddenly appears and pulls.It intensifies during sneeze, cough, turns of the body, physical effort, seat, standing position, walking.In a lie, pain is weakening considerably.Sensitivity and reflexes are preserved, the volume of movements in the lumbar region is reduced.

On palpation, they observe:

• Pain in the lumbar region;
• spasm of paravertebral muscles;
• The flattening of lumbar lordosis, which, in many cases, is combined with scoliosis.

The tension syndrome of the nerve roots with the lumbar is negative.When breeding a right leg, patients note the increase in 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 become increasingly intense and long.

With the lighting, the clinical image looks like a lumbago, however, an increase in the intensity of the pain occurs in a few days.

In the lumbar, patients complain of pain in the lower back, which radiate to one or the two lower limbs.The pain spreads on the buttocks and the back of the thigh and never reaches the feet.

Vasomotor disorders are characteristic of the lumbar intake:

• changes in the temperature and color of the skin of the lower limbs;
• feeling of warmth or thrill;
• Blood supply violation.

The development of lumbar compression syndromes manifests itself clinically by the following symptoms:

• Dermatomic gipalgésie;
• shooting pain;
• Weakening or complete loss of deep reflexes;
• Peripheral paresis.

With compression syndromes, the pain intensifies during the inclination of the body, the sneezing and the cough.

Diagnosis

The diagnosis of lumbar osteochondrosis is made on the basis of the clinical picture of the disease, laboratory research methods and instrumental.

In blood tests in the context of lumbar osteochondrosis, we can note:

• decrease in calcium concentration;
• increase in ESR;
• Increase in the level of alkaline phosphatase.

In the diagnosis of lumbar osteochondosis, radiological examination of the spine is granted of great importance.

A long compression of the nerve roots innervating certain organs of the abdominal cavity over time leads to a deterioration of their operation.

The characteristics of X -ray confirming the diagnosis are:

• modification of the configuration of the affected segment;
• Pseudospondylaz (shift in related vertebral bodies);
• deformation of closing plates;
• flattening of the intervertebral disc;
• The uneven height of the intervertebral disc (symptom of the spacer), which is associated with asymmetrical muscle tone.

Also in the diagnosis of lumbar osteochondrosis in the presence of indications are used:

• Myelography, calculated or magnetic computed tomography - are necessary for persistent symptoms, the development of a neurological deficiency;
• Scintigraphy (the study of the accumulation of a bone phosphorus system, a land technology-99)-is carried out in the event of suspicion of tumor or infectious processes, a vertebral lesion.

The differential diagnosis of lumbar osteochondosis is carried out with the following diseases:

• spondylolistz;
• degreed spondylopathy;
• Ankylosing spondylarthrite (ankylosing spondylitis);
• Infectious process (inflammation of discs, osteomyelitis of the spine);
• Neoplastic process (primary tumor of the spine or its metastatic lesions);
• rheumatoid arthritis;
• deformation of osteoarthrosis of the hip joint;
• Refleted pain (internal organ diseases and large blood vessels).

Lumbar osteochondrosis treatment

With lumbar osteochondrosis, they generally adhere to the following treatment tactics:

• The rest bed for 2-3 days;
• the traction of the affected segment of the spine;
• strengthen the muscles of the rear and abdominal press (the creation of the muscular corset if called);
• Impact on pathological myofascial and myotonic processes.

Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.

In most cases, conservative treatment of lumbar osteochondosis is carried out, including the following measurements:

• muscle infiltration with a solution of local anesthetics;
• Take non-steroidal anti-inflammatory drugs;
• reception of desensitizing agents;
• vitamins therapy;
• reception of tranquilizers and antidepressants;
• Manual therapy, massage;
• Physiotherapy physiotherapy;
• acupuncture;
• Postisometric relaxation.

The absolute indications for the surgical treatment of lumbar osteochondrosis are:

• Acute or subabiuelic compression of the spinal cord;
• The development of ponytail syndrome, characterized by an altered function of pelvic organs, sensitive and motors disorders.

Medical gymnastics for lumbar osteochondosis

In the complex treatment of lumbar osteochondosis, an important role belongs to physiotherapy exercises.Regular classes make it possible to normalize the muscular tone of the paravertebral muscles, to improve metabolic processes in the tissues affected by the pathological process, and in addition to form a well -developed muscle corset, which can maintain the spine in the right position, to eliminate its excessive static loads.

So that gymnastics with lumbar osteochondosis brings the greatest effect to adhere to the following principles:

• regularity of classes;
• gradual increase in the intensity of physical effort;
• Avoid overwork during the lesson.

Physical education should be engaged in the direction of an experienced instructor, which will select the most effective exercises for a particular patient and will control the accuracy of their implementation.

According to statistics of back pain, at least once in their life, each second adult knows, while in 95% of cases, they are due to osteochondrosis of the spine.

In addition to the lessons with an instructor, you should do a daily gymnastics complex daily, which includes special exercises with lumbar osteochondosis.

1. Relaxation and contractions of the abdominal muscles.The starting position is standing, the legs are separated from the shoulder, the hands of the body are lowered.Make a smooth breathing, relaxing the muscles of the anterior abdominal wall.During expiration, you attract as much as possible, stretching the press muscles.The exercise must be repeated before the appearance of light fatigue.
2. Movement of the head with the flexion of the spine.The starting position of the knees, resting on the back of the rear, the back is straight.Slowly lift your head and fold in the back.Damile in this position for a few seconds, then return smoothly to its original position.Repeat at least 10 to 12 times.
3. "Pendulum".The starting position lying on the back, the arms along the body, the legs are folded at right angles in the knee and hip joints.Turn your legs to the right and left with pendulum -shaped movements, trying to get the floor.At the same time, the shoulder blades cannot be torn from the ground.
4. "Boat".The starting position of the extension on the belly, the hands are extended forward.Hold the upper body and legs on the ground, leaning in the back.Damile in this position for 5 to 6 seconds and slowly return to the starting position.Perform 10 times.

Possible consequences and complications

The main complications of lumbar osteochondrosis are:

• the formation of an intervertebral hernia;
• Vegetovascular dystonia;
• spondylolis, spondylolistz;
• osteophytosis;
• spondylarthrosis;
• Stenosis of the vertebral canal, leading to the compression of the spinal cord and capable of causing a persistent loss of work capacity and reducing the quality of life.

A long compression of the nerve roots innervating certain organs of the abdominal cavity over time leads to a deterioration of their operation.Consequently, patients have intestinal dysfunctions (constipation, diarrhea, flatulence) and pelvic organs (urination, erectile dysfunction, fregidity, infertility).

Forecast

Pain syndrome for lumbar osteochondosis takes place in the form of remissions and exacerbations.Lumbago lasts 10-15 days, after which the patient's condition improves, the pain disappears.Adopted secondary diseases can interfere with a favorable result.Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which become increasingly intense and long.

In the complex treatment of lumbar osteochondosis, an important role belongs to physiotherapy exercises.

Patients with a severe course in lumbar osteochondosis, with persistent pain and other manifestations are recognized as temporarily disabled.If within four months, their condition does not improve, the question of establishing a disability group is resolved.

Prevention

The prevention of the development of osteochondrosis of the spine is the following measure:

• Refusal to smoke;
• normalization of body weight;
• Improvement of general physical condition, active lifestyle;
• Avoid provocation conditions (weight lifting, net movements, turns, inclinations).