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 provocateur of unpleasant sensations. This degenerative disease can occur even at a young age, its initial manifestations can be detected even in adolescents and schoolchildren, but the majority of patients are people after 40 years. Spine changes associated with osteochondrosis can occur in any part from the cervical to the 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 it, what is typical, and pain in the lower back always speaks about 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 the others as well) is initiated by changes in the cartilage of the discs, which constitute 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, which leads to the loss of its physiological function, causing instability and changes in the spinal 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 spinal discs begin to deform and gradually change around the age of 20. The gradual decrease in fluid in the body of the disc 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 of the anterior and posterior longitudinal ligaments of the vertebrae changes. As a result, a much greater load is placed on the spinal joints, which increases year by year. The spinal ligaments are not positioned correctly and are stretched unevenly, 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 of the vertebral body are under more stress, areas of thickening (sclerosis) and ridges at the edges (spondylophytes) gradually develop. As a result of 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 manifest as 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 only to the spine (in the lumbar region) or extend to the legs if they originate from the lumbar spine, or to the arms if they originate from the cervical spine.
Symptoms can occur during rest, exertion, or usual 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 facet joint or adjacent muscles. Often times, osteochondrosis of the lumbar spine is associated with lesions in other areas - the thoracic and cervical spine - then the symptoms will be broader. In other words, the discomfort and pain causes not only one damaged segment, but several areas of osteochondrosis at once. The disease has an undulating course with periods of exacerbations (symptoms can seriously interfere with normal life) and temporary remissions, when the manifestations diminish or almost disappear. But all 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 medical history and complaints, a physical examination with the identification of typical symptoms, and a neurological examination. Today, doctors are increasingly inclined to perform instrumental diagnostics, since other pathologies are often hidden under the guise of osteochondrosis.
For example, among patients with persistent back pain who are planning surgery for pain relief, bone health is an important factor. If a patient has low bone density before surgery, it may affect the treatment plan for osteochondrosis before, during, and after the procedure. A study from the Hospital for Special Surgery (HSS) in New York City showed that CT scans of the lumbar spine before surgery showed that a significant number of patients had low bone density that had not been diagnosed before.
Almost half of the nearly 300 patients tested were diagnosed with osteoporosis, or its precursor, osteopenia. It is particularly important to take this into account 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. Physiotherapy is the main method of pain relief in the early stages. Ultrasound, electrotherapy, heat treatment are used. Treatment is supplemented by appropriate pain management such as NSAIDs, muscle relaxants and steroids. Injection practices can be used - blockages, trigger point injections. Manual therapy, osteopathy, and exercise therapy are illustrated.
Surgical treatment is always the last resort. There are situations when surgery is necessary. An example would be paralysis of the bladder or rectum caused by narrowing of the spinal canal or prolapse of the disc, a large herniated disc. The options for the operation are selected in collaboration 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 go away anywhere, it can progress in other departments.