Many of us are familiar with back pain, which disrupts normal life for a long time. Although it can be caused by trauma, neurological diseases, or spinal disorders, osteochondrosis of the lumbar spine often becomes a provocateur of discomfort. This degenerative disease can occur even at a young age, its initial manifestations can be detected even in adolescents and school age, but the majority of patients are still human after 40 years. Changes in the spine associated with osteochondrosis can occur in any part of the cervix to the groin and sacrococcygeal. But the most common form that causes many unpleasant and painful feelings in patients is lumbar spine osteochondrosis. What pathology is it, what is characteristic of it, and does pain in the lower back always speak of this disease.
Lumbar spine osteochondrosis: what is the essence of pathology?
Osteochondrosis is a two-word term: the Greek osteon, which means bone, and the chondron, which is cartilage. Thus, osteochondrosis of the lumbar spine (and everything else) is triggered by changes in the cartilage of the discs that occur during the natural "lining" movement between the vertebrae and the shock absorber. Changes in the structure and functionality of the plate are accompanied by a natural reaction in the vertebral body. With this disease, degenerative changes occur gradually in the body of the discs. The height of the disc decreases, causing its physiological function to be lost, causing instability and changes in the vertebral joints. As the disease progresses, a reaction occurs on 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 vertebral disc begins to gradually deform and change at about the age of 20. A gradual decrease in fluid on 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 act as a shock absorber and the tension in the anterior and posterior longitudinal bands of the vertebrae changes. As a result, a much greater strain is placed on the joints of the vertebrae, which increases year by year. The spinal ligaments are not positioned correctly and are unevenly tensioned, and the movable segments of the spine gradually become unstable. The posterior section usually consists of two adjacent vertebral bodies and a disc between them. The upper and lower endplates of the vertebral body are subjected to greater stress, with thickening of the zones (sclerosis) and the vertebral ridges (spondylophytes) gradually forming. Because of such changes, the full clinical picture of the disease will develop in the future.
What are the symptoms of osteochondrosis of the lumbar spine?
Almost any 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 be limited to the spine (in the lumbar region) or may spread to the legs if they come from the lumbar spine or to the arms if they come from the cervical spine.
Symptoms may occur during rest, effort, or normal activity. There may be radical symptoms that can be 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 combined with osteochondrosis of the lumbar spine with lesions in other areas - the chest, cervical spine - then the symptoms will be wider. In other words, discomfort and pain not only provoke one injured segment, but several areas of osteochondrosis at once. The disease has a fluctuating course, with periods of exacerbation (symptoms can seriously disrupt normal life) and temporary remission when the manifestations decrease or almost disappear. But any factor, physical or mental, can lead to a sudden relapse.
How is osteochondrosis of the spine diagnosed?
The diagnosis is based on the study of the patient's medical history and complaints, physical examination, identification of typical symptoms, and neurological examination. Today, physicians are increasingly inclined to perform instrumental diagnostics because other pathologies are often hidden under the guise of osteochondrosis.
For example, in patients with persistent back pain, and surgery designed to relieve pain, bone health is an important factor. If a patient develops low bone density before surgery, this may affect the treatment plan for osteochondrosis before, during, and after the procedure. A study at the Hospital for Special Surgery (HSS) in New York found that computed tomography of the lumbar spine before surgery showed that a significant proportion of patients had low bone density that had not been previously diagnosed.
Almost half of the nearly 300 patients studied were diagnosed with osteoporosis, or its predecessor, osteopenia. It is especially important to consider this over the age of 50. The incidence 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 the symptoms. Physiotherapy is the main way to relieve pain in the early stages. Ultrasound, electrotherapy, heat treatment are used. Treatment is complemented by appropriate pain management such as NSAIDs, muscle relaxants and steroids. Injection exercises can be used - blockades, trigger point injections. They show manual therapy, osteopathy, exercise.
Surgical treatment is always the last resort. There are situations where surgery is needed. Examples include paralysis of the bladder or rectum caused by narrowing of the spinal canal or a ruptured disc, a large herniated disc. The options for surgery are selected together with the doctor. But after surgical treatment, the problem does not go away completely, long-term rehabilitation and lifelong supportive treatment are needed. This is due to the fact that osteochondrosis does not go away anywhere, it can progress in other classes.