Lumbar osteochondrosis is a chronic disease that develops following a degenerative dystrophic process in the intervertebral discs.The disease is widespread and affects people aged 25 to 40 in most cases.
According to back pain statistics, at least once in his life every second adult is experiencing, while in 95% of cases they are due to the osteochondosis of the spine.
Patients with a serious course of lumbar osteochondrosis, 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 group of disability is resolved.
Lumbar osteochondrosis is a serious medical and social problem, since the disease mainly affects the people of the working age and in addition, in the absence of treatment, it can cause the formation of hernia of the intervertebral disc.
Causes and risk factors
The factors that predispose to the development of lumbar osteocondrosis are:
- anomalies of the structure of the spine;
- The low background is a congenital pathology of the spine, characterized by the separation from the sacred of the first vertebra and its transformation into the (additional) lumbar sixth;
- Sacralization is an innate pathology, in which the fifth lumbar vertebra is fed with the sacred;
- the asymmetrical position of the joint cracks of the intervertebral joints;
- pathological narrowing of the spinal canal;
- Spondogenic reflections (somatic and muscles);
- obesity;
- sedentary lifestyle;
- prolonged exposure to vibrations;
- systematic physical tension;
- smoke.
The adverse stamodynamic 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 role of shock and providing the mobility of the spine.The basis of this process is the depolimerization of the polysaccharides, which leads to the loss of humidity with a tissue of the nucleus of the jet.Consequently, the nucleus of the jacket and with it the fibrous disc loses their elastic properties.Further mechanical loads cause the protrusion of the fibrous ring that has lost elasticity.This phenomenon is called protrusion.Crafts appear in the fibrous nucleus, through which fragments of the nucleus of the jacket fall (prolapse, hernia of the intervertebral disc).
A long compression of the nerve roots that innervate some organs of the abdominal cavity over time leads to a deterioration of their functioning.
The instability of the spinal segment is accompanied by reactive changes in the bodies of the adjacent vertebrae, of the intervertebral joints and the hilly concomitant spondile.A significant muscle contraction, for example, against the background of physical activity, leads to a movement of vertebral bodies and the violation of the nerve roots with the development of the root syndrome.
Osteophytes can be another cause of pain and neurological symptoms with lumbar osteochondrosis - bone extension on processes and bodies of vertebrae that cause Royshold syndrome or compression myelopathy (compression of the spinal cord).
Forms of illness
Depending on which structures are designed in the pathological process, lumbar osteochondrosis is clinically manifested by the following syndromes:
- Reflex- Lumbalgia, lumboichachalia, lumbago;develop against the background of the reflected overvoltage of the back muscles;
- Compression (spinal, vascular, root)- their development is leading to the compression (compression) of the spinal cord, blood vessels or nerve roots.Examples are the lumbosacral root, the radicolichemia.
Symptoms of lumbar osteochondosis
With lumbar osteochondrosis, the symptoms are determined from which the structures are designed 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 is shooting.It intensifies when sneezing, cough, body curves, physical effort, seat, standing, walking.In the liar position, the pain is weakening significantly.Sensitivity and reflections 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 voltage syndrome of the nerve roots with lumbar is negative.When a straight leg rise, patients notice the increase in pain in the lower back and not their appearance in a lower limb.
Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which every time become more and more intense and long.
With Lumbalia, the clinical picture recalls a lumbago, however, an increase in the pain intensity occurs in a few days.
In the form of lumbar, patients complain of pain in the lower back, who radiate on one or both the lower limbs.The pain spreads on the buttocks and on the back of the thigh and never reaches the feet.
Vasomotor disorders are characteristic of lumbar shaking:
- changes in the temperature and color of the skin of the lower limbs;
- feeling of warmth or coldness;
- Violation of the flow of blood.
The development of lumbar compression syndromes is clinically manifested by the following symptoms:
- Dermatomic gipalgesia;
- shooting pains;
- weakening or loss complete with deep reflections;
- Peripheral paresis.
With compression syndromes, the pain intensifies when the body is tilt, sneezing and cough.
Diagnostics
The diagnosis of lumbar osteochondrosis is carried out on the basis of the clinical picture of the research methods on the disease, in the laboratory and instrumental.
In the blood tests against the background of lumbar osteocondrosis, it can be seen:
- decrease in the concentration of calcium;
- increase in the ESR;
- Increasing the level of alkaline phosphatease.
In the diagnosis of lumbar osteochondrosis, the radiological examination of the spine is given great importance.
A long compression of the nerve roots that innervate some organs of the abdominal cavity over time leads to a deterioration of their functioning.
The X -ray features that confirm the diagnosis are:
- modification in the configuration of the segment concerned;
- pseudospondilatez (movement of related vertebral bodies);
- deformation of the closing plates;
- flattening of the intervertebral disc;
- The unequal 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:
- Myelography, calculated or magnetic refusal tomography - the development of neurological deficiency are necessary for persistent symptoms;
- Scintigraphy (the study of the accumulation of a phosphorus bone system, a melted-99 technology) was performed in case of suspicion of a tumor or an infectious process, a spinal injury.
The differential diagnosis of the lumbar osteochondrosis is carried out with the following diseases:
- spondilolistz;
- Exgormonal spondylopathy;
- ankylosing spondylitis (spondella ankilosante);
- Infectious processes (discs inflammation, osteomyelitis of the spine);
- non -plastic processes (primary tumor of the spine or its metastatic lesions);
- rheumatoid arthritis;
- deform osteoarthritis of the hip joint;
- Reflex pains (diseases of internal organs and large blood vessels).
Treatment of lumbar osteochondosis
With lumbar osteochondrosis, they usually adhere to the following treatment tactics:
- bed rest for 2-3 days;
- the traction of the affected segment of the spine;
- strengthen the muscles of the back and the abdominal press (the creation of the muscle corset thus called);
- Impact on myofascial and pathological myonic processes.
Lumbago occurs under the influence of hypothermia or physical overvoltage, and sometimes for no apparent reason.
In most cases, the conservative treatment of lumbar osteocondrosis is performed, including the following measures:
- muscle infiltration with a solution of local anesthetics;
- intake of non -pounded anti -inflammatory drugs;
- reception of desensitizing agents;
- Vitamin therapy;
- receipt of tranquilizers and antidepressants;
- manual therapy, massage;
- physical education of physiotherapy;
- acupuncture;
- Postisometric relaxation.
The absolute indications for the surgical treatment of the lumbar osteocondrosis are:
- acute or subacuta compression of the spinal cord;
- The development of horse's tail syndrome, characterized by a compromised function of the pelvic organs, sensitive disorders and motor.
Medical gymnastics for lumbar osteochondosis
Overall treatment of lumbar osteocondrosis, a significant role belongs to physiotherapy exercises.The regular classes allow to normalize the muscle tone of the paravertebral muscles, improve metabolic processes in the tissues affected by the pathological process and, in addition to forming a well -developed muscle corset, which can maintain the spine in the correct position, remove excess static loads from it.
So that gymnastics with lumbar osteochondosis leads the greatest effect to adhere to the following principles:
- regularity of the classes;
- gradual increase in the intensity of physical effort;
- Avoid overload during the lesson.
Physical education should be engaged in the leadership of an expert instructor, who will select the most effective exercises for a particular patient and control the correctness of their implementation.
According to back pain statistics, at least once in his life every second adult is experiencing, while in 95% of cases they are due to the osteochondosis of the spine.
In addition to the lessons with an instructor, you should perform a morning gymnastics complex, which includes special exercises with lumbar osteochondrosis.
- Relaxation and contractions of the abdominal muscles.The starting position is standing, the legs are remotely from the shoulder, the hands of the body are lowered.Make a smooth breath, relaxing the muscles of the front abdominal wall.During the exhalation, attracted as much as possible, by striving the press muscles.The exercise should be repeated before the appearance of light fatigue.
- Movement of the head with the flexion of the spine.The starting position of the knees, resting on the floor outside the back, the rear is straight.Slowly lift your head and fold in the back.Delay in this position for a few seconds, then return without hitches in its original position.Repeat at least 10-12 times.
- "Pendulum".The starting position lying on the back, the arms along the body, the legs are folded to corner corners in the joints of the knee and hip.Transform the legs to the right and left with swaying pendulum -shaped movements, trying to get the floor.At the same time, the shoulder blades cannot be torn from the floor.
- "Boat".The starting position of lying on the stomach, the hands are extended forward.Strew the upper part of the body and the legs from the floor, folding in the back.Delay in this position for 5-6 seconds and slowly return to the starting position.Perform 10 times.
Possible consequences and complications
The main complications of the lumbar osteocondrosis are:
- the formation of intervertebral hernia;
- Vegetable dystonia;
- spondilolis, spondilolistz;
- osteophytes;
- spondylartosis;
- Spinal canal stenosis, leading to the compression of the spinal cord and able to cause persistent loss of work capacity and reduce the quality of life.
A long compression of the nerve roots that innervate some organs of the abdominal cavity over time leads to a deterioration of their functioning.Consequently, patients have intestinal dysfunctions (constipation, diarrhea, flatulence) and pelvic organs (urination disorders, erectile dysfunction, frigidity, infertility).
Forecast
Pain syndrome for lumbar osteochondrosis proceeds in the form of remissions and exacerbations.Lumbago lasts 10-15 days, after which it improves the patient's condition, the pain attenuates.Belonging secondary diseases can interfere with a favorable result.Often, with lumbar osteochondrosis, there is a repeated occurrence of pain attacks, which every time become more and more intense and long.
Overall treatment of lumbar osteocondrosis, a significant role belongs to physiotherapy exercises.
Patients with a serious course of lumbar osteochondrosis, 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 group of disability is resolved.
Prevention
The prevention of the development of osteochondosis of the spine are the following measures:
- Refusal of smoking;
- normalization of body weight;
- Improvement of general physical conditions, active lifestyle;
- Avoid provocative conditions (weight lifting, sharp movements, curves, inclinations).