Many of us are familiar with back pain that 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 appear at a young age, its first manifestations can be detected already in adolescents and school children, but the majority of patients are people after 40 years of age. Changes in the spine associated with osteochondrosis can occur in any part from the cervix to the lumbar spine to the sacrococcygeal. The most common form that causes a lot of unpleasant and painful sensations in patients is osteochondrosis of the lumbar spine. What kind of pathology is it, what is typical of it and the pain in the lower back always speaks of this disease?
Lumbar spine osteochondrosis: what is the essence of pathology
Osteochondrosis is a term derived from two words: the Greek osteon, which means bone, and the chondron, which is cartilage. Thus, lumbar spine (and everyone else) osteochondrosis is triggered by changes in the cartilage of the intervertebral discs, which are the natural "lining" between the vertebrae and the shock absorber during movement. Changes in the structure of the intervertebral disc and its functionality are associated with a natural reaction in the vertebral body. With this disease, degenerative changes gradually appear in the body of the intervertebral discs. The height of the intervertebral disc decreases, as a result of which its physiological function is lost, which leads to 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 stages: edema due to malnutrition and dystrophic changes, fat loss and, in the last stage, sclerosis.
Causes of osteochondrosis of the spine
Our intervertebral discs gradually begin to deform and change when we are around 20 years old. The gradual decrease in fluid in the disc body leads to a decrease in the space between the vertebrae (chondrosis). This means that the intervertebral disc can no longer act as a shock absorber and the tension in the anterior and posterior longitudinal ligaments of the vertebrae changes. As a result, the vertebral joints are put under much more strain, which increases year by year. The spinal ligaments are improperly positioned and stretched unevenly, and the moving segments of the spine gradually become unstable. The dorsal segment usually consists of two adjacent vertebral bodies and an intervertebral disc between them. The upper and lower end plates in the vertebral body are exposed to more stress, zones of thickening (sclerosis) and ridges on the edges (spondylophytes) gradually develop. Due to such changes, the entire clinical picture of the disease will be formed in the future.
What are the symptoms of lumbar spine osteochondrosis?
Almost every form of the disease manifests itself 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 lumbar osteochondrosis may only be confined to the spine (in the lumbar spine) or spread to the legs if they are from the lumbar spine or to the arms if they are from the cervical spine.
Symptoms can occur during rest, exertion, or habitual activity. Radicular symptoms caused by compression, irritation in the nerve root area, or pseudoradicular symptoms can occur if the cause is in the facet joint or adjacent muscles. Often, osteochondrosis of the lumbar spine is combined with lesions in other areas - the thoracic and cervical spine, then the symptoms are wider. In other words, discomfort and pain cause not just one damaged segment, but multiple areas of osteochondrosis at the same time. The disease is wavy with periods of exacerbation (symptoms can seriously affect normal life) and temporary remissions when the manifestations subside or almost go away. But any physical or mental factor can lead to a sudden relapse.
How is osteochondrosis of the spine diagnosed?
Diagnosis is based on examination of the patient's medical history and complaints, physical examination with identification of typical symptoms, and neurological examination. Nowadays, doctors increasingly tend to conduct instrumental diagnoses, since other pathologies are often hidden under the guise of osteochondrosis.
For example, in patients with persistent back pain who are planning to have surgery to relieve pain, bone health is an important factor. If a patient is found to have low bone density before surgery, it may affect the treatment plan for osteochondrosis before, during, and after the procedure. A study by the Hospital for Specialized 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 previously been diagnosed.
Nearly half of the nearly 300 patients tested were diagnosed with osteoporosis or its precursor, osteopenia. It is especially important to keep this in mind if you are over 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 can be an aggravating factor in the treatment of osteochondrosis.
Treatment of osteochondrosis of the spine
Treatment options will depend on the severity of your symptoms. Physiotherapy is the main method for early-stage pain relief. Ultrasound, electrotherapy, heat treatment are used. Treatment is complemented by appropriately tailored pain management such as NSAIDs, muscle relaxants, and steroids. Injection practices can be used - blockades, trigger point injections. Manual therapy, osteopathy and exercise therapy are shown.
Surgical treatment is always the last resort. There are situations when surgery is required. An example would be paralysis of the bladder or rectum caused by a narrowing of the spinal canal or a herniated disc, a large herniated disc. The options for the operation are selected in collaboration with the doctor. However, after surgical treatment, the problem is not completely eliminated. Long-term rehabilitation and lifelong supportive treatment are required. This is due to the fact that osteochondrosis does not go anywhere and can progress to other departments.