Dorsalgia (back pain) are one of the most frequent causes of complaints and requests for medical assistance. Thus, throughout life, with the problem of dorsalgia facing 70-90% of the population and 28% of them develop chronic pain, leading to a temporary/prolonged disability and reduced quality of life. Back pain in addition to disability influence the behavior/mentality of people, which is manifested by the development of chronic emotional stress.
Pain syndromes are associated primarily with degenerative disc disease in the lumbosacral (lumbar osteochondrosis) characterized by high mobility/high physical load and caused by degenerative-dystrophic changes in almost all components of vertebral-motor segments of the spine (the vertebral bodies, intervertebral discs and connecting tissues).
Classification
The basis for the classification of osteoarthritis based on pathogenetic approach, reflecting the pathological process in the form of successive stages/degrees of degenerative lesions, in accordance with what, there are the following.
Osteochondrosis of the lumbar 1 degree
This is the first (initial) degree of intra disk pathological process of the generating of the affected disk pathological impulses. Osteochondrosis of 1 degree is characterized by the displacement of the nucleus pulposus inside the disc, i.e., the nucleus pulposus penetrates through cracks in the fibrous ring and its well-innervated outer fibers. Accordingly osteochondrosis of 1 degree occurs irritation of nerve endings and begin to show the pain, which form various reflex syndromes of osteochondrosis.
Osteochondrosis of the lumbar spine 2 degrees
Osteochondrosis of 2 degrees is the degree of instability, i.e. the loss of the affected disk inherent fixation ability. Characteristically, the dynamic displacement of the overlying relative to the vertebra below due to cracking of the nucleus pulposus and the fibrous ring elements. 2 the degree of degenerative disc disease is characterized by a syndrome of instability and partly reflex and compression syndromes.
Low back pain 3rd degree
Is the degree/stage of formation of herniated discs, disorders of structural integrity of the fibrous ring (prolapse/protrusion). Osteochondrosis of 3 degrees can be squeezed: the root of the spinal nerve, and adjacent to the MPD of the vascular-nervous formations.
Osteochondrosis of 4 degrees
This is the stage of fibrosis of the IPOA and the gradual formation of the bone-cartilage boundary of the growths of the vertebral bodies. As a compensatory mechanism is an increase in the area of support of the vertebrae on defective discs, there is stillness. These bony growths, in some cases, herniated discs can put pressure on adjacent neurovascular education.
Symptoms of degenerative disc disease of the lumbosacral spine
Osteochondrosis of the lumbosacral spine manifested within a wide range from slight feelings of discomfort in the lumbar up to the sharp intense pain that can be triggered by overexertion, hypothermia, heavy lifting, etc. the totality of the clinical manifestations of lumbar osteochondrosis divided into vertebral (compression) symptoms and extravertebral (reflex) symptoms.
The initial stage
The clinical symptoms of degenerative disc disease of the lumbar spine in the first stage due to a disc protrusion in the direction of the vertebral canal (back) and irritation rich in pain receptors posterior longitudinal ligament. The main symptom at this stage is of various degrees of severity of local pain syndrome, lumbago, lumbalgia, which are conventionally distinguished by the degree of severity of pain and duration of pathologic manifestations. This stage is characterized by "sign Board" (flattening of the lumbar lordosis) and marked limitation due to pain in the acute period of motion in the lumbar spine.
In addition to local pain at the level of the affected intervertebral disc due to reflex muscle reaction in most cases there is a pronounced strain of the paravertebral muscles ("défense"), which contributes to pain syndrome and smoothing/flattening the physiological lumbar lordosis and limited mobility of the spine.
In osteochondrosis first stage signs of radicular syndrome and other neurological manifestations (signs of tension) are absent. As a rule, the stimulation of the receptors (pain) posterior longitudinal ligament noted adaptation, aided by immobilization of the affected intervertebral disc. The severity of acute/subacute gradually decreases with adequate treatment and strict observance of orthopedic mode. That is, there is a transformation of exacerbation of remission, the duration of which varies as the frequency of acute lumbalgia.
At the same time, every new aggravation evidence additional offset of MPD (prolapse/protrusion), which leads to increased pressure of the disk on the posterior longitudinal ligament. Over time this leads to thinning of the ligaments and reduce its strength and thus to the risk of additional disk prolapse and perforation of the posterior longitudinal ligament at the next episode in the direction of the spinal canal that leads to the development of the next stage of neurological complications.
Vascular radicular-stage (stage neurological disorders)
A set of pathological manifestations (ischemia of the corresponding roots/spinal, complicated by the formation of a herniated disc and the occurrence of occlusion concomitant root of the artery) contributes to the development of movement disorders in myotome and decreased sensation in a specific dermatome. As a rule, the development of paresis/paralysis of muscles and sensory disturbances preceded by sudden movement, which from pain in the lumbosacral region there is a sharp transient, a irradiating in the course of the sciatic nerve (the so-called "crisis giperalgeticheskie sciatica"). In parallel, there is muscle weakness in the area of innervation of one or the other to the ischemic spinal nerve and there are sensory disorders. As a rule, there is occlusion of root artery, which runs along with the spinal nerve L5 into the spinal canal.
Characteristic is the acute development of the syndrome of "sciatica nerve", which is manifested paresis/paralysis on the affected side of the extensors of the foot/toes ("steppage" or "cock walk") that develops during disorders of the peroneal nerve. This patient raises the leg while walking, throwing it forward and pop the front part of the sock of the foot on the floor.
jpg" class='imgblock right center_mob'>The last stage of neurological manifestations
Osteochondrosis of the spine, usually is the cause of impaired blood flow in the larger radicular arteries that supply blood to the spinal cord (radicular-spinal artery). The blood supply of the spinal cord lumbar-sacral level provides only one artery of Adamkiewicz, and some people present plus spinal artery Depro of Gotteron that provides the blood supply to the caudal of a Department/cauda equina of the spinal cord.
Their functional failure causes slow the development of vascular-brain insufficiency, spinal cord, clinical manifestation of which is the syndrome of intermittent claudication, accompanied by weakness of the legs and numbness that can occur when walking and disappear after a slight rest (stop). The most severe manifestation of neurological disorders in this stage are acute circulatory disorders of the spinal cord on the type of spinal ischemic stroke.
Tests and diagnosis
Diagnosis of lumbosacral degenerative disc disease in most cases is straightforward and is based on the analysis of the nature and localization of pain syndrome and their connection with exercise (history of illness), presence of painful trigger points and symptoms of tension. Of instrumental methods leading value is given to x-ray, CT and magnetic resonance imaging (photos below). To exclude somatic pathology (metastases in the spine, kidney stones, pyelonephritis) can be assigned to the General/biochemical analysis of blood and urine.
Treatment of degenerative disc disease of the lumbosacral spine
The question how to treat degenerative disc disease of the lumbar is one of the most frequently asked. Primarily in the treatment of degenerative–dystrophic lesions of the spine should be gradual and complex, involving treatment with medicines, physiotherapy and if necessary, surgical methods.
Procedures and operations
In the treatment of lumbar degenerative disc disease are widely used physiotherapy: phonophoresis/electrophoresis of drugs (including analgesics and antispasmodics) galvanic/pulse currents; electroneurostimulation; UHF; laser therapy; magnet therapy; EHF (extremely high frequency therapy); microwave (microwave therapy); shock-wave therapy, acupuncture.
In the acute period of the observance of the musculoskeletal (orthopedic) regime with wearing the lumbar stabilizing corset. In this period it is necessary to restrict/exclude exercise in amplitude, causing pain or muscle tension. To do "through the pain" is strictly forbidden, exercises should be performed very slowly repeat 8-10 times. It is also important to prevent the increase of lumbar lordosis during movement of the legs, which can cause increased pain. In the next stage, the acute period, the pain decreases, you can gradually incorporate isometric exercises to big buttock muscles and abdominals.
While calming the pain increased opportunities and are included in the set of common educational/special exercises. In addition to exercise to increase the strength of the hip extensors and abdominals includes exercises that increase the strength of the muscles of the back and flexion in the lumbar spine. Which run at an average pace of 15-20 reps. You should be aware that charging in osteochondrosis of the lumbar needs to be regular, and not from case to case.
Exercises with osteochondrosis of the lumbar spine in the period of remission is aimed primarily at strengthening the muscular corset of the area and the increase of the spine mobility, however, they should be performed with extreme caution. The number of repetitions of this period can be increased to 50-100 times. An important task is the formation of the automatism of the muscles in maintaining a specific posture in any position (standing/sitting, walking).
Physical therapy in osteochondrosis of the lumbar spine can be performed in the pool (in the water, but it complements the main "dry" course). Of the other methods of physical therapy are extremely useful are: swimming, which is often regarded as "the most effective physiotherapy in the lumbar-sacral osteochondrosis", as well as a running track, path, ski, Bicycle Ergometer exercise with rubber bandage. To engage in such sports as volleyball, big/small tennis, rhythmic gymnastics is not recommended because of the many sudden movements that can provoke exacerbation of the disease.
The exercises with dumbbells is performed only in the supine position (on your back), to avoid vertical loads on the spine. It should be remembered that the choice of exercise frequent/constant overload/minor injury of the spine or tremors and uncoordinated movement along the axis of the spine creates a risk of rupture of the degenerated disc and the regular exacerbation of pain. Extremely useful exercise for the spine can be yoga, but many yoga exercises are quite difficult and must only be performed under the direction and supervision of an instructor. The best option at first if medical gymnastics in osteochondrosis of the lumbar spine is conducted in a dedicated room, where physiotherapists will show you exercises that you can then perform at home.
These exercises are performed as morning gymnastics in osteochondrosis. You should not search for various kind of video of physical therapy or therapeutic exercises, videos, osteochondrosis, because the video does not provide proper biomechanics of exercise and can cause exacerbation. Not less widely used and medical massage (manual, underwater, vacuum, hydro-massage). Massage in osteochondrosis of the lumbar allows you to remove/to reduce pain, eliminate muscle tension in this zone, to restore mobility of the spine.
The operational treatment is performed in cases of significant spinal cord compression, and is aimed at decompression of the spinal canal. Includes various types of surgical intervention: removal of a herniated intervertebral disc, holding microdiscectomy and laser disc reconstruction, puncture the valorisation of the disc replacement intervertebral disc implant, surgery for stabilization of the spinal segment.
Forecast
With timely and adequate treatment the prognosis is favorable. Worsens the prognosis of the emergence of lateral herniated disc L-S1 with early involvement in the pathological process of the spine and the subsequent formation of radiculopathy. Prognosis worsens in acute development of the syndrome of compression of spinal cord/cauda equina with paralysis in the legs, impaired bladder function, loss of sensitivity, in this case, the forecast will improve than before fixed a compression (hernia sequestration).