Lumbar spondylosis is a chronic degenerative-dystrophic disease of the lumbar spine, affecting the structure of the intervertebral discs and adjacent lumbar vertebrae.It affects mainly people of working age.It presents with many different symptoms, mainly pain in the lower back and legs, and limited movement in the lower back.For diagnosis, research methods such as X-ray, computed tomography or magnetic resonance imaging of the lumbar spine are used.In this article, you can learn more about the causes, symptoms and diagnostic methods of lumbar spine osteoarthritis.
Osteonecrosis is a result of aging of the body.Some signs of this disease can be found in almost every person (!), starting from the age of 25. But the severity of these changes, the rate of progression and the degree of clinical manifestations depend on many reasons, mainly on how healthy a particular person's lifestyle is.Moderate physical activity, mandatory morning exercise, correct body posture when performing certain tasks (gardening, construction, trivial house cleaning, etc.), orthopedic mattress - these are the points that prevent the development of osteoarthritis of the lumbar spine.
According to statistics, lumbar spondylosis is the cause of back pain in 80% of cases.
How does osteochondritis develop?
The entire spine consists of individual vertebrae, with intervertebral discs between the bodies.That is, there is a disc between two vertebrae.The disc consists of a dough core and a fiber ring.The core is filled with water and provides cushioning and flexibility to the spine.The fibrous ring lies along the periphery of the nucleus pulposus, as if holding it within itself.
With increased prolonged load on the nucleus pulposus, it changes its physiological properties, loses water and dries out, and over time becomes isolated: the intervertebral disc collapses and the vertebrae move closer to each other.Along with such processes, in the nucleus pulposus, the annulus fibrosus loses its elasticity and begins to swell under the influence of mechanical loads.This is called protrusion.Then, the annulus fibrosus cracks and the nucleus pulposus falls out through the cracks: a herniated disc occurs.Part of two adjacent vertebrae and an intervertebral disc located between them, called the spinal segment, is likely to move excessively, thereby increasing the load on the adjacent segments.Overloading of neighboring segments causes similar pathological processes in them.These changes are called osteonecrosis.
To partly ensure the stability of the spine, bones grow along the edges of the vertebral bodies, increasing the support area.This phenomenon is called spondylosis.Changes in the joints between vertebrae are called spondylosis.Usually all three diseases - osteoarthritis, spondylosis, and spondylosis - go together.
Reason
What causes osteonecrosis?Today there are several hypotheses about its appearance:
- mechanical theory: perhaps the main cause should be considered to be the regularly increased load on the spine.That is why osteoarthritis is an almost mandatory fate for porters, miners, construction workers and people with similar occupations.The occurrence of osteoarthritis in the lumbar region is mainly associated with bending and lifting heavy objects, due to uncomfortable working postures;
- Another developmental factor can be incorrect posture, incorrect sitting position, this is especially important for mental workers;
- sometimes the genetic characteristics of the structure of the spine and the nutrition of individual structures play a role;
- trauma theory: any injury to the spine (even the slightest one) can cause degenerative processes;
- Hormonal metabolic disorders and endocrine diseases can adversely affect metabolic processes in the tissues of the spine and contribute to the development of osteoarthritis;
- The aging theory implies natural wear and tear of intervertebral discs throughout life.
Rarely, only one of these theories can explain the occurrence of osteonecrosis in each particular case.More often than not, several factors are to blame at the same time.
Excess weight plays an important role in the occurrence of lumbar osteoarthritis, since it itself causes overload of the spine.The higher the body mass index (obesity level), the more pronounced the changes in the spine are often.Other reasons for the appearance of osteonecrosis include:
- sedentary lifestyle;
- unhealthy diet (fast food, excessive sweets, processed foods: all this leads to an imbalance of trace elements) and lack of fluids;
- abnormalities in the structure of the spine (for example, the presence of an additional lumbar vertebra);
- often wear high heels;
- pregnancy (due to excessive load on the lumbar spine);
- sudden cessation of training for those participating in professional sports;
- Smoking and alcohol abuse: are factors that accelerate the aging process in the body.
Symptom
The main manifestation of lumbar spondylosis is pain.The nature of the pain, the place of origin and the direction of propagation depend on which receptors are stimulated, that is, the degree of severity of changes in the disc and surrounding tissues, whether there is a protrusion or herniation, in what direction the protrusion has formed, etc.
There are reflex and compression syndromes in lumbar osteoarthritis.
Reflex syndrome develops in cases where the receptors of the fibrous annulus of the intervertebral disc, ligaments and joint capsule located nearby are irritated.They are called reflexes because, in addition to pain, they are accompanied by changes in myotonic, vascular or neurodystrophic reflexes, that is, stimulation with the help of reflexes is transmitted to other structures, causing symptoms mainly from soft tissues.
Compression syndrome arises due to compression (compression) of nerve roots, blood vessels or spinal cord due to changes formed during osteoarthritis.
Lumbar spinal reflex syndrome
Low back pain(lumbago): acute, sudden pain in the lumbar region that occurs during awkward movements or at times of physical stress (less common - no apparent reason).It is believed that the appearance of low back pain is associated with the movement of the nucleus pulposus in the fibrous ring, that is, it develops in the early stages of osteonecrosis.The pain is often described as “lumbar” or “stuck in the lower back.”The patient freezes in the position where the pain strikes.The slightest movement increases the pain (sneezing, coughing, trying to roll over in bed, moving your legs).If a person is in a tilted position at the time of developing low back pain (this happens most often), then the person cannot stand upright.Severe muscle tension occurs reflexively in the lumbar spine.Along the vertebrae in this area, there is a feeling of a muscle ridge, sometimes visible to the naked eye if not touched, the muscle tension is very obvious.Palpation causes pain for the patient.This increased muscle tone plays a stabilizing role, protecting the affected lumbar segment from pathological mobility, which could cause deterioration of the condition.The natural curve of the spine in the lumbar region (lordosis) is flattened and may curve to one side (scoliosis) due to muscle tension.
migraine headache– another reflex syndrome at the lumbar level.This term also means the presence of pain in the lumbar region.However, unlike low back pain, the pain is not acute but occurs gradually, over several hours and even days.The nature of the pain is dull, aching, of moderate intensity, gradually increasing when moving, when sitting or standing or when moving from one position to another.Lying on your back with a cushion under your lower back will give you some relief, but passively raising your legs straight in this position will increase pain in your lower back (Lassegue's symptom).Palpation of the lumbar spine causes pain, but muscle stretch reflexes are less pronounced than in lumbago and sometimes are completely absent.Movement in the lumbar spine is limited, but possible.This means that the patient can bend down and to the sides to a certain extent (and then the pain will increase).
Low back pain– another type of reflex syndrome at the lumbar level.This term refers to pain in the lower back, radiating down to the buttocks and legs (along the back).The pain has different qualities, mainly aching, but can gradually increase in waves like a "shooting" in the leg.Just like low back pain, it increases when you move, walk, or exert yourself and decreases when you lie on your back.Lassegue's sign is usually positive.Palpation of the lumbar spine causes pain as well as pressure on certain points (eg, in the middle of the line separating the buttocks from the thighs, in the middle of the back of the thighs, in the middle of the popliteal fossa).There is tension in the lower back muscles.Forward and side bends are limited.
Lumbar spine compression syndrome
Clinical features depend on which structure is compressed.
Between the vertebrae at each vertebral foramen there are nerve roots (spinal nerves): left and right.If pathological formations in lumbar spondylosis (mainly disc herniation) will compress the roots, then radiculopathy will develop, the symptoms of which are different in each root.Common to all lumbar radiculopathy is increased pain with sneezing, coughing, movements in the lower back (especially bending forward), muscle tension in the lumbar region, and limited movement in the lumbar spine.The most common types of radiculopathy in the lumbar spine are:
- L1, L2, L3 radiculopathy: lower back pain radiating to the front of the inner thigh.In the same area, paresthesias (crawling sensation, numbness) may occur, superficial sensitivity is impaired (strong touch is no different from normal touch, loss of hot and cold sensation).Decreased knee reflexes, showing quadriceps weakness;
- L4 radiculopathy: lumbar pain spreads to the inner front of the thigh, the inner knee joint and slightly lower along the inner leg.In these areas, people feel paresthesia and loss of superficial sensitivity (reduction).Weakness also develops in the quadriceps, knee reflexes decrease;
- L5 radiculopathy: one of the most common locations.The pain radiates down the buttock, along the outer edge of the thigh, along the outer front of the lower leg to the inner edge of the foot and big toe.Here the sensations of paresthesias, impaired superficial sensitivity and painful sensations when sneezing and coughing are transmitted here.Additionally, extending the big toe becomes difficult because the muscle that performs this action is innervated by the L5 root.Sometimes it is difficult to stand on your heels with your feet straight;
- S1 radiculopathy: also common in lumbar spine cartilage degeneration.The pain spreads down the buttocks, along the outer edge of the back of the thigh, along the outer edge of the lower leg to the outer edge of the foot and the 5th toe, heel.These areas are characterized by paresthesia and reduced superficial sensitivity.Achilles reflex decreased.When this root is damaged, the lower leg muscles and plantar flexors will develop weakness, making it difficult to stand and walk on your toes.
It is possible to develop radiculopathy in several roots simultaneously, this is especially typical in L5, S1.It happens that a hernia compresses some roots.
If a herniated disc bulges posteriorly, it can put pressure on the spinal cord.This can only happen if the hernia is localized in the upper lumbar region, since there is no spinal cord below the second lumbar vertebra (there the roots of the spinal cord are compressed and cauda equina syndrome develops).
If the blood vessels in the lumbar region supplying blood to the spinal cord are compressed, then in case of acute circulatory disorders, a spinal stroke will develop there, and with prolonged compression - myelopathy.Myelopathy manifests as muscle weakness on both sides of the legs, starting from the feet and progressing upward.Sensation in the legs is impaired, the Achilles reflex is lost and then the knee reflex is lost.Urinary disorders may occur (frequency, urgency, need for immediate gratification, urinary incontinence).
Diagnostic method
Diagnosis of lumbar osteoarthritis is based on clinical data and data from additional research methods.The main role belongs to such methods as:
- X-ray of the lumbar spine;
- computed tomography of the lumbar spine;
- Magnetic resonance imaging of the lumbar spine.
X-rays of the lumbar spine must be performed in 2 mutually perpendicular projections - directly posterior and lateral.Such images allow you to see the shape, contours and structure of the vertebral bodies, the height and shape of the intervertebral discs, irregularities in the structure of the spine and natural curves.To show the vertebral joints and intervertebral foramen, radiographs are taken in an oblique view.To determine the pathological mobility of each lumbar segment (which is a sign of osteoarthritis), radiographs are performed during functional tests, that is, in the position of spinal flexion and extension.Usually, changes in the height of the intervertebral discs in the anterior or posterior segment are evident in the direction of body tilt;with osteonecrosis, due to functional block of one of the segments, the height of the intervertebral disc does not change during flexion or extension.With pathological mobility, the displacement of the vertebrae forward or backward is determined.The main radiological signs of osteonecrosis include narrowing of the intervertebral space, pathological migration and displacement of the vertebral body, salt deposition in the disc tissue (calcification), formation of marginal growth of the vertebral body, compression of the vertebra at the border with the affected disc (subdural sclerosis).X-ray of the lumbar spine is a conventional research method, which is gradually losing its importance amid the active application of new and more informative research methods (CT and MRI).Lumbar X-rays are now used as a diagnostic screening method.
CT scan of the lumbar spine is also performed using X-rays, but the body's exposure to radiation is significantly less than with X-rays. The examination is performed on the table of a special device - a computed tomography scanner;it's completely painless.The resulting images are processed by a computer and allow you to see significantly more structures than with a spine X-ray.
MRI is a technique that uses electromagnetic radiation to create images.The examination is also performed lying down on a table that slides into the CT scan chamber.MRI is harmless and painless.
CT or MRI of the lumbar spine allows you to view all the structures of the spine, carefully examine the intervertebral discs (both the nucleus pulposus and the annulus fibrosus) and the intervertebral foramen, the contents of the spinal canal.Even a slight protrusion of the disc will go unnoticed.These methods (especially MRI) help determine the direction of disc herniation, if any, as well as the degree of compression of the nerve roots and spinal cord.Therefore, these research methods are more informative in the diagnosis of lumbar osteoarthritis than radiography.In addition, they can diagnose not only osteonecrosis, but also other diseases (tumors, circulatory disorders in the spinal cord, abscesses, congenital malformations in the structure of the spine and spinal cord), which is very important when carrying out differential diagnosis of the causes of back pain.
Lumbar spondylosis is the disease that most commonly causes back pain.In fact, it is the destruction of the intervertebral discs.Due to lumbar spondylosis, a person often loses the ability to work, because in addition to pain, the disease can also lead to impaired mobility of the spine, the inability to sit, stand and walk.Symptoms of this disease are nonspecific and additional research methods are needed to confirm the correct diagnosis.The most informative and safe modern method for diagnosing osteoarthritis is MRI of the spine.