Osteochondrosis Of The Lumbosacral Spine: Symptoms, Treatment

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Osteochondrosis of the lumbosacral spine

The content of the article:

1. Stages of osteochondrosis of the lumbosacral spine
2. Characteristics
3. Symptoms of osteochondrosis of the lumbosacral spine

4. How to cure osteochondrosis of the lumbosacral spine

   1. Drug therapy
   2. Exercise therapy
   3. Physiotherapy
   4. Massage
   5. Surgery
5. Video

Osteochondrosis of the lumbosacral spine is a multifactorial degenerative disease that affects the intervertebral structures, nerves and vessels of this anatomical region.

The term "osteochondrosis" is used only in the domestic medical literature (in Western sources, vertebral pain syndrome includes herniated discs and spondyloarthrosis).

The lumbosacral spine is most vulnerable to osteochondrosis

Stages of osteochondrosis of the lumbosacral spine

The stages are similar when the pathology is localized in other departments:

1. Chondrosis of the articular surfaces associated with disruption of the normal blood supply to bone tissue and the occurrence of local osteonecrosis.
2. Pre-hernia. The stage that is associated with the capture of all elements of the disc (the entire articular surface is involved).
3. Intervertebral hernia. Protrusion of the disc elements outside the joint (medial, lateral, paramedial).
4. Fibrosis. It occurs as a natural process of repairing a damaged disk. The deformed areas are replaced by dense fibrous tissue, but it does not stretch and is unable to provide movement in the joints.

In the English-language literature, the listed stages appear as separate diseases and symptom complexes, and not progressive phenomena of one disease.

Characteristics

The lumbar spine is prone to various degenerative-dystrophic diseases much more often than others, since it is the main support of the spinal column (the reason is the maximum load on this area).

Features of pathology in this segment:

1. It occurs more often in old age, since in addition to possible local circulatory disorders, natural processes of bone tissue discharge occur.
2. It occurs more often in men than in women, which is often associated with the characteristics of the profession.
3. In the early stages, it has nonspecific symptoms (local pain). Patients seek help more often at the stage of intervertebral hernias, which leads to osteochondrosis.
4. A typical X-ray picture of dystrophic processes in bone tissue is characteristic of many diseases of the musculoskeletal system, which complicates the diagnosis.

Symptoms of osteochondrosis of the lumbosacral spine

The clinical picture is dominated by two syndromes: static and neurological. They are associated with severe deformation of the articular surface and pinching of the nerve roots. There is a compression of the nerves located directly in the spinal cord and leaving it at different levels. More often, monoradicular syndrome (involvement of one nerve) occurs, but in rare cases it is possible that several nerve plexuses are simultaneously compressed with the appearance of a mixed clinical picture (biradicular syndrome, cauda equina syndrome).

Depending on the type of compression, two groups of symptoms are distinguished, which are presented in the table.

View	Complex of symptoms
Reflex symptoms associated with compression of extraspinal nerve endings	1. Lumbar lumbago (lumbago). Has a clear connection with physical activity. Irradiation to the surrounding areas (abdomen, buttocks) is characteristic. Sometimes, with a mild course, back pain is aching, dull in nature (lumbodynia). This type of pain occurs gradually with periodic attacks. 2. Reflex muscle contracture (muscle spasm). The severity explains the impaired posture and the forced posture of the patient. 3. Lumboischialgia. A characteristic symptom with involvement of the sacral spine of the column is associated with the spread of pain to both limbs. The feet and toes are rarely involved. 4. Muscular-tonic contractions of certain muscle groups. With the contraction of the piriformis muscle, an extremely strong painful attack occurs with irradiation to the groin area. 5. Neuroosteofibrosis (achillodynia, perigonarthrosis). It occurs with prolonged pathological impulses from a compressed root to fibrous tissues (tendons). 6. Violation of gait (intermittent claudication) - develops due to dystrophic processes in the vertebrae and discs themselves, as well as due to muscle tension.
Radicular symptoms associated with compression of nerve roots within the intervertebral disc	1. Violation of sensitivity in the limbs (numbness, cold snap, violation of pain and tactile sensations). This type of reaction is associated with hemodynamic disturbances that occur due to compression of vascular structures. With a pronounced violation, the classic symptoms of deep vein thrombosis (soreness, discoloration of the skin, a feeling of chilliness and burning, pasty feet) may appear. 2. The pain is aching or shooting in nature, spreads along the dermatomes. Plus local pain in the lumbar region and sacrum. 3. Paresis and flaccid paralysis of individual muscle structures. Less often, total defeat occurs. 4. Very rarely - dysfunction of the pelvic organs.

Depending on the level of damage, the following syndromes are distinguished:

1. L4 root syndrome (L3-L4 disc). The pain spreads along the front of the thigh to the knee. Impaired sensitivity of the anterior thighs (hypesthesia on the anterior thigh). Muscle weakness and decreased peripheral reflexes.
2. L5 root syndrome (L4-L5 disc). The pain can radiate to the gluteal region, outer thighs. Rarely extends to the back of the foot and to the I-III toes. A slight paresis of the extensor muscles of the thumb is possible.
3. S1 root syndrome (L5-L5-S1 disc). Irradiation of pain to the back of the thigh. The spread of pain is possible up to the outer edge of the foot and IV-V toe. Hypotension of the gastrocnemius muscles. Hypotrophy of the gastrocnemius, gluteal muscles and reduced part of the reflexes (Achilles and plantar).

How to cure osteochondrosis of the lumbosacral spine

Initially, treatment is carried out on an outpatient basis, the course lasts an average of 7-10 days. In the absence of effect, hospitalization is possible for additional examination.

The main directions of complex therapy:

• smoothing of pain syndrome (ideally, elimination);
• strengthening the muscle frame around the affected area for additional support;
• restoration of metabolic processes due to the normalization of blood circulation;
• elimination of signs of inflammation around the affected segment;
• restoration of full range of motion.

Treatment of osteochondrosis of the lumbosacral spine, since it is a degenerative-dystrophic process, is long-term. The disease can be completely cured only in the early stages using all methods of therapy.

Drug therapy

Since the disease is associated with damage to various structures and, as a result, the development of various syndromes (static, neurological, trophic, hemodynamic), drugs from different groups are included in the treatment.

The main drugs are presented in the table, but the scheme can be supplemented if necessary.

Group	Characteristic	Example
Analgesics	Eliminate pain by suppressing nociceptive impulses from the damage zone to the central nervous system and activating the antinociceptive system. They are able to partially relieve inflammation. May have effects on peripheral central receptors.	Acetaminophen (paracetamol), Tramadol.
Non-steroidal anti-inflammatory drugs	In addition to the pronounced analgesic effect, they have anti-inflammatory and antipyretic effects. Conditionally can be attributed to peripheral analgesics.	Ibuprofen, Indomethacin, Celecoxib, Rofecoxib
Tricyclic antidepressants	Provide reuptake of serotonin and norepinephrine and inhibit pain sensitivity.	Amitriptyline, Imipramine, Duloxetine
Muscle relaxants	Eliminate local muscle spasticity and return them to normal function.	Sirdalud, Midocalm.
Dehydration therapy	It is prescribed to eliminate aseptic inflammation in tissues, restore microcirculation and smooth out venous stasis in tissues.	Ringer's solution, saline, mannitol (diuretics).
Vascular drugs from different groups	Vasodilator, antihypertensive drugs. When osteochondrosis of the lumbar spine is used as an aid.	Actovegin, Cytoflavin.
Chondroprotectors	Prevents further destruction of cartilage tissue.	Rumalon, Structum

Blockades

Therapeutic blockades are used for severe intractable pain syndrome that cannot be eliminated by other means. The anesthetic drug is injected directly into the joint cavity, which causes an almost lightning-fast analgesic effect. Apply solutions of lidocaine and novocaine. For anesthesia of trigger points, the use of intradermal blockades is sufficient. In the case of a deeper occurrence of pain points, other types of anesthesia are indicated (conduction anesthesia, for example).

Glucocorticoids (hydrocortisone 25 mg) may be given along with the anesthetic to increase the duration of pain relief.

Anesthetic blockade is used if pain cannot be controlled by other methods.

Local therapy

It is an exclusively auxiliary method for osteochondrosis of the lumbosacral region (practically does not affect the course of the disease). Examples of drugs:

1. Ointments, creams and gels based on NSAIDs (Ketonal, Fastum gel, Piroxicam).
2. Ointments with a local irritating effect (Betanicomilon, Efkamon).
3. Topical preparations for relieving muscle spasm (Dimexidum application).

The doctor selects the drug therapy regimen for each patient individually. As a rule, it consists of 2-3 drugs (no more to avoid cross-reactions).

Exercise therapy

When done correctly, it can effectively relieve spasms and smooth out pain.

The basic rules of physical therapy for osteochondrosis of the lumbosacral region:

• consultation with a specialist before the start of classes and an accurate diagnosis with the definition of the stage (the method is contraindicated in case of disc sequestration);
• regularity and accuracy of execution;
• lack of exercise that causes additional pain irritation;
• adaptation to exercises is gradual (do not try to immediately complete the entire set set);
• beginning of classes - classic warm-up;
• the average duration of one lesson is 30-60 minutes.

Examples of exercises:

1. From a standing position, tilt the body forward and the maximum backward bend in the lumbar region. The number of executions is 5-10.
2. From a standing position, bend to the sides alternately 5-10 times.
3. From a prone position, alternately lift each leg up 5 times.
4. From a sitting position on the floor with legs tucked under the body, bend the spine forward / backward 5-10 times in each direction.

Physiotherapy

It belongs to the basic therapy and has an analgesic, decongestant and partial anti-inflammatory effect.

Methods:

1. Diadynamic currents to the paravertebral and lumbosacral regions. The method is associated with exposure to current and vibration. The course is on average 6-10 procedures.
2. Sinusoidal modulated currents to the paravertebral and lumbosacral regions. The course of treatment is 8-10 procedures.
3. Interference currents in the lumbosacral region. The course of treatment is 8-10 procedures.
4. UFO in the lumbosacral region. The course of treatment is 7-9 procedures.
5. Ultratonotherapy on the lumbosacral region and areas of pain projection along the sciatic nerve. The course of treatment is 8-10 procedures.
6. Ultraphonophoresis of hydrocortisone or analgin. A course of at least 10 procedures, in the absence of an effect, the drug can be replaced.
7. Percutaneous electroneurostimulation for painful areas. The course is 5-7 days.
8. Electrophoresis of medicinal substances (novocaine, lidocaine). The course is 5-10 days.

Also shown are mud therapy, acupuncture and hydrotherapy (therapeutic baths, showers).

Massage

The massage is prescribed to relieve muscle tension. It does not directly affect bone structures, since the effect is superficial.

Types of massage:

• classic or medicinal;
• connective tissue;
• point;
• segmental reflex.

Several courses (3-5 sessions) are indicated for the treatment of osteochondrosis, but only as an adjunct to the main treatment.

Surgery

Surgical methods are used only in the absence of the effect of treatment and for strict indications (mainly when an intervertebral hernia occurs). The main task of the operation is to eliminate the affected disc and normalize metabolic processes in the tissues.

Emergencies requiring surgery include:

• caudomedullary lesion (occurs when the cauda equina hernia is pinched);
• abnormal radiculomedular artery.

Most often, surgical techniques are resorted to in the absence of the effect of conservative therapy for 3-6 months.

The following types of surgical interventions are used:

1. Removal of herniated disc from the posterior approach (laminectomy, hemilaminectomy, arcotomy, flavectomy).
2. Removal of the disc nucleus from the anterior approach, including with stabilization.
3. Removal of the disc from the transpedicular approach.
4. Endoscopic removal of the disc nucleus, including percutaneous, transforaminal, retroperitoneal, laparo-, thoracoscopic.
5. Puncture methods: removal of the disc nucleus with high-intensity laser radiation, dissolution of the disc nucleus with papain, dereception of the disc with alcohol or ozone.

At the moment, all surgical interventions use minimal incisions, which sharply shortens the postoperative period.

After any prophylactic operation, the use of corsets and bandages, which provide additional fixation, is indicated for 3 months.

Video

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Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

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