Treatment of lumbar column osteochondrosis

Osteochondrosis (degenerative disc disease) in the lumbar column or lower back is due to changes in involution in discs, which causes back pain.

The intervertebral discs are hard and fibrous fibrous structures which act as ligaments between the vertebrae, absorb lines and provide the shock absorption of the spine.The discs are elastic, but strong enough to facilitate movements, such as the inclination of the body, the front, back or sides.

Despite the name, osteochondrosis is not considered a real disease and symptoms over time, as a rule, does not worsen.The discs, as well as all the structures of the body, the degradation and degeneration of the disc develops in all people, within the framework of the involution process.

A characteristic of osteochondrosis is a gradual decrease in symptoms while the spine begins to stabilize.The treatment of lumbar column osteochondrosis focuses on minimizing pain, stabilization of the spine and improving or maintaining mobility.

Symptoms

Most cases of manifestation of osteochondrosis in the lumbar column must have a slight constant back pain, which intensifies from time to time for several days or more.

Symptoms may vary, but the most characteristic includes:

• Moderate, constant lower back pain.Pain in the damaged disc is the most common symptom of disc degeneration.The pain may spread to the buttocks, groin and upper thigh.This pain is usually felt as dull, and the intensity can vary from mild to severe.
• Periodic acute episodes of pain.Back pain can be intensified for several days or weeks, then return to a more moderate level.Pain epidemics occur by degeneration and calm because the spine is gradually stabilized.Pain epidemics can arise suddenly and manifestations of pain often lead to a decrease in mobility.
• Local pain.The lower back of the back surrounding the degenerate disc can be sensitive to the touch.Local pain is caused by inflammation and muscle tension in the area of the disk damaged by degeneration.
• Pain in the leg.Neurological symptoms, including numbness, weakness or acute pain, shooting in the buttocks, hips and / or back of the leg, can be felt if the height of the disc is considerably reduced and that the conditions of compression of the nerve root occur.The pain in the osteochondrosis legs of the lumbar column generally does not fall below the knee.
• A feeling of weakness or sudden instability can occur with a significant weakening of the disc and the patient creates that the lower back incomplete his functions incomplete.

In addition, pain can intensify or decrease when making certain movements or certain poses, such as:

• Pain in the seat.Sits over long periods often causes an increase in back and stiffness ailments and a decrease after an occurrence or a change of position.
• Strengthening pain with inclination or rotation.The order of the spine and the tilt forward, the back or the side can cause intense pain in the damaged disc.
• Reduce pain when walking or modifying the position.When the spine changes the position, the pressure on the discs decreases or is redistributed from the discs to the muscles and the joints.Frequent positions, standing alternation and sitting position, as well as short walks can help reduce stiffness and minimize pain.

Disc degeneration should not cause symptoms of intestinal dysfunction / bladder, fever with back pain, inexplicable and rapid weight loss or intensive abdominal pain.These symptoms indicate more serious conditions and often require operational treatment methods.

Associated symptoms

With osteochondrosis of the lumbar column, in addition to lower back pain, other symptoms associated with disc degeneration can occur.For example:

• The proteins contained inside the disc can cause significant inflammation if they come into contact with the surrounding vertebral structures, and this inflammation can cause spasms of the lower back muscles, as well as radial pain, with radiation in hips and on the posterior surface of the lower limbs (also called Ishias).
• The degeneration of the lumbar disc can contribute to the development of lumbar stenosis and / or lumbar osteoarthritis, as well as other conditions in the lower back.
• A degenerated disc can also lead to the appearance of a hernia of the lumbar intervertebral disc.Neurological symptoms with a disk hernia can be acute and intense.
• The symptoms caused by the degeneration of the disc in the lumbar column can vary considerably depending on the speed or the entire disc which has undergone degeneration and the way in which it affects the surrounding vertebral structures.
• Pain for osteochondrosis is generally caused by the deformation of the muscles that support the spine and inflammation around the structures near the disc.

The causes of osteochondrosis of the lumbar spine

Osteochondrosis occurs due to the wear and tear of age and disorders of the disk structure, and the degeneration process can accelerate due to injury, general condition, health and lifestyle, and, possibly, a genetic predisposition to the development of pathological processes in the musculoskeletal system.

Osteochondrosis rarely begins with a serious injury, such as a car accident.It is more likely that the initiation of degenerative processes is associated with low-energy disc injury.

The pain of the law associated with lumbar osteochondrosis is generally generated by one or more pathological processes:

• Inflammation, the disc proteins are irritated by the surrounding nerves - the two small nerves of the disc itself and the potentially large nerves that go to the feet (sciatic nerve).
• The abnormal instability of the microphone, when the external rings of the disc, called fibrous ring, wear out and cannot effectively absorb power vectors on the spine, which leads to movements along the vertebral segment.
• For a long time, pain in osteochondrosis of the lumbar column finally decreases and does not worsen.This pain relief occurs because the disc completely damaged by degeneration no longer has inflammatory protein (which can cause pain) and the sleep disc goes into a stable position, eliminating the micro-movements that cause pain.

Risk factors

The lifestyle factors that affect the general state of health can affect intervertebral discs.The risk factors for degenerative disc disease (osteochondrosis) include:

• Family history of back pain or skeletal and muscular disorders
• Excessive load at the bottom of the rear, due to the practice of sport, or the nature of the work
• Long static loads on the discs due to prolonged seats and / or poor posture
• Lack of support from discs due to low back muscles
• Obesity
• Smoking or any form of nicotine consumption

Disc degeneration is part of the aging of the body, but all people do not develop particular pain or symptoms.Symptoms tend to occur in case of instability, muscle tension and, possibly, irritation of the nerve root.

Diagnosis

• The history of the disease include a detailed study of the patient's symptoms, their intensity and the pain relationship with the charges or the position of the body.Information on regular physical activity, sleep habits and past injuries is also necessary.
• A physical examination is necessary to study the range of movements and the state of the muscle corset.The presence of painful areas on palpation or physical anomalies is also determined.In addition, neurological tests are carried out to determine a neurological deficit.
• The above diagnostic methods are usually sufficient for the diagnosis of osteochondrosis, but accurate diagnosis requires the use of visualization methods.
• Ct
• Radiography
• MSCT
• TAP
• MRI - This diagnostic method allows you to clarify the degree of degeneration, the presence of fractures, the hernia of the stenosis disks.Often, an MRI study is necessary in preparation for surgical treatment to precisely determine the location of the degenerate disk and plan the operation.

Studies have shown that the results of MRI with degeneration of moderate or significant discs are found during patient scanner, both with intense pain and a lack of pain.In addition, many painful conditions may not appear on an MRI.For this reason, the diagnosis cannot be made exclusively on the basis of the results of the visualization, and the verification of the diagnosis is only possible on the basis of all of the clinical and instrumental examination methods.

Treatment

The initial methods of processing osteochondrosis in the lumbar column and pain manifestations generally include the following combinations:

• Overwhelming analgesics They can reduce inflammation, which contributes to discomfort, stiffness and irritation of nerve roots.
• Analgesics on prescription.In intense pain, muscle relaxants or narcotic pain relievers can be prescribed.These drugs are generally used to treat intensive and acute pain, which should last more than a few days or weeks.These drugs can cause dependence and cause serious side effects, so they must be used with caution.
• Heat and ice.The use of heat in the lower back improves blood circulation, which reduces muscle cramps and tensions and improves mobility.Ice packages can reduce inflammation and relieve moderate pain.It is useful to use heat before physical exercises to relax muscles and use ice after physical activity to minimize inflammation.
• Manual therapy. Whose manipulation is carried out by a specialist is a popular method of control of pain in lower back pain.Practitioners, manual therapists, use their hands to influence various areas of the body to reduce tensions in muscles and joints.It has been found that handling is an effective measure to reduce temporary pain and, in some cases it is as effective as drug treatment.
• Massage.Exposure by massage methods can reduce tensions and cramps in lower back muscles, reduce pressure on the spine and relieve pain.In addition, therapeutic massage can improve blood circulation, ensuring the delivery of nutrients and oxygen to tense muscles.
• Epidural steroid injections.The introduction of steroids into space surrounding the spine can reduce pain pulses, as well as inflammation.Steroid injection can be used in combination with the physiotherapy program to relieve pain during physical exercises and rehabilitation.As a rule, the epidural injection of steroids reduces the pain from a period of several weeks to one year.

In many cases, for effective anesthesia, a combination of treatment methods is necessary.The test of tests and errors, as a rule, is necessary to choose a treatment that turns out to be the most effective.

Long rest in bed is not recommended and, as a rule, immobilization is possible with intense pain during a short period, because the lack of physical activity can lead to a weakening of the muscles and normal support for the spine.

Exercise therapy and activity modification

To maintain healthy spinal mobility, physical exercises are necessary.An effective exercise program for the lumbar spine should include:

• Exercises to stretch for the lower back muscles, hips and pelvis, as well as the muscles of damage.The seal of these muscles increases the pressure on the lumbar column and contributes to the development of lower back pain.
• Power exercises on the lower back and abdomen muscles allow you to maintain a good posture and it is best to maintain the spine.The exercise program to strengthen muscles can include an individual exercise therapy program, dynamic stabilization of the lumbar column, tai chi, pilates or others.
• Aerobic exercises with low load level, which increase the frequency of heart contractions, improve blood circulation and provide nutrients and oxygen, which is necessary to restore body tissue.For example, it can be walking, swimming and water aerobic.

Physical exercise programs are generally adapted in each case, according to the general state of health, the severity of pain and personal preferences.

In addition, small adjustments to daily activity (modification of lifestyle) can effectively soften pain.For example, dressing a corset when lifting weights or avoiding twisting when lifting weights, can prevent increased pain due to excessive disks.The use of an ergonomic chair and an orthopedic mattress can also improve posture and reduce the load on the discs.

Surgical treatment

Surgical treatment of lumbar column osteochondrosis is necessary in cases where conservative treatment for 6 months was ineffective.Surgical treatment of osteochondrosis is always selective, which means that the patient himself decides whether or not the operation should undergo.

It is recommended to take into account all the factors before deciding on an osteochondrosis operation, including the duration of the recovery period, the treatment of pain during recovery and rehabilitation of the spine.

Vertebrae mergers

The standard surgical treatment of osteochondrosis of the lumbar column is a merger surgery in which two vertebrae are spent together.The goal of mergers (spondyludeza) is to reduce pain and eliminate instability in the engine segment of the spine.

All spinal fusion operations are as follows:

• The damaged disc is completely removed from the intervertebral space (discocto).
• Stabilization is carried out using a bone transplant and / or tools (implants, plates, stems and / or screws).
• Then the vertebrae merge, forming a solid and motionless structure.The fighting occurs in several months following the procedure, not during the operation itself.

After the operation, bearing a corset, taking pain relievers is prescribed.The exercises are connected very carefully, taking into account the individual characteristics of the patient and the degree of regeneration of the tissues.Complete recovery after merger can take up to a year until the vertebrae develops together.

Surgical replacement of an artificial disc

Replacing the damaged disc with an artificial implant has been developed in recent years as an alternative to fusions.The disc replacement operation consists of completely removing the disc damaged by degeneration (discotomy), restoring the disc space to the natural height and implantation of the artificial disc.

This procedure is designed to maintain movement in the spine similar to natural movements, reducing the probability of increasing the pressure on neighboring vertebral segments (fairly common complication of vertebral fusion).

Recovery after the disk replacement operation usually lasts up to 6 months.