Dorsalgia (back pain) belongs to one of the most common causes of complaints and requests for medical assistance. In this case, in the course of life with the problem of dorsalgia facing 70-90% of the population and in 28% of them develops a chronic pain syndrome, which sees to the temporary/long-lasting loss of disability and reduced quality of life. Pain in the back in addition to the constraints of life have an impact on behavior/psyche of people, which is manifested by the development of chronic emotional tension.
Pain syndromes associated predominantly with osteochondrosis in the lumbar-sacral department (lumbar osteochondrosis), which is characterised by high mobility/large physical burden, and are caused by degenerative-degenerative changes in almost all components of the vertebrae-motion segments of the spine (your body of the vertebrae, intervertebral disks and connecting their tissues).
Classification
The basis of classification is a degenerative disease of the disk stored pathogenetic approach, which reflects the disease process in the form of consecutive stages/degrees of degenerative-degenerative slaughter, in accordance with the, issue the following.
Osteochondrosis of the lumbar 1 level
This is the first (basic) degree within the disk of the defective process, generating from the affected disk pathological impulses. Osteochondrosis of 1 degree is characterized by the displacement of the nucleus pulposus inside the disc, i.e. the gelatinous nucleus seeps through the cracks in the fibrous ring and its well innervated by the outer fibers. Respectively, at an osteochondrosis of 1 degree occurs irritation of nerve endings and begin to exhibit feelings of pain, which consists of a variety of reflex syndromes are degenerative disc disease.
Osteochondrosis of the lumbar 2 level
Osteochondrosis of the 2 degree — this degree of instability, i.e. the loss was struck by the discus own his fixation ability. It is characterized by a dynamic shift of the overlapping relatively basic vertebrae, which is caused by cracking of the nucleus pulposus and the elements of the fibrous rings. 2 the degree of degenerative disc disease is characterized by a syndrome of instability, appear reflective and partially compression syndromes.
Osteochondrosis of the 3 degrees
It is the degree/level of education of the hernia of the intervertebral disc, caused by violation of the integrity patterns of the fibrous rings (prolapse/extrusion). In osteochondrosis of 3 degrees can be squeezed: the spine spinal nerve, but also adjacent to the MPD of the vascular-nervous education.
Osteochondrosis of 4 degrees
This is the stage of fibrosis MPD and the gradual emergence of pain cartilage peripheral growths of the vertebral bodies. While as a compensatory mechanism is to increase the area of support of the vertebrae on the faulty discs, leads to immobility. These bone growths, in many cases, such as herniated discs can put pressure on the adjacent neuro-vascular formation.
Symptoms of degenerative disc disease of the lumbar-sacral spine
Osteochondrosis of the lumbar-sacral spine manifests itself in relatively wide range: from mild discomfort in the lumbar when acute intense pain, which can provoke congestion, hypothermia, lifting weights, etc. All the clinical manifestations of lumbar degenerative disc disease is divided into the vertebrae (compression) symptoms and extravertebral (reflective) symptoms.
In the initial stage
The clinical symptoms of degenerative disc disease of the lumbar spine in the first stage, caused by the protrusion of the disc towards the spinal canal (back) and overstimulation of the abundant pain receptors of the posterior longitudinal ligament. The leading symptom in this stage is the different degree of severity of local pain syndrome, lumbago, lumbalgie, which conventionally differ by the degree of severity of the pain syndrome and the duration of the pathological manifestations. For this stage is a typical "flag boards" (flattening of the lumbar lordosis), and expresses the constraints due to the pain in the acute period movements in the lumbar spine.
In addition to the local pain is the affected intervertebral disc due to a reflex muscle reaction in the majority of cases are expressed by the voltage paravertebral muscles ("defense"), that contributes to the enhancement of pain syndrome, as well as the quality/flattening of the physiological lumbar lordosis and limitation of motion of the spine.
In osteochondrosis first stage symptoms of radicular syndrome and other neurological manifestations (symptoms of stress) are missing. As usual, time to irritation of receptors of the (pressure) of the rear longitudinal ligament is celebrated adaptation that contributes to immobilization of the affected intervertebral disc. The severity of the acute/subacute and gradually decreases when adequate treatment simply and compliance with the orthopedic mode. This means, that celebrates the transformation of acute into the stage of remission, long-term duration, which vary in a wide range, as well as the frequency of exacerbations of lumbalgia.
In this case, each new exacerbation is indicative of the use of the bias MPD (prolapse/protrusion), causing increased pressure of the disk on the rear of the longitudinal bunch. Over time, this leads to the dilution of the ligaments and reduction of its strength, and thus the risk of another herniated disk and a perforation of the posterior longitudinal ligaments in the next episode towards the spinal canal, which sees to the development of the next phase of neurological complications.
Vascular-root phase (the phase of neurological disorders)
A summary of the pathological manifestations (ischemia of the relevant roots/spinal, complicated the emergence of a herniated disc and the formation of occlusion, using the root of the blood vessels) contributes to the development of movement disorders in a specific myotome, and decreased sensitivity in particular on the dermatome. As usual, the development of paresis/paralysis of the muscles and disturbed sensation preceded by a sharp movement, after which the immediately — pain in the lumbar-sacral area appears the acute short-term, on irradiation in the course of the sciatic nerve (the so-called "giperalgeticheskie crisis for sciatica"). In parallel creates muscle weakness in the area of innervation of a certain ischemic spinal nerves and arise sensitive disorders. Usually arises from occlusion of the root arteries, that sees, together with the spinal nerves L5 into the spinal canal.
Characteristic is the acute development of the syndrome of "paralytic for sciatica", manifests cp/palsy on the affected side natahovačů foot/hand ("stepper" helena "gold walk"), emerging in disorders of the function of the peroneal nerve. Such a patient high lifts the foot during walking, throwing her forward and slams the front part of the toe of the foot on the floor.
jpg ' class='imgblock right center_mob'>The last stage of the neurological manifestations,
Osteochondrosis of the spine, as usual, is the cause of the violation of blood flow in large radicular arteries, which supply blood to the spinal cord (radicular-spinal artery). The blood supply of the spinal cord of the lumbar-sacral level provides only one artery Adamcewicz, for some people, is present plus a lumbar artery Depro-- Gotteron, ensuring the blood supply of the caudal department/the cauda equina of the spinal cord.
Their functional insufficiency causes a slow development of vascular injury to kidney injury to the spinal cord, the clinical manifestation of which is syndrome, intermittent claudication, accompanied by leg weakness and numbness that occurs when walking and disappears after a slight rest (stop). The hardest manifestation of neurological disorders in this stage are acute circulatory disorders of the spinal cord according to the type of spinal ischemic stroke.
Examination and diagnosis
Diagnosis of the lumbar-sacral degenerative disc disease in most cases does not cause problems, and is based on the analysis of the nature and localization of the pain syndrome and communication with physical exertion (medical history), the availability of the trigger the pressure points and symptoms of tension. From the instrumental methods of the leading role relegated to x-ray, computed and magnetic resonance imaging (photo below). For the exclusion of somatic pathology (metastases in the spine, kidney stone disease, pyelonephritis), may set apart the joint/biochemical analysis of blood and urine.
Treatment of degenerative disc disease of the lumbar-sacral spine
The question of how to treat osteochondrosis of the lumbar belong to one of the most frequently asked. Firstly, the treatment of degenerative–degenerative lesions of the vertebral pillar should be gradually and comprehensive, which include treatment, medicines, physiotherapy, and when necessary, surgical methods.
Procedures and surgery
In the treatment of lumbar degenerative disc disease is widely used physiotherapy: phonophoresis/electrophoresis with medicines (including analgesics and antispasmodics) electroplating/pulse streams; electroneurostimulation; UHF; laser; magnetic therapy; EHF (extremely high frequency therapy); MICROWAVE ovens (microwave therapy); shock-wave therapy, acupuncture.
In the acute period it is recommended that the observance of the musculoskeletal (orthopedic) mode with wearing the lumbar stabilizer corset. In this period it is necessary to limit/exclude the exercise on the amplitude, which cause pain, or muscle tension. Engage in "through the pain" is strictly prohibited, exercise should be done very slowly and with repetition for 8-10 times. It is also important not to allow an increase in lumbar lordosis when the movements of the legs, which can cause amplification of pain. In the next phase of the acute period of at least reduce pain can include gradually isometric exercises for the larger muscles of the gluteal and abdominal muscles.
In soothing the pain to increase opportunities and close complex co-development/special exercises. In addition to exercise to increase the strength of natahovačů thigh and abdominal muscles are included exercise, increasing the strength of the muscles of the back and with a flexed motion in the lumbar spine. Which are carried out at an average pace of 15-20 reps. It is necessary to give the message that charging in osteochondrosis of the lumbar must be periodically, and not from case to case.
Exercise in osteochondrosis of the lumbar spine in the period of remission are aimed primarily at strengthening the muscular corset of this zone and increase the mobility of the vertebral pillar, but should be done very carefully. The number of repetitions of exercises of this period can be enlarged to 50 to 100 times. An important task is to create the automatism of the muscles in maintaining a specific posture of your body in any position (standing/sitting, while walking).
Physical therapy in osteochondrosis of the lumbar spine it is possible to perform in the pool (in the water, but that only complements the main "dry" lesson). Of the other methods of physical therapy is very useful are: swimming, which is often considered to be "the most effective physiotherapy in pain sacral osteochondrosis", as well as the treadmill, the road, skiing, ergometer, exercise with a rubber bandage. To deal with such sports, such as volleyball, big/little tennis, gymnastics rhythmic is not recommended, because of the many sudden movements that can provoke exacerbation of the disease.
Charging with dumbbells is performed only in the supine position (on your back) to eliminate the vertical load on the spine. You need to remember that when choosing exercises, frequent/constant overload/less injuries of the spine helena uncoordinated tremors and movement in the axis of the spine create a risk of rupture of the degenerated disc and the further deterioration of the pain. A very useful exercise for the spine can be yoga, however many of the yoga exercises are quite complicated and must be carried out only under the direction and supervision of an instructor. The best choice on the first pores will, if physical therapy in osteochondrosis of the lumbar spine is performed in a specialized office, where the doctor physical therapy will show you comprehensive exercises, which then will be possible to carry out at home.
These exercises are performed as morning gymnastics in osteochondrosis of the. No need to search for a different kind of video movement therapy helena medical gymnastics, video in osteochondrosis, because the video does not allow to create the correct biomechanics of exercise and can cause deterioration. However, it is widely used and medical massage (manual, underwater, vacuum, hydromassage). Massage in osteochondrosis of the lumbar allows you to raise/reduce the feelings of pain, remove muscular tension in this area, to restore mobility of the spine.
Operative treatment is performed in cases of significant spinal cord compression of the brain and is focused on spinal decompression channel. Includes various kinds of operational intervention: the removal of a herniated intervertebral disc, holding a microdiscectomy, laser reconstruction of the disc, the puncture evaluation of the disk, replacement of the intervertebral disc implant, stabilizing operations of the spine segment.
Weather
Thanks and adequate treatment the prognosis is favorable. Worsens the prognosis of the emergence of lateral hernia of the disc L-S1 with early points, involving in pathological process of root and the subsequent creation of radiculopathy. The weather is deteriorating in the acute development of symptoms of spinal cord compression brain/cauda equina syndrome with paresis in the legs, disorders of the pelvic functions, the fallout of sensitivity, when this weather will improve than previously removed compression (hernia the sequester).