About 40-80% of people complain about pain in the lumbar spine, but no more than 25% of them seek medical help.In fact, such unpleasant sensations can be caused by both relatively harmless reasons and pathological changes in the spine.Therefore, you should not treat them with contempt.
Causes of back pain
The spine consists of the entire complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves.Changes in any of them can be accompanied by different pain.In addition, the spinal space is surrounded by paraspinal muscles, pain in which patients often confuse with pain in the spine.Therefore, there are many reasons for pain.This can be too much work, natural reorganization of the body during pregnancy, etc.But if the pain occurs regularly, it is worth contacting a vertebrologist or neurologist, because often the fact that the spine in the lumbar region systematically hurts indicates the development of a certain disease.
Often in such situations, patients are diagnosed with:
- intervertebral disc pathology (decreased disc height, protrusion, intervertebral hernia, discitis);
- facet joint pathology (spondyloarthrosis, joint cyst);
- inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
- vertebral compression fractures due to osteoporosis;
- spinal neoplastic lesions.
Intervertebral disc pathology
Degenerative changes in the intervertebral disc or osteochondrosis are very common, especially among young and middle-aged people.This is largely due to the need to sit for long periods of time or engage in heavy physical labor.In old age, the discs dry out and the vertebrae fuse together.
Already in the early stages of degenerative changes in the intervertebral disc, which is cartilage of a special configuration that separates the vertebral bodies, pain in the spine may occur.This is due to the irritation of the pain receptors of the outer layer of the disc, as well as the posterior longitudinal ligament of the spine.Often, osteochondrosis provokes an aseptic inflammatory process, which leads to reflex spasm of segmental muscles.As a result, pain in the spine increases, and movement restrictions occur.
Osteochondrosis tends to always progress, especially in the absence of appropriate treatment and lifestyle correction.After that, it leads to the formation of protrusions, and subsequently intervertebral hernia, which causes the deterioration of existing symptoms and the appearance of new ones.
The lumbar region, due to the fact that it bears the highest load in daily activities, is most often affected.
Protrusion is the protrusion of the disc while maintaining the integrity of its outer skin, called the annulus fibrosus.If the influence of the provoking factor continues over time, the fibers of the annulus fibrosus cannot withstand the load and pressure of the internal contents of the disc (nucleus pulposus) and rupture.As a result, the nucleus goes beyond the physiological position of the intervertebral disc.In this case, the spine always hurts in the lumbar region or the pain radiates to the legs, and the discomfort increases with sudden movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well as with prolonged sitting in one position, walking, standing.
Often, patients with already formed protrusions and hernias unconsciously take a forced position, leaning slightly in the healthy direction.At the same time, pain in the spine in the lumbar region can reach a high intensity, preventing a person from his ability to work.In such cases, he had to adhere to bed rest, and to relieve the pain, he tightened the bent leg and brought it to the stomach.
Often, protrusions and hernias form towards the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots that branch from it.The latter passes through a natural opening in the vertebral body and further branches into the lumbar plexus, which is responsible for the maintenance of the lower legs and various organs (including the genitals).
Therefore, often with long-term osteochondrosis, the formation of hernias in the lumbar region, the pain in the spine gradually not only increases, but is also accompanied by other disorders.If a deformed disc or soft tissue swells as a result of the inflammatory process compresses the spinal roots passing through it near it, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be accompanied by pain that radiates to the back, groin, front, inner, outer thighs, lower legs and feet.This depends on which nerve root will be pinched, that is, on the level of pathological changes of the spinal motion segment will be observed.Also, in the corresponding area on the lower part of the foot, sensitivity disorders can be observed in the form of crawling sensations, numbness, changes in sensitivity to temperature, pain, tactile stimulation and limited mobility.
Changes in the height and function of the disc that occur with osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as degeneration of the vertebral body itself.The result is the development of spondylosis, which is the calcification of the anterior longitudinal ligament and the formation of osteochondral growths on the surface of the vertebral bodies (osteophytes).They can not only injure the surrounding tissue and compress the spinal roots, causing severe pain in the spine, but also fuse with each other.As a result, adjacent vertebral bodies are combined into one whole, which sharply limits mobility in the lower back.
Osteochondrosis may be accompanied by reactive changes in the vertebral body, particularly reactive aseptic spondylitis, leading to osteosclerosis.This is accompanied by compaction of bone tissue and dramatically increases the likelihood of a spinal fracture.
Facet joint disease
Pathology of the facet joints or facets of the lumbar region, especially their arthrosis, can also cause pain in the spine in the lumbar region, including severe pain.Although more often the pain is painful and localized deep inside.Their appearance is due to the fact that their synovial capsule is heavily innervated.In such cases, the pain is usually focused directly on the affected area and tends to increase with bending, straightening, turning, or standing for long periods of time.Walking and sitting help reduce their severity.But in some cases, pain can also radiate to the groin area, tailbone, as well as the back and outer surface of the thigh.
Inflammatory diseases of the spine
Inflammatory diseases of the spine are less common than pathologies of intervertebral discs and facet joints.However, they also cause pain in the spine.These include:
- Ankylosing spondylitis or ankylosing spondylitis;
- reactive arthritis;
- psoriatic arthritis, etc.
Signs of this disease usually appear before the age of 40, and more often at the age of 20. This distinguishes it from degenerative-dystrophic pathology of the discs and joints of the spine, which more often develops after 40 years.In this case, the pain is characterized by a gradual increase in intensity.At the same time, their severity decreases after physical activity, but does not decrease during rest.Therefore, with inflammatory diseases, the spine in the lumbar region often hurts at night and is especially bad in the morning, right after sleep.
The most severe condition is observed with ankylosing spondylitis and this disease most often affects the lumbar region than other inflammatory diseases.This term refers to the inflammation of the intervertebral joints followed by their immobilization due to the formation of dense bone, cartilaginous or fibrous fusion between the articulating bony structures.
At first, it is characterized by mild pain in the lower back, but over time they gradually spread higher, covering the thorax and then the cervical spine.This is associated with the development of limited mobility of the spine in all planes, because the spinal column, as a result of the changes that occur, seems to sink in certain cases.Also noted:
- alignment of lumbar lordosis (natural curve of the spine in the lumbar region);
- aggravates thoracic kyphosis, which causes stooping;
- reflex tension of back muscles;
- progressive deterioration of limited mobility due to the involvement of facet joints and hardening of the intervertebral disc in the pathological process;
- morning stiffness for an hour or more.
In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucous membrane (conjunctivitis), iris and ciliary body of the eyeball (iridocyclitis) is observed.
The development of ankylosing spondylitis leads to the fact that an increasing number of joints become pathological.As a result, the patient had to acquire a pose called begging.This means a pronounced kyphosis of the thoracic spine, a downward tilt of the upper body, bending of the legs at the knees with a sharp limitation in the range of motion in the chest, which affects the depth of breathing.
The rate of disease progression depends on the adequacy and completeness of treatment.
Vertebral compression fracture
A compression fracture is a flattening of the vertebral body, causing it to become wedge-shaped.This leads to anatomical disorders of the spine, can cause injury to the spinal cord and its roots, and also trigger the rapid development of degenerative changes.
The 1st and 2nd lumbar vertebrae are more susceptible to injury, as they take the greatest axial load.
Most often, spinal compression fractures occur in older people due to the development of osteoporosis, which is a decrease in bone density.In such cases, not only a small fall, but also heavy lifting or unsuccessful movements may be enough to cause injury.
The pathology is characterized by the presence of pain in the spine, which limits movement and worsens when sitting, moving, and trying to lift the leg straight up.It usually lasts 1-2 weeks and then gradually decreases over 2-3 months.In some cases, pain radiates to the iliac crest and thigh.The decrease in the height of the fractured vertebra causes an increase in lumbar lordosis, which also contributes to the occurrence of pain.
If the fracture is not diagnosed in time, the decrease in the height of the vertebrae leads to a change in posture and a decrease in height.This creates reflex tension and shortening of the spinal muscles, which causes chronic back pain and the need for long periods of rest.
Spinal neoplastic lesions
Neoplastic lesions of the spine mean the formation of benign and malignant tumors in it, as well as metastases, the source of which is a neoplasm of another organ.This occurs much less frequently than intervertebral disc pathology, facet joints, ankylosing spondylitis and even compression fractures, i.e. only in 1-2% of patients with back pain.But such lesions require diagnosis and treatment as early as possible.
The characteristics of neoplastic lesions of the spine, in addition to pain in them, are:
- increased body temperature, including subfebrile levels;
- unexplained weight loss;
- inability to find a comfortable body position;
- the presence of pain at night;
- severe pain in the spine;
- inability to relieve pain with conventional analgesics.
Even if you have 1 or 2 of these symptoms, you should make an appointment with your doctor right away.
The following may appear in the same way:
- Chondroma is a malignant tumor diagnosed in 20% of patients with spinal cancer lesions.More often it forms in the sacrum and can occur in people of any age and gender.
- Young sarcoma - occurs in 8% of patients with spinal neoplastic lesions.More typical for young men.
- Chondrosarcoma is a malignant neoplasm, accounting for 7-12% of cases.More common in middle-aged men.
- Aneurysmal bone cysts are benign neoplasms.
- Hemangioma is a benign vascular tumor found in 11% of people.It may go undetected throughout a person's lifetime.But it increases the risk of spinal fractures.
- Other tumor metastases are secondary malignant neoplasms.Most often, breast, prostate, lung cancer metastasizes to the spine, and less often - kidney, thyroid and skin cancer.
Diagnostics
If your spine hurts in the lumbar region, you should make an appointment with a neurologist or vertebrologist.At the appointment, the doctor initially collects an anamnesis, asking questions about the nature of the pain, the circumstances of its occurrence, the duration of its persistence, the presence of other symptoms, lifestyle, etc.
Then the specialist conducts an examination.As part of it, he not only palpates the spine, determines the localization of pain, evaluates the gait and posture that the patient unconsciously takes, but also conducts functional tests.With their help, you can detect signs of ankylosing spondylitis, neurological deficits, assess the level of spinal mobility and obtain other diagnostic data.
Based on this, the doctor can already suggest possible causes of pain.To clarify this, as well as to accurately determine the level of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed.Often they use the help:
- X-rays in front and side projections, sometimes with functional X-ray tests;
- CT scan - allows better visualization of bone structures, therefore it is more often used to diagnose spondylosis, fractures, bone tumors, etc.;
- MRI - makes it possible to carefully assess the condition of the structure of cartilage and soft tissue, therefore it is more often used to diagnose osteochondrosis, protrusion, intervertebral hernia, spinal cord lesions, etc.;
- electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of nerve damage;
- radioisotope osteoscintigraphy - used for the diagnosis of malignant tumors and metastases;
- X-ray densitometry is the optimal method for diagnosing osteoporosis;
- myelography – used to identify signs of compression of the spinal cord and cauda equina nerve.
Treatment
For each patient, the treatment is selected strictly individually, not only based on the diagnosis, but also the nature of the existing concomitant pathology.However, the cause of lower back pain, of course, determines the treatment tactics.It may be conservative or involve surgical intervention.
But the first step is always to relieve the pain, especially if it is severe.For this, patients are given NSAIDs, antispasmodics, and painkillers.And in severe cases, a spinal block is performed - injection of anesthetic and corticosteroids at certain points in the spinal region.
Bed rest is not indicated for all patients.And in the case of intervertebral disc pathology, it may be completely contraindicated, because a decrease in physical activity contributes to the transformation of acute pain in the spine into chronic pain.
Conservative or non-surgical treatment is exclusively prescribed for:
- osteochondrosis;
- Bekhterev's disease;
- facet joint arthrosis;
- mild compression fracture.
It is usually complex and consists of:
- drug therapy, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids,
- physiotherapy (UHF, magnetic therapy, laser therapy, traction therapy, etc.);
- exercise therapy;
- manual therapy.
If the cause of lower back pain is intervertebral hernia, protrusion, spondylosis, severe spinal fracture, tumor, surgery is often indicated.It is also necessary to:
- ineffectiveness of conservative therapy for degenerative changes;
- increased neurological deficit;
- instability of spinal motion segments;
- the development of complications, especially stenosis of the spinal canal.
Most modern operations performed on the spine are minimally invasive.Thanks to this, intraoperative and postoperative risks are dramatically reduced, the recovery period is shortened and simplified, and its effectiveness is not inferior to more traumatic open operations.Depending on the disease detected, the following may be recommended:
- Discectomy is a surgery indicated mainly for hernias and protrusions, especially those causing cauda equina syndrome.It can be performed using microsurgical instruments through an incision of about 3 cm (microdiscectomy) and using endoscopic equipment brought to the spine through a pinpoint puncture with a diameter of about 1 cm (endoscopic discectomy).When the intervertebral disc is completely removed, it is usually replaced with an implant.
- Vertebroplasty and kyphoplasty are indicated for vertebral compression fractures, hemangiomas and some other diseases.The essence of the operation is to introduce bone cement that hardens quickly through a thin cannula into the vertebral body, strengthening it.With kyphoplasty, it is possible to restore the normal dimensions of the vertebral body, which is important in the event of a serious decrease in their height due to a fracture.
- Fixation surgery is used to stabilize the spine.For this purpose, metal structures of various types are used, which usually remain in the patient's body until the end of life.
Therefore, the spine in the lumbar region can be painful for various reasons.Therefore, if the pain persists for a long time, if it occurs regularly, if the pain increases over time, and above all with the addition of other symptoms, you should definitely contact a vertebrologist or a neurologist.Early diagnosis will make it possible to detect pathological changes at the stage when they are easiest to overcome and, if not cure the disease completely, then at least stop its progression and maintain a high standard of living.