About 40-80% of people complain of lower back pain, but more than 25% of them consult a doctor.In fact, such unpleasant sensations can be caused by both relatively harmless causes and pathological changes in the spine.Therefore, you should not neglect them.
Causes of back pain
The spine consists of all structural elements: bones, joints, intervertebral discs, ligaments, nerves.Changes in any of them can be accompanied by pain of a different nature.In addition, the spine is surrounded by paraspinal muscles, which patients often confuse with pain in the spine.So pain can have many causes.This is due to overwork, natural restructuring of the body during pregnancy, etc.can beHowever, if the pain occurs regularly, it is worth contacting a vertebrologist or neurologist, because systematic pain in the spine in the lumbar region often indicates the development of certain diseases.
Often, patients are diagnosed in such cases:
- pathologies of intervertebral discs (reduced disc height, protrusion, intervertebral hernia, discitis);
- pathologies of facet joints (spondyloarthrosis, joint cysts);
- inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
- vertebral compression fractures due to osteoporosis;
- neoplastic lesions of the spine.
Intervertebral disc pathologies
Degenerative changes in the intervertebral discs or osteochondrosis are very common, especially among young and middle-aged people.This is mainly due to the need to sit for a long time or engage in heavy physical labor.In old age, the disc dries up and the vertebrae fuse together.
Pain in the spine may occur in the early stages of degenerative changes in the intervertebral discs, which are cartilages of a special configuration that separate the vertebral bodies.This is due to the irritation of the pain receptors of the outer layers of the disc, as well as the posterior longitudinal ligament of the spine.Often, osteochondrosis provokes an aseptic inflammatory process, which causes reflex spasm of the segmental muscles.As a result, pains in the spine intensify, movement restrictions arise.
Osteochondrosis tends to progress constantly, especially in the absence of appropriate treatment and lifestyle correction.Subsequently, this leads to the worsening of existing symptoms and the formation of protrusions, which lead to the formation of new ones, and subsequently to intervertebral hernias.
Because it carries the most load in daily activities, the lower back is the most affected.
The protrusions are protrusions of the outer shell of the disc, called the annulus fibrosus, preserving its integrity.If the influence of provoking factors continues over time, the fibers of the annulus fibrosus cannot withstand the load and pressure of the inner contents of the disc (nucleus pulposus) and rupture.As a result, the nucleus deviates from the physiological position of the intervertebral disc.At this time, the spine always hurts in the lumbar area or the pain radiates to the leg, and the discomfort is intensified during sudden movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well as sitting, walking, standing for a long time.
Often, patients with already formed protrusions and hernias unconsciously take a forced position, bending slightly in the healthy direction.At the same time, pain in the spine in the lumbar region can reach high intensity, depriving a person of his ability to work.In such cases, he is forced to observe bed rest and squeeze his bent leg and bring it to his stomach to relieve the pain.
Most often, protrusions and tears form towards the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots that depart from it.The latter pass through the natural openings in the vertebral bodies and then branch into the lumbar plexus, which is responsible for the innervation of the lower limbs 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 also complements other disorders.If the deformed disc or soft tissues swollen as a result of the inflammatory process compress the spinal root passing by them, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be complemented by pain radiating to the hip, groin, front, inner, outer thigh, lower leg and foot.It depends on which nerve root will be compressed, that is, on which level of pathological changes of the movement segment of the spine will be observed.Also, sensitivity disorders in the form of creeping sensation, numbness, changes in temperature sensitivity, pain, tactile stimuli and limited mobility can be observed in the corresponding areas of the lower extremities.
Changes in the height and functionality of discs that occur with osteochondrosis and its complications cause damage to the articular apparatus of the spine, as well as degeneration of the vertebral bodies themselves.The result of this is the development of spondylosis, that is.calcification of the anterior longitudinal ligament and the formation of osteochondral growths on the surface of the vertebral bodies (osteophytes).They can not only damage the surrounding tissues and compress the spinal roots, causing severe pain in the spine, but also may not fuse with each other.As a result, the adjacent vertebral bodies are united into a single whole, which sharply limits the mobility of the lower back.
Osteochondrosis can be accompanied by reactive changes in the vertebral bodies, especially reactive aseptic spondylitis, which causes osteosclerosis.This is accompanied by compression of bone tissue and dramatically increases the likelihood of vertebral fractures.
Facet joint diseases
Pathologies of the facet or facet joints 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 aches and is localized inside.Their appearance is related to the rich innervation of the synovial capsule.In such cases, the pain is usually concentrated directly in the affected area and tends to be aggravated by bending, straightening, turning the body, or standing for long periods of time.Walking and sitting help reduce their severity.However, in some cases, the pain may spread to the groin, tailbone, and 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.
Symptoms of these diseases usually appear before the age of 40, and more often in the 20s. This distinguishes them from degenerative-dystrophic pathologies of the discs and joints of the spine, which develop more often after the age of 40.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 violently at night and especially in the morning immediately after sleep.
The most severe condition is seen with ankylosing spondylitis, which affects the lower back more than any other inflammatory disease.This term refers to inflammation of the intervertebral joints, accompanied by immobilization due to the formation of a dense bony, cartilaginous or fibrous joint.
At first, it is characterized by mild pain in the lumbar region, but over time, they spread higher, covering the thoracic and then the neck.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 be immersed in a certain position.Also observed:
- correction of lumbar lordosis (natural curve of the spine in the lumbar region);
- worsening of thoracic kyphosis, which causes bending;
- reflex tension of back muscles;
- progressive deterioration of limited mobility due to involvement of facet joints in the pathological process and ossification of intervertebral discs;
- morning stiffness for an hour or more.
Inflammation of the conjunctiva (iritis), cornea (keratitis), mucous membrane (conjunctivitis), iris and ciliary body of the eyeball (iridocyclitis) is observed in 10-50% of patients.
The development of ankylosing spondylitis causes an increasing number of joints to become pathological.As a result, patients are forced to adopt a so-called supplicating pose.This means open kyphosis of the chest, which affects the depth of breathing, downward bending of the upper body, bending of the legs at the knees with a sharp limitation of the range of motion in the chest.
The rate of development of the disease depends on the adequacy and completeness of the treatment.
Spinal compression fracture
A compression fracture is a flattening of the vertebral body, causing it to become wedge-shaped.This leads to a violation of the anatomy of the spine, can cause damage to the spinal cord and its roots, and can lead to rapid progression of degenerative changes.
The 1st and 2nd lumbar vertebrae are more susceptible to injury because they take the greatest axial load.
Most often, spinal compression fractures occur in elderly people due to the development of osteoporosis, that is, a decrease in bone density.In such cases, not only a small fall, but also heavy lifting or an unsuccessful movement is enough to cause injury.
Pathological, it is characterized by the presence of pain in the spine, which limits movement and intensifies when sitting, moving and trying to raise a straight leg.It usually lasts for 1-2 weeks and then gradually decreases over 2-3 months.In some cases, the pain spreads to the iliac crests and thighs.A decrease in the height of a fractured vertebra leads to an increase in lumbar lordosis, which contributes to pain.
If the fracture is not diagnosed in time, the decrease in the height of the vertebra leads to a change in posture and a decrease in height.This causes reflex tension and shortening of the spinal muscles, which causes chronic back pain and requires prolonged rest.
Neoplastic lesions of the spine
Neoplastic lesions of the spine mean the formation of benign and malignant tumors in it, as well as metastases, the source of which are neoplasms of other organs.It occurs less often than pathologies of intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, that is, only in 1-2% of patients with back pain.However, such lesions require the earliest possible diagnosis and treatment.
Characteristic features of neoplastic lesions of the spine, in addition to pain:
- increased body temperature, including subfebrile levels;
- unexplained weight loss;
- inability to find a comfortable body position;
- the presence of night pains;
- 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 look similar:
- Chondroma is a malignant tumor diagnosed in 20% of patients with cancerous lesions of the spine.It occurs more often in the sacrum and can occur in people of all ages and genders.
- Young's sarcoma - occurs in 8% of patients with neoplastic lesions of the spine.It is more typical for young men.
- Chondrosarcoma is a malignant neoplasm, accounting for 7-12% of cases.It is more common in middle-aged men.
- Aneurysmal bone cyst is a benign neoplasm.
- Hemangioma is a benign vascular tumor that occurs in 11% of people.It cannot be detected during a person's lifetime.However, this increases the risk of spinal fractures.
- Metastases of other tumors are secondary malignant neoplasms.Most often, breast, prostate, and lung cancers metastasize 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 time of admission, the doctor first collects an anamnesis, the nature of the pain, the circumstances of its occurrence, the duration of its duration, the presence of other symptoms, lifestyle, etc.
Then the specialist conducts an examination.As part of this, he not only palpates the spine, determines the localization of pain, evaluates the patient's unconscious gait and posture, but also conducts functional tests.With their help, you can detect symptoms of ankylosing spondylitis, neurological deficits, assess the degree of mobility of the spine and get other diagnostic information.
Based on this, the doctor can now suggest possible causes of pain.In order to clarify them, as well as to accurately determine the degree of damage, instrumental and sometimes laboratory diagnostic methods are additionally prescribed.They often ask for help:
- X-rays in frontal and side projections, sometimes with functional X-ray tests;
- CT scan - allows better visualization of bone structures, therefore spondylosis, fractures, bone tumors, etc.it is used more for diagnosis;
- MRI - allows a comprehensive assessment of the condition of cartilaginous structures and soft tissues, therefore, osteochondrosis, protrusions, intervertebral tears, spinal cord lesions, etc.it is used more for diagnosis;
- electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of nerve damage;
- radioisotope osteoscintigraphy - used in the diagnosis of malignant tumors and metastases;
- X-ray densitometry is the optimal method for diagnosing osteoporosis;
- myelography - used to determine signs of compression of the spinal cord and tailbone nerves.
Treatment
Treatment for each patient is selected strictly individually, not only based on the diagnosis, but also on the basis of the nature of the accompanying pathologies.Nevertheless, the cause of back pain, of course, determines the tactics of treatment.It can be conservative or involve surgical intervention.
But the first step is always to relieve the pain, especially when it is severe.For this, patients are prescribed NSAIDs, antispasmodics and painkillers.And in severe cases, spinal blocks are performed - injections of anesthetics and corticosteroids at certain points of the spinal region.
Bed rest is not indicated for all patients.In the case of pathologies of the intervertebral discs, it can be completely contraindicated, because the reduction of physical activity contributes to the transformation of acute pain in the spine into chronic pain.
Only conservative or non-surgical treatment is prescribed for:
- osteochondrosis;
- Bekhterev's disease;
- arthrosis of facet joints;
- mild compression fractures.
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 back pain is intervertebral hernia, protrusion, spondylosis, severe vertebral fractures, tumors, surgical intervention is often indicated.It is also necessary for:
- ineffectiveness of conservative therapy for degenerative changes;
- increased neurological deficit;
- instability of the spinal movement segment;
- the development of complications, especially stenosis of the spinal canal.
Most modern spine surgeries are minimally invasive.Due to this, intraoperative and postoperative risks are drastically reduced, the rehabilitation period is shortened and facilitated, and its effectiveness is not inferior to more traumatic open operations.Depending on the detected disease, the following may be recommended:
- Discectomy is the surgery indicated mainly for hernias and protrusions, especially those that cause caudal equidistant syndrome.It can be performed using microsurgical instruments through an incision of about 3 cm (microdiscectomy) and using endoscopic equipment brought into the spine through pinpoint punctures about 1 cm in diameter (endoscopic discectomy).When the intervertebral disc is completely removed, it is usually replaced with implants.
- Vertebroplasty and kyphoplasty are indicated for vertebral compression fractures, hemangiomas and some other diseases.The essence of the operation is to introduce fast-hardening bone cement into the vertebral body through a thin cannula, strengthening it.In addition, with kyphoplasty, it is possible to restore the normal dimensions of the vertebral body, which is important in case of severe reduction in height as a result of a fracture.
- Fixation operations are used to stabilize the spine.For this purpose, various types of metal structures are used, which usually remain in the patient's body until the end of his life.
Thus, the spine in the lumbar region can be damaged for various reasons.Therefore, if the pain lasts for a long time, if it occurs regularly, if the pain worsens over time, and if other symptoms are added, you should definitely consult a vertebrologist or a neuropathologist.Early diagnosis will make it possible to detect pathological changes in the stages that are easiest to cope with and, if not to completely cure the disease, at least to stop its development and maintain a high standard of living.