lumbar spine pain

About 40-80% of people complain of lumbar pain, but no more than 25% seek medical help.In fact, this unpleasant sensation can be caused by relatively harmless causes and pathological changes in the spine.Therefore, you should not take them lightly.

Causes of low back pain

The spine is made up of a complete set of structural elements: bones, joints, discs, ligaments, nerves.Changes in any of these may be accompanied by pain of varying nature.In addition, the spine is surrounded by paravertebral muscles, and patients often confuse pain there with spinal pain.Therefore, there can be many causes of pain.This could be overexertion, the body's natural reorganization during pregnancy, etc.But if pain occurs frequently, it is worth contacting a chiropractor or neurologist, since systemic pain in the spine in the lumbar region often indicates the development of certain diseases.

Most commonly in this case, patients are diagnosed with:

• Intervertebral disc pathology (disc height reduction, herniation, intervertebral hernia, discitis);
• Facet joint pathology (spondyloarthropathy, joint cysts);
• Inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
• Vertebral compression fractures caused by osteoporosis;
• Neoplasmic lesions of the spine.

Intervertebral disc pathology

Degenerative disc changes or osteochondrosis are very common, especially in young and middle-aged people.This is largely caused by the need to sit for long periods of time or perform strenuous physical tasks.In old age, the discs can dry out and the vertebrae can fuse together.

Spinal pain may occur during the initial stages of degenerative changes in the intervertebral discs, the specially constructed cartilage that separates the vertebrae.This is due to irritation of pain receptors in the outer layer of the disc and the posterior longitudinal ligament of the spine.Typically, osteochondrosis initiates a sterile inflammatory process leading to segmental muscle reflex spasms.As a result, spinal pain increases and movement is limited.

Osteochondrosis tends to progress, especially without proper treatment and lifestyle correction.It can then lead to the formation of a herniation, which can lead to an intervertebral hernia, causing existing symptoms to worsen and new ones to appear.

The lumbar area bears the highest load during daily activities and is therefore the most susceptible.

A herniation is a protrusion of the disc while maintaining the integrity of its outer shell, called the annulus fibrosus.If the influence of the irritating factor persists, the fibers of the annulus fibrosus cannot withstand the load and pressure of the disc contents (nucleus pulposus) and rupture.As a result, the nucleus pulposus extends beyond the physiological location of the intervertebral disc.In this condition, there is always pain in the spine in the lower back or pain that radiates to the legs, and the discomfort increases with sudden movements, bending, lifting heavy objects, exerting force, coughing, sneezing, laughing, and sitting, walking, standing in one position for a long time.

Often, patients who have developed protrusions and hernias will unconsciously adopt forced postures, leaning slightly toward health.At the same time, spinal pain in the lumbar region may reach a high intensity, depriving a person of the ability to work.In this case, he was forced to insist on bed rest, and in order to relieve the pain, he tightened his bent legs and brought them to his stomach.

Most commonly, herniations and hernias form toward the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots that branch from it.The latter passes through the natural openings of the vertebral bodies and further branches to the lumbar plexus, which is responsible for the innervation of the lower limbs and various organs, including the genitals.

Therefore, with long-term osteochondrosis, a hernia forms in the waist, and the spinal pain not only gradually worsens, but is also accompanied by other diseases.Neurological disorders can occur if deformed discs or soft tissue swollen due to inflammatory processes press on the spinal cord roots near them.Therefore, spinal pain in the lumbar region can be supplemented by pain that radiates to the buttocks, groin, front, medial, lateral thighs, calves, and feet.It depends on which nerve root will be compressed, i.e. at which spinal motion segment level the pathological changes will be observed.In addition, in the corresponding areas of the lower limbs, sensitivity disorders can be observed, manifested by a crawling sensation, numbness, changes in sensitivity to temperature, pain, tactile stimulation and limited mobility.

Changes in disc height and function caused by osteochondrosis and its complications can lead to damage to the spinal joint apparatus, as well as degeneration of the vertebral bodies themselves.The result is spondylosis, that is, calcification of the anterior longitudinal ligament and osteochondral growth (osteophytes) on the surface of the vertebral bodies.They not only damage surrounding tissues, compress the roots of the spine, and cause severe pain in the spine, but they also fuse with each other.As a result, adjacent vertebrae combine into a single unit, which greatly limits the mobility of the lower back.

Osteochondrosis may be accompanied by reactive changes in the vertebral bodies, particularly reactive aseptic spondylitis, leading to osteosclerosis.This is accompanied by compaction of bone tissue and dramatically increases the likelihood of vertebral fractures.

facet joint disease

Pathology of the lumbar facet joints or facet joints, especially their arthropathy, can also cause lumbar spinal pain, including severe pain.Although more often the pain is pain and localized deep inside.They arise because their synovial sacs are richly innervated.In this condition, the pain is usually localized directly to the affected area and worsens with bending, straightening, turning the body, or standing for long periods of time.Walking and sitting can help reduce its severity.But in some cases, the pain can also radiate to the groin area, tailbone, and the back and outer surface of the thigh.

spinal inflammatory disease

Inflammatory diseases of the spine are less common than lesions of the intervertebral discs and facet joints.However, they can also cause spinal pain.These include:

• Ankylosing spondylitis or ankylosing spondylitis;
• reactive arthritis;
• Psoriatic arthritis, etc.

Signs of these diseases usually appear before the age of 40, and more commonly in the 20s.This distinguishes them from degenerative dystrophic pathologies of the spinal discs and joints, which typically appear after the age of 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 not during rest.Therefore, when suffering from inflammatory diseases, the spine in the lumbar region often hurts at night, especially in the morning after going to bed.

The most serious case is ankylosing spondylitis, which most often affects the lumbar region compared to other inflammatory diseases.This term refers to inflammation of the intervertebral joints and subsequent immobilization of the intervertebral joints due to the formation of dense bone, cartilage, or fibrous fusion between the bony structures of the joint.

Initially, it is characterized by mild pain in the lower back, but over time the pain gradually spreads higher, covering the thoracic spine and then the cervical spine.This is related to limited movement of the spine in all planes, as the spine appears to be immersed in specific situations due to the changes that occur.Also observed:

• lumbar lordosis alignment (the natural curve of the lumbar spine);
• Worsening of thoracic kyphosis, leading to stooping;
• Reflexive tension in back muscles;
• Due to the involvement of facet joints and intervertebral disc ossification in the pathological process, limited mobility gradually worsens;
• Morning stiffness for an hour or more.

Inflammation of the iris (iritis), cornea (keratitis), mucous membrane (conjunctivitis), iris, and ciliary body of the eye (iridocyclitis) occurs in 10-50% of patients.

The progression of ankylosing spondylitis results in more and more joints becoming affected.As a result, the patient is forced into what is known as a supplication posture.It means that the thoracic spine is significantly kyphotic, the upper body is tilted downward, the legs and knees are bent, and the range of movement of the chest is severely limited, thus affecting 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 results in disruption of spinal anatomy, may cause damage to the spinal cord and its roots, and can also be a trigger for rapid progression of degenerative changes.

The first and second lumbar vertebrae are more susceptible to injury because they bear the greatest axial load.

Typically, older adults develop spinal compression fractures due to osteoporosis, a decrease in bone density.In this case, not only a minor fall, but heavy lifting or unsuccessful exercise may be enough to cause injury.

The disease is pathologically characterized by pain in the spine that limits movement and worsens when sitting, moving and trying to lift a straight leg.Typically lasts 1-2 weeks and then tapers off over 2-3 months.In some cases, the pain radiates to the iliac crest and thigh.The reduction in height of the fractured vertebra can cause an increase in lumbar lordosis, which can also lead to pain.

If fractures are not diagnosed promptly, reduced vertebral height can lead to changes in posture and loss of height.This causes reflex tension and shortening of the spinal muscles, leading to chronic back pain and the need for prolonged rest.

spinal neoplastic lesions

Spinal neoplastic lesions refer to the formation of benign and malignant tumors in the spine, as well as metastases, which originate from tumors in other organs.This condition occurs much less frequently than discs, facet joints, ankylosing spondylitis and even compression fractures, i.e. it occurs in only 1-2% of people with back pain.However, such lesions require early diagnosis and treatment.

In addition to pain, characteristics of neoplastic lesions of the spine include:

• Increased body temperature, including low-grade fever;
• Unexplained weight loss;
• Unable to find a comfortable body position;
• Pain at night;
• severe pain in the spine;
• Pain cannot be relieved with conventional analgesics.

Even if you experience 1 or 2 of these symptoms, you should make an appointment with your doctor immediately.

The following may appear in a similar manner:

• Enchondroma is a malignant tumor that is diagnosed in 20% of patients with cancerous lesions of the spine.It is more common in the sacrum and can occur in people of any age and gender.
• Young's sarcoma - This condition occurs in 8% of patients with spinal tumors.More typical for younger men.
• Chondrosarcoma is a malignant tumor that accounts for 7-12% of cases.More common in middle-aged men.
• Aneurysmal bone cyst is a benign tumor.
• Hemangioma is a benign blood vessel tumor that occurs in 11% of the population.It may not be detectable throughout a person's lifetime.But it can increase the risk of vertebral fractures.
• Metastasis from other tumors is secondary malignancy.The most common ones are breast cancer, prostate cancer, and lung cancer that metastasize to the spine, and less common are kidney cancer, thyroid cancer, and skin cancer.

diagnosis

If you have pain in your lumbar spine, you should make an appointment with a neurologist or chiropractor.During the appointment, the doctor first collects medical records and asks questions about the nature of the pain, its occurrence, duration, the presence of other symptoms, lifestyle and other issues.

Then experts conduct an inspection.As part of this, he not only palpates the spine to identify the location of pain, assesses the gait and posture the patient adopts unconsciously, but also performs functional tests.With their help, you can detect signs of ankylosing spondylitis, neurological defects, assess the degree of mobility of the spine and obtain other diagnostic data.

From this, doctors can already suggest possible causes of pain.In order to clarify them and accurately determine the extent of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed.They most often turn to:

• Frontal and side projection X-rays and sometimes functional X-ray testing;
• CT scan - allows better observation of bone structure, so it is more commonly used to diagnose spondylosis, fractures, bone tumors, etc.;
• MRI – allows the most thorough assessment of the condition of cartilage structures and soft tissues and is therefore more commonly used to diagnose osteochondrosis, herniations, intervertebral hernias, myelopathy, etc.;
• Electromyography - useful in unexplained neurological disorders and to assess the extent of nerve damage;
• Radioisotope bone scintigraphy - used to diagnose malignant tumors and metastases;
• X-ray densitometry is the best method for diagnosing osteoporosis;
• Myelogram – Used to identify signs of compression of the spinal cord and cauda equina nerves.

treat

For each patient, the choice of treatment is strictly individual, based not only on the diagnosis but also on the nature of the existing accompanying pathology.Nonetheless, the cause of low back pain certainly determines the treatment strategy.It may be conservative or involve surgical intervention.

But the first step is always to relieve pain, especially if it's severe.For this, patients need to take non-steroidal anti-inflammatory drugs, antispasmodics and analgesics.In severe cases, a spinal block is performed - an injection of anesthetic and corticosteroids at certain points in the spinal area.

Not all patients require bed rest.If the disc becomes diseased, it may be completely contraindicated, as a reduction in physical activity can cause acute pain in the spine to turn into chronic pain.

Totally conservative or non-surgical treatment is indicated for:

• osteochondrosis;
• Bekhterev's disease;
• Facet joint arthropathy;
• Mild compression fracture.

It is often complex and includes:

• Medication, which may include nonsteroidal anti-inflammatory drugs, chondroprotectants, muscle relaxants, immunosuppressants, corticosteroids,
• Physical therapy (UHF, magnet therapy, laser therapy, traction therapy, etc.);
• exercise therapy;
• Manual therapy.

If the cause of low back pain is intervertebral hernia, herniation, spondylosis, severe vertebral fracture, or tumor, surgery is usually required.This is also necessary:

• Conservative treatment is ineffective against degenerative changes;
• Increased neurological deficit;
• Instability of spinal motion segments;
• The occurrence of complications, especially spinal stenosis.

Most modern spine surgeries are minimally invasive.In this way, intraoperative and postoperative risks are greatly reduced, the recovery period is shortened and convenient, and the effect is no less than that of more invasive open surgery.Depending on the disease detected, the following measures may be recommended:

• Discectomy surgery is performed primarily on hernias and herniations, particularly those causing cauda equina syndrome.It can be performed using microsurgical instruments through an incision of approximately 3 cm (microdiscectomy) and using an endoscopic device through a needle tip puncture of approximately 1 cm in diameter into the spine (endoscopic discectomy).When the disc is completely removed, it is usually replaced with an implant.
• Vertebroplasty and kyphoplasty are indicated for vertebral compression fractures, hemangiomas, and some other conditions.The essence of the surgery is to introduce rapidly hardening bone cement into the vertebral body through a thin cannula to strengthen it.With kyphoplasty, it is also possible to restore the normal dimensions of the vertebral body, which is important in cases where the height of the vertebral body has been severely reduced due to fracture.
• Immobilization surgery is used to stabilize the spine.For this purpose, various types of metallic structures are used, which usually remain in the patient's body until the end of life.

Therefore, the spine in the lower back can be injured for a variety of reasons.Therefore, if the pain lasts for a long time, if it occurs regularly, if the pain worsens over time, or is even coupled with other symptoms, you should definitely contact a chiropractor or neurologist.Early diagnosis will make it possible to detect pathological changes at their most manageable stages and, if not to completely cure the disease, at least halt its progression and maintain a high standard of living.