About 40-80% of people complain that the spine in the lumbar region hurts, but no more than 25% of them see a doctor. In fact, such unpleasant sensations can be caused both by relatively harmless reasons and by pathological changes in the spine. Therefore, you should not treat them with contempt.
Causes of back pain
The spine is made up of a whole complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves. Changes in any of them can be accompanied by painful sensations and of a different nature. In addition, the spine is surrounded by paravertebral muscles, pains in which patients often confuse with pain in the spine. Thus, the causes of pain can be multiple. It can be overwork, natural restructuring of the body during pregnancy, etc. But if the pain occurs regularly, it is worth contacting a vertebrologist or neurologist, since often the fact that the spine systematically hurts in the lumbar region indicates the development of certain diseases.
Most often, in such situations, patients are diagnosed with:
- pathology of intervertebral discs (decrease in disc height, protrusion, intervertebral hernia, discitis);
- pathologies of the facet joints (spondylarthrosis, articular cysts);
- inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
- compression fractures of the vertebrae against the background of osteoporosis;
- neoplastic lesions of the spine.
Pathologies of intervertebral discs
Degenerative changes to the intervertebral discs or osteochondrosis are very common, especially in young and middle-aged people. Much of this is 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 grow together.
Already at the early stages of the appearance of degenerative changes in the intervertebral discs, which are cartilages of a special configuration dividing the vertebral bodies, pain in the spine may occur. This is due to irritation of the pain receptors of the outer layers of the disc, as well as the posterior longitudinal ligament of the spine. Often osteochondrosis causes an aseptic inflammatory process, which leads to a reflex spasm of segmental muscles. As a result, the pain in the spine increases, and there are also restrictions on mobility.
Osteochondrosis tends to progress constantly, especially in the absence of proper treatment and lifestyle correction. Subsequently, this leads to the formation of protuberances, and then intervertebral hernias, which causes the existing symptoms to worsen and new ones to appear.
The lumbar region, because it carries the highest loads in daily activities, is most often affected.
Protrusions are protrusions on the disc while maintaining the integrity of its outer shell, called the fibrous ring. While maintaining the influence of provoking factors over time, the fibers of the fibrous ring do not withstand the load and pressure of the internal contents of the disc (nucleus pulposus) and rupture. As a result, the nucleus exceeds the physiological position of the intervertebral disc. At the same time, the spine in the lumbar region always hurts or the pain radiates to the leg, and the discomfort increases with sudden movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well. than with prolonged sitting in one position, walking, standing.
Often, patients with already formed protuberances and hernias unconsciously adopt a forced posture, leaning slightly to the healthy side. In this case, the pain in the spine in the lumbar region can reach a high intensity, depriving a person of his ability to work. In such cases, he is forced to adhere to bed rest and, to relieve pain, he tightens the bent leg and brought to the stomach.
Most often, protrusions and hernias form in the direction of the spinal canal, through which the spinal cord (cauda equina) and the resulting nerve roots pass. These pass through the natural openings of the vertebral bodies and then branch out into the lumbar plexus, which is responsible for 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, pain in the spine is gradually not only intensified, but also supplemented by other disorders. If a deformed disc or swollen soft tissues as a result of the inflammatory process squeeze the spinal root that passes near them, neurological disorders occur. Therefore, pain in the spine in the lumbar region can be supplemented by radiating to the buttocks, groin, front, inner, outer thigh, lower leg and foot. It depends on the type of nerve root that will be damaged, that is, at which pathological changes in the movement segment of the spine will be observed. In addition, in the corresponding areas of the lower extremities, disturbances in sensitivity can be observed in the form of a feeling of crawling, numbness, changes in temperature sensitivity, pain, tactile stimuli and mobility. limited.
Changes in the height and functionality of the discs resulting from osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as degeneration of the vertebral bodies themselves. The consequence is the development of spondylosis, that is, calcification of the anterior longitudinal ligament and the formation of bone-cartilage growths on the surface of the vertebral bodies (osteophytes). They can not only injure the surrounding tissue and compress the roots of the spine, causing severe pain in the spine, but also grow together. As a result, the adjacent vertebral bodies are combined into one whole, which severely limits mobility in the lower back.
Osteochondrosis may be accompanied by reactive changes in the vertebral bodies, especially aseptic reactive spondyloarthritis, leading to osteosclerosis. This is accompanied by compaction of bone tissue and greatly increases the likelihood of vertebral fractures.
Facet joint diseases
Pathologies of the facet or facet joints of the lumbar spine, in particular their osteoarthritis, can also cause spine pain in the lumbar region, including severe pain. Although most often the pain is painful and localized deep inside. Their appearance is due to the fact that their synovial capsule is richly innervated. In such situations, the pain is usually concentrated directly in the affected area and tends to increase with flexion, extension, rotation of the body, prolonged standing. Walking and sitting help reduce their gravity. But in some cases, pain can also be felt in the groin, tailbone, and back and outer thighs.
Inflammatory diseases of the spine
Inflammatory diseases of the spine are less common than pathologies of the intervertebral discs and facet joints. However, they also injure 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 by the age of 20. This distinguishes them from degenerative-dystrophic pathologies of the discs and joints of the spine, which often develop after 40 years. In this case, the pain is characterized by a gradual increase in intensity. In addition, their severity decreases after physical exertion, but does not decrease at rest. Therefore, in inflammatory diseases, the spine in the lumbar region often hurts at night, and especially strong in the morning, immediately after sleep.
The most difficult situation is observed with ankylosing spondylitis, and it is she who more often than other inflammatory diseases affects the lumbar region. This term refers to the inflammation of the intervertebral joints with their subsequent immobilization due to the formation of dense bone, cartilage or fibrous fusion between the articular bone structures.
At first it is characterized by mild back pain, but over time it gradually spreads higher, covering the thoracic spine and then the cervical spine. This is associated with the development of a limitation of the mobility of the spine in all planes, since the spine, due to the changes taking place, seems to be immersed in a specific case. Also observed:
- alignment of lumbar lordosis (natural curvature of the spine in the lumbar region);
- worsening of thoracic kyphosis, which causes curvature;
- reflex tension of the back muscles;
- progressive worsening of the limitation of mobility due to the involvement of the facet joints in the pathological process and the ossification of the intervertebral discs;
- morning stiffness for an hour or more.
In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucous membranes (conjunctivitis), iris and ciliary body of the eyeball (iridocyclitis) is observed.
The progression of ankylosing spondylitis leads to the fact that an increasing number of joints in the pathological process. As a result, patients are forced to acquire the so-called supplicant pose. This means a pronounced kyphosis of the thoracic spine, an inclination of the upper body downwards, bending of the knees with a strong limitation in the range of motion of the chest, which affects the depth of breathing.
The rate of disease progression depends on the adequacy and completeness of treatment.
Compression fracture of the vertebra
Compression fracture is the flattening of the vertebral body, as a result of which it becomes wedge-shaped. This leads to disruption of the anatomy of the spine, can cause trauma to the spinal cord and its roots, and also becomes a trigger for the rapid progression of degenerative-dystrophic changes.
Lumbar vertebrae 1 and 2 are more susceptible to injury because they take on the greatest axial load.
Compression fractures of the spine often occur in older people due to the development of osteoporosis, that is, a decrease in bone density. In such cases, to injure oneself may be enough not only a slight fall, but also lifting weights, an unsuccessful movement.
Pathology is characterized by the presence of pain in the spine, which limits movement, increases with sitting position, movement and attempts to lift a straight leg. It usually lasts 1 to 2 weeks and then gradually decreases over 2 to 3 months. In some cases, there is irradiation of pain in the ridges of the iliac bones and hips. A decrease in the height of a broken vertebra causes an increase in lumbar lordosis, which also contributes to the appearance of painful sensations.
If a fracture is not diagnosed in time, a decrease in the height of the vertebra leads to changes in posture, a decrease in growth. This causes reflex tension and shortening of the muscles in the spine, 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, as well as metastases, the source of which are neoplasms of other organs. This is much less common than pathologies of intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, namely only in 1-2% of patients with back pain. But such lesions require diagnosis and treatment as early as possible.
The features of neoplastic lesions of the spine, in addition to pain, are:
- an increase in body temperature, including up to subfebrile values;
- unreasonable 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 pain relievers.
Even if you have 1 or 2 of these symptoms, you should immediately make an appointment with your doctor.
Likewise, the following may appear:
- Chondroma is a malignant tumor diagnosed in 20% of patients with cancerous lesions of the spine. Most often it is formed in the sacrum and can occur in people of any age and sex.
- Young's sarcoma - occurs in 8% of patients with neoplastic lesions of the spine. More common in young men.
- Chondrosarcoma is a malignant tumor, which accounts for 7 to 12% of cases. It is found more often in middle-aged men.
- Aneurysmal bone cyst is a benign tumor.
- Hemangioma is a benign vascular tumor that is present in 11% of people. It may go undetected throughout a person's life. But it increases the risk of vertebral fractures.
- Metastases from other tumors are secondary malignant neoplasms. Most often, cancer of the breast, prostate, lungs and less often of the kidneys, thyroid gland and skin metastasizes to the spine.
Diagnostic
If the spine in the lumbar region hurts, it is worth making an appointment with a neurologist or vertebrologist. During the appointment, the doctor first collects a history, asking questions about the nature of the pain, the circumstances of its occurrence, the duration of its persistence, the presence of other symptoms, the way of life, etc.
Then the specialist conducts an examination. As part of it, he not only palpates the spine, determines the location of pain, assesses the gait and posture that the patient takes unconsciously, but also performs functional tests. With their help, you can detect signs of ankylosing spondylitis, neurological deficit, assess the degree of mobility of the spine and obtain other diagnostic data.
Based on this, the doctor can already assume the possible causes of the pain syndrome. To clarify them, as well as to accurately determine the degree of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed. Most often they resort to help:
- frontal and lateral projection radiography, sometimes with functional radiological examinations;
- CT - allows better visualization of bone structures, therefore, it is more often used to diagnose spondylosis, fractures, bone tumors, etc.
- MRI - allows the most careful assessment of the condition of cartilage structures and soft tissues, so it is often used to diagnose osteochondrosis, protuberances, intervertebral hernias, spinal cord injuries, etc.
- electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of nerve damage;
- radioisotope bone scan - used to diagnose malignant tumors and metastases;
- X-ray densitometry is the best method for diagnosing osteoporosis;
- myelography - used to check for signs of compression of the spinal cord and nerves in the cauda equina.
Processing
For each patient, the treatment is chosen strictly on an individual basis, and not only on the basis of the diagnosis, but also the nature of the existing concomitant pathologies. Nevertheless, it is the cause of the back pain that determines the tactics of therapy. It can be conservative or involve surgery.
But the first step is always to direct efforts to relieve the pain, especially if it is severe. For this, patients are prescribed NSAIDs, antispasmodics, analgesics. And in severe cases, blockages of the spine are performed - injections of anesthetics and corticosteroids to specific points on the spine.
Bed rest is not shown to all patients. And with pathologies of the intervertebral discs, it can be completely contraindicated, since a decrease in physical activity contributes to the transformation of acute pain in the spine into chronic pain.
Exclusively conservative or non-surgical treatment is prescribed for:
- osteochondrosis;
- ankylosing spondylitis;
- osteoarthritis of the facet joints;
- mild compression fractures.
It is generally complex and consists of:
- drug therapy, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids,
- physiotherapy (UHF, magnetotherapy, laser therapy, traction therapy, etc. );
- Exercise therapy;
- manual therapy.
If the cause of back pain is intervertebral hernia, protuberances, spondylosis, severe vertebral fractures, tumors, surgery is often indicated. It is also necessary for:
- ineffectiveness of conservative treatment for degenerative-dystrophic changes;
- an increase in neurological deficit;
- instability of the motion segment of the spine;
- the development of complications, especially spinal stenosis.
Most modern spinal surgeries are minimally invasive. Thanks to this, the intraoperative and postoperative risks are greatly reduced, the rehabilitation period is shortened and facilitated, and the efficiency is not inferior to more traumatic open operations. Depending on the disease detected, it may be recommended:
- Discectomy is an operation indicated primarily for hernias and protuberances, especially those causing cauda equina syndrome. It can be performed using microsurgical instruments through an incision of the order of 3 cm (microdiscectomy) and using endoscopic material supplied to the spine by punctures with a diameter of about 1 cm (endoscopic discectomy). When the intervertebral disc is completely removed, it is usually replaced with implants.
- Vertebroplasty and Kyphoplasty - indicated for compression fractures of the vertebrae, hemangiomas and some other diseases. The essence of the operation is to inject fast-hardening bone cement through a thin cannula into the vertebral body, making it stronger. With kyphoplasty, in addition, it is possible to restore the normal dimensions of the vertebral body, which is important in the event of a significant decrease in their height as a result of a fracture.
- Fixation surgeries are used to stabilize the spine. For this, metal structures of a different nature are used, which usually remain in the patient's body until the end of his life.
So, the spine in the lumbar region can hurt for various reasons. Therefore, with the prolonged persistence of painful sensations, their regular appearance, the increase in pain over time, and even more the addition of other symptoms, it is imperative to contact a vertebrologist or neurologist. Early diagnosis will allow detecting pathological changes at the stages when it is easiest to cope with and if the disease is not completely cured, then at least stop its progression and maintain a high standard of living.