About 40-80% of people complain that the spine in the lumbar region hurts, but no more than 25% of them seek medical help. Indeed, such unpleasant sensations can be caused both by relatively harmless reasons and by pathological changes in the spine. Therefore, you shouldn't treat them with contempt.
Causes of back pain
The spine consists of a whole complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves. Changes in each of them can be accompanied by painful sensations and of a different nature. Additionally, the spine is surrounded by paravertebral muscles, pain in which patients often confuse with spine pain. Therefore, the causes of pain can be many. This 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 is systematically injured in the lumbar region indicates the development of some diseases.
Most often, in such situations, patients are diagnosed with:
- pathology of the intervertebral discs (decrease in disc height, protrusion, intervertebral hernia, discitis);
- facet joint pathologies (spondylarthrosis, joint 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.
Disorders of the intervertebral disc
Degenerative changes of the intervertebral discs or osteochondrosis are very common, especially among young and middle-aged people. This is largely due to the need to sit for a long time or engage in heavy physical work. In old age, the disc dries up and the vertebrae grow together.
Already in the initial stages of the onset of degenerative changes in the intervertebral discs, which are cartilages of a special configuration that divide the vertebral bodies, pain in the spine can 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 provokes an aseptic inflammatory process, which leads to a reflex spasm of the segmental muscles. As a result, pain in the spine increases and there are also restrictions on mobility.
Osteochondrosis tends to progress steadily, especially in the absence of appropriate treatment and lifestyle correction. Subsequently, it leads to the formation of bumps and subsequently to intervertebral hernias, which provoke the aggravation of existing symptoms and the appearance of new ones.
The lumbar region, as it carries the highest loads in daily activities, is most often affected.
The protrusions are protrusions of 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 break. As a result, the nucleus goes beyond 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 as with prolonged sitting in one position, walking, standing.
Often patients with already formed bumps and hernias unconsciously assume a forced posture, tilting slightly towards the sound side. In this case, pain in the spine in the lumbar region can reach a high intensity, depriving a person of working capacity. In such cases, he is forced to adhere to bed rest and, to relieve pain, squeezes the leg bent and brought to the stomach.
Most often, protrusions and hernias form in the direction of the spinal canal, where the spinal cord (cauda equina) and the nerve roots branching off from it pass. The latter pass through natural openings in the vertebral bodies and branch further 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 ailments. If a deformed disc or swollen soft tissue due to the inflammatory process squeezes 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, inside, outside of the thigh, lower leg and foot. It depends on the type of nerve root that will be compromised, that is, at the level of which pathological changes of the spinal motion segment will be observed. In addition, in the corresponding zones of the lower extremities, sensitivity disturbances in the form of a crawling sensation, numbness, changes in sensitivity to temperature, pain, tactile stimuli and limited mobility can be observed.
Changes in the height and function 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 of this is the development of spondylosis, that is, the calcification of the anterior longitudinal ligament and the formation of bone-cartilaginous growths on the surface of the vertebral bodies (osteophytes). Not only can they injure the surrounding tissue and squeeze the spinal roots, causing severe pain in the spine, but they can also grow together. As a result, the adjacent vertebral bodies are combined into a single whole, which sharply limits the mobility in the lower back.
Osteochondrosis can be accompanied by reactive changes in the vertebral bodies, in particular reactive aseptic spondylitis, which leads to osteosclerosis. This is accompanied by compaction of the bone tissue and greatly increases the likelihood of vertebral fractures.
Diseases of the facet joints
Pathologies of the facets or facets of the lumbar spine, especially their osteoarthritis, can also cause pain in the spine in the lumbar region, including severe pain. Although more often the pain is aching and localized deep down. 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 severity. But in some cases, pain can also be given to the groin area, tailbone, as well as the back and outside of the thighs.
Inflammatory diseases of the spine
Inflammatory diseases of the spine are less common than diseases of the intervertebral discs and facet joints. However, they also hurt the spine. These include:
- ankylosing spondylitis or ankylosing spondylitis;
- reactive arthritis;
- psoriatic arthritis, etc.
Symptoms of these diseases usually occur before the age of 40 and more often at the age of 20. This distinguishes them from degenerative-dystrophic diseases of the discs and joints of the spine, which often develop after the age of 40. In this case, the pain is characterized by a gradual increase in intensity. Furthermore, 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, cartilage or fibrous bone fusion between the articulated bone structures.
At first it is characterized by mild back pain, but over time it gradually spreads higher, covering the chest and then the cervical spine. This is associated with the development of the limitation of the mobility of the spine in all planes, since the spine, as a result of the changes taking place, seems to be immersed in a specific case. Also observed:
- alignment of the lumbar lordosis (natural curvature of the spine in the lumbar region);
- aggravation of thoracic kyphosis, which causes stooping;
- reflex tension of the back muscles;
- progressive worsening of the limitation of mobility due to the involvement of the articular facets in the pathological process and ossification of the intervertebral discs;
- morning stiffness for an hour or more.
In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucosa (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. Means pronounced kyphosis of the thoracic spine, inclination of the upper body down, bending of the knees with a sharp limitation of 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 the disruption of the anatomy of the spine, can cause trauma to the spinal cord and its roots, and also become a trigger for the rapid progression of degenerative-dystrophic changes.
Lumbar vertebrae 1 and 2 are more susceptible to injury, as they take on the greatest axial load.
Compression fractures of the spine often occur in the elderly due to the development of osteoporosis, that is, a decrease in bone density. In these cases, not only a slight fall may be enough to injure oneself, but also lifting weights, an unsuccessful movement.
The pathology is characterized by the presence of pain in the spine, which limits movement, increases with sitting, movement and attempts to lift a straight leg. It usually lasts 1-2 weeks and then gradually decreases over 2-3 months. In some cases, there is irradiation of pain in the crests 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 occurrence of painful sensations.
If a fracture is not diagnosed in a timely manner, 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 spinal muscles, which causes chronic back pain and requires a long 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 are neoplasms of other organs. This is much less common than pathologies of the intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, i. e. only in 1-2% of patients with back pain. But such injuries require diagnosis and treatment as soon as possible.
The characteristics of neoplastic lesions of the spine, in addition to pain in it, are:
- an increase in body temperature, including up to subfebrile values;
- unreasonable weight loss;
- inability to find a comfortable position of the body;
- 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.
Similarly, the following may appear:
- Chondroma is a malignant tumor diagnosed in 20% of patients with cancerous lesions of the spine. Most often it forms in the sacrum and can occur in people of any age and gender.
- Young's sarcoma - occurs in 8% of patients with neoplastic lesions of the spine. More common in young people.
- Chondrosarcoma is a malignant neoplasm, which accounts for 7-12% of cases. It is found most often in middle-aged men.
- Aneurysmal bone cyst is a benign neoplasm.
- Hemangioma is a benign vascular tumor found in 11% of people. It may not be detected during a person's life. But the risk of vertebral fractures increases.
- Metastases from other tumors are secondary malignancies. More often, breast, prostate, lung, and less often kidney, thyroid, and skin cancer metastasizes to the spine.
Diagnostics
If the spine in the lumbar region hurts, it is worth making 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 onset, 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 assumes unconsciously, but also conducts 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 additionally prescribed. Most often they resort to help:
- radiography in frontal and lateral projection, 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 you to evaluate as scrupulously as possible the state of cartilage structures and soft tissues, therefore it is often used to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord injuries, etc. ;
- electromyography - indicated for neurological disorders of unknown origin, as well as for assessing 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 detect signs of compression of the spinal cord and the nerves of the cauda equina.
Treatment
For each patient, treatment is selected strictly on an individual basis and not only on the basis of the diagnosis, but also on the nature of the existing concomitant pathologies. However, it is the cause of back pain that determines the therapy tactics. 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, pain relievers. And in severe cases, spinal blocks are performed: injections of anesthetics and corticosteroids at specific points in the spine.
Bed rest is not shown to all patients. And with the 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.
Only conservative or non-surgical treatment is prescribed for:
- osteochondrosis;
- ankylosing spondylitis;
- arthrosis of the facet joints;
- slight compression fractures.
It is usually complex and consists of:
- drug therapy, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids,
- physiotherapy (UHF, magnetotherapy, laser therapy, traction therapy, etc. );
- Physical therapy;
- manual therapy.
If the cause of back pain are intervertebral hernias, protrusions, spondylosis, severe vertebral fractures, tumors, surgery is often indicated. It is also necessary for:
- ineffectiveness of conservative therapy for degenerative-dystrophic changes;
- an increase in neurological deficit;
- instability of the spinal motion segment;
- the development of complications, in particular, stenosis of the spinal canal.
Most modern spinal surgeries are minimally invasive. Thanks to this, intraoperative and postoperative risks are sharply reduced, the rehabilitation period is shortened and facilitated, and the effectiveness is not inferior to more traumatic open operations. Depending on the disease detected, it may be recommended:
- Discectomy is an operation indicated mainly for hernias and protrusions, especially those that cause the cauda equina syndrome. It can be performed using microsurgical instruments through an incision of the order of 3 cm (microdiscectomy) and using endoscopic equipment delivered to the spine through puncture 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 rapidly hardening bone cement through a thin cannula into the vertebral body, which strengthens it. With kyphoplasty it is also possible to restore the normal size of the vertebral body, which is important in case of severe decrease in their height following 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 life.
Therefore, the spine in the lumbar region can hurt for a variety of reasons. Therefore, with the prolonged persistence of painful sensations, their regular occurrence, the increase in pain over time, and even more so the addition of other symptoms, it is imperative to contact a vertebrologist or neurologist. Early diagnosis will allow to detect pathological changes at the stages in which it is easier to cope with them and if the disease is not completely cured, at least stop its progression and maintain a high standard of living.