Dorsopathy of the lumbar spine

Such a general diagnostic definition as lumbar spine dorsopathy means the presence of symptoms, primarily pain, which are caused exclusively by musculoskeletal pathologies localized in the lumbar region of the back. [ 1 ]

Thus, dorsopathy (from Latin dorsum – back) is not a disease, but a set of symptoms.

Epidemiology

Accurate statistics of complaints of lower back pain in musculoskeletal pathologies of the lumbar spine are difficult, however, its prevalence among adults is estimated by experts at 25-45% with a peak at the age of 35 to 55 years. Although 60-80% of all people experience back pain during their lifetime.

Among chronic conditions, dorsopathy and osteochondrosis of the lumbar region come first (70% of cases).

At least 95% of all cases of intervertebral disc herniation are lumbar intervertebral disc herniations (L4-L5 or L5-S1). They are most often detected in people over 75 years of age (43% of cases) and 65+ (30%). [ 2 ] According to some data, dorsopathy in disc herniation accounts for 14-18% of cases. [ 3 ]

Causes lumbar spine dorsopathy

The most common causes of pain in the spine at the level of its lumbar or lumbar region (Latin lumbus – lower back) are:

• protrusion of the disc between the lumbar vertebrae (L1-L5) and lumbar intervertebral hernia;
• displacement of lumbar vertebrae;
• osteochondrosis of the lumbosacral spine (L5-S1);
• proliferation of bone tissue (osteophytes) along the edges of the vertebral joints - lumbar spondylosis; [ 4 ]
• inflammation of the intervertebral (facet) joints – spondyloarthritis; [ 5 ]
• deforming arthrosis of the facet joints of the lumbar region - lumbar spondyloarthrosis; [ 6 ]
• lumbar kyphosis.

Dorsopathy may be associated with curvature of the spine - scoliosis. The result of curvature of the spinal column in the thoracic and lumbar regions is thoracolumbar dorsopathy. And with severe scoliosis, with osteoarthrosis of the cervical and lumbar spine, dorsopathy of the cervical and lumbar spine is possible.

Lumbar dorsopathy and lumbago (lower back pain) are the same as lumbar dorsopathy with pain syndrome. All the details in the publication: Lumbago of the lumbar spine

Lumbosacral dorsopathy refers to pain that in most cases is caused by a herniated disc between the fifth lumbar vertebra (L5) and the first sacral vertebra (S1), which doctors may define as lumbar dorsopathy L5-S1.

Myogenic back pain is also common, caused by inflammation of the muscles (particularly the latissimus dorsi and quadratus lumborum) or damage to their tendons. More information in the articles:

• Pain in the muscles of the lower back
• Myofascial pain syndrome

Risk factors

In addition to all the above-mentioned pathologies, risk factors for the development of symptoms characteristic of lumbar dorsopathy are associated with spinal injuries; obesity; decreased bone mineral density (osteoporosis); ankylosing spondylitis leading to fusion of the vertebral joints (Strumpell-Bekhterev-Marie disease); skeletal hyperostosis (Forestier disease); congenital disorders of the spinal structures; paravertebral neoplasms.

For example, the risk of a lumbar disc herniation in the lumbar region increases with overload, including heavy lifting and prolonged stay in a forward-leaning position (particularly when working).

There is also an age factor: with age, the intervertebral disc can change its shape and volume, its biochemical and mechanical characteristics change (with weakening, stretching and rupture of the fibrous ring of the disc), which leads to an intervertebral hernia.

Pathogenesis

The main mechanisms of back pain, that is, the pathogenesis of pain syndrome in lumbar dorsopathy caused by degenerative-dystrophic diseases of the spine, are described in detail in the publication - Symptoms of back pain

Back in the late 1990s, a group of Japanese researchers identified, and European studies in the mid-2000s confirmed, the involvement of proinflammatory cytokines and inflammatory mediators in the occurrence of back pain in intervertebral disc herniation and spinal stenosis. These include interleukin-1α, interleukin-1β, interleukin-6, tumor necrosis factor alpha (TNF), as well as the cellular bioregulator prostaglandin E2, the production of which by fibroblasts, endothelial cells, cartilage cells (chondrocytes) and loose connective tissue (histiocytes) increases with pathological changes in the intervertebral discs and narrowing of the lumen of the spinal canal. [ 7 ]

As for the radicular syndrome – radiculopathy, proinflammatory cytokines, increasing the sensitivity of damaged neurons of the spinal nerve roots (radix nervi spinalis), become pain stimulators. [ 8 ]

Symptoms lumbar spine dorsopathy

The first signs of lumbar dorsopathy are pain of varying intensity in the lumbar region. It can be acute or chronic, occur after physical exertion or be present at rest. Pain of radicular etiology radiates to the thigh and buttock.

It should be borne in mind that the so-called degenerative dorsopathy of the lumbar spine implies the presence of degenerative-dystrophic diseases of the spine (osteochondrosis, spondyloarthrosis or spondylosis), which have similar symptoms. Read more:

• Symptoms of lumbar osteochondrosis
• Pain in osteochondrosis

As the name suggests, vertebrogenic lumbar dorsopathy is associated with pathologies of the vertebrae (lat. - vertebra) and, in fact, it is a synonym for degenerative dorsopathy. The diagnostic definition is also used - vertebrogenic lumbago syndrome.

Lumbar dorsopathy and radicular syndrome are manifested by pain in the back, as well as along the branching sciatic nerve - in the thigh, buttock and on the outer side of the leg with numbness. This neuropathic pain can be defined as lumbar dorsopathy and lumbosciatica. [ 9 ], [ 10 ]

Also observed are such obvious signs of nerve root compression as weakening of the knee reflex, decreased muscle tone, and changes in gait.

The same causes are responsible for lumbosacral radiculitis, which can be defined by a doctor as lumbosacral dorsopathy with radicular syndrome. [ 11 ]

Read more:

• Radicular syndromes and back pain
• Lumbar Radiculopathy and Back Pain

Complications and consequences

The main complications and consequences of lumbar dorsopathy are neurological in nature and can manifest as sensory disturbances, mono or paraparesis, paralysis of the legs, as well as functional disorders of the internal organs located in the pelvis. More information in the material - Osteochondrosis of the spine: neurological complications

Diagnostics lumbar spine dorsopathy

Instrumental diagnostics includes:

• X-ray and computed tomography of the spine;
• MRI of the lumbar spine;
• electromyography.

To exclude visceral pain in the lower back, that is, pain associated with diseases of the internal organs, differential diagnostics are carried out.

All details in the publications:

• Methods of diagnosing back pain
• Diagnosis of pain in the spine
• Diagnosis of osteochondrosis of the lumbosacral spine

Treatment lumbar spine dorsopathy

How the treatment is carried out, read:

• Treatment of pain in the spine
• Drug treatment of spinal osteochondrosis
• Treatment of vertebral hernia
• Treatment of vertebrogenic lumbago
• Treatment of lumbago of the spine: standards, medications, exercise therapy, exercises

What medications are used, detailed in the articles:

• Tablets for muscle and joint pain
• Tablets for osteochondrosis
• Ointments for lower back pain
• Ointments for osteochondrosis

Treatment with injections involves local novocaine blockades, often with the simultaneous use of corticosteroid drugs.

Physiotherapeutic treatment is prescribed, for example, physiotherapy for osteochondrosis of the spine.

The most important component of complex therapy is exercise therapy for lumbar dorsopathy:

• Physiotherapy for osteochondrosis of the lumbosacral spine
• Muscle strain in osteochondrosis of the lumbosacral spine
• Treatment of osteochondrosis: physical exercises in water
• Restorative treatment of osteochondrosis: exercise machines

Gymnastics for lumbar dorsopathy includes exercises to strengthen the muscular corset for the lower back.

What kind of massage is needed for dorsopathy of the lumbosacral spine, read in the publications:

• Treatment of osteochondrosis: massage
• Massage for osteochondrosis of the lumbosacral spine

If all attempts to reduce the intensity of pain using conservative methods fail, surgical treatment is used, and depending on the causes of dorsopathy, this may be discectomy, laser decompression of the intervertebral disc, laminectomy, etc.

Prevention

Is it possible to prevent diseases of the spine in its lumbar and lumbosacral regions?

It is probably possible if you do not injure your spine, do not overload it, watch your posture, maintain a balance of physical activity (it is useful to do exercises in the morning, walk, swim, do yoga), and do not gain extra pounds (that is, eat a balanced diet).

In the book "On the Usefulness of the Parts of the Body" by the Greek physician Galen (130-200 AD) there are the words: "Nature creates nothing without a purpose... Nature strives to keep everything in motion and at the same time strives for the safety of its components. The spinal column shows how these two more or less opposite tendencies can be maintained in equilibrium."

Forecast

The prognosis for lumbar dorsopathy depends on both its cause and the success of treatment, which is usually symptomatic and lasts for years for many patients.