Dorsopathy of the lumbar spine

Such a generalized diagnostic definition as dorsopathy of the lumbar spine 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 (in Latin dorsum - back) is not a disease, but a set of symptoms.

Epidemiology

Accurate statistics of complaints of low back pain in musculoskeletal pathologies of the lumbar region of the spine is difficult, however, experts estimate its prevalence among adults 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 spine come out on top (70% of cases).

At least 95% of all cases of herniated discs occur in lumbar disc herniations (L4-L5 or L5-S1). Most often they are detected in people older than 75 years (43% of cases) and aged 65+ (30%). [2]According to some reports, dorsopathy with herniated discs is 14-18% of cases. [3]

Causes of the dorsopathies of the lumbar spine

The most common  causes of pain in the spine  at the level of its lumbar or lumbar region (lat. Lumbus - lower back) are distinguished as:

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

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

Lumbar dorsopathy and lumbalgia (back pain) is the same as lumbar dorsopathy with pain. All the details in the publication:  Lumbodynia of the lumbar spine

Dorsopathy of the lumbosacral spine means pain, the source of which in most cases is a herniated disc between the fifth lumbar vertebra (L5) and the first sacral (S1), which doctors can define as lumbar dorsopathy L5-S1.

Myogenic back pain is also common  due to inflammation of the muscles (in particular, the latissimus dorsi and quadratus lumborum muscles) 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 pathologies, risk factors for the development of symptoms characteristic of lumbar dorsopathy are associated with spinal injuries; obesity; a decrease in bone mineral density (osteoporosis); ankylosing spondylitis, leading to fusion of the vertebral joints (Strumpell-Bekhterev-Marie disease); skeletal hyperostosis (Forestier's disease); congenital disorders of the structures of the spine; paravertebral neoplasms.

For example, the risk of a herniated lumbar disc 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: the intervertebral disc can change its shape and volume with age, 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 the appearance of back pain, that is, the pathogenesis of pain 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 pro-inflammatory cytokines and inflammatory mediators in the occurrence of back pain in herniated discs and spinal canal stenosis. These include interleukin-1α, interleukin-1β, interleukin-6, tumor necrosis factor alpha (TNF), as well as the cellular bioregulator prostaglandin E2, which are produced 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 , then pro-inflammatory cytokines, by increasing the sensitivity of damaged neurons of the spinal nerve roots (radix nervi spinalis), become pain stimulants. [8]

Symptoms of the dorsopathies of the lumbar spine

The first signs of lumbar dorsopathy are  pain in the lumbar region of varying intensity . It can be acute or chronic, occur after exercise, 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 lumbar dorsopathy implies the presence of  degenerative-dystrophic diseases of the spine  (osteochondrosis, spondylarthrosis or spondylosis) that have similar symptoms. Read more:

• Symptoms of lumbar osteochondrosis
• Pain in osteochondrosis

As the name implies, vertebrogenic dorsopathy of the lumbar spine is associated with pathologies of the vertebrae (lat. - vertebra) and, in fact, it is a synonym for degenerative dorsopathy. A diagnostic definition is also used -  vertebrogenic lumbalgia 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 outside of the leg with its numbness. This neuropathic pain can be defined as lumbar dorsopathy and sciatica. [9], [10]

There are also such clear signs of nerve root compression as a weakening of the knee jerk, a decrease in muscle tone, and changes in gait.

The same causes cause sciatica, 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 be manifested by sensory disturbances, mono or paraparesis, paralysis of the legs, as well as functional disorders of the internal organs located in the small pelvis. More information in the material -  Osteochondrosis of the spine: neurological complications

Diagnostics of the dorsopathies of the lumbar spine

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, associated with diseases of the internal organs, a differential diagnosis is carried out.

All the details in the publications:

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

Treatment of the dorsopathies of the lumbar spine

How is the treatment, read:

• Treatment of pain in the spine
• Medical treatment of osteochondrosis of the spine
• Treatment of vertebral hernia
• Treatment of vertebrogenic lumbodynia
• Treatment of lumbalgia of the spine: standards, drugs, exercise therapy, exercises

What drugs are used, in detail in the articles:

• Pills for pain in muscles and joints
• Pills for osteochondrosis
• Ointments for 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:

• Therapeutic exercise for osteochondrosis of the lumbosacral spine
• Muscle stretching in osteochondrosis of the lumbosacral spine
• Treatment of osteochondrosis: exercise in water
• Restorative treatment of osteochondrosis: simulators

Gymnastics for lumbar dorsopathy includes  exercises for strengthening 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 by 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?

Probably, it is possible if you do not injure the spine, do not overload it, monitor your posture, keep a balance of physical activity (it is useful to do exercises in the morning, walk, swim, do yoga), do not gain extra pounds (that is, eat rationally).

In the book “On the Benefits of Parts of the Body” by the Greek physician Galen (130-200 AD) there are the words: “Nature does not create anything without a purpose... Nature seeks 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 kept in balance.

Forecast

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