Symptoms of lumbar osteochondrosis

Differences of osteochondrosis of the lumbar spine from the defeat of the cervical from the clinical point of view are the following:

• absence of the spinal cord below the level of the vertebra L1, and therefore in the lumbar-sacral region, symptoms of damage to the bone-ligament apparatus and roots of the horse tail are manifested;
• at the lumbar level, pathological manifestations are mainly caused by protrusions and prolapses of the intervertebral disc, and the importance of osteophytes recedes into the background.
• pathological mobility is more often detected in the joint between L4-L5 than between L5 and S1, which is explained by the topographic features of articular processes of the lumbar vertebrae and sacrum. The displacement of the vertebrae L5 is hampered by the direction of the articular processes of the sacrum, and with the extension there is some displacement of the vertebrae anteriorly, and with flexion - posteriorly.

Clinical observations suggest a relative rarity of bulging disc herniation directly into the intervertebral foramen with the infringement of the root there;

• Disk hernia usually squeezes one, in rare cases, two roots simultaneously. The loss of the disc L ₄ -L ₅ compresses the spine L5 and, to a lesser extent, the spine S1. The lumbosacral hernias located along the middle line can, in addition to the spine S; squeeze also the roots of S ₂ -S ₃;
• spinal cord can not lengthen under the action of compression. The hernia compresses the spine, the latter is deformed from constant exposure to it, the radicular fibers undergo significant stretching, the greater the further they are from the hernia from the opposite hernia side;
• the painful phenomena from the side of the spinal roots as a result of compression and stretching of the disc herniations undergo 3 stages:
  • Stage I - irritation syndrome - paresthesia and pain;
  • Stage II - syndrome of compression;
  • Stage III - syndrome of interruption or radicular paralysis, the last phase of radicular damage: paralysis of the muscular area lying on the periphery of the affected root;
• mechanism of disc hernia formation (one of the conditioning factors) - in those cases when there is a free flexion or extension of the trunk (not accompanied by contraction of the muscles of the antagonists), the pulpous nucleus moves to avoid excessive pressure, thus relieving the pressure of the vertebral bodies located above thereby fulfilling the physiological role of the bearing. Conversely, if the force of flexion or extension acts on the spine with the muscles-antagonists in contraction, these muscles do not allow the pulpous nucleus to be manipulated and thus, from the mechanical point of view, real levers are created, whose resistance lies at the level of the pulposal core fixed between the surrounding walls , which can be freed from pressure only by falling out.

So, for example, with flexion of the trunk, whose action is directed to the spine with contracted extensor muscles, the pulpous nucleus tends to advance posteriorly, and the front part of the disc decreases. The pulpous nucleus, not being contractible, falls through the surrounding walls or "pushes" fibrous tissue into the spinal canal.

Thus, osteochondrosis of the spine is a polyfactorial disease involving both hereditary, congenital traits, and a number of acquired factors: static-dynamic, metabolic, etc. Initially, intervertebral disks are affected, and then other parts of the spine, the locomotor apparatus and the nervous system.

[1], [2], [3], [4], [5]