Symptoms of lumbar osteochondrosis

The differences between osteochondrosis of the lumbar spine and damage to the cervical spine from a clinical point of view are as follows:

• absence of the spinal cord below the level of the L1 vertebra, and therefore in the lumbosacral region, symptoms of damage to the bone-ligamentous apparatus and roots of the equine tail appear;
• At the lumbar level, pathological manifestations are caused mainly by protrusions and prolapses of the intervertebral disc, and the significance of osteophytes recedes into the background.
• pathological mobility is more often detected in the articulation between L4-L5 than between L5 and S1, which is explained by the topographic features of the articular processes of the lumbar vertebrae and the sacrum. The displacement of the L5 vertebra is prevented by the direction of the articular processes of the sacrum, and during extension there is some displacement of the vertebra forward, and during flexion - backward.

Clinical observations give reason to consider it a relative rarity for a herniated disc to protrude directly into the intervertebral foramen with the nerve root being pinched there;

• A disc herniation usually compresses one, rarely two roots at the same time. A prolapsed disc L4 _- L5 _compresses the L5 root and, to a lesser extent, the S1 root. Lumbosacral hernias located in the midline can, in addition to the S root, also compress the S2 _- S3 _roots;
• the spinal root cannot be lengthened under the effect of compression. The hernia compresses the root, the latter is deformed from constant impact on it, the root fibers are subject to significant stretching, the greater the further they are located from the hernia on the side opposite the hernia;
• painful phenomena from the spinal roots as a result of compression and stretching caused by a herniated disc go through 3 stages:
  • Stage I - irritation syndrome - paresthesia and pain;
  • Stage II - compression syndrome;
  • Stage III - interruption syndrome or radicular paralysis, the last phase of radicular damage: paralysis of the muscle territory lying on the periphery of the affected root;
• mechanism of disc herniation (one of the causative factors) - in cases where there is free flexion or extension of the trunk (not accompanied by contraction of the antagonist muscles), the nucleus pulposus, in order to avoid excessive pressure, moves, thus freeing itself from the pressure of the vertebral bodies located above it, thus performing the physiological role of a bearing. Conversely, if the force of flexion or extension acts on the spine with the antagonist muscles in contraction, these muscles do not allow the nucleus pulposus to manipulate and, thus, from a mechanical point of view, real levers are created, the resistance of which lies at the level of the nucleus pulposus, fixed between the walls that enclose it, which can only be freed from pressure by falling out.

For example, during trunk flexion, the action of which is directed at the spine with contracted extensor muscles, the nucleus pulposus tends to move backwards, and the anterior part of the disc decreases. The nucleus pulposus, not being contractible, falls through the walls surrounding it or "pushes" fibrous tissue into the spinal canal.

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

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