Vertebrogenic lumbalgia syndrome: why does low back pain appear and how to deal with it?

Spinal pain is a problem that a person can face at any age. Sudden pain can appear in any part of the back: in the cervical, thoracic or lumbar region, on the right, left or along the axial line. If painful sensations occur in the lumbar region, they talk about such a pathology as vertebrogenic lumbago with its characteristic pain syndrome.

What kind of disease is this?

The term "lumbago" is a generalized concept that doctors use to describe various types of pain in the lumbar region. That is, lumbago is a pain syndrome in the lumbar region that can have different causes. And the addition of the word "vertebrogenic" indicates that the cause of these pains lies in diseases of the spine.

Vertebrogenic lumbago cannot be called a full-fledged disease, because the pathology, which is in fact a consequence or complication of other diseases of the spine, is characterized by only one symptom - pain. Moreover, the intensity and nature of pain may vary depending on the type and characteristics of the course of the pathology.

Lumbago can occur in acute, subacute and chronic forms. It can occur as a result of injury, sudden turning or bending, and also when lifting heavy objects.

Epidemiology

According to statistics, pain syndrome in vertebrogenic lumbago is considered one of the most common reasons for visiting a doctor. And this is not surprising, given the fact that most often lumbago develops against the background of a very popular disease called "osteochondrosis", the incidence of which reaches 80% worldwide. Just before the appearance of pain syndrome, people may not even suspect the disease

About 85% of patients experience muscle-tonic pain, when spinal pathologies compress the motor nerve fibers of the spinal cord and cause long-term, stable tension in the flexor muscles, while the extensor muscles remain relaxed all the time. In this case, they speak of vertebrogenic lumbago with muscle-tonic syndrome.

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Causes vertebrogenic lumbalgia

As we have already mentioned, lumbago of vertebrogenic genesis is considered by doctors not as an independent disease, but as a complication of existing pathologies, which they focus on when making a diagnosis and prescribing treatment. But what causes, or rather diseases, can provoke the appearance of persistent pain syndrome in the lumbar region?

Scientists consider the following pathologies as causes of the development of vertebrogenic lumbago:

• osteochondrosis of the spine (development of a degenerative process in the intervertebral discs and cartilage),
• protrusion of a disc in the thoracic or lumbar spine (a disc protruding beyond the spinal column, where it can compress nerves and blood vessels),
• intervertebral hernias (disc displacement with rupture of the fibrous ring),
• tumor processes along the spine,
• the formation of bone growths along the edges of the vertebrae (spondylosis),
• inflammatory processes in the spinal column, causing the resolution of the vertebrae and deformation of the spine itself (spondylitis),
• displacement of vertebrae (spondylolisthesis),
• curvature of the spine (scoliosis),
• vertebral instability,
• destruction of bone tissue of the spine (osteoporosis),
• ankylosing spondylitis (Bechterew's disease, in which the mobility of the spine is impaired and tension in the back muscles increases, which results in chronic pain syndrome),
• inflammatory and degenerative changes in the intervertebral joints, characteristic of arthritis and arthrosis of the spine,
• congenital defects of the spinal column,
• lumbar spinal canal stenosis,
• spinal injuries.

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Risk factors

All the above diseases have pain syndrome in their clinical picture, but its occurrence is usually associated with certain moments. Thus, the risk factors for the development of vertebrogenic lumbago are considered to be:

• mechanical damage to the spine and surrounding tissues: bruises, blows, falls, sudden movements,
• excessive physical exertion,
• physical inactivity and sedentary work, which creates increased stress on the spine,
• standing for a long time and working in the garden, when the spine is in a curved position for a long time.
• hypothermia,
• systemic infectious pathologies and their relapses,
• flat feet (this pathology has a negative impact on the spine, increasing the load on it and causing curvature of the spinal column),
• sports that put a lot of stress on the spine, such as weightlifting,
• excess weight, which affects the spine in a similar way to injuries and heavy physical exertion,
• the period of puberty, when active growth of the skeleton occurs,
• the period of menopause with its characteristic osteoporosis of bones,
• pregnancy against the background of weakness of the back muscles.

All of the above factors affect the condition of our spine in one way or another, and not in the best way. This leads to the development of various diseases of the spinal column, which are accompanied by damage to nerve fibers and blood vessels, inflammation and muscle spasms, in which pain is a common symptom.

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Pathogenesis

In the pathogenesis of this disease, two important factors are considered that can cause lower back pain. We are talking about 2 syndromes: reflex and compression. The reflex form of vertebrogenic lumbago occurs as a result of irritation of sensitive receptors that are in the spine and soft tissues around it. The cause of reflex lumbago can be an inflammatory process localized in the lumbar region or a back injury of the same localization. The pain syndrome increases muscle tone and leads to their spasm, tense muscles in turn can squeeze blood vessels and nerve fibers, which only aggravates the situation, transferring pain to the category of chronic.

Compression lumbago occurs due to compression of nerve roots and vessels located near the spine, and sometimes the spinal cord itself. Compression is created by pathologically altered vertebrae and discs of the spinal column. In this case, vertebrogenic lumbago is considered a complication of spinal diseases.

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Symptoms vertebrogenic lumbalgia

The development of vertebrogenic pathology is usually indicated by its main symptom - pain, which can have a different nature, intensity and duration. Most often, patients complain of sharp shooting pains, significantly worsening their quality of life. Painful sensations arise or intensify when turning and bending, lifting weights. And in the acute form of lumbago, attacks of pain can occur with the slightest movement, so a person tries to take a position in which the severity of the symptom will be less.

The localization of pain depends on which side the infringement occurred. Thus, vertebrogenic lumbago on the right is characterized by right-sided pain, and on the left – by left-sided pain. In this case, a person can accurately indicate the painful spot. However, there are situations when there is bilateral infringement. In this case, the patient may complain of vague pain in the lumbar region.

Vertebrogenic lumbago may be accompanied by radicular syndrome. This is a concomitant pathology characterized by damage to the spinal nerve roots due to their compression, hypoxia or trophic disorders. Sensory, motor and autonomic nerves may be affected. And a person will experience reflected pain in addition to local pain in the affected area.

Pain in lumbago of vertebrogenic genesis can radiate to the lower extremities, abdominal cavity, buttocks, genitals and perineum, which makes it difficult to immediately determine their cause. Pinched nerve roots can provoke spasm of blood vessels, and if the affected area is the lower back, then the lower extremities also suffer. Many patients with lumbar pain complain that their feet are constantly cold, which is associated with impaired blood circulation in the peripheral vessels. In this case, a feeling of chilliness can be observed even when the feet remain warm to the touch.

True, the pain syndrome in vertebrogenic lumbago may not appear immediately. The first signs of the pathology may be muscle tension in the lower back, which cannot be relaxed by willpower alone, and a feeling of fatigue that occurs every time a person has to maintain the same position for some time.

Back discomfort can occur when lying on your back or stomach, so many patients report unpleasant sensations in the morning. For others, these sensations prevent them from resting. The person has to turn on their side, and then relief comes.

With vertebrogenic lumbago, it is difficult for a person to stand or sit for a long time. Back pain forces him to lean on vertical surfaces and change position frequently.

Later symptoms may include impaired sensitivity of the body in the lumbar region and lower extremities, numbness of the skin in the affected area, local and general hyperthermia. The appearance of these symptoms is associated with damage to the sensory nerve roots and the inflammatory process in the affected tissues.

Tension and pain in the lower back limit the motor activity of the spine, since a person is afraid to move for fear of experiencing a repeated attack of pain. Muscle and nervous tension accompanying the pain syndrome becomes a risk factor for the appearance of muscle spasms, in the place of which a small seal is formed. Such seals are called trigger points. They are extremely painful and when palpated cause severe pain, from which a person suddenly shudders.

In adolescence, during the period of active skeletal growth, against the background of instability of the vertebrae and weakness of the back muscles, vertebrogenic lumbago may develop. In this case, external symptoms of too active growth will be longitudinal stretch marks on the skin appearing in the lumbar region, which disappear over time.

Stages

Pain in vertebrogenic lumbago can be temporary and permanent, recurrent in nature depending on the cause of the pathology. Thus, in case of traumatic injuries of the lower spine and scoliosis, the pain can be strong, but passing, while in case of chronic diseases such as osteochondrosis, arthritis or arthrosis of the spine, dull, aching pains are usually noted, which occur regularly, and during an exacerbation can be replaced by stronger, sharp ones.

With vertebrogenic lumbago, a weak or moderate pain syndrome is usually observed. If there is strong piercing pain, then we speak of lumbago (otherwise a shooting pain in the lower back), which restricts a person's movements and does not allow him to change his position to a more comfortable one.

There are acute, subacute and chronic vertebrogenic lumbago. Acute vertebrogenic lumbago is characterized by quite severe pain associated with degenerative changes in the spinal column or traumatic injuries, as a result of which nerve roots and blood vessels are compressed. This form of pathology is characterized by muscle tension, pain during palpation, and stiffness of movement in the lumbar region. The pain is acute and moderate in intensity, occurring when lifting weights or making sudden movements (bending or twisting the spinal column).

In essence, we are talking about a shooting pain. That is, a sharp piercing pain occurs, which does not allow a person to move. Any movement contributes to the intensification of the pain syndrome. The pain subsides only with rest and relaxation, but with movement it can arise again.

In the subacute form of the pathology, all the same symptoms are present, but their severity is less. The pain can be sharp or dull, weak or moderate in intensity. The strength of the pain varies depending on the change in body position, but it is rarely cramping, as with lumbago.

Patients with a chronic form of pathology, arising against the background of long-term inflammatory-degenerative processes in the spine, complain mainly of mild dull pain of low intensity, which prevents them from sleeping, resting on their back, and also from working, since they intensify with physical activity, and at rest are accompanied by a feeling of fatigue in the spine.

Chronic vertebrogenic lumbago has 2 stages of development:

• the stage of remission, when a person feels completely healthy, and the disease reminds of itself through fatigue of the spine when sitting or standing for a long time, minor pain in the absence of muscle tension in the lower back and pain in the spine when pressing.
• exacerbation stage (relapse of the disease) with pronounced symptoms and moderate intensity of pain syndrome.

An exacerbation of the disease can be caused by hypothermia, infectious diseases, pregnancy, sudden turns or bends of the body, and even minor spinal injuries.

Vertebrogenic lumbago, along with cervicalgia (pain in the neck), thoracalgia (pain in the thoracic spine) and pathologies causing pain in the back, are classified as dorsopathies. Dorsopathies are spinal pathologies accompanied by pain syndrome.

Depending on the causes of dorsopathies, they are divided into deforming and discogenic pathologies, as well as spondylopathies. Pain syndromes (dorsalgia) that arise with these pathologies and are localized in various parts of the back are separate. Vertebrogenic lumbago can be considered a special case of dorsalgia, in which pain occurs in the lumbar region.

Complications and consequences

It should be said that vertebrogenic lumbago is a pain syndrome characteristic of many spinal pathologies. The moderate pain syndrome inherent in lumbago and even acute pain in lumbago do not pose a danger to human life, although they have a very negative impact on the patient's quality of life.

Much greater danger can be posed by pathologies that have caused the occurrence of lower back pain. After all, pain always indicates the presence of a pathological process in the body, which in most cases has an inflammatory-degenerative nature and always affects the functionality of the affected organ (in our case, the spine).

How do acute and chronic pains affect a patient's life? Suddenly occurring during working hours, they can become an obstacle to performing work duties. If the situation is repeated regularly, a person has to take sick leave, which is usually not liked by management, or look for another job that will put less strain on the spine. The hardest hit are those people whose work involves standing for a long time or sitting at a table, carrying heavy objects, and exercising.

Since pain in vertebrogenic lumbago limits the choice of sleeping and resting positions, a person often simply cannot fully relax and get enough sleep. Pain at night causes frequent awakenings and difficulty falling asleep. All this affects the state of the nervous system. A person becomes irritable, nervous, conflicted, which affects the attitude towards him in the work team, at home, among friends.

The expectation of pain attracts pain itself, which is facilitated by the excited state of the nervous system, which reacts sharply to any irritants. This only aggravates the situation.

Because of the fear of lower back pain, a person may try to move less, which leads to hypodynamia, which complicates almost all existing pathologies, including diseases of the gastrointestinal tract, spine, and joints. Without realizing it, a person makes things worse for himself.

But that's not all. In most patients, vertebrogenic lumbago occurs in combination with muscular-tonic syndrome, in which the flexor muscles experience hypertonia, while the extensor muscles lose their ability to contract (hypotonia). Increased tone of the flexor muscles is associated with the formation of trigger points on them, which react to touch with acute pain. And prolonged hypotonia of the extensor muscles can cause their atrophy and dysfunction.

Having bent over, it becomes difficult for a person to straighten up, so he himself, without noticing it, does not straighten up completely, walks with the upper part of the spine arched, slouches, provoking the development of scoliosis and congestion in the lumbar region. Over time, tendon reflexes and muscle functionality decrease not only in the spine area, but also in the legs (in the knee area), which is already considered a neurological problem.

Despite the fact that pains in lumbago of veterinary genesis do not pose a danger to the patient's life, they can radically change it for the worse. And this means that this symptom cannot be tolerated. It is necessary to undergo a diagnostic examination, establish the cause of the pain and do everything so that the pain no longer reminds of itself.

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Diagnostics vertebrogenic lumbalgia

Back pain is a symptom characteristic of many pathologies. It can appear with inflammation of the muscles of infectious and non-infectious genesis, pathologies of the lungs and pleura, diseases of the spine, injuries and even gastrointestinal and cardiac pathologies (radiating pain). It is almost impossible to determine by eye which disease led to the development of vertebrogenic lumbago. Therefore, any moments that the patient can tell him are important for the doctor.

Physical examination for back pain includes:

• study of external symptoms (asymmetry of the sides, protrusion of the vertebrae, curvature of the spine),
• palpation (in the affected area, there is usually tension in the soft tissues, painful lumps can be felt, etc.),
• auscultation (necessary to exclude pulmonary and cardiac pathologies),
• tapping (to check tendon and muscle reflexes).

The doctor pays great attention to the localization and nature of pain, which he can learn from the patient's words, about their change depending on the position of the body and the work performed. Studying the anamnesis provides information about the possible causes of pain, because in most cases vertebrogenic lumbago is a symptom of existing diseases, the treatment of which was not carried out or was unsuccessful.

Patients are prescribed standard tests: general urine analysis and clinical blood analysis. But it is important to understand that laboratory tests are not of decisive importance in diagnosing pathology. A blood test can show the presence of an inflammatory process, but where exactly it occurs will remain a mystery. A urine test is necessary to confirm or exclude a pain syndrome called renal colic, which usually occurs against the background of kidney stone disease. Kidney pain often radiates to the back and is difficult to distinguish from lumbago.

The causes of pain in the lumbar region with vertebrogenic lumbago are deep inside, so the most relevant in this case will be the results of instrumental diagnostics. And since we are talking about pain caused by diseases of the spine, first of all, an X-ray of its lumbar region is prescribed (sometimes in combination with the thoracic region, because the pathological inflammatory-dystrophic process tends to spread).

X-ray imaging most accurately reflects the condition of the bone structures of the spinal column, its shape. The image shows the relative position of the vertebrae, changes in their size and shape. If it is necessary to obtain more detailed information about the structure of the spine, a computer tomogram is prescribed, which allows you to obtain a three-dimensional image of the human skeleton and identify those pathologies that were not shown by a standard image on a plane.

Soft tissues are less visible on a regular X-ray than hard tissues, so if myositis, tumor processes, or soft tissue injuries are suspected, additional testing may be required – magnetic resonance imaging. This testing is considered preferable for these pathologies, because it does not use X-rays that are permeable to muscles, cartilage, and tendons.

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Differential diagnosis

Dorsopathies, one of which is vertebrogenic lumbago, also include some other pain syndromes that are similar in their manifestations to the pathology described. Vertebrogenic thoracalgia is a spinal pain syndrome localized in the thoracic spine. Vertebrogenic cervicalgia is pain in the cervical spine. But if with cervical pathologies, pain almost never radiates to the lower back (occipital pain and discomfort in the upper shoulder area are more typical for it), then with diseases of the thoracic spine, it is very difficult to establish the boundary. With thoracalgia, reflected pain can be noted both in the shoulder area and in the lumbar region. But in general, we are talking about pain behind the breastbone or in the thoracic spine.

Sciatica is also a pain syndrome, and the pain associated with this pathology is localized in the lumbar region. However, the cause of the pain in this case is damage to the sciatic nerve, which is considered one of the largest and is responsible for the innervation of the buttocks and legs. Along with pain in the lower back, there are painful sensations in the muscles of the buttocks, thighs, shins, and even feet. In this case, we are not talking about reflected pain (in this case, lumbar pain will be reflected). The pain syndrome in the lower extremities will be more intense than in the lower back.

If, in addition to lower back pain, the patient notes the appearance of such in the buttocks and the back of the thighs and shins, without touching the foot, the doctor diagnoses lumbosciatica. With this pathology, damage to both the spinal roots and the sciatic nerve is observed.

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Treatment vertebrogenic lumbalgia

Vertebrogenic lumbago is, first of all, a painful pain syndrome, which in the acute form of the pathology has a significant intensity and becomes an obstacle to normal life. It is clear that the main and very first task of lumbago therapy is considered to be pain relief.

Prevention

Vertebrogenic lumbago is a syndrome that should be considered primarily as one of the symptoms of some spinal pathology. It is the disorders in the spinal column that cause muscle spasms, increased muscle tone with the formation of painful seals, damage to nerve roots, increasing the patient's sensitivity to pain. It turns out that the prevention of lumbago is a set of measures to prevent spinal diseases that cause lower back pain.

Simple measures such as high physical activity (without fanaticism), balanced nutrition, and giving up bad habits will help prevent degenerative changes in the tissues of the spinal column. Morning exercises, daily walks in the fresh air, swimming, cycling, and many sports games will help maintain the health of the spine for many years.

But sudden movements, lifting and carrying heavy objects, passion for fast food, processed foods and other products of dubious quality with harmful additives, smoking, alcohol abuse, overeating and excess weight, physical inactivity and sedentary work will negatively affect the condition of the spine, which, in the end, can result in excruciating pain in the lower back.

If a person regularly has to sit for a long time (for example, when working on the Internet), he should understand that at this moment his back experiences maximum loads and can quickly get tired. It is necessary to allow it to rest, walk a little and do a few relaxation exercises. Even in a busy work schedule, for your own good, you need to set aside a few minutes for physical work and walks. This will only increase labor productivity.

It is necessary to include at least a small set of physical exercises for various parts of the spine, upper and lower extremities in the daily routine. It is necessary to understand that our body is a single whole, and failures in some parts can lead to disruption of the work of others. That is why it is necessary to train the whole body as a whole.

It is advisable to include hanging on a horizontal bar in the exercise complex. This basic exercise helps to stretch the spine and is a preventative measure for many of its diseases, as well as pathologies of other organs that suffer from disorders in the spinal column. It is believed that almost all human diseases are associated with a violation of the health and performance of the spine.

When lifting weights, you need to remember one important condition. You need to take a heavy object in a sitting position, not in a bending position. This way we reduce the load on the spine, giving it to the lower limbs, which have fewer joints, and therefore are more resistant to loads.

Particular attention should be paid to your diet. The health of the joints of the spine and limbs is supported by products with a high content of iron, magnesium, calcium, phosphorus, vitamins D, C, F, mucopolysaccharides. The menu should include dishes based on gelling agents (agar, gelatin).

It is clear that difficulties with choosing a job, lack of finances to buy healthy quality products, and sometimes simple human laziness or carelessness quite often become the reason that at some point we have to see a doctor about back pain. Often this happens when the degenerative process in the spine has already started, and it is impossible to fully restore the health of this important organ.

Yes, treatment of spinal diseases is not an easy task and its early start becomes the key to restoring its functionality. Therefore, it is worth contacting a doctor when the first signs of ill health appear (rapid fatigue and discomfort in the back). But even if the prognosis for treating the disease is not the most favorable, this is not a reason to give up, you need to fight for your health.

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Forecast

In principle, the prognosis for the treatment of vertebrogenic lumbago depends on the underlying disease, the prescribed therapeutic methods and means, and the patient's compliance with the doctor's requirements. It is almost always possible to relieve lower back pain using one method or another, and often quite quickly, but in the future there is still a long road to recovery or regular treatment to prevent exacerbations of the disease.

Vertebrogenic lumbago and the army

Now, regarding future conscripts. Lower back pain in itself is not a significant reason for exemption from military service, especially since there are many methods for treating pain syndrome. If a conscript is diagnosed with a spinal pathology that causes lower back pain, impaired tissue sensitivity, and limited mobility, then he will most likely be given a deferment from service to undergo effective treatment.

It is a different matter if we are talking about a recurring pathology that periodically reminds us of itself with lower back pain. To be released from service, multiple documented visits to a doctor about back pain will be required. If we are talking about pathologies of intervertebral discs, then only those patients who have three or more vertebrae affected in the presence of pain syndrome and accompanying symptoms can count on being enlisted in the reserve.

It turns out that to be exempt from conscription, it is not enough to have a diagnosis of some spinal pathology that provokes the development of vertebrogenic lumbago. Documents (medical records) confirming repeated visits to doctors regarding pain syndrome, records of the treatment and its effectiveness are also needed. That is, we are talking about chronic recurrent lumbago, military service in which can provoke an exacerbation of the disease.

Vertebrogenic lumbago is a symptom complex characteristic of many spinal pathologies. Its symptoms can be quite painful and become an obstacle to normal human existence. That is why it is better not to neglect existing diseases and treat them before the onset of pain syndrome, and not when the pain no longer allows you to straighten up.

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