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The syndrome of vertebrogenic lumbalgia: why does pain develop in the lower back and how to fight it?

 

Spinal pain is a problem that a person can face at any age. Sudden pain may appear in any part of the back: in the cervical, thoracic or lumbar region, right, fame or along the center line. If the pain occurs in the lumbar region, talk about a pathology such as vertebrogenic lumbalgia with a characteristic pain syndrome.

What is this disease?

The term "lumbalgia" refers to a generalized notion by which physicians describe various pains in the lumbar region. That is, lumbalia is a pain syndrome in the lumbar region, which can have different causes. And the addition of the word "vertebrogenic" suggests that the cause of these pains lies in the diseases of the spine.

Vertebrogenic lumbalgia can not be called a full-fledged disease, because for pathology, which is actually a consequence or complication of other diseases of the spine, there is only one symptom - pain. And the intensity and nature of pain can be different depending on the type and characteristics of the pathology.

Lumbalia can occur in acute, subacute and chronic form. It can occur as a result of trauma, sudden turn or tilt, as well as when lifting weights.

Epidemiology

According to statistics, the pain syndrome with vertebrogenic lumbulgia is considered one of the most frequent reasons for going to the doctor. And this is not surprising, given the fact that most often lubumbia develops against a very popular disease called "osteochondrosis", the incidence of which reaches 80% worldwide. Just before the onset of pain, people may not even be aware of the disease

About 85% of patients experience muscular-tonic pain, when spinal cord nerve fibers are squeezed due to pathologies of the spine and a prolonged, steady tension of the flexor muscles occurs, while the extensor muscles remain relaxed during this time. In this case, they speak of vertebrogenic lumbargia with muscular-tonic syndrome.

Causes of the vertebrogenic lumbargia

As we have already mentioned, lumbargia of vertebrogenic genesis is considered by doctors not as an independent disease, but as a complication of existing pathologies, on which they emphasize the diagnosis and treatment. But what are the reasons, or rather the disease, can provoke the emergence of a persistent pain syndrome in the lumbar region?

As the reasons for the development of vertebrogenic lumbargia, scientists consider the following pathologies:

  • osteochondrosis of the spine (development of the dystrophic process in intervertebral discs and cartilages),
  • protrusion of the disk of the thoracic or lumbar spine (protrusion of the disc on the spine, where it can squeeze nerves and blood vessels),
  • intervertebral hernia (disc displacement with fibrous ring rupture),
  • tumor processes along the spine,
  • formation of bony outgrowths along the edges of the vertebrae (spondylosis),
  • inflammatory processes in the vertebral column, causing vertebral resolution and deformation of the spine itself (spondylitis),
  • displacement of vertebrae (spondylolisthesis),
  • curvature of the spine (scoliosis),
  • instability of the vertebrae,
  • destruction of bone tissues of the spine (osteoporosis),
  • ankylosing spondylitis (Bechterew's disease, in which the mobility of the spine is disrupted and the tension of the back muscles increases, which translates into a chronic pain syndrome),
  • inflammatory-degenerative changes in the intervertebral joints, characteristic of arthritis and arthrosis of the spine,
  • congenital defects in the development of the spine,
  • stenosis of the cerebral canal of the lumbar spine,
  • spine trauma.

Risk factors

All of the above diseases have a pain syndrome in their clinical picture, but its appearance is usually associated with certain moments. So, factors of risk of development of vertebrogenic lumbalgia are:

  • mechanical damage to the spine and surrounding tissues: bruises, bumps, falls, sudden movements,
  • excessive physical activity,
  • hypodynamia and sedentary work, which creates an increased burden on the spine,
  • long stay in a standing position and work in the garden when the spine is in a long time in a curved state.
  • supercooling,
  • systemic infectious pathologies and their relapses,
  • Platypodia (this pathology has a negative effect on the spine, increasing the load on it and causing a curvature of the spinal column),
  • exercise with a high load on the spine, for example, weightlifting,
  • excess weight, which on the spine acts like injuries and heavy physical exertion,
  • the period of puberty, when there is active growth of the skeleton,
  • The period of menopause with its characteristic osteoporosis of bones,
  • Pregnancy against the background of weakness of the dorsal muscles.

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

Pathogenesis

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

Compression lumbargia occurs due to the compression of the nerve roots and the vessels that lie close to 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 lumbalgia is considered as a complication of diseases of the spine.

Symptoms of the vertebrogenic lumbargia

The development of vertebrogenic pathology usually speaks of its main symptom - pain, which can have a different nature, intensity and duration. Most often, patients complain of acute shooting pains, which significantly worsen the quality of their life. Painful sensations arise or are amplified at turns and inclinations, lifting of weights. And in the acute form of lumbulgia, pain attacks can occur with the slightest movement, so a person tries to adopt a posture in which the severity of the symptom will be less.

The localization of pain depends on the side of the infringement. So, vertebrogenic lumbalgia on the right is characterized by right-sided pains, and to the left - by left-sided pains. In this case, a person can accurately show a painful place. True, there are situations when there is a bilateral pinch. In this case, the patient may complain of blurred pain in the lumbar region.

With vertebrogenic lumbulgia, the radicular syndrome can occur. This is a concomitant pathology, characterized by the defeat of the roots of the spinal nerves due to their compression, hypoxia, or trophic disorders. Under the impact sensitive, motor and autonomic nerves can fall. A person besides local pain in the area of defeat will also experience reflected.

Pain in lumbalgia of vertebrogenic genesis can be irradiated to the lower extremities, abdominal cavity, buttocks, genitals and perineum, which does not immediately determine their cause. Pinching the nerve roots can trigger a spasm of blood vessels, and if the lesion is the lower back, then the lower extremities also suffer. Many patients with lumbar pains complain that their feet are constantly cold, which is associated with impaired blood circulation in peripheral vessels. This feeling of chilliness can be observed even when the feet feel warm to the touch.

True, pain syndrome with vertebrogenic lumbargia may not appear immediately. The first signs of pathology may be muscle tension in the lower back, which can not be relaxed by mere effort of will, and a feeling of fatigue that arises every time a person has to keep the same pose for some time.

Discomfort in the back can occur when lying on the back or abdomen, so many patients note the appearance of discomfort in the morning. To others, these feelings prevent you from resting. Man has to turn on his side, then comes relief.

With vertebrogenic lumbargia, it is difficult for a person to stand or sit for a long time. Back pain forces it to rest on vertical surfaces, often to change position.

Later symptoms can be a violation of the sensitivity of the body in the lower back and lower extremities, numbness of the skin in the affected area, local and general hyperthermia. The appearance of these symptoms is associated with the lesion of the sensitive nerve roots and the inflammatory process in the affected tissues.

Stress and low back pain limit the motor activity of the spine, because a person is afraid to move in fear of experiencing a repeated attack of pain. Muscular and nervous tension accompanying 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 cause severe pain when palpating, from which a person jerks violently.

In adolescence, during active growth of the skeleton against vertebral instability and weakness of the dorsal muscles, vertebrogenic lumbargia may develop. In this case, external signs of too active growth will appear in the lumbar region longitudinal stretch marks on the skin, which eventually disappear.

Stages

Pain in vertebrogenic lumbulgia can have a temporary and permanent, recurrent nature depending on the cause of the pathology. So, with traumatic injuries of the lower spine and scoliosis, the pain can be severe, but passing, while in chronic diseases such as osteochondrosis, arthritis or arthrosis of the spine, usually blunt, aching pains occur regularly, and during the exacerbation period can change more powerful, sharp.

With vertebrogenic lumbargia, there is usually a mild or moderate pain syndrome. If there are strong piercing pains, then they speak of lumbago (otherwise lumbago), which hinders the movement of a person and does not allow him to change his position to a more comfortable one.

There are acute, subacute and chronic course of vertebrogenic lumbargia. Acute vertebrogenic lumbalgia is characterized by rather strong painful sensations associated with degenerative changes in the vertebral column or traumatic injuries, as a result of which the roots of the nerves and blood vessels were clamped. For this form of pathology, muscle tension, and soreness in palpation, and stiffness of movements in the lumbar region are also characteristic. The pains are acute and of moderate intensity, arising when lifting heavy loads or abrupt movements (slopes or twists of the spinal column).

In fact, it's about lumbago. That is, there is a sharp piercing pain that does not allow a person to move. Any movement contributes to the pain syndrome. The pain subsides only during rest and relaxation, but when moving, it can arise again.

In the subacute form of pathology, all the same symptoms occur, but their severity is less. The pain may be acute or dull with mild or moderate intensity. The strength of pain varies depending on the change in the position of the body, but it is rarely stiffening, as with lumbago.

Patients with a chronic form of pathology that occurs against the backdrop of long-lasting inflammatory-degenerative processes in the spine complain mostly of unintended blunt pain of low intensity that prevent them from sleeping, resting on their backs, and also to work, as they become more active in physical activity, and in a state rest are accompanied by a feeling of fatigue in the spine.

Chronic vertebrogenic lumbalgia has 2 stages of development:

  • the stage of remission, when a person feels completely healthy, and the illness reminds oneself of fatigue of the spine with prolonged sitting or standing, minor pain in the absence of tension in the lower back muscles and pain in the spine with pressure.
  • stage of exacerbation  (relapse of the disease) with severe symptoms and moderate intensity of pain syndrome.

Exacerbation of the disease can cause hypothermia, infectious diseases, pregnancy, sharp turns or torso of the trunk and even minor injuries of the spine.

Vertebrogenic lumbalgia, along with cervicalgia (pain in the neck), thoracalgia (pain in the thoracic region of the spine) and causing pain in the back of the pathology belongs to the category of dorsopathy. Dorsopathy refers to the pathology of the spine, accompanied by pain syndrome.

Depending on the causes of dorsopathy, they are divided into deforming and discogenic pathologies, as well as spondylopathy. Separately, there are pain syndromes (dorsalgia) arising from these pathologies and localized in various parts of the back. Vertebrogenic lumbargia can be considered as a particular case of dorsalgia, in which pain occurs in the lumbar region.

Complications and consequences

It must be said that vertebrogenic lumbalgia is a pain syndrome characteristic of many spinal pathologies. In itself, a moderate pain syndrome, characteristic of lumbargia, and even acute pains with lumbago do not pose a threat to human life, although they affect most negatively the quality of life of the patient.

A much greater danger may be presented by the pathologies that caused the pain in the lower back. After all, pain always indicates the presence of a pathological process in the body, which in most cases has an inflammatory-degenerative character and always affects the functionality of the affected organ (in our case, the spine).

How do acute and chronic pains affect the patient's life? Suddenly arising during working hours, they can become an obstacle to performance of labor duties. If the situation repeats regularly, a person has to take a sick leave, which is usually not pleasant to management, or to look for another job, in which the load on the spine will be less. The hardest part is for those people whose activities involve a long standing on their feet or sitting at a table, carrying heavy loads, sports loads.

Since pain in vertebrogenic lumbalia limits the choice of poses for sleep and rest, a person often simply does not get to fully relax and get enough sleep. Pain at night causes frequent awakenings and difficulties with 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 collective, at home, in the circle of friends.

Waiting for the appearance of pain attracts the pain itself, which contributes to the nervous state of the nervous system, which reacts sharply to any stimuli. This only aggravates the situation.

Because of fear of pain in the lower back, a person can try to move less, which leads to hypodynamia, complicating almost all available pathologies, including diseases of the digestive tract, spine, joints. Without realizing this, a person makes himself worse.

But that's not all. In most patients, vertebrogenic lumbalgia occurs in combination with the muscular-tonic syndrome, in which the flexor muscles experience hypertonicity, while the extensor muscles lose the ability to contract (hypotonic). The increase in the tone of the flexor muscles is associated with the formation of trigger points on them, which react to the contact with acute pain. A prolonged hypotension of the extensor muscles can cause their atrophy and disruption of functionality.

Bending over, it becomes difficult for a person to unbend, so he does not completely unbend himself fully, goes around arching the upper part of the spine, hunches, provoking the development of scoliosis and stagnation in the lumbar region. Over time, tendon reflexes and muscle functionality decrease not only in the spine, but also in the legs (in the knee region), which is already considered a neurological problem.

Despite the fact that pain with lumbalgia of wind-born genesis does not pose a danger to the life of the patient, they can radically change it for the worse. And this means that you can not tolerate this symptom. It is absolutely necessary to undergo a diagnostic examination, to establish the cause of the pain and do everything to make the pain no longer remind you of yourself.

Diagnostics of the vertebrogenic lumbargia

Back pain is a symptom typical of many pathologies. They can appear with inflammation of the muscles of infectious and non-infectious genesis, pathologies of the lungs and pleura, spine diseases, injuries and even gastrointestinal and cardiac pathologies (irradiating pains). Determine by eye what kind of disease led to the development of vertebrogenic lumbalgia is almost impossible. Therefore, any points that the patient can tell him are important for the doctor.

Physical examination with pain in the back implies:

  • the study of external symptoms (asymmetry of the sides, bulging of the vertebrae, curvature of the spine),
  • palpation (in the affected area usually noted the tension of soft tissue, can be palpated painful seals, etc.)
  • Listening (necessary for the exclusion of pulmonary and cardiac pathologies),
  • percussion (for testing of tendon and muscle reflexes).

The doctor pays much attention to the localization and nature of the pains, which he can learn from the patient's words, about their changes depending on the position of the body and the work performed. The study of the anamnesis gives information on the possible causes of pain, because in most cases vertebrogenic lumbalgia is a symptom of already existing diseases, the treatment of which has not been carried out or has not been successful.

Analyzes to patients appoint the standard: a general urine test and a clinical blood test. But we need to understand that laboratory studies do not have a decisive role in the diagnosis of pathology. A blood test can show the presence of an inflammatory process, but where exactly it flows will remain a mystery. Urinalysis is necessary to confirm or exclude pain syndrome, called renal colic, which usually occurs against a background of kidney stone disease. Kidney pain is often given up in the back and is difficult to distinguish from lumbago.

Causes of pain in the lumbar region with vertebrogenic lumbalgia lie deep inside, so the most relevant in this case will be the results of instrumental diagnosis. And since we are talking about the pains provoked by diseases of the spine, first of all, the x-ray of his lumbar region is appointed (sometimes in combination with the thoracic, after all, the pathological inflammatory-dystrophic process has the property to spread).

Radiography most accurately reflects the state of the bone structure of the spinal column, its shape. In the picture, one can see the interposition of the vertebrae, the change in their size and shape. If it is necessary to obtain more detailed information on the structure of the spine, a computer tomogram is prescribed, which allows to obtain a three-dimensional image of the human skeleton and to reveal those pathologies that did not show a standard picture on the plane.

Soft tissues on an ordinary X-ray are seen worse than solid, so if suspicion of myositis, tumor processes, soft tissue injuries, additional research - a magnetic resonance tomogram - may be required. This study is considered more preferable for these pathologies, because it does not use x-rays, permeable to muscles, cartilage and tendons.

Differential diagnosis

To dorsopathies, one of which is vertebrogenic lumbalgia, include some other pain syndromes, which in their manifestations are similar to the described pathology. Vertebrogenic thoracalgia is a spinal pain syndrome with localization in the thoracic region of the spine. Vertebrogenic cervicalgia is a pain in the cervical part of it. But if in cervical pathologies pain is almost never irradiated in the lower back (for it more characteristic occipital pain and discomfort in the upper part of the shoulders), then with the diseases of the thoracic spine the border is very difficult to establish. In the case of thoracalgia, reflected pain can be noted both in the shoulder region and in the region of the lower back. But in general, we are talking about pain behind the sternum or in the thoracic region of the back.

Ischialgia also belongs to the number of pain syndromes, and pains in this pathology are localized in the lumbar region. However, the cause of pain in this case is the defeat of the sciatic nerve, which is considered one of the largest and 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, hips, legs and even feet. In this case, we are not talking about the reflected pain (reflected in this case will be lumbar pain). The pain syndrome in the lower extremities will be stronger in intensity than in the lower back.

If, in addition to low back pain, the patient observes the appearance of those in the buttocks and the back of the thighs and lower legs, without touching the foot, the doctor makes a diagnosis of lumboschialgia. In this pathology, damage is observed to both the spinal roots and the sciatic nerve.

Treatment of the vertebrogenic lumbargia

Vertebrogenic lumbagia is first and foremost a painful pain syndrome, which in acute forms of pathology has a significant intensity and becomes an obstacle to normal functioning. It is clear that the main and the very first task of lumbar therapy is the coping of pain.

Prevention

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

To prevent degenerative changes in the tissues of the spinal column, simple measures such as high physical activity (without fanaticism), balanced nutrition, rejection of bad habits will help. Morning exercise, daily walks in the air, swimming, cycling, many sports games will help maintain the health of the spine for years to come.

But sudden movements, lifting and carrying heavy loads, fascination with fast food, half-finished products and other products of questionable quality with harmful additives, smoking, alcohol abuse, overeating and the appearance of excess weight, inactivity and sedentary work will adversely affect the condition of the spine, which, in in the end, can turn into agonizing 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 that moment his back experiences maximum loads and can quickly get tired. It is necessary to allow her to rest, a little walking around and doing some relaxation exercises. Even in a busy working schedule for your own good, you need to allocate a few minutes for physical work and walks. This will only increase labor productivity.

In the daily routine, you must include at least a small set of physical exercises for various parts of the spine, upper and lower extremities. We must understand that our body is a single whole, and failures in some departments can lead to disruption of the work of others. That's why you need to train the whole organism.

In the complex of exercises it is desirable to include the vis on the horizontal bar. This elementary exercise helps stretch the spine and is the prevention of many of its diseases, as well as pathologies of other organs suffering from disorders in the spinal column. There is an opinion that almost all human diseases are associated with a violation of health and working capacity of the spine.

When lifting weights, one important condition must be remembered. Take a heavy object in the sitting position, and not in the slope. So we reduce the load on the spine, giving it to the lower limbs, which has a smaller number of joints, and hence more resistant to stress.

Particular attention should be paid to their nutrition. Health of the joints of the spine and limbs help to maintain foods high in iron, magnesium, calcium, phosphorus, vitamins D, C, F, mucopolysaccharides. The menu should contain dishes based on gelling agents (agar, gelatin).

It is clear that the difficulties with choosing a job, the lack of finance for the purchase of useful quality products, and sometimes simple human laziness or carelessness quite often cause that at some point we have to go to the doctor for back pain. Often this happens when the degenerative process in the spine is already running, and it is impossible to completely restore the health of this important organ.

Yes, the treatment of diseases of the spine is not an easy matter and its early onset becomes the key to restoring its functionality. Therefore, the doctor should be consulted at the appearance of the first signs of ill health (rapid fatigue and discomfort in the back). But even if the prognosis of the treatment of the disease is not the most favorable, this is not an excuse to give up, one must fight for one's health.

Forecast

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

Vertebrogenic lumbalgia and the army

Now as for future conscripts. In themselves, low back pain is not an essential reason for discharge from military duty, especially since there are many methods of treating pain syndrome. If the conscript has a pathology of the spine, causing lumbar pain, a violation of the sensitivity of the tissues, a restriction of mobility, then most likely he will be given a respite from the service for effective treatment.

Another thing, if we are talking about a recurring pathology, which periodically reminds oneself of back pain. For release from the service, documented multiple complaints to the doctor about back pain will be required. If we are talking about the pathologies of the intervertebral discs, only those patients who have three or more vertebrae with pain syndrome and the accompanying symptoms can count on the reserve.

It turns out that it is not enough to have a diagnosis of some spinal pathology provoking the development of vertebrogenic lumbalgia for getting rid of conscription. We also need documents (medical card), confirming repeated appeals to doctors about the pain syndrome, a record of the treatment and its effectiveness. That is, it is a chronic relapsing lumbalgia, the service in the army in which can exacerbate the disease.

Vertebrogenic lumbalgia is a symptomatic complex that is characteristic of a multitude of pathologies of the spine. His symptoms can be quite painful and become a barrier to normal human existence. That is why it is better not to run the existing diseases and treat them before the onset of pain syndrome, and not when the pain no longer allows you to straighten up.

Last update: 14.10.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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