Lumbar lumbar spine: diagnosis, how to treat

From the point of view of medical terminology, the last three words in the definition - lumbar lumbar spine - are clearly superfluous, and now you will understand why and what it is?

Doctors talk about lumbargia when a person feels pain (Greek - algos) in the lumbar spine or just in the lower back (lat. - lumbus). Therefore, as you know, lumbulgia of the thoracic or cervical is nonsense.

Back pain is called dorsalgia (Latin dorsum - back, back side). In ICD-10, the lumbar region has the code M54.4-M54.5 in the class of diseases of the musculoskeletal system. However, this term refers to a locally manifested clinical symptom, which can cause any disease or dorsopathy of the lumbar spine.

Interchangeably use the definition: pain in the lower back, lumbar pain. But the lumbago of the lumbar spine or just  lumbago  is called the sudden "acute" acute pain.

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

Epidemiology

The Global Burden of Disease Study, conducted among patients in 47 countries around the world in 2012, confirmed the fact that lumbar pain is the leading cause of disability worldwide: nearly 600 million people are affected (twice as many as 25 years ago).

As clinical statistics show, almost 20% of people suffering from acute and subacute pain can develop a chronic lumbar lumbar region within a year.

According to the European Spine Journal, the frequency of treatment of adult Europeans for the first episode of acute pain in the lower back, diagnosed as lumbago or lumbar spinal lumbar spine, ranges from 6.3 to 15.4% per year. And the frequency of relapses during the year is observed on average in 36% of the population.

According to the National Institute of Neurological (USA), lumbalia most often persecutes people from 40 to 60 years. The prevalence of lower back pain is somewhat higher in women.

Only in the US, degenerative changes in the intervertebral discs affect about 12 million at the age of 20 to 65 years (3.8% of the adult population), 52% of whom feel lumbar pains of varying strength.

[6], [7], [8], [9], [10], [11], [12]

Causes of the lumbar lumbar spine

The lumbar spine (vertebrae LI-LV) and the entire lower back provide support for most of the body and the work of the musculoskeletal system. In addition, this work is controlled by the nerves of the spinal cord passing here.

So, no matter what the pain is called  in the lumbar region, the main identifiable causes of lumbar lumbar spine are related to all vertebra structures: vertebra vertebra and disci intervertebrales, muscles, ligaments, fascial structures , nerve roots, as well as visceral organs of the abdominal cavity.

Lumbalia has a biomechanical etiology with skeletal defects, including scoliosis, lordosis,  diffuse idiopathic skeletal hyperostosis, ligament abnormalities (for example, in the Ehlers-Danlos syndrome).

The lumbar region of the lumbar region is of a mechanical nature during pregnancy, and its etiology consists in changing the normal curvature of the spine in the lumbar region due to an increase in the weight load with simultaneous (necessary for forthcoming births) loosening of the ligament joint and lumbosacral joint under the influence of the hormone relaxin.

Back pain of varying intensity is observed with excessive stretching of the anterior longitudinal ligament of the spine and muscle tendons (for example, when lifting weights), with traumas that can  cause lesions of the lumbar intervertebral discs, including the  displacement of the lumbar vertebrae. These injuries, in turn, lead to compression of the nerve endings and the development  of horse-tail syndrome  (sauda equina), in which the pain - in addition to the lower back - seizes the areas of the sciatic mounds, coccyx, groin and thighs.

In many cases, lumbulgia is associated with  spondylosis of the lumbar spine  (bony growths that span the intervertebral discs) or spondyloarthrosis (when the intervertebral facet joints are calcified with age). Then the spondylogenic lumbar region of the lumbar region is determined.

Chronic lumbar lumbar lumbar region appears with a decrease in the damping properties of intervertebral disks due to dystrophic changes in their cartilaginous tissue - when the osteochondrosis of the lumbar spine is diagnosed, as well as in the  hernia of intervertebral discs, pathological changes of the intervertebral facet joints or the formation of osteophytes.

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Risk factors

With a variety of conditions provoking the appearance of back pain, specific risk factors for lumbar development are seen in the natural aging processes, that is, age changes and vertebral joints, and intervertebral discs, as well as in the negative consequences of occupational effects on the lumbar region (occurring with standing or sitting work).

Significantly increases the likelihood of pain in the muscles of the waist, defined as a muscle tension syndrome or myofascial syndrome, if a person moves little and stays in one position for a long time.

The pain in the lower back is excruciated by most people with overweight (obesity) - due to increased stress on the lumbar vertebrae. And if you abuse alcohol, the substances contained in it quickly destroy the cartilaginous tissue of the intervertebral discs and make their diffuse nutrition difficult.

[16], [17], [18], [19], [20], [21], [22], [23]

Pathogenesis

Pathogenesis of lumbulgia can be associated with inflammatory processes in patients with Bechterew's disease, spine osteomyelitis, bone tuberculosis (Pott's disease), intervertebral disc disease, sacroelitis (inflammation of the sacroiliac joint).

Because of the lesion of the roots of the lumbosacral spinal cord, a very painful sciatica inflammation develops   -sciatica or lumbosacral sciatica, in which lumbargia of the lumbosacral spine or lumbosciatica is observed: the pain seizes the waist and gluteal region, as well as the hind thigh of the knee joint.

The condition caused by compression, inflammation and / or damage to the spinal nerve root is called radiculopathy, in which the symptoms of lumbar lumbar spine, often with reduced sensitivity of the lower limbs. Radiculopathy can occur due to constriction or  stenosis of the spinal canal. For details, see -  Radicular syndromes and back pain

In addition, lumbulgia is a symptom of  myositis of the back  and focal seals in the large or small lumbar muscles (associated with their constant stress and worsening trophism of tissues).

Pain syndrome, which manifests itself in the periodic lumbar region of the lumbosacral section, is noted for diseases of the abdominal organs and pelvic organs: nephrolithiasis, pyelonephritis and granulomatous enteritis; endometriosis, polycystic ovary and uterine prolapse; with an aneurysm of the abdominal aorta, as well as with neoplasias of the spine (myeloma and sarcoma) and the spread of metastases of malignant tumors of any localization to it.

Useful information also in the material -  Causes of back pain

[24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34],

Symptoms of the lumbar lumbar spine

Lumbalia is usually characterized by a combination of the following symptoms:

• sensation of tension (stiffness) in the back after sleep (due to contracture of muscles);
• increased blunt aching pain in all movements (change of posture) or after prolonged sitting;
• restriction of movements (bending forward, backward or sideways);
• unilateral irradiation of pain in the buttocks, groin, down the back of the thigh;
• decreased sensitivity and "tingling" (paresthesia) in the lower back, buttocks and legs;
• spasms of lumbar muscles;
• forced changes in posture (associated with attempts to reduce soreness).
• numbness and muscle weakness.

Forms

Duration distinguishes such types of lumbargia as acute, subacute and chronic. Acute lower back pain lasts less than 6 weeks; subacute - from 6 to 12 weeks, and chronic lumbar lumbar ligature lasts longer than three months (with periodic attenuations and gains).

If the pathogenesis of lumbar pain lies in the damage to the structures of the spine, it is considered a vertebrogenic lumbar region. Questions of pathogenesis are discussed in detail in the publication -  Symptoms of back pain

When the lumbar muscles ache (with myositis) - lumbar tongue is called neuromuscular (muscle-tonic), and the compression of the nerve roots is classified as neurogenic or neurodystrophic lumbargia.

Western vertebrologists allocate mechanical (or axial) pain in the lower back (due to muscle tension), reflexive lumbargia and radiculopathy (radicular pain)

Reflexive lumbar pain is not perceived where its focus is localized. For example, a degenerative change in the lumbar vertebra can cause pain in the region of the sacrum or thighs; such pain occurs when the activation of nociceptors in the internal organs leads to the perception of pain in the lumbar spine).

Burning radicular pain is the result of compression or inflammation of the spinal nerve root, at which irritation of the sensory root or dorsal root ganglion of the spinal nerve occurs.

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Complications and consequences

What is fraught with lumbar lumbar spine? Problems with back pain are recognized by specialists of the North American Spine Society as one of the most common reasons for visiting doctors and the most common cause of disability among people under 45 years of age.

So the consequences and complications of lumbulgia are quite serious, including: numbness of the legs, difficulty in moving - neurogenic lameness (due to stenosis of the spinal canal); loss of control of the bladder (enuresis) or intestines (encopresis) - with horse tail syndrome or in cases of protrusion of the intervertebral disc into the spinal canal.

As the experts note, the recurring episodes of lumbalia not only restrict patients in their daily lives, but also reduce stress resistance, often leading to emotional imbalance and a state of depression.

[37], [38], [39], [40], [41], [42]

Diagnostics of the lumbar lumbar spine

It is impossible to diagnose lumbargia without a complete medical history and physical examination of the patient. But, as the doctors themselves admit, the cause of chronic low back pain is often difficult to determine even after a thorough examination, for which, first of all, instrumental diagnostics are used: radiography, CT / myelogram, MRI, discography, electromyography and electroneurography.  

Blood tests usually include general clinical, sedimentation rate of erythrocytes and C-reactive protein (for the detection of inflammatory processes). Blood tests can also detect leukocyte antigen HLA-B27, a genetic marker for the propensity to Bechterew's disease and other inflammatory diseases of articular connective tissues (spondyloarthropathies).

Of course, differential diagnosis is necessary, since innervation of most anatomical structures of the lumbar region of the spine is interrelated, which often prevents the central nervous system from distinguishing between damage to one structure and another. For example, sensations for lumbargia due to a herniated intervertebral disc and damage to ligaments of the lumbar muscles are identical.

Also read -  Diagnosis of back pain

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Treatment of the lumbar lumbar spine

The methods of treatment of lumbar pain may vary depending on the manifestations of this symptom in patients with various dorsopathies of the lumbar spine.

Is it possible to quickly treat lumbar lumbar spine? And than to treat such pains?

For rapid relief of severe pain, injections are made: epidural corticosteroids are administered in combination with anesthetics in the form of a  novocaine blockade.

The most commonly used medications are non-steroidal anti-inflammatory drugs (NSAIDs) - Diclofenac, Ibuprofen, Ketoprofen, Naproxen, etc., are taken orally. For dosage, contraindications and side effects, see in detail -  Tablets for back pain, and  Treatment of low back pain.

It is useful to take vitamins C, E, B1, B6, B12.

Widely used various means of external application, which is - in the article  Mazi from low back pain.

To significantly alleviate the pain and reduce inflammation in acute, subacute or chronic lumbagia can be treated at home with hot or cold compresses. Doctors recommend during the first two days after the onset of pain to do cold compresses (several times a day apply cold for 20 minutes).

When the pain in the loin is associated with myalgia, two to three days you need to alternately make hot and cold compresses (for 20-30 minutes). But if the pulsation is felt when the heat is affected or the pain intensifies, it is necessary to stop using heat and make only cold compresses, and after a couple of days again try warming procedures.

Alternative treatment is carried out by rubbing the sore spot with a mixture of vodka with turpentine, heated badger fat, alcohol tincture of red pepper; compresses from grated horseradish, dissolved in water mustard powder, bischofite.

Complex therapy includes physiotherapy with the use of: electrophotophoresis, diadynamic currents, paraffin and peloid applications, therapeutic baths, massage, acupuncture (acupuncture), etc.

An integral part of the curative program is exercise and exercise therapy in lumbar lumbar region, in most cases giving a positive result. What kind of exercises you need to perform, in detail in the material -  Exercises for the waist

Surgery

Surgical treatment can be recommended in the absence of the effect of conservative therapy for at least three to four months; with damage to nerve fibers and serious changes in bone structures, for which corrective surgical or minimally invasive transcutaneous procedures have been developed.

Surgical intervention is not always successful: dissection or microdiscectomy (removal of the intervertebral disc with his hernia) provides relief of pain in 85-90% of patients. So, the risks associated with surgical treatment of lumbar lumbar region, exist, and patients should know about them.

Variants of such treatment include: vertebroplasty and kyphoplasty (restoration of compression fractures of vertebrae caused by osteoporosis), spinal laminectomy (spinal decompression in stenosis of the spinal canal), foraminotomy (widening of the opening through which the nerve root leaves the spinal canal), pulsed radiofrequency treatment moderately expressed hernias of the intervertebral disc of the lumbar region).

Prevention

Regular physical activity is the most important method of preventing lumbargia and the only effective way to maintain the range of motion and flexibility of the spine. Walking at an average pace, swimming or an exercise bike (half an hour a day) increase muscle strength. Yoga can also help stretch and strengthen the muscles, as well as improve posture.

Try at least two or three times a week (ideally - every day) to carry out specially designed  exercises for the lower back that will help to avoid lumbar pain.

It is necessary to exclude the "sofa" way of rest, lose weight, wear comfortable shoes with a low heel, sleep on their side with half-bent knees (the position of the fetus in the womb reduces pressure on the lumbar vertebrae) and do not lift weights.

[45], [46],

Forecast

The prognosis of a locally manifested clinical symptom, which is the lumbar lumbar spine, depends on the disease that causes it.

For example, one of the most famous US presidents, John F. Kennedy, suffered from back pain after a trauma to the lumbosacral spine obtained during a football game during his student years (in 1937). He underwent four operations (laminotomy and dissectomy) and wore a special corset supporting the spine. And the President's injection of analgesics, physiotherapy, swimming and massage facilitated the president's lumblagia.

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