Lumbosacral dorsopathy

Most specialists define lumbosacral dorsopathy as a spinal pain syndrome or back pain due to the presence of pathologies of the musculoskeletal system - diseases of the lumbosacral spine and the immediately adjacent tissues (connective and muscular). Some clinicians refer to all spinal disorders as dorsopathies.

Epidemiology

Lumbosacral dorsopathy in about 60-70% of cases is due to degenerative-dystrophic changes in the intervertebral discs and arcuate (facet) joints, and in 4% of cases - disc herniation. Also, about 4% of cases are statistically recorded in vertebral compression fractures in patients with osteoporosis and 1% of cases in other types of fractures of the lower spine.

Lumbosacral vertebral misalignment accounts for no more than 2% of cases as a causative factor.

The etiologic association of lumbosacral dorsopathy with kyphosis or scoliosis does not exceed 1% of cases.

Causes of the lumbosacral dorsopathies

The key causes of dorsopathy of this localization are attributed to:

• Osteochondrosis of the lumbosacral spine (L5-S1); [1]
• lumbar disc herniation (between L5 and S1 vertebrae); [2]
• Spondylolisthesis - displacement of the lumbar vertebrae (vertebrae lumbales), often accompanied by spinal canal stenosis; [3]
• degenerative-dystrophic diseases of the spine, primarily spondyloarthrosis of its lumbosacral region, as well as ankylosing spondyloarthrosis (Bechterew's disease); [4]
• lumbar kyphosis or scoliosis; [5]
• inflammation of the sacroiliac joint (sacroileitis).

Chronic low back pain with diseases of this area of the spine is also called vertebrogenic lumbalgia syndrome. [6]

Dorsopathy can be a manifestation of muscle-tonic syndrome with back muscle pain that develops not only in patients with muscular dystrophy or dystonia, but also due to spinal curvature or the same lumbosacral osteochondrosis.

Risk factors

The risk of dorsopathies is significantly increased by a history of spinal trauma. Thus, dorsopathy of the sacral spine (consisting of five fused vertebrae of the distal part of the spine - vertebrae sacrales) is observed almost exclusively in cases of traumatic injury.

Risk factors for the development of lumbosacral dorsopathy - in addition to the above vertebrogenic diseases - also include: repeated increased loads on this section of the spinal column (frequent lifting of heavy weights, prolonged stay in an uncomfortable position, etc.); violation of vertebral trophism with sedentary lifestyle or endocrine pathologies and metabolic syndrome (with obesity); dystrophic and/or degenerative changes in adjacent muscle and connective tissues; the presence of tumor formations of the spine.

There are also occupational risks of lumbosacral dorsopathy, for example, in drivers of public transport and "truckers", as well as in people engaged in heavy physical labor.

Pathogenesis

In dorsopathies of any localization, the pathogenesis of pain sensations is due to the activation of proinflammatory cytokines and inflammatory mediators (interleukins, prostaglandins, necrosis factors) at the site of tissue damage and the response of the nociceptive system - with depolarization of nociceptors (pain receptors), excitation of primary afferent fibers and transmission of sensory impulses to the dorsal horns of the spinal cord.

Here, primary afferent fibers form synapses on intermediate or insertion neurons (interneurons), and interneurons that have received peripheral signals, stimulated by neurotransmitters (chemical mediators of pain), provide further transmission of these signals to the CNS.

Read more:

• Anatomy of the nociceptive system
• Nociceptive pain

Symptoms of the lumbosacral dorsopathies

In almost all cases there is lumbosacral dorsopathy with pain syndrome. So its first signs are lower back pain or lumbosacral dorsalgia. The pain syndrome can be acute transient or chronic.

Dorsopathy is also indicated by symptoms such as numbness/tingling, loss of sensation, and muscle weakness.

Read more about lumbar dorsopathy in the publication - Dorsopathy of the lumbar spine

Lumbosacral dorsopathy with radicular syndrome - when the roots of the spinal nerves from L1 to S4 are affected - is called lumbosacral radiculitis or radiculopathy, which may be accompanied by pain irradiating to the pelvis, buttocks, lower extremities, as well as paresthesias or hypoesthesias (decreased pain). radiculopathy, which may be accompanied by pain, irradiating to the pelvis, buttocks, lower extremities, as well as paresthesia or hypoesthesia (decreased sensitivity) of the corresponding dermatome or myotome, flaccid paresis and loss of some tendon reflexes in the zone of innervation of the affected root. These symptoms are intensified in an upright position, coughing or sneezing. According to some data, the prevalence of lumbosacral radiculopathy is 10-25%.

Read more: Spine syndromes and back pain

Complications and consequences

Lumbosacral dorsopathy with radicular syndrome can lead to pronounced neurological disorders: flaccid paresis or paralysis of the lower extremities. Patients with pain when walking and stiffness have pseudochromotics.

The consequence of lumbosacral dorsopathy is often restricted mobility, reduced ability to work and disability.

Diagnostics of the lumbosacral dorsopathies

The basis for identifying the causes of lumbosacral dorsopathy is instrumental diagnostics: X-ray and MRI of the lumbosacral spine, myelography. Electromyography.

Read more:

• Spinal examination methods
• Methods of diagnosing back pain
• Diagnosis of spinal pain

Patients may be diagnosed with sciatica, fibromyalgia, or myopathy for lumbosacral back pain, which is most often nonspecific. Therefore, the differential diagnosis should exclude nonvertebrogenic back pain as well as pain of visceral origin. For example, in women it is important to differentiate lumbosacral dorsalgia and lumbar and sacral pain due to gynecologic diseases and pathologies of the pelvic organs. And if the pain is caused by pinching of the sciatic nerve, sciatica is diagnosed, which belongs to neurology.

Treatment of the lumbosacral dorsopathies

How is lumbosacral dorsopathy treated? All in detail in the publications:

• Treatment of back pain: strategies for drug therapy
• Treatment of spinal lumbalgia: standards, medications, LFK, exercises
• Treatment of vertebrogenic lumbalgia

About physical therapy for lumbosacral dorsopathy - Physical therapy for lumbosacral spine osteochondrosis

What exercises are recommended for lumbosacral dorsopathy, more details:

• Lower back exercises to help avoid lumbar pain
• Lumbar exercises
• Complex of exercises for back pain

Massage is also used for lumbosacral dorsopathy, see - Massage for osteochondrosis of the lumbosacral spine. And after the massage it is reasonable to perform exercises for muscle stretching.

Prevention

To prevent the development of dorsopathy, it is necessary not only to timely treat etiologically related diseases, but also to dose the load on the lumbosacral spine this section of the spinal column, watch your posture, control your weight and get rid of extra pounds, and move more. Very useful for the spine walking at a relaxed pace, swimming, exercises to develop and strengthen the back muscles.

Forecast

Dorsopathy of the lumbosacral spine can be treated, and its prognosis regarding life expectancy is favorable. However, the quality of this life depends on the correct treatment and progression of the disease, in which spinal pain syndrome develops.