Osteonecrosis is a common disease of the spine, affecting the intervertebral discs and cartilage. The cervical and lumbar regions are more susceptible to such processes. Lumbar osteonecrosis can cause constant pain in the lower back and significantly complicate a person's life. In the treatment of the disease, priority is given to conservative methods, surgical intervention is used only in extreme cases.
Causes of lumbar spondylosis
Osteoarthritis is not necessarily a disease, but it is often a natural phenomenon that occurs due to age-related degenerative changes in the spine. Normally, the intervertebral discs in the lumbar spine act as shock absorbers between two vertebrae, helping the joints and spine move easily. The outer part of the disc, the annulus fibrosus, surrounds the soft inner core of the disc, the nucleus pulposus. Everyone's spinal discs undergo degenerative changes as they age, but not everyone develops symptoms.
It is believed that osteochondrosis begins with changes in the annulus fibrosus, intervertebral disc, and subchondral bone. The annulus fibrosus loses water, making it less able to bear the daily loads on the spine, distributing them improperly. Overload in the posterior part of the vertebrae leads to arthritis of the facet joints and hypertrophy (growth, formation of bone spurs - bone growth) of the vertebral bodies close to the affected intervertebral disc.
Authority to solve! According to statistics, 30% of people between 30 and 50 years old have some degree of disc degeneration.
There are two main pathophysiological causes of pain in lumbar osteoarthritis. One possible cause of pain is neuritis due to rupture of the outer part of the disc and leakage of the inner core. Inflammatory proteins are released, causing nerve tissue irritation.
According to the second reason, the vertebrae, due to age-related deformation, are no longer able to effectively absorb loads. This causes abnormal movement of the spine and causes painful spasms of the back muscles that are trying to stabilize the spine.
The result of osteoarthritis can be destruction of spinal segments, leading to radiculitis. Risk factors that trigger and accelerate the degenerative process in the spine are:
- Genetic predisposition to diseases of the musculoskeletal system;
- Smoke;
- Previous injury;
- Hormonal and vascular disorders;
- Excess body weight;
- Muscles are too weak and do not provide the necessary support for the spine;
- Occupational activities associated with heavy manual labor (athletes, porters).
Stages of development of lumbar osteoarthritis
Disc disorders occur gradually, leading to degeneration and destruction. The entire pathological process goes through many stages, according to which the stages (or levels) of lumbar osteoarthritis are distinguished:
- The first stage (degree) is characterized by mild symptoms. Painful sensations develop based on irritation of nerve endings by the nucleus pulposus, penetrating into the cracks of the annulus fibrosus.
- The second stage is characterized by displacement of the upper vertebrae relative to the lower vertebrae, due to cracking of the core and ring. These pathological processes, in addition to causing pain during movement, also cause neurological symptoms, numbness and instability in the affected area.
- The third stage is characterized by increased pain and the appearance of disc herniation due to violation of the integrity of the annulus fibrosus. Pain, sensory impairment, and muscle weakness interfere with daily tasks. Due to nerve roots being compressed, the functioning of the urinary and intestinal systems may be disrupted.
- The fourth stage corresponds to the complete destruction of the intervertebral discs, they become fibrotic, and the growth of bone and cartilage of the vertebral body causes immobility of the spine in this part.
Symptoms of lumbar osteoarthritis
To get started, get advice from the experts:
- Neurologist
- orthopedist
- therapist
The main symptom of lumbar and sacral osteoarthritis is pain. This condition is often aggravated by sitting for long periods of time or by rotating, bending the spine, or lifting heavy objects. The pain can spread to the legs and groin and is accompanied by a feeling of numbness and weakness. Moderate, aching, dull pain may be followed by more severe attacks.
Symptoms directly depend on the stage of development of the pathology:
- In the early stages, when degenerative changes are just starting to appear, symptoms are minimal.
- The intermediate stage, characterized by weakening of the annulus fibrosus, may manifest as lower back pain.
- In later stages, as fibrosis develops in the structures and bone spurs form, pain becomes less pronounced but spinal mobility is significantly reduced.
Sensitivity of the lower back may increase to touch. Typical pain in the buttocks, thighs and tingling sensations are signs of nerve root compression caused by degeneration of the intervertebral disc. Patients with lumbar spondylosis have difficulty bending forward, backward, and to the sides. Osteoarthritis can be complicated by disc herniation and spinal stenosis, accompanied by the appearance of additional symptoms.
Diagnosis of lumbar osteoarthritis
Diagnosis begins with collecting a medical history, interviewing and examining the patient. The specialist will be interested in your complaints, physical activity, the presence of old injuries, bad habits and cases of illness of relatives. During a physical exam, the doctor palpates (feels) the lower part of the spine, looking for areas of pain, inflammation, or any abnormalities. He or she may also test sensation and perform motor tests.
The most common method for diagnosing lumbar osteoarthritis is X-rays. Imaging will show the presence of bone spurs, narrowing of the joint space of the intervertebral disc, also known as the "vacuum" symptom, when air bubbles are detected in the thickness of the disc. Other methods used are:
- MRI shows hydration (degree of saturation with water), shape of intervertebral discs, their height, allowing to identify pinched nerves.
- CT scan, allows you to study in detail the condition of tissues and diagnose disorders at the earliest stages.
- Disc provocation is used to determine the location of the affected disc.
Authority to solve! MRI is a fairly accurate diagnostic method but cannot detect rupture of the outer ring of the disc.
Treatment methods for lumbar spondylosis
The preferred treatment for lumbar degenerative disc disease associated with chronic pain is conservative treatment with physical therapy, exercise, and medication. For patients with lumbar osteoarthritis, you should:
- A daily routine that includes adequate rest and adequate physical activity;
- Exercise regularly to strengthen muscles;
- Lifestyle adjustments, including reviewing nutrition and weight loss.
Physical therapy
Many different physical therapy techniques have been used successfully to relieve low back pain. Physiotherapy promotes regeneration in the intervertebral disc, stimulates metabolism and transport, prevents the formation of adhesions and further damage.
Physical therapy methods used to treat spinal degeneration include:
- Electrical stimulation. Electrical impulses help relieve back pain and improve blood circulation in the affected spine.
- Ultrasound therapy. Ultrasound waves can penetrate deep tissue layers and help reduce inflammation and pain.
- Magnetic therapy. Magnetic fields can improve blood circulation and metabolism in tissues, promoting their regeneration.
- Laser therapy. Laser beams can help relieve pain, stimulate blood circulation and stimulate tissue regeneration.
- Supersonic. This method combines ultrasound therapy with the use of drugs that penetrate deep tissue layers and help reduce inflammation and pain.
Important! Contrary to popular belief, osteoarthritis can and should be treated. If left untreated, it becomes a source of chronic pain and can lead to many problems, including disruption of the functioning of internal organs.
Treatment medicine
To relieve pain that interferes with daily activities, patients are prescribed pain relievers and nonsteroidal anti-inflammatory drugs. According to indications, the doctor may prescribe stronger drugs: muscle relaxants, steroids and narcotic pain relievers. Therapeutic blockade is performed using local anesthetics and glucocorticoids to relieve severe pain.
Surgery
Less often, surgical intervention is used for osteoarthritis in the lumbar region. It may include discoplasty or lumbar spinal fusion (which facilitates the fusion of two vertebrae, while also reducing pain by eliminating motion in this part of the spine).
If the movement of the spine is significantly impaired, special intervertebral spacers can be installed. For patients who do not respond to all other treatments, total lumbar disc replacement may be performed.
Treatment of lumbar spondylosis at home
The most effective thing you can do at home to maintain function and control pain is exercise. They will increase the flow of blood, oxygen and nutrients to the spine, helping to keep the cartilage hydrated and the spine flexible for as long as possible. In addition, during exercise, endorphins are released, which have a natural pain-relieving effect.
Changing positions regularly also brings relief. Some positions help deal with pain: kneeling, reclining, lying down. Short periods of rest are necessary and beneficial, but prolonged bed rest will only make the condition worse. It is important to stay active to prevent the disease from progressing. Patients with lumbar osteoarthritis benefit from walking, swimming, cycling, yoga, Pilates, stretching exercises, and strengthening corsets. The following measures are also helpful:
- Applying heat to the lower back improves blood circulation and reduces muscle spasms and tension.
- Ice packs will help relieve pain and reduce inflammation.
- Massage also relaxes muscles, reduces spasms and reduces pressure on the spine, thereby reducing pain. By increasing blood circulation in this area, metabolism improves and tissues are enriched with oxygen.
- Use orthopedic mattresses and pillows. They will help maintain the correct position of the spine during sleep.
- Correctly distributes the load on the spine. When lifting heavy objects, you should use proper lifting technique to avoid putting stress on your lumbar spine.
- Proper nutrition. Eating a balanced diet rich in calcium and vitamins will help maintain healthy bones and joints.
However, if you have pain or other symptoms, before starting home treatment for osteoarthritis, you should consult your doctor to receive more precise recommendations and evaluate the condition of your spine.
Which doctor should I contact if I have lumbar osteoarthritis?
If symptoms characteristic of lumbar osteoarthritis appear, consultation with a neurologist or orthopedist is recommended. If you have lower back pain, you can also make an appointment with a therapist. He will prescribe the necessary tests for diagnosis and refer you to a specialist.
Treatment of lumbar osteoarthritis
Specialists from the nearest clinic in your city or other locality are ready to find out the cause and help cope with the pain. Doctors usually have extensive clinical experience and master all modern methods of treatment and diagnosis of osteoarthritis in women and men. For the most part, convenient location, excellent equipment and flexibility of institutions are at the forefront of modern medicine, allowing you to quickly undergo any examination and restore your healthof the musculoskeletal system. You can make an appointment by calling the clinic convenient for you, as well as on the website by filling out the online form.
Prevention of lumbar spondylosis
Effective methods to prevent lumbar osteoarthritis are:
- Get regular physical activity. Maintain good physical condition. Strengthen your back muscles. Stretching and strengthening exercises for your back will help keep your spine healthy.
- Reduce stress on the spine: Avoid unnecessary stress on the spine. When lifting heavy objects, use proper lifting technique.
- Posture correction: ensure correct posture. Sit and stand straight, don't slouch. Choose an orthopedic pillow and mattress when sleeping to maintain the correct posture of the spine while resting. Buy quality shoes with good cushioning and support.
- Pay attention to back support by using an orthopedic chair if you are forced to sit for long periods of time due to your occupation. Avoid staying in one position for a long time. Rest regularly and stretch your spine.
- Track your weight. Excess weight can put additional stress on the spine.
- Avoid uncontrolled movements and back injuries. Be careful when playing sports or doing physical activity.
- Stop smoking, which can negatively affect your spinal health.
By following these simple recommendations, you can live an active and fulfilling life, minimizing your risk of back pain. If you already have symptoms of low back pain, be sure to see your doctor for diagnosis and treatment.