Dorsalgia (back pain) are one of the most frequent causes of complaints and requests for medical attention. To the east, in the course of life with the problem of the dorsalgia facing the 70-90% of the population, while 28% of them develops a chronic pain syndrome that leads to the temporary/long loss of working capacity and the reduction of the quality of life. The pain in the back in addition to the limitation of the means of life influence the behavior/psyche of the people, which is manifested by the development of chronic emotional stress.
Pain syndromes primarily related to the osteochondrosis in the lumbar-sacral department (lumbar osteochondrosis), characterized by a high mobility of/the large physical burden, and are degenerate-degenerative changes in almost all components of the vertebral-motor segments of the spine (bodies of the vertebrae, intervertebral discs, and bind their tissues).
Classification
On the basis of the classification of osteochondrosis as pathogenic approach, which reflects a pathological process in the form of successive stages, grades, and on the other hand, degenerative of defeat, in virtue of that, we distinguish the following.
The osteochondrosis lumbar 1 degree
This is the first (initial) the degree of intra-disk pathological of a generation process of closing the album patalgico painful impulsatsiyu. The osteochondrosis of 1 degree is characterized by the movement of pulpous nucleus within the unit, that is to say, gelatinous nucleus penetrates through the cracks in the fibrous ring and its well-innervated exterior of the fiber. Therefore, when osteochondrosis of 1 degree occurs irritation of nerve endings and begin to appear the pain sensations, which are different reflections of the syndromes of osteochondrosis.
The osteochondrosis lumbar 2-degree
The osteochondrosis 2 degree is the degree of instability, that is to say, the loss surprised disk inherent fixation band. It is characteristic dynamics of displacement overlying relatively lower vertebra, which is due to the cracking pulpous nucleus, and the elements of the fibrous rings. 2 degree of the degenerative disc disease is characterized by a syndrome of instability, appear reflexes and part of the compression syndromes.
The osteochondrosis of 3 grade
Is the degree/stage of the education of hernias of intervertebral discs, caused by the violation of the integrity of the structure of fibrous rings (prolapse/main). The osteochondrosis 3 grade can be squeezed: lomo spinnomozgovogo of the nerve, as well as adjacent to the med-sosudisto-nervous education.
The osteochondrosis 4 grade
This is the stage of the fibrosis med and the progressive formation of the osteo-cartilage provincial growths of the bodies of the vertebrae. As a compensatory mechanism there is an increase in the area of support of the vertebrae in the disks are defective, it produces immobility. These bony expansion, in some cases, such as herniated disc, can put pressure on adjacent neuro-vascular education.
The symptoms of degenerative disc disease lumbar-part sacrum of the vertebral column
The osteochondrosis lumbar-part sacrum of the vertebral column shows itself in a fairly wide range: from small discomfort in the lumbar area of the sharp pains intense they can to cause the surge, hypothermia, the uprising of the gravity and any other of the totality of the clinical manifestations of the degenerative disc disease lumbar are divided into vertebral (compression) symptoms and extravertebral (reflexes) symptoms.
The initial phase of
The clinical symptoms of degenerative disc disease lumbar spine in the first stage are based protrusion of the disc towards the spinal canal (is a player), and irritation of the rich in pain receptors in the rear of the longitudinal ligaments. The main symptom of this stage is of different degree of severity of local pain syndrome — back pain, low back pain, which conventionally differ in the degree of severity of the pain syndrome and the duration of the pathological manifestations. For this stage, it is characteristic of the "symptom of the slate" (flattening of the lumbar lordosis), and expresses the limitation by acute pain in the period of the movements in the lumbar region of the spine.
In addition to the local pain at the level of the affected entrevertebralth of the disk due to the therapeutic of the muscle reaction in the majority of cases, there is a expresses the tension paravertebral muscles ("la défense"), which contributes to the pain syndrome, as well as to smoothing/flattening the physiological lumbar lordosis and limitation of motion of the spine.
The osteochondrosis of the first stage of the signs of radicular syndrome and other neurological manifestations (symptoms of stress) that are missing. As a general rule, with the time, to the irritation of the receptors (pain) posterior longitudinal ligament is seen the adaptation, which contributes to the immobilization affected entrevertebralth disk. The expressiveness acute/subacute decreases gradually with the right treatment, and simple compliance of orthopedics so. That is to say, we observe the transformation of the recurrence in the phase of remission, the length of time that varies within wide limits, such as the frequency of the recurrence of low back pain.
Thus, each new exacerbation of the evidence on the displacement of the med (prolapse/protrusion), which determines the increase of the pressure disc rear longitudinal of the piece. With time, this leads to the degradation of the ligaments and the reduction of its strength and, consequently, to additional risk of prolapse of the unit and of the perforation of the posterior longitudinal ligament in the next episode towards the spinal canal, which leads to the development of the next stage of the neurological complications.
Sosudisto-root stage (the stage of neurological disorders)
The set of pathological manifestations (ischemia respective roots/spinnomozgovogo, complicated the formation of a herniated disc and the aspect of the occlusion of any root of the artery) promotes the development of movement disorders in a particular myotome, and decreased sensation in a dermatome. As a general rule, the development of peresia/paralysis of the muscles, and disorders of sensation preceded by a sharp movement, that at once — pain in the lumbar-sacral shows acute short-term, irradiation of the sciatic nerve (the so-called "giperalgeticheskie the crisis of the sciatica"). In parallel, it produces weakness in the muscle zone of innervation of one or other ischemic spinnomozgovogo of the nerve and occur sensitive the disease. As a general rule, it produces occlusion of the root of the artery, which is held in conjunction with spinal nerve L5 in the spinal canal.
It is significant to the acute development of the syndrome paralytic sciatica", which is manifested paresis/paralysis of the affected side the extensors of the foot/toes ("step by step" or "cock walk"), developed to function disorders peroneal nerve. This patient, who lifts her leg at the time of walk, looking forward and hits the front of the toes of the foot on the ground.
jpg class='imgblock right center_mob'>The last stage of neurological manifestations
The osteochondrosis of the spine, as a general rule, is the cause of the violation of the blood flow in the large root of the arteries that supply blood to the spinal cord (radicular-spinal artery). The blood supply of the spinal cord lumbar-sacral level only provides an artery Adamcewicz, and in some persons is present incremental of an artery Depro—Gotteron, which ensures the supply of blood flow department/horsehair from the tail of the spinal cord.
Its functional failure determines the slow development of sosudisto-cerebral insufficiency, spinal cord injury, a clinical manifestation is the syndrome of lameness intermittent, escorted by the weakness of the legs and the numbness that comes when walking and disappears after a short break (stop). The most severe manifestation of neurological disorders in this stage are acute violation of blood circulation in the spinal cord of type spinal ischemic stroke.
Analysis and diagnosis of the
The diagnosis of lumbar-sacral of the osteochondrosis in the majority of cases it is not simple and is based on the analysis of the nature and location of the pain syndrome and relationship to physical activity (medical history), the availability of trigger points weak and the symptoms of stress. Of tools techniques the primary value assigned to the x-ray, computer and magnetic resonance imaging (photo below). To exclude the pathology is (metastases in the spine, urolithiasis, pyelonephritis), you can assign the total/biochemical analysis of the blood and of the urine.
The treatment of osteochondrosis lumbar-part sacrum of the vertebral column
The question of how to treat osteochondrosis lumbar of the division refers to one of the most frequent. First of all, the treatment and on the other hand, degenerative of the defeat of the spine should be gradual and complex, which includes the treatment of medications, physical therapy and, when appropriate, of the surgical techniques.
Operations and procedures
In the treatment of degenerative disease of the lumbar disk is widely used physiotherapy: phonophoresis/electrophoresis drugs (including analgesics and antispasmodics) galvanic/pulse currents; electroneurostimulation; uhf; lazeroterapija; magnetotherapy; kwh (very high-frequency therapy); microwave (microwave therapy); shock wave therapy, iglorefleksoterapija.
In the acute phase it is recommended that the compliance period of the motor (orthopedic) mode with the use of lumbar stabilization brace. In this period should be to limit/exclude the exercise by the amplitude that cause pain or muscle tension. Through the pain," it expressly prohibits, the exercise should be performed very slowly with the repetition of 8-10 times. It is also important to prevent the increase of the lumbar lordosis in the movements of the feet, which can lead to more pain. In the following the acute phase of a period of less reduce the pain can gradually include isometric exercise for the large muscles of the glutes and abdominals.
When soothing the pain increases the chances of a and are included within the structure of the civil society that develop/series of physical exercises special. In addition to the exercises to increase the strength of the hip extensors and the abdominal include exercises that increase the strength of the muscles of the back and flexion in the lumbar region of the spine. That are made are, in average, a rate of 15 to 20 repetitions. It should be recalled that the charge to the osteochondrosis lumbar of the division must be regular, and not case-by-case basis.
Exercises at the osteochondrosis of the lumbar spine in the period of remission mainly directed at the muscular strengthening of the corset of this area and increase mobility of the spine, however, must be done with care. The number of repetitions of the exercises of this period can be increased up to 50 to 100 times. An important task is the formation of an automatism of the muscles and in the maintenance of the specific pose in any position (sitting/standing, walking).
Physiotherapy to the osteochondrosis of the lumbar spine can be performed in the pool (in the water, but it is only a supplement to the main "dry" of the lesson). Other methods of physiotherapy is extremely useful are: swimming, which is often considered as "the most efficient physical therapy to the lumbar-sacrum osteochondrosis", as well as a treadmill, road, trails, the Ergometer, the exercises with the rubber band. Participate in sports such as volleyball, big/little tennis, rhythmic gymnastics, is not recommended due to the multitude of sudden movements that may cause the aggravation of the disease.
The load weight is only executed in supine position (on your back) to the exclusion of the vertical loads on the spine. Please note that if you select the exercise, a physical common/overhead permanent/mild injuries of the spine or uncoordinated tremors and movements in the axis of the spine to create the risk of rupture of the degenerated of the unit and the intensification of the pain. Very useful to the occupation of the spine can be the yoga, however, many of the yoga-exercises are very complex and must be performed exclusively under the direction and supervision of an instructor. The best option in the beginning, if the gym to the osteochondrosis of the lumbar spine is performed in a doctor's office, where the doctor of physical therapy will show you a series of exercises that then you are going to perform in the home.
These exercises are performed as gymnastics in the morning to osteochondrosis. You should not seek a different type of video physical therapy, or curative gymnastics, and the video to the osteochondrosis, because the video does not allow to form the proper biomechanics of exercise and that may be the cause of the exacerbation. Not less widely used and the health of massage (hand, submersible, vacuum, bath tub). Massage the osteochondrosis lumbar help to eliminate and/or reduce pain, remove stress of muscles of this area, to recover the mobility of the spine.
Surgery the treatment is carried out on significant cases sdavleniya of the spinal cord and is aimed at the decompression of the spinnomozgovogo of the channel. Includes different types of intervention: removal of the hernia of the intervertebral disc, the realization of microdiscectomy, laser, reconstruction of the unit, punktsionnoy the valuation of the unit, the replacement of the intervertebral disc implant, the operations of stabilizing the vertebral segment.
Prognosis
With a timely and adequate treatment, the prognosis is favorable. Worsens the prognosis of the appearance of the side of the herniated disc L-S1 with the participation in the process of loin and the consequent formation of radiculopathy. The prognosis worsens dramatically acute in the development of the syndromes sdavleniya of the spinal cord/horsehair from the tail of paresis in the legs, disorders of the pelvic functions, the level of the sensitivity, in this case, the outcome will improve, before is solved the compression ratio (of an abduction).