About 40-80% of people complain of pain in the lower back, but no more than 25% of them seek medical help.In fact, such unpleasant sensations can be caused both by relatively harmless causes and by pathological changes in the spine.Therefore, you should not treat them with contempt.
Causes of back pain
The spine consists of a whole complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves.Changes in each of them can be associated with pain of a different nature.In addition, the spine is surrounded by paraspinal muscles, pain in which patients often confuse with pain in the spine.Thus, there can be many reasons for pain.This can be overwork, natural restructuring of the body during pregnancy, etc.But if the pain appears regularly, it is worth contacting a vertebrologist or neurologist, since often the fact that the spine in the lumbar region hurts systematically indicates the development of some diseases.
More often in such situations, patients are diagnosed with:
- intervertebral disc pathologies (disc height reduction, protrusion, intervertebral hernia, discitis);
- joint pathologies (spondyloarthrosis, joint cysts);
- inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
- vertebral compression fractures due to osteoporosis;
- neoplastic lesions of the spine.
Pathologies of intervertebral discs
Degenerative changes in the intervertebral discs or osteochondrosis are very common, especially among the young and middle-aged.This is mainly due to the need to sit for a long time or engage in heavy physical work.In old age, the disc dries up and the vertebrae fuse together.
Already in the initial stages of the appearance of degenerative changes in the intervertebral discs, which are cartilages of a special configuration that separate the vertebral bodies, back pain may appear.This is due to the irritation of the pain receptors of the outer layers of the disc, as well as the posterior longitudinal ligament of the spine.Often, osteochondrosis provokes an aseptic inflammatory process, which leads to a reflex segmental muscle spasm.As a result, pain in the spine intensifies and movement restrictions occur.
Osteochondrosis tends to progress continuously, especially in the absence of proper treatment and lifestyle correction.Then, it leads to the formation of protrusions, and then intervertebral hernias, which provoke an aggravation of existing symptoms and the appearance of new ones.
The middle region, due to the fact that it bears the highest loads in daily activities, is affected more often.
Extensions are extensions of the disc while maintaining the integrity of its outer layer, called the annulus fibrosus.If the influence of provoking factors continues over time, the fibers of the annulus fibrosus cannot withstand the load and pressure of the internal contents of the disc (nucleus pulposus) and rupture.As a result, the core extends beyond the physiological position of the intervertebral disc.In this case, the spine always hurts in the lumbar region or the pain radiates to the legs and the discomfort intensifies with sudden movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well as with prolonged stay in one position, walking, standing.
Often, patients with already formed protrusions and hernias unconsciously take a forced position, bending slightly in the healthy direction.At the same time, pain in the spine in the lumbar region can reach high intensity, depriving a person of his ability to work.In such cases, he is forced to adhere to bed rest, and to relieve the pain, he squeezes the bent leg and brings it to the stomach.
Most often, protrusions and hernias form towards the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots that branch off from it.The latter pass through natural openings in the vertebral bodies and further branch into the lumbar plexus, which is responsible for the innervation of the lower extremities and various organs (including the genitals).
Therefore, often with long-term osteochondrosis, the formation of a hernia in the lumbar region, the pain in the spine gradually not only intensifies, but is also supplemented by other disorders.If a deformed disc or swollen soft tissues due to an inflammatory process press on the spinal root passing by them, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be complemented by pain radiating to the buttocks, groin, front, inner, outer thigh, lower leg and leg.It depends on which nerve root will be pressed, i.e.at the level of which segment of the movement of the spine will be observed pathological changes.Also, in the corresponding areas of the lower extremities, sensitivity disorders can be observed in the form of a crawling sensation, numbness, changes in temperature sensitivity, pain, tactile stimuli and limited mobility.
Changes in the height and functionality of the discs that occur with osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as degeneration of the vertebral bodies themselves.The consequence of this is the development of spondylosis, i.e. calcification of the anterior longitudinal ligament and the formation of osteochondral growths on the surface of the vertebral bodies (osteophytes).They can not only damage the surrounding tissues and compress the spinal roots, causing severe pain in the spine, but also fuse with each other.As a result, adjacent vertebral bodies are combined into a single whole, which significantly limits mobility in the lower back.
Osteochondrosis can be associated with reactive changes in the vertebral bodies, in particular reactive aseptic spondylitis, leading to osteosclerosis.This is accompanied by compression of bone tissue and significantly increases the possibility of vertebral fractures.
Diseases of facial joints
Pathologies of the facet joints or the joints of the lumbar part, especially their arthrosis, can also cause back pain in the lumbar region, including severe pain.Although more often the pain is aching and localized deep inside.Their appearance is due to the fact that their synovial capsule is highly innervated.In such situations, the pain is usually focused directly on the affected area and tends to intensify with bending, running, turning the body, or standing for long periods of time.Walking and sitting help reduce their severity.But in some cases, the pain can also radiate to the hip area, the tail, as well as the back and the outer surface of the thighs.
Inflammatory diseases of the spine
Inflammatory diseases of the spine are less common than pathologies of the intervertebral discs and facet joints.However, they also cause back pain.These include:
- Ankylosing spondylitis or ankylosing spondylitis;
- reactive arthritis;
- psoriatic arthritis etc.
The signs of these diseases usually appear before the age of 40 and more often at the age of 20. This distinguishes them from degenerative-dystrophic pathologies of the discs and joints of the spine, which most often develop after 40 years.In this case, the pain is characterized by a gradual increase in intensity.At the same time, their severity decreases after physical activity, but does not decrease during rest.Therefore, with inflammatory diseases, the spine in the lumbar region often hurts at night and especially badly in the morning, right after sleep.
The most serious situation is observed with ankylosing spondylitis and it is this disease that affects the lumbar region more often than other inflammatory diseases.This term refers to inflammation of the intervertebral joints followed by their immobilization due to the formation of a dense bony, cartilaginous or fibrous fusion between the articulating bony structures.
At first it is characterized by mild pains in the lower back, but over time they gradually spread higher, covering the chest and then the cervical spine.This is associated with the development of limited mobility of the spine in all planes, since the spine, as a result of the changes that occur, seems to have sunk into a specific case.It was also noted:
- the extent of lumbar lordosis (the natural curve of the spine in the lumbar region);
- worsening of thoracic kyphosis, which causes bending;
- reflex tension of the back muscles;
- progressive deterioration of limited mobility due to the involvement of the facet joints and ossification of the intervertebral discs in the pathological process;
- morning stiffness for an hour or more.
In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucosa (conjunctivitis), iris and ciliary body of the eye socket (iridocyclitis) is observed.
The progression of ankylosing spondylitis leads to the fact that an increasing number of joints become pathological.As a result, patients are forced to take the so-called prayer pose.It means pronounced kyphosis of the thoracic spine, downward tilt of the upper body, bending of the legs at the knees with a sharp limitation in the range of motion in the chest, which affects the depth of breathing.
The rate of progression of the disease depends on the appropriateness and completeness of the treatment.
Vertebral compression fracture
A compression fracture is a flattening of the vertebral body, causing it to become wedge-shaped.This leads to disruption of the anatomy of the spine, can provoke damage to the spinal cord and its roots, and trigger the rapid progression of degenerative changes.
Lumbar vertebrae 1 and 2 are more susceptible to injury, as they receive the greatest axial load.
Often, spinal compression fractures occur in older people due to the development of osteoporosis, i.e., decreased bone density.In such cases, not only a slight fall, but also heavy lifting or unsuccessful movement can be enough to cause injury.
The pathology is characterized by the presence of pain in the spine, which limits movement and intensifies when you sit, move and try to raise a straight leg.It usually lasts 1-2 weeks and then gradually tapers off over 2-3 months.In some cases, the pain radiates to the iliac crests and thighs.Lowering the height of a broken vertebra provokes an increase in lumbar lordosis, which also contributes to the occurrence of pain.
If the fracture is not diagnosed in time, a decrease in vertebral height leads to changes in posture and a decrease in height.This provokes reflex tension and shortening of the spinal muscles, which causes chronic back pain and necessitates long periods of rest.
Neoplastic lesions of the spine
Neoplastic lesions of the spine mean the formation of benign and malignant tumors in it, as well as metastases, the source of which are neoplasms of other organs.This occurs much less often than the pathologies of intervertebral discs, joints, ankylosing spondylitis and even compression fractures, respectively in only 1-2% of patients with back pain.But such lesions require the earliest possible diagnosis and treatment.
The characteristic features of neoplastic lesions of the spine, in addition to pain in it, are:
- increased body temperature, including subfebrile levels;
- unexplained weight loss;
- inability to find a comfortable body position;
- the presence of pain at night;
- severe pain in the spine;
- inability to relieve pain with conventional analgesics.
Even if you have 1 or 2 of these symptoms, you should make an appointment with your doctor right away.
The following may appear similarly:
- Chondroma is a malignant tumor diagnosed in 20% of patients with cancerous lesions of the spine.Most often it forms in the sacrum and can occur in people of any age and gender.
- Young's sarcoma - occurs in 8% of patients with neoplastic lesions of the spine.More typical for young people.
- Chondrosarcoma is a malignant neoplasm, accounting for 7-12% of cases.It is more often found in middle-aged men.
- Aneurysmal bone cyst is a benign neoplasm.
- Hemangioma is a benign vascular tumor present in 11% of people.It may not be detected throughout a person's life.But it increases the risk of vertebral fractures.
- Metastases of other tumors are secondary malignant neoplasms.Most often, breast, prostate, lung cancer metastasizes to the spine, and less often - kidney, thyroid and skin cancer.
Diagnosing
If your spine hurts in the lumbar region, you should make an appointment with a neurologist or vertebrologist.At the meeting, the doctor first collects anamnesis, asking questions about the nature of the pain, the circumstances of its occurrence, the duration of its continuation, the presence of other symptoms, the way of life, etc.
Then the specialist performs an examination.As part of it, he not only palpates the spine, determines the localization of pain, evaluates the gait and posture that the patient takes unconsciously, but also performs functional tests.With their help, you can detect signs of ankylosing spondylitis, neurological deficits, assess the degree of mobility of the spine and get other diagnostic data.
Based on this, the doctor can already suggest the possible causes of the pain.To clarify them, as well as to accurately determine the degree of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed.Most often they use help:
- X-rays in frontal and lateral projections, sometimes with functional X-ray tests;
- CT scan – enables better visualization of bone structures, therefore it is used more often for the diagnosis of spondylosis, fractures, bone tumors, etc.;
- MRI - enables the most complete assessment of the condition of cartilaginous structures and soft tissues, therefore it is used more often to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord lesions, etc.;
- electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of nerve damage;
- radioisotopic osteoscintigraphy – used for the diagnosis of malignant tumors and metastases;
- X-ray densitometry is the optimal method for diagnosing osteoporosis;
- myelography - used to identify signs of compression of the spinal cord and cauda equina nerves.
Treatment
For each patient, the treatment is chosen strictly on an individual basis, not only based on the diagnosis, but also on the nature of the existing accompanying pathologies.However, the cause of back pain, of course, determines the treatment tactics.It can be conservative or involve surgical intervention.
But the first step is always to relieve the pain, especially if it is severe.For this, patients are prescribed NSAIDs, antispasmodics and pain relievers.And in severe cases, spinal blocks are performed - injections of anesthesia and corticosteroids at certain points in the spinal area.
Bed rest is not indicated for all patients.And in case of pathologies of the intervertebral discs, it can be completely contraindicated, since a decrease in physical activity contributes to the transformation of acute back pain into chronic pain.
Exclusively conservative or non-surgical treatment is prescribed for:
- osteochondrosis;
- Bekhterev's disease;
- arthrosis of facial joints;
- easy compression fractures.
It is usually complex and consists of:
- drug therapy, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids,
- physiotherapy (UHF, magnetic therapy, laser therapy, traction therapy, etc.);
- exercise therapy;
- manual therapy.
If the cause of back pain is intervertebral hernia, protrusion, spondylosis, severe vertebral fractures, tumors, surgery is often indicated.It is also necessary for:
- ineffectiveness of conservative therapy for degenerative changes;
- increased neurological deficit;
- instability of the spinal movement segment;
- the development of complications, in particular spinal canal stenosis.
Most modern spine surgeries are minimally invasive.Thanks to this, intraoperative and postoperative risks are significantly reduced, the rehabilitation period is shortened and facilitated, and the effectiveness is not inferior to the more traumatic open operations.Depending on the disease detected, the following may be recommended:
- Discectomy is an operation mainly indicated for hernias and protrusions, especially those causing cauda equina syndrome.It can be performed using microsurgical instruments through an incision of about 3 cm (microdiscectomy) and using endoscopic equipment brought into the spine through sharp punctures about 1 cm in diameter (endoscopic discectomy).When an intervertebral disc is completely removed, it is usually replaced with implants.
- Vertebroplasty and kyphoplasty are indicated for compression fractures of vertebrae, hemangiomas and some other diseases.The essence of the operation is the introduction of fast-hardening bone cement through a thin cannula into the vertebral body, strengthening it.With kyphoplasty, it is also possible to restore the normal dimensions of the vertebral body, which is important in case of a serious decrease in their height as a result of a fracture.
- Fixation surgeries are used to stabilize the spine.For this, metal structures of various types are used, which usually remain in the patient's body until the end of life.
Thus, the spine in the lumbar region can hurt for a number of reasons.Therefore, if the pain continues for a long time, if it appears regularly, if the pain intensifies over time and even more so with the addition of other symptoms, you should definitely contact a vertebrologist or neurologist.Early diagnosis will make it possible to detect pathological changes in those stages when they are easier to cope with and, if the disease is not completely cured, at least stop its progression and maintain a high standard of living.