Dystrophic changes in the lumbar spine treatment. Reasons for the development of pathology

Degenerative-dystrophic changes in the lumbar sacral region spine is a syndrome in which pathology of the intervertebral disc provokes the appearance of lower back pain.

Although there is a small genetic predisposition to the occurrence of this disease, the real reason The appearance of degenerative changes in the spine appears to be multifactorial in nature. Degenerative changes can be caused by the natural aging process of the body or have a traumatic nature. However, they are rarely the result of extensive trauma, such as a car accident. Most often, we will be talking about a slow traumatic process leading to damage to the intervertebral disc, which progresses over time.

The intervertebral disc itself does not have a blood supply, so if it is damaged, it cannot repair itself in the same way as other tissues in the body. Therefore, even minor damage to the disk can lead to the so-called. a “degenerative cascade” due to which the intervertebral disc begins to deteriorate. Despite the relative severity of this disease It is very common and current estimates suggest that at least 30% of people aged 30-50 years have some degree of disc space degeneration, although not all experience pain or are diagnosed with it. In fact, patients over 60 years of age have some level of degeneration intervertebral discs detected by MRI is the rule rather than the exception.

Causes

Degenerative-dystrophic changes in the lumbosacral spine are usually provoked by one or both of the following two reasons:

• Inflammation that occurs when proteins in the disc space become irritated by a herniated disc. nerve roots.
• Pathological instability of micromotion, when the outer shell of the disc (annulus fibrosus) wears out and cannot effectively withstand the load on the spine, which leads to excessive mobility in the affected spinal segment.

The combination of both factors can lead to constant pain in the lower back.

The combination of both factors is most common in the formation of intervertebral hernia, which is a complication of the degenerative process in the intervertebral discs. When a disc herniation occurs, mechanical compression of the neurovascular bundle passing in the spinal canal is also added, as a result of which the pain in the lower back increases significantly and becomes permanent.

Symptoms

Most patients with degenerative-dystrophic changes in the lumbosacral spine experience constant but tolerable pain, which intensifies from time to time for several days or more. Symptoms may vary depending on specific case, but the main symptoms of this disease are as follows:

• Pain localized in the lower back, which can radiate to the hips and legs;
• Long-lasting pain in the lower back (lasting more than 6 weeks);
• Low back pain is usually described as dull or aching, as opposed to a burning pain in the areas to which it radiates;
• The pain is usually worse in a sitting position, when the discs are subjected to more pronounced stress compared to what is placed on the spine when the patient stands, walks or lies down. Prolonged standing can also increase pain, as can bending forward and lifting objects;
• The pain worsens when performing certain movements, especially when bending, turning the body and lifting heavy objects;
• When a disc herniates, symptoms may include numbness and tingling in the legs and difficulty walking;
• With a medium or large size of intervertebral hernia, the nerve root emerging from spinal cord at the affected level, it can be compressed (foraminal stenosis), which, in turn, can lead to pain in the legs (sciatica);
• Neurological symptoms (eg, weakness in the lower extremities) or pelvic organ dysfunction ( various disorders urination and defecation) may be a consequence of the development of cauda equina syndrome. Cauda equina syndrome requires immediate action to provide qualified medical care.
• In addition to lower back pain, the patient may also experience leg pain, numbness, or tingling. Even in the absence of nerve root compression, others vertebral structures may cause pain to radiate to the buttocks and legs. The nerves become more sensitive due to inflammation caused by proteins within the disc space, causing numbness and tingling sensations. Usually in such cases the pain does not go below the knee;

In addition to degenerative changes in the intervertebral discs, the cause of pain can be:

• Stenosis (narrowing) of the spinal canal and/or osteoarthritis, as well as other progressive diseases of the spine, the occurrence of which is facilitated by degeneration of the intervertebral discs;
• Intervertebral hernia, a consequence of intervertebral disc degeneration.

Diagnostics

Diagnosis of the presence of degenerative-dystrophic changes in the lumbosacral spine is usually carried out in three steps:

• Compiling a history of the patient, including when the pain began, a description of pain and other symptoms, as well as actions, positions and treatments (if treatment was carried out) that relieve or, conversely, increase pain;
• A medical examination during which the doctor checks the patient for signs of intervertebral disc degeneration. This examination may include checking the patient's range of motion, muscle strength, looking for painful areas, etc.
• MRI scanning, which is used to confirm suspicions of degenerative changes in the spine, as well as to identify other potential causes that led to the appearance of painful symptoms in the patient.

MRI results most likely indicating the presence of degenerative changes as the cause of pain symptoms:

• Disk space is destroyed by more than 50%;
• Initial signs of disc space degeneration, such as dehydration of the disc (on MRI such a disc will appear darker because it contains less water than in a healthy disk);
• There are signs of erosion of the cartilaginous end plate of the vertebral body. The disc does not have its own blood supply system, but, nevertheless, living cells are located inside the disc space. These cells receive nutrition by diffusion through the end plate. Pathological changes end plate as a result of degeneration lead to disruption of cell nutrition. Such changes are best seen on T2-weighted images taken in the sagittal plane. Typically, the end plate appears as a black line on MRI. If this black line is not visible, it indicates endplate erosion.
• Rupture in the annulus fibrosus
• Presence of protrusion or intervertebral hernia

Treatment

The vast majority of cases of intervertebral disc degeneration do not require surgical intervention and are treated using conservative methods, which include special therapeutic exercises, physiotherapy, different kinds massages. In addition, spinal traction helps very well with disc degeneration, since it increases the distance between the vertebrae, allows the intervertebral disc to receive the water and nutrients it needs, which contributes to its recovery.

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We bring to your attention a classic article on this issue.

Degenerative-dystrophic changes in the lumbosacral spine (prevalence, clinical picture, prevention)

ON THE. Pozdeeva, V.A. Sorokovikov
GU NTs RVH VSNTs SB RAMS (Irkutsk)

Diagnosis of lumbar vertebral displacement is one of the least studied issues in radiology. Interest in this pathological condition of the spine is not accidental. Instability - displacement of the vertebrae - as one of the forms of dysfunction of the motor segment becomes the cause pain syndrome and subsequent neurological disorders. Taking into account the costs of diagnosis and treatment, as well as workers' compensation and disability, it can be argued that low back pain syndrome is the third most expensive disease after heart disease and cancer.

DEGENERATIVE-DYSTROPHIC CHANGES IN LUMBOSACRAL PART OF THE SPINE
(OCCURRENCE, CLINIC, PROPHYLAXIS)
N.A. Pozdeyeva, V.A. Sorokovikov
SC RRS ESSC SB RAMS, Irkutsk
Diagnostics of dislocation of lumbar vertebrae is one of the less studied issues of radiology. Interest in this pathological condition is not at all casual. Instability - vertebrae dislocation. - as one form, of the dysfunction of movement segment becomes a cause of pain syndrome and further coming neurological disorders. Taking into consideration expenses of diagnostics and treatment, and also of compensation of disablement of working patients, invalidity, we may assert that lumbar pain syndrome is the third, of the most "expensive" disease after coronary disorders and cancer.

Degenerative diseases of the spine are one of the leading social problems, which have an important economic aspect, since this pathology most often affects young and middle-aged people, who make up the largest category of the working population. According to Holger Pettersson (1995), the diagnosis of these diseases is difficult, because there is a weak correlation between the results of X-ray examination and clinical symptoms.

Diagnosis of lumbar vertebral displacement is one of the least studied issues in radiology. Interest in this pathological condition of the spine is not accidental. Instability - displacement of the vertebrae - as one of the forms of dysfunction of the motor segment, becomes the cause of pain and subsequent neurological disorders. Taking into account the costs of diagnosis and treatment, as well as compensation for workers' incapacity and disability, it can be argued that low back pain syndrome is the third most expensive disease after cancer and heart disease.

The medical and socio-economic significance of the problem of diagnosis and treatment of osteochondrosis of the lumbar spine is due to a number of reasons. According to the World Health Organization (2003), spinal osteochondrosis affects 30 to 87% of the most able-bodied population aged 30 to 60 years. Spinal osteochondrosis accounts for 20 to 80% of cases of temporary disability. Incidence rates in Russia tend to increase, while in the vast majority of patients the disease is accompanied by damage to the lumbar spine. According to the VIII World Congress on Pain, which took place in Vancouver in 1996, back pain is the second most common reason for visiting a doctor and the third most common cause of hospitalization after respiratory diseases, while 60-80% of the population have experienced it at least one day. In the structure of morbidity among the adult population of our country, lumbar osteochondrosis accounts for 48–52%, ranking first, including in terms of the number of days of disability. Temporary disability in 40% of neurological diseases is caused by lumbar ischialgic syndromes. In the general structure of disability from diseases of the osteoarticular system, degenerative-dystrophic diseases of the spine account for 20.4%. Disability rate for degenerative diseases spine is 0.4 per 10,000 inhabitants. Among disabled people with other diseases of the musculoskeletal system, this pathological condition ranks first in frequency of occurrence, and in 2/3 of patients the ability to work is completely lost.

Mobility of the spine is possible thanks to the complex interactions of the elastic apparatus of the vertebral bodies, arches and intervertebral discs. The functional unit of the spine at any level is the motion segment, a concept introduced by Iunghanus in 1930. The motion segment includes two adjacent vertebrae, the disc between them, the corresponding pair of intervertebral joints and the ligamentous apparatus at this level. At the level of any one segment, the mobility of the spine is relatively small, but the summed movements of the segments provide it generally within a wider range.

Research by L.B. Fialkova (1967), Buetti-Bauml (1964) and others show that in the lumbar region the most mobile segment in terms of flexion and extension in the frontal plane is the L4 - L5 segment; this explains its overload, leading to degenerative lesions and vertebral displacements.

Intervertebral joints belong to the group of low-moving joints and are combined joints. Basics functional purpose joints of the spine - the direction of movement, as well as the limitation of the range of movement within these directions.

Under normal static conditions, the articular processes do not bear vertical loads: the function of absorbing vertical pressure forces (the weight of the head, torso) is carried out by the intervertebral discs. In cases where the articular processes are forced to at least partially perform a supporting function that is not characteristic of them (with large static loads on the spine in combination with obesity), local arthrosis and anterior displacement of the vertebrae (antelisthesis) develop in the true joints, and with significant, ever-increasing vertical load - neoarthrosis of the articular processes with the bases of the arches.

The role of the disc in the statics of the spine is to absorb the pressure exerted on the spine by the weight of the body and physical activity. This means that the force acting on the intervertebral disc must be balanced by an equal but opposite force on the disc.

The applied force is resisted not only by the entire spine, but also by the muscular-ligamentous apparatus of the torso, which adapts to the external load. Most important have forces acting in the plane of the disks, in other words, traction forces transmitted to the disk. They can reach significant intensity and cause most mechanical damage to discs.

A particular form of spinal injury can be categorized as either a stable or unstable injury. The concept of “stable and unstable injuries” was introduced by Nicoll in 1949 for the lumbar thoracic spine, and in 1963 Holdsworth extended to the entire spine. According to this theory, disruption of the posterior structure is a necessary condition for spinal instability.

F. Denis (1982-1984) introduced the three-support concept of spinal instability - the “three columns” theory, with the anterior supporting structure consisting of: the anterior longitudinal ligament, the anterior part of the fibrous ring, the anterior half of the vertebral bodies; the middle supporting structure consists of: the posterior longitudinal ligament, the posterior part of the fibrous ring, the posterior half of the vertebral bodies and the posterior supporting structure includes: the supraspinous ligament, interspinous ligament, joint capsules, ligamentum flavum, vertebral arches. According to this theory, rupture of both the posterior and medial supporting structures is necessary for instability to occur.
Degenerative-dystrophic changes in spinal segments develop mainly as a result of acute and chronic overloads under the influence of cumulative microtraumas.
Intervertebral discs are highly durable and can withstand static loads that are applied slowly, such as carrying a heavy load. A dynamic, instantly applied load, creating impacts of high local force, as a rule, leads to varying degrees of compression of the vertebral bodies, and also causes damage to the discs. With disc lesions, when the nucleus pulposus loses its function as the axis of the ball joint, movements are reduced in volume or blocked, despite the intactness of the rest of the musculoskeletal and ligamentous apparatus.
The disc prevents not only the convergence, but also the distance of the vertebral bodies. This function is provided by the collagen fibers of the plates of the fibrous ring, which is tightly fixed to the cartilaginous layer and in the peripheral portion of the limbus. In cases where the connection between them weakens, for example, with degenerative lesions in the spinal segments, the vertebral bodies, not being firmly connected to the discs, can shift in different directions.
The variety of emerging pathomorphological and pathophysiological situations also determines the clinical polymorphism of the disease. Anatomical formations of different structure and functions are involved in the pathological process.
The clinical manifestations of this process are dorsalgia - pain in the back (with possible irradiation to the limbs), which is caused by functional and dystrophic changes in the tissues of the musculoskeletal system (muscles, fascia, tendons, ligaments, joints, disc) with the possible involvement of adjacent structures of the peripheral nervous system(root, nerve).
In the pathogenesis of chronic dorsalgia, the leading role is played by decompensation of dystrophic changes in the tissues of the musculoskeletal system, as well as dysfunction of individual muscles and joints, which leads to the formation of sources of nociception with subsequent segmental and suprasegmental response.
In the mechanism of development of radiculopathy, compression of the root in a narrow “tunnel”, the walls of which can be formed, plays a role various structures: disc herniation, ligamentum flavum, facet joint tissues, osteophytes. Of great importance in this case is the disruption of the blood circulation of the root in the compression zone with subsequent swelling.
Risk factors for the development of pain syndromes of a musculoskeletal nature include:
o Motor imbalance (improper posture, scoliosis, decreased extensibility, strength and endurance of muscles, pathological motor stereotype);
o Spinal dysplasia;
o Constitutional hypermobility;
o Dystrophic changes in the musculoskeletal system.
They create the prerequisites for the development of functional disorders at various levels musculoskeletal system and disruption of compensation of natural age-related degenerative processes under the influence of provoking factors.
The problem of instability of the spinal motion segment, which arises under the influence of various factors, is far from being resolved. First of all, this concerns the systematization of the most important pathogenetic mechanisms, taking into account the role of morpho-functional changes in spinal structures, biomechanics, as well as the need to diagnose SMS instability in the early stages of the degenerative process.

LITERATURE

1. Galley R.L. Emergency orthopedics. Spine / R.L. Galley, D.W. Speight, R.R. Simon: Transl. from English - M.: Medicine, 1995. - 432 p.

In many countries, according to world statistics, diseases of the vertebral region of the human body are very common.

Degenerative dystrophic changes in the lumbosacral spine appear during the influence of certain external factors on the patient’s body. This disease is diagnosed especially often in elderly people. over 50 years old.

Understanding the reasons why dystrophic changes in the lumbosacral spine appear is an important step in the beginning proper therapy diseases. When an adverse effect appears on the human body, it ceases to cope with heavy loads that previously did not cause any trouble. Therefore they begin their destruction intervertebral cartilage.

A number of reasons that influence the destruction and changes in the structure of the spine:

1. Sudden physical stress on an unprepared body.
2. Diseases that are inflammatory in nature.
3. Sedentary lifestyle.
4. Sedentary work.
5. Hypothermia of the body.
6. Poor diet.
7. Constantly playing sports.
8. Hormonal imbalances.
9. Problems with the thyroid gland.
10. Aging of the body.
11. Problems with gastrointestinal tract intestinal tract.
12. Spinal injuries.

If the patient does not exercise much physical activity, then his body is weakened and not prepared for possible excessive stress, which leads to spinal column deformities. It is in such patients that degenerative changes in the lumbosacral spine manifest themselves very rapidly.

Such changes in the spine may be accompanied by pain syndrome, but only if:

• The inflammatory process begins with the formation of an intervertebral hernia.
• With a large activation of the vertebrae in the department where the growth of the cartilaginous structure began.

It is worth noting that such reasons may also be responsible for the development and degenerative changes in the thoracic spine. Only in this case, symptoms such as pain in the ribs and the presence of visible changes in organs in the thoracic region are also observed. How to determine the development of a disease such as degenerative spinal dystrophy

There are a number of manifestations that may indicate the development of such a disease in the human body.

1. The most common manifestation is pain affecting the lumbar spine. The pain usually extends lower to the patient's hips. Pain syndrome has aching pain.
2. When the pain moves to the patient's hips and legs, tingling sensations in the legs. There is a feeling of loss of control over the limbs of the legs.
3. Problems with the intestinal tract and difficulty urinating begin to appear.
4. Reproductive function is also affected by this disease.
5. Upon awakening, patients feel difficulty walking.
6. An increase in body temperature in the localization of the body where degenerative changes in the lumbar spine began.
7. The skin becomes flushed, there are manifestations of swelling in the area of ​​localization of the disease.
8. The spine changes and as a result appears curvature of the figure.

As soon as the disease begins its inflammation, the patient immediately feels pain syndromes in the spine. In cases where inflammation can be extinguished, patients do not notice any changes causing discomfort.

The disease has four stages of onset:

Diagnosis of the disease

When consulting with a doctor, if the patient complains of pain in the vertebral area, the doctor may prescribe diagnostic measures such as:

• Visual examination by a specialist, using the palpation method to identify the source of inflammation.
• An x-ray of the spine is prescribed.
• Magnetic resonance imaging.

The most common method for detecting the disease is MRI. But X-ray can also tell about many visible changes in the spinal column, such as, for example:

1. Change in the height of the intervertebral discs.

2. Deformation of joints.

3. Changing the position of the spinal bodies.

4. Presence of marginal osteophytes.

And with MR, the disease can be identified by such signs as:

1. Changes in the color scheme of vertebral discs primarily due to the fact that damaged disks do not receive enough power.

2. Intervertebral cartilage is worn away.

3. Tears in the annulus fibrosus.

4. Formation of protrusions.

5. Possible formation of hernias between the vertebrae.

Upon receipt of an accurate diagnosis of the disease, therapy must be carried out immediately, since the disease is detected at severe stages of development. Failure to comply with doctor's instructions can cause paralysis and lead to disability of the patient.

Treatment of the disease

Treatment of degenerative changes in the lumbar spine should be comprehensive and contain not only the use of medications. The treatment process will include the following procedures:

• Taking medications.
• Physiotherapy.
• The use of alternative medicine.
• Can be applied surgical intervention.

Treatment should be carried out in all directions and be comprehensive, in order to avoid surgical intervention in the human body.

Pain can be reduced by using medications available in the form of a gel or ointment. Injections of painkillers against painful spasms are also very often used. And tablets with pain-suppressing properties. It is considered highly effective to apply something cold to the area where the disease is located, this will help reduce pain.

To begin to restore the structure of vertebral tissues after damage to a degenerative dystrophic disease, medications are prescribed that can relieve tension in the muscles. Such drugs are called muscle relaxants. Thanks to the intake of chondroprotectors, the process of regeneration of connective cartilage occurs in the lumbar and thoracic regions of the spine affected by dystrophic disease. A course of taking vitamins belonging to group B plays a very important role in treatment.

The following therapeutic procedures with hardware effects on the patient’s body are often prescribed for changes in the lumbosacral and thoracic regions, such as:

1. Treatments performed in a physical therapist's office.

2. Therapeutic massage.

One of the most effective methods, but at the same time extremely dangerous when discs are damaged by such a disease, is considered to be the spinal traction procedure. This procedure should not involve any pulling loads. With this treatment manages to stretch the spinal column in the correct position, and eliminate pinched nerves and blood vessels.

In order to begin to restore tissue damaged at the site of the disease such as the sacral and thoracic regions. Doctors prescribe the following procedures:

1. Treatment with medicinal leeches.

2. Apitherapy.

3. Acupuncture.

Very important factor influencing the outcome of positive dynamics, doctors call the beginning balanced nutrition. The specialist observing the patient will recommend following a diet. Extremely healthy products When treating such a disease, all dishes that have a jelly base are considered. It is very important to completely exclude from the patient’s diet:

· Alcohol.

· Dishes with high fat content.

· Dishes with strong spices.

The appointment of such dietary nutrition should be made by a specialist observing the patient, which is an inseparable part of the treatment.

If, after all conservative methods for treating the disease, painful spasms do not stop, then doctors prescribe a planned surgical intervention. This operation involves the removal of a damaged disc in the thoracic or lumbar region. If signs of an intervertebral hernia are diagnosed, then surgery is inevitable.

Prevention

It is very important, when the very first signs of the disease appear, not to attribute everything to fatigue during the day or the rhythm of the patient’s life. You need to contact a specialist in time to carry out complex diagnostics condition of muscle tissue and cartilage of intervertebral discs. If you contact a specialist at an early stage of development, then treatment will be prescribed without surgical intervention, and this is extremely important for the patient. Because every operation carries a risk of other serious abnormalities in the functioning of the body as a whole. Degenerative changes in the lumbosacral spine are a treatable disease.

Today the most common are. Sedentary work, a sedentary lifestyle, unhealthy diet, excessive physical activity - all this leads to the appearance of degenerative changes in the lumbosacral spine. It is necessary to consider in more detail what this is.

Possible complications

This condition is observed with pathology of the intervertebral disc, which is accompanied by lower back pain. The intervertebral disc has no blood vessels and therefore is not supplied with blood. For this reason, it cannot repair itself in the same way as other body tissues. Despite the seriousness of this condition, it occurs in 30% of people over the age of 30. Although no longer excluded early cases. Such damage to the spine is not always accompanied by pain. After 60 years, dystrophic changes are already a pattern.

If not treated in time this state, this will lead to complications. Due to pinching of the intervertebral canals, nerves are damaged. Then the nerve endings swell, their conductivity decreases (therefore, numbness of the limbs and a feeling of fatigue in the back occur). The vertebrae change their growth pattern: to reduce the load, they expand. This leads to osteochondrosis and more pinched nerves. If to this process When an infection (bacteria, fungi) is added, diseases such as arthrosis, arthritis, and osteochondropathy develop. Degenerative changes in muscles lead to scoliosis, displacement of the vertebrae. Severe conditions are accompanied by ischemia, circulatory disorders, paresis, and paralysis of the limbs. A person may become disabled.

Causes of the disease

There are several reasons for the appearance of this syndrome:

1. Passive lifestyle. IN healthy body the load on the spine is distributed evenly. But due to a sedentary lifestyle, the muscle corset weakens. The muscles do not provide reliable support for the spine, as a result of which even a small load can be fraught with displacement and destruction of the vertebrae.
2. Active sports. Not only the lack of load can lead to the appearance of degenerative changes in the lumbar spine. Excessive exercise also has a negative impact on health. Many athletes have joint problems.
3. Injuries. IN at a young age the presence of diseases such as arthrosis, pinched nerves, intervertebral hernia, usually associated with injury. This includes birth injuries.
4. Degenerative changes are often associated with the aging process of the body. In this case, the changes are irreversible. And treatment does not imply drastic measures (surgery): only supportive therapy is carried out.
5. Poor nutrition. Due to impaired metabolism, the body's cells do not receive sufficient nutrition. Limiting certain foods affects the condition of the entire body. Abuse junk food leads to obesity. This creates additional stress on the spine.
6. Inflammatory diseases of the spine. For example, arthritis, ankylosing spondylitis.
7. Hypothermia.

The causes of pain are 2 factors:

1. When a hernia forms between the vertebrae, the proteins in the interdisc space begin to irritate the nerve endings. This causes inflammation.
2. Excessive mobility of the vertebrae in the affected area.

Signs of degenerative-dystrophic changes in the spine

The following symptoms of the syndrome are known:

1. The main symptom is pain in the lower back. It can radiate to the legs and buttocks (sciatica). Lower back pain is usually aching and dull.
2. Numbness or tingling in the lower extremities.
3. Dysfunction of the pelvic organs (impaired urination, defecation), violation reproductive function, weakness in legs.
4. Feeling of stiffness in movements. This is especially felt in the morning when getting out of bed. The patient needs to “diverge” in order to fully move.
5. Local increase in temperature. The area where degenerative changes are observed becomes hot.
6. Redness, swelling.
7. Asymmetry of the buttocks.

Typically, spinal diseases are chronic, characterized by periods of exacerbation and remission.

During an exacerbation, the symptoms become very pronounced, especially pain. During remission, a person may feel practically healthy.

Types of diagnostics

• X-ray;
• CT (computed tomography);
• MRI (magnetic resonance imaging).

The first of these methods is the most accessible, but at the same time the least informative. X-rays provide information about the location of the bones and deformities of the spine. It is able to detect the disease in its later stages. CT and MRI are more modern methods. MRI allows you to see the destruction of the disc space, dehydration of the disc, erosion of the cartilaginous end plate of the vertebral body, the presence of an intervertebral hernia, and a rupture in the annulus fibrosus. But such procedures are usually expensive.

Complex treatment

Treatment involves the use of medications, gymnastics and methods traditional medicine. Surgery is often required. In any case, treatment should be comprehensive:

1. To relieve pain, ointments, injections, and tablets with an analgesic effect are used. Ice is often applied to the affected area. Prescribe diclofenac, indomethacin, ibuprofen, ketoprofen.
2. For recovery and during remission, treatment is prescribed with muscle relaxants (relieve muscle tension), chondroprotectors (restore cartilage tissue), vitamins (especially B vitamins).
3. Physiotherapy, massage, exercise therapy. Non-stress stretching of the spine often helps. It allows you to eliminate the cause itself (vertebral displacement), but is considered the most dangerous method.
4. Acupuncture, apitherapy, hirudotherapy. Thanks to these methods, mechanisms for restoring damaged tissues are launched.
5. Treatment also includes following a diet. To restore cartilage, it is recommended to eat jelly-like products (jelly, jelly, etc.). Alcoholic drinks, strong coffee, fatty and spicy foods are prohibited. Your doctor will usually give you dietary recommendations.
6. If the pain does not go away and the degeneration process does not stop, then surgery is prescribed. Surgery usually removes the damaged disc. The absolute indication for surgical treatment are the development of caudal syndrome, the presence of a sequestered herniated intervertebral disc, severe radicular pain syndrome that does not decrease despite the treatment.

Prevention of diseases of the spinal column

Treatment involves consolidating the effect through preventive measures.

It is necessary to exercise (in moderation) to form a muscle corset. If you have problems with excess weight, then you definitely need to get rid of it. This is an extra load on the spine. Be sure to follow the principles of proper nutrition (discussed above). Main - good rest. Many diseases are a signal of overload in the body.

Thus, degenerative changes in the lumbosacral spine (as well as in the cervical spine) are treatable. The main thing is to consult a doctor in time and follow all his recommendations.

Degenerative-dystrophic changes in the lumbosacral region are a set of pathologies in the intervertebral disc or, alternatively, in the lumbar vertebrae. This disease can mainly be recognized by lower back pain.

In most cases, able-bodied people suffer from such problems, and gender does not play a role here. Statistics say the following: there are now an extremely large number of people with this diagnosis, and this number is growing, with no intention of slowing down the pace of development, which is not encouraging.

The body of any person is an extremely delicate and well-functioning system. And it is not surprising that changes in the activity of at least one of its components inevitably entail disruptions in the functioning of all other parts of the body. In recent years, cases of diseases of the musculoskeletal system have increased greatly among the population. Because of this, people's ability to meet their needs has decreased.

The spine is a component of the human skeleton. This organ plays a certain number of vital functions:

• support;
• participation in the movement;
• giving the body flexibility;
• distribution of nerve fibers throughout the body.

Because of high complexity structure of the body, its organs and tissues not so rarely age before the time allotted by nature. Degenerative dystrophic changes begin to appear in the spine, which necessarily cause osteochondrosis, coupled with extremely severe pain.

Without such changes in the spine, none of its known diseases is possible. Any osteochondrosis, spondyloarthrosis, intervertebral disc herniation and the like are precisely the results of untreated degenerative dystrophic pathologies of the intervertebral disc, which can be detected by doing necessary examination from a specialist. However, an examination is not so necessary when the disease can be indicated by the most common symptoms of pathology, which can be detected during the first examination.

Despite the fact that a person may not have a very strong tendency towards this pathology, inherited to him, in reality its root lies in the combination of many genes. Degenerative processes are also possible due to the aging process or due to any injury. And yet, extensive injuries like the same car accident do not often lead to this. In most cases, they occur due to a slow traumatic process that damages the intervertebral disc. Moreover, this damage gradually becomes more pronounced, which leads to the disease.

The intervertebral disc does not receive blood, and therefore, in case of damage, it will not be able to “patch” them in the same way as other organs and tissues. For this reason, any, even the slightest, damage to this tissue can lead to the most serious consequences, starting the so-called “degenerative cascade.” This inevitably leads to the destruction of the intervertebral disc. And this severe pathology has a very high “popularity”. According to modern statistics, almost a third of the world's population who have reached the age of four to six decades has this problem, at least to the smallest extent. This means that almost every elderly patient has such a diagnosis or pain, if not both.

Why does the disease begin?

In more than half of the cases, this problem occurs for at least one of the following reasons:

• inflammatory processes that begin due to the fact that the nerve roots are irritated by the protein located in the disc space during the appearance of a hernia;
• microscopic damage that occurs if the annulus fibrosus wears out, completely losing any ability to bear load. The consequence is excess mobility in the affected area.

Most often, the combination of these two factors occurs when an intervertebral hernia begins to develop, which is a complication of the pathological process in intervertebral discs. When it appears, the neurovascular bundle passing through the spinal canal is compressed by mechanical action. Because of this factor, lower back pain becomes much stronger and does not stop.

In general, degenerative-dystrophic pathologies most often cannot arise without wrong image life. This is characterized by a lack of moderate exercise, an unbalanced diet, as well as insufficient sleep and, of course, bad habits such as addiction to tobacco and alcohol consumption. Other reasons why dystrophy of the lumbar spine may begin:

• the harmful effects of heavy loads on the spine, due to which the segments of the lumbar region become less elastic. Because of this circumstance, people who constantly expose themselves to severe physical activity, especially if it is required for work;
• staying in a sitting position for a long time, and with incorrect posture, which also leads to impaired blood supply. And this affects both the lumbar region and the rest of the body. This entails metabolic disorders in bones and muscles. Metabolic disorders spoil the structure of tissues. And because of all this, microtraumas can easily appear in the spine from any movement. In this regard, pathology may begin to develop;
• infectious pathologies, as well as diseases associated with the endocrine system. Because of them, harmful processes in the lower back can also easily begin;
• one or another mechanical injuries spine. They cause injuries to bones and muscles;
• back muscle damage. This, of course, also has a detrimental effect on the spine in general, and on its lumbar region in particular;
• Often the cause of the pathology can be described with just one simple word: “old age.” Then the disease can hardly be cured. In this case, they do not try to cure the person, but only provide supportive therapeutic procedures to prevent the disease from worsening.

What can happen due to this pathology

Once you start degenerative changes in the spine, severe complications in the lumbar region cannot be ruled out:

• hernias;
• osteochondropathy;
• numbness and partial paralysis lower limbs;
• complete paralysis of the legs;
• difficulty going to the toilet;
• decrease/loss of libido.

To avoid such problems, you should promptly and wisely choose what and how to cure the pathology. This way you can most effectively keep the intervertebral discs intact.

How to recognize the disease

More than half of the patients who have degenerative-dystrophic pathologies in the lower back complain of ongoing pain, which, however, can be tolerated. But sometimes they become stronger for a long time. For the most part, each patient has his own symptoms of the disease, but there are several common signs:

• the back hurts, and pain in the hips and legs is possible;
• pain in the lumbar region lasting over one and a half months;
• in the lower back the pain is dull/aching, and in the hips and legs it is burning;
• when the patient sits, the pain becomes stronger. Standing, walking or lying down, he feels less pain. Standing for too long, bending forward or lifting something heavy, the patient feels a more “bright” pain;
• If a person has a herniated disc, his legs may go numb and their legs may tingle. In addition, he may have trouble walking;
• if the hernia turns out to be medium in size, it is possible that the nerve root that exits the spinal cord at the affected level will be compressed (foraminal stenosis), and this will already provoke pain in the legs ();

• symptoms of neuralgia, such as weak legs, as well as various problems in the functioning of organs in the pelvic area (difficulty going to the toilet) can quite eloquently “hint” at the appearance of cauda equina syndrome. Then you need to urgently consult a doctor;
• inflammation caused by proteins trapped in the disc causes the nerves to react more sharply to stimuli. This is what makes your legs go numb and tingling. Moreover, in most cases, such sensations are localized in the knee or higher.

If you want to learn more about how to treat, and also consider the symptoms, diagnosis and alternative methods treatment, you can read an article about this on our portal.

Lower back pain can easily appear not only due to pathological processes in the discs, but also from the following:

• narrowing (stenosis) of the spinal canal, osteoarthritis, any other spinal pathology that worsens over time, caused by deterioration of the discs. However, this does not mean that such diseases cannot be combined;
• hernia caused by disc pathology.

Moreover, with the development of the disease, as well as the transition from one stage to another caused by it, its symptoms become increasingly stronger:

• stage№1 . The disease rarely manifests itself in any way. Unless after physical work you can feel dull pain, however, in most cases it is mistaken for normal fatigue;
• stage№2 . It is possible to accurately distinguish symptoms from normal phenomena. From time to time there is a “shoot” in the back. It's also hard to bend sometimes. The reason lies in the nerve endings: they are compressed, and therefore the pelvic area “tingles”;
• stage№3 . Spicy. At this time, metabolism in the lower back is disrupted because the blood vessels are damaged. Ischemia, cramps, and numbness of the legs appear. The pain becomes stronger;
• stage№4 . Due to deformation of the spinal cord, the legs may become paralyzed. This pathology has exacerbations - the time of greatest severity of symptoms. If dystrophy becomes chronic, the symptoms weaken to a state of tolerable discomfort.

Diagnostics

It is very important that the disease is diagnosed before the first complications appear. For this purpose, diagnosis is made using the most different methods so that they pick up many types of stimuli. However, the patient must first be examined by a neurologist. After the examination, the specialist will definitely prescribe additional examinations to make the diagnosis more accurate.

In most cases, the following methods are used: x-ray, computed tomography(CT), as well as MRI.

X-rays are the most accessible, but at the same time they are the least useful. This technique allows you to diagnose pathology when it has already reached one of the fairly late stages. MRI and CT are much more useful. Using these methods, it is possible to more reliably determine both where the focus of the disease is and how far it has developed.

Moreover, it is best to rely on MRI for information about the presence/absence of changes.

What an MRI can show for disc degeneration:

• destruction of the disk if it exceeds half of it;
• disc dehydration. On MRI, such tissue is shown darker;
• the presence of hernias, as well as protrusions;
• erosion of the cartilage plate that allows the disc to receive nutrients.

Sometimes electroneuromyography is necessary to determine where and how the nerve is damaged. Of course, doctors take blood tests. They need this to identify infections and endocrine pathologies.

If you want to find out in more detail and also consider when a magnetic resonance examination is indicated, you can read an article about this on our portal.

How to treat

First of all, conservative therapy procedures are carried out. Among them are the use of painkillers, warming ointments, therapeutic exercises, massage, and physiotherapy. If there is no benefit from these treatment methods, surgery is performed.

Medicines

First of all, you should calm down painful sensations so that the patient can walk normally. For this purpose, the doctor prescribes the necessary painkillers (for example, Ketanov and Ketonal), as well as anti-inflammatory drugs (Movalis and Diclofenac).

Next, to relax the lower back muscles, muscle relaxants (Mydocalm and Sirdalud) are used. These drugs are not used constantly, but with periodic breaks, because otherwise they do muscular system less strong.

Chondroprotectors are also used in treatment. With their help, you can quickly restore cartilage and joints.

But with all the miraculousness of the complex of drugs, it is necessary to remember that they can easily cause an unpleasant “side effect”, disrupting the functioning of the gastrointestinal tract.

Exercise therapy

Of course, therapeutic exercises should be done both during treatment and rehabilitation. Properly selected and planned exercises are very useful for any symptoms of degenerative-dystrophic pathologies in the lower back. When selecting and planning exercises, it is necessary to look at the causes, severity and main signs of the disease.

If the pathology is acute, of course, it is recommended to abstain from exercise therapy. First, it is necessary to use other methods to alleviate pain: NSAIDs, a state of complete rest, local cooling, blockades.

If the symptoms are severe, static gymnastics with low amplitude will be very useful. But it should be done extremely carefully, and haste can only do harm. IN rehabilitation period It is much better to use dynamic exercises.

As the patient’s condition improves, you can make it more complicated and also begin to use weighting agents in it.

Massage and physiological procedures

Doctors still cannot come to a consensus about the advisability and safety of massage for dystrophic changes in the lumbar spine. Even for a spine that is not affected by disease, it is harmful when it is mechanically affected. If you really can’t do without a massage, such a procedure should only be carried out by a real professional. And only while the pathology is at the first stage of development.

During the acute period, the back is not massaged. This is because due to this action, blood rushes to it, and after this the sore spot begins to become more inflamed and swollen.

In remission, that is, temporary absence of inflammation and acute pain, physiological procedures can be used. Thanks to electrophoresis, acupuncture, and magnetic therapy, the patient can quickly recover from the disease. And with the help of manual therapy, the vertebrae can be placed where they are supposed to be by nature.

Surgery

Surgical intervention is carried out in case of revealed uselessness of massage, therapeutic exercises, as well as taking medications, and further progression of the disease. This method is also used for the diagnosis of intervertebral hernia. During the operation, the doctor installs devices in the patient’s body to support the diseased area of ​​the spine. This allows you to reduce pressure on the ridge to avoid further development of the disease.

Table. Types of spine surgeries

Possibility of complications

Launching this pathology, a hernia may occur. This term refers to the displacement of a deformed disc. This can rarely be cured without surgery. Also, with advanced dystrophic processes, it can become inflamed. sciatic nerve and malfunction begins genitourinary system. Moreover, there are usually problems with going to the toilet “for minor needs.”

Prevention

You can prevent such pathologies in the spine by following simple rules. First of all, greater physical activity is required. You should start your morning with exercise. Moreover, it is worth choosing exactly the kind of exercises that would help make your back muscles stronger. Those who are forced to sit for long periods of time while working should sometimes pause to stretch their muscles.

Also, to maintain the health of the spine, it is useful to know how to choose a mattress: it should be firm, but in moderation. It is best to also use orthopedic pillows. It is important that the width of such a pillow is suitable for the distance of the shoulders. If you are obese, you should lose weight: it puts extra strain on the spine.

Bottom line

Regular back pain is a reason to consult a doctor. Alas, any organism is not eternal, and with aging, the spine suffers first. If a person begins to feel the first signs of the disease, he should immediately be examined by a doctor. Many serious illnesses At first they signal themselves with completely minor discomfort, but if you miss the moment, you can forget about normal life for a long time. Degenerative-dystrophic pathologies cannot always be cured, but it is quite possible to stop their development and maintain health.

Video - What are degenerative-dystrophic changes in the lumbosacral region?

Pathologies of the musculoskeletal system are currently among the most common problems among the adult population. Most often, degenerative changes in the spine are diagnosed, which with age can lead to loss of ability to work or even disability.

What is spinal dystrophy?

Many people are familiar with painful sensations in the back area, which are usually associated with fatigue, salt deposits and various other reasons. In fact, the cause should be sought in the deterioration of the properties and characteristics of the vertebrae.

Degenerative-dystrophic changes are irreversible metabolic disorders of the bone tissue of the vertebrae, loss of their elasticity and premature aging. In advanced cases, degeneration can lead to serious dysfunction internal organs.

Pathological changes affect different sections: cervical, thoracic, lumbar, sacral. Experts say that this is a kind of payment for a person’s ability to move upright. With proper load distribution and regular physical exercise, it is possible to significantly extend the “shelf life” of the spine.

Reasons for development

Most doctors are inclined to believe that there is one main reason that causes irreversible changes in the spinal column. Its essence lies in the incorrect distribution of the load, which may be due to both professional activity, and with the usual way of life. Weakening of the back muscles is directly related to limited mobility during the day and lack of exercise.

Degenerative changes can be caused by inflammatory processes occurring in ligaments of nerve endings and muscles. Similar problems health problems arise after suffering a viral or bacterial pathology. Non-inflammatory causes include intervertebral hernia and scoliosis.

The following factors can provoke the development of degenerative-dystrophic changes:

• Aging of the body (vertebrae).
• Pathologies of blood vessels.
• Hormonal imbalances.
• Bruises, injuries.
• Sedentary lifestyle.
• Genetic predisposition.

Degenerative changes in the spine: types

Pathology manifests itself various diseases, among which osteochondrosis is considered the main one. The disease is a dystrophic process during which the height of the intervertebral disc decreases.

With absence adequate therapy Degenerative changes over time lead to the development of another spinal disease - spondyloarthrosis. The disease typically affects all components of the spinal column: cartilage, ligaments, surfaces of the vertebrae. As the pathology develops, cartilage tissue gradually dies away. Inflammation occurs due to the entry of cartilage fragments into the synovial fluid. Most often the disease occurs in elderly patients, but there are cases when characteristic symptoms young people face.

Degenerative-dystrophic changes (any - cervical, thoracic lumbosacral) can be expressed in the form of intervertebral hernia, slipping of the vertebrae, narrowing of the canal.

Cervical problems

The development of dystrophy is caused by the structure of the vertebrae themselves and the high concentration of veins, arteries and nerve plexuses. Even the slightest violation leads to compression of the spinal cord and which can lead to cerebral ischemia.

For a long time, symptoms of the pathological condition may be absent. Over time, the patient will begin to experience the following symptoms:

Pain syndrome radiating to the upper back.

Discomfort.

Increased fatigue.

Muscle tension.

Overload of the spinal segments (two vertebrae and the disc separating them) leads to blockade metabolic processes, which subsequently causes more severe consequences - intervertebral hernia or protrusion. Degenerative changes cervical region spine in the form of a hernia are considered the most severe complication. In an advanced stage, the formation puts pressure on the nerve roots and spinal cord.

Pathological condition of the thoracic region

Due to the limited movements of the thoracic vertebrae, dystrophy is observed quite rarely here. Most cases are due to osteochondrosis. The peculiarity of the location of the nerve roots contributes to the fact that the symptoms characteristic of the disease may be weakly expressed or completely absent.

The reasons that can provoke degenerative changes in this department include, first of all (congenital or acquired) and trauma. Availability also affects hereditary pathologies associated with malnutrition of cartilage tissue, decreased blood flow.

When cartilage tissue becomes inflamed, symptoms develop such as It's a dull pain, increasing during movement, sensory disturbance (numbness, tingling), disruption of the functioning of internal organs.

Lumbar and sacral region

IN medical practice Most often, cases of degenerative lesions of the lumbosacral spine are diagnosed. The lower back bears the greatest load, which provokes the development of bone and cartilage tissue of the vertebrae and a slowdown in metabolic processes. A predisposing factor allowing the development of the disease is a sedentary lifestyle ( sedentary work, lack of regular physical activity).

Degenerative changes in the lumbosacral region occur in young patients 20-25 years old. Wear of the annulus fibrosus leads to the onset of inflammatory process and irritation of nerve roots. The presence of a pathological condition can be determined by the appearance of pain, which can radiate to the gluteal muscle, causing tension.

The pain can be either constant or intermittent. The main location is the lower back. Numbness of the toes also appears, and in advanced cases, the functionality of the internal organs located in the pelvis may be impaired. Similar symptoms are characteristic of intervertebral hernia.

The ongoing degenerative-dystrophic changes in the lumbar region are irreversible. Therapy usually consists of relieving pain, relieving inflammation and preventing worsening of the condition.

Diagnostics

Having discovered symptoms of spinal column pathology, the patient should first of all seek help from a neurologist. The specialist will conduct an examination, collect anamnesis and prescribe additional examination. Most precise methods diagnostics that allow us to determine the slightest disorder are computed tomography and magnetic resonance imaging.

CT and MRI belong to modern methods medical examination. Irreversible changes spine can be detected at a very early stage. Radiography makes it possible to diagnose the disease only at a late stage.

Treatment

It is impossible to completely cure the degenerative changes occurring in the spine. Available medical methods make it possible only to stop the development of pathology and eliminate painful symptoms. Drug therapy involves taking painkillers from the group of analgesics and non-steroidal anti-inflammatory drugs. Local preparations in the form of ointments and gels can also be used.

Chondroprotectors, which can strengthen the deteriorating vertebra and cartilage tissue, contribute to the reduction of degeneration and dystrophic processes. Medications from the group of muscle relaxants will help relieve muscle tension. IN mandatory It is recommended to use B vitamins (initially in the form of injections and then in tablet form).

Physical therapy brings good results and relief of symptoms. Exercises for each patient are selected by a rehabilitation specialist, taking into account the location of the affected area. Also, do not forget about dietary nutrition enriched with products containing gelatin.

Surgery is indicated only in severe cases. After the operation, the patient faces a long and difficult rehabilitation.

Prevention

The main method of prevention is to form and strengthen the muscle corset. To do this you need to exercise regularly physical exercise. Excess weight is an unnecessary burden on the spine, which you should definitely get rid of.