Spine pain in the lumbar region.

About 40-80% of people complain of pain in the lumbar spine, but no more than 25% seek medical help.In fact, such unpleasant sensations can be caused by both relatively harmless causes and pathological changes in the spine.Therefore, you should not treat them with disdain.

Causes of low back pain.

The spine consists of a whole complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves.Changes in any of them may be accompanied by pain of a different nature.Additionally, the spine is surrounded by paraspinal muscles, a pain that patients often mistake for pain in the spine.Therefore, there can be many reasons for the pain.This could 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 certain diseases.

Most often, in such situations, patients are diagnosed with:

• pathologies of the intervertebral discs (reduced disc height, protrusion, intervertebral hernia, discitis);
• pathologies of the facet joints (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.

Intervertebral disc pathologies.

Degenerative changes in the intervertebral discs or osteochondrosis are very common, especially among young and middle-aged people.This is largely due to the need to sit for long periods or perform heavy physical work.In old age, the disc dries out and the vertebrae fuse.

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, pain in the spine may appear.This is due to 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 that leads to reflex spasm of segmental muscles.As a result, pain in the spine intensifies and mobility restrictions occur.

Osteochondrosis tends to progress constantly, especially in the absence of adequate treatment and lifestyle correction.Subsequently, it leads to the formation of bulges and subsequently intervertebral hernias, which causes a worsening of existing symptoms and the appearance of new ones.

The lumbar region, because it supports the greatest loads in daily activities, is the most affected.

Bulges are protrusions of the disc that maintain the integrity of its outer layer, called the annulus fibrosus.If the influence of provoking factors persists 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 nucleus 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 leg, and the discomfort intensifies with sudden movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well as with prolonged sitting in one position, walking, standing.

Often, patients with already formed bulges and hernias unconsciously adopt a forced position, leaning slightly in the healthy direction.At the same time, pain in the lumbar spine can reach great intensity, depriving the person of their ability to work.In such cases, he is forced to rest in bed and, to relieve the pain, he squeezes the leg bent and drawn towards the stomach.

Most often, bulges and hernias form into the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots branching from it.The latter pass through natural openings in the vertebral bodies and branch into the lumbar plexus, which is responsible for the innervation of the lower extremities and various organs (including the genitals).

Therefore, often with prolonged osteochondrosis, the formation of hernias in the lumbar region, pain in the spine not only gradually intensifies, but is also complemented by other disorders.If a deformed disc or swollen soft tissues due to an inflammatory process compress the spinal root passing near them, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be complemented by pain that radiates to the buttocks, groin, front, inner and outer thigh, lower leg and foot.This depends on which nerve root is pinched, that is, at the level of which segment of the spine pathological changes will be observed.In addition, in the corresponding areas of the lower extremities, sensitivity disorders can be observed in the form of a tingling sensation, numbness, changes in susceptibility to temperature, pain, tactile stimuli and limited mobility.

The changes in the height and functionality of the discs that occur with osteochondrosis and its complications cause 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, that is, the calcification of the anterior longitudinal ligament and the formation of osteochondral growths on the surface of the vertebral bodies (osteophytes).Not only can they damage surrounding tissues and compress the roots of the spine, causing severe pain in the spine, but they can also fuse together.As a result, the adjacent vertebral bodies are combined into a single whole, which sharply limits mobility in the lower back.

Osteochondrosis may be accompanied by reactive changes in the vertebral bodies, in particular reactive aseptic spondylitis, leading to osteosclerosis.This is accompanied by compaction of bone tissue and dramatically increases the likelihood of vertebral fractures.

Facet joint diseases

Pathologies of the facet or facet joints of the lumbar region, in particular their osteoarthritis, can also cause spinal pain in the lumbar region, including severe pain.Although more often the pain is painful and located deep inside.Its appearance is due to the fact that its synovial capsule is richly innervated.In such situations, the pain is usually concentrated directly in the affected area and tends to intensify when bending, straightening, twisting the body, or standing for long periods of time.Walking and sitting help reduce its severity.But in some cases, the pain can also radiate to the groin area, tailbone, as well as the back and 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 pain in the spine.These include:

• Ankylosing spondylitis or ankylosing spondylitis;
• reactive arthritis;
• psoriatic arthritis, etc.

Signs of these diseases usually appear before the age of 40 and most frequently 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 the age of 40.In this case, the pain is characterized by a gradual increase in intensity.At the same time, its severity decreases after physical activity, but does not decrease at rest.Therefore, in inflammatory diseases, the spine in the lumbar region often hurts at night and especially in the morning, immediately after sleeping.

The most serious situation is observed in ankylosing spondylitis and it is this disease that affects the lumbar region more frequently than other inflammatory diseases.This term refers to inflammation of the intervertebral joints followed by their immobilization due to the formation of dense, cartilaginous or fibrous bone fusion between the articulated bony structures.

At first, it is characterized by mild pain in the lower back, but over time they gradually spread upward, covering the thoracic 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 be immersed in a specific case.It was also observed:

• lumbar lordosis alignment (natural curve of the spine in the lumbar region);
• worsening thoracic kyphosis, which causes bending over;
• reflex tension of the back muscles;
• progressive worsening 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.

Inflammation of the iris (iritis), cornea (keratitis), mucous membranes (conjunctivitis), iris and ciliary body of the eyeball (iridocyclitis) is observed in 10-50% of patients.

The progression of ankylosing spondylitis leads to the fact that an increasing number of joints become pathological.As a result, patients are forced to adopt the so-called supplicant posture.It means pronounced kyphosis of the thoracic spine, downward tilt of the upper body, flexion of the legs at the knees with a strong limitation in the range of motion of the chest, which affects the depth of breathing.

The rate of disease progression depends on the adequacy and completeness of treatment.

Vertebral compression fracture

A compression fracture is a flattening of the vertebral body, causing it to become wedge-shaped.This leads to an alteration of the spinal anatomy, can cause injuries to the spinal cord and its roots, and also triggers the rapid progression of degenerative changes.

The first and second lumbar vertebrae are most susceptible to injury, as they carry the greatest axial load.

Often, compression fractures of the spine occur in older people due to the development of osteoporosis, that is, a decrease in bone density.In such cases, not only a small fall, but also a heavy lift or a failed movement may be enough to cause injury.

The pathology is characterized by the presence of pain in the spine, which limits movement and intensifies when sitting, moving and trying to lift the straight leg.It usually lasts 1 to 2 weeks and then gradually decreases over 2 to 3 months.In some cases, the pain radiates to the iliac crests and thighs.A decrease in the height of a broken vertebra causes an increase in lumbar lordosis, which also contributes to the appearance of pain.

If the fracture is not diagnosed in time, a decrease in vertebral height causes changes in posture and a decrease in height.This causes reflex tension and shortening of the spinal muscles, leading to chronic back pain and requiring long periods of rest.

Neoplastic lesions of the spine.

Neoplastic lesions of the spine involve the formation of benign and malignant tumors, as well as metastases, the origin of which are neoplasms of other organs.This occurs much less frequently than pathologies of the intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, specifically in only 1-2% of patients with back pain.But such injuries require diagnosis and treatment as early as possible.

The characteristic features of neoplastic lesions of the spine, in addition to pain in the spine, 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.It most often forms in the sacrum and can occur in people of any age and sex.
• Young's sarcoma: occurs in 8% of patients with neoplastic lesions of the spine.More typical of young men.
• Chondrosarcoma is a malignant neoplasm that represents between 7 and 12% of cases.It is most 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 during a person's entire life.But it increases the risk of vertebral fractures.
• Metastases from other tumors are secondary malignant neoplasms.Most often, breast, prostate and lung cancers metastasize to the spine, and less frequently, kidney, thyroid and skin cancers.

Diagnosis

If your spine hurts in the lumbar region, you should make an appointment with a neurologist or vertebrologist.At the appointment, the doctor initially collects a history and asks questions about the nature of the pain, the circumstances of its occurrence, the duration of its persistence, the presence of other symptoms, lifestyle, etc.

Then the specialist performs an examination.Within its framework, it not only palpates the spine, determines the location of pain, evaluates the gait and posture that the patient adopts unconsciously, but also performs functional tests.With its help, it is possible to detect signs of ankylosing spondylitis, neurological deficits, evaluate the degree of mobility of the spine and obtain other diagnostic data.

Based on this, the doctor can already suggest possible causes of the pain.To clarify them, as well as to accurately determine the extent of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed.Most often they resort to help:

• X-rays in frontal and lateral projections, sometimes with functional radiological tests;
• Computed tomography - allows better visualization of bone structures, therefore it is more often used to diagnose spondylosis, fractures, bone tumors, etc.;
• MRI - allows you to further assess the condition of cartilaginous structures and soft tissues, therefore it is most often used to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord injuries, etc.;
• electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of damage to the nerves;
• osteoscintigraphy with radioisotopes: 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, treatment is selected strictly individually, not only based on the diagnosis, but also on the nature of the existing concomitant pathologies.However, the cause of low back pain, of course, determines the treatment tactics.It may be conservative or involve surgical intervention.

But the first step is always to relieve the pain, especially if it is intense.For this, patients are prescribed NSAIDs, antispasmodics and pain relievers.And in severe cases, spinal blocks are performed - injections of anesthetics and corticosteroids at certain points in the spinal region.

Bed rest is not indicated for all patients.And in case of pathologies of the intervertebral discs, it may be completely contraindicated, since a decrease in physical activity contributes to the transformation of acute pain in the spine into chronic pain.

An exclusively conservative or non-surgical treatment is prescribed for:

• osteochondrosis;
• Bekhterev's disease;
• osteoarthritis of the facet joints;
• Mild compression fractures.

It is usually complex and consists of:

• drug therapy, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids, 
• physiotherapy (UHF, magnetotherapy, laser therapy, traction therapy, etc.);
• exercise therapy;
•  manual therapy.

If the cause of low back pain is an intervertebral hernia, protrusion, spondylosis, severe vertebral fractures, tumors, surgery is often indicated.It is also necessary for:

• ineffectiveness of conservative therapy for degenerative changes;
• increasing neurological deficit;
• spinal motion segment instability;
• the development of complications, in particular stenosis of the spinal canal.

Most modern operations performed on the spine are minimally invasive.Thanks to this, intraoperative and postoperative risks are drastically reduced, the rehabilitation period is shortened and facilitated, and the effectiveness is not inferior to more traumatic open operations.Depending on the disease detected, the following may be recommended:

• Discectomy is an operation indicated mainly for hernias and protrusions, especially those that cause cauda equina syndrome.It can be performed using microsurgical instruments through an incision of approximately 3 cm (microdiscectomy) and using endoscopic equipment brought to the spine through point punctures with a diameter of approximately 1 cm (endoscopic discectomy).When an intervertebral disc is completely removed, it is usually replaced with implants.
• Vertebroplasty and kyphoplasty are indicated for compression fractures of the vertebrae, hemangiomas and some other diseases.The essence of the operation is to introduce rapidly hardening bone cement through a thin cannula into the vertebral body, strengthening it.With kyphoplasty, in addition, it is possible to restore the normal dimensions of the vertebral body, which is important in case of a serious decrease in its 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.

Therefore, the spine in the lumbar region can hurt for various reasons.Therefore, if the pain persists for a long time, if it occurs 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 it is easier to cope with them and, if not cure the disease completely, then at least stop its progression and maintain a high standard of living.