The lumbar region has a higher load than all other parts of the spine. Osteochondrosis develops as a result of degenerative-dystrophic processes due to a reduction in disc height. Marginal osteophytes develop along the edges of the vertebrae. At the same time, the intervertebral foramen narrows, the root is compressed, and symptoms of osteochondrosis appear. Treatment of lumbar osteochondrosis depends on the stage of the disease.
Osteochondrosis sometimes manifests itself in such a way that its symptoms "simulate" damage to other organs. It has been assigned a code in the ICD - 10. We will try to understand all the intricacies in more detail.
International classification
According to ICD-10, osteochondrosis has the code M42 and is divided into subtypes. Code M42. 0, according to ICD-10, indicates that this is a youthful variant, osteochondrosis is manifested by Scheuermann-Mao or Calve disease. Code M42. 1 according to ICD-10 gives an idea of the disease in adults.
If the disease variant is not specified, then the ICD-10 code will be M42. 9. There are also complications of pediatric osteochondrosis, in which ICD-10 is completely different. The complication occurs in the form of juvenile kyphosis, which causes Scheuermann-Mao disease. Its code according to ICD-10 M40. 0.
Reasons for occurrence
Why everything occurs is not yet fully known, one thing is certain: there is a violation of the structure of the intervertebral disc, which leads to further changes in the spine. Symptoms are clearly seen after 35 years, accelerate the injury process, long stay in a static position, due to the load. But it's not just the load that's to blame, it's often a genetic disease. The cause can be flat feet, especially grade 3 or 4.
Symptoms
The insidiousness of this disease of the spine is indisputable, and over time it only progresses. In total, doctors distinguish four stages of development of this pathology.
The first degree does not cause pain, the person can sit still and painlessly, but the changes characteristic of the disease already occur in the nucleus of the intervertebral disc. The ligaments that strengthen the vertebrae can also suffer. Locally, discomfort can be noticed, which can give away from the problem area. As a result of breaking the innervation of the veins of the lower extremities, they become cold.
In the second stage, the fibrous ring of the intervertebral disc is destroyed. Instability occurs in the lumbar spine, increased mobility and local tension of the lumbar muscles can be observed. The person feels constant fatigue, a feeling of some discomfort in the back and insecurity.
In the third degree, osteochondrosis leads to the fact that the fibrous ring completely loses strength and bursts, the nucleus pulposus, in turn, passes over it, and a hernia is formed. Compression of the roots of the spinal nerves occurs, symptoms develop, primarily pain. In the zone of innervation of the compressed nerve root, the sensitivity decreases completely or partially. Morning or daily exercise brings significant pain. In the initial stages, there is a burning sensation, tingling, then numbness. Decreased or lack of sensitivity can be considered a cause of paralysis, resulting in muscle atrophy.
According to the characteristic zones of sensitivity damage, it can be assumed in which segment the fault occurred. If the sciatic nerve fibers are affected (the thickest in the body), Lasègue’s symptom will be positive, it is easy to check at home. It is necessary to lie on your back, the stranger helps to lift a straight leg at the knee upwards. With a positive symptom, the pain will increase if the leg is bent at the knee joint, completely disappearing.
With significant hernia size, spinal cord function may suffer. You can often notice the symptoms of "horsetail" compression, so osteochondrosis often manifests itself, it is a bundle of nerves that, leaving the spinal cord, passes in the lumbar and sacral spine. Symptoms are manifested by impaired mobility and sensitivity of the lower extremities. Additionally, disorders of the pelvic organs are added, very often it is the urinary bladder.
In the fourth stage, the intervertebral joints and ligaments are involved in the degenerative process and symptoms of spinal instability appear. Arthrosis of the joints between the vertebrae, spondylarthrosis, develops. At this stage there is practically no pain, but with it, the ability to move in it, exercise or gymnastics for a person almost completely disappears and becomes a real problem.
Due to the defeat of various nerves that innervate the internal organs, their function can be disturbed. Sometimes a person struggles with one problem for a long time and is actually the cause of osteochondrosis. In addition to the characteristic symptoms, osteochondrosis of the spine must be determined instrumentally.
Diagnosis
The symptoms are important, but additional confirmation of osteochondrosis enables a picture of the lumbar part of the spine. It shows damage to the vertebral joints, reduction in disc height, narrowing of the intervertebral foramen. An image of the spine is made in two projections, additional functional tests may be needed.
The presence of a disc herniation can be confirmed by MR, the image will show characteristic changes. CT will show the structure of the tissue more clearly, it is especially suitable because the techniques are performed in different planes and cross-sections. It is possible to consider the place where the symptoms occur and are disturbing.
Treatment
Before treating lumbar osteochondrosis, it is necessary to consult a neurologist. Medications have always been effective in helping us get rid of disease. They are prescribed in courses of about 10 days, they supplement all physiotherapy, daily exercises, gymnastics, massage.
With the help of medication, you can effectively eliminate severe pain caused by inflammation and swelling. After treatment in the hospital, taking medication and following the doctor's instructions can be continued at home.
They all start with nonsteroidal anti-inflammatory drugs or NSAIDs. Due to the fact that they reduce the inflammatory process in osteochondrosis, the swelling and pain disappear. The doctor deals with the choice of drugs: they have a lot of contraindications. But in addition, they quickly allow the condition to alleviate, after a few days the person will get rid of the pain and sit normally, osteochondrosis will recede.
Treatment will be worse if you do not use medications that aim to restore cartilage structure. They are called chondroprotectors and contribute to better cartilage nutrition, renewal of disc tissue in the initial stages. You have to take them for a long time, even at home.
Muscle relaxants allow you to get rid of lower back muscle cramps. This condition is a response to root compression.
Drugs that improve microcirculation are needed. All this will remove the swelling at the place where the compression occurred, give the nerve cells more oxygen and nutrients. Exercises and massage, which can be performed at home to relieve pain, have a similar effect.
If your back hurts a lot and sitting becomes a real problem, you will need analgesics. This group of drugs will quickly resolve the manifestations of the disease.
Vitamins improve the nutrition of nerve roots, strengthen them. With the use of this group of drugs, the treatment is much more effective. Perfectly overcomes the symptoms of pain ointment, which must be smeared at the site of maximum pain.
The doctor prescribes ointment if your back hurts a lot and you can't sit up. By penetrating the tissues, the ointment has an anti-inflammatory effect on the roots. You can apply the ointment in the form of a coating at night. Apply the ointment to the painful areas three times a day.
Physiotherapy
Complete rehabilitation treatment consists of:
- physiotherapy exercises;
- physiotherapy;
- massage;
- traction;
- manual therapy;
- reflexology.
Therapeutic gymnastics consists of applying a dosed load to the lumbar spine. With its help, the tightened roots are released, the muscles are strengthened, and proper posture is established, which is then supported by filling. Gymnastics allows you to increase the range of motion, make the ligaments more elastic. Gymnastics is chosen individually for each person.
The technique, like filling, is simple to perform, contributes to the normalization of blood circulation and improves metabolism. Gymnastics helps to improve the nutrition of the intervertebral disc, increasing the space between the vertebrae. Due to the formation of the corset, the pain and load on the spine is reduced. Gymnastics is performed under the supervision of a specialist, and filling is needed every morning, it will prevent osteochondrosis.
Physiotherapeutic methods are used, as well as filling, very widely. Low-frequency currents, alternating current, ultrasound, laser and much more are especially helpful. In addition to ultrasound, you can additionally use ointment. The methods alleviate the inflammatory process, pain and swelling. Most popular:
- UHF;
- diodynamic;
- magnet;
- shock wave therapy;
- ultrasound;
- electrophoresis.
Massage is very often used at the stage when it was possible to remove the pain. Massage, as well as exercise, stimulates cartilage nutrition, improves metabolic processes. It is a massage combination of special techniques: rubbing, kneading, caressing and shock vibrations.
Properly performed massage is the key to successful treatment and subsequent recovery. Massage should be performed only by a specialist. In addition, you can use an ointment with anti-inflammatory action. Massage allows you to relieve muscle spasms, improve blood flow, strengthen the back.
Manual therapy is also massage, only with a special technique. Its effect is the same as with massage.
Traction is performed with the help of specially selected weights and techniques. The procedure helps to increase the space between the vertebrae, relieves pain, and restores the anatomical axis of the spine.
Acupuncture is based on the action of a needle prick on the active points of the human body. The technique is especially indicated in severe pain syndrome.