Degenerative-dystrophic changes in the lumbar spine: symptoms, causes, treatment. Degenerative dystrophic changes in the lumbar spine: symptoms and treatment Initial degenerative changes in the lumbar spine

Causes of the appearance of pathology

To understand the nature of the development of degenerative-dystrophic changes in the intervertebral discs, it is very important to understand the causes of such processes. The fact is that the human body is a verified mechanism that can withstand enormous loads, but under the influence of various kinds of adverse factors, a weakening of the natural defense mechanism is observed, which leads to a rapid violation of the integrity of cartilage structures. An important role in the violation of the trophism of the intervertebral discs is played by modern look life. Thus, the following triggers contribute to the development of degenerative-dystrophic changes in the spine:

sharp loads; inflammatory diseases; passive lifestyle; hypothermia; malnutrition; active sports; hormonal disorders; diseases endocrine system; normal aging process; metabolic disorders; chronic and recent spinal injuries.

Most often, degenerative-dystrophic changes in the spine are observed in people who lead an extremely sedentary lifestyle and at the same time eat improperly. The fact is that, normally, the load on the spinal column is distributed evenly, and a developed muscular frame provides significant support to it. In people who lead a sedentary lifestyle and have excess body fat, as a rule, the muscles are poorly developed, so even the slightest strength exercises lead to a serious overload of the intervertebral discs. In this case, the muscular frame can no longer take on part of the load during movement, which contributes to the rapid appearance of degenerative-dystrophic changes.

The influence of other unfavorable factors and their combinations also affects the condition of the spinal column, so in most cases it is extremely difficult to determine what exactly was the impetus for the appearance of such disorders in the cartilaginous tissue of the intervertebral discs. At the same time, understanding the cause of the appearance of such a pathological condition as degenerative-dystrophic changes in the spine makes it possible to take effective preventive measures.

The pathogenesis of the development of the disease

It is now well known how degenerative-dystrophic changes develop. lumbar spine. The spine in the sacrum and lower back bears the greatest load during any movement and even while sitting. Due to the influence of overloads, as well as other adverse factors, in the area of the intervertebral discs of this department, malnutrition of cartilage tissues is primarily observed. Directly in the intervertebral discs there are no blood vessels that could feed it directly, therefore, the appearance of malnutrition of the soft tissues surrounding the spinal column is often observed first. In the absence of the proper level of nutrition of the intervertebral discs, the cartilage tissue begins to gradually break down, losing elasticity.

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The second stage in the development of degenerative-dystrophic changes is the thinning and weakening of cartilage tissue. At this time, there is a gradual drying of the cartilage, which leads to a slow decrease in the height of the intervertebral discs. Due to the destruction of the fibrous membrane, various protrusions, that is, protrusions of the discs, may occur. With critical destruction of the tissues of the fibrous ring, it can rupture, which in the vast majority of cases leads to the release of the gelatinous body beyond the intervertebral disc and the appearance of a hernial formation. Such protrusions inevitably entail changes in the proportions of the vertebrae and pinching of the nerve roots extending from the spinal cord.

In response to a violation of cartilage tissue, activation is observed immune system, cat cells begin to produce prostaglandins, that is, substances that are inducers of the inflammatory process. Due to the production of these substances, there is an increase in blood supply and swelling of the soft tissues surrounding the spinal column, which is often accompanied by the appearance of even greater stiffness of the lumbar spine and pain in the affected area. Degenerative-dystrophic changes in the lumbosacral spine, as a rule, are characterized by slow progression and chronic course. In the future, dystrophic changes in the lumbar spine can become a springboard for the development of a number of dangerous diseases and complications, including osteochondrosis, sciatica, etc.

Characteristic symptoms of the disease

In the vast majority of cases, patients cannot independently determine the onset of the development of degenerative-dystrophic changes, since there are usually no pronounced symptoms in the initial stages of this pathological process. In fact, there are 4 main stages in the development of degenerative-dystrophic changes, each of which has its own characteristics. At the initial stage, obvious symptoms that can indicate a person without medical education existing problems of the spine may not be observed.

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However, often at this stage of the process there may be severe dull pain in the lower back after increased physical activity. In addition, some people note the presence of a certain stiffness in the lower back.

At the 2nd stage of the development of the disease, severe symptoms can be observed. First of all, in people with this stage, there is a serious limitation of the mobility of the spine, with any flexion, so-called “lumbago”, that is, attacks of sciatica, can appear. Patients may complain of tingling and goosebumps on the buttocks and lower extremities.

At the 3rd stage of the development of degenerative-dystrophic processes, the disease passes into an acute stage, since at this time there is compression of the radicular blood vessel and malnutrition of the soft tissues surrounding the spinal column, which leads to their ischemia. The physical manifestations of this stage include increasing pain, frequent cases of numbness lower extremities and convulsions.

When degenerative-dystrophic processes of the spine enter stage 4, damage to the spinal cord and its branching roots can be observed, which is fraught with paresis and paralysis of the lower extremities. As a rule, such complications are the result of compression damage to the spinal cord or malnutrition.

Methods for early diagnosis

In most cases, patients with degenerative-dystrophic processes in the lumbar spine come to the doctor already in the later stages, when the symptoms are quite intense, preventing a person from leading a full daily life. Diagnosis of this pathological condition begins with the collection of a detailed analysis, examination of the lumbosacral spine and palpation.

As a rule, an external examination is not enough to assess the presence of pathological changes in the intervertebral discs and their prevalence. To confirm the diagnosis, a series of studies using modern medical equipment is required. Such studies include:

general analysis blood; radiography; CT scan: Magnetic resonance imaging.

Despite the fact that radiography is a publicly available diagnostic method, it is at the same time considered the least accurate and informative, since early stages the development of pathology does not allow to identify the existing degenerative changes in the lumbosacral spine. CT and MRI are more reliable and modern imaging tools, so they can detect existing abnormalities even at an early stage. With MR, the picture allows you to notice the existing degenerative-dystrophic changes thoracic spine or lumbar, even if they are extremely weak. Thus, MRI is the most accurate modern method diagnostics.

How is the therapy carried out?

Treatment of degenerative-dystrophic changes in the lumbar spine primarily involves the appointment of medical support to eliminate pain.

As a rule, injection blockades, ointments and creams with analgesic action are prescribed.

Drugs are prescribed to help restore blood supply, eliminate soft tissue edema, improve cartilage trophism, and relieve muscle spasm. In addition, B vitamins are prescribed, which can reduce damage to nerve fibers during their infringement and accelerate its recovery. Common drugs prescribed for the detection of degenerative-dystrophic changes include:

Diclofenac; Ketanov; Revmoxicam; Teraflex; Chondroitin; Mydocalm.

This is not a complete list of medications that can be used to detect degenerative-dytrophic processes. The picture of dystrophic changes in the lumbosacral spine largely affects the selection of medications in each final case. After the elimination of acute symptomatic manifestations, a whole complex of physiotherapeutic procedures and exercise therapy is prescribed. Physiotherapeutic procedures used for such pathologies of the spine include magnetotherapy and electrophoresis. Acupuncture, acupuncture, massotherapy and other means.

Given that the development of degenerative-dystrophic changes in the lumbosacral spine is chronic course, it is very important for the patient to responsibly approach exercise therapy. Therapeutic exercise allows you to develop a muscular frame and reduce the load on the spinal column, improve cartilage nutrition, preventing further degenerative changes in the spine.

Many pathologies of the spine have complex causes of origin. For example, degenerative and dystrophic changes in the lumbosacral region occur as a result of prolonged exposure to various pathogenic factors, mainly related to the patient's lifestyle and injuries. Before you figure out what dystrophy of the vertebral bone is and what it can entail, you should understand the features of the device of the vertebra and what risks it is exposed to after damage.

The essence of pathology

As such, the diagnosis of degenerative dystrophic changes in the lumbosacral spine does not exist. This phrase refers to the syndrome, which leads to traumatic effects, as well as internal processes occurring in the bone tissues of the body.

In most cases, the pathology develops gradually, and not as a result of a fracture, a severe blow (for example, a lesion in an accident) and is associated with a violation of metabolic processes in the tissues of the bones of the spine. Sometimes it can be provoked by hereditary factors, but most often the disease progresses due to the patient's long-term maintenance of an unhealthy lifestyle.

As a result, there is a violation of the structure of the intervertebral disc. Normally, it consists of a pulpous nucleus, which is surrounded on all sides (along the circumference) by a fibrous membrane. When, due to an incorrect lifestyle, excessive pressure on the back, the vertebral bones, which are located above and below the disc, begin to shift relative to their normal position, they put pressure on the disc and gradually destroy its pulp and shell.

Thus, dystrophic changes in the lumbosacral spine are biochemical changes that lead to the destruction of the structure of the intervertebral disc, which negatively affects the functioning of the spinal column as a whole.

This name refers to a whole group of specific diagnoses:

osteochondrosis of different stages; spondylosis; spondylarthrosis; protrusion and intervertebral hernia.

The structural features of the intervertebral disc are such that it is restored due to the division of its own cells, since it is deprived of blood supply. Accordingly, the nutrition of these tissues occurs differently. That is why, in most cases, degenerative dystrophic change occurs rather slowly, over several years, without showing any signs.

Causes of the disease

When a syndrome of degenerative dystrophic changes in the lumbosacral region is observed, it is rather difficult to establish one or more underlying causes. Therefore, they talk about the specific causes that led to the disease, without analyzing what factors gave rise to these causes.

Usually two reasons lead to these pathological changes:

Inflammatory processes that occur due to the fact that the substance released from the dilapidated disc begins to come into contact with nerve fibers(they are located in the spinal cord) and irritate them. Increased mobility of the vertebral bones in the lumbar and other regions, which occurs due to the fact that the disc wears out, decreases in size and loses the ability to properly hold the bones in space.

NOTE

Both of these causes lead to a violation of the mobility of the vertebrae, and this leads to excessive mechanical friction of the bones, squeezing the nerve fibers. Therefore, there are pains in the corresponding department, and in advanced cases this can lead to serious complications up to paralysis of the lower extremities.

Risk group

Ceteris paribus, the risk group includes people who have a back injury, and also lead an unhealthy lifestyle:

constant impact on the back due to weight lifting (non-compliance with the load and the rules for lifting the load); active sports, risks of sports injuries; sedentary lifestyle; obesity - excess weight constantly puts pressure on the spine, having a negative impact on its integrity.

Persons over 60 years of age are also at risk, and women are more susceptible to the disease due to hormonal disruptions that occur after menopause.

PLEASE NOTE - A syndrome in which degenerative-dystrophic changes in the lumbar or other parts of the spinal column are observed is recorded in varying degrees of development in a third of people aged 30 to 50 years. In patients older than 60 years, such pathologies are observed in more than 60% of cases.

Symptoms of the disease

For degenerative dystrophic changes in the lumbar region, as well as in the sacral spine, the manifestation of any symptoms is not always characteristic - for some time the disease can develop in a latent (hidden) stage.

As pathological processes develop, extraneous sensations appear, and then severe pain, as well as other symptoms:

Pain in the lumbar region, extending to the buttocks, thighs and legs. Occurs irregularly, may be aching and sometimes sharp. At the same time, in the lower back itself, the pain is in most cases dull, and it gives off with sharp blows. Aching, very long-lasting pain in the lower back - they can last for several weeks, slightly weakening with the introduction of painkillers, and then intensifying again. Initial signs syndrome - aching sensations that increase during a sitting position, because it is at this moment that the lower back experiences an increased load (the discs are compressed). Also, extraneous sensations can arise from prolonged standing. The transition of aching sensations into sharp ones during the performance of simple, familiar movements: leaning forward, turning the body. Pain becomes especially severe when lifting even small weights. In more advanced cases, when intervertebral hernias form, the pain becomes pronounced, sharp, sometimes burning, and numbness, tingling, cold in different parts of the legs are often observed; severe fatigue when walking. If the nerve fibers are compressed by the vertebrae, this is manifested not only by numbness in the legs, but also by pain - the corresponding pathology is called sciatica. Symptoms from other organ systems are also observed in advanced cases of degenerative dystrophic changes in the lumbar: defecation and urination disorders .In rare cases, pain can pass along the entire back - this is due to the fact that changes in the spine lead to a general disruption in the functioning of nerve fibers that transmit pain sensations along their entire length.

The most common complication is stenosis (i.e. narrowing) spinal canal, as well as the formation of hernias and protrusions, which often require urgent surgical intervention. Such cases are the result of untimely seeking medical help.

IMPORTANT - If there are constant disturbing pains or any other extraneous sensations (for example, a feeling of swelling in the lower back when standing for a long time), you should immediately consult a doctor, since in the early stages treatment is always carried out without surgical intervention.

Diagnosis of pathology

In almost all cases, degenerative changes in the lumbar spine are detected using complex diagnostics, in which, along with traditional methods, instrumental ones are used:

Analysis of the patient's complaints and his medical history - it is especially important to take into account previous requests for help in situations where the patient has already undergone back surgery or courses of physiotherapy. External examination and identification of painful areas using palpation (palpation). X-ray examination. As a rule, an x-ray of the lower back is performed in two projections - straight and sideways. However, such a diagnosis may not reveal all dystrophic changes in the lumbar spine. Very often, magnetic resonance imaging (MRI) is used to obtain accurate information and correct diagnosis, which results in the so-called mr picture of dystrophic changes. It has a high degree of detail, so you can confidently determine the cause of the pathology, its degree and prescribe an effective course of treatment.

Usually, the syndrome of dystrophic changes is diagnosed if the following mr signs are observed:

the disk space (pulp and fibrous ring) is more than half destroyed; dehydration of the disk substance - in the picture, the affected tissues look darker due to lack of moisture; external signs of destruction of the cartilaginous tissue of the end plate of the disk - externally observed as a black stripe in the corresponding place. tears ( complete or partial) and other violations of the integrity of the fibrous ring; protrusion or intervertebral hernia - in this case, the pulp completely breaks through the fibrous ring, as a result of which the disk collapses, and its tissues come into contact with nerve fibers, provoking inflammatory processes.

Dystrophic changes are most often observed in the lumbar than in the sacral spine. The reason is that heavier loads are placed on the lower back. However, in cases where the patient is injured when falling on the coccyx, the pathology begins to develop precisely in the sacrum.

Treatment

In most cases, treatment does not involve surgery. The impact on the tissues of the vertebra is chemical (with the help of medicines), mechanical and electromagnetic.

Medication treatment

Medicines in this case perform 2 important tasks - they relieve pain, and also contribute to the restoration of tissues by improving their nutrition. For these purposes are used:

muscle relaxants (relax back muscles); chondroprotectors (restore cartilage tissue); sedatives and painkillers (to relieve pain and as sedatives for general relaxation of the patient); B vitamins and mineral complexes are introduced so that tissues receive additional nourishment and recover faster .

Medicines are administered both intravenously (injections, dropper) and externally (ointments, gels).

Physiotherapy and massage courses

These procedures have the same goals as drug treatment, but they affect the body differently (mechanically, with the help of electric currents, electromagnetic fields, etc.). The following types of therapy are used:

electrophoresis; UHF; magnetotherapy, etc.

The course of treatment is always prescribed individually and usually takes several weeks.

Exercise therapy and spinal traction

This type of treatment for degenerative and dystrophic changes in different areas of the spine involves a mechanical effect on the spinal column as a whole in order to optimize the position of the bones relative to each other and stabilize their mobility. A special set of exercises is supposed, which is developed and performed under the supervision of a doctor. Homework is also acceptable, but only according to approved instructions.

The use of self-medication in such cases may not only not give the desired effect, but also worsen the situation. The fact is that only a doctor can make a professional diagnosis and only after an instrumental examination. If treated for the wrong disease, the back can only be hurt.

Disease prevention

Prevention of the development of degenerative dystrophic diseases provides for the observance of natural, simple rules healthy lifestyle life: maintaining regular physical activity, which includes exercises for the development of the spine (swimming helps a lot); correct technique weight lifting; avoiding situations of hypothermia of the lower back; balanced nutrition: the daily menu should include not only calcium, but also substances that contribute to its absorption.

Prevention of the disease is much easier than its treatment, so we can say that in most cases the health of a person's back is in his own hands.

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

Although there is a slight genetic predisposition to the occurrence of this disease, the true cause of degenerative changes in the spine appears to be multifactorial. Degenerative changes may be due to natural process aging of the body or have a traumatic nature. However, they are rarely the result of major trauma, such as a car accident. Most often, we will talk about a slow traumatic process, leading to damage to the intervertebral disc, which progresses over time.

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

The reasons

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

Inflammation that occurs when proteins in the disc space irritate the nerve roots during the formation of an intervertebral hernia. Pathological instability of micromotions, 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 persistent low back pain.

The combination of both factors is most common in the formation of an intervertebral hernia, which is a complication of the degenerative-dystrophic process in the intervertebral discs. When a disc herniation occurs, mechanical compression of the neurovascular bundle passing through 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 increases from time to time for several days or more. Symptoms may vary depending on the individual case, but the main symptoms in this disease are as follows:

Pain localized in the lower back, which may radiate to the hips and legs; Prolonged pain in the lower back (lasting more than 6 weeks); Low back pain is usually described as dull or aching, as opposed to burning pain where it radiates; The pain is usually aggravated in a sitting position, when the discs are under more pronounced load compared to that which is placed on the spine when the patient is standing, walking or lying down. Prolonged standing can also make the pain worse, as can bending forward and lifting objects; The pain is exacerbated by certain movements, especially when bending over, turning the torso and lifting weights; If a herniated disc develops, symptoms may include numbness and tingling in the legs, and difficulty walking; With a medium or large herniated disc, the nerve root exiting the spinal cord at the affected level can be compressed (foraminal stenosis), which in turn can lead to pain in the legs (sciatica); Neurological symptoms(for example, weakness in the lower extremities) or dysfunction of the pelvic organs (various disorders of 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, other spinal structures can cause pain to radiate to the buttocks and legs. The nerves become more sensitive due to the inflammation triggered 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, pain can be caused by:

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

Diagnostics

Diagnosis of the presence of degenerative-dystrophic changes in the lumbosacral spine, as a rule, is carried out in three steps:

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

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

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

Treatment

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

Load-free traction of the spine is ideal for the treatment of degenerative lesions of the intervertebral discs (osteochondrosis of the spine) and its complications - spondylosis, spondylarthrosis, intervertebral hernias and protrusions. Traction takes place with the preservation of all physiological curves of the spine and is safe, since no force is applied during traction. With an increase in the intervertebral distance, there is an improvement in the nutrition of all intervertebral discs, the restoration of their structure and the removal of pain.

By using complex treatment it is possible to achieve a complete recovery of the patient, and not just pain relief for a limited period.

If you have a pain syndrome, you can consult a neurologist in one of our Moscow Clinics. For citizens of the Russian Federation, the consultation is free of charge.

The article was added to Yandex Webmaster on 07/22/2014, 13:32

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

ON THE. Pozdeeva, V.A. Sorokovikov
GU SC RVH VSNC SO RAMS (Irkutsk)

Diagnosis of displacements of the lumbar vertebrae 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 diagnostics and treatment, as well as compensation for disability, 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 location. - 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 more often affects people of young and middle age, 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 displacements of the lumbar vertebrae 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 diagnostics and treatment, as well as compensation for disability for workers, 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), 30 to 87% of the most able-bodied population aged 30 to 60 suffer from spinal osteochondrosis. The share of osteochondrosis of the spine accounts for 20 to 80% of cases of temporary disability. Morbidity rates in Russia tend to increase, while in the vast majority of patients the disease is accompanied by lesions of the lumbar spine. According to the VIII World Pain Congress, held in Vancouver in 1996, back pain is the second most common reason for seeking medical attention and the third most common reason for hospitalization after respiratory diseases, with 60-80% of the population experiencing it at least once. In the structure of the incidence of the adult population of our country, lumbar osteochondrosis is 48 - 52%, ranking first, including the number of days of disability. Temporary disability at 40% neurological diseases due to lumboischalgic syndromes. AT overall structure disability from diseases of the osteoarticular system, degenerative-dystrophic diseases of the spine account for 20.4%. The disability rate for degenerative diseases of the spine is 0.4 per 10,000 inhabitants. Among disabled people with other diseases of the musculoskeletal system, this pathological condition ranks first in terms of frequency of occurrence, and in 2/3 of patients, the ability to work is completely lost.

Spinal mobility is possible due to complex interactions elastic apparatus of the vertebral bodies, arches and intervertebral discs. The functional unit of the spine at any level is the motor segment - a concept introduced by Iunghanus in 1930. The motor segment includes two adjacent vertebrae, a disc between them, a corresponding pair of intervertebral joints and a 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 on the whole in a wider range.

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

Intervertebral joints belong to the group of sedentary, and are combined joints. The main functional purpose of the joints of the spine is the direction of movement, as well as limiting the amount of movement within these directions.

Under normal static conditions, the articular processes do not carry vertical loads: the function of damping vertically pressing forces (weight of the head, torso) is carried out by 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 a significant, ever-increasing vertical load - neoarthrosis of the articular processes with the bases of the arches.

The role of the disc in spinal statics is to cushion 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 disc force.

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

A certain form of spinal injury can be categorized as either stable or unstable injury. The concept of "stable and unstable injuries" was introduced by Nicoll in 1949 for the lumbothoracic spine, and in 1963 Holdsworth extended to the entire spine. According to this theory, the rupture of the posterior structure is necessary condition spinal instability.

F. Denis (1982-1984) introduced the three-bearing concept of spinal instability - the theory of "three columns", while the anterior support structure consists of: the anterior longitudinal ligament, the anterior part of the annulus fibrosus, the anterior half of the vertebral bodies; middle support structure of: posterior longitudinal ligament, posterior annulus, posterior half of the vertebral bodies and posterior support structure includes: supraspinous ligament, interspinous ligament, joint capsules, yellow ligament, vertebral arches. According to this theory, for the occurrence of instability, a rupture of both the posterior and middle support structures is necessary.
Degenerative-dystrophic changes in the segments of the spine 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 heavy loads. A dynamic, momentarily applied load that creates impacts of a large local force, as a rule, leads to varying degrees compression of the vertebral bodies, and also causes damage to the discs. With lesions of the discs, when the nucleus pulposus loses its function as the axis of the spherical joint, the 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 on the cartilaginous layer and in the peripheral part of the limbus. In cases where the connection between them weakens, for example, with degenerative lesions in the segments of the spine, the vertebral bodies, not being firmly connected to the discs, can move 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 function are involved in the pathological process.
The clinical manifestations of this process is dorsalgia - a pain syndrome in the back (with possible irradiation to the limbs), which is caused by functional and degenerative changes in the tissues of the musculoskeletal system (muscles, fascia, tendons, ligaments, joints, disk) with 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, the compression of the root in a narrow "tunnel" plays a role, the walls of which can be formed by various structures: disc herniation, yellow ligament, tissues of the facet joint, osteophytes. Great importance at the same time, it has a violation of the blood circulation of the root in the compression zone, followed by edema.
Risk factors for the development of musculoskeletal pain syndromes 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 functional disorders at various levels musculoskeletal system and disruption of compensation of natural age-related dystrophic processes under the influence of provoking factors.
The problem of instability of the spinal motion segment, which occurs under the action 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 morphological and functional changes in the structures of the spine, biomechanics, as well as the need to diagnose PDS instability in the early stages of the degenerative process.

1. Gally R.L. Emergency Orthopedics. Spine / R.L. Galley, D.W. Spaite, R.R. Simon: Per. from English. - M.: Medicine, 1995. - 432 p.

2. Epifanov V.A. Osteochondrosis of the spine / V.A. Epifanov, I.S. Roller, A.V. Epifanov. - M.: Medicine, 2000. - 344 p.

Degenerative-dystrophic changes in the lumbosacral spine - a slow destruction of tissue structures related to the discs. All this happens for the simple reason that the tissues are no longer supplied with enough nutrition, and this leads to their dryness and loss of elasticity.

Dystrophic changes in the lumbosacral spine is a dangerous disease. It is almost impossible to detect pathology immediately. In such situations, there is nothing left to do but take various medications and go to the hospital for procedures. The situation is further aggravated by the fact that in order to bring the spine back to normal, it may be necessary to change some habits, and not rely only on the power of medicine.

DDZP include in their group several pathological conditions. They are united by some generalized signs and features. In practice, the following types of changes are traditionally encountered:

- problems associated with the broken integrity of the disks, their thinning, deformation;
spondylosis - a manifestation of growths of a pathological nature in the region of the vertebrae, these elements limit the patient's motor capabilities;
spondylarthrosis is a phenomenon in which there is a violation of the joints, which entails severe pain during movement.

These are the types of these states. In order for the clinical picture to be revealed as clearly and clearly as possible, a detailed diagnosis is necessary.

Causes of the disease

There are several causal factors of degenerative-dystrophic changes in the lumbosacral region:

Leading a sedentary lifestyle. If the body is healthy, there is a uniform distribution of the load along the spine. But lack of mobility leads to excessive weakness of the muscular corset and weakening of the muscles. Therefore, even a minimal load factor can lead to displacement of the vertebrae.
Excessive physical activity. Lead to pathology, maybe the opposite state of affairs, when a person is intensively involved in sports, not sparing his own muscles. Statistics show that joint diseases occur in 90% of athletes.
traumatic events. If we are talking about young patients, then such pathologies (arthrosis, nerve infringement, hernia) are most often caused by injuries, including birth processes.
Aging is another process that causes irreversible changes. In the treatment process, there can be no talk of surgery, since dystrophy is natural. Only supportive therapy is considered acceptable.
Irrational nutrition. Due to problems with metabolic reactions, body cells do not receive the proper quality of nutrition. This has a negative impact on the state of the whole organism and creates an extra load.
inflammatory processes. Changes can occur against the background of inflammation. For example, the most common causative agents of such conditions are arthritis, ankylosing spondylitis.

Thus, degenerative changes in the lumbar spine can manifest themselves in various ways. causative factors. For their exact establishment, it is necessary to pay a visit to the attending specialist.

The course of development of pathology

The spinal column, especially the sacral region, is an object of increased load during any body movements. Because of this, there are violations of the supply of nutrients to cells and tissues. The discs lack blood vessels that could hypothetically provide direct nutrition. Therefore, there is a gradual loss of tissue elasticity and its slow destruction. In the next step, the tissue becomes thinner and more loose.

The cartilage shrinks, the discs lose their height. In response to these processes, the immune function comes into active work. Its cellular structures begin to produce inflammation inducers. As a result, the tissues swell, pain appears. Usually, the course of degenerative-dystrophic changes in the lumbosacral spine is slow and chronic. In the future, against their background, the development of other dangerous conditions may occur.

Stages of progression and main symptoms

In the lion's share of clinical situations, there are problems in self-determination of the onset of the development of the disease. The fact is that at first there are no pronounced signs. As the practical side of the issue shows, there are 4 stages of progression of pathology. And each of them is accompanied by special signs.

First stage. A person without a medical education may not notice any changes in health, since in fact there are no signs of degenerative-dystrophic changes. Some patients note that they have experienced excessive stiffness in the lumbar region.
Second stage. In this process, more severe symptoms may come into play. First of all, we are talking about limiting movements in the lumbar spine. Even with the slightest bending, shooting pain and attacks of initial sciatica can make themselves felt.
Third stage. There are problems with the nutrition of the soft tissues that surround the spinal column. As for the physical manifestations, there is increasing pain, numbness of the limbs and a convulsive state.
Fourth stage. This is the most neglected condition in which obvious damage to the spinal cord and roots can progress. This condition entails the formation of paresis and paralysis.

As you can see, there is a direct relationship between the stage at which the pathological process has passed and the characteristic manifestations of the disease. Thus, DDSD of the lumbar spine proceeds within several stages and is a dangerous condition. It is important to determine the condition as early as possible in order to start the treatment process in a timely manner.

Diagnostic measures

The complex of surveys is quite simple and is carried out within the framework of three common stages.

Drawing up a general history of the disease. In this case, attention is paid to the symptoms of the disease and the general conditions under which the attack began.
Examination of the patient. At this stage, the specialist checks the characteristic signs of degeneration, examines the degree of mobility, determines muscle strength and the area in which the lesion is localized.
Holding. This event serves to reveal the evidence base for dystrophic changes and causal factors in the development of pathology.

Other measures can be used as additional tests to determine dystrophic changes in the spine. This is a blood test. But not all of these activities are able to demonstrate the symptoms of pathology at an early stage. The most in-depth examination methods are measures such as CT, MRI. But patients resort to them in the case when the lesion of the lumbar region has already begun to actively develop.

Complex of therapeutic measures

The list of methods of therapy is quite wide, most often it involves a complex of medication, physical and surgical treatment. The desired method of therapy is selected by a medical specialist.

Drugs for the treatment of the disease

First, doctors prescribe conservative treatment. It involves the use medicines analgesic, warming action. They allow you to relieve pain and ensure free movement and normal performance. Most often, preference is given to representatives of the group of non-steroidal anti-inflammatory compounds:

Diclofenac.
Nise.
Meloxicam.
Ibuprofen.
Movalis.

They are effective, but are accompanied by quite dangerous side effects for the intestines, up to the formation of ulcers.

To improve overall well-being, degenerative-dystrophic change involves the use of simple medicinal formulations - Ketonal, Ketanov. The principle of action of drugs is to eliminate pain and alleviate general well-being.

In order to relax tense muscles, Sirdalud, Mydocalm are prescribed. These drugs are indicated for use only intermittently, since they have a serious effect on the condition of the muscles.

In addition to these remedies, doctors prescribe regular use, which are aimed at activating the regeneration of joints and tissues.

Complexes of special vitamins and minerals are often used to restore the body. Group B drugs have the greatest effect (6, 12).

If a pain sensation expressed strongly enough and cannot be suppressed by popular medicines, novocaine blockade is used. The procedure involves the introduction of a drug directly into the area of the spinal cord.

It is quite simple to cure dystrophic changes in the lumbar region if you follow all the rules for the use of drugs and follow the dosages.

Therapeutic exercise and massage

This set of procedures usually contributes to the normalization of the blood circulation option in the problem area. And also it is aimed at muscle relaxation and providing thinned tissues with the necessary nutrition. Exercise therapy for degenerative lesions improves metabolic processes and brings blood to the lumbar region. In addition, the event will be useful for obese people, as it helps to eliminate excess weight.

It is important to correctly plan a set of physical activities, and as a result, it will be possible to achieve muscle strengthening, which will subsequently be able to take on moderate loads.

The main nuance of these activities is the possibility of increasing the distance between the vertebrae of the lower back, as well as the ability to release nerves that have been compressed. So, with degenerative-dystrophic changes in the lumbosacral spine, it will be possible to get rid of the pain syndrome and relieve inflammation.

And it is also advisable to sign up for a pool, because high-quality classes will help strengthen the muscles and ensure their smooth stretching. Through weight loss, you can achieve the removal of excess stress. But at this time, it is important to correctly think over and plan the diet so that the body receives a sufficient amount of vitamin and mineral substances.

Surgery

Fortunately, in a huge number of clinical cases, the use of medicines and medical treatments comes to the rescue. exercise. The operation is needed only in case of active progression of the disease, even with timely and regularly taken therapy measures. At the same time, the doctor looks at the MR picture of degenerative-dystrophic changes. During the event, devices are installed that help maintain the lumbar spine. This approach allows you to remove excess pressure and prevent further process of deformation of the intervertebral discs.

Another common case is the formation of a serious lumbar herniation, involving the protrusion of the disc from the vertebral borders. The pulp that has left the disc is then cauterized with a laser or pulled out.

The operation process implies the possibility of solving several clinical problems at the same time:

decompression in the region of the nerves of the spinal type;
elimination of an object that leads to compression of nerve fibers;
removal of stenosis that has developed in the spinal cord.

If the phenomenon of degenerative change is acute, emergency intervention is indicated. It is intended to prevent neurological disorders. Through this measure, specialists can eliminate brain compression and restore the options of the pelvic organs.

Preventive actions

Due to the vast scope in which these changes are propagated, some preventive measures must be observed. They will help protect against disability at a young age, as well as extend the time of activity until old age. To improve the MR picture of degenerative-dystrophic changes in the lumbosacral region and improve general well-being in the present and future, certain actions should be taken.

Degenerative dystrophic changes in the lumbosacral region are associated with a complex effect on the cartilaginous intervertebral and bone tissues of the vertebrae of various age, metabolic, inflammatory, traumatic, and behavioral factors.

Pathology refers to progressive changes - without adequate treatment, not only painful symptoms join, but dangerous complications.

Therefore, it is important for patients to know whether the progress of pathology can be prevented, and how to deal with already formed changes.

general characteristics

Quite often, doctors explain the appearance of pain, backache, numbness and weakness, cramps in the lower extremities, and even malfunctions of the pelvic organs with degenerative changes in the spine.

To understand this relationship, let's try to figure out what it is - dystrophic changes in the lumbar spine.

To prevent friction and provide cushioning, the vertebrae that protect against external influences spinal cord and provide support and movement of the body, separated by layers of fibrous cartilage - intervertebral discs.

Movement and flexibility depend on the state of the vertebral processes that form the joints, which are lined with cartilage.

Under the influence of various factors, the intervertebral and articular cartilages lose their functionality: they dry out, crack, lose their elasticity, which entails a number of physiological changes.

Doctors do not consider DDSD to be a disease of the lumbar spine of a degenerative dystrophic nature. Usually, cartilage is destroyed simultaneously in other departments. Degenerative processes also affect the joints of the hands and feet.

But if, with the defeat of the joints of the limbs, we are talking about diseases of arthritis, arthrosis, bursitis, then with the destruction of the vertebral cartilage, it develops:

osteochondrosis - a decrease in the height of discs with coracoid growth of the vertebrae and the formation vertebral hernias, protrusion;
spondylosis in the form of marginal bone growths covering the disc;
spondylarthrosis - destruction of the intervertebral joints.

The mechanism of development of such diseases is directly related to dystrophic changes in the discs, cartilage of the joints, which are dehydrated, dry out and thicken, which leads to subsidence of the fibrous ring, proliferation of bone tissues.

Video

Video - changes in the lumbosacral region

Causes of the disease and risk group

The state of cartilage tissue is affected by various factors, so it is almost impossible to single out a single cause of dystrophic changes.

Among the most common are:

Cartilaginous tissue malnutrition. It is associated with the aging of the body, insufficient intake of nutrients from food, metabolic disorders against the background of hormonal disruptions and endocrine diseases.
Excessive load on the spine. Risk factors - playing sports, stress on the lower back associated with professional and labor activity, excess weight.
Lack of physical activity. A passive lifestyle, prolonged immobility due to other diseases, being in weightlessness lead to dehydration of cartilage tissues and their destruction.
Spinal injuries, including birth. For a young or growing organism, traumatic conditions become an impetus for the development of tissue dystrophy.
Inflammatory diseases of an autoimmune, infectious, etc. nature.

The most common cause of dystrophy is still called age. On the MR picture, degenerative and dystrophic changes in the lumbosacral spine of varying degrees are observed in 80% of elderly people.

Symptoms and signs

Clinical picture pathology directly depends on the degree of destruction. A degenerative dystrophic change develops in the lumbar spine for quite a long time.

Therefore, characteristic signs in the initial stages of the development of pathology may be completely absent.

Cartilaginous degeneration in the initial stages of degenerative changes in the lumbosacral spine can be manifested by aching pain, heaviness in the lower back after exertion or a long stay in a static position.
With the progress of the pathology, a violation of the mobility of the spine joins. In addition to aching and dull pain symptoms of a periodic nature, “lumbago” can be observed radiating to the buttocks, legs, and to the sacrum. Patients are concerned about numbness of the skin, goosebumps, cramps of the lower extremities. The development of scoliosis is observed.
At the third stage, the radicular syndrome joins, manifested by sharp, piercing pains with a concentration at the site of the pathology and the spread of pain along the damaged nerve. When the blood vessels are squeezed, soft tissue ischemia develops. There are malfunctions internal organs, primarily, Bladder, genital organs, rectum.
Symptoms and signs of degenerative-dystrophic changes in the lumbar region of the advanced 4th stage are manifested by the addition of complications in the form of paresis, paralysis of the lower extremities. The mobility of the spine itself is practically absent, the pain becomes chronic.

Diagnostic methods

Doctors use various direct and differential diagnostic methods that allow not only to identify changes, but also to exclude the presence of diseases similar in symptoms.

The examination begins with the study of the anamnesis, external examination, palpation, and motor neurological tests.

But such methods are not enough to assess the picture of dystrophic changes in the lumbosacral spine.

A preliminary diagnosis can be confirmed only after instrumental examinations:

An x-ray will show subsidence of discs, the presence of bone growths, displacement of the vertebrae.
CT reveals the pathological picture in more detail in a 3-dimensional image, and allows diagnosing the presence of hernias and protrusions by indirect signs.
To study the condition of soft tissues, damaged nerves and blood vessels, doctors prescribe an MRI. This method is considered the most informative and safe. A significant disadvantage is the cost of such an examination.

Computer images show ruptures (hernias) and protrusions (protrusions) of the fibrous ring.

Treatment

For diseases associated with pathological changes in the spine, the alternation of periods of exacerbations with temporary remissions against the background of the progress of dystrophy is characteristic.

Therefore, for each period and stage, its own tactics for the treatment of degenerative dystrophic changes are chosen:

At the initial acute stages and during remission, preventive and behavioral treatments predominate.
During periods of exacerbations, conservative medical and physiotherapeutic methods come to the fore.
In advanced stages, when changes affect the nerves, the spinal cord, accompanied by loss of mobility, other complications, they resort to operations.

Preparations

Medicines for dystrophic changes in the lumbar spine of degenerative origin are selected individually, taking into account the stage, intensity of pain, and the presence of complications.

Pain relief may include:

Non-steroidal drugs that not only relieve pain, but also relieve inflammation in the form of Diclofenac, Movalis, Meloxicam, Ortofen, Ketanov, Ibuprofen. The most commonly prescribed infusion nonsteroidal drugs which accelerates the analgesic effect. During the recovery period and with non-intense pain, the use of external agents is allowed: ointments, gels, patches.
Analgesics: Dexamezaton, Analgin, Spazgan are administered drip for quick relief of pain.
Steroid preparations of Betamethasone, Triamcinolone, Prednisolone in short courses in the form of injections.

With radicular syndrome, a paravertebral or epidural blockade is performed with the introduction of anesthetics: Lidocaine, Novacaine, or combinations of drugs.

Additionally, the following may apply:

muscle relaxants;
B vitamins;
chondroprotectors;
means for restoring nerve conduction;
vasodilators.

Physiotherapy

Exercise therapy is an excellent way to restore mobility of the spine and strengthen the muscular corset. Adequate physical activity helps to stop the progress of changes and even relieve pain during recovery period.

But you need to be careful when choosing exercises.. Intense loads, jumping, twisting are prohibited, especially with exacerbation and the presence of hernias.

The complex should be developed individually and include exercises for:

traction of the spine;
strengthening the muscle corset from both the back and the press.

In diseases of the back, other exercise therapy exercises can aggravate the condition or lead to complications.

Water aerobics, swimming, traction on the crossbar, on an inclined board are considered safe and effective for such patients.

Massage

Some patients see salvation in massage, without thinking that the mechanical effect on the vertebrae harms even a healthy spine. Only massaging soft tissues and exclusively by a professional massage therapist will give a positive effect in the initial stages of the pathology.

When degenerative changes in the lumbosacral spine are accompanied by the formation of an intervertebral hernia, protrusion, the spinal cord is affected, nerves are blocked, massage, especially manual massage, is strictly prohibited.

It is impossible to massage the back during the acute period of the disease. The blood flow under the influence of massage will provoke increased swelling, inflammation and pain.

Diet

There is no special diet for patients with diseases of the spine in the list of therapeutic diets.

Doctors recommend that patients adhere to a balanced diet that can provide the body with all the necessary nutrients, vitamins and minerals, which in turn will contribute to the proper nutrition of cartilage tissue.

To a greater extent, diet is important for overweight people, since obesity is one of the risk factors for the development of dystrophic changes.

Prevention

It is rather difficult to avoid age-related dystrophic processes, but it is possible to prolong an active life, despite age.

Due to the fact that most people lead a sedentary lifestyle, dystrophic changes in the lumbosacral spine are one of the most common pathologies. The complexity of the phenomenon lies in the fact that the intervertebral discs do not have a direct blood supply, and, as a result, are not capable of self-regeneration. This pathology occurs in almost every 3rd person over the age of 30 years. At the same time, this phenomenon is present in almost all people over 60 years old.

A significant role in the process of deformation is played by the fact that it is extremely difficult to detect the development of pathology at the initial stage.

Such a pathology as dystrophic degenerative changes in the lumbosacral spine is a process characterized by the gradual destruction of the intervertebral discs in the lumbar region. The main destruction occurs due to the loss of elasticity and dehydration of tissues, against the background of a nutritional deficiency of these elements.

A significant role in the process of deformation is played by the fact that it is extremely difficult to detect the development of pathology at the initial stage. The phenomenon noticeably makes itself felt already at the stage of serious destruction, most often not amenable to simple conservative treatment.

Reasons for the development of pathology

Degenerative changes in the lumbosacral spine can occur due to a variety of reasons. The main ones are:

Sedentary lifestyle. Practically complete absence regular loads on the lumbar spine leads to a gradual weakening of the muscles located around. As a result, they become unable to withstand even minor loads.
Intense sports with exorbitant loads for the body. Quite often, the onset of a destructive change in the lumbosacral region comes from lifting significant weights and as a result of sudden movements with insufficiently warmed up muscles.
Various mechanical injuries, including birth.
The wrong principle of nutrition, as a result of which a sufficient amount of elements useful for metabolism does not enter the body. Often, in this case, the patient has obesity, which also has an extremely negative effect on the condition of the spine.
The presence of inflammatory processes in the spine. These include many diseases, such as Bechterew's syndrome and arthritis.
Severe hypothermia.
Age-related aging of the body, in which there is a persistent leaching of useful components from bone and cartilage tissues. With this type of pathology, surgical intervention is not performed, but general state the patient is supported with the help of special preparations and methods of physiotherapy.

During the manifestation of dystrophic changes in the lumbosacral spine, pain always occurs. Its appearance in this case is a consequence of excessive mobility of individual vertebrae, and also occurs when the pressure of the hernia is placed on the nerve processes located in the interdiscal space.

Symptoms

The development of pathology in the sacral spine is accompanied by quite striking symptoms that manifest themselves during the period of exacerbation. With the transition of dystrophic processes into a chronic form, the signs of the disease often take on the character of muffled discomfort.

The main symptoms of destructive-dystrophic manifestations in the lumbosacral spine are:

pain in the lumbar region. In this case, there may be a transition of pain to the buttocks and legs. The pain itself at the same time has the character of aching and dull;
complete or partial loss of sensitivity skin in the area of damage;
tingling sensation in the legs;
persistent disruption of the pelvic organs, accompanied by urinary incontinence, problems with defecation, as well as reproductive function and potency in men;
feeling of weakness in the legs;
severe limitation in the mobility of the joints and individual parts of the body;
redness of the skin area in the area of damage to the spine, accompanied by a local increase in body temperature;
swelling.

Diagnostics

One of the most characteristic symptoms, manifested in dystrophic changes in the lumbosacral spine, is a slight change in gait and asymmetry of the gluteal muscles.

It is extremely difficult to determine the initial process of degenerative dystrophic changes in the lumbosacral spine. Most often, it is detected during a comprehensive examination on a magnetic resonance imaging machine. And for the formulation and confirmation of the diagnosis, the patient must definitely contact a neurologist.

The process of diagnosing pathology includes two stages. The first is an examination by a doctor, as well as an analysis of complaints and palpation of a disturbing area of the back. The second stage includes the collection of general analyzes and examination on diagnostic equipment. So to confirm the diagnosis it is necessary:

pass a general blood and urine test to determine the state of the patient's body as a whole;
blood donation for biochemistry. The procedure allows you to identify specific markers that indicate inflammatory processes inside the body;
an x-ray that can demonstrate obvious destructive disorders of the spine;
examination with CT;
MRI diagnosis.

The use of x-rays, although it allows you to see dystrophic changes in the lumbosacral spine, however, it is possible to clearly see this pathology only at an extremely later dates. That is why examinations for CT and MRI, despite the high cost of procedures, are a higher priority. It is these devices that allow you to consider in detail the degree and localization of damage.

Treatment

The selection of treatment is based on the degree of destruction of the intervertebral discs in dystrophic changes in the lumbosacral spine. Therapy can be conservative or with the use of surgical methods.

Conservative treatment of pathology involves:

prompt removal of symptoms of pain and elimination of inflammation with the help of drugs based on ketoprofen, ibuprofen, diclofenac and indomethacin;
restoration of damaged tissues with the help of chondroprotectors, muscle relaxants and B vitamins;
the use of physiotherapy methods, including therapeutic massage, a visit to the exercise therapy room.

The process of treating dystrophic changes in the lumbosacral spine also requires maximum unloading of the body with its full nutrition. That is why, with a pathology of this type, it is very important to follow a diet.

The surgical method of treatment is applied strictly in the absence of the proper effect of the conservative technique. Also, the operation is performed in case of serious damage to the disc or vertebrae that cannot be naturally restored.

Since such a phenomenon as a dystrophic change in the lumbosacral spine is an extremely serious pathology, its analysis and the appointment of an effective and safe treatment are performed strictly by the attending physician.

Different parts of the spine take on the load of varying degrees of complexity. And a sedentary or hyperactive lifestyle can aggravate the situation and lead to the destruction of bone and cartilage tissue. Very often, such changes occur in the sacral and lumbar region, which leads to the appearance of a stable pain syndrome and limited skeletal mobility.

Degenerative-dystrophic changes in the lumbosacral region are understood as the result of prolonged mechanical destruction of the bone and cartilage tissues of the spinal column. Destructive changes are accompanied by deformation, loss of cartilage elasticity. Degenerative processes are accompanied by systematic pain in the event of complications in the form of pinched nerves and blood vessels.

The complexity of diagnosing the problem lies in the slow progression, due to which it is not always possible to identify the initial degenerative changes in the lumbosacral spine.

All destructive disorders have common signs, symptoms and causes. However, they can also be divided into the following types:

Similar pathologies are also diagnosed in other parts of the spine. However, due to the peculiarities of the mobility of the skeleton, it is the lumbosacral that is most often affected.

Risk factors and causes of destruction

Women suffer from diseases of this group much more often than men, since their muscular corset in the lumbar region is somewhat less developed. Because of this, the spinal column lacks support and experiences a lot of stress.

In addition, the spine is a complex element of the skeleton, consisting of many vertebrae, vertebral discs and joints. The cartilage here plays the role of a shock absorber and, with a significant loss of moisture, wears out and becomes thinner, and can also protrude.

Among the main risk factors and prerequisites for the development of degenerative changes in the lumbar spine:

Increased physical activity with uneven distribution along the spinal column;
Sedentary lifestyle and weakness of the muscular frame;
Traumatic injuries of the spine, muscles and ligaments;
Overweight, obesity;
Hormonal disorders in the body;
Infectious pathologies;
Age-related changes in the skeleton, ligaments and muscles;
Bad habits;
Poor diet and lack of vitamins and minerals;
Poor environmental situation;

An important role in degenerative-dystrophic changes in the lumbar spine is played by the hereditary factor. The presence of a genetic predisposition significantly increases the risk of diseases of the spine and its components. In addition, the basis of the problem can be laid back in childhood especially with poor nutrition.

Symptoms

In the early stages of the progression of the disease, they practically do not manifest themselves in any way; in some cases, fatigue is possible. Therefore, patients turn to doctors only when visible symptoms occur.

The following pronounced signs of degenerative-dystrophic changes in the lumbar spine are distinguished:

pain different type(stabbing, aching, burning);
Cold surface of the skin in the lumbar region;
Weakness in the lower limbs;
Difficulties in tilting and turning the body, the occurrence of pain;
Body asymmetry;
Significant mobility of the body, mainly in the morning;
The occurrence of pain syndrome with a long stay of the body in one position;
Difficulties in urination, stool disorders.

Symptoms of degenerative-dystrophic changes in the lumbar and sacral spine appear gradually, depending on the stage of development of the disease.

There are four main stages:

The sooner dystrophic changes in the lumbosacral spine are detected, the more chances for recovery the patient will have. Significant tissue destruction and pinching is practically untreatable.

Other signs also help to identify diseases in the early stages:

Dryness and peeling of the skin;
chilliness;
Increased susceptibility to cold.

Modern diagnostic methods

Diagnosis of the disease takes place in several stages. First of all, the doctor forms an anamnesis, studies the patient's medical history and makes an initial conclusion. It is mandatory to conduct an external examination for visible changes, mobility, muscle strength. Palpation of the affected area is also used.

At the second stage, the following types of diagnostic studies are required:

It may also be necessary to consult specialists and other areas to exclude other possible pathologies organism.

Treatment methods for disorders

In practice, three main types of treatment for degenerative-dystrophic disease of the lumbar spine are used: conservative, physiotherapy, surgery. In some cases, it is possible to use combinations of methods in therapy.

Medical treatment

The use of medicines in the form of tablets, injections, ointments and gels is necessary to reduce inflammation and relieve pain. For this, appoint:

Vitamin and mineral complexes are also additionally prescribed for the restoration and maintenance of cartilage and bone tissue.

Massage and therapeutic gymnastics

These measures are aimed at solving the following tasks:

In addition, to improve the condition with degenerative-dystrophic changes in the lumbar, swimming, acupuncture, acupressure, physiotherapy (laser and electrophoresis) are used.

Surgical intervention

In the last stages of the progression of degenerative-dystrophic changes in the lumbosacral region, conservative methods help only slightly alleviate the patient's well-being. As a rule, in such situations, surgery is chosen as the main method of treatment. The course of intervention depends on the specific type of destruction.

Treatment usually includes the following measures:

After the operation, the patient is shown proper rest and sleep, a specialized diet, wearing a corset, taking prophylactic medicines, physiotherapy(in the last stages of recovery).

Folk remedies

At acute diseases of the spine to relieve pain and reduce inflammation help recipes traditional medicine:

It is highly discouraged to use traditional medicine recipes as an alternative to professional treatment. Before use, you must consult a doctor.

Possible Complications

In the absence of proper treatment, it is possible serious complications in the form of protrusion of discs, growth of osteophytes to a significant limitation of mobility, paralysis of the limbs, hernias.

Elimination and alleviation of the course of these pathologies is much more difficult and does not always bring positive results. Therefore, it is important to start the therapy of destructive disorders of the spinal column at the early stages of their appearance.

Prevention

Preventive measures against degenerative changes in the lumbar spine should be carried out from a young age, especially in the presence of a genetic predisposition. For this are used:

It is important to monitor your posture and correctly distribute the load on the spine. If you experience discomfort in the back, you should contact an orthopedist or surgeon as soon as possible.

Conclusion

Degenerative-dystrophic changes in the lumbar spine are a complex of various diseases affecting cartilage and bone tissues, joints, muscles and ligaments. The occurrence of these pathologies is most often associated with improper distribution of loads on the skeleton or a sedentary lifestyle, in which the supporting muscles atrophy.

That is why it is important not to go to extremes, to apply therapeutic exercises in practice, and if the first signs of discomfort occur, consult a doctor for professional help.