Spinal pain in the lumbar region

About 40-80% of people complain of lumbar pain, but no more than 25% of them 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 contempt.

Causes of lower 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.In addition, the spine is surrounded by paraspinal muscles, pain that patients often mistake for pain in the spine.Therefore, there can be many reasons for pain.This can be overload, natural restructuring of the body during pregnancy, etc.However, if pain occurs regularly, it is worth contacting a vertebral doctor or neurologist, since often the fact that the spine systematically hurts in the lumbar region indicates the development of certain diseases.

In such situations, patients are most often diagnosed with:

• Pathologies of the intervertebral discs (reduced disc height, bulging, herniated disc, discitis);
• Pathologies of the facet joints (spondyloarthrosis, joint cysts);
• Inflammatory diseases (Bechterew's disease or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
• Vertebral compression fractures due to osteoporosis;
• neoplastic lesions of the spine.

Pathologies of the intervertebral discs

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

Even at the initial stage 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 occur.This is due to irritation of the pain receptors of the outer layers of the intervertebral disc and the posterior longitudinal ligament of the spine.Osteochondrosis often leads to an aseptic inflammatory process, leading to reflex spasm of the segmental muscles.This increases the pain in the spine and limits mobility.

Osteochondrosis tends to progress constantly, especially without appropriate treatment and lifestyle correction.Subsequently, the formation of protrusions occurs and subsequently intervertebral hernias, which leads to a worsening of existing symptoms and the appearance of new symptoms.

The lumbar spine is most commonly affected because it bears the highest loads in everyday life.

Protrusions are protrusions of the intervertebral disc while maintaining the integrity of its outer shell, the so-called annulus fibrosus.If the influence of provoking factors continues for a long time, the fibers of the annulus fibrosus cannot withstand the load and pressure of the internal contents of the intervertebral disc (nucleus pulposus) and rupture.This means that 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 increases with sudden movements, bending over, lifting heavy objects, straining, coughing, sneezing, laughing, as well as with prolonged sitting in one position, walking, standing.

Patients with already formed bulges and hernias often unconsciously adopt a forced posture and lean slightly in the healthy direction.At the same time, pain in the spine in the lumbar region can reach high intensity and impair the ability to work.In such cases, he is forced to remain in bed and, to relieve the pain, he tenses his leg, which is bent and brought to his stomach.

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

Therefore, with prolonged osteochondrosis, the formation of hernias in the lumbar region, the pain in the spine often not only gradually increases, but is also complemented by other diseases.When a deformed intervertebral disc or swollen soft tissue due to an inflammatory process compresses the adjacent spinal root, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be complemented by pain radiating to the buttocks, groin, front, inner side, outer thigh, lower leg and foot.This depends on which nerve root is pinched, i.e.h.at what level of the spinal motion segment pathological changes are observed.Sensitivity disorders in the form of crawling sensations, numbness, altered temperature sensitivity, pain, tactile stimuli and limited mobility can also be observed in the corresponding areas of the lower extremities.

Changes in the height and functionality of the intervertebral discs that occur in osteochondrosis and its complications lead to damage to the articular apparatus of the spine and to degeneration of the vertebral bodies themselves. The consequence of this is the development of spondylosis, i.e. calcification of the anterior longitudinal ligament and the formation of osteochondral growths on the surface of the vertebral bodies (osteophytes).Not only can they injure surrounding tissues and compress the spinal roots, causing severe pain in the spine, but they can also fuse together.As a result, neighboring vertebral bodies are combined into one whole, which severely limits mobility in the lower back area.

Osteochondrosis can be associated with reactive changes in the vertebral bodies, especially reactive aseptic spondylitis, and lead to osteosclerosis.This is accompanied by a compaction of the bone tissue and significantly increases the likelihood of vertebral fractures.

Diseases of the facet joints

Pathologies of the facet or facet joints of the lumbar spine, especially their arthrosis, can also cause pain in the spine in the lumbar region, including severe pain.However, the pain hurts more often and is localized deep inside.Their appearance is due to the fact that their synovial capsule is richly innervated.In such situations, the pain is usually concentrated directly on the affected area and tends to worsen when bending, straightening, turning the body or standing for long periods of time.Walking and sitting help reduce the severity.In some cases, the pain can also radiate to the groin, tailbone, back and outside of the thighs.

Inflammatory diseases of the spine

Inflammatory diseases of the spine are less common than diseases of the intervertebral discs and vertebral joints.However, they also cause pain in the spine.This includes:

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

The signs of these diseases usually appear before the age of 40, but more often after the age of 20.This distinguishes them from degenerative-dystrophic diseases of the intervertebral discs and joints of the spine, which more often develop after the age of 40.In this case, the pain is characterized by a gradual increase in intensity.At the same time, their severity decreases after physical activity, but not at rest.Therefore, in inflammatory diseases, the spine in the lumbar region often hurts at night and especially strongly in the morning, right after sleeping.

The most severe situation is observed in ankylosing spondylitis and it is this disease that most often affects the lumbar region compared to other inflammatory diseases.This term refers to inflammation of the intervertebral joints with subsequent immobilization due to the formation of dense bone, cartilage or fiber fusions between the articulating bone structures.

Initially, mild pain is characteristic in the lower back, but over time it spreads upward, covering the thoracic and then cervical spine.This is associated with the development of limited mobility of the spine in all levels, as the spine appears to be immersed due to the changes that occur in a particular case.Also observed:

• Alignment of the lumbar lordosis (natural curvature of the spine in the lumbar region);
• worsening thoracic kyphosis leading to stooping;
• reflex tension of the back muscles;
• progressive deterioration of limited mobility due to the involvement of facet joints and ossification of intervertebral discs in the pathological process;
• Morning stiffness for an hour or longer.

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

The progression of Bechterew's disease leads to more and more joints becoming pathological.This forces patients to adopt the so-called supplicant attitude.It means a pronounced kyphosis of the thoracic spine, a downward tilt of the torso, bending of the legs at the knees with a sharp limitation of the range of motion in the chest, which affects the depth of breathing.

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

Vertebral compression fracture

A compression fracture causes the vertebral body to flatten, causing it to become wedge-shaped.This leads to a disruption in the anatomy of the spine, can lead to injuries to the spinal cord and its roots, and also becomes a trigger for the rapid progression of degenerative changes.

The 1st and 2nd lumbar vertebrae are more susceptible to injury because they absorb the greatest axial load.

Compression fractures of the spine often occur in older people due to the development of osteoporosis, i.e. a decrease in bone density.In such cases, not only a minor fall, but also heavy lifting or unsuccessful movement can be enough to cause an injury.

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

If the fracture is not diagnosed in time, a decrease in the height of the vertebrae leads to changes in posture and a decrease in height.This leads to reflex tension and shortening of the spinal muscles, which leads to chronic back pain and requires long periods of rest.

Neoplastic lesions of the spine

Neoplastic lesions of the spine mean the formation of benign and malignant tumors in it, as well as metastases, the source of which are neoplasms of other organs.This occurs much less frequently than diseases of the intervertebral discs, vertebral joints, ankylosing spondylitis and even compression fractures, namely in only 1-2% of patients with back pain.However, such lesions require as early diagnosis and treatment as possible.

The characteristic features of neoplastic lesions of the spine, in addition to pain in it, are:

• increased body temperature, including subfebrile values;
• weight loss for no reason;
• Inability to find a comfortable posture;
• the presence of pain at night;
• severe pain in the spine;
• Inability to relieve pain with traditional analgesics.

Even if you experience one or two of these symptoms, you should make an appointment with your doctor immediately.

The following may look similar:

• Chondroma is a malignant tumor diagnosed in 20% of patients with cancerous lesions of the spine.It more commonly arises in the sacrum and can occur in people of all ages and genders.
• Young's sarcoma - occurs in 8% of patients with neoplastic lesions of the spine.More typical for young men.
• Chondrosarcoma is a malignant neoplasm that accounts for 7-12% of cases.More common in middle-aged men.
• An aneurysmal bone cyst is a benign neoplasm.
• Hemangioma is a benign vascular tumor that occurs in 11% of people.It may not be recognized throughout a person's life.However, it increases the risk of vertebral fractures.
• Metastases from other tumors are secondary malignant neoplasms.Most commonly, breast, prostate and lung cancers metastasize to the spine and, less commonly, kidney, thyroid and skin cancers.

diagnosis

If your spine hurts in the lumbar region, you should make an appointment with a neurologist or vertebral doctor.At the appointment, the doctor first takes an anamnesis and asks questions about the type of pain, the circumstances of its occurrence, the duration of its persistence, the presence of other symptoms, lifestyle, etc.

The specialist then carries out an examination.He not only palpates the spine, determines the location of the pain, assesses the gait and posture that the patient unconsciously adopts, but also carries out functional tests.With their help, you can detect signs of ankylosing spondylitis and neurological deficits, assess the degree of mobility of the spine and obtain other diagnostic data.

On this basis, the doctor can provide information about possible causes of pain.To clarify and precisely determine the extent of the damage, additional instrumental and sometimes laboratory diagnostic procedures are prescribed.Most often they resort to help:

• X-rays in frontal and lateral projection, some with functional X-ray examinations;
• CT scan – allows better visualization of bone structures and is therefore more commonly used to diagnose spondylosis, fractures, bone tumors, etc.;
• MRI – allows the most thorough assessment of the condition of cartilaginous structures and soft tissues, and therefore is more often used to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord lesions, etc.;
• Electromyography – indicated for neurological disorders of unknown cause and to assess the extent of nerve damage;
• Radioisotope osteoscintigraphy – for diagnosing 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, based not only on the diagnosis, but also on the nature of the existing concomitant diseases.Nevertheless, of course, the cause of the lower back pain determines the treatment tactics.It may be conservative or require surgical intervention.

However, the first step is always to relieve the pain, especially if it is severe.For this purpose, patients are prescribed NSAIDs, antispasmodics and painkillers.And in severe cases, spinal blocks are performed - injections of anesthetics and corticosteroids at specific points in the spinal area.

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

Only conservative or non-surgical treatment is prescribed for:

• osteochondrosis;
• Bechterew'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, magnetic therapy, laser therapy, traction therapy, etc.);
• exercise therapy;
•  manual therapy.

When the cause of lower back pain is a herniated disc, bulging, spondylosis, severe vertebral fractures, or 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, especially spinal canal stenosis.

Most modern spine surgeries are minimally invasive.As a result, the intraoperative and postoperative risks are significantly reduced, the rehabilitation time 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 primarily for hernias and bulges, especially those that cause cauda equina syndrome.It can be carried out with microsurgical instruments through an incision about 3 cm long (microdiscectomy) and with endoscopic devices that are inserted into the spine through punctual punctures with a diameter of about 1 cm (endoscopic discectomy).If 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 core of the operation is to insert quickly hardening bone cement into the vertebral body through a thin cannula and thus strengthen it.In addition, with kyphoplasty it is possible to restore the normal dimensions of the vertebral bodies, which is important in the event of a sharp decrease in their height as a result of a fracture.
• Fixation operations serve to stabilize the spine.For this purpose, metal structures of various types are used, which, as a rule, remain in the patient's body until the end of his life.

The spine in the lumbar region can hurt for various reasons.Therefore, if the pain persists for a long time, occurs regularly, the pain worsens over time and other symptoms appear, you should definitely contact a vertebral specialist or neurologist.Early diagnosis makes it possible to detect pathological changes at the stages when they are most easily managed and, if not to cure the disease completely, then at least to stop its progression and maintain a high standard of living.