Achilles and swelling of the legs aches
To the causes of lumbar osteochondrosis most oftencarry a sedentary lifestyle and a back injury. For this disease, those at risk belong to those whose profession is directly related to the burden on the back. They are builders, porters and even waiters. In addition, people who have a sedentary job: drivers, various office workers.
Significant role in the development of the diseasebelongs to an adverse heredity. The contribution of hereditary factors to the appearance of lumbar osteochondrosis is about 60%, the rest is attributed to factors of adverse external impact on the spine.
Lumbar osteochondrosis can cause painof a different nature - like aching that occurs with prolonged sitting or after a dream, and sharp shooting, catching in the most uncomfortable position and not giving the opportunity to unwind. The pain is caused by pinching of the nerve roots, irritation of the spinal column nerves, edema and irritation of muscles and ligaments located in the zone of innervation of the lumbar spine.
It should be noted that isolated lumbar osteochondrosis practically does not occur, most often it can be observed simultaneously with cervical osteochondrosis.
The most common and earliest symptomlumbar osteochondrosis can be called pain in the lumbar region. She can give in the buttocks, in the hips and shin on the outer surface. The term degenerative-dystrophic lesion of the intervertebral disc (osteochondrosis) used by doctors implies a whole complex of problems that are associated with various structures of the spinal column: joints, discs, osteophytes. Problems that arise directly from the defeat of the disc include protrusion of the disc and discogenic pain.
There may be lumbar pains of variouscharacter - aching pains that appear after a night's sleep or prolonged sitting, as well as shooting sharp pains, catching in an uncomfortable position and not giving the opportunity to straighten. All these pains are associated with irritation of nerve endings, jamming of the nerve roots, irritation and edema of the muscles, ligaments in the innervation zone of the nerve endings of the lumbar spine.
When sneezing and coughing, there may be an increaselumbar pain, as well as with movements, especially when the torso is tilted forward. Lumbar osteochondrosis may manifest as pain in the lower back, a violation of sensitivity in certain areas of the skin or muscles of the legs and lower body, and the weakening or complete disappearance of tendon reflexes of the legs. Usually, osteochondrosis causes a curvature of the lumbar spine.
Depending on the plane of curvature,osteochondrosis is divided into scoliosis (curvature occurs to the right or left), lordosis (the spine is bent forward) and kyphosis (the lumbar region is smoothed or even bent backwards). In the case of a pinch in the osteochondrosis of the nerve roots of the spinal cord at the level of the lumbar spine, there may be a violation of urination or defecation, a violation of sensitivity in the perineum or in the genitals.
Usually, the onset of pain or exacerbationlumbar osteochondrosis occurs after physical overload. In this case, the emergence of a painful reaction is possible both immediately after the load, and after a certain time after it. Most often, patients complain of aching dull pain in the lower back, which sometimes gives in the leg (lumbalgia). There may also be complaints of pain in the leg, worse when trying to lift the weight, jolting the ride, sneezing and coughing, changing the position of the trunk and long-term preservation of one posture.
Exacerbation of lumbar osteochondrosis leads tostrong and constant tension of the muscles of the back, to the inability to move and straighten. With any movement, the pain intensifies. Even a short stay in the cold causes a sharp pain in the lower back, the so-called "chamber".
Symptoms of lumbar osteochondrosis also include:
- impaired sensitivity in the buttocks, hips, lower leg, in some cases - in the foot
- chill feet, spasm of the arteries of the feet (sometimes before the disappearance of the pulse)
- crawling, tingling in the legs
- dryness, peeling of the skin in places of pain or loss of sensitivity
- disturbed sweating.
The most unpleasant complication of lumbarosteochondrosis is the instability of the vertebrae. The vertebra is not fixed by the disc, when the load occurs, the lumbar region "slides" from the sacrum under the action of gravity. This can provoke dangerous violations of internal organs. Especially it concerns the genitourinary system: for women - the appearance of problems with the uterus, ovaries, appendages, for men - with potency.
Clinical manifestations of lumbar osteochondrosis
Clinical manifestations lumbar osteochondrosis diverse and depend on the degree of expressionarthrosis process, its localization in segments of the vertebrae and prevalence. The main complaint of the patient with lumbar osteochondrosis is pain. It can only be in the lumbosacral region (lumbulgia), in the lumbosacral region with irradiation in the leg (lumboschialgia) and only in the leg (ischialgia).
In the initial stages of lumbar osteochondrosis patients complain of moderate back pain. arising or aggravated with movement, tilt forward, physical exertion, prolonged stay in one position. In the future, after 1 - 2 years of pain spread to the gluteal region, in the leg, more often on one side.
The first exacerbation of the disease often beginsacutely after physical exertion, trauma or at the time of emotional and physical stress, uncoordinated movement. In this case, acute pain (lumbago lumbago) is accompanied by a characteristic reflex-tonic tension of the lumbar muscles. This muscle strain also determines protective postures - fixed changes in the configuration of the lumbar spine (kyphosis or hyperlordosis and scoliosis with rotation). Significant immobility of the lower lumbar spine as a result of muscular-tonic reactions occurs when the 4th lumbar vertebral disc is involved and less frequently in the lesion of the fifth disc.
Clinical picture of lumbar osteochondrosis
Clinical picture of lumbar osteochondrosisis typical. The pain is sharp, the patient rushes to the place, when trying to move the pain becomes unbearable. An objective examination I note the presence of an explicit contracture of the lumbar muscles with a characteristic antalgic deformation of the spine. Attack of acute lumbulgia passes quickly, for several days, usually not more than 12, and in some cases after several hours. The first attack ends more quickly than the subsequent ones, which can be repeated after a year or more. Often aggravated pain in the lumbar region occurs mainly in young people.
Subacute or chronic lumbar incontinenceotherwise. It is usually preceded by cooling, static stress, prolonged stay in an uncomfortable position. Pain often predominates on one side of the lower back, increases with prolonged sitting, standing, after tilting the trunk. The peak of exacerbation occurs on the 4th - 5th day, after which the pain begins to weaken, if peace is observed, providing relaxation of spasms. Subacute lumbulgia occurs for weeks, and in adverse cases - for months, i.e. becomes chronic. At the same time, there is a tendency to expand the zone of pain manifestations - on the sacrum, buttock, leg, ie. to the reflex formation of the picture of lumboschialgia.
The reflex syndromes of lumboschialgia aremuscular-tonic, neurovascular and neurodystrophic manifestations localized in the lumbar region and in the leg and lower extremity belt (syndromes: pear-shaped muscle, periarthrosis of the hip or knee joint, cocciogeny, achillodynia, extensor lumbar-hip rigidity, and others).
The pear-shaped muscle is composed oflesions of the muscle itself and compression of the sciatic nerve and lower-artery artery. Between the pear-shaped muscle and the caudal sacrum-osteous ligament located at that time, the sciatic nerve and the lower-artery artery pass. These formations undergo compression between these structures with prolonged tonic muscle tension. Arthrosis changes in the discs L3-L4, L4-L5, L5-S1 promote extensive impulses from them and the emergence of a pathological muscular-tonic reflex at a distance, in particular, as a spasm of pear-shaped muscle. For the reflex myotonic syndrome of the pear-shaped muscle, the symptoms of Bone are characteristic (hip reduction accompanied by muscle tension, soreness) and vibrational recoil. In pear-shaped muscle syndrome, signs of sciatic nerve damage are formed: shin and foot pain and autonomic disorders in them. With a significant compression of the nerve, there are violations of the motor and reflex sphere: muscle hypotrophy, reduction of the achilles reflex. When the lower artery and the vessels of the sciatic nerve are compressed, patients suffer from transient spasms of the leg vessels, leading to intermittent claudication.
With lumbar osteochondrosis reflexvascular dystonia in the lower extremities can be manifested in two versions: vasospastic and vasodilator. With a vasospastic variant, in addition to pain in the waist and leg, patients experience the chilliness of the affected limb. Skin hypothermia is more pronounced in the distal parts of the limbs, after the load disappears, and sometimes on the contrary, it intensifies. With the vasodilator variant, in addition to pain in the waist and leg, patients often feel heat or heat. Cutaneous hyperthermia is determined tactilely mainly in the distal parts of the extremities. The symptoms of vasodilation become more pronounced after physical exertion.
Lumbar osteochondrosis as well as osteochondrosis of the cervical region. is manifested by compression root syndromes (radiculopathy). Most often within the spine is affected the site of the root, extending from the dura to the radiculo- ganglionic segment - the radicular nerve of Najotte. It undergoes compression in the epidural zone of the vertebral canal and the medial (inner) zone of the intervertebral foramen. The lower the nerve roots of Najott are, the longer they are, therefore, in the lumbar region, they are more susceptible to the action of the hernia in the epidural cellulose. In the lumbar region, the median hernia exerts pressure on many roots of the horse's tail.
Irritation of the root is accompanied by a shootingpain and hypalgesia in the zone of the corresponding dermatome and symptoms of loss of the corresponding myotome (hypotrophy, hypotension, hyporeflexia, weakness). With radicular syndromes, the neurological picture is determined by the localization and degree of involvement of intervertebral discs.
Relatively rare localization of L1-L3 lesionherniated disc. The hernia of the L1-L2 disc also affects the cone of the spinal cord. The onset of radicular syndrome is manifested by pain and loss of sensitivity in the corresponding dermatomes, and more often by the skin of the inner and anterior femur. When the spine of the spinal nerve L3 is affected, sensitivity changes in the region of the anterior surface of the thigh and the inner surface of the tibia, lordosis is expressed, there is a decrease or absence of knee reflexes, often homolateral scoliosis.
Lesion of rootlet L4 (disks LIII-LIV) infrequentlyis found. In this case, there is an unsharp pain that irradiates along the inner front of the thigh, sometimes to the knee and slightly lower; motor disorders manifest themselves in the quadriceps muscle: blurred weakness and hypotrophy with a preserved (often even elevated) knee reflex.
Lesion of the root of L5 as a result of its compressionhernia of the LIV-LV disc often occurs usually after a long period of lumbar lumbago, and the pattern of radicular lesion is rather severe. The pain irradiates from the waist to the buttock, along the outer edge of the thigh, along the front-outer surface of the shin to the inner edge of the foot and the first fingers. In the same zone, especially in the distal parts of the dermatome, gipalgesia is revealed. A decrease in the strength of the extensor of 1 finger (muscle innervated only by the spine of L5), a decrease in the reflex from the tendon of this muscle, hypotension, and hypotrophy of the anterior tibial muscle are determined.
The most common damage is the spine S1herniated disc LV-SI. Since the hernia of the disc is not kept long narrow and thin at this level by the posterior longitudinal ligament, the disease often begins immediately with radicular pathology. The period of lumbago and lumbulgia, if it precedes radicular pain, is short. When this root is injured, sensitivity is disturbed in the area of the posterolateral surface of the thigh and lower leg, there is a hypotrophy of the gluteus muscle weakness, a decrease in the strength of the flexor of the foot, a decrease or loss of achilles reflexes.
In the anterolateral discs, both roots are affectedwith a picture of bilateral radicular syndrome. Monoradicularity of lesion is a sign of discogenic radiculitis. Distinguishing it from infectious radiculitis.
Ponytail compression syndrome mosta serious complication of lumbar osteochondrosis, the cause of which in all cases are massive prolapses of discs or migration of their fragments into the lumen of the spinal canal.
Bi-and polyradicular lesions occuroften as a result of multiple (two) hernias, compression of neighboring roots, one large hernia, tension of neighboring roots with hypertrophied yellow ligament, reactive inflammation, discirculatory disorders, etc.
Diseases that contribute to the appearance of lumbar osteochondrosis
The appearance of lumbar osteochondrosis and associated withVarious pains of internal organs contribute to the pain. More than 30% of patients with clinical manifestations of lumbar osteochondrosis complain of problems with the gastrointestinal tract or liver. The reason for this is that in the presence of diseases of the gastrointestinal tract, liver or pancreas, the flow of pain impulses causes spasm and tension of muscles and vessels, which in turn creates oxygen starvation and development of the dystrophic process in certain areas of the body. It aggravates the process of metabolic disorders, which is inherent in these diseases. Also, lumbar pain can provoke diseases of the pelvic organs: for women it is an inflammation of the appendages of the uterus (adnexitis), for men - inflammation of the prostate gland (prostatitis). Also, the manifestation of lumbar osteochondrosis is promoted by stagnation in the pelvic cavity arising from these diseases, as well as with constipation, hemorrhoids, and chronic colitis.
Varieties of manifestations of lumbar osteochondrosis
One of the most complete classifications of vertebrogenic diseases of the peripheral nervous system (associated with the spinal column) is proposed by I.P. Antonov.
In accordance with this classification, such clinical syndromes of lumbar osteochondrosis are distinguished:
- reflex syndromes - lumbago, lumbalgia, lumboschialgia;
- radicular syndromes - vertebrogenic (discogenic) lumbosacral radiculitis, in which the fifth lumbar or first sacral spine is most often damaged;
- radicular-vascular syndromes - radiculo-ischemia, manifested by squeezing the vessels (radicular artery or vein) together with the spine.
Lumbago - acute lumbar pain as a "lumbago". Usually occurs when lifting weights, awkward movement, in some cases after sneezing and coughing.
Lumbalia is a chronic (subacute) pain, gradually arising after physical exertion, a prolonged stay in an uncomfortable position or sitting position.
Lumbo-schiaalgia is a back pain that spreads to one or both legs. Muscle-tonic, vegetative-vascular and neurotrophic manifestations may be present.
Radiculitis (radicular syndromes) are manifestedcompression of one or two roots. Characterized by root pain, as well as impaired motor (weak flexors and extensors of the thumb or foot) and the sensitive area (loss of function of the damaged root)
Radiculo-ischemia appears due to compressionradicular-spinal arteries. The clinical picture is manifested by gross motor (paresis, paralysis) and sensory impairment with weakly manifested pains, in some cases in their absence.