Dorsalgia (back pain) are one of the most common causes for complaints and ask for medical help. In this case, in the course of life with the Problem of dorsalgia 70-90% of the population and 28 percent of them faced a chronic pain syndrome, which go to a pre-developed/to be prolonged inability to work and decreased quality of life. Back pain in disability has an impact on the behavior/Psyche of the people, which is reflected in the development of chronic emotional Stress.
Pain syndromes are mainly associated with osteochondrosis in lumbosacral part of the spine (lumbar osteochondrosis), for the high mobility/high physical strain, due to degenerative-degenerative changes in almost all components of the spinal motion segments of the spine (the bodies of the vertebrae, intervertebral discs and connecting tissues).
Classification
In the basis of the classification of intervertebral disc degeneration pathogenetic approach placed, reflective of the pathological process in the Form of successive stages/degrees of degenerative-dystrophic lesions, according to what you are the following.
Osteochondrosis of the lumbar spine 1 degree
The first (initial) degree of intra-diskalen of the pathological process, the production of the affected hard drive pathological impulses. Osteochondrosis of 1 degree by displacement of the nucleus pulposus within the disc, i.e., gelatinous core penetrates through the cracks in the fibrous Ring and inner fourth with the outer fibers. Each at 1 degree of osteochondrosis irritation of the nerves occurs and to manifest the pain and makes various Reflex syndromes of osteochondrosis.
Osteochondrosis of the lumbar spine 2 degrees
Osteochondrosis degree of 2 is the degree of instability, i.e. the loss of the affected disc to its inherent capabilities of fixing. Characteristic is the dynamic displacement of the overlying relatively low-lying vertebra, what by crack nucleus pulposus and the elements of the annulus fibrosus is. 2 the degree of the osteochondrosis syndrome is characterized by instability, Reflex appear, and partial compression syndromes.
Osteochondrosis 3 Degrees
This is the stage/Phase of the education of hernias of intervertebral discs, caused by the violation of the integrity of the structure of the fiber ring (prolapse/protrusion). In the case of osteochondrosis degree 3 can be expressed: spine, spinal nerves, and adjacent to MTD vascular-nervous structures.
Osteochondrosis 4 Degrees
This is the stage of fibrosis, MTD, and of the gradual construction of an osteochondral growths of the regional vertebral bodies. As compensatory Mechanisms to increase the footprint of the eddy on defective hard drives is, immobility. These bony growths, in some cases, such as herniated discs, can the circuit, the pressure on the adjacent nerve formation.
The symptoms of osteochondrosis of the lumbar-sacral spine
Osteochondrosis of the lumbar-sacral spine is manifested rather in Schlierbach limits: a slight feeling of discomfort in the lumbar spine up to the acute severe pain that might cause overexertion, hypothermia, the rise of the heavy, etc., the totality of the clinical manifestations of lumbar intervertebral disc degeneration of parts of the spine (compressive) symptoms and extra-vertebral (Reflex) symptoms.
The first Phase
Clinical symptoms of osteochondrosis of the lumbar spine in the first stage, due to the projection of the disc in the direction of the vertebral canal (back) irritation and is rich in pain receptors in the posterior longitudinal ligament scattered. The leading Symptom in this Phase is of varying degrees of severity of local pain syndrome, Lumbago, lumbalgia, which differ due to the degree of pain and the duration of the pathological phenomena. This stage is characteristic Symptom-Board "(flattening of the lumbar lordosis) and marked limitation due to pain in the acute Phase of the movements in the lumbar spine".
In addition to the local pain at the level of the affected intervertebral disc due to muscle Reflex responses in the majority of cases a pronounced voltage of the paravertebral muscles ("ark"), resulting in the amplification of the pain syndrome, as well as smoothing/flattening of the physiological lumbar lordosis and limitation of mobility of the spine.occurs
In the case of the osteochondrosis of the first Phase, signs of the arrangement of the edge syndrome, and other neurological symptoms (symptoms of stress) is missing. In General, the time to a irritation of the skin receptors (pain) posterior longitudinal ligament celebrated adaptation by immobilization of the affected intervertebral disc. The severity of the acute/subacute can be gradually reduced, if the treatment appropriate and compliance with strict orthopedic mode. That is, it is the Transformation of the deterioration in reflectance is varied, the duration of which, as well as the frequency of acute low back pain.
Each new exacerbation demonstrates an additional offset MTD (prolapse/protrusion), resulting in increased pressure of the disc to the posterior longitudinal bundle. With time, this leads to the thinning ligaments and reducing its strength and, consequently, to an additional cost prolapse disc and Perforation of the posterior longitudinal ligament in the next Episode in the direction of the vertebral canal, which leads to the development of the next Phase of neurological complications.
Vaso-radicular Phase (Phase of neurological diseases)
The totality of the pathological findings (ischemia of the corresponding nerve roots, spinal/CSF, difficult formation of the intervertebral disc occurs incident and occlusion of the accompanying root arteries) promotes the development of motor disorders in a specific myotome, and a reduction of sensitivity in a particular dermatome. In General, the development of paresis/paralysis of the muscles and the sensibility is preceded by interference sharp movement, which is directly — pain in the lumbosacral area appears to be an acute short-term, a radiation along the sciatic nerve (the so-called "giperalgeticheskie Kriz sciatica"). In Parallel, a muscle weakness in the area of Innervation of the ischemic spinal nerve arises arise, and sensory disturbances. In the rule, the occlusion of root artery, which goes along with spine L5 nerve in the spinal canal.
Characteristic are the acute development of the syndrome "paralytic sciatica", which is manifested paresis/paralysis of the extensors on the affected side of the foot/toes ("stepper" or "tail gear"), developing diseases of the peroneal nerve is. Such a Patient is lifting the foot while walking, she accused him to the heated seats in the front and bangs the front part of the sock to the foot on the ground.
jpg" class='imgblock right center_mob'>The last Phase of the neurological manifestations
Osteochondrosis of the spine, usually the cause of the violation of blood flow in the great radicular is the arteries, the blood spinal cord (radicular-spinal artery). Blood supply to the lumbosacral spinal cord level provides only an artery Adamcewicz, and for some people available, the incremental lumbar spine artery Depression—Gotteron, the blood supply to the cock Department and/or Cauda equina of the spinal cord is.
The loss of function due to the slow development of the circulatory cerebral insufficiency, spinal cord, clinical Manifestation of the syndrome of intermittent claudication is accompanied by a weakness of the legs and numbness, which when walking and disappear after a slight recovery (stop). The most severe Manifestation of neurological diseases in this stage are acute circulatory disorders of the spinal cord according to the type of spinal of ischemic stroke.
The analyses and diagnostics
Diagnosis of lumbosacral degenerative disc disease in the majority of cases, no difficulties and is based on the analysis of the nature and localization of pain and its communication with the physical stress (medical history), the presence of pain, Trigger points and symptoms of tension. From the instrumental methods of leading importance for x-ray, Computer and magnetic resonance imaging (see photo below). For the exclusion of physical disease (metastases in the spine, Urolithiasis, Pyelonephritis) can be assigned to General/biochemical analysis of blood and urine.
The treatment of osteochondrosis of the lumbar-sacral spine
Question as to the treatment of osteochondrosis of the lumbar spine is one of the most frequently asked. Especially the treatment of degenerative–dystrophic lesions of the spine should be gradual and multi-layered, comprising a therapy with drugs, physiotherapy and, if needed, surgery techniques.
Procedures and processes
In the treatment of lumbar intervertebral disc degeneration electrochemical cells/surge currents is far physiotherapy: phonophoresis/electrophoresis with drugs (including analgesics and antispasmodics) widespread; electro nerve stimulation; UHF; laser therapy; magnetic field therapy; EHF (extremely high frequency therapy); SHF (microwave Therapy); shock-wave therapy, acupuncture.
In the acute Phase, it is recommended that compliance with the motor (orthopedic) mode with the wearing of a lumbar stabilizing corset. In this period, you should restrict/exclude physical motion in the Amplitude, causes pain or muscle tension. To engage in prohibited "through the pain" is, strictly, the exercises must be very slowly performed with the repeat after 8-10 times. It is also important not to allow the increase in the lumbar lordosis in the movements of the legs, pain to. In the next Phase of the acute period with a decrease in pain isometric exercises for the large gluteal muscles and abdominal muscles can gradually.
When stihanii pain, the availability is increased and included in the complex of the total development/special exercise. The movement increases the force of the extensors of the hip and abdominal muscles exercises, the strength of the muscles of the back and flexion in the lumbar spine. also be included The run at a reasonable pace after 15-20 repetitions. You should give the report that the charging should be in the case of osteochondrosis of the lumbar spine on a regular basis and not from case to case.
Exercises in osteochondrosis of the lumbar spine in the period of Remission aims mainly at strengthening the muscle corset of this Zone and an increase in the mobility of the spine, but you need to be very carefully executed. The number of repetitions of this period can be increased up to 50-100 times. An important task is the formation of the automatism of the muscles in maintaining a specific posture in any Position (standing, sitting, walking) is.
Movement therapy in osteochondrosis of the lumbar spine can be performed in the pool (in the water, but it only supplemented the main "dry" classes). Other methods of physiotherapy is extremely useful in the often referred to as "the most effective physiotherapy lumbosacral osteochondrosis", as well as treadmill, health path, Ski, exercise bike, exercises with rubber ' Association are: swimming,. To not recommend with these sports such as Volleyball, big/little Tennis, rhythmic gymnastics because of the many sudden movements, the aggravation of the disease can trigger.
The charging process is carried out only with dumbbells in a supine position (on your back) exceptions for vertical loads on the spine. Note that in the selection of exercise frequent/permanent overload/slight injuries of the spine or uncoordinated aftershocks and movement along the axis of the spine to manage the risk through a degenerate rupture of the disc and the subsequent exacerbation of the pain. Extremely useful exercise for the spine can be Yoga, but many Yoga exercises are very complex and need a teacher, only under the direction and supervision of a flight. The best Option in the first time, when medical gymnastics in osteochondrosis of the lumbar spine is performed in a specialized office, where the doctor, the physiotherapy shows you a series of exercises to perform and then home.
These exercises are carried out, such as morning gymnastics in osteochondrosis. You should not different types of Video movement therapy or therapeutic exercises, Video case of osteochondrosis, as Videos of the exercises allows for a valid biomechanics and may be the cause of the exacerbation. Not less widespread and medical Massage (manual, underwater, vacuum, Hydro-Massage). Massage in osteochondrosis of the lumbar spine will be able to remove/reduce pain, eliminate muscle of this Zone of tension, the mobility of the spine to restore.
The postoperative treatment is carried out in the cases of significant compression of the spinal cord, and aims at decompression of the spinal canal. Includes various types of Operation: removal of the herniated disc is the implementation of the micro-discectomy, Laser reconstruction of the hard disk, puncture valorisation of the disc, the intervertebral disc replacement of the implant, the surgery to stabilize the vertebral Segment.
Prediction
In the event of timely and reasonable treatment, the prognosis is favorable. Worsens the prognosis of the emergence of lateral herniated disc L-S1 with an early involvement in the pathological process of the spine of the book and the subsequent formation of radiculopathy. The prognosis worsens with the development of the acute Syndrome with compression of spinal cord/Cauda equina with paralysis in the legs, disorders of the pelvic functions, fallout sensitivity, wherein the forecasting is improved, the sooner the compression is removed (hernia, sequestration).