Spinal pain in the lumbar region

About 40-80% of people complain of pain in the lumbar spine, but no more than 25% of them resort to medical help.Indeed, such unpleasant sensations can be caused both by relatively harmless causes and by pathological changes in the spine.Therefore, you should not treat them with contempt.

Causes of back pain

The spinal column consists of a whole complex of structural elements: bones, joints, intervertebral discs, ligaments, nerves.Changes in each of them can be accompanied by pain of a different nature.In addition, the spine is surrounded by paraspinal muscles, pain in which patients often confuse with spinal pain.Therefore, the reasons for pain can be many.This could be overwork, natural restructuring of the body during pregnancy, etc.But if the pain occurs regularly, it is worth contacting a vertebrologist or neurologist, since often the fact that the spine in the lumbar region systematically hurts indicates the development of certain diseases.

Most often in such situations, patients are diagnosed:

• intervertebral disc pathologies (reduced disc height, protrusion, intervertebral hernia, discitis);
• pathologies of the facet joints (spondyloarthrosis, joint cysts);
• inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
• vertebral compression fractures due to osteoporosis;
• neoplastic lesions of the spine.

Intervertebral disc pathologies

Degenerative changes of the intervertebral discs or osteochondrosis are very common, especially among young and middle-aged people.This is largely due to the need to sit for a long time or engage in heavy physical work.In old age, the disc dries out and the vertebrae fuse together.

Already in the initial stages of the occurrence 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 disc, as well as the posterior longitudinal ligament of the spine.Often osteochondrosis causes an aseptic inflammatory process, which leads to a reflex spasm of the segmental muscles.As a result, pain in the spine intensifies and limitations in mobility occur.

Osteochondrosis tends to constantly progress, especially in the absence of adequate treatment and lifestyle correction.Subsequently, it leads to the formation of bumps and subsequently intervertebral hernias, which cause a worsening of existing symptoms and the appearance of new ones.

The lumbar region, since it bears the greatest loads in daily activities, is the one most often affected.

Protrusions are protrusions of the disc while maintaining the integrity of its outer shell, called the fibrous ring.If the influence of provoking factors persists over time, the fibers of the fibrous ring cannot withstand the load and pressure of the internal contents of the disc (nucleus pulposus) and break.As a result, 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 intensifies with sudden movements, bending, lifting heavy objects, strains, coughing, sneezing, laughing, as well as with prolonged sitting in one position, walking, standing.

Often, patients with already formed bumps and hernias unconsciously take a forced position, leaning slightly in the healthy direction.At the same time, pain in the spine in the lumbar region can reach a high intensity, depriving a person of his ability to work.In such cases, he is forced to adhere to bed rest and, to relieve pain, squeezes his bent leg and brings it to his stomach.

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

Therefore, often with long-term osteochondrosis, the formation of hernias in the lumbar region, pain in the spine gradually not only intensifies, but is also complemented by other ailments.If a deformed disc or swollen soft tissues due to an inflammatory process compress the spinal root passing near them, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be complemented by pain radiating to the buttocks, groin, front, inner, outer thigh, lower leg and foot.This depends on which nerve root will be pinched, that is, at the level of which movement segment of the spine pathological changes will be observed.Additionally, in the corresponding areas of the lower extremities, sensitivity disorders can be observed in the form of a crawling sensation, numbness, changes in temperature susceptibility, pain, tactile stimuli and limited mobility.

Changes in the height and functionality of the discs that occur with osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as to the degeneration of the vertebral bodies themselves.The consequence of this is the development of spondylosis, that is, 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 spinal roots, causing severe pain in the spine, but they can also fuse together.As a result, adjacent vertebral bodies are combined into a single whole, which severely limits mobility in the lower back.

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

Facet joint diseases

Pathologies of the facets or facet joints of the lumbar region, especially their arthrosis, can also cause pain in the spine in the lumbar region, including severe pain.Although more often the pain is aching and 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 in the affected area and tends to intensify when bending, straightening, turning the body, or standing for long periods of time.Walking and sitting help reduce its severity.But in some cases, the pain can also radiate to the groin area, coccyx, as well as the back and outer surface of the thighs.

Inflammatory diseases of the spine

Inflammatory diseases of the spine are less common than pathologies of the intervertebral discs and facet joints.However, they also cause spinal pain.These include:

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

Signs of these diseases usually appear before the age of 40, and more often before the age of 20. This distinguishes them from degenerative-dystrophic pathologies of the 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 does not decrease at rest.Therefore, in inflammatory diseases, the spine in the lumbar region often hurts at night and especially in the morning, immediately after sleep.

The most serious situation is observed with ankylosing spondylitis and it is this disease that affects the lumbar region more often than other inflammatory diseases.This term refers to the inflammation of the intervertebral joints followed by their immobilization due to the formation of dense, cartilaginous or fibrous bone fusion between the joint bony structures.

It is initially characterized by mild pain in the lower back, but over time it gradually spreads higher, covering the thoracic and then the cervical spine.This is associated with the development of limited mobility of the spine in all planes, since the spine, as a result of the occurring changes, seems to be immersed in a specific case.Also noted:

• alignment of the lumbar lordosis (natural curve of the spine in the lumbar region);
• worsening of thoracic kyphosis, which causes curvature;
• reflex tension of the back muscles;
• progressive worsening of limited mobility due to the involvement of the facet joints and ossification of the intervertebral discs in the pathological process;
• morning stiffness for an hour or more.

In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucosa (conjunctivitis), iris and ciliary body of the eyeball (iridocyclitis) is observed.

The progression of ankylosing spondylitis leads to the fact that an increasing number of joints become pathological.As a result, patients are forced to acquire the so-called supplicant pose.It means pronounced kyphosis of the thoracic spine, downward inclination of the upper body, bending of the legs at the knees with a strong limitation of the range of motion of the chest, which affects the depth of breathing.

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

Vertebral compression fracture

A compression fracture is a flattening of the vertebral body, causing it to take on the shape of a wedge.This leads to disruption of the anatomy of the spine, can cause injury 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 most susceptible to injury as they bear the greatest axial load.

Compression fractures of the spine often occur in older adults due to the development of osteoporosis, that is, decreased bone density.In these cases, not only a slight fall, but also heavy lifting or unsuccessful movement can be enough to cause injury.

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

If the fracture is not diagnosed timely, a decrease in vertebral height leads to changes in posture and a decrease in height.This causes reflex tension and shortening of the spinal muscles, which causes 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 inside it, as well as metastases, the source of which are neoplasms of other organs.This occurs much less frequently than in pathologies of intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, that is, only in 1-2% of patients with back pain.But such injuries require the earliest possible diagnosis and treatment.

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

• increased body temperature, including subfebrile levels;
• causeless weight loss;
• inability to find a comfortable body position;
• the presence of pain at night;
• severe pain in the spine;
• inability to relieve pain with conventional analgesics.

Even if you experience 1 or 2 of these symptoms, you should make an appointment with your doctor immediately.

The following might look similar:

• Chondroma is a malignant tumor diagnosed in 20% of patients with cancerous lesions of the spine.Most often it forms in the sacrum and can occur in people of any age and gender.
• Young's sarcoma: occurs in 8% of patients with neoplastic lesions of the spine.More typical for young people.
• Chondrosarcoma is a malignant neoplasm, accounting for 7-12% of cases.It is most often found in middle-aged men.
• Aneurysmal bone cyst is a benign neoplasm.
• Hemangioma is a benign vascular tumor found in 11% of people.It may not be detected throughout a person's life.But it increases the risk of vertebral fractures.
• Metastases from other tumors are secondary malignancies.Most often, breast, prostate, lung cancers metastasize to the spine, and less often to the kidneys, thyroid, and skin.

Diagnostics

If your spine hurts in the lumbar region, you should make an appointment with a neurologist or vertebrologist.At the appointment, the doctor initially collects the medical history, asking questions about the nature of the pain, the circumstances of its onset, the duration of its persistence, the presence of other symptoms, lifestyle, etc.

Then the specialist carries out an examination.As part of it, he not only palpates the spine, determines the localization of pain, evaluates the gait and posture that the patient unconsciously takes, but also conducts functional tests.With their help it is possible to detect signs of ankylosing spondylitis, neurological deficits, assess the degree of mobility of the spine and obtain other diagnostic data.

Based on this, the doctor can already suggest possible causes of pain.To clarify them, as well as to accurately determine the extent of damage, instrumental and sometimes laboratory diagnostic methods are also prescribed.Most often they resort to help:

• Radiographs in frontal and lateral projections, sometimes with functional radiological examinations;
• CT scan – allows better visualization of bone structures, therefore it is most often used to diagnose spondylosis, fractures, bone tumors, etc.;
• MRI – allows you to more thoroughly evaluate the state of cartilaginous structures and soft tissues, therefore it is often used to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord injuries, etc.;
• electromyography - indicated for neurological disorders of unknown origin, as well as to assess the degree of nerve damage;
• osteoscintigraphy with radioisotopes – used for the diagnosis of 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 on an individual basis, not only based on the diagnosis, but also on the nature of existing concomitant pathologies.However, the cause of back pain, of course, determines the tactics of treatment.It may be conservative or involve surgery.

But the first step is always to relieve the pain, especially if it is severe.For this, patients are prescribed NSAIDs, antispasmodics and painkillers.And in more severe cases, spinal blocks are performed: injections of anesthetics and corticosteroids into certain points of the spinal area.

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

Exclusively conservative or non-surgical treatment is prescribed for:

• osteochondrosis;
• Bekhterev's disease;
• arthrosis 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, magnetotherapy, laser therapy, traction therapy, etc.);
• physical therapy;
•  manual therapy.

If the cause of lower back pain is intervertebral hernia, protrusion, spondylosis, severe vertebral fractures, tumors, surgery is often indicated.It is also necessary for:

• ineffectiveness of conservative therapy for degenerative changes;
• increased neurological deficit;
• spinal motion segment instability;
• the development of complications, in particular spinal canal stenosis.

Most modern operations performed on the spine are minimally invasive.Thanks to this, intraoperative and postoperative risks are significantly reduced, the rehabilitation period is shortened and facilitated, and the effectiveness is not inferior to the most traumatic open operations.Depending on the disease detected, the following may be recommended:

• Discectomy is an operation indicated mainly for hernias and protrusions, especially those that cause cauda equina syndrome.It can be performed using microsurgical instruments through an incision of approximately 3 cm (microdiscectomy) and using endoscopic equipment brought to the spine through pinpoint punctures with a diameter of approximately 1 cm (endoscopic discectomy).When 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 essence of the operation is to introduce quickly hardening bone cement through a thin cannula into the vertebral body, strengthening it.With kyphoplasty it is also possible to restore the normal dimensions of the vertebral body, which is important in case of severe decrease in height following a fracture.
• Fixation surgeries are used to stabilize the spine.For this purpose, various types of metal structures are used, which usually remain in the patient's body until the end of life.

Therefore, the spine in the lumbar region can hurt for a number of reasons.Therefore, if the pain persists for a long time, if it occurs regularly, if the pain intensifies over time, and even more so with the addition of other symptoms, it is absolutely necessary to contact a vertebrologist or neurologist.Early diagnosis will make it possible to detect pathological changes in those stages when they are easier to deal with and, if not completely cure the disease, then at least stop its progression and maintain a high standard of living.