Pain in the spine in the lumbar region

About 40-80% of people complain of pain in the lumbar vertebrae, but no more than 25% of them seek medical help.In fact, 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 disdain.

Causes of lower back pain

The spine 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, the pain in which patients often confuse with pain in the spine.Therefore, there can be many causes of pain.It can be overwork, natural restructuring of the body during pregnancy, etc.But if the pain occurs regularly, it is worth contacting a vertebrologist or neurologist, because 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 with:

• pathologies of the intervertebral discs (reduced disc height, protrusion, intervertebral hernia, discitis);
• facet joint pathologies (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.

Pathologies of the intervertebral discs

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

Already in the initial stages of the occurrence of degenerative changes in the intervertebral discs, which are cartilages with a special configuration that separate the bodies of the vertebrae, pain in the spine may appear.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 provokes an aseptic inflammatory process, which leads to a reflex spasm of the segmental muscles.As a result, pain in the spine intensifies, mobility restrictions occur.

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

The lumbar region, due to the fact that it bears the greatest loads in daily activities, is most often affected.

Protrusions are protrusions of the disc while preserving the integrity of its outer shell, called the annulus fibrosus.If the influence of the provoking factors continues over time, the fibers of the annulus fibrosus cannot withstand the load and pressure of the internal contents of the disc (nucleus pulposus) and tear.As a result, the nucleus protrudes 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, lifting heavy objects, tension, coughing, sneezing, laughing, as well as with prolonged sitting in one position, walking, standing.

Often, patients with already formed protrusions and hernias unconsciously take a forced position, bending 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 observe bed rest, and to relieve the pain, tighten the bent leg and bring it to the stomach.

Most often, protrusions and hernias are formed towards the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots that branch 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 limbs and various organs (including the genitals).

Therefore, often with prolonged osteochondrosis, the formation of a hernia in the lumbar region, the pain in the spine gradually not only increases, but is also supplemented by other disorders.If a deformed disc or soft tissues, swollen due to an inflammatory process, press on the spinal root that passes near them, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be complemented by pain radiating to the buttock, groin, front, inner, outer thigh, lower leg and foot.It depends on which nerve root will be pressed, i.e.at the level of which spinal motor segment pathological changes will be observed.Also, in the corresponding areas of the lower limbs, sensitivity disorders can be observed in the form of a crawling sensation, numbness, changes in sensitivity to temperature, pain, tactile stimuli and limited mobility.

Changes in the height and functionality of the discs occurring in osteochondrosis and its complications lead to damage to the articular apparatus of the spine, as well as 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 formation of osteochondral growths on the surface of the vertebral bodies (osteophytes).They can not only injure the surrounding tissues and compress the spinal roots, causing severe pain in the spine, but also merge with each other.As a result, adjacent vertebral bodies are united into a single unit, which sharply limits mobility in the lower back.

Osteochondrosis can be accompanied by reactive changes in the vertebral bodies, in particular, reactive aseptic spondylitis leading to osteosclerosis.This is accompanied by densification of bone tissue and sharply increases the likelihood of vertebral fractures.

Diseases of the facet joints

Pathologies of the facet or facet joints of the lumbar region, in particular their arthrosis, can also cause pain in the spine in the lumbar region, including severe pain.Although more often the pain is painful 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 worsen when bending, standing, turning the body, or standing upright for long periods of time.Walking and sitting help reduce their weight.But in some cases, the pain can also spread to the groin, tailbone, and 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 in the 20s.This distinguishes them from degenerative-dystrophic pathologies of the discs and joints of the spine, which more often develop after 40 years.In this case, the pain is characterized by a gradual increase in intensity.At the same time, their weight decreases after physical activity, but does not decrease at rest.That is why, with inflammatory diseases, the spine in the lumbar region often hurts at night and especially strongly in the morning, immediately after sleep.

The most severe situation is observed in ankylosing spondylitis, and this disease most often affects the lumbar region compared to other inflammatory diseases.This term refers to inflammation of the intervertebral joints, followed by their immobilization due to the formation of a dense bony, cartilaginous or fibrous fusion between the articulating bony structures.

Initially, it is characterized by mild pains in the lower back, but over time they gradually spread upwards, covering the thoracic and then the cervical spine.This is related to the development of limited mobility of the spine in all planes, since the spine, as a result of the changes that have occurred, appears submerged in a particular case.Also observed:

• alignment of the lumbar lordosis (natural curve of the spine in the lumbar region);
• worsening of thoracic kyphosis, which causes stooping;
• reflex tension of the back muscles;
• progressive worsening 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 more.

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 ankylosing spondylitis leads to the fact that an increasing number of joints become pathological.As a result, patients are forced to assume the so-called supplicating position.This means pronounced kyphosis of the chest, tilting the upper part of the body down, bending the legs at the knees with a sharp limitation of the range of motion in the chest, which affects the depth of breathing.

The rate of disease progression 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 a wedge shape.This leads to a violation of the anatomy of the spine, can provoke an injury to the spinal cord and its roots, and also cause a rapid progression of degenerative changes.

The first and second lumbar vertebrae are more susceptible to injury because they bear the greatest axial load.

Often, compression fractures of the spine occur in the elderly due to the development of osteoporosis, i.e.decrease in bone density.In such cases, not only a slight fall, but also lifting a weight or a failed movement can be enough to cause injury.

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

If the fracture is not diagnosed in time, the reduction in the height of the vertebrae leads to changes in posture and a decrease in height.This provokes reflex tension and shortening of the spinal muscles, which causes chronic back pain and necessitates 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 happens much less often than pathologies of the intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, namely only in 1-2% of patients with back pain.But such lesions require the earliest possible diagnosis and treatment.

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

• increased body temperature, including subfebrile levels;
• unexplained 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 have 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.It is more often formed 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 of young men.
• Chondrosarcoma is a malignant neoplasm that accounts for 7-12% of cases.It is more common in middle-aged men.
• Aneurysmal bone cyst is a benign neoplasm.
• Hemangioma is a benign vascular tumor that occurs in 11% of people.It may not be detected during a person's lifetime.But it increases the risk of vertebral fractures.
• Metastases of other tumors are secondary malignant neoplasms.Cancer of the breast, prostate, and lung metastasize most often in the spine, less often – cancer of the kidneys, thyroid gland, and skin.

Diagnosis

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 an anamnesis, asking questions about the nature of the pain, the circumstances of its occurrence, the duration of its persistence, the presence of other symptoms, lifestyle, etc.

The specialist then conducts 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 assumes unconsciously, but also conducts functional tests.With their help, you can find signs of ankylosing spondylitis, neurological deficits, assess the degree of mobility of the spine and get other diagnostic data.

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

• X-rays in frontal and lateral projection, sometimes with functional X-ray studies;
• CT - allows better visualization of bone structures, which is why it is more often used for diagnosis of spondylosis, fractures, bone tumors, etc.;
• MRI - enables the most in-depth assessment of the condition of cartilaginous structures and soft tissues, which is why it is more often used to diagnose osteochondrosis, protrusions, intervertebral hernias, lesions of the spinal cord, etc.;
• electromyography - indicated in neurological diseases of unknown origin, as well as to assess the degree of nerve damage;
• radioisotope osteoscintigraphy – used for 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, the treatment is selected strictly individually, not only based on the diagnosis, but also on the nature of the existing concomitant pathologies.However, the cause of pain in the lower back, of course, determines the tactics of treatment.It can 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 severe cases, spinal blockades are performed - injections with anesthetics and corticosteroids at certain points in the area of the spine.

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

Extremely 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, magnetic therapy, laser therapy, traction therapy, etc.);
• exercise therapy;
•  manual therapy.

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

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

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

• Discectomy is an operation mainly indicated for hernias and protrusions, especially those causing cauda equina syndrome.It can be performed using microsurgical instruments through an incision of about 3 cm (microdiscectomy) and using endoscopic equipment brought to the spine through punctures about 1 cm in diameter (endoscopic discectomy).When the intervertebral disc is completely removed, it is usually replaced with implants.
• Vertebroplasty and kyphoplasty are indicated for compression fractures of vertebrae, hemangiomas and some other diseases.The essence of the operation is to introduce rapidly hardening bone cement through a thin cannula into the body of the vertebrae, strengthening it.With kyphoplasty, it is possible to additionally restore the normal dimensions of the vertebral body, which is important in case of a serious reduction in their height as a result of a fracture.
• Fixation surgeries are used to stabilize the spine.For this purpose, metal structures of various types are used, which usually remain in the patient's body until the end of life.

Thus, the spine in the lumbar region can hurt for various reasons.Therefore, if the pain lasts for a long time, if it occurs regularly, if the pain increases over time, and even more so with the addition of other symptoms, you should definitely contact a vertebrologist or neurologist.Early diagnosis will make it possible to detect pathological changes in these stages, when it is easiest to deal with them and, if not to completely cure the disease, at least to stop its progression and maintain a high standard of living.