Pain in the spine in the lumbar region

About 40-80% of people complain of pain in the lumbar spine, but no more than 25% of them seek medical help.In fact, such unpleasant sensations can be caused by relatively harmless causes and pathological changes in the spine.Therefore, they should not be treated 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 can be accompanied by pain of a different nature.In addition, the spinal column is surrounded by paraspinal muscles, a pain that patients often confuse with spinal pain.Therefore, there can be many reasons for pain.It can be overload, 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:

• intervertebral disc pathologies (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.

Intervertebral disc pathologies

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

Already at 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 the 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 reflex spasm of the segmental muscles.As a result, the pain in the spine intensifies and there is limitation of mobility.

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 a worsening of existing symptoms and the appearance of new ones.

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

Protrusions are protrusions of the disc while maintaining the integrity of its outer shell, called the annulus fibrosus.If the influence of 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 rupture.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 increases with sudden movements, bending, lifting heavy objects, straining, 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, leaning slightly in the healthy direction.At the same time, pain in the spine in the lumbar region can reach 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, he tightens the leg bent and brought to the stomach.

Most often, protrusions and hernias are formed along the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots that branch from it.The latter pass through the 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, often with long-term 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 the inflammatory process squeeze the spinal root passing by them, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be supplemented by pain that spreads to the buttocks, groin, front, inner, outer thigh, lower leg and foot.This depends on which nerve root will be pinched, i.e.at the level of which spinal motion segment pathological changes will be observed.Also, sensitivity disorders in the form of crawling, numbness, changes in sensitivity to temperature, pain, tactile stimuli and limited mobility can be observed in the corresponding areas of the lower extremities.

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 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).They can not only injure surrounding tissues and compress the spinal roots, causing severe pain in the spine, but also fuse with each other.As a result, adjacent vertebral bodies are combined into a single whole, which sharply limits mobility in the lower back.

Osteochondrosis can be accompanied by reactive changes in the vertebral bodies, especially reactive aseptic spondylitis, which leads to osteosclerosis.This is accompanied by compaction of bone tissue and sharply increases the likelihood of vertebral fractures.

Facet joint diseases

Pathologies of the facet 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 increase when bending, straightening, turning the body or standing for long periods of time.Walking and sitting help reduce their weight.But in some cases, pain can also radiate to the groin area, tailbone, 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 intervertebral discs and facet joints.However, they also cause pain in the spine.This includes:

• 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 develop more often after the age of 40.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.Therefore, with inflammatory diseases, the spine in the lumbar region often hurts at night, and especially in the morning, right after sleeping.

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

At first, it is characterized by mild pain in the lower back, but over time they gradually spread 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 spinal column, as a result of the changes that occur, seems to be immersed in a specific case.Also noted:

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

In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucous membrane (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 tilt of the upper body, bending of the legs at the knees with a sharp limitation in 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 the treatment.

Vertebral compression fracture

A compression fracture is a flattening of the vertebral body, causing it to become wedge-shaped.This leads to a violation 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 vertebra are more susceptible to injury, because they take on the greatest axial load.

Compression fractures of the spine often occur in elderly people due to the development of osteoporosis, i.e. a decrease in bone density.In such cases, not only a minor fall, but also lifting a heavy load or failing to move 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 spreads to the iliac crests and thighs.A decrease in the height of the broken vertebra causes an increase in lumbar lordosis, which also contributes to pain.

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

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

• elevated body temperature, including subfebrile levels;
• causeless weight loss;
• inability to find a comfortable body position;
• 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 right away.

The following can appear in a similar way:

• Chondroma is a malignant tumor that is diagnosed in 20% of patients with cancerous lesions of the spine.It is more often formed in the sacrum and can appear 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 men.
• Chondrosarcoma is a malignant neoplasm, which accounts for 7-12% of cases.It is more often found in middle-aged men.
• Aneurysmal bone cyst is a benign neoplasm.
• Hemangioma is a benign vascular tumor present in 11% of people.It may not be revealed throughout a person's lifetime.But it increases the risk of vertebral fractures.
• Metastases of other tumors are secondary malignant neoplasms.Most often, cancer of the breast, prostate, and lungs metastasizes to the spine, and less often - cancer of the kidney, thyroid gland, and skin.

Diagnostics

If your spine hurts in the lumbar region, make an appointment with a neurologist or vertebrologist.At the appointment, the doctor initially collects 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.

Then the specialist performs 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 takes unconsciously, but also conducts functional tests.With their help, you can 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 the pain.To clarify them, as well as to accurately determine the extent of damage, instrumental and sometimes laboratory diagnostic methods are additionally prescribed.They most often resort to help:

• X-rays in frontal and lateral projections, sometimes with functional X-ray tests;
• CT scan – allows better visualization of bone structures, therefore it is more often used to diagnose spondylosis, fractures, bone tumors, etc.;
• MRI - makes it possible to most thoroughly assess the condition of cartilaginous structures and soft tissues, therefore it is more often used to diagnose osteochondrosis, protrusions, intervertebral hernias, spinal cord lesions, etc.;
• electromyography - indicated for neurological disorders of unknown origin, as well as for assessing 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 nerves of the cauda equina.

Treatment

For each patient, treatment is selected strictly on an individual basis, not only on the basis of the diagnosis, but also 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 surgical intervention.

But the first step is always to relieve the pain, especially if it is severe.For this, patients are prescribed non-steroidal anti-inflammatory drugs, antispasmodics and painkillers.And in more severe cases, spinal blocks are performed - injections of anesthetics and corticosteroids into specific points in the spine.

Bed rest is not indicated for all patients.And in the case of 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 chronic pain.

Exclusive conservative or non-surgical treatment is prescribed for:

• osteochondrosis;
• Bekhterev's disease;
• arthrosis of 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 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;
• increase in neurological deficit;
• instability of the spinal movement segment;
• development of complications, especially stenosis of the spinal canal.

Most modern spine surgeries 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 indicated mainly for hernias and protrusions, especially those causing cauda equina syndrome.It can be performed with microsurgical instruments through an incision of about 3 cm (microdiscectomy) and endoscopic equipment that is brought to the spine through precise punctures of 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 vertebral compression fractures, hemangiomas and some other diseases.The essence of the operation is to introduce fast-hardening bone cement through a thin cannula into the body of the vertebra, strengthening it.With kyphoplasty, it is additionally possible to 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 spinal column.For this purpose, metal constructions of various types are used, which usually remain in the patient's body for the rest of his life.

So, 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 intensifies over time, and even more so with the addition of other symptoms, definitely consult a vertebrologist or neurologist.Early diagnosis will make it possible to detect pathological changes in those stages when they are easiest to deal with and, if not to cure the disease completely, then at least stop its progression and maintain a high standard of living.