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 consult a doctor.In fact, such unpleasant sensations can be caused by both relatively harmless causes and pathological changes in the spine.They should therefore not be treated 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 any of them may be accompanied by pain of a different nature.In addition, the spine is surrounded by paraspinal muscles, pain in which patients often confuse with pain in the spine.Thus, the causes of pain can be multiple.This may 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 consistently hurts indicates the development of certain diseases.

Most often, in such situations, patients are diagnosed with:

• pathologies of the intervertebral discs (reduction in disc height, protrusion, intervertebral herniation, 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 in the intervertebral discs or osteochondrosis are very common, especially in young and middle-aged people.This is largely due to the need to sit for a long time or engage in heavy physical work.With old age, the disc dries out and the vertebrae fuse.

Already in the early stages of the appearance 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 in 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 segmental muscles.As a result, pain in the spine intensifies and mobility restrictions occur.

Osteochondrosis tends to constantly progress, especially in the absence of proper treatment and lifestyle correction.Subsequently, this leads to the formation of protrusions, and then intervertebral hernias, which causes an aggravation of existing symptoms and the appearance of new ones.

The lumbar region, because it bears the highest loads in daily activities, is most often affected.

Protrusions are protrusions from the disc while maintaining the integrity of its outer shell, called the annulus fibrosus.If the influence of the provoking factors persists 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 intensifies with sharp movements, bending, lifting heavy objects, straining, coughing, sneezing, laughing, as well as sitting in one position for a long time, walking, standing.

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

Most often, protrusions and hernias form toward the spinal canal, which contains the spinal cord (cauda equina) and the nerve roots extending from it.These pass through the natural openings of the vertebral bodies and then branch into the lumbar plexus, which is responsible for the innervation of the lower limbs 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 intensifies, but is also supplemented by other disorders.If a deformed disc or soft tissues swollen by an inflammatory process compress the spinal root passing nearby, neurological disorders occur.Therefore, pain in the spine in the lumbar region can be supplemented by pain radiating to the buttocks, groin, front, inner, outer thigh, lower leg and foot.It depends on which nerve root will be pinched, that is, at which pathological changes in the spinal movement segment will be observed.In addition, in the corresponding areas of the lower extremities, sensitivity disturbances can be observed in the form of a crawling sensation, numbness, changes in temperature sensitivity, 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 degeneration of the vertebral bodies themselves.The consequence 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 spinal pain, but also fuse with each other.As a result, adjacent vertebral bodies are grouped into a single whole, which severely limits the mobility of 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 compaction of bone tissue and considerably increases the risk of vertebral fractures.

Facet joint diseases

Pathologies of the facet joint(s) of the lumbar region, in particular their osteoarthritis, can also cause pain in the spine in the lumbar region, or even intense pain.Although most 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, standing up, turning the body or standing for long periods of time.Walking and sitting help reduce their severity.But in some cases, the pain can also radiate to the groin, 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 the intervertebral discs and facet joints.However, they also cause pain in the spine.These include:

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

Signs of these diseases generally appear before the age of 40, and more often at the age of 20. This distinguishes them from degenerative-dystrophic pathologies of the discs and joints of the spine, which develop more often after 40 years.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 more 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 a dense, cartilaginous or fibrous bone fusion between the joint bone structures.

At first it is characterized by mild pain in the lower back, but over time it gradually spreads higher, covering the thoracic and then 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 changes occurring, seems to be immersed in a specific case.We also observe:

• alignment of the lumbar lordosis (natural curve of the spine in the lumbar region);
• worsening 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 to 50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucous membranes (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 adopt the so-called suppliant pose.This means a pronounced kyphosis of the thoracic spine, a downward tilt of the upper body, flexion of the legs at the knees with a sharp limitation of the range of movement of 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, giving it the shape of a wedge.This leads to disruption of the anatomy of the spine, can cause damage to the spinal cord and its roots, and also trigger the rapid progression of degenerative changes.

The 1st and 2nd lumbar vertebrae are more susceptible to injury, as they bear the greatest axial load.

Compression fractures of the spine often occur in older people due to the development of osteoporosis, which is a decrease in bone density.In such cases, not only a minor fall but also heavy lifting or an unsuccessful movement may 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 raise a straight leg.It usually lasts 1 to 2 weeks, then gradually diminishes over 2 to 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 in time, a decrease in spinal height leads to changes in posture and a decrease in height.This causes reflex tension and shortening of the spinal muscles, causing chronic back pain and requiring long periods of rest.

Neoplastic lesions of the spine

Neoplastic lesions of the spine mean the formation of benign and malignant tumors, as well as metastases, the source of which are neoplasms of other organs.This occurs much less frequently than pathologies of the intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, namely in only 1-2% of patients with back pain.But such lesions require diagnosis and treatment as early as possible.

Characteristic signs of neoplastic lesions of the spine, in addition to pain, are:

• increased body temperature, including subfebrile levels;
• weight loss without cause;
• 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 may appear the same:

• 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 men.
• Chondrosarcoma is a malignant tumor which represents 7 to 12% of cases.More often found in middle-aged men.
• Aneurysmal bone cyst is a benign tumor.
• Hemangioma is a benign vascular tumor present in 11% of people.It may go undetected throughout a person's life.But this increases the risk of vertebral fractures.
• Metastases from other tumors are secondary malignant neoplasms.Most commonly, breast, prostate, and lung cancers metastasize to the spine, and less commonly, kidney, thyroid, and skin cancers.

Diagnosis

If your spine hurts in the lumbar region, you should make an appointment with a neurologist or vertebrologist.During the appointment, the doctor first collects the history, 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 carries out an examination.In this context, he not only palpates the spine, determines the location of the pain, evaluates the gait and posture that the patient adopts unconsciously, but also carries out functional tests.With their help, you can detect signs of ankylosing spondylitis, neurological deficits, assess the degree of spinal mobility 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.Most often they resort to help:

• X-rays in frontal and lateral projections, sometimes with functional radiological tests;
• Scanner – allows better visualization of bone structures, so it is more often used to diagnose osteoarthritis, fractures, bone tumors, etc. ;
• MRI – allows you to more thoroughly assess the condition of cartilaginous structures and soft tissues, therefore it is more 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;
• radioisotope osteoscintigraphy – used for diagnosis of malignancies 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 chosen strictly on an individual basis, not only based on the diagnosis, but also on the nature of existing concomitant pathologies.However, the cause of lower back pain, of course, determines the treatment tactics.It may be conservative or involve surgical intervention.

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

Bed rest is not indicated for all patients.And in case of pathologies of the intervertebral discs, it may be completely contraindicated, since a reduction 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;
• osteoarthritis of the facet joints;
• slight compression fractures.

It is generally complex and includes:

• drug treatment, which may include NSAIDs, chondroprotectors, muscle relaxants, immunosuppressants, corticosteroids, 
• physiotherapy (UHF, magnetotherapy, 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, surgical intervention is often indicated.It is also necessary for:

• ineffectiveness of conservative treatment for degenerative changes;
• increasing neurological deficit;
• instability of the spinal movement segment;
• the development of complications, including spinal stenosis.

Most modern spinal operations 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 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 carried out using microsurgical instruments through an incision of approximately 3 cm (microdiscectomy) and using endoscopic equipment brought to the spine by point 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 certain other diseases.The essence of the operation consists in introducing rapidly hardening bone cement through a thin cannula into the vertebral body, thereby strengthening it.With kyphoplasty, it is also possible to restore the normal dimensions of the vertebral body, which is important in the event of a significant reduction in their height following 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 his life.

So, the spine in the lumbar region can be painful for various 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, you should definitely contact a vertebrologist or neurologist.Early diagnosis will make it possible to detect pathological changes at the stages when they are most manageable and, if not to completely cure the disease, at least to stop its progression and maintain a high standard of living.