Waist back pain

Approximately 40-80% of people complain of pain in the lumbar spine, but no more than 25% of them seek medical help. In fact, this unpleasant feeling may be caused by relatively harmless reasons and pathological changes in the spine. Therefore, you should not treat them contemptuously.

Causes of low back pain

The spine is composed of a set of structural elements: bones, joints, intervertebral discs, ligaments, and nerves. Changes in any of them may be accompanied by painful feelings and have different properties. In addition, the spine is surrounded by paravertebral muscles, and patients often confuse pain with spinal pain. Therefore, there may be many causes of pain. This may be due to overwork, natural reorganization of the body during pregnancy, etc. But if the pain occurs frequently, it is worth contacting a chiropractor or neurologist, because systemic spinal pain in the lumbar area usually indicates the development of certain diseases.

In most cases, in this case, the patient is diagnosed as:

• Intervertebral disc pathology (decreased disc height, herniation, herniated disc, discitis);
• Small joint disease (spondyloarthropathy, joint cyst);
• Inflammatory diseases (ankylosing spondylitis or ankylosing spondylitis, reactive arthritis, psoriatic arthritis)
• Compression fractures of the vertebrae under the background of osteoporosis;
• Tumorous lesions of the spine.

Intervertebral disc disease

Degenerative disc changes or osteochondrosis are 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 labor. In old age, the intervertebral discs dry up and the vertebrae grow together.

Already in the initial stage of degenerative changes in the intervertebral disc, the intervertebral disc is a special structure of cartilage that separates the vertebral bodies and may cause spinal pain. This is due to irritation of the pain receptors in the outer layer of the intervertebral disc and the posterior longitudinal ligament of the spine. Usually, osteochondrosis triggers an aseptic inflammatory process, leading to segmental muscle reflex spasm. As a result, the pain in the spine is aggravated and mobility is restricted.

Osteochondrosis tends to develop continuously, especially in the absence of proper treatment and lifestyle corrections. Subsequently, it leads to the formation of protrusions, followed by intervertebral hernias, which causes aggravation of existing symptoms and the appearance of new symptoms.

The waist area bears the highest load during daily activities and is therefore most often affected.

The protrusion is the protrusion of the intervertebral disc while maintaining the integrity of its outer shell, called annulus fibrosus. Although the influence of inducing factors is maintained over time, the fibers of the annulus can not bear the load and pressure of the internal contents of the intervertebral disc (nucleus pulposus) and rupture. As a result, the nucleus exceeds the physiological position of the intervertebral disc. At the same time, lumbar spine pain or pain often radiates to the legs, sudden movement, bending, lifting heavy objects, exertion, coughing, sneezing, laughing, and sitting for a long time and other discomforts aggravate. A posture, walking, standing.

Usually, patients who have formed protrusions and hernias will unconsciously adopt a forced posture and lean slightly to the healthy side. In this case, the spine pain in the lumbar region can reach a high intensity, depriving a person of the ability to work. In this case, he was forced to stay in bed. In order to relieve the pain, he tightened his bent leg and brought it to his stomach.

In most cases, protrusions and hernias are formed in the direction of the spinal canal, and the spinal cord (cauda equina) and the nerve roots branching from it pass through the spinal canal. The latter passes through the natural opening in the vertebral body and further branches to the lumbar plexus, which is responsible for the innervation of the lower limbs and various organs (including the genitals).

Therefore, it is often accompanied by long-term osteochondrosis, hernia in the lumbar spine, and the pain of the spine not only gradually increases, but also supplemented by other diseases. If the deformed intervertebral discs or soft tissues swell due to the inflammatory process and squeeze through the spinal cord near them, neurological diseases will occur. Therefore, the pain of the lumbar spine can be supplemented by radiation to the buttocks, groin, front, medial, outer thighs, calves and feet. It depends on what kind of nerve root will be damaged, that is, at which level the pathological changes of the spinal motor segment will be observed. In addition, in the corresponding areas of the lower limbs, sensitivity disorders can be observed in the form of crawling sensation, numbness, temperature sensitivity changes, pain, tactile stimulation, and restricted activity.

The changes in the height and function of the intervertebral discs caused by osteochondrosis and its complications can cause damage to the spinal joint devices and the degeneration of the vertebral body itself. The result is the development of spondylosis, that is, the calcification of the anterior longitudinal ligament and the formation of osteochondral growth (osteophytes) on the surface of the vertebral body. They can not only damage the surrounding tissues, squeeze the roots of the spine and cause severe pain in the spine, but they can also grow together. As a result, adjacent vertebral bodies are combined into a whole, which greatly limits the mobility of the lower back.

Osteochondrosis can be accompanied by reactive changes in the vertebral body, especially reactive aseptic spondylitis, which leads to bone sclerosis. This is accompanied by compaction of bone tissue and significantly increases the possibility of vertebral fractures.

Small joint disease

Lesions of the facet joints or facet joints of the lumbar spine, especially their arthropathy, can also cause spinal pain in the lumbar region, including severe pain. Although more often the pain is pain and is confined to the deep heart. Their appearance is due to the abundant innervation of their synovial sac. In this case, the pain is usually directly concentrated in the affected area and tends to aggravate with bending, stretching, turning the body, and standing for a long time. Walking and sitting can help reduce their severity. However, in some cases, pain in the groin area, tailbone, and the back and outside of the thigh can also occur.

Inflammatory diseases of the spine

Compared with the disease of the intervertebral disc and facet joints, inflammatory diseases of the spine are less common. However, they also hurt the spine. These include:

• Ankylosing spondylitis or ankylosing spondylitis;
• Reactive arthritis;
• Psoriatic arthritis and so on.

The symptoms of these diseases usually occur before the age of 40, and more commonly at the age of 20. This distinguishes them from degenerative dystrophy of the intervertebral discs and spinal joints, which usually develop after 40 years. In this case, the pain is characterized by a gradual increase in intensity. In addition, their severity decreases after physical exertion, but does not decrease during rest. Therefore, in inflammatory diseases, the spine of the waist is often painful at night, especially in the morning immediately after going to bed.

The most difficult situation is ankylosing spondylitis, which affects the waist more often than other inflammatory diseases. The term indicates inflammation of the intervertebral joints, which subsequently leads to fixation due to the formation of dense bone, cartilage, or fibrous fusion between the joint bone structures.

At first, it was characterized by mild back pain, but over time, they gradually spread to higher positions, covering the thoracic spine, and then the cervical spine. This is related to the development of restricted movement of the spine in all planes, because the spine appears to be immersed in a specific situation due to changes. It was also observed:

• Alignment of lumbar lordosis (natural curvature of the spine in the lumbar region);
• Increased thoracic kyphosis, causing bending;
• The reflex tension of the back muscles;
• As facet joints participate in the pathological process and the ossification of the intervertebral disc, the limitation of movement is gradually aggravated;
• Morning stiffness lasts an hour or more.

In 10-50% of patients, inflammation of the iris (iritis), cornea (keratitis), mucous membranes (conjunctivitis), iris and ciliary body of the eye (iridocyclitis) are observed.

The progression of ankylosing spondylitis leads to an increase in the number of joints during the pathological process. As a result, the patient is forced to obtain the so-called supplicant pose. This means that the thoracic spine is obviously kyphotic, the upper body is tilted downward, the knees are bent, and the range of chest movement is obviously limited, which affects the depth of breathing.

The rate 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, thereby turning into a wedge shape. This can lead to the destruction of the anatomical structure of the spine, trauma to the spinal cord and its roots, and it can also become a trigger for the rapid progress of changes in degenerative dystrophy.

Lumbar vertebrae 1 and 2 are more susceptible to injury because they bear the greatest axial load.

Due to the development of osteoporosis, that is, a decrease in bone density, spine compression fractures often occur in the elderly. In this case, the injury may not only be a slight fall, but also weightlifting, which is an unsuccessful exercise.

The pathology is characterized by pain in the spine, which restricts movement, exacerbated by sitting, exercising, and trying to lift straight legs. It usually lasts for 1-2 weeks and then gradually decreases in 2-3 months. In some cases, there is radiating pain at the top of the ilium and buttocks. The reduction in the height of the fractured vertebra will cause an increase in lumbar lordosis, which can also lead to pain.

If the fracture is not diagnosed in time, a decrease in the height of the vertebrae will cause a change in posture and a decrease in growth rate. This can cause reflex tension and shortening of the spine muscles, which can lead to chronic back pain and require long periods of rest.

Spinal tumor lesions

Tumorous lesions of the spine means the formation of benign and malignant tumors, as well as metastases, whose source is tumors of other organs. This is much less than the lesions of intervertebral discs, facet joints, ankylosing spondylitis and even compression fractures, which only occurs in 1-2% of patients with back pain. However, such lesions need to be diagnosed and treated as soon as possible.

In addition to pain, the characteristics of spinal neoplastic lesions include:

• Increase in body temperature, including reaching sub-calorie value;
• Unreasonable weight loss;
• Unable to find a comfortable body posture;
• The presence of pain at night;
• Severe pain in the spine;
• Cannot relieve pain with traditional analgesics.

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

In a similar manner, the following situations may occur:

• Chondroma is a malignant tumor and is diagnosed in 20% of patients with spinal cancerous lesions. In most cases, it forms in the sacrum and can occur in people of any age and gender.
• Young's Sarcoma-Occurs in 8% of patients with spinal neoplastic lesions. More common in young men.
• Chondrosarcoma is a malignant tumor that accounts for 7-12% of cases. It is more common in middle-aged men.
• Aneurysmal bone cyst is a benign tumor.
• Hemangioma is a benign vascular tumor that occurs in 11% of people. It may not be detected in a person's lifetime. But it increases the risk of vertebral fractures.
• The metastasis of other tumors is secondary malignant tumors. More commonly, breast cancer, prostate cancer, lung cancer, and less common kidney cancer, thyroid cancer, and skin cancer will metastasize to the spine.

diagnosis

If the lumbar spine is injured, it is worth making an appointment with a neurologist or chiropractor. At the time of the appointment, the doctor will initially collect medical records and ask questions about the nature of the pain, its occurrence, duration, whether there are other symptoms, and lifestyle.

Then the expert conducts an inspection. Within its framework, he not only palpates the spine, determines the location of pain, assesses the patient's unconscious gait and posture, but also performs functional tests. With their help, you can detect signs of ankylosing spondylitis, neurological deficits, assess the mobility of the spine and obtain other diagnostic data.

Based on this, doctors can already speculate on the possible causes of the pain syndrome. In order to clarify them and accurately determine the degree of damage, instrument diagnostic methods and sometimes laboratory diagnostic methods are also specified. In most cases, they turn to:

• Radiography of front and side projections, sometimes for functional radiology;
• CT-can better observe the bone structure, therefore, it is more commonly used to diagnose spondylosis, fractures, bone tumors, etc. ;
• MRI-can evaluate cartilage structure and soft tissue state as carefully as possible, so it is often used to diagnose osteochondrosis, herniation, intervertebral hernia, spinal cord disease, etc. ;
• Electromyography-suitable for unexplained neurological diseases and to assess the degree of nerve damage;
• Radioisotope bone imaging-used to diagnose malignant tumors and metastases;
• X-ray densitometry is the best way to diagnose osteoporosis;
• Myelography-used to detect signs of compression of the spinal cord and cauda equina.

treatment

For each patient, the choice of treatment is strictly based on individual circumstances, not only based on the diagnosis, but also on the nature of the existing accompanying pathology. However, it is the cause of back pain that determines the treatment strategy. It can be conservative or involve surgical intervention.

But the first step is always to work directly to reduce the pain, especially when the pain is strong. To this end, patients were prescribed non-steroidal anti-inflammatory drugs, antispasmodics, and analgesics. In severe cases, spinal obstruction occurs-anesthetics and corticosteroids are injected into specific parts of the spine.

Not all patients can rest in bed. For intervertebral disc disease, it may be completely contraindicated, because the reduction of physical activity can cause acute pain in the spine to turn into chronic pain.

Completely conservative or non-surgical treatment is suitable for:

• Osteochondrosis;
• Ankylosing spondylitis;
• Arthropathy of the small joints;
• Mild compression fracture.

It is usually complex and includes:

• Medications, which may include non-steroidal anti-inflammatory drugs, chondroprotectants, muscle relaxants, immunosuppressants, corticosteroids,
• Physical therapy (ultra high frequency, magnetic therapy, laser therapy, traction therapy, etc. );
• Exercise therapy
• Manipulative therapy.

If the cause of low back pain is herniated disc, herniated disc, spondylopathy, severe vertebral fracture, or tumor, surgical treatment is usually required. still need:

• Conservative treatment is not effective for changes in degenerative malnutrition;
• Increased neurological deficits;
• Instability of spinal motion segments;
• The development of complications, especially spinal stenosis.

Most modern spine surgeries are minimally invasive. This greatly reduces the intraoperative and postoperative risks, shortens and promotes the recovery period, and the effect is not inferior to the more traumatic open surgery. Depending on the disease detected, it may recommend:

• Discectomy is a type of surgery that is mainly used for hernias and protrusions, especially those that cause cauda equina syndrome. The surgery can be performed with microsurgery instruments through an incision of approximately 3 cm (microdiscectomy) and endoscopic equipment provided to the spine through a puncture with a diameter of approximately 1 cm (endoscopic discectomy). When the intervertebral disc is completely removed, it is usually replaced with an implant.
• Vertebroplasty and kyphoplasty-suitable for vertebral compression fractures, hemangioma and other diseases. The essence of the operation is to inject fast-hardening bone cement into the vertebral body through a thin cannula to strengthen the vertebral body. Kyphoplasty can also restore the normal size of the vertebral body, which is very important for severely reduced vertebral body height due to fractures.
• Fixation surgery is used to stabilize the spine. To this end, metal structures of different properties are used, which usually remain in the patient's body until the end of life.

Therefore, the spine in the lumbar region may be injured for many reasons. Therefore, as the pain sensation continues for a long time, occurs frequently, the pain worsens over time, and even more other symptoms increase, it is necessary to contact a chiropractor or neurologist. Early diagnosis can find pathological changes at the easiest stage. If the disease is not completely cured, then at least its development can be stopped and a high standard of life can be maintained.