Lumbar osteochondrosis symptoms
lumbar degenerative disc disease because of anatomical and physiological characteristics, has its differences from degenerative disc disease of the cervical and thoracic localization and is characterized by the following features.
1. Lack of spinal pathology because the spinal cord ends at L1;rare exceptions occur when the lesions of radicular arteries, until the cone syndrome.
2. Clinic of lumbar degenerative disc disease is mainly due to the defeat of the disc (hernia rupture, instability, etc.) and to a lesser extent, changes in bone (osteophytes).
3. In the first place nominated pain, radicular syndromes and static, and vegetative .narusheniya recede into the background.
4. More clearly stands traumatic factor in the development of the disease.
Pain. main complaint of the patient with lumbar osteochondrosis
are a pain.They can only be in the lumbosacral region (lumbodynia) in the lumbosacral region
radiating to the leg of the overwhelming number of patients
(sciatica) and only in the leg (sciati
had pain in the lower thoracic and verhnepoyasnichnom departments.The disease almost all began with the appearance of lumbosacral pain, which over time (usually 1-3 years) began to radiate to the lower limbs (usually on one side).Lumbosacral pain were spilled in nature, were
dull and aching, worse awkward and sharp movements, change of body position and long-term
stay in one position.In the horizontal position, the pain is significantly reduced.Onset of pain or aggravation often preceded by a long stay in an uncomfortable position, physical overload.Being in a bent position, patients with difficulty unbend, it is difficult to wash, brush your teeth, wash, iron.
Radicular (radiating) pain had mostly
stinging character.Quite a long time pain localized
only in the gluteal region, or at the level of the sacroiliac joint;they rarely appeared at once in the thigh, lower leg and foot
.In all patients, radiating pain registered only in one leg.When the intensity of their bilateral pain was still more to any one side.
Pain often be permanent.A number of patients with a sharp pain torso appeared like a passage of current.For the most part they were very intense sick poor sleep, loss of appetite, difficulty walking, and at times (weeks or months) could not get out of bed.Employability has been sharply reduced.Increased pain noted in
coughing, sneezing, and especially in the shaking, so some patients could not use the bus.In a number of cases brought relief forced position: lying on his back, bent on the healthy side, on all fours, with a pillow under the belly, or squatting.In untrained, with weakened muscles of patients, dealing mainly in mental work, unusual
physical activity, such as carrying heavy loads, caused
exacerbation of pain until the following day, even after the rest
(& lt; a phenomenon of Day 2 & gt;).The mechanism of this phenomenon seems to us
follows: first slowly increases the compression of the affected disk with asymptomatic areas of nucleus pulposus protrusion in the slot of the fibrous ring.Gradually rising disc swelling blocks the core areas with a sharp, irritated nerve receptors.When lumbago, on the contrary, rapid compression of the disc leads to the infringement of (blocking) of the core areas of almost lightning speed, and then increases swelling.
Do not dwell specifically on moderately severe in elderly and senile vertebral pain, mostly the morning, accompanied by & lt; crunch & gt ;, & lt; crash & gt;and sedentary due to secondary spondyloarthrosis in small joints;discs by this time partly blocked
fibrosis.These pains usually disappear after a workout gym and walking.
Half of the patients the disease began lumbar lumbago (lumbago, or & lt; a sharp drive & gt;), which appeared suddenly while trying to lift heavy, when a sharp inclination or the extension of the body, and lasted for several days.At the same time there were very strong pain
or lumbosacral region, the retaining body in a bent position.Patients could not move because any movement caused a sharp increase in pain.Back muscles are very tense (symptom & lt; a locked back & gt;).Discography conducted in patients with clinical & lt; acute disc & gt ;, showed that
while there is always a gap posterior regions of the fibrous ring and often hernial protrusion.Subluxation of intervertebral joints in patients of this group do not occur
Lumbago caused by sudden movement of the core fragment of the fracture is richly innervated fibrous ring.Reflex muscle contraction at the same time blocking the affected segment, to prevent complete loss of track, but also closes his way back.Spontaneously or movement can occur suddenly unlocking the return of the displaced fragment into place and the rapid disappearance of pain.
dynamic observation of patients with lumbar osteochondrosis revealed a direct correlation of severity of the clinical picture of the disease on the intensity of pain.
scheme TIBobrovnikova (1967) confirms this relationship.
mild pain (grade 1):
- dull pain in the lower back and leg, cold extremities, numbness and other discomfort;
- the appearance of pain during sudden movements inadequate - forced
tilt, turn, sudden transition from od.noy posture to another, shaking,
heavy lifting in an awkward position for a long stay in the irrational position;
- a limitation of movement in the lumbosacral region;
moderately severe pain (II degree):
- minor pain at rest, sometimes stops for a while, appearing when moving, tilting and lifting weights;
- perhaps a long stay in one position;
-light voltage paravertebral muscles;
- restriction of movements in the spine;
- moderate tension symptom.
Expressed pain syndrome (III degree):
- the patient may be in a position to 1 hour, preferring to position on the healthy side and the AIDS bent legs;
- increased pain with movement, coughing and sneezing;
- short-term pain relief during a short sleep;
-vstavanie with the support of the surrounding objects and move with difficulty,
limping on his injured leg in the antalgic position or with a focus on the knee;
- voltage poyasnichdyh muscles;
- the lack of movement in the spine;
- coarse tension symptom.
pronounced pain syndrome (IV degree):
- pronounced pain at rest (the patient can not lie in one position for more than 5-10 minutes), worse when you cough, sneeze, trying to motion;
- forced position on the healthy or diseased side with bent
and given to the abdomen legs, knee-elbow position, etc.
-.. Sleeplessness due to pain, irritability, agitation.
-vstavanie with assistance, walking with crutches and canes, with a focus on the knee, the pelvis;
-rezkoe voltage paravertebral muscles;
- the lack of movement in the spine;
- absolute and brutal tension symptom.
sensory disturbances. Such disturbances in the limbs,
developing in the area of pain and characteristic of far-gone
disease, marked by us in 53% of patients.Sensory disorders as radicular pain, are the projection, i.e.
their location does not coincide with the center of local irritation.Hyperesthesia had only some patients, anesthesia individual sites.More typical was the reduction of pain and tactile sensation (hypoesthesia).Usually the sensitivity zone violation arranged in bands, exciting gluteal region, along the thigh, lower leg, foot less.
Paresthesia (abnormal sensations experienced no irritation from the outside) in the form of tingling, pins and needles, and so on. D. Is often combined with hypoesthesia.Even in the absence of violations of the sensitivity of many of the patients indicated paresthesia in the diseased limb, which represent
process of radicular compression.Our observations, however, do not agree with the opinion of Arseni (1973), that this symptom is always a harbinger of paresis and requires urgent surgical intervention.
Diagnostic value of sensory disturbances topography is treated differently.Known schemes dermatome innervation Geda, Dejerine, Keegan et al. Differ in individual variability due to overlapping dermatomes.In our work we use the scheme Keegan.
irradiation of pain and violation of the sensitivity in the area of the rear foot, one toe (sometimes neighboring fingers) often show compression spine L5 (L4-5 disc).If these changes are found on the outer edge of the foot and the heel, there is a compression of the spine S1 (L5-S1 disc), but here
possible error in determining the level of the lesion.According Spurling (1955), the correct information can be obtained only in the study of the distal portion dermatome, leg and foot.If these areas are not subject to foot, to determine the location even more difficult.Regarding paresthesias, they
even less can be used for this landmark.
Set the level of destruction on the basis of the sensitivity of violations can be less than half of the patients.Thus, the sensitivity of these disorders are diagnostic value, but they are not sufficient criterion for accurate preoperative diagnosis.
symptoms of tension. There is a lot of pain reflexes
tension;of which the most constant symptom Lasegue described in 1881.Its essence lies in the appearance of pain in his outstretched leg with its rise.If at this moment bent leg at the knee, the pain disappears.Cross symptom Lasegue (spondylitis symptom) is the occurrence of pain on the affected side with the rise
healthy leg.The cause of this symptom in additional displacement of irritable spine.Charnley (1951) investigated the mechanism Lassegue cadaver after the removal of the vertebral bodies.When lifting the back legs shifted to 0.4-0.8 cm. · Fixed he remained until the foot is not raised to 30-40 °,
then began to move.Based on these data, the authors concluded that a pronounced symptom Lasegue, iethe appearance of pain when lifting the leg to 30-40 °, linked to mechanical reasons beyond the spine, and caused the defeat of the disc.The same opinion is shared by most authors.They believe
Lasegue symptom of almost constant at the rear protrusions disc herniation.Symptom Lasegue rated as strongly positive, if the pain in his foot appeared at the rise up to 40 °, as a positive - at the rise to 60 °
and a weak positive, more than 60 °.In some cases,
Lasegue symptom can confirm the nature of discogenic disease, without specifying, however, is its location.The majority of patients we observed was sharply positive and positive, especially in exacerbations, and was absent in 12.6% of patients.If the height of Lassegue, iewhen straightened leg to do additional dorsiflexion of the foot, the pain increases sharply (Bragar symptom).
Among other signs of tension should be noted the emergence lyumboishialgicheskih pain when bending head (Peri symptom), with an increase in CSF pressure (Dejerine symptom or cough shock), in extension legs at the hip joint (Wasserman symptom) and flexion of the knee (Mackiewicz symptom).The last two symptoms are determined
position of the patient on his stomach.
atrophy and paresis of muscles. in 57% of patients was observed
muscle atrophy, most noticeable in the leg, where the difference reached in a circle of 3 cm. These patients buttocks and thigh muscles were atrophic to varying degrees.Gluteal fold on the affected side was located below.Atrophy bvsegda muscles accompanied by lowering their tone.Movement disorders were expressed in paresis of certain muscle groups.Thus, the weakness of the long extensor 1 finger often characteristic of the compression of kchreshka U, a weakness of the gastrocnemius muscle for root-S1.In the case of paresis of the extensors of the foot patients experience sudden trouble while attempting to walk on his heels, with pareze calf or flexor of the foot, on the contrary, -at walking on tiptoe, and the stairs.Furthermore, paresis detected by conventional assays resistance.When paralysis of two root-L5 and S1-there is complete dangling foot.However, Steen paresis, not sparing due to pain associated with lumbar degenerative disc disease are rare.
massive flaccid paralysis most often develop during compression of the cauda equina median disc herniation or its free & lt; sequestration & gt ;.In addition, paralysis and paresis can be caused by compression of herniated disc radicular artery, accompanying.root L5 or S1.
Violation reflexes.Diagnostic value
knee-jerk changes is negligible, since
this reflex may be reduced in the defeat not only the L3, but also the underlying lumbar disks.Most valuable are the data on the violation of the Achilles reflex, typical for hernias L4-5, and L5-S1.Only in the absence of Achilles reflex can speak more specifically about the lumbosacral disc lesion.
compression of the cauda equina syndrome (paralytic sciatica).
most severe necrotic complication of lumbar degenerative disc disease, the cause of which in all cases were massive prollapsy disks or migration of the fragments in the lumen of the spinal canal epidural.
There are three options of cauda equina compression syndrome.
1. Slowly but steadily progressing on the background of constant pain lyumboishialgicheskih compression
development of horse tail.This option is particularly difficult for the differential diagnosis with spinal tumors.
2. Progressive development of compression with remissions lyumboishialgicheskogo pain,
3. Acute insultoobraznoe development of cauda equina compression.This option (the most common) is caused by a sudden movement of the disc sequestration or blood circulation in the lower regions of the spinal cord with the compression of radicular artery.At the time of physical exertion or awkward movements on background
sciatica occurs a sharp pain syndrome type
lumbago, and after a few minutes or hours developing paresis feet, saddle anesthesia sacral segments and urinary retention.Following the development of paresis and anesthesia disappear pain and vertebral syndromes.
Autonomic disorders .Degenerative changes in the intervertebral discs are often accompanied by a number of autonomic disorders.The source of their irritation are numerous afferent and volokan vasomotor reflex spasm of blood vessels under the influence of pain.Burning, stinging, itching pain, strengthening them in connection with the change of weather, are often cooled simpatalgichesky character.Radicular pain unlike them are & lt; sweep & gt;and strictly localized, including the fingers, worse when coughing or sneezing.By vegetative disorders are also trophic symptoms - cyanosis, sweating disorders, dryness and peeling of the skin.These disorders zonal and meet the affected nodes.Characterized by vasomotor disturbances in the form of a chill limbs, lowering skin temperature, spasm, and sometimes (rarely) the disappearance of the pulse.
reflected visceral syndromes in lumbar osteochondrosis little studied, except for the so-called neurogenic bladder.Gross violations of its functions as a delay or the true incontinence (full compression of the cauda equina roots) is always accompanied by a flaccid paralysis of the detrusor, sphincter and pelvic floor anesthesia or hypoesthesia in the anogenital region.
Static violations. Smoothness, the complete absence of IPT, lumbar lordosis (a symptom of a flat back, strings).The flattening of the lumbar lordosis in the presence of the protrusion is adaptive reaction, reduces the volume of the rear disc herniation, which leads to a weakening of pressure on the spine.Here it is necessary stop for rare in lumbar osteochondrosis syndrome opposite character - hyperlordosis as fixed extensions.This marked
& lt; proud & gt;