lumbar spondylosis
Introduction
Introduction to lumbar spondylosis Lumbar spondylosis is caused by acute and chronic soft tissue injury around the spine and spine, lumbar disc degeneration, lumbar vertebrae hyperplasia, etc. It is clinically characterized by low back pain, limited lumbar activity and low back pain. Medically speaking, lumbar spondylosis covers "lumbar soft tissue strain, lumbar myofasciitis, lumbar degenerative osteoarthrosis, lumbar trigeminal syndrome, lumbar disc herniation, acute lumbar sprain, piriformis syndrome, Lumbar tuberculosis and other diseases. Main symptoms: can not stand upright, headache, dizziness, blurred vision, memory loss, neck and shoulder pain, loss of appetite, nausea, vomiting, weakness of the lower limbs, severe cases may lead to paralysis. Causes include 1. Incorrect postures such as sitting, standing, lying, and working at a desk in the same position for a long time or other labor. Unreasonable bedding can cause ligaments, excessive muscle tension and strain, disc herniation, and small joint dysfunction. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: sciatica, lower limb nerve injury
Cause
Causes of lumbar spondylosis
Environmental factors (20%):
The cause of lumbar disc herniation is that the environment is humid and cold. Frequently in a cold or humid environment, it is a condition that induces lumbar disc herniation to a certain extent. Not paying attention to keep warm, cold and wet, is also the cause of lumbar disc herniation. Cold or damp can cause small blood vessels to contract, muscle spasm, increase the pressure of the intervertebral disc, and may also cause degeneration of intervertebral disc.
Waist trauma (20%):
Sexual trauma can affect the structure of the fibrous ring, cartilage plate, etc., and promote the nucleus pulposus that has been degenerated. Increased abdominal pressure can also be a common cause of lumbar spondylosis, such as severe coughing, forced bowel movements during constipation.
Improper waist position (20%):
When not fully prepared, the waist load is suddenly increased, which easily causes the nucleus pulposus to protrude.
Sudden load (20%):
When the waist is in the flexion position, if it is suddenly rotated, the nucleus pulposus is easily induced. Sudden weight bearing, when not fully prepared, suddenly increase the waist load, easy to cause the nucleus pulposus.
Prevention
Lumbar spondylosis prevention
(1) Protection of the waist: The bed should be soft and moderate, avoiding the bed being too hard or too soft, so that the psoas muscle can be fully rested, avoiding the wind from being affected by the wind and cold, avoiding the waist being in a posture for a long time, and the muscle strength is unbalanced. Causes strain on the waist.
(2) Correct use of the waist: When lifting heavy objects, you should first squat, when you use the waist for too long, you should change the waist position, do more waist activities, prevent gradual strain, and use excessive waist or light due to the nature of work. When straining, it is necessary to avoid further increase of strain and eventually cause degeneration of the lumbar spine.
(3) Lumbar health care exercise: adhere to the waist health care exercise, often carry out activities in all directions of the lumbar spine, so that the lumbar vertebrae always maintain physiological stress state, strengthen the psoas muscle and abdominal muscles exercises. The strength of the psoas and abdominal muscles can increase the stability of the lumbar spine, strengthen the protection of the waist, and prevent degenerative changes in the lumbar spine.
(4) Moderate sports are appropriate. Sports may cause impact, compression, extreme rotation, buckling and other movements on the spine, causing damage to the lumbar spine, causing early degeneration or aggravation. Understand these mechanisms and help people choose and regulate sports.
Complication
Lumbar spondylosis complications Complications sciatica lower limb nerve injury
(1) infection
After surgery, it can be seen that the infection of the incision may also occur in the intervertebral space infection. The main manifestations are: the original symptoms of neuralgia and low back pain disappear. After 5 to 14 days, severe low back pain and pain in the buttocks or lower abdomen and muscle spasm can not be turned over, which is very painful.
(2) nerve damage
It is possible to damage nerve roots in the epidural or dura mater during surgery.
(3) large vessel injury
The most common is the vascular injury that damages the posterior wall of the abdomen during posterior surgery.
(4) adhesions and scars
The nerve roots at the surgical site and the exposed part of the dura mater after the laminectomy often have adhesions and scars, which may leave low back pain or nerve root radiation pain, scar tissue hyperplasia at the posterior wall of the spinal canal, and adhesion leads to postoperative restenosis. Hematoma mechanization, adhesions and calcification often lead to re-stenosis of the nerve root canal.
(5) instability of the spine
In some patients, postoperative leg pain disappeared and low back pain persisted.
(6) Organ damage
Vascular injury may be accompanied by other organ damage, such as the ureter or small intestine.
(7) cerebrospinal fluid fistula or meningeal pseudocyst
Cerebrospinal fluid sputum occurs on the 3rd to 4th day after surgery; dural pseudocysts often have low back and leg pain within a few months after surgery, and there are spherical sacs and dural adhesions at the surgical scar or lumbosacral region. Compression of a cystic mass can cause sciatica.
Symptom
Lumbar spondylosis symptoms Common symptoms Low back pain, hands and feet, low back, low back pain, tiredness, waist pain, or pain, backache, low back pain, calf inner feeling, loss of lumbar pain, lumbar soreness and weakness, third lumbar vertebrae
Lumbar disc herniation:
1. Low back pain: It is the first symptom in most patients, and the incidence rate is about 91%. Because the outer ring of the annulus fibrosus and the posterior longitudinal ligament are stimulated by the nucleus pulposus, the lower back of the sinus vertebrae induces pain in the lower back, sometimes accompanied by pain in the buttocks.
2. Lower extremity radiation pain: Although high lumbar disc herniation (lumbar 2 ~ 3, waist 3 ~ 4) can cause femoral neuralgia, but clinically rare, less than 5%. The vast majority of patients with lumbar 4 ~ 5, waist 5 ~ 1 gap prominent, manifested as sciatica. Typical sciatica is radiation pain from the lower back to the buttocks, the back of the thigh, the outside of the calf, and the foot. The pain is exacerbated by increased abdominal pressure such as sneezing and coughing. The limbs of the radiation pain are mostly on one side, and only a few of the central or central parafascicular nucleus protruded as symptoms of both lower extremities. There are three reasons for sciatica: 1 ruptured discs produce chemical stimulation and autoimmune reactions that cause chemical inflammation of the nerve roots. 2 prominent nucleus pulposus compression or stretch the nerve roots that have inflammation, hindering venous return, further aggravating edema, making the sensitivity to pain increased. 3 compressed nerve root ischemia. The above three factors are related to each other and are mutually reinforcing factors.
3. Cauda equina symptoms: the nucleus pulposus or prolapsed, the free intervertebral disc tissue that presses the cauda equina nerve, which is mainly characterized by large and urinary disorders, perineal and perianal sensation. In severe cases, symptoms such as loss of control of the stool and incomplete paralysis of the lower extremities may occur, which is rare in clinical practice.
Acute lumbar sprain: Immediately after the injury, there is a pain in the lower back, which is a persistent severe pain. The next day may be more severe due to local bleeding, swelling, and low back pain. There was also a slight twist on the waist. There was no obvious pain at the time, but the waist felt pain the next day after the break. Lumbar activity is limited, can not be straight, difficulty in leaning, leaning, twisting, coughing, sneezing, urination can make the pain worse. When standing, often hold the waist with your hands, and use your hands to support the chair when sitting, to relieve the pain. Pain occurs immediately on one or both sides of the psoas muscle sprain. Sometimes it can be painful after half an day or overnight, the waist is blocked, the pain is slightly light at rest, and the pain is more active or coughing. Local muscle tension, tenderness and traction pain were obvious during the examination, but there was no congestion.
Lumbar degenerative small joint injury arthritis:
1. Symptoms: (1) Low back pain is persistent dull pain or soreness, which is aggravated after exercise. In the case of an acute attack, the waist can be stiff and there is generally no waist movement disorder.
(2) Root Symptoms When the nerve roots are stimulated, radiation pain in the lower extremities may occur, and the range of involvement is relatively limited. The pain does not spread completely according to the distribution of nerve roots.
2. Signs
There is fixed tenderness at the small joints, and the tender points are deep, with slap pain and conduction pain. In the acute attack, the lumbar spine physiological curvature can disappear, the lumbar spinous processes are not aligned, and the distance between the spinous processes of the vertebral spine increases, and a depression can occur at this point.
Lumbar spinal stenosis: the disease is more insidious, the course of the disease is slow, and it occurs in men between 40 and 50 years old. The cause of stenosis is very complicated. Depending on the location of the clinical stenosis, typical symptoms of the patient may include: long-term lumbosacral pain, leg pain, progressive weakness of both lower limbs, numbness, intermittent spasm, difficulty walking. Among them, numbness can gradually develop from the foot to the calf, thigh and lumbosacral part, and the abdomen has a sense of banding. In severe cases, there is abnormal bowel movement and paraplegia. Doing excessive stretching of the waist can cause increased pain in the lower extremities. This is a positive test for overextension and is an important sign for the diagnosis of spinal stenosis.
Third lumbar transverse process syndrome:
1. It is more common in young and middle-aged people who are engaged in manual labor. There are many males and often complain of a history of waist injuries ranging from light to heavy.
2. The main symptom of the intrinsic is lumbar pain. The pain varies from person to person. Some of the pain is very severe, and some are persistent dull pain. The nature of the pain is generally related to it, and it is also sore. Pain often worsens after sedentary, standing for a long time or getting up in the morning. In severe cases, the pain can be radiated down the thigh to the knee. In a few cases, the pain can extend to the outside of the calf, but it is not aggravated by increased abdominal pressure (such as coughing, sneezing, etc.).
3. There is obvious local tenderness at the tip of the transverse process of the third lumbar vertebrae, and the positioning is fixed. It is a characteristic of this syndrome. In some cases, the transverse process of the third lumbar vertebrae is longer, and the tip of the muscle can reach the active muscle nodules. At the leading edge of the gluteus maximus, the gluteus gluteal muscle can be touched, and the local tenderness is obvious.
Examine
Lumbar spondylosis examination
1, CT examination: This CT scan can help diagnose the prominent part of the waist, you can understand whether the intervertebral foramen are narrow, and whether the lamina is hypertrophic.
2, X-ray examination: This is the most basic examination, through the basic X-ray examination can find the narrowing of the intervertebral space and the presence of hyperplasia at the edge of the vertebral body, which can help patients to exclude some other diseases, such as spondylolisthesis.
3, physical examination: low back pain sometimes combined with sciatica to cause calf pain, raise the leg test is positive; at the same time see the calf and foot have radioactive pain.
4. MRI examination: This kind of examination is a great progress in the history of human imaging. It is more detailed and accurate than CT examination. It has a clear image display of human tissue, helping the diagnosis of cervical spondylosis, and through different levels of imaging. The data can clearly observe the shape of the lumbar vertebrae and the relationship with the surrounding nerve root tissue.
Diagnosis
Diagnosis and diagnosis of lumbar spondylosis
Clinical diagnosis of lumbar disc herniation and lumbar deformity:
According to the survey, about 30% of the normal healthy people have intervertebral disc bulging or prominent, but there is no clinical symptom, and some of the patients with low back pain or sciatica show normal imaging. It is a medical problem that needs to be explored. In actual work, we can't show the pathological changes of a certain intervertebral joint and intervertebral disc because of radiology or imaging examination. It is considered that this is the origin of the pain; on the contrary, it cannot be because the imaging examination has not found any abnormality. It is arbitrarily considered that there is no problem with the lumbar spine. At this time, a comprehensive analysis is necessary to investigate the root cause of the pain.
Spinal dysplasia is more common in the upper and lower ends of the spine, that is, in the upper neck and lower back. It is manifested as: the transitional vertebrae, the adjacent vertebrae merge, the left and right asymmetry of the spinal structure, and the defect of a certain part of the spine (such as spine fissure). The appearance of excess bone, etc. They are asymptomatic. They often find X-ray examinations of other diseases. As they grow older, they will gradually develop neurological symptoms such as low back pain. At this time, they should be differentiated from lumbar disc herniation. The details are as follows.
Transitional spine:
At the junction of the cervical, thoracic, lumbar, and atlas of the spine, they can move to each other, such as lumbar vertebrae, lumbar vertebrae, lumbar vertebrae, thoracic spine, etc. The most common site is the lumbosacral region. This accounts for about 1/3 of the X-ray examination of patients with low back and leg pain.
Articular deformity:
The direction of the articular processes on both sides is often asymmetrical, more common in the lumbosacral region, followed by L4 and 5. The direction and shape of the articular process have a great relationship with the movement of the spine. If the arrangement of the facet joints is consistent, the movements in the various directions of the spine will be coordinated; if the two sides are asymmetrical, the movement of the spine in all directions will be difficult to coordinate, resulting in The strain of the facet joints, ligaments, and surrounding muscles, which causes lumbar and leg pain, sometimes accompanied by intervertebral disc herniation in the upper space of the deformed articular process.
Spinous process deformity:
The spinous process is the secondary bone center, which fuses around the age of 25. The most common variations are:
1. Contact with spinous processes: In normal cases, there is still a certain distance between two adjacent spinous processes when the lumbar extension is extended, and the congenital spinous processes are too long, the lumbar vertebrae are excessively lordotic, the humerus is horizontal, or the disc is degenerated. When the intervertebral space is obviously narrow, the distance between two adjacent spinous processes becomes smaller. When the waist is extended, the adjacent spinous processes collide with each other and continuously rub, thereby forming a pseudo joint, so-called contact spinous process. With the continuation of time, it can cause synovitis or damaging arthritis, causing low back pain. When the waist is stretched, the pain will be aggravated. At this time, the back extension of the waist should be controlled, and the unreasonable posture should be adjusted to reduce the diseased spinous process. The impact, which is conducive to local congestion, edema subsided.
2, sickle-like spinous processes: verrucous spinous processes are more common in L5, the spinous processes are slender, and the distal end is bent backwards into the shape of a bird's beak, so it is called a sickle spine. Slim and curved L5 spinous processes can be seen on the lateral X-ray films. When the lumbar extension is active, the sickle spines hit the 1 lamina, causing local congestion, edema, or formation of burs, and low back pain; oppression When 1 nerve, the pain radiates to the buttocks and lower limbs; if combined with sacral vertebrae, it can cause low back pain, numbness of the perineum, falling sensation and abnormal urination. The treatment is mainly based on waist braking and limiting the extension of the waist.
3, sickle spinous process: the sacral spinous process at the atlas of the atlas of the atlas is fused with the L5 spinous process, which is similar to the sputum. Therefore, its pathological changes and treatment principles are similar to the sickle spines.
Recessive spine:
It is a developmental disorder in the embryonic cartilage center or ossification center. The vertebral arches on both sides do not heal in the posterior part, and the lamina and spinous processes leave different degrees of fissures. Occurs in the lower lumbar spine and the upper atlas. When only the bone is involved, it is called a recessive sacral spine; if it is accompanied by a sacral or spinal bulge, it is called a dominant spine. It generally only involves one segment, the light one has only one crack, and the severe lamina is completely absent. The recessive spine fissure has fibrous tissue coverage, which may have pigmentation of the lumbosacral skin, hair growth or small lipoma-like changes, generally asymptomatic, but the lumbosacral weight is too large and active during adulthood. Some of the ligaments and muscles lack attachment points or are not firmly attached, which tends to form lumbosacral strain.
The principle of treatment is to adjust the posture of daily life and work, and strengthen the exercise of the back muscles so as to be able to compensate for its congenital defects.
Lumbar vertebrae and disc herniation:
After the disc is protruded, the intervertebral disc becomes thinner, the vertebral body space becomes narrow, the ligament is loose, the intervertebral body activity increases, and tiny, repeated, cumulative damage occurs at the edge of the vertebral body, resulting in minute local bleeding and exudation, bleeding. And the gradual calcification of the exudation, so that in the local, that is, the upper and lower edges of the vertebral body, there is a proliferative reaction of the bone, which is the bone spur, that is, bone hyperplasia. Lumbar vertebrae hyperplasia manifests in a variety of X-ray films, generally "lip-like bone hyperplasia", but also can form a "bone bridge".
Clinically, there are often lumbar vertebrae and lumbar soft tissue soreness, stiffness, fatigue, and even bending down. For example, compression of the sciatic nerve can cause sciatic neuritis, severe pain in the affected side and radiation to the lower extremities, numbness in the calf and chills and weakness.
Lumbar vertebrae hyperplasia and lumbar degeneration, disc herniation, intervertebral disc thinning, there is a direct relationship, so the treatment of lumbar disc herniation must be able to treat bone hyperplasia at the same time, otherwise the effect is inevitable.
