Lumbar osteochondrosis symptoms
Lumbar osteochondrosis due to anatomical and physiological features, has its differences from osteochondrosis of cervical and thoracic localization and is characterized by the following symptoms.
1. Absence of spinal pathology due to the fact that the spinal cord ends at the level of L1;rare exceptions occur with lesions of radicular arteries, up to the cone syndrome.
2. The clinic of lumbar osteochondrosis is mainly caused by disc damage( hernia, rupture, instability, etc.) and to a lesser extent by bone-change( osteophytes).
3. In the first place are put forward pain, radicular and static syndromes, and vegetative disorders disappear into the background.
4. A more pronounced traumatic factor in the development of the disease.
T.I.Bobrovnikova( 1967) confirms this dependence.
Slightly expressed pain syndrome( 1 degree):
- dull pains in the lower back and leg, cold extremities, numbness and other unpleasant sensations;
- the appearance of pain in sharp inadequate movements - forced
tilt, turn, sudden transition from one posture to another, shaking, lifting
of gravity in an uncomfortable position, prolonged stay in a non-rational position;
- some restriction of movements in the lumbosacral department;
Moderate pain syndrome( grade II):
- minor restless pain, sometimes stopping for a while, appearing in movements, inclinations, and lifting of gravity;
- possible long stay in one position;
-an effortless tension of the paravertebral muscles;
- restriction of movements in the spine;
is a mild symptom of tension.
Severe pain syndrome( grade III):
- the patient can be in one position for up to 1 hour, preferring a position on the healthy side and on the AIDS with bent legs;
- increased pain during movement, coughing and sneezing;
- short-term pain reduction during a short sleep;
-step with reliance on surrounding objects and movement with difficulty,
limping on an aching leg in an antalgic pose or with an emphasis on the knee;
- tension of the lumbar muscles;
- absence of movements in the spine;
is a rough symptom of tension.
Acute pain syndrome( IV degree):
- severe pain in rest( the patient can not lie in one position for more than 5-10 min), worse with coughing, sneezing, trying to move;
- forced position on a healthy or diseased side with bent
and abdominal legs, knee-elbow position, etc.
- insomnia due to pain, irritability, agitation.
- getting up with help, walking with crutches and walking stick, with an emphasis on the knee, pelvis;
- a sharp tension of the paravertebral muscles;
- absence of movements in the spine;
is an absolute and gross symptom of tension.
Sensitivity impairment. Such disorders in the limb,
developing in the pain zone and characteristic of the far-advanced
disease, were noted by us in 53% of patients. Sensitive disorders, as well as radicular pain, are projection, i.e.
their localization does not coincide with the source of local irritation. Hyperesthesia was available only in some patients, anesthesia of individual sites. More characteristic was a decrease in pain and tactile sensitivity( hypoesthesia).Usually the zones of sensitivity disorder were located in the form of bands that capture the gluteal region, along the thigh, lower leg, less often the foot.
Paresthesia( abnormal sensations experienced without irritation from the outside) in the form of a sensation of tingling, crawling, etc., often combined with hypoesthesia. Even in the absence of impaired sensitivity, many patients referred to paresthesia in the diseased limb, which displayed the 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.
The diagnostic value of the sensitivity sensitivity topography is treated differently. Known schemes of innervation dermatomes of Ged, Dezherin, Kigan, etc. differ from each other by individual variability due to mutual overlapping of dermatomes. In our work we used the Kigan scheme.
Irradiation of pain and sensitivity disturbance in the area of the rear of the foot, 1 finger( sometimes and adjacent fingers) more often testify to the compression of the rootlet L5( disk L4-5).If these changes are detected along the outer edge of the foot and heel, there is compression of the spine S1( disk L5-S1), but here as well
errors in determining the level of damage. According to Spurling( 1955), one can obtain correct information only when examining the distal part of the shin and foot dermatome. If these zones do not extend to the foot, the localization is even more difficult. As for paresthesias, they
to an even lesser degree can serve as a benchmark for this.
Set the level of damage based on sensitivity disorders can be less than half of patients. Thus, data on sensitivity disorders are of diagnostic value, but are an inadequate criterion for accurate preoperative diagnosis.
Symptoms of tension. There are many painful reflexes of
tension;of them the most persistent symptom of Lasega, described in 1881.The essence of it is the appearance of pain in the elongated leg when it is raised. If at this moment to bend a leg in the knee, the pain disappears. The cross symptom of Lasega( Bekhterev's symptom) is the appearance of pain on the side of the lesion with
lifting a healthy leg. The cause of this symptom is the additional displacement of the irritated root. Charnley( 1951) investigated the mechanism of Laseg's symptom on corpses after removal of vertebral bodies. When lifting the leg, the rootlet was displaced by 0.4-0.8 cm. It stayed stationary until the leg rose 30-40 °, the
then began to move. Based on these data, the author came to the conclusion that the expressed Lasega symptom, i.e.the appearance of pain when raising the leg to 30-40 °, is associated with a mechanical cause located outside the spine, and is caused by a lesion of the disc. The same opinion is shared by most of the authors.
They consider Laceg's symptom almost constant with posterior protrusions of herniated disc. Lasega's symptom is assessed as a dramatically positive if the pain in the leg appears when lifting to 40 °, as positive - when rising to 60 °
and as a weakly positive-over 60 °.In some cases, the
Lacega symptom can confirm the discogenic nature of the disease without indicating, however, its localization. In most of the patients we observed, it was sharply positive and positive, especially with exacerbations, and was absent in 12.6% of patients. If at the height of Laceg's symptom, i.e.when the leg is unbent, do additional back folding of the foot, the pain is sharply increased( Bragar's symptom).
Other signs of tension include the appearance of lumboschialgic pains when bending the head( Pery's symptom), with increasing liquor pressure( a symptom of Dejerine, or a cough thrust), with extension of the leg in the hip joint( Wasserman's symptom) and bending at the knee joint( Mackiewicz symptom).The last two symptoms are determined in the
position of the patient on the abdomen. Atrophy and paresis of muscles. In 57% of the patients
was found atrophy of the muscles, most noticeable on the shin, where the circumference difference was up to 3 cm. In the same patients, the muscles of the buttocks and thighs were also atrophic to varying degrees. The gluteal fold on the patient side was located below. Atrophy of the muscles was always accompanied by a decrease in their tone. Movement disorders were expressed in the paresis of certain muscle groups. Thus, the weakness of the long extensor 1 of the finger is most often characteristic for the compression of the U, and the weakness of the gastrocnemius muscle for the root S1.In the case of the paresis of the extensor of the foot, patients experience severe difficulties when trying to walk on the heels, with the calf muscles or the flexors of the foot, on the contrary, when walking on tiptoes and stairs. In addition, pareses are detected by ordinary resistance tests. When paralysis of two roots-L5 and S1-the complete drooping of the foot is observed. However, steely paresis, and not shy because of pain in lumbar osteochondrosis are rare.
Massive flaccid paralysis often develops when the pony tail is compressed by the median hernia of the disc or loose by its
Violation of reflexes. The diagnostic value of changes in the
of the knee reflex is very small, since this
reflex can be reduced by affecting not only L3, but also the underlying lumbar discs. Of great value are the data on the violation of the Achilles reflex, characteristic of both hernia L4-5 and L5-S1.Only with the complete absence of the Achilles reflex can we more definitely speak about the lesion of the lumbosacral disk.
Pair tail compression syndrome( paralytic sciatica).
The most severe necrotic complication of lumbar osteochondrosis, caused in all cases by massive disk prolapses or migration of their fragments into the lumen of the spinal canal in an epidural manner.
There are three variants of the development of the horse tail compression syndrome.
1. Slowly but steadily progressing against the background of constant lumboschialgic pains development of compression of horse
tail. This option is especially difficult for differential diagnosis with spinal tumors.
2. Progressive development of compression with remissions of lumboschialgic pain syndrome,
3. Acute stroke development of compression of the cauda equina. This variant( the most frequent) is caused either by sudden movement of the disk sequestration, or by a violation of blood circulation in the lower parts of the spinal cord during compression of the radicular artery. At the moment of physical strain or awkward movement of
against a background of lumboschialgia, a sharp pain syndrome like
lumbago occurs, and within a few minutes or hours a stop paresis, saddle anesthesia of sacral segments and delay of urination develop. Following the development of paresis and anesthesia, pain and vertebral syndromes disappear.
Vegetative disorders of .Degenerative changes of intervertebral discs are often accompanied by a number of vegetative disorders. Their source is irritation of numerous afferent vasomotor vessels and reflex spasm of vessels under the influence of pain sensations. Burning, stitching, itchy pains, their intensification in connection with the change of weather, cooling are often sympathetic. Radicular pains, unlike them, are & lt; sweeping & gt;and strictly localized, including the fingers, are strengthened by coughing and sneezing. To vegetative disorders are also symptoms of a trophic nature - cyanosis, sweating disorders, dryness and peeling of the skin. These disorders are zonal and correspond to the affected nodes. Characteristic vasomotor disorders in the form of chilliness of the limb, lowering of skin temperature, spasm, and sometimes( rarely) disappearance of the pulse.
Reflected visceral syndromes in lumbar osteochondrosis have been studied little, except for the so-called neurogenic bladder. Rough violations of its function in the form of delay or true urinary incontinence( with full compression of the roots of the horse tail) have always been accompanied by a flaccid paralysis of the detrusor, sphincter, pelvic floor muscles and anesthesia or hypoesthesia in the anogenital area.
Static violations. Smoothness, or complete absence, of lumbar lordosis( a symptom of a flat back, strings).Compaction of lumbar lordosis in the presence of protrusion is an adaptive response that provides a reduction in the volume of posterior hernial protrusion of the disc, which leads to a weakening of pressure on the spine. Here it is necessary to stop on a syndrome of an opposite nature, rarely encountered with lumbar osteochondrosis - hyperlordosis in the form of a fixed extension. In this case,
& lt; proud & gt;gait, impossibility of movements in the hip
joint with knee flexed in the knee. When trying to bend the leg in the hip joint with the straightened leg rises the trunk( a symptom of the board).Fixed hyperlordosis is a syndrome of various pathological conditions, with pain and radicular symptoms uncharacteristic. The exception is lumbar osteochondrosis, where it is rare and occurs with a marked pain symptom. Naturally, this does not include cases of hyperlordosis, caused by the displacement of the center of gravity anteriorly. The effect of
traction therapy was almost nonexistent.
Pshialgic scoliosis is a reflex response of the body, aimed at reducing pain. When scoliosis changes the position of the nerve root, which shifts in the direction opposite to the hernial protrusion of the disc.
Perhaps this is due to the examination method, since on X-rays made in the horizontal position of the patient, a slight degree of scoliosis is sometimes not detected. In more pronounced cases, we detected S-shaped scoliosis due to the attachment of the compensator iiOro curvature in the thoracic region to the lumbar scoliosis. More often scoliosis was homolatzralnym, less often heterolateral and only in some patients-alternating. Patients with an alters scoliosis could arbitrarily change the side of scoliosis: the side of tension of long back muscles changed;they could not straighten their spine. More expressed degrees of scoliosis were more common with lesions of the L4-5 disk than L5-S1.This pattern still does not make it possible in each case to determine the localization of the affected disc.
The limitation of spinal mobility in most patients is expressed in antalgic
In an effort to reflexively increase the lordosis even in a horizontal position, the patient puts a pillow under the abdomen, and with sharp pains,
often takes a knee-elbow position.
Usually mobility is limited in several planes, but more often there is a restriction of extension and flexion. In curvimetric terms, the
restriction was 15 to 20 mm instead of 30 mm normal.
Charnley( 1951) notes that the inclination of the trunk to the front corresponds to Laceg's symptom in the position of the patient lying down. Often patients could not reach out to the ankles with their hands and used a stick to take off their shoes. At the same time, the trunk remained almost immobile, and the slope was due to flexion in the hip joints and to an insignificant extent due to the thoracic spine( as in tuberculous spondylitis).
The instability of the lumbar spine is a consequence of the weakening of the fixation function of the disc. Initially, it manifests itself compensatory permanent contraction of long back muscles, which over time overwork. The crumbling and displacement of the vertebra are detected on functional radiographs. The spine of such patients does not withstand vertical loads, especially when sitting, when they are much larger than standing.
Patients complain of rapid fatigue and lack of confidence in their back. Some of them could sit, only resting on the chair with their hands and then no more than 10-15 minutes, after which they were forced to take a horizontal position. For this reason, many patients could not attend cinema, theater, etc.
Some of them used for years unloading corsets.
The increase in the tone of the paravertebral muscles( more often on the side of the scoliosis) is revealed in the form of a rigid dense shaft. In neglected cases, when patients spend most of their time in bed or move with crutches, the muscles of the back develop atrophy. In such patients,
has a hypotonia of the gluteal muscles in the form of a gluteus fold on the diseased side.
Questions of conservative therapy of lumbar osteochondrosis are relevant not only in connection with the large spread of this disease, but also because the vast majority of patients with success are treated conservatively. Our experience is based on the use of conservative methods of treatment in 1495 patients.
Immobilization of the spine .We attach great importance to discharge corsets of light type, which ensure a reduction in the axial load on the spine due to the transfer of part of the body mass to the ilium. The corset moves the trunk in front and bottom from behind and up in the direction of the spine, which is especially beneficial with the concomitant sagging stomach. Persons performing physical work are advised to wear a weightlifter belt.
Relief with external immobilization of the spine occurs rather quickly, especially with lumbalgic syndrome and instability phenomena. However, limiting the pathological mobility in the affected segment of the spine, the corset to some extent immobilizes and healthy segments, leading to muscular atrophy. Therefore, wearing a corset or belt should not be permanent and long and necessarily accompanied by medical gymnastics and muscle massage.
Often the positive effect of wearing a corset, without which the patient can not do without, serves as an additional indication for the operation, the internal fixation of the affected segment.
Expressed and long-term existing static disorders in the form of a combination of scoliosis with kyphosis, especially continuing for more than 3-4 months, take a structural nature and conservative treatment usually does not lend itself. In such cases, an error is the appointment of a corset, since it is unloading, not corrective. Radulescu's( 1963) statement about the dangers of an orthopedic corset is quite suitable in such situations: & lt; It should not be forgotten that so many corsets are a curtain, followed by a drama of spinal deviation, deformation and a decrease in muscle strength & gt; .
Mode. It should be considered unreasonable recommendations of some authors to increase the mobility of the spine & lt; for kneading & gt;in the period of exacerbation. Harmful also is prolonged rest, which leads to osteoporosis and to even greater muscle hypotrophy. All patients during an exacerbation are assigned
bed rest on a rigid shield under the mattress, which provides unloading of the affected segment of the spine, helps reduce internal disk pressure and reduces the tension of the roots. At the same time, conditions are created for the scarring of the ruptures of the fibrous ring. Bed rest for 8-10
days rather quickly leads to a reduction in pain, especially with the short duration of the disease.
Based on this, we believe that in the acute period the patient should be treated either in the hospital or at home, but not out-patiently, as is often the case when the patient hardly gets to the clinic to get a physiotherapy procedure or an injection of vitamin B1 and vitreous.
Looking ahead, we note that we are also opponents of premature discharge of the patient from hospital to outpatient care, if there is practically no effect of conservative therapy. Such outpatient treatment is often delayed for months, and the patient remains incapacitated.
Conservative treatment in a hospital should lead to the disappearance or significant reduction of the pain syndrome, and a few days after discharge the patient should start his or her facilitated work, continuing to follow the recommendations for prevention. If the pain syndrome does not stop,
should be asked about the operation.
Extension( traction treatment). Is pathogenetically
grounded method. TI Bobrovnikova( 1966) established radiographically an increase in the height of intervertebral foramen to 4 mm, and intervertebral disc-up to 3 mm with horizontal traction. However, the unloading of the posterior parts of the disc can be achieved by flexing the legs in the hip and knee
joints. As for the traction force, until recently there has been a purely empirical approach to this issue due to the lack of data on the state of internal disk pressure by the tendency to use large loads. The negative impact of large loads, even when stretched over an inclined plane, was expressed by the intensification of the pain syndrome and muscular tension.
We came to the following conclusions.
1. Extension in the position of passive flexion( reduction of lumbar
lordosis) allows to reduce the internal disk pressure regardless of the stage of degeneration.
2. The reaction of the internal disk pressure on the traction is in the straight
depending on the degree of degeneration of the disc. In the initial stage of disk degeneration, loads of 15 to 35 kg cause a smooth decrease in the internal disk pressure of
( an average of 0.9 kg / cm "for initial doses of 3.1-2.3 kg / cm").Further increase of the cargo does not change the figures reached. With pronounced degeneration of the
, perverted reactions appear: the decrease in the internal disk pressure occurs only with the extension by small loads;an increase in weight( over 20 kg)
causes an increase in internal disk pressure( within 2 kg / cm.) Consequently, the traction in these patients should be carried out with small loads and at a slow pace
3. Preliminary physiotherapy with an analgesic and antispasmodic action allowstraction of small
with loads up to 20 kg with a maximum reduction of the internal disk pressure up to
0,7 kg / cm
The simplest method is pulling on an inclined plane with a mass of own body with an elevated goalat the end of the bed and fixation by soft rings for axillary basins. The duration of the traction is 4-6 hours per day in
for 3-4 weeks. The body mass often pulls out
with kyfization for the elimination of lordosis
The wearing of the corset after extension is mandatory.
is difficult to dose, and they are not always easily tolerated by patients. It is used for the purpose of restoring
normal muscle tone: improving lymph and blood circulation
in the affected segment and aching limb, strengthening the back muscles, abdominals and extremities, eliminating posture disorders. In the first period of the course of exercise therapy, the basis is the exercises aimed at relaxing the muscles in a state of protective tension and improving the
anatomical relationship between the structures of the spine, which helps to reduce the pain syndrome. The exclusion of the axial load on the spine is achieved by using the original lying positions( on the back, on the side, on the abdomen) and standing on all fours. Even more effective is the unloading of the spine when doing gymnastic exercises in "water." In the second period of the course, the main goal is to increase the stability of the spine.
Pain syndrome. The main complaint of the patient with lumbar
osteochondrosis is pain. They can only be in the lumbosacral region( lumbalgia), in the lumbosacral
area with radiating in the leg in the overwhelming majority of
patients( lumbosciagia) and only in the leg( ischialgia).In 128 cases of
, there were pains in the lower thoracic and upper lumbar regions. The disease almost all began with the appearance of lumbosacral pain, which eventually( usually in 1-3 years) began to irradiate to the lower extremities( more often on the one hand).Lumbosacral pains were diffuse,
was blunt and aching, increased with awkward and abrupt movements, change in the position of the trunk, and with prolonged stay of
in one position. In the horizontal position, the pains decreased significantly. The onset of pain or exacerbation is usually preceded by a prolonged stay in an uncomfortable position, physical overload. Being in a bent position, patients with difficulty unbend, they find it difficult to wash, brush their teeth, wash, iron.
Radicular( irradiating) pains were predominantly
stitching. For a long time the pains were localized
only in the gluteal region or at the level of the sacroiliac joint;less often they occurred immediately in the region of the thigh,
leg and foot. In all patients, radiating pains are recorded in only one leg. With bilateral pains, their intensity was still greater from any one side.
Pains were more frequent. In a number of patients with a sharp inclination of the trunk, pains appeared like the passage of a current. For the most part they were very intense, the patients did not sleep well, lost their appetite, moved with difficulty, and sometimes( weeks or even months) could not get out of bed. The disability was sharply reduced. Pain intensification was noted with
coughing, sneezing and especially with shaking, so some patients could not use the bus. In a number of cases, relief was brought by a forced situation: lying on his back, bent on a healthy side, on all fours, with a pillow under his belly or squatting. In untrained, muscular-weakened patients who are mainly engaged in mental work, the unusual physical load of
, for example, the carrying of weights, caused the
to aggravate pain only the next day, even after resting
(
to us: first, the compression of the affected disc slowly increases with asymptomatic protrusion of the sites of the pulpous nucleus in the cleft of the fibrous ring. Gradually, the swelling of the disc blocks the parts of the nucleus with a sharp, irritating nerve receptors. With lumbago, on the contrary, rapid compression of the disc leads to the infringement( blocking) of the nucleus sites almost instantaneously, and then edema develops.
We will not dwell specifically on the moderately expressed in persons of elderly and senile vertebral pains, mainly morning ones, accompanied by a & crunch, & lt; cod & gt;and lack of mobility, caused by secondary spondylarthrosis in small joints;disks by this time partially
are blocked by fibrosis. These pains usually disappear after a warm-up, gymnastics and walking.
In half of the patients, the disease started with lumbar puncture( lumbago, or & lt; acute disc & gt;), which appeared suddenly when trying to lift the weight, at the time of a sharp tilt or extension of the trunk, and lasted for several days. In this case, there were extremely severe pain in the back of the
or the lumbosacral region, fixing the trunk in a bent position. Patients could not move, because any movement caused a sharp increase in pain. The muscles of the back are very tense( symptom & lt; of the locked back & gt;).Discography performed in patients with the clinic & lt; acute disk & gt; showed that the
always has a rupture of the posterior sections of the fibrous ring, and often hernia protrusion. Subluxations of intervertebral joints in patients of this group do not occur
Lumbago is caused by the sudden movement of a fragment of the nucleus into the crack of a richly innervated fibrous ring. Reflex muscular contracture at the same time blocks the affected segment, prevents complete loss of the fragment, but also closes it back way. Spontaneously or with movement, a release can suddenly occur with the return of the displaced fragment to its place and the rapid disappearance of the pain syndrome.
Dynamic observation of patients with lumbar osteochondrosis revealed a direct dependence of the severity of the clinical picture of the disease on the intensity of the pain syndrome.
They are used to combat pain. We are very skeptical if the main emphasis is put on medical treatment. Often, patients who received many hundreds of injections of vitamins, aloe, vitreous and who took a colossal amount of tablets analgin, sedalgin, etc., are looking for new drugs.
Drug therapy for osteochondrosis we assign a modest
place. When prescribing analgesics, one should not give preference to a certain type of drug( acetylsalicylic acid, amidopyrine, analgin, reopyrin, etc.).Much more important is their regular use and in a large dosage, for example rheopyrin or salicylamide, 0.5 g 4 times a day, 50% solution of analgin or pyrabutol 2 ml intramuscularly 2 times a day. The combination of analgesics with neuroplegics and ganglion blocking agents( aminazine, dimedrol, pipolfen, pahikarpin) enhances their effect. Sedatives can be used bromides, trioxazine, meprobamate in usual dosages.
In order to improve neuromuscular conduction with decreased function of the nerve root( weakness in individual muscle groups, decreased sensitivity), for 15-20 days, prozeryn, galantamine, nivalin, a complex of B vitamins and nicotinic acid should be prescribed to patients: B12 - daily 500μg, 5% solution B1-1 ml, Be( pyridoxine) -to 0.02 g 3 times a day, Bg( riboflavin) -to 0.1 g 3 times a day, nicotinic acid - to 0.025 g 3 times per dayday.
Due to the involvement of the sympathetic nervous system in autonomic disorders, pain reduction can be achieved by small doses of ganglion blockers( pachycarpin, platyphylline, padutin).This treatment is desirable to combine with the use of diphenhydramine. A synergistic anti-inflammatory and analgesic effect is exerted by the combination of phenylbutazone with amidopyrine.
Biogenic stimulants( aloe, vitreous) possess resorbability properties. On this mechanism, the action of bee and snake venom is based. However, some caution is required with the parenteral administration of these drugs, since allergic reactions are possible. The pronounced therapeutic effect from the use of biogenic stimulants was not observed.
Blockades of .In patients with osteochondrosis, 0.5%
solution of novocain in the form of deep paravertebral blockade,
, i.e., the introduction of the solution to the arches and transverse processes of L5,
L1 and L5( 15 ml at each level) is often used in patients with osteochondrosis. The analgesic effect is unstable.
The best results were obtained from the use of epidural blockades through hiatus sacralis( Cathelen, 1903).This method can remove unbearable pain, when other methods of treatment were ineffective, and it would seem that there were all the prerequisites for urgent surgical intervention.
In conclusion, it should be emphasized that the comprehensive treatment of
does not mean the use of all methods. The approach should be individual, as the template in treatment often leads to failures. Conservative therapy for lumbar osteochondrosis
should be purposeful, taking into account orthopedic, pain and reactive factors, as well as the features of the course and phase of the disease. The question of the sequence of individual types of treatment, which is of great practical importance, is little covered in the literature. Long-term observations allowed to develop a certain sequence of complex conservative therapy, taking into account the stage of the disease, according to the following scheme.
Period of exacerbation: 1) bed rest( 6-8 days);2) painkillers( large dosages of analgesics for 5-6 days);3) Novocain blockades( preferably epidural);4) physiotherapy( currents of Bernard, UFO, UHF);
5) traction with small loads;6) vitamin therapy;7) dehydration;8) ganglion blockers;9) sedatives.
With the reduction of acute pain: 1) therapeutic gymnastics;2) physiotherapy( inductothermy, ray-58, ultrasound);3) hydrotherapy( coniferous-saline, radon baths);4) traction: 5) massage of the muscles of the back and lower limbs;6) vitamin therapy;7) sedatives.
It is clear that the developed scheme can not always be strictly observed. The age of the patient, concomitant diseases, individual & lt; intolerance & gt;to some medicated remedies, such as novocaine. It is especially necessary to take into account the results of previous treatment.
The duration of treatment under stationary conditions is usually 1-1 / 2 months.
Estimating the immediate results of complex treatment of patients with lumbar osteochondrosis, it can be noted that most of them managed to eliminate the pain syndrome. More modest results have been achieved in eliminating static( mainly scoliosis) and especially neurological disorders.
For this, reflex and isometric exercises,
, are used to strengthen the muscles of the back and abdomen without increasing mobility. In addition, it is advisable to use exercises for self-stretching and more vigorous massage techniques with the mandatory wearing of a corset or a wide belt. Physiotherapy is prescribed for all patients. In the acute period, classes are conducted by an individual method in the ward( in bed), and after an acute period - by a group method in a special room( study).
Massage. Assigned to restore the normal tone of the
( usually the hypotrophic muscles of the lower limbs) and reduce muscle contractures in the lumbar region. The entire lumbar and lower thoracic parts, gluteal region, and also the lower extremity on the side of the lesion are massaged.
Massage should be applied daily for 20-30 minutes. In the first days of treatment, massage should be cautious( stroking, mild kneading).By stihanii acute phenomena massage is carried out more vigorously. Favorable results are provided by
water massage performed by a water jet at a pressure of 2.5 atm, through a water layer for 10-15 minutes. The course of treatment is 10-15 sessions.
We give indications and contraindications to traction treatment for lumbar osteochondrosis.
Indications:
1. Osteochondrosis with a sharp discalgic syndrome( & lt; lumbago & gt; , sharp rupture of the disc) - and preferably underwater traction.
2. Osteochondrosis with exacerbation of lumboschialgic syndrome( vertebral and radicular disorders) - preferably underwater traction.
3. Osteochondrosis with chronic lumbargia and lumboschialgia - underwater or & lt; dry & gt;extension.
4. Post-traumatic osteochondrosis( mainly after
of uncomplicated compression fractures of the spine) -underwater or & lt; dry & gt;extension.
5. Secondary osteochondrosis on soil: a) Static disorders( scoliosis, limb shortening);b) the anomalies are different or & lt; dry & gt;extension.
6. Recurrence of herniated disc after postoperative operation at the post-
sphynx - preferably underwater traction. Contraindications:
. 1.Osteochondrosis with horse tail compression syndrome,
, mediated by mechanical factors( herniated disc)
or vascular disorders.
2. Deforming spondylosis with the presence of a block of osteophytes.
It should be noted that not every form of osteochondrosis is an indication for an operation of anterior spinal fusion. Most neurosurgeons limit the testimony to anterior spondylodesis. Wiltberger( 1963), Rens( 1969) and
et al consider this operation to be shown in severe lumbargia,
lumbago, disc damage in combination with spondyloarthrosis, and in the presence of disc herniation in persons engaged in heavy( physical labor.) In all other casesin the opinion of these authors, should be postponed to a later date if removal of the hernia is ineffective. Other authors( mostly orthopedists) adhere to the opposite point of view. Thus, L. Tsivyan( 1966) considers such operations to be shown in all casesPlumbar osteochondrosis not accompanied by compression of the ponytail
As can be seen, there is still no consensus on this score, while the effect of surgical intervention mainly depends on the strict separation of indications to the anterior and posterior accesses.
Based on the literature and experience, the followingindications for discectomy with anterior spondylodesis:
- pronounced disk degeneration with posterolateral
presence of protrusions, ruptures, with frequent exacerbations of the lumboishnalgia;
is a permanent lumbagia with frequent attacks of lumbago and
with marked spinal instability phenomena;
- spondylolisthesis occurring with severe pain syndrome:
- unsatisfactory results after surgery with posterior
access( relapses associated with the progression of osteochondrosis).
In all these cases, indications for surgery are determined by
only after failure of conservative treatment.