Osteochondrosis of the 3rd degree of the lumbar region is clinically manifested by constant aching, dull, pressing pains in the lower back, limitation of mobility, muscle atrophy of the lower extremities. Almost all vertebral segment structures are involved in the pathological process: vertebral bodies, intervertebral discs, ligaments, muscles, spinal roots, blood vessels. The functioning of not only the spine, but also of the pelvic organs is disrupted.
Treatment is started immediately, immediately after the diagnosis of the disease. Conservative therapy is ineffective in pathology of the 3rd degree. If the patient’s condition does not improve within a few months of taking the drugs and physiotherapy, then he is being prepared for surgery.
Features of the disease
Osteochondrosis of the lumbar spine of the 3rd degree is the final stage of degenerative-dystrophic pathology. His diagnosis means that the person ignored even the pronounced symptoms of the disease of 2 severity.
The lack of medical intervention often leads to disability of the patient. Conducting complex therapy of grade 3 osteochondrosis is often impractical because of the destructive changes that have occurred in the lumbar region. The intervertebral disc is almost completely destroyed, the ligaments and tendons lose elasticity and strength, and muscle fibers lose elasticity. The shape of the vertebral bodies has also changed. Their edges have become thinner, overgrown, and many bone growths – osteophytes – have formed on the surface.
But the greatest danger is a hernia of the intervertebral disc. With osteochondrosis of the 3rd degree, the posterior longitudinal ligament breaks, and the disc protrudes into the spinal canal. A hernia is formed – one of the main causes of acute pain and circulatory disorders. Compression myelopathy is even more dangerous. This is called damage to the nervous system as a result of compression of the spinal cord by osteophytes. The patient may lose motor and sensory functions below the affected area.
Often with osteochondrosis of the 3rd degree of the lumbar, not complicated by radicular syndrome or myelopathy, the pain is not as pronounced as with pathology of the 2nd degree. This is due to the presence of many osteophytes. They seem to stabilize the vertebrae and discs, preventing their displacement. But at the same time stiffness arises, provoking muscle atrophy (a decrease in muscle volume).
The pain at this stage of osteochondrosis becomes constant. Its intensity increases with inclinations, turns, after hypothermia or even slight physical exertion. If a bone growth or hernia compresses the spinal root, then there is a lumbago, or “backache”. The pain is sharp, piercing, causing a person to freeze in place for several minutes. When it appears in a slope, a person often needs outside help to slowly and carefully bend. Also for osteochondrosis of 3 severity, the following clinical manifestations are characteristic:
- a crunch in the back while walking, bending, turning the body;
- decreased sensitivity of the hips, buttocks, ankles, and sometimes feet;
- constant muscle tension, provoking an increase in the intensity of the pain syndrome;
- paresthesia – a disorder of sensitivity, characterized by feelings of numbness, tingling sensations, “crawling ants”;
- the adoption of a forced posture in which the severity of pain is reduced;
- gait change;
- visible curvature of the spinal column.
Patients with lumbar osteochondrosis of the 3rd degree move slowly, avoid making movements that can cause acute pain. In addition to vertebral symptoms, extravertebral syndrome occurs. One of its clinical manifestations is lumbar ischialgia. This is the name of pain that spreads along the sciatic nerve, the cause of which was the compression of its roots.
The involvement of the nervous system in the pathological process leads to a change in tendon reflexes. Often, patients at the doctor’s office complain of urination disorders, problems with bowel movements, decreased libido.
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It is easy to diagnose osteochondrosis of the lumbar spine of the 3rd degree. When examining a patient, displacement of the vertebral segments is revealed, and a series of functional tests can detect stiffness. When making the initial diagnosis, the patient’s complaints are taken into account, as well as the presence of a history of systemic chronic pathologies.
Radiography of the spinal column in two projections becomes the most informative instrumental study. Disks that undergo destructive changes and vertebrae are visualized on images.
With the help of MRI and CT, it is possible to assess the condition of muscles, ligaments, tendons, detect muscle atrophy and aseptic inflammatory process provoked by the breakdown of tissues. These diagnostic procedures are carried out in order to differentiate osteochondrosis from neoplasms, ankylosing spondylitis, osteomyelitis.
If it is necessary to study in detail the damaged lumbar segment, then discography is used. With damage to the spinal cord and nerve roots, electroneurography and electromyography are used.
Principles of treatment
Treatment of osteochondrosis of the 3rd degree of the lumbar is aimed at eliminating all clinical manifestations and stopping destructive degenerative processes. In acute pain, drugs are used in tablets or in the form of solutions for parenteral administration. Medical blockades are practiced, especially with osteochondrosis with radicular syndrome. The hormones Diprospan, Kenalog, Dexamethasone are used in combination with anesthetics Lidocaine, Novocaine.
Glucocorticosteroids relieve a person of pain for several days, but cannot be used often due to toxic effects on bone, cartilage and soft tissues.
|Clinical and pharmacological group of drugs for the treatment of lumbar osteochondrosis 3 degrees||Name of the drug and therapeutic effect|
|Nonsteroidal anti-inflammatory drugs||Diclofenac, Ketoprofen, Nimesulide, Ibuprofen, Ketorolac stop aseptic inflammation, reduce the intensity of pain and swelling|
|Muscle relaxants||Midokalm, Tolperizon, Sirdalud, Baclosan relax spasmodic muscles, eliminate compression of the spinal roots|
|Ointments with a warming, distracting, locally irritating effect||Capsicam, Viprosal, Finalgon, Nayatoks, Apizartron improve blood circulation in the lower back, accelerate the excretion of tissue decomposition products from the affected segments|
|Chondroprotectors||Teraflex, Alflutop, Structum, Dona, Rumalon partially restore connective tissue structures, and with prolonged use they have analgesic and anti-inflammatory effects|
Patients with grade 3 osteochondrosis are shown to wear bandages, corsets with rigid inserts to reduce the load on the lumbar. Physiotherapeutic procedures can reduce the intensity of symptoms: UHF-therapy, laser therapy, magnetotherapy, electrophoresis, shock-wave therapy.
If conservative treatment has failed, then in some cases traction or spinal traction is used. It can be dry, that is, carried out on a special orthopedic couch. But underwater traction is most effective. Traction helps to increase the distance between the vertebrae, eliminating the infringement of blood vessels, nerves, and spinal cord.
When diagnosing a pathology, many patients are immediately invited to resort to surgical intervention. An experienced doctor warns that with such degeneration of the vertebral segments, conservative treatment is inappropriate. The indication for surgery is a significant compression of the spinal cord. The surgeon removes the intervertebral hernia, decompresses the spinal canal. In severe lesions of the lumbar segments, patients are shown microdisectomy, puncture valorization of the disk or its laser recovery. The intervertebral disc can be replaced by an implant.
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