Lumbago, sciatica and lumbodynia
Lumbago (low back pain) - is suddenly an upcoming intense paroxysmal pain due to pathological process structures of the lumbar spine and intervertebral discs. Lumbago is exclusively and only vertebral (back bone) character. Of course, that intense pain may also occur in pathological processes in the abdominal cavity (urolithiasis, appendicitis, peritonitis, etc.). However, it is not lumbago, and its differential diagnosis is substantiated somewhat different clinic and physical examination data of patient's physician.
Low back pain (lumbago) - is suddenly an upcoming intense paroxysmal pain due to pathological process structures of the lumbar spine and intervertebral discs.
In the core of low back pain (lumbago) lies several mechanisms:
- rapid movement of the amended dystrophic process nucleus pulposus or part thereof in the direction of the fibrous ring and irritation of nerve receptors sinuvertebral Lyushka
- stretching or pinching of capsule-ligament apparatus of intervertebral (facet) joints in spondyloarthrosis
- acute attack of musculo-tonic syndrome (fibromyalgia) any of the psoas radiating to the back, sometimes the nature of herpes zoster, or shot in the leg
Lumbago usually occurs when an awkward movement, bending, heavy lifting, minor injury or spontaneously. Clinical manifestations of pain in lumbago patients figuratively represented as follows: "Beginning attack - as the impetus," the gap ", crunch, as the piercing stabbing pain in the deep tissues, like an electrical current, lightning, like a contraction (like pliers seized") or Straining, boring, mozzhaschuyu, sometimes tinged with burning or cold sensation, extending across the back or in its lower sections, usually symmetrically.
A patient with lumbago frozen in a forced posture, and his every movement intensifies the pain. At rest and horizontally pain in lumbago sometimes decreases. Intense pain in lumbago usually lasts up to 30 minutes, sometimes longer. When you try to get the patient with lumbago spare the waist. He first draws his hands behind the back, then stands on all fours and slowly rising as if myopathy, leaning his hands on the hips.
On examination the patient with lumbago detected voltage paravertebral muscles in the lumbar region. Patellar and Achilles reflexes in lumbago is not changed or increased uniformly, and paralicheynet paresis, the sensitivity is not compromised. When lumbago can be determined by positive symptoms Lasegue, Neri, Dejerine. After a few hours or days of pain in lumbago and decreases gradually goes away. Possible re-aggravation of pain or other transformation in the reflex and radicular syndromes of lumbar osteochondrosis.
Contradictory opinions of different authors on the occurrence of lumbago in people of different age groups. Do not exclude isolated cases of lumbago in adolescence and childhood, but in each case should be carefully differential diagnosis for exclusion of the primary processes of another nature.
By analogy with lumbago describe stenosoliyu (stenosis - narrowing, tightening; soleys - soleus muscle) - a painful, compress, mozzhaschuyu, burning pain in the depths of triceps legs. Stenosoliya arises paroxysmal and immediately is very intense, and the nature of pain is somewhat reminiscent constricting pain in the heart. When the sample Lasegue the pain in the buttocks and calves in the area. Such a state must be distinguished from krumping - painful tonic reduction triceps legs. Isolated cases of krump observed in children and adolescents.
Lumbodynia (pain) - a subacute or chronic low back pain as a result of disease spinal structures. Lumbodynia occurs predominantly in osteochondrosis of the lumbar intervertebral discs. In adults, childhood and adolescence lumbodynia occurs approximately equally often in boys and girls, only at the age of 17-18 years is dominated by males. The girls fell ill mostly at 11-12 years (mean 11.7 years), while the boys 13-17 years (average 13.7 years). This may be due to an earlier physical and sexual development of girls.
Lumbodynia clinically manifested by the presence of weakly or moderately severe pain syndrome in the waist and features a reflex-tonic muscular protection of the spine.
Lumbodynia (pain) - a subacute or chronic low back pain as a result of disease spinal structures.
Appearance of pain for lumbodynia usually precede the various external influences on the structure of the spine:
- contusion of the lumbar
- systematic physical fatigue or excessive physical exertion
- sharp, jerky movements
- work in an uncomfortable position
- acute respiratory infections
- exacerbation of focal infection foci
It was also established that the occurrence of pain in children lumbalgia often coincides with an intense increase in growth (up to 8-10 cm per year) and body weight, which contributes to the development of spine instability. Approximately 20% of patients with lumbodynia, mostly teenagers, in the lumbosacral region revealed a transverse whitish stripes (stretch marks, striae distensae). This is an indirect confirmation of the musculoskeletal inadequacies in the period of intensive growth of the skeleton.
The examination of sick children with lumbodynia in most cases is determined by pain paravertebral points and spinous processes. Strain of lumbar muscles in children with lumbalgia installed in approximately 25% of cases, it is much rarer than in adults. Rare occurrence of this musculo-tonic syndrome in lumbalgia can be explained by the fact that the stress of paravertebral muscle depends largely on the severity of pain is a protective reflex for the immobilization of the affected spine.
Symptoms of pain provocation ("tension") at lumbalgia moderately or weakly expressed and determined in about 1 / 3 of patients: the most commonly identified symptom Lasegue and in rare cases - Neri, dejerine, Vassermapa, Matskevich. Movement disorders and changes in tendon-reflexes during nadkostnichnyh lumbalgia absent. When lumbalgia in pure form is not as impairments of sensitivity.
The x-ray of spine in children and adolescents often (about 50%) was determined by flattening the lumbar lordosis, and Schmorl's hernia. Schmorl's nodule usually multiple, large size, often located in the anterior areas of upper lumbar vertebrae, sometimes cause distortion and reduce height of 1 or 2 vertebrae. In the lower lumbar vertebrae disc prolapses usually in the rear half of the sites. Small single Schmorl hernia, probably do not have clinical significance. In some cases they are significantly different from the classic mushroom shmorlevskih cartilaginous nodules and are a reflection of widespread destruction of intervertebral discs.
Pain syndrome (lumbodynia) in the presence of multiple Schmorl's hernia in most cases it is persistent and difficult to conservative therapy. Somewhat less for lumbodynia defined small antalgichesky scoliosis of the lumbar spine, often combined with the smoothness of the lumbar lordosis. Reducing the height of the intervertebral spacing is extremely rare.
In addition to these changes in patients with lumbodynia identify congenital anomalies of the lumbosacral spine:
- splitting of the vertebral arch - spina bifida
- lumbosacral transitional vertebra - lumbosacralization and sacralization
During lumbalgia can be long, chronic, with alternating periods of remission and recurrence of back pain. Even after the disappearance of pain for lumbodynia long the discomfort in the lumbar spine, indicating that defective or not carried out until the end of treatment and rehabilitation of the patient.
Sciatica - a subacute or chronic low back pain, radiating in one or both legs. As lumbodynia, sciatica include pain symptoms and syndromes appropriate location due to spine pathology, mostly osteochondrosis of the lumbar intervertebral discs. The emergence of sciatica usually contributes the impact of the same factors that when lumbalgia.
Sciatica - a subacute or chronic low back pain, radiating in one or both legs.
Sciatica on clinical signs and symptoms have some similarities with lumbodynia:
- with sciatica and lumbalgia patient revealed moderately or weakly expressed pain syndrome
- with sciatica and lumbalgia the same frequency of occurrence in children and adults, male and female
- sciatica and lumbodynia regarded as reflex syndromes of lesions of the peripheral nervous system caused by diseases of the spine
However, between sciatica and lumbodynia there are a number of quantitative and qualitative differences. Thus, when sciatica in almost all cases the symptoms are determined by the tension and strain of lumbar muscles is detected much less frequently than in adults with this pathology in children with lumbodynia. Unlike lumbalgia in patients with sciatica is sometimes easy hypalgesia on foot, on the side of the localization of pain may be a slight hypotonia and hypotrophy of thigh and shin. In addition, when sciatica may be reduced knee and ankle reflexes, marked autonomic disorders in the form of hyperhidrosis (excessive sweating) and chilly feet.
There are several clinical variants of sciatica:
- sciatica with leading musculo-tonic symptoms
- sciatica with vegetative-vascular symptoms manifestations
- sciatica with neurodystrophic symptoms manifestations
In childhood, when sciatica predominate musculo-tonic disorders, much less - vegetative-vascular disorders, and neurodystrophic form of sciatica in children and adolescents are not revealed, but this does not preclude its existence in this age.
The spinal X-ray at the same frequency as in the lumbalgia, revealed scoliosis of the lumbar spine, often combined with the smoothness of the lumbar lordosis. At the same time much less than lumbalgia, found Schmorl hernia, are more common, such indirect signs of lumbar degenerative disc disease as lowering the height of intervertebral space, fish vertebrae, lateral displacement of the vertebral body.
Congenital anomalies of the lumbosacral spine is much more frequent than in other clinical manifestations of lumbar degenerative disc disease (50%). They themselves do not lead to lumbosacral pain (sciatica), but help to reduce the static stability of spine and accelerate the development of degenerative changes in adjacent to the abnormality in the intervertebral disc at elevated exertion. It can be assumed that the sciatica in children, unlike lumbalgia occurs at lower external influences, while the more pronounced changes in congenital spine. This ultimately contributes to the development of subsequent radicular syndromes of lumbar osteochondrosis.
The patient with lumbago, sciatica lumbodynia and must comply with bed rest for 3-5 days and possibly lie on a hard surface. Recommended in the supine position under his knees lay a folded blanket or pillow to unload the lumbar muscles. In the side position for relief for lumbago, sciatica and lumbalgia can give lies between the knee pillow or cushion.
When moving or sitting the patient with lumbago, and sciatica lumbodynia should first in the supine position wearing lumbosacral corset.
Wearing a lumbosacral corset removes the pain of lumbago, sciatica and lumbalgia against the backdrop of osteochondrosis with hernia or protrusion of the intervertebral disc.
Of the drugs in lumbago, sciatica and prescribed lumbalgia dehydrating agents (furosemide, diakarb, Lasix), painkillers and nonsteroidal anti-inflammatory drugs (analgin, revodipa, reopirin, ibuprofen, voltaren, diclofenac, ksefokam, movalis) in combination with neyropsihotropnymi (radedorm, medazepam, Nialamide) drugs. In some cases, effective in lumbago may be analogues of carbamazepine (better finlepsin).
In the sequel by the patient with lumbago, and sciatica lumbodynia possible to choose a profession for which no place of increased physical load on the spine, temperature in the workplace, exposure to vibration, prolonged monotonous work in a forced situation.
Physiotherapy in the treatment of lumbago, sciatica and lumbalgia against spinal osteochondrosis with eliminating inflammation, pain and restores movement in joints and muscles of back.
Depending on the severity of symptoms and causes of lumbago, sciatica and lumbalgia against the backdrop of osteochondrosis with a hernia or disc protrusion in a patient, the following therapeutic action in our clinic:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic blockade - the injection of drugs into the cavity of the channel
- manual therapy (muscle, joint and radicular technique)
- physiotherapy (UHF, SMC, etc.)
- spinal traction (contraindicated in the acute stage)
- medical gymnastics and swimming (after primary treatment)
- surgical treatment
In the intervertebral joints of the lumbar spine (facet joints) can also be produced by therapeutic blockade. Blockade with local anesthetic and hormonal preparations are made for faster relief of pain and inflammation, and get an early positive clinical effect.
Typically, for therapeutic blockade sufficiently low doses of anesthetic (procaine, lidocaine) and cortisone injected into the lumen of the affected joint.
Acupuncture is effective in treating treatment of lumbago, sciatica and lumbalgia against the backdrop of osteochondrosis with a hernia, or protrusion of the intervertebral disc.
When combined with a properly chosen mode, physiotherapy, therapeutic blockade of these can give good and long-term effect in the treatment of lumbago, sciatica and lumbalgia in a patient with spinal osteochondrosis.
Questions for the diagnosis or treatment of lumbago, sciatica and lumbalgia can check them at our neurosurgeon or neurologist by phone:
- Ankylosing spondylitis (Bechterew's disease)
- Back pain in pregnancy
- Coccydynia (sore tailbone)
- Compression fracture of the spine
- Degenerative and hereditary myelopathy
- Epiduritis and spinal abscess
- Low back pain, pain in leg, Sherman Mau diseases
- Lumbago, sciatica and lumbodynia
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- Vertebral hemangioma (vertebral angioma)
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