Degenerative dystrophic changes in the spine. Degenerative-dystrophic changes in the lumbosacral spine

People of all ages suffer from problems, pathologies, pains of the spine. Instability of the vertebrae, their displacement, changes in the structure are most often the cause of pain and neurological disorders.

One of the many such diseases of the spine is degenerative dystrophic changes in the lumbar region.

The development of these changes in the spine contributes to a number of factors: heavy workload, sedentary, sedentary lifestyle, overweight.

Kinds

The most common cause of pain in the lumbar region is a degenerative dystrophic disease of the spine (osteochondrosis, spondylosis, spondylarthrosis). It is characterized by changes in vertebral tissues, transformations of intervertebral discs, joints, bone tissue, and ligamentous apparatus.

A change in the intervertebral discs due to a complex of dystrophic disorders leads to osteochondrosis. There is a progressive deformation - a decrease in the height of the disk, separation into parts, stratification.

The most common degenerative change is lumbar osteochondrosis. This is due to the heavy workload on this department. The aggravation and development of this problem is facilitated by:

spinal injuries (fractures, bruises);
overload;
predisposition;
age-related changes;
vibration and more.

Due to the functional congestion of the segments of the spinal trunk, the lumbar region suffers more often.

People suffering from osteochondrosis complain of dull, aching pain in the lumbar region, muscle spasms, aches and numbness of the limbs.

Osteochondrosis of the lumbar requires intensive, long-term, complex treatment.

Chronic disease of the spine, which is accompanied by degenerative-dystrophic disorders of the fibrous tissue of the intervertebral discs and the formation of osteophytes, is called spondylosis.

More often aged people get sick. Spondylosis can develop in any part of the spinal trunk, but the lumbar is more often affected.

Main reasons: static overloads, microtraumas, dynamic loads, metabolic disorders, age. Pain can be in the buttocks, legs, hips.

Possibly restricted mobility. Occurs when walking, vertical static load. The pain continues until the person leans forward.

Lumbar spondylosis progresses for a long time and is chronic.

Spondylarthrosis is a degenerative disease of the facet joints of the spine. Dysfunction of the facet joints leads to severe lower back pain.

It can develop independently, as well as simultaneously with osteochondrosis.

The reasons may be congenital anomalies of the spine, trauma, chronic microtrauma of the spine. Most often, pain occurs during the transition from rest to movement.

Exacerbated by tilting and turning the body back. Has a localized character.

The reasons

Degenerative changes can occur due to injury or in the process of natural aging of the body.

The cause of degenerative dystrophic disorders of the lumbar spine is either inflammation or pathological instability of micromovements. Or both together.

With the formation of an intervertebral hernia, proteins in the disk space irritate the nerve roots.

And the fibrous ring loses its strength, cannot withstand the load on the spine, which leads to great mobility in the affected area of the spine. All this together gives a huge constant pain in the back.

A complication of degenerative dystrophic changes is the formation of an intervertebral hernia. When a disc herniation appears, mechanical compression of the neurovascular bundle is also added, as a result, the pain intensifies and is permanent.

Symptoms

People who have degenerative dystrophic changes in the lumbar region feel constant pain, which sometimes gets worse. Symptoms may appear as the processes progress. Symptoms can be many, but most often they are:

a feeling of discomfort with certain body movements (turns, tilts, lifting weights);
numbness, tingling in the legs;
dull, aching pain in the lower back;
prolonged discomfort in the lumbar region;
neurological disorders;
more discomfort when sitting than standing, walking or lying down.

There are several stages of manifestation of degenerative dystrophic changes:

The first stage, when a person has pronounced pain in the lower back. The discomfort is so great that a person has to restrict movement. This makes it difficult to lead a normal life.

The second stage is characterized by limited mobility, backache, tingling in the legs.

The next stage leads to circulatory disorders. There are convulsions, numbness of the lower extremities.

And the most difficult stage, when paralysis or paresis occurs.

It is important to get decent therapy in a timely manner in order to avoid serious consequences.

Degenerative dystrophic changes in sections of the spinal trunk mainly develop as a result of chronic and acute overloads under the influence of all microtraumas.

With degenerative lesions, the vertebral bodies can move in different directions.

Treatment, diagnosis

When a patient sees a doctor with back pain, diagnosing such a disease is quite difficult, since many diseases can cause this.

Usually used in several ways:

X-ray examination.
CT scan.
Magnetic resonance imaging.
Comprehensive neurological examination.

It is undesirable to ignore pain in the lumbar region. By itself, this problem will not go away. And self-medication can worsen the condition even more. When prescribing treatment, the doctor must take into account all the features of the patient's body and make it complex.

Treatment methods:

physiotherapy procedures;
drug treatment;
physiotherapy;
swimming pool;
folk methods;
acupuncture;
surgical treatment (rare cases);
massage.

Such treatment anesthetizes, strengthens the muscular corset, removes muscle tension, and increases the blood supply to the spine.

At the moment, it has become possible to deal with the cause of such problems. Taking into account the severity of the consequences, treatment and diagnosis should be carried out in a timely manner, as well as by qualified specialists.

Degenerative-dystrophic changes in the lumbosacral spine is a slow destruction of the tissues of the intervertebral discs of the lower back. They cease to receive nutrition, dehydrate, become dry and lose elasticity. Excess weight and sedentary work lead to weakening of the back muscles and excess weight. As a result, the spine presses on the intervertebral discs, their structure is deformed.

Disk pathologies are dangerous because, as a rule, they can be detected only at critical moments. Preventive measures will no longer be able to help, and the patient will have to take medications, attend a variety of medical procedures. But treatment on its own may not be enough. After all, in order to improve the condition of the spine and prevent the development of serious complications, you need to reconsider your daily life as a whole.

What are degenerative-dystrophic changes in the lumbosacral region? To understand, let's look at how the intervertebral discs are arranged. These peculiar springs of the spine are composed of cartilage tissue. From above, they are covered with a denser fibrous ring, and inside there is a pulpous nucleus. The discs are normally quite soft, elastic - because they provide the mobility of the spine.

When the muscles can no longer withstand the load, they transfer it to the vertebrae. The spine is compressed, the disks are under pressure for which they were not designed. The cells of their soft cartilaginous tissues begin to die.

Intervertebral discs can also weaken and deform because their cartilage tissue is not nourished. This can happen because the vertebrae reduce the distance between them and squeeze the blood vessels and capillaries. Either an inflammatory process, a lumbar injury led to the same consequences.

The risk factors are as follows:

sudden movements, heavy lifting;
Inflammatory processes;
sedentary work;
Cold and drafts;
Unhealthy food;
Professional sports;
Disturbed hormonal background;
Elderly age;
Pathologies of metabolic processes;
Traumatic injuries of the vertebrae.

Most often suffer from problems in the lumbar spine people who move very little and at the same time are overweight. Usually the spine stabilizes the muscles, but if the muscles are weakened and excess weight constantly weighs down the back, even light household loads cause deformation of the discs. The modern lifestyle, as we see, increases the risk of developing dystrophic changes in the lumbar.

We advise you to read:

The course of development of pathology

It is in the lumbosacral region that the lion's share of tension falls, it is here that the intervertebral discs are most often deprived of the necessary nutrition. Cartilage tissues lose nutrients, regenerate worse, cease to be elastic.

The fibrous ring becomes fragile, the nucleus pulposus sharply loses moisture and dries up. As a rule, at the same time, more and more loads fall on the lower back, and the space between the vertebrae narrows even more. Excess tissue of the lumbar discs protrudes from the boundaries of the spinal column - this is called protrusion. And when the fibrous ring around the disc breaks its structure, breaks, the result will be first the release of the pulp from the disc, and then the disc itself from its place in the spine. This is called a hernia of the lumbar spine.

Protrusions and hernias pinch, squeeze the nerves, severe pain appears. The body turns on the immune system to protect itself from the source of pain. As a result of this protection, inflammation and swelling are formed in the lumbar region, which prevent the patient from living normally.

Degenerative-dystrophic changes in the lumbar spine develop imperceptibly, and when it is too late to engage in prevention, they strike a blow at the patient. Even if you are lucky, and no protrusions or hernias have formed, a person can get consequences such as osteochondrosis or sciatica.

Symptoms

Unfortunately, as long as the disease of the lower back does not endanger the patient's performance, the person is unaware of the disease in principle. It is not the degenerative process itself that has symptoms, but its complications and consequences.

It is worth responding to the appearance of the following sensations by visiting a neurologist or vertebrologist:

Stitching, burning or dull pain in the lower back;
The appearance of pain after exercise;
Pain after a long stay in one position;
Difficulty performing certain movements, such as tilting or turning;
Weakness in the legs;
Difficulty in urination, constipation;
Cold skin of the lumbar region;
Loss of mobility, especially in the morning;
Violation of the symmetry of the body;
Edema and red skin in the lumbar region.

There are four stages in the development of this pathology of the lumbosacral region:

At first, symptoms appear very rarely. True, often after physical exertion, people experience dull pain and a stiff feeling in the lumbar region. But almost always it is attributed to fatigue;
In the second stage, symptoms appear. It is much more difficult to move the back, it is difficult for the patient to bend or turn. It “shoots” in the back, that is, sciatica speaks about itself. Due to the compressed nerves, it can tingle in the pelvis and legs. There is a feeling of "goosebumps";
The third stage is acute. The blood vessels are pinched, the metabolism of the muscles of the lower back is sharply disturbed, which leads to their ischemia. The pains are getting stronger. The legs go numb, they are pierced by convulsions;
The fourth stage is diagnosed if the spinal cord and the roots of its nerves are deformed. This can lead to paralysis of the legs.

Read also:

Diagnostics

Diagnosis of degenerative-dystrophic changes in the lumbosacral region is carried out in three stages:

A medical history is compiled, symptoms and the usual conditions for the onset of a painful attack are indicated;
The doctor examines the patient for signs of degeneration of the tissues of the lumbosacral region - he studies the level of mobility, muscle strength, and the area of localization of the pain syndrome;
An MRI is being performed. She will find evidence that the patient is experiencing dystrophic changes in the lumbosacral region of the spine. He will find physiological causes, which ultimately led to the development of pathology.

If the degenerative process in the lower back is indeed observed, then the MRI will certainly show that the symptoms make themselves felt for one of the following reasons:

Intervertebral discs were deformed by more than half;
The discs are just beginning to deform, for example, the level of moisture in them is lowered;
The fibrous ring is already beginning to collapse, cartilage tissue cells are dying;
The annulus fibrosus is ruptured and the nucleus pulposus begins to leave the disc. That is, a hernia of the lumbosacral region has developed.

You may also need:

Blood tests;
X-ray examination;
CT scan.

However, an x-ray will not be able to show signs of a pathological process at an early stage. Computed tomography and MRI go much deeper into the spine. But unfortunately, these diagnostic methods are usually resorted to only when the problem has already made itself felt.

Many pathologies of the spine have complex causes of origin. For example, degenerative and dystrophic changes in the lumbosacral region occur as a result of prolonged exposure to various pathogenic factors, mainly related to the patient's lifestyle and injuries. Before you figure out what dystrophy of the vertebral bone is and what it can entail, you should understand the features of the device of the vertebra and what risks it is exposed to after damage.

As such, the diagnosis of degenerative dystrophic changes in the lumbosacral spine does not exist. This phrase refers to the syndrome, which leads to traumatic effects, as well as internal processes occurring in the bone tissues of the body.

In most cases, the pathology develops gradually, and not as a result of a fracture, a severe blow (for example, a lesion in an accident) and is associated with a violation of metabolic processes in the tissues of the bones of the spine. Sometimes it can be provoked by hereditary factors, but most often the disease progresses due to the patient's long-term maintenance of an unhealthy lifestyle.

As a result, there is a violation of the structure of the intervertebral disc. Normally, it consists of a pulpous nucleus, which is surrounded on all sides (along the circumference) by a fibrous membrane. When, due to an incorrect lifestyle, excessive pressure on the back, the vertebral bones, which are located above and below the disc, begin to shift relative to their normal position, they put pressure on the disc and gradually destroy its pulp and shell.

Thus, degenerative changes in the lumbosacral spine are biochemical changes that lead to the destruction of the structure of the intervertebral disc, which negatively affects the functioning of the spinal column as a whole.

This name refers to a whole group of specific diagnoses:

osteochondrosis of different stages;
spondylosis;
spondylarthrosis;
protrusion and intervertebral hernia.

The structural features of the intervertebral disc are such that it is restored due to the division of its own cells, since it is deprived of blood supply. Accordingly, the nutrition of these tissues occurs differently. That is why, in most cases, degenerative dystrophic change occurs rather slowly, over several years, without showing any signs.

When a syndrome of degenerative dystrophic changes in the lumbosacral region is observed, it is rather difficult to establish one or more underlying causes. Therefore, they talk about the specific causes that led to the disease, without analyzing what factors gave rise to these causes.

Usually two reasons lead to these pathological changes:

Inflammatory processes arising from the fact that the substance that came out of the dilapidated disc begins to come into contact with the nerve fibers (they are located in the spinal cord) and irritate them.
Increased mobility of the vertebral bones in the lumbar and other regions, which occurs due to the fact that the disc wears out, decreases in size and loses the ability to properly hold the bones in space.

NOTE

Both of these causes lead to a violation of the mobility of the vertebrae, and this leads to excessive mechanical friction of the bones, squeezing the nerve fibers. Therefore, there are pains in the corresponding department, and in advanced cases this can lead to serious complications up to paralysis of the lower extremities.

Ceteris paribus, the risk group includes people who have a back injury, and also lead an unhealthy lifestyle:

constant impact on the back due to weight lifting (non-compliance with the load and the rules for lifting the load);
active sports, the risk of sports injuries;
sedentary lifestyle;
obesity - excess weight constantly puts pressure on the spine, having a negative impact on its integrity.

Persons over 60 years of age are also at risk, and women are more susceptible to the disease due to hormonal disruptions that occur after menopause.

PLEASE NOTE - A syndrome in which degenerative-dystrophic changes in the lumbar or other parts of the spinal column are observed is recorded in varying degrees of development in a third of people aged 30 to 50 years. In patients older than 60 years, such pathologies are observed in more than 60% of cases.

For degenerative dystrophic changes in the lumbar region, as well as in the sacral spine, the manifestation of any symptoms is not always characteristic - for some time the disease can develop in a latent (hidden) stage.

As pathological processes develop, extraneous sensations appear, and then severe pain, as well as other symptoms:

Pain in the lumbar region, extending to the buttocks, thighs and legs. Occurs irregularly, may be aching and sometimes sharp. At the same time, in the lower back itself, the pain is in most cases dull, and it gives off with sharp blows.
Aching, very long back pain - they can last for several weeks, slightly weakening with the introduction of painkillers, and then intensifying again.
The initial signs of the syndrome are aching sensations that intensify during a sitting position, because it is at this moment that the lower back experiences an increased load (the discs are compressed). Also, extraneous sensations can arise from prolonged standing.
The transition of aching sensations into sharp ones during the performance of simple, familiar movements: leaning forward, turning the body. The pain becomes especially severe when lifting even small weights.
In more advanced cases, when intervertebral hernias are formed, the pains acquire a pronounced sharp, sometimes burning character, while numbness, tingling, cold in different parts of the legs are often observed; severe fatigue when walking.
If the nerve fibers are compressed by the vertebrae, this is manifested not only by numbness in the legs, but also by pain - the corresponding pathology is called sciatica.
Symptoms from other organ systems are also observed in advanced cases of degenerative dystrophic changes in the lumbar region: defecation and urination disorders.
In rare cases, pain can run along the entire back - this is due to the fact that changes in the spine lead to a general disruption in the functioning of nerve fibers that transmit pain sensations along their entire length.

The most common complications are stenosis (i.e. narrowing) of the spinal canal, as well as the formation of hernias and protrusions, which often require prompt surgical intervention. Such cases are the result of untimely seeking medical help.

IMPORTANT - If there are constant disturbing pains or any other extraneous sensations (for example, a feeling of swelling in the lower back when standing for a long time), you should immediately consult a doctor, since in the early stages treatment is always carried out without surgical intervention.

In almost all cases, degenerative changes in the lumbar spine are detected using complex diagnostics, in which, along with traditional methods, instrumental ones are used:

Analysis of the patient's complaints and his medical history - it is especially important to take into account previous requests for help in situations where the patient has already undergone back surgery or courses of physiotherapy procedures.
External examination and determination of painful areas using palpation (palpation).
Carrying out radiographic examination. As a rule, an x-ray of the lower back is performed in two projections - straight and sideways. However, such a diagnosis may not reveal all degenerative changes in the lumbar spine.
Very often, to obtain accurate information and correct diagnosis, magnetic resonance imaging (MRI) is used, which results in the so-called mr picture of dystrophic changes. It has a high degree of detail, so you can confidently determine the cause of the pathology, its degree and prescribe an effective course of treatment.

Usually, the syndrome of dystrophic changes is diagnosed if the following mr signs are observed:

disk space (pulp and annulus fibrosus) is destroyed by more than half;
dehydration of the disk substance - in the picture, the affected tissues look darker due to a lack of moisture;
external signs of destruction of the cartilaginous tissue of the end plate of the disc - outwardly observed as a black stripe in the corresponding place.
ruptures (full or partial) and other violations of the integrity of the fibrous ring;
protrusion or intervertebral hernia - in this case, the pulp completely breaks through the fibrous ring, as a result of which the disc collapses, and its tissues come into contact with nerve fibers, provoking inflammatory processes.

Dystrophic changes are most often observed in the lumbar than in the sacral spine. The reason is that heavier loads are placed on the lower back. However, in cases where the patient is injured when falling on the coccyx, the pathology begins to develop precisely in the sacrum.

In most cases, treatment does not involve surgery. The impact on the tissues of the vertebra is chemical (with the help of medicines), mechanical and electromagnetic.

Medication treatment

Medicines in this case perform 2 important tasks - they relieve pain, and also contribute to the restoration of tissues by improving their nutrition. For these purposes are used:

muscle relaxants (relax the back muscles);
chondroprotectors (restore cartilage tissue);
sedatives and painkillers (to relieve pain and as sedatives for general relaxation of the patient);
B vitamins and mineral complexes are introduced so that the tissues receive additional nourishment and recover faster.

Medicines are administered both intravenously (injections, dropper) and externally (ointments, gels).

These procedures have the same goals as drug treatment, but they affect the body differently (mechanically, with the help of electric currents, electromagnetic fields, etc.). The following types of therapy are used:

electrophoresis;
magnetotherapy, etc.

The course of treatment is always prescribed individually and usually takes several weeks.

Exercise therapy and spinal traction

This type of treatment for degenerative and dystrophic changes in different areas of the spine involves a mechanical effect on the spinal column as a whole in order to optimize the position of the bones relative to each other and stabilize their mobility. A special set of exercises is supposed, which is developed and performed under the supervision of a doctor. Homework is also acceptable, but only according to approved instructions.

The use of self-medication in such cases may not only not give the desired effect, but also worsen the situation. The fact is that only a doctor can make a professional diagnosis and only after an instrumental examination. If treated for the wrong disease, the back can only be hurt.

Disease prevention

Prevention of the development of degenerative dystrophic diseases involves the observance of natural, simple rules of a healthy lifestyle:

compliance with regular physical activity, which includes exercises for the development of the spine (swimming helps a lot);
adherence to the correct technique of lifting weights;
avoiding situations of hypothermia of the lower back;
balanced nutrition: the daily menu should include not only calcium, but also substances that contribute to its absorption.

Prevention of the disease is much easier than its treatment, so we can say that in most cases the health of a person's back is in his own hands.

Degenerative-dystrophic changes in the spine are observed in 80% of the adult population of the planet. They worsen the quality of life, lead to the development of serious complications. How to avoid pathologies?

Take any person: everyone has suffered from back pain at least once in their life. Medical statistics says: 20% complain of low back pain constantly, and 1-3% need surgical treatment.

The lumbosacral region is the center of gravity of the body, it takes on all the loads that accompany any movement of the human body. Sometimes these loads exceed the permissible limits, temporary changes and deformation of cartilaginous tissues occur in the spine. Under the influence of pressure on the damaged area of the spine, salts present in the bloodstream and plasma begin to actively penetrate into its structure. There is a beginning of calcification of a certain area of cartilage tissue. This is degenerative-dystrophic changes in the spine.

How do degenerative changes in the lumbar spine develop?

In order for degenerative changes to pass into an irreversible phase, a lot of time must pass. And this time the disease wins back in a person, due to the fact that the disease does not manifest itself immediately.

Expressed symptoms show themselves when time is lost, and the degenerative changes themselves have become large-scale and irreversible.

The medical term "degenerative-dystrophic changes in the spine" summarizes several diseases:

Degenerative-dystrophic changes in the lumbar spine: main symptoms

The clinical picture of changes can be different, depending on which structures of the spine are damaged and how serious these injuries are.

Symptoms of the diseases appear as degenerative-dystrophic lesions develop, but at the initial stages they pass without pronounced external signs.

As the pathological process develops, the patient may feel stiffness and heaviness in the lower back. But, the main symptom of all degenerative changes in the spine is pain. Pain in the lumbar region occurs during a long walk and during physical exertion, prolonged sitting in one position, during bending. The pain syndrome is undulating: it arises, then decreases, disappears.

A progressive degenerative process in the intervertebral discs of the spine can lead to serious and dangerous complications.

Degenerative changes develop in stages:

initial stage

The first symptom, "screaming" about the presence of pathological changes in the lumbar spine, is a pronounced pain syndrome in the lower back. The pain sensations are so palpable that the patient is forced to limit his movements, and this significantly reduces the normal standard of living and working capacity.

Complaints of pain directly depend on the place where the lesion is localized.

The second stage of the disease

Further progression of degenerative changes is characterized by the presence of:

severe mobility restrictions;
"lumbago" that occurs in the lower back;
tingling and "goosebumps" in the limbs and buttocks.

At the second stage of the disease, radicular syndrome develops - compression of the nerve roots occurs.

Third stage

At the third stage, blood circulation is disturbed due to compression of the radicular vessel, which leads to the development of ischemia. In addition to increasing pain, the third stage is noted:

partial or temporary numbness in the lower extremity girdle;
convulsions.

Fourth stage

Degenerative pathological processes of the spine that have not received proper treatment are fraught with paralysis and paresis at the fourth stage of development. These complications arise as a result of a complete violation of the blood circulation of the spinal cord.

Causes of degenerative-dystrophic changes in the spine

The human body is a delicate and precise mechanism. It is determined by nature itself - the load on the human spine should be distributed evenly. A healthy spinal column can withstand both jumping and lifting weights. But, all this works only when a person follows the posture, has a strong muscular corset. The modern lifestyle is sedentary. And this leads to a weakening of the muscular corset, weight gain.

Sedentary work contributes to the appearance of degenerative changes in the spine.

According to studies, the human spine is in a bent position 75-80% of the time: the intervertebral discs become less elastic, and the vertebrae are deformed.

Due to degenerative changes, the intervertebral discs lose moisture, cracks and all kinds of ruptures form in them. This contributes to the appearance of intervertebral hernias. The vertebrae, when the load changes, try to increase their area, grow, thicken intensely, pinching the adjacent nerves.

Causes that provoke pathological changes:

constant or sudden loads;
active sports with heavy loads;
trauma;
natural aging;
inflammatory diseases of the spine;
improper nutrition.

Treatment methods

Unfortunately, degenerative-dystrophic changes in the lumbar spine are observed in a large number of people, and therefore the question of how to treat these pathologies is very relevant.

After all, if degenerative changes are not treated, they will progress, and the consequences can be the most deplorable, up to disability due to impaired motor activity.

Treatment of diseases of the lumbar region is considered complete and promotes recovery if after its implementation there is:

reduction or disappearance of pain syndrome;
relieving tension in the muscles of the lumbar, pelvis and lower extremities, strengthening muscles;
improvement of blood flow and supply of tissues with nutrients and oxygen, normalization of metabolic processes;
removal or reduction of inflammation;
normalization of the sensitivity of the lumbar;

Proper treatment is essential to achieve the above results. Specialists prescribe complex therapy using the latest achievements of modern medicine. For the treatment of degenerative changes in the lumbosacral spine, the following is prescribed:

drug therapy;
physiotherapy;
massage, therapeutic exercises, manual therapy;
acupuncture, acupuncture;
in extremely severe cases, surgery.

Conclusion

From the foregoing, it follows that there are several ways to overcome diseases of the lumbosacral region. But, it is better not to allow irreversible pathological processes to appear. You should consult a doctor in time, monitor your health, lead a proper lifestyle.

Causes of the appearance of pathology

To understand the nature of the development of degenerative-dystrophic changes in the intervertebral discs, it is very important to understand the causes of such processes. The fact is that the human body is a verified mechanism that can withstand enormous loads, but under the influence of various kinds of adverse factors, a weakening of the natural defense mechanism is observed, which leads to a rapid violation of the integrity of the cartilage structures. An important role in the violation of the trophism of the intervertebral discs is played by the modern lifestyle. Thus, the following triggers contribute to the development of degenerative-dystrophic changes in the spine:

sharp loads; inflammatory diseases; passive lifestyle; hypothermia; malnutrition; active sports; hormonal disorders; diseases of the endocrine system; normal aging process; metabolic disorders; chronic and recent spinal injuries.

Most often, degenerative-dystrophic changes in the spine are observed in people who lead an extremely sedentary lifestyle and at the same time eat improperly. The fact is that normally the load on the spinal column is distributed evenly, and a developed muscular frame provides significant support to it. In people who lead a sedentary lifestyle and have excess body fat, as a rule, the muscles are poorly developed, so even the slightest strength exercise leads to a serious overload of the intervertebral discs. In this case, the muscular frame can no longer take on part of the load during movement, which contributes to the rapid appearance of degenerative-dystrophic changes.

The influence of other unfavorable factors and their combinations also affects the condition of the spinal column, therefore, in most cases, it is extremely difficult to determine what exactly became the impetus for the appearance of such disorders in the cartilaginous tissue of the intervertebral discs. At the same time, understanding the cause of the appearance of such a pathological condition as degenerative-dystrophic changes in the spine makes it possible to take effective preventive measures.

The pathogenesis of the development of the disease

At present, it is well known how degenerative-dystrophic changes in the lumbar spine develop. The spine in the sacrum and lower back bears the greatest load during any movement and even while sitting. Due to the influence of overloads, as well as other adverse factors, in the area of the intervertebral discs of this department, malnutrition of cartilage tissues is primarily observed. Directly in the intervertebral discs there are no blood vessels that could feed it directly, therefore, the appearance of malnutrition of the soft tissues surrounding the spinal column is often observed first. In the absence of the proper level of nutrition of the intervertebral discs, the cartilaginous tissue begins to gradually break down, losing elasticity.

IMPORTANT TO KNOW! Dikul: “Remember! If the joints of the legs and arms began to hurt, in no case should you ... "

The second stage in the development of degenerative-dystrophic changes is the thinning and weakening of the cartilaginous tissue. At this time, there is a gradual drying of the cartilage, which leads to a slow decrease in the height of the intervertebral discs. Due to the destruction of the fibrous membrane, various protrusions, that is, protrusions of the discs, may occur. With a critical destruction of the tissues of the fibrous ring, it can rupture, which in the vast majority of cases leads to the release of the gelatinous body beyond the intervertebral disc and the appearance of a hernial formation. Such protrusions inevitably entail changes in the proportions of the vertebrae and pinching of the nerve roots extending from the spinal cord.

In response to a violation of cartilage tissue, activation of the immune system is observed, cat cells begin to produce prostaglandins, that is, substances that are inducers of the inflammatory process. Due to the production of these substances, there is an increase in blood supply and swelling of the soft tissues surrounding the spinal column, which is often accompanied by the appearance of even greater stiffness of the lumbar spine and pain in the affected area. Degenerative-dystrophic changes in the lumbosacral spine, as a rule, are characterized by slow progression and chronic course. In the future, dystrophic changes in the lumbar spine can become a springboard for the development of a number of dangerous diseases and complications, including osteochondrosis, sciatica, etc.

Characteristic symptoms of the disease

In the vast majority of cases, patients cannot independently determine the onset of the development of degenerative-dystrophic changes, since there are usually no pronounced symptoms in the initial stages of this pathological process. In fact, there are 4 main stages in the development of degenerative-dystrophic changes, each of which has its own characteristic features. At the initial stage, there may be no obvious symptoms that may indicate to a person without a medical education that there are problems with the spine.

Do not cauterize papillomas and moles! To make them disappear, add 3 drops to the water.

How I cured OSTEOCHONDROSIS without doctors ...

However, often at this stage of the process there may be severe dull pain in the lower back after increased physical activity. In addition, some people note the presence of a certain stiffness in the lower back.

At the 2nd stage of the development of the disease, severe symptoms can be observed. First of all, in people with this stage, there is a serious limitation of the mobility of the spine, with any flexion, so-called “lumbago”, that is, attacks of sciatica, can appear. Patients may complain of tingling and goosebumps on the buttocks and lower extremities.

At the 3rd stage of the development of degenerative-dystrophic processes, the disease passes into an acute stage, since at this time there is compression of the radicular blood vessel and malnutrition of the soft tissues surrounding the spinal column, which leads to their ischemia. The physical manifestations of this stage include increasing pain, frequent cases of numbness of the lower extremities and convulsions.

When degenerative-dystrophic processes of the spine enter stage 4, damage to the spinal cord and its branching roots can be observed, which is fraught with paresis and paralysis of the lower extremities. As a rule, such complications are the result of a compression injury to the spinal cord or malnutrition.

Methods for early diagnosis

In most cases, patients with degenerative-dystrophic processes in the lumbar spine come to the doctor already in the later stages, when the symptoms are quite intense, preventing a person from leading a full daily life. Diagnosis of this pathological condition begins with the collection of a detailed analysis, examination of the lumbosacral spine and palpation.

As a rule, an external examination is not enough to assess the presence of pathological changes in the intervertebral discs and their prevalence. To confirm the diagnosis, a series of studies using modern medical equipment is required. Such studies include:

general blood analysis; radiography; computed tomography: magnetic resonance imaging.

Despite the fact that radiography is a publicly available diagnostic method, at the same time it is considered the least accurate and informative, since in the early stages of the development of the pathology it does not allow to detect existing degenerative changes in the lumbosacral spine. CT and MRI are more reliable and modern imaging tools, so they can detect existing abnormalities even at an early stage. With MR, the picture allows you to notice the existing degenerative-dystrophic changes in the thoracic spine or lumbar, even if they are extremely weakly expressed. Thus, MRI is the most accurate modern diagnostic method.

How is the therapy carried out?

Treatment of degenerative-dystrophic changes in the lumbar spine primarily involves the appointment of medical support to eliminate pain.

As a rule, injection blockades, ointments and creams with analgesic action are prescribed.

Drugs are prescribed to help restore blood supply, eliminate soft tissue edema, improve cartilage trophism, and relieve muscle spasm. In addition, B vitamins are prescribed, which can reduce damage to nerve fibers during their infringement and accelerate its recovery. Common drugs prescribed for the detection of degenerative-dystrophic changes include:

Diclofenac; Ketanov; Revmoxicam; Teraflex; Chondroitin; Mydocalm.

This is not a complete list of medications that can be used to detect degenerative-dytrophic processes. The picture of dystrophic changes in the lumbosacral spine largely affects the selection of medications in each final case. After the elimination of acute symptomatic manifestations, a whole complex of physiotherapeutic procedures and exercise therapy is prescribed. Physiotherapeutic procedures used for such pathologies of the spine include magnetotherapy and electrophoresis. Acupuncture, acupuncture, therapeutic massage and other means are actively used.

Considering that the development of degenerative-dystrophic changes in the lumbosacral spine is a chronic course, it is very important for the patient to responsibly approach exercise therapy. Therapeutic exercise allows you to develop a muscular frame and reduce the load on the spinal column, improve cartilage nutrition, preventing further degenerative changes in the spine.

The essence of pathology

This name refers to a whole group of specific diagnoses:

osteochondrosis of different stages; spondylosis; spondylarthrosis; protrusion and intervertebral hernia.

Causes of the disease

Usually two reasons lead to these pathological changes:

Inflammatory processes that occur due to the fact that the substance released from the dilapidated disc begins to come into contact with the nerve fibers (they are located in the spinal cord) and irritate them. Increased mobility of the vertebral bones in the lumbar and other sections, which occurs due to the fact that the disc wears out, decreases in size and loses the ability to properly hold the bones in space.

NOTE

Risk group

Ceteris paribus, the risk group includes people who have a back injury, and also lead an unhealthy lifestyle:

constant impact on the back due to weight lifting (non-compliance with the load and the rules for lifting the load); active sports, risks of sports injuries; sedentary lifestyle; obesity - excess weight constantly puts pressure on the spine, having a negative impact on its integrity.

Persons over 60 years of age are also at risk, and women are more susceptible to the disease due to hormonal disruptions that occur after menopause.

Symptoms of the disease

As pathological processes develop, extraneous sensations appear, and then severe pain, as well as other symptoms:

Pain in the lumbar region, extending to the buttocks, thighs and legs. Occurs irregularly, may be aching and sometimes sharp. At the same time, in the lower back itself, the pain is in most cases dull, and it gives off with sharp blows. Aching, very prolonged pain in the lower back - they can last for several weeks, slightly weakening with the introduction of painkillers, and then intensifying again. The initial signs of the syndrome are aching sensations , which are amplified during a sitting position, because it is at this moment that the lower back experiences an increased load (the discs are compressed). Also, extraneous sensations can arise from prolonged standing. The transition of aching sensations into sharp ones during the performance of simple, familiar movements: leaning forward, turning the body. Pain becomes especially severe when lifting even small weights. In more advanced cases, when intervertebral hernias form, the pain becomes pronounced, sharp, sometimes burning, and numbness, tingling, cold in different parts of the legs are often observed; severe fatigue when walking. If the nerve fibers are compressed by the vertebrae, this is manifested not only by numbness in the legs, but also by pain - the corresponding pathology is called sciatica. Symptoms from other organ systems are also observed in advanced cases of degenerative dystrophic changes in the lumbar: defecation and urination disorders .In rare cases, pain can pass along the entire back - this is due to the fact that changes in the spine lead to a general disruption in the functioning of nerve fibers that transmit pain sensations along their entire length.

Diagnosis of pathology

In almost all cases, degenerative changes in the lumbar spine are detected using complex diagnostics, in which, along with traditional methods, instrumental ones are used:

Analysis of the patient's complaints and his medical history - it is especially important to take into account previous requests for help in situations where the patient has already undergone back surgery or courses of physiotherapy. External examination and identification of painful areas using palpation (palpation). X-ray examination. As a rule, an x-ray of the lower back is performed in two projections - straight and sideways. However, such a diagnosis may not reveal all dystrophic changes in the lumbar spine. Very often, magnetic resonance imaging (MRI) is used to obtain accurate information and correct diagnosis, which results in the so-called mr picture of dystrophic changes. It has a high degree of detail, so you can confidently determine the cause of the pathology, its degree and prescribe an effective course of treatment.

Usually, the syndrome of dystrophic changes is diagnosed if the following mr signs are observed:

the disk space (pulp and annulus fibrosus) is more than half destroyed; dehydration of the disk substance - in the picture, the affected tissues look darker due to lack of moisture; external signs of destruction of the cartilaginous tissue of the end plate of the disk - externally observed as a black stripe in the corresponding place. tears ( complete or partial) and other violations of the integrity of the fibrous ring; protrusion or intervertebral hernia - in this case, the pulp completely breaks through the fibrous ring, as a result of which the disk collapses, and its tissues come into contact with nerve fibers, provoking inflammatory processes.

Treatment

In most cases, treatment does not involve surgery. The impact on the tissues of the vertebra is chemical (with the help of medicines), mechanical and electromagnetic.

Medication treatment

Medicines in this case perform 2 important tasks - they relieve pain, and also contribute to the restoration of tissues by improving their nutrition. For these purposes are used:

muscle relaxants (relax the muscles of the back); chondroprotectors (restore cartilage tissue); sedatives and painkillers (to relieve pain and as sedatives for general relaxation of the patient); B vitamins and mineral complexes are introduced so that the tissues receive additional nourishment and recover faster .

Medicines are administered both intravenously (injections, dropper) and externally (ointments, gels).

Physiotherapy and massage courses

electrophoresis; UHF; magnetotherapy, etc.

The course of treatment is always prescribed individually and usually takes several weeks.

Exercise therapy and spinal traction

Disease prevention

Prevention of the development of degenerative dystrophic diseases involves the observance of natural, simple rules of a healthy lifestyle: regular physical activity, which includes exercises for the development of the spine (swimming helps a lot); observing the correct technique for lifting weights; avoiding situations of hypothermia of the lower back; balanced nutrition: in the daily the menu should include not only calcium, but also substances that contribute to its absorption.

Prevention of the disease is much easier than its treatment, so we can say that in most cases the health of a person's back is in his own hands.

If you find an error, please select a piece of text and press Ctrl+Enter.

Degenerative-dystrophic changes in the lumbosacral spine is a syndrome in which the pathology of the intervertebral disc provokes the appearance of pain in the lower back.

Although there is a slight genetic predisposition to the occurrence of this disease, the true cause of degenerative changes in the spine appears to be multifactorial. Degenerative changes can be caused by the natural aging process of the body or be traumatic in nature. However, they are rarely the result of major trauma, such as a car accident. Most often, we will talk about a slow traumatic process, leading to damage to the intervertebral disc, which progresses over time.

The intervertebral disc itself is not provided with a blood supply, so if it is damaged, it cannot recover in the same way that other tissues of the body recover. Therefore, even minor damage to the disk can lead to the so-called. "degenerative cascade", due to which the intervertebral disc begins to collapse. Despite the relative severity of this disease, it is very common, and current estimates suggest that at least 30% of people aged 30-50 have some degree of disc space degeneration, although not all experience pain or are diagnosed with it. In fact, in patients over 60 years of age, some level of intervertebral disc degeneration detected by MRI is the rule rather than the exception.

The reasons

Degenerative-dystrophic changes in the lumbosacral spine are usually provoked by one or both of the two following reasons:

Inflammation that occurs when proteins in the disc space irritate the nerve roots during the formation of an intervertebral hernia. Pathological instability of micromotions, when the outer shell of the disc (annulus fibrosus) wears out and cannot effectively withstand the load on the spine, which leads to excessive mobility in the affected spinal segment.

The combination of both factors can lead to persistent low back pain.

The combination of both factors is most common in the formation of an intervertebral hernia, which is a complication of the degenerative-dystrophic process in the intervertebral discs. When a disc herniation occurs, mechanical compression of the neurovascular bundle passing through the spinal canal is also added, as a result of which the pain in the lower back increases significantly and becomes permanent.

Symptoms

Most patients with degenerative-dystrophic changes in the lumbosacral spine experience constant but tolerable pain, which from time to time increases for several days or more. Symptoms may vary depending on the individual case, but the main symptoms in this disease are as follows:

Pain localized in the lower back, which may radiate to the hips and legs; Prolonged pain in the lower back (lasting more than 6 weeks); Low back pain is usually described as dull or aching, as opposed to burning pain where it radiates; The pain is usually exacerbated in a sitting position, when the discs are under more pronounced load compared to that which is placed on the spine when the patient is standing, walking or lying down. Prolonged standing can also make the pain worse, as can bending forward and lifting objects; The pain is exacerbated by certain movements, especially when bending over, turning the torso and lifting weights; If a herniated disc develops, symptoms may include numbness and tingling in the legs, and difficulty walking; With a medium or large herniated disc, the nerve root exiting the spinal cord at the affected level can be compressed (foraminal stenosis), which in turn can lead to pain in the legs (sciatica); Neurological symptoms (eg, weakness in the lower extremities) or pelvic organ dysfunction (various urination and defecation disorders) may result from the development of cauda equina syndrome. With cauda equina syndrome, immediate action is required to provide qualified medical care. In addition to lower back pain, the patient may also experience leg pain, numbness, or tingling. Even in the absence of nerve root compression, other spinal structures can cause pain to radiate to the buttocks and legs. The nerves become more sensitive due to the inflammation triggered by proteins within the disc space, which causes numbness and tingling sensations. Usually in such cases the pain does not go below the knee;

In addition to degenerative changes in the intervertebral discs, pain can be caused by:

Stenosis (narrowing) of the spinal canal and / or osteoarthritis, as well as other progressive diseases of the spine, the occurrence of which contributes to the degeneration of the intervertebral discs; Intervertebral hernia, a consequence of degeneration of the intervertebral disc.

Diagnostics

Diagnosis of the presence of degenerative-dystrophic changes in the lumbosacral spine, as a rule, is carried out in three steps:

Compiling a patient history, including when the pain began, a description of pain sensations and other symptoms, as well as actions, positions and methods of treatment (if treatment was carried out), which weaken or, conversely, increase pain; A medical examination, during which the doctor checks the patient for signs of degeneration of the intervertebral disc. This examination may include checking the patient's range of motion, muscle strength, looking for painful areas, etc. An MRI scan, which is used to confirm the suspicion of degenerative changes in the spine, as well as to identify other potential causes that led to the patient's painful symptoms.

The results of MRI, most likely indicating the presence of degenerative changes as the cause of pain symptoms:

Disk space destroyed by more than 50%; Initial signs of disc degeneration, such as disc dehydration (such a disc will appear darker on an MRI because it contains less water than a healthy disc); There are signs of erosion of the cartilaginous end plate of the vertebral body. The disk does not have its own blood supply system, but, nevertheless, living cells are located inside the disk space. These cells are nourished by diffusion through the end plate. Pathological changes in the end plate as a result of degeneration lead to malnutrition of the cells. These changes are best seen on T2-weighted images taken in the sagittal plane. Usually, the end plate appears as a black line on MRI. If this black line is not visible, this indicates an erosion of the end plate. Rupture in the fibrous ring Presence of protrusion or intervertebral hernia

Treatment

The prevailing majority of cases of intervertebral disc degeneration do not require surgical intervention and are treated using conservative methods, which include special therapeutic exercises, physiotherapy, and various types of massages. In addition, spinal traction helps with degeneration of the discs, as it increases the distance between the vertebrae, allows the intervertebral disc to receive the water and nutrients it needs, which contributes to its recovery.

Load-free traction of the spine is ideal for the treatment of degenerative lesions of the intervertebral discs (osteochondrosis of the spine) and its complications - spondylosis, spondylarthrosis, intervertebral hernias and protrusions. Traction takes place with the preservation of all physiological curves of the spine and is safe, since no force is applied during traction. With an increase in the intervertebral distance, there is an improvement in the nutrition of all intervertebral discs, the restoration of their structure and the removal of pain.

With the help of complex treatment, it is possible to achieve a complete recovery of the patient, and not just pain relief for a limited period.

If you have a pain syndrome, you can consult a neurologist in one of our Moscow Clinics. For citizens of the Russian Federation, the consultation is free of charge.

The article was added to Yandex Webmaster on 07/22/2014, 13:32

When copying materials from our site and placing them on other sites, we require that each material is accompanied by an active hyperlink to our site:

1) The hyperlink may lead to the www.spinabezboli.ru domain or to the page from which you copied our materials (at your discretion); 2) On each page of your site where our materials are placed, there should be an active hyperlink to our site www.spinabezboli.ru; 3) Hyperlinks should not be prohibited from being indexed by search engines (using "noindex", "nofollow" or any other means); 4) If you have copied more than 5 materials (that is, your site has more than 5 pages with our materials, you need to put hyperlinks to all author's articles). In addition, you must also put a link to our website www.spinabezboli.ru on the main page of your website.

We bring to your attention a classic article on this issue.

ON THE. Pozdeeva, V.A. Sorokovikov
GU SC RVH VSNC SO RAMS (Irkutsk)

Diagnosis of displacements of the lumbar vertebrae is one of the least studied issues in radiology. Interest in this pathological condition of the spine is not accidental. Instability - displacement of the vertebrae - as one of the forms of dysfunction of the motor segment becomes the cause of pain and subsequent neurological disorders. Taking into account the costs of diagnostics and treatment, as well as compensation for disability, disability, it can be argued that low back pain syndrome is the third most expensive disease after heart disease and cancer.

DEGENERATIVE-DYSTROPHIC CHANGES IN LUMBOSACRAL PART OF THE SPINE
(OCCURRENCE, CLINIC, PROPHYLAXIS)
N.A. Pozdeyeva, V.A. Sorokovikov
SC RRS ESSC SB RAMS, Irkutsk
Diagnostics of dislocation of lumbar vertebrae is one of the less studied issues of radiology. Interest in this pathological condition is not at all casual. Instability - vertebrae location. - as one form, of the dysfunction of movement segment becomes a cause of pain syndrome and further coming neurological disorders. Taking into consideration expenses of diagnostics and treatment, and also of compensation of disablement of working patients, invalidity, we may assert that lumbar pain syndrome is the third, of the most "expensive" disease after coronary disorders and cancer.

Degenerative diseases of the spine are one of the leading social problems that have an important economic aspect, since young and middle-aged people, who are the largest category of the working population, most often suffer from this pathology. According to Holger Pettersson (1995), the diagnosis of these diseases is difficult, because there is a weak correlation between the results of x-ray examination and clinical symptoms.

Diagnosis of displacements of the lumbar vertebrae is one of the least studied issues in radiology. Interest in this pathological condition of the spine is not accidental. Instability - displacement of the vertebrae - as one of the forms of dysfunction of the motor segment becomes the cause of pain and subsequent neurological disorders. Taking into account the costs of diagnostics and treatment, as well as compensation for disability for workers, disability, it can be argued that low back pain syndrome is the third most expensive disease after cancer and heart disease.

The medical and socio-economic significance of the problem of diagnosis and treatment of osteochondrosis of the lumbar spine is due to a number of reasons. According to the World Health Organization (2003), 30 to 87% of the most able-bodied population aged 30 to 60 suffer from spinal osteochondrosis. The share of osteochondrosis of the spine accounts for 20 to 80% of cases of temporary disability. Morbidity rates in Russia tend to increase, while in the vast majority of patients the disease is accompanied by lesions of the lumbar spine. According to the VIII World Pain Congress, held in Vancouver in 1996, back pain is the second most common reason for seeking medical attention and the third most common cause of hospitalization after respiratory disease, with 60-80% of the population experiencing it at least once. In the structure of the incidence of the adult population of our country, lumbar osteochondrosis is 48 - 52%, ranking first, including the number of days of disability. Temporary disability in 40% of neurological diseases is due to lumboischalgic syndromes. In the general structure of disability from diseases of the osteoarticular system, degenerative-dystrophic diseases of the spine account for 20.4%. The disability rate for degenerative diseases of the spine is 0.4 per 10,000 inhabitants. Among disabled people with other diseases of the musculoskeletal system, this pathological condition ranks first in terms of frequency of occurrence, and in 2/3 of patients, the ability to work is completely lost.

The mobility of the spine is possible due to the complex interactions of the elastic apparatus of the vertebral bodies, arches and intervertebral discs. The functional unit of the spine at any of its levels is the motor segment - a concept introduced by Iunghanus in 1930. The motor segment includes two adjacent vertebrae, a disc between them, a corresponding pair of intervertebral joints and a ligamentous apparatus at this level. At the level of any one segment, the mobility of the spine is relatively small, but the summed movements of the segments provide it on the whole in a wider range.

Research L.B. Fialkov (1967), Buetti-Bauml (1964) and others show that in the lumbar region the most mobile in terms of flexion and extension in the frontal plane is the segment L4 - L5; this explains its overload, leading to degenerative lesions and displacement of the vertebrae.

Intervertebral joints belong to the group of sedentary, and are combined joints. The main functional purpose of the joints of the spine is the direction of movement, as well as limiting the amount of movement within these directions.

Under normal static conditions, the articular processes do not carry vertical loads: the function of damping vertically pressing forces (weight of the head, torso) is carried out by intervertebral discs. In cases where the articular processes are forced to at least partially perform a supporting function that is not characteristic of them (with large static loads on the spine in combination with obesity), local arthrosis and anterior displacement of the vertebrae (antelisthesis) develop in the true joints, and with a significant, ever-increasing vertical load - neoarthrosis of the articular processes with the bases of the arches.

The role of the disc in spinal statics is to cushion the pressure exerted on the spine by the weight of the body and physical activity. This means that the force acting on the intervertebral disc must be balanced by an equal but opposite disc force.

The applied force is resisted not only by the entire spine, but also by the musculo-ligamentous apparatus of the body, which adapts to the external load. The most important are the forces acting in the plane of the disks, in other words, the traction forces transmitted to the disk. They can reach considerable intensity and be the cause of most mechanical damage to discs.

A certain form of spinal injury can be categorized as either stable or unstable injury. The concept of “stable and unstable injuries” was introduced by Nicoll in 1949 for the lumbothoracic spine, and in 1963 Holdsworth extended to the entire spine. According to this theory, rupture of the posterior structure is a necessary condition for spinal instability.

F. Denis (1982-1984) introduced a three-bearing concept of spinal instability - the theory of "three columns", while the anterior support structure consists of: the anterior longitudinal ligament, the anterior part of the annulus fibrosus, the anterior half of the vertebral bodies; middle support structure of: posterior longitudinal ligament, posterior annulus fibrosus, posterior half of the vertebral bodies and posterior support structure includes: supraspinous ligament, interspinous ligament, articular capsules, yellow ligament, vertebral arches. According to this theory, for the occurrence of instability, a rupture of both the posterior and middle support structures is necessary.
Degenerative-dystrophic changes in the segments of the spine develop mainly as a result of acute and chronic overloads under the influence of cumulative microtraumas.
Intervertebral discs are highly durable and can withstand static loads that are applied slowly, such as carrying heavy loads. A dynamic, momentarily applied load that creates impacts of large local force, as a rule, leads to varying degrees of compression of the vertebral bodies, and also causes damage to the discs. With lesions of the discs, when the nucleus pulposus loses its function as the axis of the spherical joint, the movements are reduced in volume or blocked, despite the intactness of the rest of the musculoskeletal and ligamentous apparatus.
The disc prevents not only the convergence, but also the distance of the vertebral bodies. This function is provided by the collagen fibers of the plates of the fibrous ring, which is tightly fixed on the cartilaginous layer and in the peripheral part of the limbus. In cases where the connection between them weakens, for example, with degenerative lesions in the segments of the spine, the vertebral bodies, not being firmly connected to the discs, can move in different directions.
The variety of emerging pathomorphological and pathophysiological situations also determines the clinical polymorphism of the disease. Anatomical formations of different structure and function are involved in the pathological process.
The clinical manifestations of this process is dorsalgia - a pain syndrome in the back (with possible irradiation to the limbs), which is caused by functional and degenerative changes in the tissues of the musculoskeletal system (muscles, fascia, tendons, ligaments, joints, disk) with possible involvement of adjacent structures of the peripheral nervous system (root, nerve).
In the pathogenesis of chronic dorsalgia, the leading role is played by decompensation of dystrophic changes in the tissues of the musculoskeletal system, as well as dysfunction of individual muscles and joints, which leads to the formation of sources of nociception with subsequent segmental and suprasegmental response.
In the mechanism of development of radiculopathy, the compression of the root in a narrow “tunnel” plays a role, the walls of which can be formed by various structures: disc herniation, yellow ligament, tissues of the facet joint, osteophytes. Of great importance in this case is a violation of the blood circulation of the root in the zone of compression, followed by edema.
Risk factors for the development of musculoskeletal pain syndromes include:
o Motor imbalance (improper posture, scoliosis, decreased extensibility, strength and endurance of muscles, pathological motor stereotype);
o Spinal dysplasia;
o Constitutional hypermobility;
o Dystrophic changes in the musculoskeletal system.
They create prerequisites for the development of functional disorders in various parts of the musculoskeletal system and disruption of compensation for natural age-related dystrophic processes under the influence of provoking factors.
The problem of instability of the spinal motion segment, which occurs under the action of various factors, is far from being resolved. First of all, this concerns the systematization of the most important pathogenetic mechanisms, taking into account the role of morphological and functional changes in the structures of the spine, biomechanics, as well as the need to diagnose PDS instability in the early stages of the degenerative process.

1. Gally R.L. Emergency Orthopedics. Spine / R.L. Galley, D.W. Spaite, R.R. Simon: Per. from English. - M.: Medicine, 1995. - 432 p.

2. Epifanov V.A. Osteochondrosis of the spine / V.A. Epifanov, I.S. Roller, A.V. Epifanov. - M.: Medicine, 2000. - 344 p.