The lumbar region bears more load than all other parts of the spine. Osteosarcoma develops as a result of degenerative-dystrophic processes due to a decrease in disc height. The vertebrae at the edge grow along the edges of the vertebrae. At the same time, the intervertebral discs narrow, the roots are compressed, and symptoms of osteonecrosis appear. Treatment of lumbar osteonecrosis depends on the stage of the disease.
Osteochondrosis sometimes manifests itself in such a way that its symptoms "simulate" damage to other organs. He has been given a code in ICD - 10. We will try to understand all the intricacies in more detail.
International Classification
According to ICD-10, osteonecrosis has the code M42 and is divided into subspecies. Code M42. 0, according to ICD-10, indicating that this is a young variant, osteonecrosis is represented by Scheuermann-Mao disease or Calve disease. Code M42. 1 according to ICD-10 gives an idea of this disease in adults.
If the variant of the disease is not specified, then in ICD-10 the code will be M42. 9. There are also complications of osteonecrosis in children, the ICD-10 code is completely different for them. A complication occurs in the form of juvenile kyphosis, which causes Scheuermann-Mao disease. Its code according to ICD-10 M40. 0.
The reason for appearing
Why things appear is still not completely known, one thing is for sure: a violation of the structure of the intervertebral disc develops, which leads to deeper changes in the spine. Symptoms are clearly visible after 35 years, accelerated trauma, long periods of time in a static position, due to loads. But it is not only the load that is the cause, often the disease is hereditary. The cause can be flat feet, especially 3rd or 4th grade.
Symptom
There is no denying the smoldering disease of this spine disease, over time the disease only gets worse. In total, doctors distinguish four degrees of development of this pathology.
The first degree does not cause pain, the patient can sit calmly and painlessly, but characteristic changes have occurred in the nucleus of the disc. The ligaments that give strength to the vertebrae may also be affected. Locally, discomfort may be noted, which can lead to being away from the problem area. As a result of a violation of the internalization of the vessels of the lower extremities, they become cold.
In the second degree, destruction of the annulus of the disc occurs. Instability occurs in the lumbar spine, increased mobility and local tension of the lumbar muscles may be noted. A person feels constant fatigue, a feeling of discomfort in the back and insecurity.
In grade 3, the bone necrosis leads to the fibrous capsule completely losing its strength and breaking, the medullary nucleus on the contrary extends beyond, forming a herniated mass. There is compression of the roots of the spinal nerves, symptoms develop, mainly pain. In the inner region of the compressed nerve root, the sensitivity is completely or partially reduced. Morning or daily exercise both bring significant pain. In the early stages, there is a burning sensation, unpleasant tingling, then it turns to numbness. A decrease or lack of sensitivity can be attributed to the paralysis, leading to muscle atrophy.
According to the characteristic regions of the sensitivity degradation, it can be assumed in which segment the failure occurred. If the fibers of the sciatic nerve (thickest in the body) are affected, Lasègue symptoms are positive, which can be easily tested at home. Need to lie on his back, a stranger helps raise one leg straight at the knee. With positive symptoms, the pain will increase if the leg is bent at the knee joint will completely disappear.
Given the significant size of the hernia, the function of the spinal cord can be affected. Often you can observe symptoms of "horsetail" compression, so osteonecrosis usually manifests outwardly, this is a bundle of nerves leaving the spinal cord passing through the lumbar spine and sacrum. Symptoms are manifested by impaired mobility and sensitivity of the lower extremities. In addition, dysfunctions of the pelvic organs are added, very often the bladder.
In the fourth stage, the joints and ligaments of the disc participate in the degenerative process, and symptoms of spinal instability appear. Arthritis between the vertebrae, spondylolisthesis develops. The fact is that there is no pain at this stage, but with it, the ability to move in it, exercises or gymnastics for a person almost completely disappears and becomes a real problem. the.
Due to the defeat of the various nerves that nourish the internal organs, their function can be impaired. Sometimes for a long time a person struggles with a problem, but in fact the cause is bone necrosis. In addition to the fact that there are characteristic symptoms, the osteolysis of the spine must be instrumentally established.
Diagnose
The symptoms were problematic, but further confirmation of osteonecrosis allowed lumbar spine imaging. It shows damage to the joints of the vertebrae, reduced height of the disc, narrowing of the disc lumen. Spine scan taken twice, additional functional tests may be required.
You can confirm the presence of a herniated disc with an MRI, the images of which will show characteristic changes. CT will show the structure of the tissue more clearly, which is especially convenient because the techniques are performed in different planes and sections. May consider where symptoms and disorders arise.
The treatment
Before treating lumbar osteonecrosis, it is necessary to consult a neurologist. Medicines are always effective in helping to get rid of the disease. They are prescribed in courses for about 10 days, in addition to all physiotherapy, daily exercises, gymnastics, massage.
With the help of drugs, you can effectively eliminate severe pain caused by inflammation and swelling. After treatment at the hospital, you can continue to take the medicine and follow the doctor's prescription at home.
Everyone starts with a nonsteroidal anti-inflammatory drug, or an NSAID. Due to the fact that they reduce the inflammatory process in osteonecrosis, swelling and pain disappear. Doctors are involved in the selection of drugs: they have a lot of contraindications. But with this, they quickly allow the condition to subside, after a few days a person will be pain free and will sit normally, the osteonecrosis will go into remission.
Treatment will be less effective if you do not use drugs to restore the structure of cartilage. They are called chondroprotectors and contribute to better nutrition of cartilage, restoration of disc tissue in the early stages. You need to take them for a long time, even at home.
Muscle relaxants help you get rid of muscle spasms in your lower back. This condition is a response to root compression.
Medications to improve microcirculation are needed. All this will remove the puffiness where the compression occurs, providing the nerve cells with more oxygen and nutrients. Exercise and massage have similar effects, which can be done at home to relieve pain.
If your back hurts a lot and sitting becomes a real problem, you will have to resort to pain relievers. This group of drugs will quickly get rid of the manifestations of the disease.
Vitamins improve the nutrition of nerve roots, strengthening them. With the use of this group of drugs, the treatment will be much more effective. Perfectly overcoming the symptoms of pain-relieving ointments, this drug must be applied to the place of maximum pain.
The doctor prescribes an ointment if the back hurts so much that you can't sit. Penetrating into tissues, the ointment has an anti-inflammatory effect on the roots. You can apply the ointment in the form of a compress at night. Apply ointment to the painful area three times a day.
Physical therapy
Full recovery treatment includes:
- physical therapy exercises;
- physical therapy;
- Massage;
- traction;
- manual therapy;
- Acupressure.
Therapeutic gymnastics involves a dose-loading effect on the lumbar spine. With its help, the clamped roots are released, the muscles are strengthened, the correct posture is established, which is then supported by charging. Gymnastics allows you to increase the range of motion, making the ligaments more elastic. Exercises are selected individually for each person.
This technique, like charging, is easy to perform, contributes to the normalization of blood circulation and improves metabolism. Exercise helps improve nutrition for the discs, increasing the space between the vertebrae. Due to the formation of a corset, reduce pain and load on the spine. Exercise is performed under the supervision of a specialist, need to be energized every morning, it will prevent osteonecrosis.
Physical therapy methods, as well as charging, are very widely used. Especially low frequency current, alternating current, ultrasonic wave, laser and many other helpers. With ultrasound, you can use additional ointments. Methods to reduce inflammation, pain and swelling. Most popular:
- UHF;
- dynamics;
- magnet;
- shock wave therapy;
- supersonic;
- electrophoresis.
Massage is very often used at a stage where pain can be relieved. Massage, like exercise, promotes cartilage nutrition, improves metabolism. It is a combination of special techniques: massage, kneading, caressing and shock vibration.
Properly performed massage is the key to successful treatment and subsequent recovery. Massage should only be performed by a specialist. In addition, you can use ointments that have an anti-inflammatory effect. Massage allows you to relieve muscle spasms, improve blood flow, strengthen your back.
Manual therapy is also a massage therapy, using only a special technique. Its effects are similar to those of massage.
With the help of specially selected weights and techniques, traction is realized. The procedure helps to increase the space between the vertebrae, relieve pain, restore the anatomical axis of the spine.
Acupuncture is based on the impact of needles on acupuncture points on the human body. This technique is especially indicated for severe pain syndromes.