Lumbar kyphosis – causes of development, diagnosis, treatment
Lumbar kyphosis – an atypical condition characterized by the reverse hyperextension legationsrat arc (the concavity anterior to the vertebral column).
Physiologically in the lower back lordosis is observed that depreciation reduces the burden when walking and prevents the entrapment of nerve fibers occurring in the intervertebral gaps. In the Central part of the vertebrae passes the spinal cord. Therefore, when straightening or reverse hyperextension legationsrat arc, a high probability of compression of the spinal segments.
Lumbar kyphosis occurs in children with well-developed musculature of the back. In adults, this pathology is observed on the background of traumatic lesions of the spine and herniated discs.
How is the kyphosis of the lumbar spine
depending on the reasons, the pathology is classified into:
Congenital form develops on the background of various anomalies of the vertebral column. Young people kyphotic lumbar arc is formed because of the posture of weakness in the muscle corset back that may be associated with hereditary diseases (myodystrophy, myositis).
In adults, acquired kyphosis of the spinal column is observed at 3 stages of herniated disc, which leads to limited mobility. In adolescence to the formation of a posterior bulge in the lower back causes scoliosis of 2 or 3 degrees, associated with impaired functionality of the muscle corset back.
Under the above described conditions, the formation of kyphosis is a protective reaction in response to stimulation of nerve receptors longitudinal ligament, annulus fibrosus and nerve root compression.
Numerous x-ray studies of the lumbar spine proved that when bending of a person the size of the intervertebral gaps increases and extension decreases. In the latter case, reduced backup space, therefore, increases the likelihood of spinal cord compression.
When forming kyphotic arc of the posterior longitudinal ligament, the peripheral part of the annulus fibrosus of the intervertebral disc and joint capsule is stretched. Against this background, a protective flexion, which further increases lumbar kyphosis.
Symptoms of pathological concavity of the lumbar vertebral column are classified into 3 groups:
- Compression myelopathy.
It Should be noted that the clinical picture of the disease consists of a combination between motor, sensory and pain syndromes. To them might join the faulty of the pelvis.
The Specificity of lumbar kyphosis is the periodic appearance of symptoms with the episodic nature of radicular syndromes (entrapment of the nerve trunk).
Combine all of the above syndromes generates the following symptoms:
- back Pain, radiating to the lower limbs
- Numbness of the lower extremities and a decrease in sensitivity
- Intercostal neuralgia
- a Disorder of sexual function;
- Incontinence of feces and urine;
- Availability of lumbar "hump".
The symptoms are almost impossible to cure without surgery to eliminate compression syndrome.
Compression myelopathy as a concomitant symptom
The Hyperextension of the lower back can form epigonus syndrome, which is caused by loss of the intervertebral disc between Th12 and L1 (12 and lumbar 1 thoracic vertebra). Very often there is impairment of spinal nerves passing in the spine between L4-L5 and S1-S2 segments. If epigonus typical complaints of a person:
- Pain in your lower back;
- Weakness in lower limbs
- dysesthesia of the feet;
- Reduced the tonus of the gluteal muscles;
- Absence of the Achilles and patellar reflex
- Segmental loss of reflex from the muscles of the postero-lateral surface of the tibia.
The figure clearly shows the relationship between the peripheral symptoms and level of lesion of the spinal cord.
the Syndrome of the cone.
Kyphosis of the lumbar spine with loss of intervertebral disc at the level of L1-L2 is accompanied by the compression of the first coccygeal segment (S3) with the development of compression syndrome of the cone. The clinical picture of this condition is dominated by gross violations of the pelvic organs in the form of incontinence of urine and feces, and urinary retention.
Disorders of surface anddeep sensitivity in the pathology also localized in the anogenital region with the formation of a "rider pants" (see picture).
In the "cone" may be absent anal reflex. When a person experiences constipation. Because of a violation of skin sensitivity increases the probability of formation of bedsores. All of the above symptoms improve poor prognosis of the disease.
a Syndrome "a horse tail".
The cauda equina Syndrome occurs when loss of the intervertebral disc at the level L4-L5 (between 4 and 5 lumbar vertebrae) with compression of the nerve roots of the cauda equina, which are in the lower part of the spine (see figure).
The Clinical manifestations of cauda equina syndrome are severe pain radiating to the gluteal region, back of the thighs, anogenital region and rump. Simultaneously develops impair the functionality of the pelvic organs.
Peripheral paresis and paralysis (complete or partial violation of the mobility of the nerves) characterized by sensory disorders in the area of "lanes" passing nerves. Clinical symptoms of the disease are exacerbated by the presence of in the lumbar of protrusions and hernias.
Diagnosis and treatment of the disease
To Define pathology on the basis of medical history and radiological methods.
When examining a patient with kyphosis of the lumbar spine are the following signs of disease:
- Significant curvature of spine in the lumbar region;
- In the morning, the patient experiences stiffness
- Pain in the neck and back;
- Numbness in the hands and feet in the morning;
- Legs become weak;
- At the expense of the nerves there is pain in the lower back and lower extremities;
- there are "failures" in the work of the digestive system;
- Loss of sexual function;
- Incontinence of feces and urine.
Radiography, computed tomography and magnetic resonance imaging allow us to estimate the curvature of the curvature of the spine and to examine the state of the intervertebral gaps.
For using conservative methods the study is part therapeutic exercise and manual therapy.
To prevent complications of kyphosis that can lead to disability it is necessary to diagnose a pathological condition in adolescents and children and to begin to correct the offset of the axis of the vertebral column.
If the pathology is not characterized by severe impairment of the nerve roots, the complex of manual therapy and physical therapy is to prevent further curvature of the axis of the vertebral column.
specific exercises can effectively strengthen the muscle corset back and to restore your posture. To relieve pain in the lower back, you should regularly perform a set of exercises. When the kyphotic curvature of the spine is useful to go swimming.