Back pain may be limited to the lumbar-sacral division (lumbodynia) or radiate into the legs (sciatica). When acute intense lower back pain also used the term “lumbago” (lumbar backache). Traditionally, back pain was defined as “sciatica”, however the irritation or compression of spinalroots (radiculopathy) is a cause of pain in no more than 5% of cases. Much more often the source of back pain are lesions of the muscles, joints, ligaments, intervertebral discs.
1. Acute lumbodynia can be triggered by trauma, lifting of their load, unprepared motion, prolonged stay in the non-physiological position, hypothermia. Most often it occurs against a backdrop of ongoing degenerative process in the spine (osteochondrosis). The intervertebral discgradually loses water, shrinking, loses its shock absorbing function and becomes more sensitive to mechanical load. Fibrous ring, located on theperiphery of the disc becomes thinner, it cracks, in which the Central part of the disk pulpous nucleus shifts to the periphery, forming a protrusion (a protrusion). Due to trauma or heavy load, the protrusion may abruptly increase, leading to protrusion of nucleus pulposus and a portion of the fibrous ring into the spinal canal, which is usually referred to as herniated disc. The pain is localized only in the back, eliminates the defeat of the spine and may be associated with lesions of the spine (being the first manifestation of the emerging protrusion of the disc) and with lesions of soft tissues (spasm or muscle strain, sprain). Usually there is a pronounced tension of lumbar muscles with straightening of the lordosis and antalgicscoliosis. In the supine position, the pain is reduced, but at the slightest movement it increases sharply. Acute lumbodynia spontaneously goes away within a few days, rarely weeks. But sometimes she transforms into a sciatica. Frequent causes of acute pain in the lumbar region arediseases of the kidney and perinephric fat (renal colic, pyelitis, paranephritis, infarction of the kidney). Sudden sharp pain in the lumbar region that radiates to the groin, genitals, thigh and accompanied by frequent and painful urination, which is characteristic for renal colic. In acute pyelitis or pyelonephritis Bay in the lower back is usually more dull in nature and rarely reaches such intensity as in case of renal colic. In acute pyelitis is characterized by high fever, chills, the phenomenon of General intoxication, quite often macroscopically (to the eye) there is admixtureof pus in urine pyuria. Occurrence of acute lower back pain with chills and fever in women in the second half of pregnancy is usually due to very frequent pathology pyelitis pregnant. Back pain, fever and chills are characteristic of acute inflammation of the perinephric tissue paranephritis,which usually occurs due to the transition from primary infection of the affected kidney in paranari. The examination of the patient paranephritis often show flattening or bulging of the contours of the waist on the affected side and a lateral curvature of the lower thoracic and lumbar spine, with convexity facing in a healthy way. In some cases, spastic contraction of the psoas muscle, due to the inflammatory process in paranari causesbringing bent in the hip joint of the thigh medially and anteriorly. The straightening of the thigh causing a sharp pain in iliac region. Acute lower back pain may be due to thrombosis or (more often) thromboembolism of renal arteries. The latter is observed in patients with rheumatic heart disease, active current rheumatic or septic endocarditis, myocardial infarction and post-infarction heart aneurysm. Very often intracardiac thrombosis and subsequent embolism of the clot to occur in patients with atrial fibrillation. Due to shutdown of kidney or her area of bloodcirculation appear necrosis and infarction of the kidney. Along with sharp pains in the lumbar region and abdomen during a heart attack the kidneys as acute hypertension develops from a sharp increase in diastolic blood pressure. Blood in the urine is always accompanied with heart attack kidney, however, the hematuria is usually microscopic (microscopic hematuria) and are detected only with the study of urinary sediment.The diagnosis of thromboembolism of the renal vessels as the cause of sudden acute pain in the lumbar region is extremely difficult, but can be supplied upon careful examination of the patient and identifying the underlying pathology that gives thromboembolic complications.
2. Acute sciatica can be:
reflex (referred) pain, the Genesis of which an important role is played by the stimulation of nociceptors in ligaments, intervertebral joint capsulesand other tissues of the spine, as well as regional muscle spasm;
radicular pain due to involvement of spinal roots (radiculopathy), which is characterized not only by mechanical compression but also by inflammation, edema and demyelination.
Radicular pain is usually more intense than reflex, often has a paroxysmal shooting or penetrating in nature, radiating into the distal part of the region innervated by the root, accompanied by numbness and paresthesia, loss of tendon reflexes, weakness and atrophy of the muscles in thisregion. At the age of 30-50 years, the cause of sciatica is often a herniated disk, in older ages will be of critical importance other degenerative changes (hypertrophy of ligaments, arthropathy of the intervertebral joints, the formation of osteophytes) that cause narrowing of the intervertebral foramen. Most often a disc herniation is formed C—S,1 (cause of radiculopathy S) and L4-L5 (the cause of the radiculopathy C), at least C—L4 (cause radiculopathy L4). L5 radiculopathy with pain radiating on the outer surface of the feet to finger I, marked weakness of the extensor of the thumb and hypoesthesia along the medial edge of the foot. If it’s a radiculopathy, pain radiates along the rear surface of the legsto the V of the thumb and heel drops ankle reflex, it is noted hypoesthesia on the outer edge of the foot. L4 radiculopathy with pain radiating to the knee joint and verhnemedialnoy part of the tibia, revealed the loss or reduction of the knee reflex. Pain with disc herniation often occurs when sudden movement, bending over, heavy lifting or a fall. In history there are usually indications of recurrent episodes of lumbodynia and sciatica. Leg pain is usually accompanied by pain in the lower back, but the young of the disc herniation can be manifested only by pain in the leg. At first it is dull, aching, but gradually increases, less immediately reaches maximum intensity. The pain increases with movement, straining, heavy lifting, sitting in a deep armchair, a prolonged stay in one position, coughing and sneezing, pressure on the jugular vein is weakened and alone, especially if the patient lies on the healthy side, bending the affected leg at the knee and hip joints. When viewed from the back is usually fixed ina slightly bent position. Scoliosis is often detected, worse when bending in front, but lost in the supine position. The slope sharply limited anteriorly and is only due to the hip joint. The extension is limited to a lesser extent. A sharp increase in pain in extension could be a sign of disc prolapses. Severely restricted and the tilt to the affected side. Marked expressed by the voltage paravertebral muscles, decreasing in the supineposition. Usually, you can find positive Symptoms of tension. Symptom Lasegue test, slowly lift straight leg up patient, waiting for strengthening leg pain along the sciatic nerve. When compression of the nerve roots L5 and S, the pain appears or increases sharply when the foot is raised to30-40° and subsequent flexion of the leg at the knee and hip joints it passes. If the pain appears when the foot is raised above 70°, it is likely thatit is not associated with compression of the spine. If you still have pain when bending the leg at the knee joint, it may be due to hip joint pathology or a psychogenic. When receive Lasegue pain in the lower back and leg can occur in necroscopic lesions, for example, at a voltage of paravertebral muscles or the back muscles of the femur and tibia. In addition, check the “front” of the symptom of tension is a symptom of Wasserman: thepatient lying on his stomach, lift straight leg up, straightening the thigh at the hip, or bend the leg in the knee joint. The appearance of root irradiation may indicate a compression or L4 of the lumbar plexus. Muscle weakness in discogenic radiculopathy is usually easy. But sometimes amid a sharp increase in radicular pain can occur acutely marked paresis of the foot (crippling sciatica). The development of this syndrome is associated with ischemia of the spine caused by compression of the feeding vessels. In most cases, paresis safely regresses within a few months with conservative therapy. Acute bilateral radicular syndrome (cauda equina syndrome) occurs due to massive midline hernias nizhnespasskoe disk. It is manifested by rapidly progressive bilateral leg pain, numbness and reduced sensitivity in the crotch, asymmetrical lower flaccidparaparesis, urinary retention, sometimes fecal incontinence. This condition requires emergency hospitalization and usually urgent surgical intervention. Slower development of intensive bilateral radicular syndrome in meningoradiculitis possible in patients with meningealcarcinomatosis, neuroborreliosis, sarcoidosis.