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Low back and leg pain

Low back or leg pain is one of the most common (and experienced) pains worldwide. Everyone, regardless of age, has experienced such pain and can confirm that the feeling is not pleasant at all.

In most cases, low back pain is simply due to overexertion and after a good rest, it passes. But, in another large percentage of pain it is due to more serious diseases of the spine, so it is good to visit a specialist while there is time.

Among the most common diseases related to the spine are disc herniation (or as we used to call it “discopathy”) and spinal stenosis – two seemingly different diseases that have quite common symptoms and markers.

What is a herniated disc and what are the symptoms that accompany the disease?

Дискова херния | Lejanki.bg

Discopathy is a disease in which the outer fibrous ring of the intervertebral discs ruptures. When torn, the translucent pulpal nucleus deforms and enters the spinal canal, squeezing the nerve roots that pass through the area.

Similar ruptures can occur with each disc of the spine, but the two most common forms of discopathy are cervical (in the region of the neck) and lumbar (in the region of the waist). The most common discopathy is in the lumbar region, affecting more than 15% of patients.

Causes of disc herniation

The disease can be due to various causes with the most common being heredity, trauma, inflammatory processes, overexertion of the spine, long hours of sitting, immobility, metabolic disorders, poor posture, and others.

Although discopathy is considered a disease that affects people between the ages of 30 and 50, symptoms can appear as early as adolescence.

Symptoms of a herniated disc

The symptoms of discopathy (symptoms of a herniated disc) are different depending on the affected intervertebral disc or nerve. If the torn fibrous ring does not press hard on the nerve, the pain may be mild and bearable, but if the condition is not so slight then the patient experiences severe and sharp pain that intensifies when moving, sneezing, coughing, or even laughing.

When the disease is localized in the lumbar region (in the lower back), it can affect not only the lower back but also the buttocks and legs. Characteristic of a disc herniation in the lumbar region is that the pain is unilateral and “starts” from the waist, to the buttocks, legs and reaches the foot.

Although the disease is not life-threatening, it can cause great discomfort and sharp pain when moving, leading to immobility, disability and others, so it should not be underestimated. In addition to being painful, discopathy is one of the causes of spinal stenosis in later life.

What is spinal stenosis?

Спинална стеноза, гръбнак | Lejanki.bg

The term “stenosis” means “reduction in diameter, narrowing”. Taking this into account, the simplest explanation for this disease is a narrowing of the spinal canal in one of its diameters.

The disease is associated with advancing age, as spinal stenosis most often affects people over 50 years of age. The percentage in younger patients is small and people around the age of 30 are not insured against spinal stenosis. In these cases, however, the causes of the disease are congenital problems of the spine.

The main symptom of spinal stenosis is low back pain, which can affect the legs.

Causes of spinal stenosis

To make it a little clearer what spinal stenosis is, it is necessary to understand the anatomy of the spine. The spine consists of thoracic, cervical, lumbar, and caudal vertebrae, as well as the sacral bone. Between the vertebrae are the cartilages and intervertebral discs that connect the vertebrae. Inside the spinal canal is the spinal cord, and between the walls of the canal and the spinal cord the space is filled with cerebrospinal fluid (CSF) and adipose tissue. This “layer” makes it possible to compensate for the slight narrowing of the canal that may occur during normal human activity. But when the canal continues to narrow, it inevitably leads to pressure on the nerve roots or spinal cord, which in turn leads to various neurological symptoms.

In addition to the natural aging of the patient, the reasons for the narrowing of the canal can be diseases such as disc herniation, trauma, tumors, arthrosis of the joints, and the appearance of osteophytes (thorns) to name a few. When the disease is the result of a preexisting diseases, it is defined as “secondary stenosis of the spinal canal.”

One of the unpleasant consequences of spinal stenosis is the fact that the supply of valuable nutrients and oxygen to the spinal cord is severely disrupted. In general, with any physical activity, the spine needs an increased supply of nutrients and oxygen, but with spinal stenosis this does not happen. Instead, the disease increases the interstitial pressure in the spinal canal, leading to compression of the blood vessels. The vessels then cannot transfer the required volume of blood at the required speed. The result is as expected – the person begins to experience pain and weakness in the lower back and legs.

How does spinal disease manifest itself?

The symptoms of spinal stenosis are many and depend on the area and extent of the disease, but if we have to summarize, we can say that the most common complaints are low back pain when walking or exercising. 1/3 of patients also complain of pain in the legs, which is very strong at the beginning of the movement, gradually decreasing. In some of the more severe cases, clumsiness, instability, numbness, weakness and paresthesia in the muscles of the legs are observed.

All these symptoms usually occur after prolonged standing in the same position or while walking and they pass after a short rest. It is also possible to relieve pain when the patient leans forward.

When nerve root compression occurs, radicular pain syndrome develops. In this case, the patient experiences sharp pain in the lesion, and it is also possible for the pain to spread to the lower extremities.

Cases of stenosis of the cervical spine are much rarer, but this disease is extremely dangerous due to the fact that the spinal canal in the cervical region is narrow and with even greater narrowing the pain is felt immediately. In this case, compression of the spine in the affected area often leads to the development of myelopathy – a severe neurological disease in which there is paresis of the limbs, decreased or increased sensitivity of the affected areas, muscle spasticity of the lower extremities, and others.

There are several forms of spinal stenosis:

Странична стеноза - рентгенова снимка | Lejanki.bg

Formal stenosis

In it, in the intervertebral foramina of the spine, the nerves develop bone growths – osteophytes. This type of stenosis is also called lateral spinal stenosis. This is the most common form of spinal stenosis. In 72% of cases, formal stenosis is manifested by pain in the lower back and legs, which descends to the sciatic nerve.

Central stenosis of the spine

This is the second most common form of spinal stenosis. This form is manifested as a result of degenerative changes in the structure of the spinal canal, which increase the burden on the joints.

Lateral stenosis

In this form of stenosis, the spinal nerve is released from the intervertebral foramen, and creates compression of the bone branches.

Spinal stenosis can be congenital or acquired.

Congenital stenosis is a consequence of the anatomical features of the human structure, while acquired stenosis is most often associated with degenerative changes in the spine, which are usually expressed after the fifth decade of life.

The main cause of acquired stenosis is wear and tear of the intervertebral ligaments with age, but narrowing of the spinal canal or stenosis of the spine can also lead to diseases such as arthritic facet joints, disc herniation, spinal injuries, osteophytes, hypertrophy of the yolk sac, tumors and others.

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