It is a clinical picture due to the wear and tear of the structures that make up the lumbar spine.
Degeneration (wear) may occur in the discs and joints between the spine. Different clinical findings occur at various stages of wear. Radiological findings may not parallel the patient's clinic. Wear is a process, it occurs over years. We do not go to bed one night with a healthy memory and wake up the next morning with a worn memory. It should be noted that a patient's complaints may begin anywhere in this process, indicating that calcification has occurred below the pain threshold throughout life. Additionally, wear in one movement segment may predispose adjacent segments to similar events. Different stages of the wear process can be seen in different spinal motion segments of the patient. The aging process is not always compatible with the clinical phase of wear.
The first stage of the wear process is segmental dysfunction. We call the situation where movement decreases beyond normal, dysfunction. At this stage, the first clinical finding usually reflects joint dysfunction, unlike a herniated disc. In joint dysfunction, there is joint pain, inflammation and limitation of movement. Constant contraction of the short muscles, especially around the spine, contributes to restriction in joint movement. The reason for consulting a doctor is low back pain. Low back pain increases with standing, walking, bending backwards from the waist, and turning left and right at the waist. It may be slightly relieved by bending forward, but these findings are not diagnostic, especially in the presence of chronic pain. Regional tenderness and muscle spasm, limited joint range of motion and normal neurology examination are the expected findings. There may be pain radiating to the hip and thigh. Disc wear can also occur during this initial stage of wear. Joint dysfunction may not allow adequate weight bearing, so increased stress is transmitted through the disc located between the vertebrae. Late stages of dysfunction are more likely to result in a herniated disc.
Low back pain due to disc wear increases with bending, coughing and sneezing. However, this clinical picture may not always be present and atypical pain may occur, especially in young athletic individuals. In the presence of herniation due to disc calcification, the predominant clinical symptom is weakness, and there may be minimal back pain and leg pain. waist f� Depending on the location of the sore, the patient may present with severe back pain or leg pain. The pain can be extremely severe. It gets worse with standing and walking, and can sometimes get better with sitting.
In the second stage of wear, there is excessive segmental movement. A patient who has never suffered from back pain and has never had any complaints may enter the second stage of wear. Gross range of motion evaluates soft tissue flexibility and monitors the effect of treatment, but does not provide information about segmental movement. Information about segmental movement can be provided by experienced manual examination. Stiffness and painful arch when bending forward during the recovery period may be indicative of excessive segmental motion. If tenderness and muscle spasm occur when lateral force is applied to the spinal protrusions during examination, it is understood that the examined segment is excessively mobile. In the second stage of wear, the wear of the discs between the vertebrae continues and the disc loses height accordingly.
In the third stage of wear, segmental stabilization occurs. Fibrosis, expansion and adhesion occur in the joints. The wear of the disc progresses and the water content decreases significantly. Tiny bone protrusions form at the corners of the vertebrae. At this stage of wear, joint range of motion is restricted and stiffness occurs. There may be narrowing in the channels through which the nerves pass, resulting in nerve root compression, stenosis and slippage in the waist. At this stage, numbness, muscle cramps and weakness occur. Typically, the patient's complaints disappear with maneuvers such as leaning forward and sitting.
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