1. What are lumbalgia, lumbosciatalgia and lumbocruralgia?
They are pain syndromes often (but not always) caused by disc alteration of the lumbar rachis.
A person suffers from lumbalgia when the pain symptoms are limited to the lumbar region. A person suffers from lumbosciatalgia and lumbocruralgia when the pain extends up to the lower limb in the area of the sciatic nerve or crural nerve.
2. What are disc protusion and herniation?
Disc protusion is when the intervertebral disc located between the two vertebrae (made up by an external part called fibrous ring and internal part defined as pulpy nucleus) gets reduced in height due to various reasons. Once it becomes overabundant ( “ a bit like the effect of jam splashed between two pieces of bread”) and reduced in height, it becomes convex all along its circumference and it forms a widely spread and regular bulge (“a bulging disc”). The pain at lumbar level is due to the irritation or compression of the nerves that reach the fibrous nerve as well as the neighbouring structures ( posterior longitudinal ligament, periosteum which covers the vertebrae, capsule-ligamentous formations, etc).
Hernia (with different levels of severity) is when a more marked bulge is formed on a part of nuclear material through complete fissuration of the fibrous ring. The hernia (according to the area where it comes out) can irritate or compress the nervous roots of the sciatic nerve or femoral nerve resulting in pain, paresthesia and reduction of reflexes in the affected lower limb.
3. What are the main factors that cause protrusion or herniation?
The “compression” of the intervertebral disc can be caused by several factors:
a) Age - (during the aging process, the intervertebral disc is affected by progressive decay)
b) Traumatic events - (for example: fall from height)
c) Daily stress on the spine - ( heavy jobs, daily assistance to patients lying in bed)
d) Incorrect postures - there are people who do not suffer from a trauma in the spine nor carry out heavy duties but nevertheless they often report lumbalgic pain due to static or sedentary postures maintained for long periods of time ( for example: sales agents, truck drivers, people who sit at the office for many hours a day). Static postures that are kept for long periods of time may cause general muscle-fascia stiffness and, over time, they can alter the balance of paravertebral structures.
e) Overweight - (it is not the main cause but it can be a worsening factor)
4. What instrumental tests can be performed in order to understand the degree of protusion or herniation of the intervertebral disc more precision?
After an accurate objective test is carried out, the doctor may better understand the degree of the pathology by performing instrumental test.
The first test to be performed is a lumbar radiography, which provides the first indication. It can suggest a disc distress, but it does not detect light protrusion, since only the vertebrae can be seen and not the intervertebral discs. Instead axial tomography (CAT) and/or magnetic resonance (NMR) are more detailed tests which provide a better overview of the intervertebral disc.
5. How many people suffer from this disease?
Between 80% and 90% of adults report “pain in the back” during their life and 75% of them at working age. Considering that these diseases affect people during their most productive age, from 40 to 50 years old, lumbalgia has high social and health costs due to medical expenses and lost working days.
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