The sacralization of the lumbar spine is a condition whereby the bony successive vertebrae fuses with adjacent discs.
The end-plates of adjacent spinal vertebrae become permeated by fibrous tissue. Which then fuses to connect the two vertebral bodies together. Initially, this process occurs between one or more contiguous intervertebral disc spaces. But may eventually extend across all four disc spaces. So that eventually almost an entire lumbar segment (L1/2 – L4/5) becomes solid bone with no intervening discs.
What is Lumbar Scaralisation? – A Short Synopsis:
Stadius (1948) first described this condition and named it atoophorosis which means degeneration without ossification. But later changed his mind. And renamed it to scaralisation so that there won’t be any confusion with chondrodystrophic calcificans congenita. He put it “not yellowness” as had been described previously by Grashey (1937). The first report on a patient with a degenerative intervertebral disc disease causing scaralisation was by Gordon and McPherson (1930). Who described a case of “oophorosis” in the lumbar spine. Lanyon (1970), in his review of bone formation around intervertebral discs, suggested that at least seven cases reported prior to 1948. But most early descriptions were gross anatomical changes rather than clinical diagnoses.
Causes:
Lumbar sacralization may occur in the presence of acute or chronic inflammatory conditions. And also as a result of bony overgrowth following reflexive end-plate ossification due to trauma or injury. Normally, after injury to an intervertebral joint, no extensive intradiscal calcification occurs. Unless there has been an associated intervertebral disc injury.
The earliest signs of sacralization are loss of end-plate definition and the development of irregularity in its contour.
This follows by slight greying. This later on increase in density which can sometimes cause slight enlargement of the adjacent vertebrae. As sacralization progresses, small foci of bony cellular proliferation appear within the substance of the adjacent intervertebral discs.
This process can progress rapidly. But usually takes several months to years before complete union has occurred. And most cases remain asymptomatic for many years before eventual fusion occurs. The solid bone produced by sacralization, unlike normal vertebral end-plates. These endplates are cartilaginous, is less compressible and may become the cause of adjacent segment spinal stenosis. In addition, the solid bone endplates will not permit healing by graft or fusion. And surgical options for treatment are limited to conservative methods.
Lumbar sacralization occurs most commonly in young adults. Adults who have sustained a severe lumbar disc injury. The injury resulting in hyaline cartilage degeneration and ossification within an adjacent intervertebral disc. It has also been reported following transforaminal injections, prosthetic disc replacements. And even result from chronic recurrent back pain which has been mistaken for failed back surgery syndrome.
Clinical presentation:
Presentation may be quite varied depending on the degree of scarring and the location. In L5 – S1, there are uncommon presentations. Such as pseudo-ankylosing spondylitis, degenerative disc disease resulting in severe spinal stenosis with neurogenic claudication or cauda equina syndrome. This can also lead to acute lower bowel or bladder dysfunction. Patients present usually with symptoms of back pain which is acute where trauma is present. Patients complain of pain mainly localised to their buttock, hip and thigh areas. This pain radiates down into their leg and occasionally up into their lower abdomen. If patients have had recurrent episodes they will normally present whenever it occurs again. This may be accompanied by significant weakness of one or both lower extremities.
Clinical Examination
Clinical examination of back and lower limb muscles will be normal but an erect posture may be painful. Straight leg raising may reveal pain in the buttock or thigh areas. When there is weakness present. However, this should also be tested for other causes e.g. disc herniation, nerve root compression, etc.
Because patients with lumbar scaralisation can have obstruction from endplate bony overgrowth without any associated nerve root involvement resulting in severe buttock pain which straight leg raise tests may not reveal due to muscle spasm. If they do it will only cause a slight increase of pain and no further progression in the test as opposed to disc related symptoms where there would normally be significant extension loss with different hamstring muscle tests in disc herniation.
Although it is a diagnostic challenge imaging is very important and MRI scanning will show bony proliferation which is irregular but often has concentric rings of bone seen between adjacent discs on T2 or STIR sequences, in some cases, it may be difficult to appreciate because of the increased intensity of the background scar from degenerative changes within other discs. This usually separates the opposed bones by about 1 – 3 mm, although it can extend up to 9mm at times.
In patients with lumbar scaralisation there may also be mild sclerosis on CT myelography or MRI scanning showing prominent peridiscal spaces during flexion and extension series taken at a neutral position.
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How does sacralisation causes low back ache?
If tuberosity involves in the lumbar scaralisation. It will cause pain at the area where it touches one’s spine or sacral axis. In this case, through the joint which joins the lumbosacral region and thigh bone shows severe pain when touched.
The confirmations of injury confirms by an MRI scan showing the irregular structure of degenerated intervertebral disc with partial separation of vertebrae with fusion between two adjacent vertebrae. Instead of space between them like a normal spine. When there are changes in the spinal column.
Like sacaralisation, low backache may occur because fluid-filled sac around one’s spinal cord. This leads to pinch nerve or causing trapped nerve signals to send messages to the brain about pain.
Moreover, lumbar sacralization rarely causes severe disc herniation because bone overgrowth is located in the lower spine which doesn’t push any nerves out of their position. This is different from a herniated disc. Because when this condition occurs, damaged ligaments pulls up along with vertebrae. And an intervertebral space expands. When scar tissue occupies the space between vertebrae, it blocks the spinal cord and nerve roots causing back pain or other problems such as urinary incontinence and muscle weakness to happen.
Common features of lumbar scaralisation:
•Back pain may occur locally at the site where the ligament has been overgrown by bony tissue.
•Other symptoms may include low back pain, knee or buttock pain after standing for a long period of time.
•It is difficult to pinpoint the exact location of the source of your back pain because it will vary from patient to patient depending on the involved tissue. In some cases, people may experience numbness and tingling sensations in their limbs that can radiate down into their lower extremities.
Lumbar sacralization is common in adults with mild disc herniation who suffer from chronic low back pain. Which persists for more than three months and are asymptomatic (no signs or symptoms). On top of that, patients will often complain about intermittent low back pain with weakness, especially during the morning hours. Scoliosis is very rare in patients with spinal stenosis because the disease only causes chronic low back pain without any neurologic symptoms.
How to maintain your spine with lumbar sacralization?
Use a good lumbar support mattress if you need it to help relieve and prevent low back pain.
Even though the most common cause of low back pain is the soft disc, there are other causes such as osteoarthritis, degenerative disc disease or spondylolisthesis that can contribute to the back pain. That’s why avoiding activities that might aggravate your back condition is important. It may also be helpful to consult with a medical professional who has experience in treating patients with recurrent back problems so they can review your situation and recommend some exercises to strengthen your muscles around your spine which will improve the overall strength and stability of one’s spine.
How to treat back pain due to sacralisation through Ayurveda?
This can be done by bringing the patient to room temperature. Then by supporting the spine with a lumbar support mattress and making sure that their spinal column maintains its normal straight position. Next is to carry out Ayurvedic treatments through herbal medicine to cure sacralization. A good Ayurvedic doctor will suggest remedies based on your symptoms, lifestyle, and medical history so they can highly help you get rid of low back pain without any side effects whatsoever as well.
Fomentation and medicated oil massage
Ayurveda recommends that you use a compress around the affected area to treat spine problems, this treatment will enable the patient to get relief from their pain.
Read more: How to get Slip Disc Back to Normal Without Surgery
After carrying out fomentation and medicated oil massage on the patient’s lumbar region, they should rest for at least 15 minutes to let their body recover and heal itself slowly until all other symptoms disappear. The next step is administering herbal medicines to cure lumbar sacralisation in Ayurveda which can highly help reduce back pain by strengthening the ligaments and relieving the affected discs while improving blood circulation throughout one’s body. Remedies depend on your individual case. So a specific Ayurvedic doctor should consult for more information on how to treat it effectively.