More than fifty percent of all cases of the formation of intervertebral hernias occur, as a rule, in the lumbar region, and often in its last segment, which is formed by the vertebrae L4, L5, and in addition, by the disk between them. The formation of the L4-L5 disk is forty-six percent of the total number of occurrences of this pathology in the lumbar sacral sector of the spine.
In this article, we will understand what a hernia L4-L5 is.
About pathology
In the case of protrusion in this segment, there is a danger of compression, that is, compression of the nerve emerging at this level, and, as a result, there is a violation of the innervation of the limbs from the affected side, along with a decrease in sensitivity and amplitude of movement, as well as the development of muscle atrophy.
Hernia L4-L5 is the most dangerous of all types of intervertebral pathologies. It can provoke a malfunction in the pelvic organs in combination with a restriction of motor functions, leading the patient to either partial or complete paralysis.
The symptomatology of the pathology manifests itself almost from the very beginning of the appearance of education: a person may be tormented by aching and shooting pains in the lower back and legs, the patient can constantly feel numbness of the foot and lower leg, legs bend badly in the knees. And the feet when walking do not fully fulfill their functions.
But there is good news that the development of modern medicine makes it possible to get rid of the unpleasant symptoms of L4-L5 disc herniation, without resorting to surgery. And subsequent compliance with the regime of physical activity and nutrition makes it possible to restore damaged tissue by eighty percent.
Causes of pathology
Why does an L4-L5 disc hernia occur?
Elements of the lumbar region are much larger than the remaining segments of the spine and are wider in diameter than in height. This feature is explained by the heavy load, which the lumbar region is tested continuously throughout the day. Without any supporting structure, except for the muscle frame, the elements of the “L” group (from Lumbar, which means “lower back”) take on the weight of the entire body, since they get the center of gravity. And at the same time, they enable the body to turn in different directions with large amplitude.
Most of the severity is tested by the last vertebral segment, consisting of the L4-L5 vertebrae, and in addition, by the presence of a disc between them. In the case of a slight disturbance in the power of the disc or changes in strong pressure, the process of formation of an intervertebral hernia quickly ends. In this regard, this spine and specifically the L4-L5 disk is the most vulnerable place for the occurrence of the corresponding pathology.
Forms and symptoms of the disease
L4-L5 disc herniation has several forms of manifestation, and each of them has its own symptoms. There are also manifestations that are characteristic of any type of this pathology:
- Increased pain during movement, and in addition, during bowel movements, eating, and so on.
- Silence of discomfort in a standing position.
- The presence of autonomic disorders (we are talking about increased sweating, dry skin, swelling of the ankles and the like).
- The occurrence of severe lower back pain in the case of an attempt to lie on the back to raise the leg and its instantaneous calming down when the raised limb is bent at the knee.
Diagnosis of the disease
In addition to the visual examination and the history-taking procedure, the following can be performed by doctors as part of the diagnosis of L4-L5 and L5-S1 disc hernias:
- Performing computed tomography.
- Conducting magnetic resonance imaging.
- Radiography procedure.
- Passage of electroneurography by the patient.
Based on the results of the study, therapy is prescribed.
What are the treatments for this pathology?
Choosing the right method of treatment for such a hernia directly depends not only on the direction of protrusion, but also on the size. Therefore, it is very important to accurately establish any parameters of the disease, which can be done by computed tomography or MRI (the fact is that conventional radiography does not provide enough information to doctors).
- A hernia with sizes up to five millimeters will not require hospitalization. The main method of treatment in this case is special gymnastics along with spinal traction.
- The protrusion is up to eight millimeters. In this situation, a hernia is easily amenable to conservative therapy, including medical treatment along with gymnastics, massage and physiotherapeutic procedures.
- Education up to twelve millimeters will require hospitalization in the acute period, along with strict bed rest until the pain is completely relieved. Further treatment is usually carried out on an outpatient basis. The operation is performed only in case of obvious symptoms of compression of the brain or with signs of a ponytail (in this situation, we are talking about a complex of very serious manifestations against a background of advanced pathology, which includes impaired urination, leg motor functions, etc.).
- With a hernia size L4-L5 of the lumbar spine more than twelve millimeters, an urgent operation is indicated for patients.
The appeal to conservative therapy of this disease
Of primary importance in the process of treating the formation of L4-L5 disc is the reduction in the load on this area. Therefore, on the first day of therapy, strict bed rest is required in order to ensure rest of the spine directly in a horizontal position. The next stage of conservative support is drug therapy, which consists of taking analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants, chondroprotectors, vitamins and glucocorticoids. After stopping pain, the following treatment method is added:
- Physiotherapy (that is, treatment is carried out with long or short electric waves, electrophoresis, ultraviolet radiation and so on).
- Classes in the pool.
- Performing a massage.
- Classes in therapeutic gymnastics.
A mandatory component of therapy is the wearing of a supportive rigid corset. The first months such a corset is worn constantly, and then it is worn mainly during the performance of work related to weight lifting.
What else is the treatment for L4-L5 hernia?
Therapeutic gymnastics as a method of treating a disease and its features
The leading place in the treatment of hernia of this disc is gymnastics. Special exercises relieve abnormal tension in the muscles of the back, they are strengthened, helping the weakened spine to be properly maintained.
The insidious hernia of the disc in question consists in the presence of an imbalance that it causes in different muscle groups: one of them is dense and tense, and the other is relaxed. Only a doctor who is a specialist in physiotherapy exercises can take into account all the necessary nuances and correctly assign suitable exercises. All classes should be carried out under his direct supervision. Self-training without the supervision of an appropriate specialist can only exacerbate the situation and lead to nerve infringement.
The main rule for performing exercises in the treatment of L4-L5 hernia is the exclusion of axial loads on the spine. We are talking about all types of exercises, in which the basic pressure falls on the spine directly, that is, on the axis of the body (squatting, bending, swing or lunge). All classes are held in a prone position or on a special inclined simulator.
Surgical intervention for this pathology
The main objective of the operation is the release of nerve roots or the area of the spinal cord from under pressure. To date, the following four surgical procedures are practiced:
- Microdisectomy involves the removal of the herniated disc itself with the least intervention in the human body. The most effective technique among others.
- Perform endoscopic hernia removal. The operation is performed without incisions through a small puncture using special tools. Control over the actions of surgeons is carried out using a monitor.
- Implantation During the operation, the surgeon completely removes the damaged tissue of the disk, and an artificial implant is installed in its place.
- The implementation of nucleoplasty is considered to be a direct effect on the nucleus of a damaged disc through a pulse of cold plasma. Through small punctures, an electrode of an electronic optical converter is introduced into the disk core, along which pulses pass. As a result, the tissue of the nucleus evaporates, the hernial protrusion becomes smaller, and the nerve root is released.
Surgical treatment gives doctors the opportunity to quickly remove the pain syndrome, restoring the conductivity of the nerve impulse, however, there are high risks of relapse, since the very reason for the formation of a hernia remains unresolved.
Alternative treatments for the disease
It is possible to completely get rid of the symptoms of L4-L5 hernia of the lumbar spine, as well as to eliminate the main cause of its appearance only under the condition of an integrated approach to treatment, which includes the following treatment methods:
- Conducting hirudotherapy (i.e. treatment with leeches).
- Performing ozone therapy when injections of ozone are used in the affected areas.
- Carrying out homeosiniatria, with the injection of homeopathic medicines at biologically active points, which are responsible for the condition of the affected tissues.
Dorsal disc herniation L4-L5
Dorsal hernia is a rupture of the fibrous ring, which usually occurs on the back side. The protrusion goes back directly to the spinal cord. This is the most dangerous type of hernia L4-L5 and L5-S1 because of its close proximity to the human spinal cord. It not only compresses and injures the body of the brain, but also causes difficulties in treatment. The danger with the dorsal hernia L4-L5 is also the following:
- In patients, the sensitivity of the legs is impaired.
- Muscle weakens.
- Uncontrolled withdrawal of urine and feces may be observed.
- Sexual function is impaired.
Therapy for dorsal hernia is prescribed only after the diagnosis is made exactly. First, it is very important to determine the size of the formation along with the degree of protrusion and the location of the pathology.
Reviews about this pathology
Doctors and patients in the reviews report that the hernia of the disc described is a dangerous pathological condition that will require mandatory medical treatment. People who have encountered this disease write that today there are a lot of ways to eliminate such a problem. Much depends on the size of education. It is also emphasized that it is possible to completely get rid of it and defeat the main cause of the appearance of a hernia only under the condition of an integrated approach to therapy.