Lumbar spinal hernia is a degenerative disease characterized by a violation of the structural integrity of the intervertebral disc. The pathology development mechanism is associated with the anatomical features of the structure of our ridge. In this article, we will get acquainted with the main methods of treatment and symptoms that are found in patients with such a disease.
What is this disease
Between the vertebrae that make up the spine are complex formations of the fibrous ring and the pulpous nucleus. The first element is the flexible outer shell of the second. The pulpous nucleus is a soft and thick substance of a jelly-like consistency that fills the bulk of the intervertebral disc.
Like other pathologies of the spine, a lumbar hernia occurs due to a violation of the integrity of the vertebrae. The reason for the development of pathological changes can be both excessive motor activity, leading to bruises in the back, strokes associated with weight lifting, sharp turns, and a sedentary lifestyle, accompanied by the progression of physical inactivity, weight gain.
The occurrence of a hernia of the lumbosacral spine is preceded by an intense or prolonged effect on the ridge. The predominant factor in clinical cases that leads to the development of this disease is osteochondrosis. Thus, the symptoms and treatment of a hernia of the lumbar spine are almost the same symptoms of advanced osteochondrosis with a similar treatment regimen.
Causes
The predisposing factors leading to a problem with the spinal column are:
- violation of metabolic processes;
- various injuries, in particular after accidents, incidents in which there was a sharp jerk head first;
- hard labour;
- scoliosis;
- hip dysplasia;
- obesity and overweight.
All of the above reasons can activate a pathological degenerative process. You can not discount other conditions and conditions that serve as a favorable background for the development of the disease. In particular:
- muscle hypotension;
- infectious ailments;
- lack of sufficient motor activity;
- long sitting in front of the computer;
- alcohol abuse
- age-related changes;
- genetic predisposition.
All these causes can lead to early aging, premature wear of cartilage and bone tissue, and, as a result, the formation of an intervertebral hernia.
How does pathology develop?
The lumbar region and the junction of the fifth lumbar vertebra and sacrum can be considered the most vulnerable fragment of the spine from an anatomical point of view. For the same reason, in the spaces between the fourth and fifth lumbar vertebrae, as well as between the fifth lumbar vertebra and the sacral bone, a hernia of the lumbar spine is formed. Treatment of a pathology largely depends on what stage it is diagnosed with.
The disease is classified according to the degree of change and condition of the intervertebral disc:
- The first stage is prolapse (protrusion). There is a minimum displacement of 1-2 mm, no more. The core does not go beyond the fibrous ring .
- The second stage is a 1.5 cm displacement. In this case, the pulp nucleus, as before, is located within the vertebral body.
- The third stage is extrusion. In the tomographic image, there is a noticeable displacement of the nucleus to the outside, affecting the fibrous ring.
- Fourth stage. At this stage, the hernial formation becomes larger, the risk of rupture of the fibrous ring and leakage of the liquid substance beyond it increases.
At the beginning of the development of the disease, the patient may feel short back pain. As the pathology progresses, discomfort increases, and other symptoms of a hernia of the lumbar spine arise.
Varieties of pathology
Depending on the location of the affected vertebra, the disease is of two types. The first is L4-L5, the second is L5-S1. Each section of the spinal column is indicated by the corresponding letter of the Latin alphabet. The lumbar vertebrae are identified by the letter L, and the sacral region by the letter S.
In more detail, the first type of hernia L4-L5 means that between the fourth and fifth segments of the lumbar region the nerve process was infringed. Thus, L5-S1 is a hernia that formed between the fifth lumbar and first sacral vertebrae.
Symptoms of the disease
As a rule, a hernia of the lumbar spine is extremely rare latent. The characteristic signs of the disease are:
- severe pain in the lumbosacral area;
- feeling of heaviness in the legs;
- weakness, especially when walking;
- stiffness of movements;
- pain radiating to the hips.
In advanced complex cases, disorders of the pelvic organs are possible. When pinched nerve endings, the patient may feel numbness of the toes, feet.
The clinical picture associated with the disease is described by specialists taking into account the difference between pain, vertebral and radicular syndromes. Symptoms appear in two stages:
- On the first, there is a tolerable lower back pain, which indicates the onset of degenerative changes in the intervertebral discs.
- Without appropriate treatment, microscopic clefts form in the fibrous ring, its strength decreases, and therefore the patient may feel discomfort in the area of the affected intervertebral disc.
- Further, the pain is caused by the tension of the nerve root, there is a direct contact of the hernial formation and the nerve ending, which is the cause of the sharp pain syndrome.
At the beginning of the disease, the patient may feel a dull aching pain localized at the site of the lesion of a vertebra. Unpleasant syndrome increases with stress, physical exertion, sudden movements, prolonged sitting and weight lifting. As soon as the patient takes a lying position, the symptoms disappear. However, as the disease progresses, the pain syndrome becomes more intense, spreading to the muscles of the lower back, lower limbs, acquiring a stable character.
What can be the complications
Intervertebral hernia of the lumbar spine can bring a number of health problems. One of them is lumbalgia. This is a pain syndrome, expressed by a strong backache in the lower back. Discomfort increases dramatically even with minimal activity. This condition may haunt the patient for several weeks.
Another complication that can occur with a hernia is associated with damage to the nerve receptors that control the functioning of the bladder and large intestine. Pressure on these ends can provoke the inability of the muscular sphincters to hold feces and urine.
How to treat an intervertebral hernia
It is possible to remove the formation in the lumbosacral region only surgically. However, a radical method of treatment is resorted to in isolated cases. As a rule, the fight against hernia is reduced to the need to stop the progression of the pathology and eliminate the symptoms. The responsibility for choosing the optimal method for the treatment of a hernia of the lumbosacral spine lies on the shoulders of the attending physician, who, making a decision, takes into account the individual characteristics of the patient’s body, stage of the disease, the presence or absence of aggravating chronic ailments, contraindications, etc.
It must be borne in mind that in some cases, drug treatment of a hernia of the lumbar spine is not able to bring any significant results. However, symptomatic therapy often avoids surgery and the high risk associated with it. If you turn to a specialist in time, you will be able to increase the chances of preventing the further development of the disease.
Hernia
Drug therapy is necessary primarily for the relief of pain during an exacerbation of the disease, and as soon as it is completed - to prevent relapse. The list of drugs that will help alleviate the condition of the patient is approved by the doctor. Typically, for a hernia of the lumbar spine, NSAIDs are used. These remedies eliminate pain, relieve swelling and for some time restore patient freedom of movement. The drugs in this group include:
- Diclofenac.
- Nise.
- Naproxen.
- "Dolarn."
- "Meloxicam."
To improve blood circulation during hernia, patients are prescribed Actovegin, Pentoxifylline and Berlition, and muscle spasms are removed with the help of muscle relaxants (Tizanidin, Diazepam, Tetrazepam, Midokalm, Sirdalud). In order to restore and start regenerative processes, chondroprotectors are used, including Arthron and Chondrolon. The duration of treatment is determined by the attending physician.
With severe pain, an excellent analgesic effect is exerted by paravertebral and epidural blocks with hormonal drugs.
In addition to the use of drugs, bed rest is equally important for a patient with a hernia. It must be observed until the aggravation recedes. Any movements must be performed carefully, slowly and confidently, to avoid bending forward, lifting weights.
As soon as the pain syndrome recedes, it is necessary to reduce the dosage of the drugs used and focus on physiotherapy exercises, massages by the chiropractor and physiotherapy. Such treatment has a preventive goal, and also helps to improve the condition of the patient's muscles and ligaments.
Surgical intervention
It is advisable to continue conservative treatment for no more than 2 months. If the exacerbation does not recede, the patient's condition worsens, and the drugs are ineffective, the doctor should review the tactics of therapy and consider the advisability of surgery. An operation on a hernia of the intervertebral disc is the most effective treatment, due to which it is possible to eliminate not only the symptoms, but also the immediate cause of the pathology. Indications for its use are pronounced neurological symptoms, dysfunctions of the pelvic organs, decreased sensitivity in the limbs.
Today, these types of operations are performed with a hernia of the lumbar spine:
- Microdisectomy - involves the removal of part of the intervertebral disc. In a predominant number of cases, after such manipulation, the hernia develops repeatedly.
- Laminectomy is a surgical procedure that involves the removal of pathological bone processes. They create compression on the intervertebral disc at the level of the affected area. Meanwhile, this type of surgical intervention is fraught with serious complications: the risk of affecting serious nerve endings and, as a result, impaired support function of the spinal column is too great.
- One of the modern options for the treatment of hernia of the spine is the installation of titanium implants instead of a destroyed intervertebral disc.
Recovery
Rehabilitation after an operation to remove a hernia of the lumbar spine requires a serious and responsible approach. For the next three months, the patient is strictly forbidden to sit. In addition, at least three hours a day, the patient will be forced to wear a medical corset, which is necessary to minimize the load on the lower back.
A mandatory element of rehabilitation measures is the implementation of physical therapy exercises. With a hernia of the lumbar spine, gymnastics is done slowly, slowly, smoothly. All exercises are performed without sudden movements, turns, jerks. Before exercise therapy, doctors recommend doing a lumbar massage - it is easier to prepare muscles for physical education. It is ideal to combine massage with rubbing of an anti-inflammatory ointment, which includes chondroitin or another non-steroidal component.
The complex of exercises for a hernia of the lumbar spine is as follows:
- To warm up, you need to stand up straight, legs apart at shoulder width apart. Next, take a deep breath, and then exhale. Repeat 15-20 times.
- Inhaling air, try to get the top of the crown as high as possible. It is important to feel how the joints are stretched. Then, while exhaling, relax. Then repeat the pull-up again, trying to reach the ceiling. The exercise is repeated several times.
- Palms hooked into the "castle". Then raise your hands up, trying to get them behind you. The brushes should be turned towards the ceiling. To rise in this position on the toes, with all his strength to stretch the spine. It is important to fix your body in this position for 10-20 seconds.
- On a deep breath, it is necessary to raise both hands up, and on the exhale, tilt the body forward as much as possible. No wiggles and sudden movements are necessary. The chin should face up. For convenience, you can use the means at hand, for example, resting your palms on the wall, table, back of the chair. In this position, you need to stay for 10-20 seconds, repeat 3-4 times.
- Lying on your back, first pull the right foot to the left chest, then vice versa - the left to the right chest. Continue the exercise for 2-3 minutes, during which time the legs should be changed alternately.
- Lie on your stomach, spread limbs to the sides. As you exhale, raise your arms and legs as high as possible, tip your head so that your chin is facing up. Fix the position for 30-40 seconds, then relax and repeat three more times.