A hernia in the intervertebral disc is a protrusion or loss of its fragments in the spinal canal. It develops due to osteochondrosis or trauma. A protrusion can provoke compression of nerve fibers.
Anatomy
In the spine, individual elements are connected to each other by means of disks. These structures have a certain density and include an elastic core. It is located in the central part of the disk. The nucleus is surrounded by strong rings formed by connective tissue. The intervertebral discs give the pillar flexibility and strength. Some pathological conditions provoke the destruction of these elements. As a result, hernias form.
Prevalence
Most often, the disease appears in people 25-50 years old. However, in old age, a hernia develops rarely. This is due to the fact that age-related changes in the elements reduce its mobility. In children, protrusions are also formed quite rarely. As a rule, at an early age, pathology is congenital.
Reasons for the appearance
The main provoking factors include a variety of failures during metabolic processes, infectious lesions, poor posture, trauma, osteochondrosis. As a rule, the development of intervertebral hernia is accompanied by an increase in pressure inside the disk. This phenomenon can be triggered by various reasons. In the presence of osteochondrosis, the appearance of a hernia can be caused by a increase in weight. Risk factors also include increased body weight. With heavy weight, strong pressure is exerted on the spinal column. Drives and other items are under increased stress. Over time, they are destroyed. One of the first pathological conditions in this case is precisely hernia of the intervertebral disc l5 S1. A protrusion can also form when the body is turned sharply to the side.
Localization
The greatest load is experienced on the lumbar spine. Therefore, most often a protrusion is formed in this department. Cases of the appearance of pathology in the cervical and thoracic segments are considered rare.
Intervertebral disc herniation l5 S1: description
In this segment, protrusion is formed most often. Often, a herniated disc l5 S1 extends to nearby areas. The pathology under consideration indicates that the protrusion of the pulpous nucleus occurred (if this is the initial stage) between the fifth lumbar and first sacral elements. It is in this area that the greatest load on the spinal column during the movement of a person is noted. A herniation of the l5 S1 disc may be the result of injury or past illnesses. With constant physical overvoltage, the situation worsens.
Complications
A disc herniation l5 S1 may be in an advanced stage. This significantly complicates the therapy and increases its duration. In the presence of unresolved factors and symptoms that enhance the pathology, a herniation of the intervertebral disk l5 S1 can be complicated by concomitant diseases. Of particular importance is the location of the protrusion. Also, a hernia of the l5 S1 disk can be accompanied by a number of complications that are due to the individual characteristics of the body. Due to the strong axial load, internal pressure on this area may increase. Significantly complicates the therapy of paramedian hernia of the l5 S1 disk. Over time, or under the influence of a complex of various factors, the destruction of the fibrous ring located between the disks can begin. In accordance with the stage of protrusion of the pulpous nucleus, as well as depending on deviations from the anatomical norm of the surrounding tissue, the therapy will also differ.
Classification
In the area of the fifth lumbar and first sacral elements, the longitudinal anterior ligament is strengthened quite strongly. This protects the structure of the intervertebral disc. In this regard, the protrusion can break through in the opposite direction. The posterior longitudinal ligament is less elastic. Because of this, it is more prone to damage. As a result of the breakthrough, a dorsal hernia of the l5 S1 disk is formed. The protrusion in this case can be of two types. In particular, there is a medial hernia of the l5 S1 disk. In this case, a protrusion occurred in the middle line. The specialist makes this kind of diagnosis if a hernial formation has penetrated into the intervertebral openings. It begins to narrow, and the walls of the dural sac are deformed. A paramedian hernia is also determined. In this case, there is a curvature of the column according to the scoliotic type. In this case, the deformation occurs in the other direction from the protrusion.
Therapy Features
The posterior hernia of the l5 S1 disc is particularly difficult. It is much easier to conduct therapeutic measures with anterior protrusion. Often, concomitant diseases join the pathology . They significantly complicate the clinical picture and subsequent treatment of intervertebral hernia. Among the concomitant pathologies, antespondylolisthesis, retrospondylolisthesis, uncoarthrosis are most often detected. In the list of pathologies, spondyloarthra can also be added. They are also often accompanied by a herniation of the l5 S1 disk. Treatment in such cases will also be aimed at eliminating the symptoms of complicating pathologies. Among the previous diseases, osteochondrosis is most often diagnosed.
The importance of timely detection of pathology
The protrusion itself is quite easy to eliminate. It is important to begin treatment of intervertebral hernia in a timely manner. In this regard, do not delay the visit to the doctor. However, already advanced stages of the disease are often diagnosed. A particular method of therapy is selected depending on the clinical picture, which is accompanied by a disc herniation l5 S1. Treatment can be either conservative or surgical. The surgical method is used for prolonged periods and serious complications.
Protrusion
This is one of the most frequent complications of all, which is accompanied by a disc herniation l5 S1. Treatment in this case requires a comprehensive. Protrusion is a condition against which a shift in the pulp nucleus is noted. In this case, the fibrous ring retains its integrity. The disk itself during protrusion can shift by 6 mm. The pathological condition can be of several types. In particular, they distinguish:
• Circular protrusion. In this case, there is a uniform expansion and enlargement of the intervertebral disc. The circular type of pathology is diagnosed more often than others.
• Median protrusion. She is sometimes confused with another type of protrusion - Schmorl's hernia. This condition is characterized by falling out towards the center of the spinal canal.
• Dorsal protrusion. This protrusion may be accompanied by pinching of the elements of the nervous system.
• Diffuse protrusion. In this case, the damage to the disc is more than 40%.
• Foraminal protrusion. In this case, the protrusion occurs in the direction of the intervertebral canal. In this case, an infringement of the fifth root of the lower back is noted.
• Paramedian protrusion. For this pathological condition, the infringement of the first nerve root in the sacrum is characteristic. The protrusion itself in this case is directed to the center of the spinal canal.
• Joint protrusion. In this case, a simultaneous lesion of two vertebral segments is diagnosed.
Sequestered education
This form is considered the most dangerous. It develops with untimely or improper treatment of extrusion. This is the stage at which it is difficult to normalize the vital activity of the spine without surgery. Against the background of sequestered education, the nerve roots of the sacral and lumbar regions are infringed. Along with this, the lesion extends to the fibers passing through the spinal canal. In people, this condition is called "horse tail syndrome."
Clinical picture
In the initial stages of the patient’s disease, local pains localized in the affected area begin to bother. Over time, they will spread to the buttock. The intensification of the pain syndrome occurs with an increase in load or in the process of movement. With a strong infringement of the nerve fibers, the pain will begin to give to the part of the thigh. The patient will feel a deterioration in sensitivity in the area where the compressed nerve root “reacted”. There is numbness in the foot or the corresponding reflexes disappear. Such symptoms are especially characteristic of dorsal protrusion. Median stumbling can compress particularly important nerve fibers. This, in turn, often provokes disturbances in the activity of the pelvic organs. If untreated, leg paralysis can occur. To avoid such complications, specialists prescribe an operation.
Therapeutic measures
The protrusion treatment is carried out by two methods: conservative and operational. Conventional therapy includes anti-inflammatory non-steroidal medications. These include, for example, drugs such as Naproxen or Ibuprofen. Also included in the complex of conservative measures is physiotherapy. It is aimed at releasing pinched roots and stabilizing the spine. There are special sets of exercises recommended for patients. At first it can be squats and slow inclines. With exacerbation, a 2-day bed rest is recommended. You should not lie longer, because it will be more difficult to recover. If there is no result after conservative measures, the operational method is used. Surgical intervention, as a rule, allows you to quickly and for a long period to get rid of the pathology. However, relapse is possible.