An intervertebral hernia in the lumbar region indicates wear or overload of the lower segment of the spinal column. Such a pathology is one of the most common and dangerous. It is characterized by protrusion of the intervertebral disc, the task of which is to distribute pressure on the vertebrae at the slightest load.
Features of the disease
A hernia in the lower back most often occurs between the fourth and fifth vertebra, or between the first sacral and extreme lumbar. Pain in the intervertebral hernia of the lumbar region, which is given to the leg and prevents full-fledged motor activity is a characteristic feature of the disease. Against the background of a lumbar hernia, protrusion of the intervertebral discs in other parts of the spine often occurs, which helps to blur the clinical picture and the appearance of atypical symptoms.
What can cause a hernia in the lower back
In the sacral and lumbar spine, the disease often develops as a result of the progression of osteochondrosis, a complex degenerative change in the articular cartilage. At risk, mostly people over 60 years old, but despite this, the disease can occur in people at a young age. Among the factors predisposing to the development of a hernia of the intervertebral disc of the lumbar, it is worth noting:
- injuries in an accident, falling from a height;
- excessive physical exertion (associated with work);
- constant weight bearing;
- metabolic problems;
- sedentary work and a sedentary lifestyle;
- deformation (curvature) of the spinal column;
- overweight;
- congenital malformations;
- benign and malignant tumors.
Infectious-inflammatory diseases, alcohol abuse, tobacco smoking, which have been transferred in the recent past, are capable of playing a negative role in the occurrence of a hernia.
How is the pathology manifested?
Symptoms of an intervertebral hernia of the lumbar at an early stage may be hidden. As the formation and duration of the disease increases, the severity of its manifestations increases. In this case, the main sign of a hernia is a diverse pain. Among the symptoms, tingling and heaviness in the limbs, numbness of the toes after long sitting should also be noted.
Initially, symptoms of an intervertebral hernia of the lumbar spine do not bring significant discomfort to the patient. Unpleasant sensations localized in the lumbosacral region are unstable, they arise periodically. Most often, the pain intensifies during movements, with bends, sharp turns with a torso and lifting weights. In this case, the pain is clearly felt in the lower back, that is, exclusively in the affected segment of the spine.
When the protrusion of the disk becomes larger, the nature of the pain syndrome changes:
- sudden lumbago lower back;
- the pain radiates to the pelvic area, thigh, lower leg and even the foot, as a result of which the patient begins to limp, and each movement is difficult;
- when coughing or sneezing, the lower back begins to hurt even more;
- possibly visually noticeable curvature of the spine;
- swelling in the sacro-lumbar segment;
- development of hypertonicity of the muscles of the back and abdomen;
- limited motor activity.
It is not difficult to recognize a hernia of the lumbar intervertebral disc by clinical manifestations. However, to make a diagnosis, as well as determine the exact location and size of the protrusion, a comprehensive diagnosis will be required (MRI, CT, radiography).
What pathology can lead to
Without proper treatment, a hernia can lead to disability. Symptoms of radiculitis may indicate that the disease is developing. It is characterized by inflammation of nerve fibers, which cause severe shooting pain.
An even more dangerous consequence of the intervertebral hernia of the lumbar spine is leg paralysis. The immobility of the lower body is possible due to neglect of the pathology or its delayed diagnosis. The result of a progressive disease is disability and the patient's inability to live a full life. A protrusion of the intervertebral disc can cause pelvic dysfunction, loss of ability to control urination and defecation. Due to the squeezing of the nerve processes, the sensitivity of the genital organs is lost, which leads to a number of problems in the reproductive system.
The main methods of treatment
With intervertebral hernia of the lumbar spine, the patient can be helped conservatively or surgically. As a rule, treatment begins with the use of non-radical methods. It is important to understand that to achieve a complete cure of the disease is possible only with the help of surgical intervention. In some cases, conservative therapy helps to stop the development of the disease and improve the quality of life of the patient. The average course of treatment is 3-4 months. During this period, it is possible to stop the pain syndrome in the acute manifestation of a hernia and prevent its increase in size.
An individual program is created for each patient, including the following components:
- physiotherapy and massage;
- drug anesthesia.
If conservative therapy does not allow us to observe positive dynamics or the patient’s condition rapidly deteriorates, in some cases the intervention of surgeons becomes advisable, despite the risks inherent in radical treatment of lumbar intervertebral hernia. Without surgery, it is impossible to get rid of ponytail syndrome, cure pinched nerves and restore partially lost musculoskeletal functions. Thanks to surgery, the pressure on the spinal cord and the roots of the nerves is eliminated, which allows the patient to feel much better.
Reconstructive gymnastics
Exercises with intervertebral hernia of the lumbar spine are an integral part of both conservative treatment and the postoperative rehabilitation period. Physical culture demonstrates the maximum therapeutic effect when combined with medication. All exercises that are performed to treat hernia are based on the principle of stretching the spinal column, extension and flexion of the back. The gymnastic complex is selected individually for each patient after an MRI diagnosis.
The training begins with several warm-up exercises (turns, tilts of the head, body), and then proceed to the main ones:
- Sit on the floor, put your feet on your buttocks. Press your palms to the floor and try to reach with your hands as far as possible, without unclenching your hips. The patient should have a feeling of stretching of the lower back. Repeat the exercise 10-12 times.
- Lie on your back, bend your knees. With outstretched arms, you need to slightly raise and stay in this position for 5-7 seconds, then again take the starting position and repeat the exercise 10 times.
- Roll over on your stomach, rest your chin on the floor, stretch your arms at the seams with your palms up. The patient’s task in this exercise with lumbar intervertebral hernia is to maximize torso and bend backward. It is important that your arms are raised up. In this position, you need to freeze for a couple of seconds and return to the starting position.
- Take a knee-elbow position, alternately extend the arm and the opposite leg forward, fixing the position for 10 seconds. For example, to extend the right hand and left leg, freeze in this position for a while, return to the starting position and put forward the left hand and right leg.
If the patient's well-being improves, he can be allowed to include twisting and tilting exercises in the gymnastics complex. You can train at home, because such classes do not require the use of sports equipment, special devices, equipment.
In addition to standard physical education, yoga, swimming, and Pilates are very effective for lumbar hernia. It should be understood that improper exercise can be harmful instead of the expected improvement. At the beginning of treatment of an intervertebral hernia of the lumbar spine without surgery, it is advisable to engage in the supervision of a physiotherapist. After the patient has mastered the sequence and technique of performing the exercises, you can proceed to home workouts.
Drugs for lumbar hernia to relieve inflammation
Medicines can reduce the intensity of manifestations, relieve inflammation and swelling. In the treatment of protruding intervertebral disc use:
- Nonsteroidal anti-inflammatory drugs that help with mild or moderate pain. With gastrointestinal diseases, such drugs are not prescribed. These include Ibuprofen, Naproxen, Nimesil, Aspirin, Celebrex, Diclofenac. In relation to the circulatory system, they have practically no side effects; they can be used before or after surgery.
- Hormonal anti-inflammatory drugs. Unlike the previous ones, they are used for a limited period (5-7 days). With intervertebral hernia of the lumbar spine, “Methylprednisolone", "Decadron" are used, which relieve swelling and inflammation.
- Muscle relaxants. Indicated for patients with spasms of the paravertebral muscles (Valium, Midokalm, Sirdalud).
Analgesic (systemic and local) drugs
To block pain receptors, not only analgesics such as Analgin, Paracetamol, Tylenol are used, but also antidepressants. The latter stimulate the production in the body of natural painkillers - endorphins. At the advanced stage of the disease, when the patient suffers from severe pain, opiates can be prescribed - analgesics based on narcotic components ("Morphine", "Codeine", "Tramadol"), which, if uncontrolled, cause addiction and serious side effects.
Many drugs for relieving pain and inflammation in the intervertebral hernia of the lumbosacral region are made on the basis of bee or snake venom (Apizartron, Viprosal, Virapin). As a local external anesthesia for this disease, you can use Diclofenac, Movalis, Ketoprofen, Phenylbutazone or combined ointments and gels-chondroprotectors (Dolobene, Teraflex, Deep Rilif).
Surgical intervention
Radical treatment of intervertebral hernia of the lumbar spine is justified and appropriate only in severe advanced cases. Regardless of the method of access to the affected disk, the essence of the intervention is as follows: an incision is made through which the surgeon removes the fibrous ring and the pulpous nucleus partially or completely (in this case, the subsequent installation of an intervertebral disk implant is assumed).
Laser removal
This method of eliminating the intervertebral hernia of the lumbar is one of the most effective and expensive. During the operation, anesthesia is not required, since the specialist does not perform tissue incision. This minimally invasive procedure can be performed according to one of the methods:
- Reconstruction - implies low radiation, provoking heating of the intervertebral cartilage. Usually, several procedures are required.
- Vaporization is the evaporation of a portion of the intervertebral disc. The laser beam destroys the protruding formation.
Electric pulses
In addition to lumbar intervertebral hernia surgery, surgical treatment involves the use of other, more modern and innovative techniques. One of them that has proven itself is spinal cord stimulation. The principle of such an intervention is as follows. Stimulating electrodes are implanted into the sacro-lumbar region, and an electric pulse generator is introduced into the buttocks or abdomen.
The device is controlled using special devices and connecting wires. The product stimulates the work of the spinal cord, peripheral nerve endings and cerebral hemispheres, thereby eliminating pain. Thus, the chronic malaise characteristic of the lumbar intervertebral hernia is due to the pulsating action of the electrical signals.
Rehabilitation after surgery
After surgery, whether it is laser removal or complete diskectomy, it is important to strictly comply with all the instructions of the attending physician, which is guaranteed to minimize the risks of complications and relapse of the disease.
After removal of the lumbar intervertebral hernia, patients are prescribed to wear a special supportive corset. In addition, it is strictly prohibited:
- weight lifting;
- physical activity;
- hypothermia and overheating.
For a speedy recovery, it is important to choose a comfortable orthopedic mattress and lie only in those poses that are recommended by a doctor. For example, you can’t sleep half-sitting. Care should be taken to climb the stairs - you need to walk along them slowly and slowly, without sudden movements. Also, in no case should you wear tight clothing and remove the bandage or supporting corset without the permission of a doctor.