The human spine acts as a shock absorber. The anatomical structure of the spinal column allows you to soften the axial load on it. In some situations, pressure on the spine may increase. There are a number of professions in which the vertebrae experience stress all working hours (driver, accountant, writer, athlete). The intervertebral layers can extend beyond the vertebrae, and this is called protrusion. Pathology is more common in the lumbar. L4 L5 Disk Protrusion - What Is It?
What is most important in the spine?
Between the vertebrae are discs, which by their nature are cartilage. The disk repeats the rounded shape of the articular surfaces of adjacent vertebrae. The periphery of the disk is a multilayer fibrous capsule, and the center is the gelatinous nucleus. The central component of the disk is a gel-like substance. It smooths pressure on the vertebrae during exercise. In this case, the nucleus is flattened, and the fibrous ring of the intervertebral disc holds it. When the pressure ceases, gelatinous substance is again collected in the center. The thickness of the intervertebral "pillows" increases from top to bottom. The greatest height of the disc in the lumbar, then it decreases in the direction of the coccyx.
Changes
L4 L5 Disk Protrusion - What Is It? How is it determined?
It is a protrusion of the disc beyond the intervertebral space. Most often occurs in the lumbar, because it carries the greatest load. The most commonly affected disc is between L4 and L5. When exposed to damaging factors, the fibrous ring becomes thinner, microscopic ruptures of the fibers occur. Moreover, its integrity is maintained. When the degree of protrusion increases, the fibrous capsule ruptures and the gelatinous substance enters the space between the vertebrae. This pathology is called intervertebral hernia.
Causes of protrusion
- Osteocondritis of the spine. Discs receive power diffusely from the upper and lower vertebrae. With osteochondrosis, metabolic processes and blood circulation in the spine are disturbed. Intervertebral "layers" lack nutrients, water, and lose their elasticity. Protrusion is the end result of osteochondrosis.
- Injuries to the spine that can disrupt the structure of the disc.
- Excessive load on the spinal column. May occur with a sharp increase in gravity.
- Background diseases of the spine are ankylosing spondylitis, tuberculous spondylitis, osteomyelitis.
- Overweight.
- Hereditary connective tissue diseases.
- Weakness of the muscular corset of the back.
- Violation of posture and curvature of the spine.
- Age-related changes.
The main types of protrusion of the intervertebral disc L4 L5
They differ in the nature and direction of protrusion.
- Circular - there is a uniform protrusion of the gelatinous nucleus along the entire circumference of the disk. The most common type of protrusion.
- Back (dorsal) - there is a protrusion towards the spinal canal. Often leads to serious neurological disorders.
- Diffuse - is a posterior type of protrusion, but degenerative changes affect a small area of the disk.
- Median (Schmorl's hernia) - characterized by a protrusion of the central part of the disk towards the upper or lower vertebra.
Clinical manifestations of protrusion of the disc L4 L5
According to successive degenerative processes in the intervertebral disc, several stages of the disease are distinguished.
- Stage 1 (initial) - is a consequence of neglected and untreated spinal osteochondrosis. Pain syndrome in the form of short-term outbreaks that occurs during a prolonged sitting position, during intense physical exertion, when lifting weights. The process is organic level of the lumbar.
- Stage 2 - pain becomes longer and spreads to other parts of the spine, lower limbs, inguinal region. This is due to a more significant protrusion of the disk and compression of the roots of the spinal cord. Neurological disorders are manifested in the form of feelings of numbness in the limb, weakness of the muscles of the thigh and lower leg.
- 3 stage. The degree of stretching of the fibrous ring is maximum, the disk swells even more and causes serious disturbances in the nervous supply. It is a condition bordering on a hernia of the intervertebral disc. In general, everything is very serious.
What is L4 L5 disc protrusion? This is a borderline state between the last stage of osteochondrosis and a hernia of the spine.
Diagnostics
The disease may not manifest itself for a long time. First you need to understand the condition of the disc - protrusion or hernia. It is necessary to analyze the patient's complaints, find out the history of life data (focus on occupational hazards), the history of the disease (does osteochondrosis occur). Neurologist examination is necessary to identify neurological symptoms.
Instrumental types of diagnostics:
X-ray of the spine
What helps to find out?
- Curvature that may cause protrusion.
- The condition of the vertebrae and the degree of damage.
- Estimating the distance between the vertebrae where the discs are located.
The method carries little information, because it is aimed only at the bone structures of the spinal column.
MRI (magnetic resonance imaging)
Such a procedure is also carried out. On MRI of the lumbosacral spine, prices range from 2500-3000 thousand rubles. Pretty affordable. You can study in detail the L4 L5 vertebrae, where the protrusion of the gelatinous nucleus is located, and evaluate the integrity of the fibrous membrane. It is carried out in two projections and is the gold standard for the diagnosis of protrusions. It exhausts all questions when making a final diagnosis.
Where to do an MRI of the spine?
So. Where to do an MRI of the spine? Tomographs are located in almost every city. There are specialized diagnostic centers. If the person is from the district, he can go to the central district hospital or regional clinic. On MRI of the lumbosacral spine, prices in each region are different. Some cities have quotas. There you can do an MRI of the spine for free. Minus - there is a record, you need to wait in turn.
CT scan
It is rarely used because it has a low degree of information.
The results obtained help to choose the most optimal therapy. How to treat protrusion is decided by a neurologist or vertebrologist. Each of them has its own methods.
Disc protrusion treatment L4 L5
Doctors approach the treatment of disease of the lumbosacral spine comprehensively. Protrusion is well treated in the initial stages of the process. The last stage of the development of pathology often has to be treated surgically.
Conservative methods
- Elimination of the causes and factors of the disease.
- Physical rest, exclusion of increased axial load on the spine.
- Wearing an orthopedic corset for the lower back.
- The elimination of pain. A group of non-steroidal anti-inflammatory drugs ("Nise", "Ibuprofen") and non-narcotic analgesics ("Tempalgin", "Pentalgin") are used.
- Chondroprotective therapy (restoration of cartilage). Chondroitin sulfate injections are used. The course of treatment is 25 injections, which are carried out every other day.
- Prescribing medications that improve cerebral circulation (Cavinton).
- Reception of vitamin and mineral complexes.
- Massage. It allows you to passively strengthen the muscle corset of the back, relax tense muscle areas, improve local blood supply to tissues. Performed by a specialized medical professional.
- Physiotherapy. Allowed when pain is eliminated. Should be a daily routine. It is developed individually for each patient by a rehabilitation doctor.
- Physiotherapy and manual therapy. They help improve local metabolic processes, relieve tissue swelling, activate blood circulation and reduce pain. The courses are carried out after the main drug treatment and include methods: acupuncture, magnetic and laser exposure.
- Spinal traction, the need for which is determined by the doctor.
How to treat protrusion when the effect of conservative treatment is not achieved for a long time. What to do?
Surgical treatment of protrusions is rarely used (10% of cases). Apply minimally invasive techniques:
- Bone blockade. A non-narcotic analgesic is injected into the spine, which removes signs of inflammation (edema and pain). A steady improvement in well-being is achieved.
- Hydroplasty. It is the most effective and physiological method. Under the control of the X-ray machine, a liquid is introduced, which washes the destroyed part of the core and fills the remaining water. Negative symptoms disappear almost immediately.
- Laser treatment. Effective in the early stages of protrusion, when the gel-like substance is not ossified. It is based on burning out the protruding part of the pulpous nucleus.
- Cold plasma nucleoplasty. Cold plasma is introduced into the gelatinous nucleus, and part of the disk is evaporated. The pressure inside it drops, and this reduces the stretching of the fibrous membrane. Clinical manifestations disappear.
Prevention of protrusion of the disc L4 L5
Worry about spinal health should be from early childhood. You can not engage in self-medication, which in most cases leads to an aggravation of the pathological process. For pain in the spine, a doctor should be seen and examined. In the early stages of the disease, they are successfully treated. The main thing:
- In time to identify and treat a violation of posture, fixed curvature of the spine, osteochondrosis and other degenerative diseases of the osteoarticular apparatus.
- Eat foods that are high in calcium (cottage cheese, milk, cheese). To restore the cartilage structure, gelatin and agar-based products are recommended: marmalade, jelly, fruit jelly, bone broth.
- Refusal of alcohol and smoking. These bad habits disrupt the calcium metabolism in the body and lead to osteoporosis.
- Regular exercise. Trained muscles are a physiological corset for the lower back.
- Do swimming, yoga, skiing, cycling.
- When lifting weights, evenly distribute the load on both hands.
- For sedentary work, arrange small physical education minutes. Ensure yourself a proper fit at the table. Do not stoop your back.
- Keep your weight normal, because each extra kilogram additionally loads the spinal column.
- Use an orthopedic mattress and pillow. The bed should be hard.
- Preventive massage courses.
What is L4 L5 disc protrusion? This is a serious disease requiring immediate treatment and an adequate rehabilitation program. The prognosis is favorable with timely contact with the clinic and the implementation of the recommendations of the attending physician. Without specialized therapy, the disease will inevitably lead to an intervertebral hernia, an increase in pain. The pressure of a hernia on the spinal cord and its roots can lead to the development of paresis and paralysis.