Spinal problems worry many people. Some people, due to hard work, develop such a condition as an intervertebral hernia of the lumbosacral spine.
What is she like?
An intervertebral hernia is most often called a serious condition in which an intervertebral disc is displaced from the plane of the spine. Most often, this condition develops as a result of excess load attributable to the spinal column.
Suffer from this disease mainly men aged 20 to 50 years.
The incidence of this disease is about 100 cases per 100,000 population per year.
Most of these hernias appear due to physical overload of the spine as a result of labor. The manifestation of a traumatic hernia after surgery on the spine or as a result of a lesion. Rarely, congenital hernias of the spine are found.
In elderly people, cases of the development of hernias are known against the background of physiological weakness of the ligaments of the spine.
The most common is the intervertebral hernia of the lumbosacral spine, since the lower back is the most vulnerable place for the development of this disease.
Pathogenesis of hernia
Under the influence of a high load on the spinal column, a gradual compression of the intervertebral disc occurs. Because of this, rupture of the outer rim of the disc (outer fibrous ring) most often occurs, after which the contents of the intervertebral disc exit.
The released pulpous nucleus can be displaced both inside the spinal canal and to the sides of it. In the first case, an infringement of the spinal cord develops, which can lead to irreversible consequences. In the second case, radicular syndrome may develop due to compression of the nerves emerging from the spinal cord. Aseptic inflammation develops at the site of compression, edema of surrounding tissues appears, which further worsens the situation.
As a result, the symptoms of radicular syndrome (pain, impaired sensation and limb function) are characteristic of the intervertebral hernia. Over time, mobility in the spinal column is impaired.
As you can see, the place where the intervertebral hernia most often occurs is the lumbosacral spine. Treatment should be prescribed as soon as disk displacement is diagnosed.
Treatment
In any case, treatment of an intervertebral hernia should be started immediately. The lumbosacral spine performs an extremely important function of the body - maintaining balance and overlying organs in an upright position. With the development of a hernia in the lumbar region, it becomes much more difficult to perform this function due to the intense pain syndrome that develops with compression of the nerves. The condition exacerbates the untimely treatment of doctors.
When the first symptoms appear, treatment of the intervertebral hernia should be started immediately. The lumbosacral spine responds well to such non-drug methods as the use of orthopedic mattresses, massage, and the use of cold compresses. These methods have a purely symptomatic orientation (to alleviate the patient's condition) and can only be used for some time to avoid hernia complications. With an aggravation of the condition, it is advisable to immediately make an appointment with a neurologist.
Drug therapy
If nevertheless an intervertebral hernia has developed, how to treat it so as not to harm your body? To do this, use anti-inflammatory drugs from the group of non-steroidal drugs. The most common are ointments, gels and creams. They usually contain “Diclofenac” (“Rumacar”, “Dicloberl”), “Indomethacin” (“Metindol”, “Rumacid”). The concentration of drugs in these drugs allows you to remove intense pain and inflammation (however, taking the same dose of drugs inside may not have the proper effect, and also contribute to the development of stomach ulcers or 12 duodenal ulcers).
It is possible to combine non-steroidal anti-inflammatory drugs with glucocorticoids.
Glucocorticoids are prescribed either orally or intravenously to achieve the effect as soon as possible. Used drugs such as Prednisone and Dexamethasone. Treatment with glucocorticoids should be prescribed only if NSAIDs are ineffective, as long-term use of corticosteroids does the body more harm than good.
Physiotherapy in the treatment of hernia of the spinal column
In second place in frequency of use is physiotherapeutic treatment of intervertebral hernia. The lumbosacral spine is one of the most accessible parts of the musculoskeletal system for using various devices.
According to many experts, physiotherapy can contribute to a faster recovery than when using medications.
Currently, the use of multifunctional electrodes is the most effective method for treating intervertebral hernias. The essence of this technique is the interruption of incoming pain impulses using radio frequency waves.
Of the more well-known methods, electrophoresis with analgesics, therapeutic baths, and laser therapy are often used. Electrophoresis and phonophoresis can deliver drugs directly to the spinal column. The effect is often noticeable after just a few treatments.
Relaxing hot baths in some cases can contribute to spontaneous reduction of the hernia into place.
If a worsening of the condition is observed, despite the measures taken, then the disease of the intervertebral hernia has become complicated. How to treat it in this situation?
Surgical treatment of intervertebral hernias
If the conservative treatment used is ineffective or if severe neurological symptoms appear (limb paralysis, urination and bowel movements, paresis, paresthesia, intense pain, pain on the back surface of the lower extremities), surgical treatment should be started immediately.
Indications for emergency treatment are infringement of the spinal cord, compression of the vessels passing by.
Treatment is carried out mainly in specialized surgical departments (most often in neurosurgery).
Among the treatment methods used, two main groups are distinguished - endoscopic surgery and traditional microsurgery.
Depending on how the disease proceeds, tactics of operative access are determined.
Treatment is necessarily carried out under general anesthesia and with the support of basic vital functions.
Microsurgical removal
Before the introduction of microscopes in medical practice, if surgical treatment of an intervertebral hernia was indicated, the lumbosacral spine often underwent various complications in the postoperative period (suppuration, relapse). The real revolution was the use of optical devices in the treatment of hernias. This allowed us to reduce the extent of online access, which significantly reduced the incidence of developing complications.
Most often, the intervertebral hernia of the sacral region is removed through a microscopic incision (laminectomy is performed). Under high magnification, it becomes possible to accurately remove the hernial protrusion without damage to adjacent tissues.
Activation of the patient occurs the next day. The patient is allowed to daily business in 10 days, and after a month he can already engage in physical labor without the risk of complications.
Endoscopic surgery
These intervertebral hernia operations are a relatively new area in neurosurgery. Most often they are conducted through the posterolateral endoscopic approaches. The advantages of these methods is even greater safety in creating an operating wound (sometimes a regular puncture of the skin is done). However, this is also the main disadvantage - in this case, the possibilities of complete excision of the hernia and its removal from the puncture zone are limited. Inaccessible hernias, or hernias accompanied by compression of the spinal cord, cannot be removed by such operations.
The patient can, on the day when the operation was performed, rise, walk. Work is permitted approximately one week after discharge from the hospital.
Hernia Complications
Over time, if a hernia begins to squeeze nearby tissues, complications may develop.
If a normal hernia (intervertebral) has developed, the lumbosacral does not completely lose its function, and damage to the spinal cord is not observed. Everything worsens when the hernia is displaced towards the spinal canal.
The most dangerous of them is the infringement of the spinal cord. At the same time, the functions of urination and defecation are impaired, which poses a threat to life (severe intoxications, ruptures of the bladder, intestines and urethra are possible). In addition, if the inflammation passes to the spinal cord, it is possible to damage the overlying departments with a violation of the functions of the internal organs, up to the death.
Another common complication of hernia is radicular syndrome. With prolonged existence, significantly worsens the condition.
More favorable complications are decreased sensitivity and paresthesia.
Rehabilitation and Prevention
For the development of a hernia, some time is required (i.e., conditionally, it can be called a chronic disease). If you follow the basic recommendations, you can prevent its development.
To prevent relapse, after removal of the intervertebral hernia, the load should be adequately distributed during physical work. Do not overdo it, because it can end badly.
Also, for the prevention of hernias, physical education and exercises are recommended that strengthen the muscular skeleton of the back (for example, deadlift with reasonable loads).
During long and hard work, it is recommended to take relaxing hot baths for prevention purposes - they contribute to a small discrepancy of the vertebrae, which prevents pinching of the disc between them.
Rehabilitation after a hernia has included stress avoidance, exercise therapy, massage and manual therapy or acupuncture.