Causes, symptoms and treatment of intervertebral hernias of the lumbar spine
It is a Hernia of the lumbar spine most frequently encountered in the practice of doctors. The whole life of the people "exploiting" the spine and often this exploitation is wrong. There is progressive degeneration of the fibrous ring, and decreases its elasticity. From permanent loads pulpous nucleus begins to shift in the direction of least resistance where fibrous ring has a minimum strength.
Why there are herniated discs in the lower back
This is due to several factors:
- Location. Being at the bottom of the spine, the intervertebral discs of the division, along with the vertebrae that have the most intensive load. This includes dynamic physical work load and static with a simple walk.
- Anatomical features. The discs of the lumbar spine and lumbosacral (L5-S1 disc) have a large height compared with the discs of the cervical and thoracic. In addition, they are larger in size. This makes them more prone to protrusion, and the formation of large hernias.
- Functional features. The larger size discs and causes difficulties in blood flow and provide them with nutrients. And a metabolic disorder is one of the reasons for the development of intervertebral hernias.
The above Mentioned factors not only lead to more frequent occurrence of hernia in the lumbar spine, but cause a heavier flow and treatment.
The Immediate cause of the aggravation of the hernia may be a factor is suddenly increased load on the spine during weight lifting, asymmetric load – carrying heavy objects in one hand or twisting motion in the lower back. The result is the manifestation of the disease in the form of pain.
based On changes in the intervertebral disc hernias are classified as follows:
- Protrusion – pulpous nucleus shifts slightly to the side, resulting in the spinal canal protrudes the portion of the fibrous ring, but his integrity is not infringed;
- Extrusion in the spinal canal prolabium not only the fibrous ring, and a pulpous nucleus;
- Prolapse – prolapse of nucleus pulposus through a break in the fibrous ring
- Sequestration – pulpous nucleus loses connection with the vertebrae, fragmentation and shifts in the vertebral canal may be formed interaction of forces within a fibrous connection.
In Addition to these degrees highlight the directions in which bulges herniation of the lumbar spine, posterior, lateral and posterolateral.
Symptoms and signs of hernias of the lumbar spine
herniation of lumbar and lumbosacral can be a long time does not manifest itself, which is the major cause of late referral to a doctor. Most people are waiting for the manifestation of a hernia in the form of pain, but if you pay attention to the following symptoms, the disease can be diagnosed at an early stage and successfully treated.
The Signs of a developing hernia:
- vertebral syndrome, manifested by back pain, strain of lumbar region (antalgic scoliosis), the voltage of the paravertebral muscles;
- sensitive disorders (paresthesia, hypoesthesia) in the area of innervation of the corresponding nerve bundle;
- hypokinesia (low mobility) of the muscles innervated by the affected nerve;
- weakening of reflexes, up to their disappearance;
- violation of functions of pelvic organs (incontinence of urine and/or feces, reduced potency in men and frigidity in women).
- specific changes of the vertebrae and discs are identified by neuroimaging methods (CT, MRI) or radiography;
- abnormalities in the functional state of the nerves, determined by electro neuro physiological techniques (transcranial magnetic stimulation, H-reflex, F-wave).
If the first five signs can be signs of other diseases of the spine (degenerative disc disease, spinal tumors), the last two items allow you to 100% confirm the diagnosis of herniated discs of the lumbar.
the consequences of progressive disease
Timely diagnosis and prompt initiation of treatment can fully restore the intervertebral disc and lead to complete regression of the disease. But, as a rule, people notice the hernia is very late and all the events in this case is aimed at reducing the intensity of symptoms.
what can cause untreated hernia of the spine?
The Most frequent manifestation of a hernia is lumbodynia acute pain in the lumbar region radiating to the leg. Without proper treatment it can lead to significant limitation of mobility. But if the pain canto stop the analgesics, the consequences of the hernia is extremely difficult correction.
Can be expressed disorders of the genitourinary system. The nerves innervating the bladder leads to dystonia that is accompanied by a violation of urination. With the defeat of the nerves responsible for the innervation of the bowel disorders marked stool – constipation or uncontrolled defecation.
May develop impotence and reduced libido, both in men and women.
Spinal nerves of the lumbosacral plexus are combined into a large sciatic nerve responsible for motor and sensory innervation of muscles of lower limbs. With the defeat of the spinal nerve roots of the lower back may be in breach of sensitivity and movement in the legs. In severe cases, when sequestration hernia may develop lower paraplegia – complete paralysis of both legs.
In less complicated cases, there may be a monoparesis (weakening moves) or monoplegia (paralysis) in one leg. The result of this phenomenon is the restriction of motor activity of man.
Methods of treatment – conservative and surgical
Hernia lower back pain in 95% of cases amenable to methods of conservative treatment and only in the most extreme situations it is advisable to resort to surgical treatment. Therapeutic methods of treatment include:
- medications – non-steroidal anti-inflammatory drugs for relief of pain, B vitamins to restore the function of damaged nerves,protective agents for repair of the intervertebral disc;
- paravertebral blockade the paravertebral introduction in the area of local anesthetics with corticosteroids and vitamins to improve the metabolism of the muscles and nerves
- Central action muscle relaxants (mydocalm, sirdalud) to eliminate muscle spasm
- physical therapy including a variety of techniques – Machines Dikul, Pellico, as well as swimming, fitness;
- leech therapy
- massage and manual therapy (osteopathy, visceropathies, kinesitherapy).
Conservative methods should be continued for 4-8 weeks. If during this time they were completely ineffective, you must either change the tactics of treatment, or to consider surgical intervention.
The Indications for surgical treatment:
- the progression of the syndrome of caudal progression of signs of paralysis and disorder of functions of pelvic organs;
- sequestration of a herniated disc;
- pronounced stenosis of the spinal canal.
- the ineffectiveness of conservative treatment for 3 months;
- recurrent disease (recurrent sciatica);
It Must be remembered that the methods of exercise therapy, manual therapy may be used for the treatment of lumbar hernia is only in remission. The aggravation is better to stop medical drugs.
In some cases surgery is contraindicated. For example, during the acute infectious diseases; malignant neoplasms; mental pathology.
Types of operations for hernias of the intervertebral
The Traditional method is considered to be an open discectomy where an incision on the back is removed the affected disk and between adjacent disks is formed a fixed connection (installation of the metalwork).
The Most popular methods in recent times are the methods of surgery using minimally invasive techniques.
- Laser reconstruction surgery is performed under local anesthesia. Effective in the case of the protrusion and extrusion.
- Percutaneous nucleoplasty – with the help of this method, by radio frequency denervation and the use of cold plasma, docked persistent pain.
- Endoscopic microdiscectomy through a small incision on the back provides access to the affected disc, under the control of the endoscopic video systems are manipulations aimed at the reconstruction of the disk or its removal.
In conclusion, it should be noted that no method of treatment does not have 100% efficiency, so it is better to prevent disease than to try to cure it.
forces any person to take a minimum effort to herniation of the lumbosacral spine was caused as little inconvenience or even have disappeared completely. The main activities aimed at the prevention of sacral intervertebral hernia:
- active lifestyle, a moderate load on the spine and firming the muscles. If you work in an office, find time for sports or even gymnastics
- contraindicated load beyond measure, even if your work involves heavy physical labor;
- monitor weight – it is recommended to keep the body mass index of 30
- correct position during sleep – sleep better on a moderately hard bed, preferably in the supine position, the spine had the opportunity to relax;
- proper, balanced diet and avoiding harmful habits.
Observing these simple rules will allow us to maintain intervertebralhealthy discs.