Causes, symptoms and treatment of herniated discs l3-l4, l4-l5, l4-s1, l5-s1
The Most serious complication of the course of osteochondrosis of the spine is the formation of hernial disk corruption. We consider the following localization of the lesion: l3-l4, l4-l5, l4-s1, l5-s1. Analyze the causes, symptoms, characteristics and treatment. For convenience of perception, the symptoms of each type of list separately. And diagnosis, treatment and prevention will be common for both l3-l4 and l4-l5 and l4-s1 and l5-s1.
According to statistics, the most frequent localization of the pathology of the intervertebral segment, is determined in the lumbar-sacral spine. This area suffers from the phylogenetic development of humans (walking upright) and is subject to the greatest load (power Stanovaya, prolonged sitting, and so forth).
The population of patients with osteoarthritis, complicated by the development of disc herniation is growing and getting younger. Now the ranks of patients include not only people of middle and old age, but also schoolchildren and students.
In some patients, the hernia shows its symptoms only at the stage of formation of protrusions, when the mechanism of pathological innervation and the degeneration of muscle tissue will already be running.
Formation and causes the development of disc herniation
A Hernia is formed due to the violation of biomechanical balance in a spinal motion segment (two vertebrae between which the disc is located, the joints to ensure the intervertebral joints, ligaments and muscles).
The Reasons for the development of osteochondrosis and, as a consequence, complications such as compromising the integrity of the disk, can be:
- congenital anomalies of the spine, paravertebral muscles;
- scoliosis, straightening of the physiological lumbar lordosis;
- genetically determined (pathology of the musculoskeletal system caused by genetic disease) or acquired (usually in childhood) curvature of the spine;
- an electrolyte and trace element imbalances in the body (lead to malnutrition of the intervertebral space);
- incorrect mode water (chronic dehydration causes similar changes in the disk; at first he uses water from the spongy substance of the vertebrae nearby, and then loses its functions);
- lack of exercise, obesity;
- peripheral vascular changes (microcirculation, represented by capillaries, delivers the essential nutrients, since discs do not have their own vessels);
- trauma of the spine.
A Pulpous nucleus of the intervertebral disc surrounded by fibrous ring, is his core, jelly-like consistency, consisting of trace elements, electrolytes and water (95 %). It's a scary dehydration (reduction of fluids in the body). In the period of pathological changes in the discs lose their elasticity, cushioning properties reduced.
With long-term lack of a sufficient amount of liquid, changing the structure of the intervertebral disc. It becomes dry, loses its height and flattened. In this situation, even minimal physical activity causes the appearance of cracks, in extreme cases, rupture of the fibrous ring. Gradually formed intervertebral disc herniation (protrusion – stretching, extrusion – partial prolapse of the nucleus through fissures of the fibrous ring, sequestration – out of the nucleus into the spinal canal of the spine due to complete rupture of the ring).
Symptoms depending on the localization of pathology
Patients suffering from osteochondrosis of the spine, are under medical observation by a doctor-neurologist. If developing intervertebral disc herniation (l3-l4, l4-l5, l4-s1, l5-s1), treatment of patients begins to control and neurosurgeon.
Neurological symptoms depend on the damaged segment of the spine (l3-l4, l4-l5, l4-s1, l5-s1). Originate from the spinal cord spinal nerves, the number of which corresponds to the number of intervertebral spaces. Nerves carry the sensitive-motor function and Innervate certain organs of the human body. If there is poor circulation, nerve compression, develops a hernia can affect the function of the urogenital system, causing pains and cramps in the legs, until the development the bottom of paresis and paralysis.
The Main clinical symptoms are:
- pain (may be different in character (aching, stabbing, radiating, cutting, strong) and duration (permanent, periodical);
- sensitivity (reduction, lack of or increased sensitivity).
Herniated disc l3-l4
Herniated disc l3-l4 is a relatively rare occurrence. Fiber l3 are part of the femoral-pudendal nerve, lateral cutaneous nerve of the thigh. Their defeat is characterized by the following symptoms:
- pain in groin, inner thigh, lower abdomen (in any position, gets worse when standing);
- dysesthesia (burning, "pins and needles", numbness and other symptoms) perednenaruzhnaya surface of the femur.
Front fiber l3–l5 are part of the obturator nerve and cause:
- pain in the groin area and inside of thighs;
- paresthesia and numbness (sometimes complete lack of sensitivity) in the thigh, lower leg
- hypotrophy (volume reduction and strength) of the muscles of the thighs;
- weakness of adduction, and rotation of hip;
- autonomic dysfunction (anhidrosis) of the skin of the thigh.
Fiber nerves l3, l4 participate in the formation of the femoral and saphenous nerves, the functions of which are manifested by the presence of painful, sensitive and trophic disorders from hip to foot.
Hernial protrusion of l4-l5
Herniated disc l4-l5 is the most common form and compresses the l5 nerve. The symptoms identified on the affected side:
- weakness of the first toe (difficulty in straightening, lifting);
- reduced range of motion in the foot;
- a feeling of pain and reduced sensation in the foot and the first toe.
disc herniation l5-s1
Hernia l5-s1 is also being developed, and in the area of l4-l5. It compresses the s1 nerve that causes:
- the inability of the patient to rise on the toes (the weak fingers);
- the pain and numbness in the calf muscles and the outer surface of the foot.
You Should know that the herniated l5-s1 disc causes malfunction of the sacral plexus are:
- pain in the sacrum, the buttock, the perineum, thigh, Shin, foot;
- paralysis of the muscles of the pelvis and legs.
Herniated discs l4-s1 can be formed as a single, or several in a row. In the latter case, their sizes differ. Therefore, the treatment policy is chosen for the whole group but more pronounced in the hernia.
Fiber l4, l5, s1 are part of the sciatic nerve, tibial and common fibular nerves. His defeat is characterized by:
- impaired sensation on the skin of the leg and foot;
- impaired flexion of the leg at the knee joint;
- lack of movement in the fingers and feet, the foot hangs down, there is atrophy of the muscles;
- expressed pain at the back of the thigh, the outer surface of the leg and foot;
- cold skin of the foot.
Modern methods of diagnosis
A Qualified technician will assess the overall health of your spine. In severe course of the disease can be diagnosed with several herniated discs in adjacent segments and in different parts of the spine.
To assess the status of disc herniation have a value of its sagittal (front-back) sizes: small (3-5 mm), medium (7-8 mm), large (10 mm or more).
In addition to the medical examination, details of the collected history (history of symptoms) of the disease, it is necessary to conduct laboratory and instrumental examination of the spine:
- General blood test (shows the presence of inflammation, infection)
- magnetic resonance imaging of the spine (helps assess the integrity of the vertebrae, the presence of pathological tissue, the height and condition of the intervertebral discs, vertebral canal, presence of hernia orifices of the pockets, their location, size and so on); this type of diagnostics is more informative compared to x-rays and computed tomography
- electromyography (detects level of lesion of muscle fibers);
- ultrasound of the spine (screening method);
- discography, myelography (according to indications);
- physicians of narrow specialties (urologist, gynecologist, gynecologist, andrologist, rheumatologist, orthopedist, traumatologist, the psychotherapist, etc.).
Therapeutic measures – only an integrated approach
Treatment of herniated discs is based on historical, proven methodologies in tandem with innovative discoveries of modern medicine. Required is an integrated approach where treatment combines all kinds of therapy (medication, physiotherapy, in severe cases, and surgical).
The following principles of treatment of herniated discs have proven effectiveness (based on the data of multicenter studies, scientific publications, approved patents).
In the acute stage requiring hospitalization of the patient in the hospital round the clock or at home, to ensure bed rest (rest in the horizontal position of the body).
In most cases, treatment begins with conservative methods:
- Drug therapy: nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin therapy, muscle relaxants, local paravertebral injections of analgesics, glucocorticoids or chondroprotectors;
- physical Therapy: electrotherapy short and long waves, different kinds of kinesitherapy (deinothere), therapeutic exercise (physical therapy), acupuncture, manual therapy, medical massage, mud treatment and mineral waters;
If you have lingering painsyndrome (more than three months), reflex changes (loss of tendon reflexes), muscle (reducing the volume and force of muscles of legs, buttocks) areas, impaired functions of pelvic organs may be recommended surgical treatment.
A Certain percentage of patients decides to undergo surgical treatment designed to eliminate pain.
- Microdiscectomy (removal of damaged disc, is performed under General anesthesia);
- Percutaneous discectomy (under local anesthesia, x-ray control, through the skin are surgical instruments and the removal of the damaged fragment of the disk to reduce mechanical irritation of the spinal nerve, for example, if a herniated disc l5-s1);
- Fusion (surgical treatment, which spliced the two adjacent vertebrae; recommended when recurrent course)
- Introduction artificial disc (after removal of the grafted destroyed new);
- Laminectomy, laminotomy (removal of part of the vertebrae to free the spinal nerve from compression)
- Electro thermal therapy (minimally invasive treatments, the catheters a certain temperature "welded" the end of nerve fibers and eliminated pain syndrome).
Comprehensive treatment of hernia must be completed a rehabilitation course. The best option would be a Spa treatment every year.
Prevention is better than cure
The chronically sick osteochondrosis intervertebral hernia may not develop, if you follow the following guidelines:
- diet (eating foods rich in vitamins and minerals), normalization of weight;
- severe exception of physical activity in the form of turnings, liftings weights, quick sports; reasonable fitness classes and physical therapy in specialized rehabilitation centers;
- to generate the correct motor behavior (at the same time raise not more than 3 kg from the squat, keep the load at the abdomen, on the midline);
- to avoid hypothermia;
- to be in psycho-emotional balance;
- regular exercise in a swimming pool
- the use of orthopedic products (corsets small period of time, shoes and bedding.
remember that the herniated disc – the disease is acquired and progressive. However, the rate of progression depends on individual behavior. Don't forget that your spine is sick! Treat him carefully. After all, even healthy people advancing age degenerative changes. Halting the progression of the disease, can be saved: her figure is symmetrical, gait – smooth, the facial expression – happy attitude to life is positive. Wish you long life!