Lumbar spine hernia isdegenerative disease, which is characterized by a violation of the structural integrity of the intervertebral disc. The mechanism of pathology development is associated with the anatomical features of the structure of our ridge. In this article we will look at the main methods of treatment and the symptoms that occur in patients with this disease.
What is this disease
Between the vertebrae that make up the spine,complex formations from the fibrous ring and the pulpal nucleus are located. The first element is the flexible outer shell of the second. The pulpous core is a soft and thick substance of jelly-like consistency, which fills the main part of the intervertebral disc.
Like other spinal pathologies, hernialumbar spine occurs due to the integrity of the vertebrae. The reason for the development of pathological changes can be as excessive motor activity, leading to contusions of the back, blows associated with weight lifting, sharp turns, and a sedentary lifestyle, accompanied by progression of physical inactivity, weight gain.
Возникновению грыжи пояснично-крестцового отдела the spine is preceded by intense or prolonged exposure to the ridge. The prevailing factor in clinical cases that leads to the development of this disease is osteochondrosis. Thus, the symptoms and treatment of a hernia of the lumbar spine are practically the same symptoms of advanced osteochondrosis with a similar treatment regimen.
Causes
Predisposing factors leading to the problem with the spinal column, consider:
- violation of metabolic processes;
- various injuries, in particular after accidents, incidents in which there was a sharp jerk headfirst;
- hard work;
- scoliosis;
- hip dysplasia;
- obesity and overweight.
All of the above reasons mayactivate the pathological degenerative process. Other conditions and conditions that serve as a favorable background for the development of the disease cannot be discounted. In particular:
- hypotone muscular system;
- infectious diseases;
- lack of sufficient motor activity;
- long sitting in front of the computer;
- alcohol abuse;
- age changes;
- genetic predisposition.
All these causes can lead to early aging, premature wear of cartilage and bone tissues, and, as a consequence, the formation of an intervertebral hernia.
How pathology develops
Lumbar spine and joint of the fifth lumbarvertebra and the sacral bone can be considered the most vulnerable fragment of the spine from the anatomical point of view. For the same reason, in the intervals between the fourth and fifth lumbar vertebrae, as well as between the fifth lumbar vertebra and the sacral bone, a lumbar spine hernia is formed. Treatment of pathology depends largely on what stage it is diagnosed.
The disease is classified according to the degree of change and the state of the intervertebral disk:
- The first stage is prolapse (protrusion). There is a minimum offset of 1-2 mm, no more. The core does not extend beyond the fibrous ring.
- The second stage is a displacement of 1.5 cm. At the same time, the pulpous nucleus, as before, is located within the vertebral body.
- The third stage is extrusion. The tomographic image shows a noticeable displacement of the nucleus to the outer side, acting on the fibrous ring.
- Fourth stage. At this stage, the hernial formation becomes larger, the risk of rupture of the fibrous ring and leakage of the liquid substance beyond its limits increases.
At the onset of the disease, the patient mayfeel short back pain. As the pathology progresses, discomfort increases, and other symptoms of a hernia of the lumbar spine occur.
Varieties of pathology
Depending on the location of the affectedvertebra, the disease is of two types. The first is L4-L5, the second is L5-S1. Each section of the vertebral column is indicated by the corresponding letter of the Latin alphabet. The lumbar vertebrae are identified by the letter L, and the sacral part by the letter S.
Speaking more objectively, the first kindHernia L4-L5 means that a nerve process was trapped between the fourth and fifth lumbar segment. Thus, L5-S1 is a hernia that was formed between the fifth lumbar and first sacral vertebrae.
Symptoms of the disease
As a rule, hernia of the lumbar spine is extremely rarely latent. The characteristic signs of the disease are:
- severe pain in the lumbosacral area;
- feeling of heaviness in the legs;
- weakness, especially when walking;
- stiffness of movement;
- pain radiating to the hips.
In advanced cases of possible violations of the pelvic organs. When pinched nerve endings, the patient may feel numbness of the toes, feet.
The clinical picture associated with the disease is described by specialists, taking into account the difference between pain, vertebral and radicular syndromes. Symptoms manifest in two stages:
- At first, there is tolerable back pain, which indicates the start of dystrophic changes in the intervertebral discs.
- Without appropriate treatment in the fibrous ringmicroscopic clefts are formed, its strength decreases, and therefore the patient may feel discomfort in the area of the affected intervertebral disc.
- Further, the pain is caused by the tension of the nerve root, there is a direct contact of the hernial formation and nerve ending, which is the cause of a sharp pain syndrome.
At the onset of the disease, the patient may feeldull aching pain, localized at the site of lesion of a vertebra. An unpleasant syndrome increases with tension, physical exertion, sudden movements, prolonged sitting and weight lifting. As soon as the patient takes a lying position, the symptoms disappear. However, as the disease progresses, the pain syndrome becomes more intense, spreading to the muscles of the lower back, lower limbs, becoming stable.
What complications can there be?
Intervertebral hernia lumbarThe spine can bring along a number of health problems. One of them is lumbodynia. This is a pain syndrome, which is expressed by a strong backache. Discomfort increases dramatically even with minimal activity. This condition may haunt the patient for several weeks.
Еще одно осложнение, которое может возникнуть при hernia, associated with damage to the nerve receptors that control the bladder and colon. The pressure on these endings can trigger the inability of the muscle sphincters to hold feces and urine.
How to treat intervertebral hernia
Remove lumbosacral formationcan only be done surgically. However, the radical method of treatment is resorted to in isolated cases. As a rule, the fight against hernia is reduced to the need to suspend the progression of the pathology and eliminate the symptoms. Responsibility for choosing the optimal method of treating a hernia of the lumbosacral spine lies on the shoulders of the attending physician, who, when making a decision, takes into account the individual characteristics of the patient, stage of the disease, the presence or absence of chronic chronic diseases, contraindications, etc.
It should be borne in mind that in some casesDrug treatment of lumbar spine hernia is not able to bring any significant results. However, symptomatic therapy often avoids surgery and the high risk associated with it. If you consult a specialist in time, you will be able to increase the chances of preventing further development of the disease.
Hernia Drugs
Drug therapy is needed first.queue for relief of pain in the period of acute illness, and as soon as it is completed - to prevent relapse. The list of drugs that will help alleviate the patient’s condition is approved by the doctor. Usually, hernia of the lumbar spine is used with NSAIDs. These remedies eliminate pain, relieve puffiness and for some time return patient freedom of movement. For drugs in this group include:
- Diclofenac.
- "Nyz".
- "Naproxen."
- "Dolar".
- Meloxicam.
To improve blood circulation in hernia patients“Actovegin”, “Pentoxifylline” and “Berlition” are prescribed, and muscle spasms (“Tizanidine”, “Diazepam”, “Tetrazepam”, “Mydocalm”, “Sirdalud”) are removed with the help of muscle relaxants. In order to restore and start regeneration processes, chondroprotectors are used, among which are “Artron” and “Hondrolon”. The duration of treatment is determined by the attending physician.
In severe pain syndrome, paravertebral and epidural blockages with hormonal drugs have excellent analgesic effects.
In addition to the use of drugs, not lesssignificant for a patient with a hernia is bed rest. It must be observed until the aggravation retreats. Any movement should be done carefully, slowly and confidently, to avoid bending forward, lifting weights.
As soon as the pain syndrome subsides, it is necessaryreduce the dosage of the means used and focus on physical therapy, massages at the chiropractor and physiotherapy. Such treatment has a prophylactic purpose, and also helps to improve the patient’s muscles and ligaments.
Surgical intervention
Conservative treatment is advisable to continueno more than 2 months. If the exacerbation does not recede, the patient's condition worsens, and the drugs have proved ineffective, the doctor should review the treatment tactics and consider the feasibility of the surgery. The operation on a herniated disk is the most effective method of treatment, thanks to which it is possible to eliminate not only the symptoms, but also the immediate cause of the pathology. The indications for its implementation are pronounced neurological symptoms, dysfunction of the pelvic organs, and decreased sensitivity in the extremities.
To date, these types of operations are performed with hernia of the lumbar spine:
- Microdiscectomy - involves the removal of part of the intervertebral disc. In the predominant number of cases after such a manipulation, the hernia develops again.
- Ламинэктомия — хирургическая процедура, которая is the removal of pathological bone processes. They create compression on the intervertebral disc at the level of the affected area. Meanwhile, this type of surgery is fraught with serious complications: the risk of serious nerve endings is too great and, as a result, the support function of the spine is impaired.
- One of the modern options for the treatment of hernia of the spine is the installation of titanium implants instead of a destroyed intervertebral disc.
Recovery
Реабилитация после проведенной операции по removal of a hernia of the lumbar spine requires a serious and responsible approach. The patient for the next three months is strictly forbidden to sit. In addition, at least three hours a day, the patient will be forced to wear a medical corset, which is necessary to minimize the load on the lower back.
Mandatory element of rehabilitationactivities is the implementation of physical therapy exercises. With hernia of the lumbar spine, gymnastics is done slowly, slowly, smoothly. All exercises are performed without sudden movements, turns, jerks. Before exercise therapy, doctors recommend doing a lumbar massage - it is easier to prepare muscles for physical education. It is ideal to combine massage with rubbing anti-inflammatory ointment, which includes chondroitin or other non-steroid component.
The complex of exercises for hernia of the lumbar spine is as follows:
- To warm up you need to stand up straight, legs apart shoulder-width apart. Next, take a deep breath, and then exhale. Repeat 15-20 times.
- Inhaling the air, try to reach the top of the head.as high as possible. It is important to feel how the joints are stretched. Then, breathing out, relax. Then repeat the pull-up again, trying to reach the ceiling. Exercise is repeated several times.
- Palms link in the "lock".Then raise your hands up, trying to lead them behind you. The brushes should be turned towards the ceiling. To rise in such a position on the socks, with all his strength to stretch the spine. It is important to fix your body in this position for 10-20 seconds.
- Take a deep breath with both hands.up, and on the exhale - tilt the body forward as much as possible. Swinging and sharp movements do not need. The chin should be pointing up. For convenience, you can use the tools at hand, for example, leaning your palms on the wall, table, chair back. In this position, you need to stay for 10-20 seconds, repeat 3-4 times.
- Lying on your back, first pull your right leg to your left chest, then vice versa - your left leg to your right chest. Continue the exercise for 2-3 minutes, during this time the legs should be alternately changed.
- Lie on the stomach, limbs spread apart.Exhaling, raise your arms and legs as high as possible, tilt your head so that your chin is looking up. Fix the position for 30-40 seconds, then relax and repeat three more times.
