The human spine has 32-34 vertebrae, which are separated by intervertebral discs. They are formed by the outer (fibrous) ring and pulpal nucleus. The latter is localized in the center of the disk and has a jelly-like consistency. Lumbar hernia is formed under the action of the load, in violation of the integrity of the fibrous ring. The pulpous nucleus extends beyond the outer ring, squeezing the nerve fibers and disrupting blood circulation in the spinal cord.
Why may appear a hernia in the lower back? This condition occurs for several reasons:
- metabolic pathology,
- spinal curvature, scoliosis, dysplastic changes in the hip joint,
- spinal injury in an accident, when falling on his back, hitting,
- heavy physical exertion, weight lifting, bending,
- diseases of the spine: syphilis, tuberculosis, neoplasms.
The risk of lumbar spine hernia formation increases with the following conditions:
- male gender: it is more prone to hernia formation,
- sedentary lifestyle,
- genetic predisposition
- age 30-50 years old
- sedentary work,
- minor spinal injuries.
Under the influence of these factors, cartilage and bone tissue are subject to wear, which contributes to the rapid appearance of intervertebral hernia.
What are the signs of a hernia in the lumbar region?
Symptoms of hernia in the lumbar region include:
- limited mobility
- weakness of leg muscles,
- sensitivity impairment
- skin changes in the affected area,
- dysfunction of the pelvic organs,
- external changes.
Localization of pain during a hernia can be varied, it depends on which root is clamped. Often, the pain syndrome affects the inner side of the thigh to the knee joint, the inner part of the ankle or lower leg. The pain may radiate to the area of the buttocks, feet. Often, pain is felt only at one point.
Over time, the soreness changes its location, spreading lower to the heel, the rear foot, the thumb.
At the beginning of the development of the pathology, the patient may describe the pain as “backache”. In severe cases, the pain immediately becomes aching in nature. Its intensity increases with prolonged tension of the limbs and lower back (long walking or standing, exercises on the lumbar muscles, riding on a rough road).
Pain syndrome disappears in the supine position. As the process progresses, the pain can be reduced only by bending the sore limb in all joints.
Low back hernia contributes to the violation of sensitivity. The patient no longer feels the touch of hot and cold in the affected area, feels numb, burning, tingling or freezing. In the hearth pathology there is no feeling of pain.
Such changes can be localized in the crotch, waist, outer and inner thighs, lower leg.
Dysfunction of the pelvic organs
These symptoms of a lumbar hernia occur only when a spinal cord is squeezed.
On the part of the intestine, the patient has diarrhea, and in some cases constipation. In this case, no pain in the abdomen, or his swelling is not observed.
On the part of the bladder - the frequent urge to urinate. It is painless, with little blood, no urine is separated. Incontinence is sometimes formed.
On the part of the reproductive system - erectile dysfunction and prostatitis in men and gynecological pathology in women.
People from the side may notice that the patient's gait, posture has changed, hunchbacked, slouching, shortening of the limb appeared.
A hernia in the lower back is accompanied by the appearance of a muscle strand on one side of the spine, which is determined by palpation. Smoothness of the folds of the buttocks is visualized.
What doctor treats a lumbosacral hernia?
If there are signs of a hernia of the lumbosacral spine, it is necessary to receive it from a traumatologist-orthopedist or vertebrologist. In the presence of neurological manifestations, a consultation with a neurologist will be required.
A neurosurgeon will promptly treat a pathology. In case of a lumbar intervertebral hernia, if necessary, an appointment is given to a chiropractor, an exercise therapy doctor or an osteopath.
How to diagnose vertebral hernia? To do this, during the reception of the patient's doctor:
- conducts a test with the rise of the lower limb,
- examines the temperature, pain, vibration sensitivity in the area of possible lesions,
- determines tendon reflexes on the legs.
For instrumental diagnosis using CT or MRI of the lumbosacral. In the presence of spinal cord injury, myelography may be indicated.
How to treat lumbar hernia? This can be done in two ways: conservative and surgical. Which method will be chosen depends on the symptoms, the stage of the pathology, associated diseases and the presence of contraindications.
For the treatment of hernia of the waist it is important that the patient visits a specialist in time. This will allow for a conservative therapy, to avoid complications and stop the progression of the pathology.
Treatment of hernia of the lumbar spine without surgery consists in:
- drug therapy,
- manual therapy
- Exercise therapy,
- carrying out therapeutic massage.
Treatment of lumbar hernia in the acute period is aimed at eliminating pain. To do this, prescribe the following drugs:
- NSAIDs - Diclofenac, Ibuprofen, Movalis, Meloxicam. First, the drugs are injected intramuscularly, then transferred to tablet forms,
- muscle relaxants - Mydocalm, Sirdalud. They relieve muscle spasms, reducing pain,
- vitamins B1, B6, B12 (Milgamma, Neurobeks, Neurovitan). They contribute to the restoration of nerve fibers and improve the conductivity of the pulse.
During the acute period it is necessary to observe bed rest. It is forbidden to move sharply, lift heavy objects.
After stopping the exacerbation, you can proceed to manual therapy, therapeutic massage, exercise therapy and physiotherapy.
Surgical treatment for hernia of the lumbosacral spine can be used only if non-invasive therapy did not bring results within 1-2 months.
For the surgical treatment of hernia of the lumbar spine, the following methods are used:
- laminectomy - this intervention involves the removal of bone processes that exert pressure on the intervertebral disc in the affected area,
- microdiscectomy - deletes part of the disk. Frequent relapses,
- installation of titanium implants in the intervertebral space.
Treatment of herniated intervertebral discs of the lumbar spine with the help of an operation helps to eliminate the cause of the pathology. Surgical intervention is indicated in the presence of neurological symptoms or impaired sensitivity of the limb.
Complications of a hernia in the lower back are:
- lumbodynia (backache) at the slightest movement. Lasts up to several weeks
- loss of sensation in the big toe or ankle,
- leg paralysis.
Lumbar hernia - a pathology that develops under the influence of the load due to degenerative processes in the fibrous ring. Symptoms of this disease are pain, loss of sensation, restriction of mobility and changes in the skin of the affected area.
It is possible to cure a hernia conservatively if it is timely to ask for help. In severe cases, perform the operation. To delay with the elimination of this pathological process is impossible, because it can result in serious complications.
Causes of pathology
The reason for the development of intervertebral hernia of the spine in the lumbosacral can be:
- Excessive exercise. This especially applies to weight lifting without the use of a special support band.
- The development of osteochondrosis, which leads to the fact that the delivery of nutrients to the spine is impaired.
- Spinal injury, as a result of which it was the lumbosacral region that suffered. Most often, this occurs as a result of an accident.
- The presence of lumbar scoliosis.
- The presence of a tumor or other neoplasm in the spine.
- Diseases of the spine (ankylosing spondylitis, tuberculosis, etc.).
- Violation of metabolic processes, as a result of which the nutrition of the spinal tissue is disturbed.
- Long ride in the car. During the trip, the person is in a position where the spinal column is unnaturally bent, which contributes to a high load on the lumbosacral region.
The risk of developing L5 S1 hernia between the lower back and the sacrum includes people with the following diseases, as well as other factors:
- Dysplasia of the hip joints.
- Pathology of the muscular-ligamentous apparatus of hereditary nature.
- Spinal weakness.
- Age over 30 years.
- The presence of excess weight.
- Disturbance in the structure of the vertebrae of innate nature.
- Displacement of the pelvis to the side.
- Spinal surgery.
- Sedentary lifestyle.
- The presence of bad habits that contribute to poor circulation and nutrition of the spinal tissues.
Symptoms of pathology
The development of lumbosacral hernia occurs gradually. There are 3 stages of the process, each of which has its own characteristics. At the initial stage, the patient is concerned about:
- A pain of dull character that can intensify during moments of movement, sneezing or coughing.
- The weakening of the muscles in one of the lower limbs and a decrease in their volume.
- The sensation of burning and shooting pain in one leg.
- The temperature of the skin on both legs is different.
If at this stage you do not start the treatment of a hernia that develops in the lumbosacral spine, the pain increases and the mobility of the lower back is disturbed.
In the second stage of lumbosacral hernia development, the patient is worried about:
- Constant pain.
- The pain extends to the thigh, lower leg and buttock area.
- While walking or trying to bend down, the pain becomes very strong.
- Goose bumps on the skin of the legs.
- Violation of the sensitivity of the skin of the lower extremities (they are not able to respond to stimuli and temperature changes).
- The emergence of trophic ulcers.
Lack of treatment of the lumbosacral hernia at the second stage will lead to the transition of the disease to the advanced stage, which is characterized by the following symptoms:
- Delay or, conversely, urinary incontinence.
- Decreased libido.
- Erectile dysfunction in men.
- Spontaneous defecation.
- Paralysis of the lower limbs.
For the treatment of intervertebral hernia, which originated in the lumbosacral region, commonly used drugs. To save the patient from pain and eliminate inflammation, nonsteroidal anti-inflammatory medications are prescribed:
- Movalis is an enolic acid-based drug that is suitable for prolonged use. Available in the form of tablets and solution for injection.
- "Diclofenac" - the active ingredient of the drug phenylacetic acid. Available in the form of tablets, injections and drugs for local use. “Diclofenk” helps to quickly arrest the pain, relieve swelling and inflammation.
- “Ibuprofen” is a preparation based on propionic acid. It has analgesic, anti-inflammatory and antipyretic properties. It can be assigned at the initial stage of the pathology, as it has a weak effect.
- "Ketoprofen" - the active substance propionic acid. The drug has a powerful anti-inflammatory effect and is used to relieve pain.
- "Aspirin" - can be administered as an independent means or as part of other medicines. It is characterized by anti-inflammatory and antipyretic properties. Allows you to quickly save the patient from pain.
Additionally, patients are prescribed treatment with chondroprotective medications. They must be taken over a long period of time. Only with this condition can the expected effect be achieved. Usually for treatment prescribed:
- "Alflutop" - a drug made on the basis of marine organisms. Thanks to its use, damaged tissues are restored, motor activity improves and recovery occurs faster. In addition, the drug has anti-inflammatory and analgesic properties.
- “Artra” is a combination drug based on glucosamine and chondroitin. After using the drug, swelling and inflammation in the tissues are reduced.
- "Teraflex" - provides tissue regeneration and accelerates the process of treatment. You can use it no longer than 3 weeks.
- “Struktum” is a monopreparation with reducing and anti-inflammatory effects. The tool should be used with caution to those who have a tendency to bleed.
The course of treatment of intervertebral hernia involves the use of muscle relaxants, which relieve pain, due to the removal of muscle spasm. To do this, appoint:
- "Mydocalm" - an anesthetic drug that is able to relieve cramps and dilate blood vessels. In case of intervertebral hernia, it is prescribed in the form of injections.
- "Baclofen" - the drug quickly restores mobility in the lumbosacral and speeds recovery.
- "Tizanidine" - an anesthetic drug that can relieve inflammation.
Home treatment can be supplemented with folk remedies. However, they must be used together with medicines that the doctor prescribes, since they cannot cure the intervertebral hernia on their own. Patient reviews prove the effectiveness of such funds:
- Compress with horse oil.
- Compress based on red clay.
- Massaging the mixture of natural honey, mummy and fir oil.
- Compress using fresh Kalanchoe leaf.
- Compress with alcohol tincture of garlic.
Despite the fact that the composition of such funds include only natural ingredients, before their use should consult with your doctor, as contraindications are possible.
To improve the effectiveness of drug treatment and speed up recovery, the patient is prescribed a massage. Thanks to him, he manages to warm up the muscles and reduce the pressure on the hernia of nerve roots clamped by the intervertebral. To avoid complications, it is important that the massage is performed by a qualified technician.
Dear readers, in the video below you will see a set of exercises for the treatment and rehabilitation of the disease:
Healing spine without surgery helps therapeutic exercises. Choose a set of exercises will help the doctor. This is done depending on the place of formation of an intervertebral hernia. Yoga has a good effect. Do not exercise during exacerbation of the disease.
Causes of intervertebral hernia
The development of pathology rarely occurs on a completely healthy spine - this will be hindered by the flexibility and elasticity of the cartilaginous discs. Normally, their strength is enough to withstand even the fall of a person from a height. There is only one reason that weakens their protective properties - osteochondrosis. Only against its background can a hernia develop, since it violates the stability of the spinal column from the inside.
Many patients think that the disease occurs suddenly - this is caused by the sudden onset of symptoms. But pathology can last for several years, causing only periodic discomfort in the lower back. "Break through" the symptoms causes physical activity - it serves as a trigger factor for the development of pain.
A hernia of the lumbosacral spine is always the outcome of a long course of osteochondrosis. It has similar symptoms (they are less pronounced), but patients can live long with them. This is due to the minimal limitation of activity - discomfort in the back is easily eliminated after a warm-up or change of posture. With a hernia, the situation is different - sharp pains limit even minimal activity, forcing a person to see a doctor. Between these states, certain changes occur in the intervertebral disk:
- Osteochondrosis causes damage to the external parts of the cartilage disc, causing them to seal. Normally, the outer ring is dense and elastic, which allows it to stretch when moving.
- Compaction of the disc makes it less resistant to shocks, which is accompanied by the appearance of small cracks on the outer edge.
- They gradually increase, reaching the central parts of the disk. Since the interior has a jelly-like consistency, it can easily penetrate into these defects.
- When the crack reaches a critical size, excessive load causes a soft core of the disk to fall through it.
- Then a hernia is formed - at first it has a small size, but with preservation of activity, its increase is always observed.
Usually, hernias form in the posterolateral parts of the intervertebral disc - in this place the joint is almost not strengthened by the longitudinal ligaments.
The debut of the disease is always associated with excessive physical exertion. Moreover, it is not the weight that is lifted, but the sharpness and incorrect movement performance. With daily activity, the hernia cannot occur - even with severe osteochondrosis, the spine continues to perform a support function. The first symptoms may occur as a result of the following actions:
- The most common occurrence of pain when lifting with a bent back and straight legs. This situation is detrimental to the spine, as it causes an excessive load on the anterior sections of the cartilaginous discs.
- The next reason is a sharp turn of the body with fixed legs. This movement leads to an increase in the size of the cracks in the disk, which serve as a site for the introduction of a hernia.
- A jump even from a small height to straight legs causes a strong shaking of the spine. Sometimes patients jump off just one step, which is enough for the introduction of a hernia.
Therefore, even with a slight discomfort in the lumbar region, such loads should be avoided, and prophylactic treatment of osteochondrosis should be initiated.
The protrusion in almost 80% of cases is localized on the border of the fifth lumbar vertebra and the sacrum, which makes it possible to call it a hernia of the sacral part. Unlike osteochondrosis, it will always be accompanied by symptoms "in the distance." They are called radicular syndromes that are caused by hernia pressure on the intervertebral nerves. They have enough diversity, which determines the characteristics of the clinic in individual patients:
- The development of complications is always accompanied by increased pain in the lower back. If earlier it had a nagging character and was associated with an uncomfortable posture, then with a hernia there is a sharp backache from the side of the spine at the height of the load.
- Since there is pressure on the intervertebral nerves, first of all, there are disorders of sensitivity in the legs. Immediately there are discomfort spreading along the buttock and the back of the foot.
- The weakness of the muscles of the legs on the part of the lesion develops, which is associated with their reflex "off". The pain overloads the spinal cord too much, and in this way it tries to protect itself from excessive impulses. Even if there is no lameness, it can be actively identified - the patient in the prone position cannot lift a straightened leg.
- Sensory disturbances are manifested by burning and or tingling on the skin from the side of the lesion. It can be observed in the buttocks and toes.
- All disorders result in a forced posture as a result - the patient is slightly tilted forward and supports the lower back with his hand, his back is half-bent. There is a “guarding” of the back - careful and shallow breathing, slow steps.
The formation of an "acute" hernia of the spine serves as a reason for immediate access to a doctor - in the hospital they will be able to perform additional examinations, and prescribe treatment.
Methods of treatment of intervertebral hernia are complex and staged, which allows you to create a continuity of management of each patient. Each period includes a certain amount of assistance, which accelerates the person's return to the usual activity. Allocate the following procedure in assisting patients with intervertebral hernia:
- Always begin with conservative methods - unloading the spine and the creation of its rest, the use of painkillers and relaxing drugs.
- Gradually, physiotherapy methods are added to them that have a tonic effect. If these measures are ineffective for 3 months, then decide on the need for surgery.
- Surgical treatment is currently represented by small operations, allowing to recover from them within a week.
- Complete all the restoration of the patient with the help of physical therapy. It allows the spine to return a strong frame of muscles and ligaments, which is important support.
On average, these activities take about a year - but even after their completion the patient is obliged to continue strengthening the back for preventive purposes.
It includes methods of medical care, allowing to eliminate the main symptoms - pain and stiffness during movements. To do this, use different routes of administration of drugs:
- Unlike osteochondrosis with a hernia, large doses of anti-inflammatory and painkillers are used, which are injected in the form of injections. This achieves their maximum effect, as they enter the blood immediately.
- Apply electrophoresis to the lumbar region with painkillers or enzymes. This method allows you to deliver medicine directly to the source of pain.
- Additionally, the patient is prescribed muscle relaxants to relax the muscles - they eliminate stiffness during movement.
- Proper nutrition and vitamins are needed to speed up the process of cartilage repair.
- Already from the first day they begin physical therapy, which will improve blood circulation in the soft tissues. Good muscle tone will return the normal position of the spine, curved under the influence of pain.
Local remedies (ointments or gels) for hernia are ineffective, since their dosage is not enough to eliminate a strong pain syndrome.
Hernia surgery is resorted to only when the conservative methods fail, and when there is a risk of damage to the nerves or the spinal cord. Now the list of interventions differs by a considerable variety:
- Nucleoplasty allows using the laser or liquid nitrogen to “evaporate” the internal volume of the hernial sac. Then it collapses, and is replaced by connective tissue - the scar.
- Microsurgical removal of a hernia allows inserting equipment into the area of the defect through point incisions, and removing the protrusion. The resulting defect is then sutured, which prevents further loss of the disk core.
- Disc prosthetics are used in rare cases when the entire cartilage is irreversibly altered. At the same time, an old intervertebral disk is removed through a large incision, and a synthetic prosthesis is installed in its place.
The choice of method is based on the age and condition of the patient, as well as on the results of MRI, which allows to create a three-dimensional picture of the affected area. Preparation for surgery also includes the elimination of the main symptoms - pain and stiffness, to prevent complications after the intervention. Treatment after a hernia is removed includes medical gymnastics, which is performed for a year. Then all patients are recommended to wear a corset for life to support the back.
Anatomy of the connection of the lumbar and sacral spine
The lumbar spine consists of 5 vertebrae, the lower of which is connected to the upper vertebra of the sacrum. The device of the sacral division is due to the supporting function in the composition of the pelvic girdle: all 5 vertebrae have changed, uniting into a single pyramidal structure.
The lumbar vertebrae in anatomy are called “true” because possess the device of elements of mobile connection:
- the body is a massive capsule with a large surface of contact zones and thick walls. Inside is a cellular bone structure filled with red bone marrow, adipose tissue, blood vessels and nerve endings,
- arc - bone semicircular formation, connected to the body by two bridges,
- shoots located on the arc, in the amount of 7 units: paired lower articular, paired upper articular, paired transverse (lateral long), spinous (located in the center of the arc).
The arc and the body form the spinal opening, which contains the spinal cord.
Articular processes (other names. "Facets"), connecting with the paired processes of adjacent vertebrae, create "facet joints". Thanks to the flexible ligaments, the joints do not impede bending forward, but when bending backward they create additional rigid support to the main pole.
The upper vertebra of the sacrum has the same area of the contact area as the last lumbar vertebra, but differs in structure: the transverse processes have greatly increased, the articular reduced, leaving only the two upper articular fossae, the spinous process has decreased significantly. Places of fusion of the vertebrae give barely noticeable "seams".
The vertebral junction L5-S1 is the last true intervertebral disk in the post. This imposes certain obligations: a powerful cartilage tissue withstands the entire weight of the upper body. The disk device corresponds to the purpose:
- in the center there is a lenticular formation “gelatinous nucleus” (another name is “pulpal body”). The gel core consists of a mixture of collagen and water (up to 98%). Incompressible fluid serves as an ideal shock absorber for vertical loads.
- the nucleus is located inside the cartilage capsule - “fibrous ring”. A thick layer of fibrous tissue contains collagen (up to 20%), proteoglycans (water-retaining substances) and water itself (up to 75%). Constant nutrition is provided through the hyaline layer covering the cartilage. Water, amino acids and minerals come directly from the surrounding tissues.
Causes of hernia
MRI hernia lumbosacral joint L5-S1
Intervertebral hernia is a natural result of the destructive action of the most common disease of the musculoskeletal system - osteochondrosis. The gradual degradation of the cartilaginous tissue of the fibrous rings, caused by constant loads and poor feeding, leads to microscopic ruptures, multiplied with each inclination and lifting of gravity.
The L5-S1 connection is distinguished by its inclined position relative to the vertical of the spinal column. The two lower facet joints partially compensate for the load on the vertebral body, but still this is the most loaded fibrous ring in the whole spine.
The main tension in the intervertebral disk falls on the external side, and it is here that protrusion is formed - the thinning of the fibrous ring with cracks radially from the center. It is in the protrusion bed that the liquid core finds its way out of the central region of the disk. A “hernial canal” is formed, and the flowing contents of the nucleus create a vesicle outside the disc, the “hernial sac”.
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Symptoms of intervertebral hernia is determined by the place of formation: whether the hernial sac is located centrally or is shifted to the right or left. Depending on the magnitude of the swelling, the symptoms will appear with a certain intensity.
The first and necessarily present symptom is pain in the lumbar spine with recoil in the legs (external sides of the gluteal and femoral muscles). The size of the hernia determines pain syndrome: the more violations of the integrity of the intervertebral disc have already occurred, the sharper the pain in the lower back. Dull, breaking pains (lumbalgia) after sitting for a long time or standing with a slightly tilted torso give out the initial stage of development. A more mature hernia causes sharp, jerking painful attacks (lumbago).
The second symptom indicates the location of the hernial sac. Nerve roots pass through the foraminal openings under the facet joint, connecting the spinal cord with the leg muscles. A swelling bubble of a hernia presses on the nerves, preventing the passage of impulses. Of primary importance for further treatment is what kind of leg is visited by pain and numbness of the gluteal and femoral parts, the outer side of the leg and ankle. Numbness periodically comes and goes, but remains a feeling of weakness, lethargy.
Pressure on the vessels passing along the spinal column and near the nerve roots leads to anemia of the pelvic region, which is the cause of weakness and functional disorders of the organs of the genitourinary system.
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Treatment of intervertebral hernia of the lumbosacral joint L5-S1
Intervertebral hernia is not the cause of complete immobilization, but in very neglected cases it can turn the patient into an invalid. Neuropathologists and osteopathologists approach the treatment of hernias from the standpoint of a careful combination of drugs, physiotherapy and physical therapy. That is why conservative treatment is considered fundamental - it is not capable of misunderstanding to damage the innervation of the leg muscles and immobilize a person forever.
Drugs used to treat intervertebral hernias are aimed at relieving pain, inflammation of blocked vessels and nerves and restoring cartilage tissues. NVPV (nonsteroidal anti-inflammatory drugs) with the support of muscle relaxants best cope with the first two tasks. For severe pain, analgesics are prescribed. To increase the strength of fibrous ring cartilage tissues, chondroprotectors are used - biologically active substances that promote the active formation of collagen fibers. Closure of the hernial canal will help to reduce the hernial sac with associated procedures.
Exercise therapy for hernia of the lumbosacral spine is considered an active medical procedure. The technique is simple: when a joint is stretched, a region of reduced pressure arises in the space between the vertebrae. The contents of the hernial sac, connected by a channel with a rarefied area, are drawn into the cavity, reducing the pressure on the nerve roots and vessels.From the effectiveness of measures depends on the ability of the core to return to the "rightful place." A video tutorial demonstrates exercises that help to reduce hernia.
The physiotherapy procedure “traction therapy” works in the same direction. The stretching of the spine with the help of mechanical devices is considered an effective method of treating rather large hernias.
Oriental medicine has also made progress in relieving pain and local inflammation. Acupuncture and manual therapy can bring considerable relief to patients for the use of more effective treatments.
Forums that acquaint people with methods of treatment, effectiveness and results describe various cases: for some with a large enough hernia, the ability to move actively remains, for others, a slight swelling causes painful pains from which they are able to get rid of in any way. Most often with the help of surgeries.
For the treatment of small hernias, laser surgery for vaporization (evaporation) and decompression of the disk is recommended. Large protruding hernia excised with partial replacement of the disk (to prevent re-occurrence of "leakage").
Video with a detailed description of the occurrence of hernia and methods of treatment
The method of treatment of hernia LFK prof. Bubnovsky
Types of lumbar hernia
Spinal hernia in any department may appear relative to its circumference in many different areas. Localization plays a huge role. The protrusion of the intervertebral disc can have 4 forms:
- Lateral. A hernial sac forms in one of the sides of the spine. Usually, if it is small, it does not cause any special inconvenience and is not too dangerous for health.
- Posterior side. Hernia of this form is the most dangerous. This is due to the fact that the protrusion of the disc is capable of transmitting the spinal cord, if it is directed deep into the spinal canal. In the case when it bulges towards the spinal roots, it may threaten with compression, inflammation or irritation, which causes no less serious complications.
- Ventral (front). In fact, it does not manifest in any way and does not bear any pathological consequences. Moreover, this type of hernia is usually detected by chance.
- Classic. Especially dangerous form, because the disk bulges in a circle and it threatens compression. This type is subdivided into 2 subspecies:
- diffuse, that is, when in one of the areas it is squeezed out the most,
- circular - the disc extends beyond the normal limits evenly, without any special projections.
Symptoms of herniation of the lumbosacral region depend on how large they are. Allocate:
- small (up to 5 mm),
- medium (up to 8 mm),
- large (up to 12 mm),
- giant (over 12 mm).
Symptoms of hernia of the sacral spine
Hernia of the sacral spine has symptoms that appear quite brightly at the stage when it was not fully formed. The pain pursues at first only after intensive labor, long walking. Further to this phenomenon are added such signs as:
- cold extremity
- feeling stiff, harder to make habitual movements,
- goose bumps, numbness,
When the radicular syndrome occurs, the symptoms progress, and such a serious phenomenon as muscular atrophy can be added to them.
What pain in hernia sacral resembles
The symptoms of this disease are described above, but the main one, of course, is pain. Moreover, a hernia of the sacral spine can manifest itself in different ways. So, it is customary to distinguish 3 types of pain sensations of a different nature and degree of intensity:
- Lumbodynia. In a similar way is called pain, which is felt constantly, without exacerbations. In some cases, the aching sensations subside and appear only after overloading the lumbar part.
- Lyumboishalgiya. In this case, there are exactly the same phenomena as in lumbodynia, only the pain spreads even on the surface of the thighs and buttocks. Irradiate such a syndrome can immediately in both legs or only one.
- Lumbago. Similarly, it is also called the backache. This is an acute attack that occurs suddenly. Its intensity is so strong that for some time a person is not even able to change his position. Usually, lumbago quickly passes and the pain subsides somewhat, becoming similar in character to lumbodynia.
Causes and risk factors
The lumbar spine is characterized by various injuries and a general susceptibility to various diseases of the musculoskeletal system. This exposure is directly related to the structural features of the skeleton itself, so it is very important not to allow risk factors that can cause an intervertebral hernia in this area of the back. These are:
- adverse working conditions
- excess weight
- emerging problems with posture,
- anomalies of congenital nature,
- playing sports associated with severe stress
- low mobility and, as a result, weakening of the muscular system.
The appearance of a hernia in the sacral region will inevitably entail problems with the blood circulation of this area, and this already threatens to impair the functions of the pelvic organs.
Methods for diagnosing lumbosacral hernia
Sacral hernia requires careful diagnosis, because it must be differentiated from other diseases that have a similar clinical picture. Selection of the correct treatment by a doctor will occur based on the results of several studies at once. The greatest value in the diagnosis in this situation are such methods as:
- myelography (invasive or non-invasive),
- CT scan
In addition, the patient is sent for laboratory tests, as well as a consultation with a neurologist in order to identify possible violations that could develop as a result of a hernia.
Treatment of herniated lumbosacral hernia with medications is the basis of all spinal therapy. Treatment involves taking drugs in several groups:
- Muscle relaxants (Mydocalm, Xeomin).
- Angioprotectors that have a positive effect on blood circulation (Actovegin, vitamin C, rutin).
- Anti-inflammatory drugs (Ibuprofen, Meloxicam, Diclofenac).
- Anticonvulsants (Neuralgin, Lyrics). They are selected if there is a violation of the peripheral nerve.
- Chondroprotectors (Hondroksid, Teraflex).
Physiotherapy for lumbar hernia
Physiotherapeutic measures also have a healing effect on hernia. Usually select several types of physiotherapy. Thanks to her, she is able to improve the local blood circulation processes, which will reduce inflammation and contribute to the strengthening of local immunity. Complex procedures will help to achieve and reduce pain.
Here is a standard set of physiotherapeutic procedures used for hernia:
- application of paraffin, mud,
- galvanic current
- electrophoresis with the use of drugs
- magnetic therapy.
Manual therapy and ordinary massage sessions can also have a great therapeutic effect, however, they with a hernia are necessarily prescribed only individually. Moreover, the procedure should be carried out by a highly qualified specialist.
Therapeutic physical training - exercise therapy
The sacral spine is very susceptible to injury, so with a small hernia, a person must be sent to exercise therapy. Constant exercises will strengthen the muscular corset in this area, and this, in turn, will reduce the likelihood of further squeezing the disc out of the spinal column.
Exercises for herniation of the lumbar spine at the initial stage are performed with the aim of a slight stretching of the muscles and stretching of the spine, as this will allow to remove spasm and pain. In the future, be sure to continue stretching, but complement these exercises and exercises aimed at strengthening the muscle fibers.
The complex is selected only by a doctor, since it must include a proven load that will not be excessive with a hernia of the spine.
For the treatment of intervertebral hernia can not be used only folk remedies. It is permissible to use decoctions of herbs that strengthen the overall immunity or contribute to the removal of the inflammatory process, but only after consulting a doctor. It is desirable to refuse from folk remedies at all, since the risk of complications with such a serious disease increases several times.
The development of vertebral hernia of the sacro-lumbar spine is greatly influenced by lifestyle. For prevention it is very important to follow a number of tips:
- Get rid of an uncomfortable pillow, get an orthopedic mattress.
- Watch your posture.
- Do not allow weight gain.
- Avoid excessive physical exertion.
- Exercise regularly and perform exercises aimed at strengthening the muscular system.
- Take a multivitamin and eat fully.
Try to change your lifestyle to a more favorable one. Follow the tips above and this will help prevent damage to the intervertebral disc and significantly slow down the progression of the disease.
How does a hernia appear in the lumbosacral region?
In order to promptly begin non-surgical treatment of intervertebral hernia, it is necessary to differentiate the protrusion from other similar diseases of the spine.
Symptoms of lumbosacral hernia:
- The aching pains in the lumbar spine, aggravated during movement and during the exacerbation,
- Heaviness and stiffness when moving
- Discomfort and pain when bending and turning the body,
- Backache - sudden pain in the spine, which runs away on its own,
- Long-term symptoms in the lower extremities: numbness, pain along the sciatic nerve, tingling sensation.
- Complicated hernia gives symptoms of bladder and bowel disruption: dyspepsia, involuntary urination.
Therapy of protrusion of the spine with the appearance of similar symptoms is mandatory, as this may result in impaired blood circulation in the pelvic organs, muscle atrophy, limited mobility and reduced skin sensitivity in the area of the affected spine.
The choice of treatment
It is possible to eliminate the symptoms and improve the quality of life of a patient with spinal pathology by conservative methods: medication, physiotherapy, spinal traction, hardware methods, including laser removal. The main goal of non-surgical treatment is the elimination of compression of the spinal roots and the release of the intervertebral space.
Stages of treatment of hernia in the lumbosacral spine:
- Drug symptomatic course: the appointment of NSAIDs and analgesics. Symptoms should be removed first of all in order to continue a comfortable hernia treatment. The patient is prescribed drugs for anesthesia, relieve inflammation, eliminate edema. It is also important to use vitamins and fortifying agents that will help prevent frequent complications, eliminate infectious lesions. The disadvantage of this approach can be identified negative effects on the organs of the gastrointestinal tract, as non-steroidal anti-inflammatory drugs with prolonged use can lead to gastritis, reflux and even peptic ulcer. Another disadvantage of painkillers is a false relief when the patient feels good and continues to load the spine, which ends with an acute process and the need to carry out surgical treatment,
- Physiotherapy treatment is more effective and important for the patient, since the effect begins directly on the affected spine. The main activities for the patient's spine: massage, electrophoresis, current therapy, therapeutic baths and manual therapy,
- Surgical removal is performed after 8 weeks of conservative treatment with no results. The patient may undergo discectomy, endoscopic removal, microdiscectomy, laminectomy, laser treatment.
Physiotherapy treatment of hernia is quite effective. This may be manual therapy.
The choice of treatment method depends on the patient's condition, the duration of the pathological process and the presence of contraindications to the individual options for eliminating hernia.
Conservative or non-surgical treatment is carried out immediately after the diagnosis of intervertebral protrusion in the lumbosacral spine.
The patient is shown massage and therapeutic exercises, which can be carried out at home.
The prescribed drugs the patient can combine with traditional methods of treatment that improve health, strengthen the immune system, relieve symptoms of pain and inflammation.
Indications for conservative treatment of disc herniation:
• small hernial defect,
• lack of muscle atrophy and associated diseases of the back,
• effective elimination of pain with medicines and physiotherapy,
• contraindications for surgical treatment of disc herniation.
Gymnastics helps to fight pain and stiffness in hernia.
Gymnastics and massage more effectively fight pain and stiffness of movement, so these methods are always used, both before the operation and during the rehabilitation period.
Indications for surgery
Radical removal of a herniated disc is carried out strictly according to indications in neurosurgical departments. Intervertebral hernia requires surgery in such cases:
- Sequestered spinal hernia,
- Paralyzes and paresis on the background of atrophic lesions,
- Permanent symptoms of pain and restricted movement,
- The presence of severe neurological symptoms.
A popular method of disc removal is microdiscectomy, which allows you to remove a hernial defect of any location with minimal tissue injury. The patient is in the hospital a week after surgery, after a week and a half she can return to non-physical work and in a month to physical work.
The structure of the spinal column
Its purpose is to perform a support function, provide support to internal organs and protect them from external damage, and also contain the spinal cord. To do this, the spinal column must have the strength and mobility.
The vertebrae, that is, the components of the spine, have common features with the exception of a few. Each vertebra has a body, from which the arms with processes go, forming a vertebral foramen. Processes 7: spinous, 2 transverse, paired upper and lower. The vertebral bodies, firmly connected to each other with the help of ligaments and joints, protect the spinal cord, which is located in the spinal canal. It is formed by processes of the vertebra and ligament apparatus, which is represented by long, short ligaments, fibers. Between the vertebrae there is a cartilaginous disc, which provides spinal mobility in all directions.
The spine consists of several departments, their constituent parts have their own characteristics.
- The cervical region is represented by 7 vertebrae, it provides the mobility of the neck. At the same time, 1 and 2 vertebrae have their own characteristics: the first (atlas) consists of 2 arches, has no body.On the sides, the arms pass into the lateral masses, the skull and the second cervical vertebra are attached to them. The peculiarity of the second vertebra is that there is a protrusion on the body, which is the body of the first one, modified in the process of development, it is called a tooth. Atlanta rotates around it. In the transverse processes of all cervical vertebrae there are holes in which the vertebral artery passes. Between the vertebrae there are holes through which the spinal roots come out.
- The thoracic spine has 12 components, adjacent to them 12 pairs of ribs. For this, there are articular fossa on the bodies and transverse processes.
- The lumbar region is composed of 5 vertebrae, which are the most massive. Their body resembles a bob, and the processes are massive, this is due to the fact that this part of the back accounts for the bulk of the body. Helps the spine in this area pelvis.
- Sacral vertebrae, of which 5, together with the coccyx, having 3-5 components, are spliced together, which is due to the erect position of the person. The sacrum performs an auxiliary support function, relieving the lumbar region.
Often, in medical sources, the last 2 spinal sections are combined, joining together in the lumbosacral part.
The cervical and lumbar section are bent forward, which is called lordosis, and the thoracic and sacral parts are bent back (kyphosis).
The concept of hernia and the reasons for its occurrence
During the life of a person, the vertebrae are aging.wear discs. The disk has a ring,within which the core is located. Under heavy load, the ring is weakened or torn, inAs a result, the nucleus may fall into or out relative to the vertebral body. This situation leads to compression of the nerve roots, which are located in the spinal column, provoking the appearance of signs of pathology.
Hernias most often occur in the lower back (between the last lumbar vertebra and the sacral joint) and are called intervertebral hernia of the lumbosacral spine.
The reasons for the violation can be not only age-related changes, but also other factors:
- significant one-time exercise,
- the nature of labor associated with constant loads, lifting weights,
- injuries (accident, impact, fall from a height),
- damage to the copula and muscular system,
- obesity and overweight,
- the presence of metabolic disorders and endocrine diseases,
- with a sedentary lifestyle, atrophy of the muscular system occurs,
- hip dysplasia in childhood, especially improperly treated,
The more factors from this list a person has, the greater the likelihood of pathology.
The mechanism of violation is as follows: under the influence of a damaging factor or excessive pressure, the fibrous membrane of the disk is stretched or torn, and the nucleus protrudes into the resulting space.
Forms and stages of formation
Symptoms and treatment of pathology formed in any part of the spine depends on its form and extent of the process.
Since the prolapse of the disk can occur in different directions, there are several types of intervertebral hernia.
- The formation that bulges inside the spinal canal is called posterior. At the same time, the spinal cord can be squeezed, which is manifested by serious disorders, up to the development of paresis or paralysis, disorders of the pelvic organs. If at the same time the hernia is directed towards the nerve roots, then their compression and inflammation develops in that zone. Hernia or protrusion is called posterior lateral.
- The location of the hernia is lateral, that is, lateral. In this form, manifestations are usually absent, are observed only with a large amount of protrusion.
- They speak of a ventral hernia if it is located in front of the spinal column. Symptoms may also be absent and make themselves felt with a large hernia.
- With a common process, bulging of a disk occurs in all directions, and this can occur equally from all sides or unevenly (somewhere more, somewhere less). In this case, the whole complex of symptoms is pronounced, there may be signs of compression of the spinal cord.
The emergence of protrusion does not occur in a large volume at once, there are several stages of its formation:
- protrusion, when there is still no rupture of the fibrous membrane, but the disc is already protruding approximately 3 mm beyond the limits of the vertebral body,
- hernia is accompanied by rupture of the annulus,
- the process of sequestration, when the separation of the protruding part already occurs, its loss. At this stage, the patient experiences severe pain, symptoms develop.
Education may range from small to giant, parameters defined in the medical literature.
Symptoms of a hernia of the lumbosacral spine depend on the form of the pathology: posterolateral and widespread protrusion are the most dangerous, most clearly manifested, have a less favorable prognosis. The lateral and ventral forms of pathology have almost no symptoms, can be detected by random examination.
Hernia may be the following manifestations:
- Pain of a different nature. It can be acute or nagging, manifest locally or give up the pelvis.
- Numbness of the lower extremities up to a complete loss of sensitivity.
- Reducing the temperature of the toes.
- Restriction of movement, strengthening of signs when the body position changes.
- The appearance of involuntary bowel movement and urination.
- Reduced functional activity of the muscles.
The first and most important symptom of pathology is pain, which can be of a different nature. Its amplification or change of manifestation indicates the spread of the process.
When hernia lumbosacral, there are several types of discomfort:
- Lumbodynia, in which the pain is aching permanent after physical exertion.
- Lumbago is a sharp shooting pain, after its occurrence a person often remains in the same position in which it originated.
- Lumboischialgia combines the signs of aching pain, which gives along the nerve.
Consequences, further period of life
The outcome of treatment is generally favorable, especially in the early stage of the disease. The operation can also bring a positive effect, especially if the hernia is single. Subsequently, a person must adhere to certain rules and observe a healthy lifestyle. It is important to control your weight, which will eliminate the increased load, constantly strengthen your back with the help of gymnastics.
In some situations, the doctor may recommend wearing a corset, which allows you to unload the lumbar. It is useful, especially after the operation to do swimming, under the supervision of an exercise therapy instructor to perform gymnastics. Heavy physical loads are excluded, if they are related to work, then it is necessary to change the type of professional activity. If you follow all the recommendations of the doctor, the hernia does not bother, and after the operation you can completely forget about it.
What is a
Intervertebral hernia of the lumbosacral spine is a disease of the human musculoskeletal system, characterized by the displacement of the pulpal nucleus of the intervertebral disk through the rupture of the fibrous ring.
The lumbosacral spine consists of 5 vertebrae, between the bodies of which there are discs that function as a shock absorber and ensure the distribution of a uniform load on the vertebrae. When a significant load on the lumbar region occurs uneven squeezing of the disk, which leads to its protrusion.
Intervertebral hernia is a serious pathology of the lumbosacral spine, requiring the appointment of the most appropriate therapy. Therapeutic tactics are selected depending on the exact location of the protrusion, its size, severity of the clinic and associated diseases.
Intervertebral hernia in the sacral region is classified as follows:
- the most dangerous type of pathology is the exit of the nucleus into the region of the spinal canal, which leads to pinching of the nerves and the development of marked pain, such hernias are called posterolateral,
- intervertebral lateral hernia is formed on the left or right of the spinal column, provokes the appearance of a symptomatic complex only as a result of the progression of the disease,
- the advance of the pulpal nucleus forward is considered the least dangerous variety, such protrusions are rarely prone to progression,
- the nucleus is released from all sides of the spine.
The disease is classified according to the size of the hernia:
- up to 6 mm - do not pose a threat to the patient, comprehensive non-surgical treatment is carried out,
- 7-9 mm - inpatient treatment is prescribed, surgery is not required,
- 11-13 mm - conservative therapy is carried out (medications, methods of physiotherapy, diet is prescribed), with marked pains that significantly restrain movement and are not amenable to complete elimination, drug therapy is prescribed surgery,
- over 13 mm - surgical intervention and drug therapy.
Hernia of the sacral spine is more often caused by osteochondrosis, which is a complex of dystrophic changes in articular cartilage. Other reasons include:
- lower back injuries
- regular exercise (mainly related to professional activities),
- carrying weights,
- metabolic disorder,
- excess weight,
- congenital anomalies of the spine,
- tumor processes.
Negatively influencing factors contributing to the development of the disease include infectious processes in the body, drinking alcohol, smoking, muscle weakness, old age and a sedentary lifestyle.
How is the disease manifested
The severity of symptoms of lumbosacral hernia depends on the size of the protrusion and the duration of the disease. The main symptom is the development of pain of a different nature in the affected area.
At the beginning of the formation of the pathology, the symptoms of a hernia appear as follows:
- periodically there is pain in the lumbosacral region,
- the feeling of pain increases with motor activity, sharp bending, weight lifting, intense pain also occurs when changing the position of the body after a long sitting in one place,
- localized pain (only in the affected spine).
Symptoms of a hernia in the sacral spine are aggravated by an increase in pathology in size:
- there are sudden sharp pain in the form of lumbago in the back,
- pain gives to the lower limbs, pelvic region and other parts of the body, located nearby with the affected area,
- movements are difficult, there is lameness,
- soreness when sneezing and coughing
- spinal curvature occurs,
- over time, a slight swelling occurs in the lumbosacral spine,
- muscles of the back and abdomen becomes tense,
- motor activity is significantly limited.
It is possible to diagnose intervertebral hernia by clinical manifestations. To determine the exact location of the pathology, to identify the size of the protrusion, x-ray examination and MRI are performed.
The treatment of a herniated disc of the lumbosacral region is carried out by several specialists - a neurologist and a vertebrologist. The clinical picture suggests the presence of a hernia, an X-ray image and magnetic resonance imaging will show changes in the spinal column. Differential diagnostics with other pathological conditions with similar symptoms (myositis, hematoma, spondylarthrosis and tumor process) are carried out.
After the examination, the tactics of treatment measures are chosen: conservative therapy or surgical intervention. Most physicians are inclined to believe that with a small amount of pathology, the appointment of complex therapy, including medication, physiotherapy, traditional medicine and lifestyle adjustment, can do without surgery.
First of all, when diagnosing a hernia of the lumbosacral spine, sharp movements should be avoided. During the period of manifestation of severe pain, a strict bed rest and drug-based painkillers and anti-inflammatory drugs are prescribed. During remission, therapeutic massage, gymnastics, thermal effects in the form of mud applications and compresses with ointments are used (only according to the testimony of a doctor).
The procedure is performed using massage cream or baby oil. All movements are smooth with moderate pressure. At first, stroking is done, then light rubbing and impact on points. For greater performance after a classic massage is recommended to perform simple exercises, relieving pressure from the lower back.
The essence of the technique is to conduct a massage with a jet of water supplied under pressure. The temperature regime is selected warm temperature, the most comfortable for a person.
The procedure involves performing massage with special cans of silicone or glass to improve blood circulation and lymph flow. After the use of canned massage improves the power of intervertebral discs.
For therapeutic massage, warm honey is used, in which a few drops of fir or olive oil are added. At the beginning of the procedure, the body is warmed up with a classic massage, then a mixture of honey and oil is applied to the affected area of the back with rubbing movements. After thorough rubbing in the honey mixture, the specialist applies the palms to the rubbed place and tears them off sharply. The procedure continues until the formation of white plaque on his hands.
For the treatment of hernia, various methods of physiotherapy are used that can relieve the patient from severe pain, improve blood circulation and reduce the manifestation of puffiness. In addition, these procedures accelerate the regenerative processes in cartilage tissues, stimulate metabolism.
The main types of physiotherapy include:
- electrophoresis (the use of low frequency currents in combination with the introduction through the skin of various medicinal substances),
- EHF-therapy (extremely high-frequency) - radiation of millimeter waves, aimed at specific points, stimulates regeneration and metabolic processes, positively affects the body as a whole, increasing its protective properties,
- ultrasound therapy - ultrasound waves are able to penetrate deeply into the human body (up to 6 cm), thereby warming the affected area, helping to restore and nourish the cartilage tissue,
- acupuncture - the procedure is the impact on the point of thin needles and the joint introduction of medicinal solutions,
- paraffin treatment - paraffin baths are used as a warming agent to eliminate inflammation and pain, white paraffin, previously heated to 60 degrees, is also used.
Exercise and exercise therapy
Physical therapy is applied daily and consists of a set of simple exercises aimed at strengthening the spinal muscles, unloading and stretching the spine.An exception is the period of exacerbation, so in case of acute form, any movements should be avoided and bed rest should be observed so as not to worsen the situation.
Treatment of home intervertebral hernia with the help of exercise:
- the patient takes a supine position: the right leg should be bent in the knee, the left one should be lifted from the floor as high as possible, hold it with hands and pull to the body, stay in this position for up to 10 seconds, then return to the starting position, then the right one bend, and the left attract to the body, during the day it is recommended to perform from 3 to 5 times,
- the initial position is on the abdomen: the arms are straight above the head, the legs are straight, then the patient is required to raise the head and legs at the same time, bending back well, repeat 5-10 times,
- standing on all fours you should bend your back down, then arch upwards, repeat up to 15 times.
The procedure involves the correction of the pathological position of the bones, muscles and ligaments. The treatment is carried out by a qualified specialist - manual therapist. The impact on the affected area is made using the hands of the manual. When stretching the ligaments, muscles and effects on the bones, the vertebrae take the most correct position, which allows to reduce excessive and incorrectly distributed load from the lumbosacral region. Read more about manual therapy.
Acupuncture is a method of Chinese medicine, which consists in acting on biologically active points with the help of needles. Acupuncture activates many physiological processes in the body, contributes to the nutrition of tissues, improves blood circulation.
After the course of procedures (10 sessions), a significant decrease in swelling is noted, pain sensations appear less frequently and with less intensity after the first session. The main purpose of treatment with needles during protrusion of the intervertebral disc is to relax the muscles of the back and reduce pressure on the affected part of the body.
Diseases of the spine - it is always a major change in its normal functioning, which as a result leads to the development of strong, unbearable pain and stiffness of movements. Only timely treatment in a medical institution and the appointment of adequate therapy will help avoid dangerous complications and surgical intervention in case of spinal hernia.