home Diseases Symptoms and treatment of hernia of the lumbar spine. Hernia of the lumbar spine: symptoms and treatment

Symptoms and treatment of hernia of the lumbar spine. Hernia of the lumbar spine: symptoms and treatment

Intervertebral hernia lumbar region of the spine occurs when the pulpous core of the intervertebral disc is squeezed out of the fibrous ring. The tissues of the destroyed disc put pressure on the nerve endings of the spine and cause severe pain. A hernia of the lumbar spine occurs more often than others, its symptoms need to be known in order to begin treatment on time.

If a lumbar disc hernia is not treated, the patient may for a long time become incapacitated.

Most often, the disc between the fourth and fifth lumbosacral vertebrae is deformed; the pain radiates to the leg, deprives the patient of mobility, and sometimes leads to disability. Diagnosing a hernia is quite easy, but curing it without surgery is quite difficult. Physical therapy, massage, and medications can help with this.

The intervertebral disc is a small cylinder made of special cartilage tissue. On the outside it is protected by a fibrous ring, and inside there is an elastic substance that turns our spine into a kind of spring - the nucleus pulposus.

If the intervertebral disc is deformed due to injury or constant negative action, the fibrous ring becomes brittle and cracks. The pulp inside extends beyond the fiber through a crack. This phenomenon is called intervertebral hernia. If the affected disc is in the lumbosacral region of the spine, then it is a lumbar hernia.

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Pain and others unpleasant symptoms appear because with a hernia of the lumbar spine, the spinal nerve is pinched by excess pulp.

Stages

Signs of a hernia are noticeable differently at different stages. By starting treatment for lumbar disc herniation as early as possible, you can stop the development of the disease.

Prolapse – the disc changes its position slightly. If negative factors stop influencing him, he will again take a natural position.
Protrusion - the disc changes its position greatly, but does not yet go beyond the boundaries marked by the vertebrae.
Extrusion - the nucleus leaves the immediate area of the spine and is in a suspended state.
– the appearance of ruptures and cracks in the fibrous ring, the pulp coming out.

Symptoms

Symptoms of a herniated disc begin to manifest themselves due to deformation of the nerves. The muscles of the legs and buttocks atrophy. The patient may feel cold, numbness in the extremities, “pins and needles” and a mild but unpleasant stabbing sensation.

The ability to jump, walk up stairs, and find it very difficult to sit down or pick something up from the floor disappears. The root of these problems is that the muscles have weakened. In addition, the patient begins to hold the body in a new way - asymmetrically. In the area for which the affected nerves are responsible, the process of sweating is affected - either the skin dries out a lot, or, on the contrary, it sweats a lot.

If the hernia goes inside the spinal column, it begins to put pressure on the spine in the lumbar region. This completely deprives the patient of the ability to move his legs. Strong pressure hernia becomes life-threatening.

Symptoms of a lumbar disc herniation may include impairment of the pelvic organs. The patient loses the ability to control bowel movements and urination. Males with a lumbar hernia may suffer from libido disorders, while in women, lumbar hernias cause a frigid state.

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Muscle atrophy sometimes causes the patient to limp severely. If the disease remains neglected for a long time, it can lead to disability.

Hernia pain

Symptoms of a lumbar hernia are primarily severe pain. Intervertebral hernia is the cause of attacks of lower back pain. The pain is aching or dull in nature, preventing the patient from sitting quietly, coughing, or even standing. It becomes easier only when the patient takes a horizontal position. The pain will not go away on its own, it can torment for years, and you need to start thinking about how to treat a vertebral hernia as early as possible.

The hernia grows over time, compressing more and more nerve roots spinal cord, causing sciatica. The pain intensifies, radiating more and more to the gluteal region and legs.

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Pain shoots through the lower back, as soon as you change your position or make an effort. This phenomenon is called sciatica. If the fifth lumbar vertebra is deformed, it will hurt thumb lower limb. If the pathology is localized between the fifth lumbar and first sacral vertebrae, pain will appear in the sacrum area, in the back of the leg and in the little finger. Unfortunately, only severe pain forces patients to schedule a visit to the doctor.

Causes

The causes of intervertebral hernia of the lumbar spine are as follows:

Traumatic effects from blows, falls or accidents;
Osteochondrosis of the lumbosacral back;
Incorrectly formed hip joint from birth;
Curvature of the spine;
Strong sudden loads;
Large body weight;
Smoking creates a lack of oxygen, worsening the trophism of the intervertebral discs;
Constantly driving a car incorrectly distributes the load on your back;
Metabolic disorders.

What other factors will affect the occurrence of a hernia in the lumbar region?

Sedentary work and lack of physical activity;
Age over thirty;
Genetic predisposition;
Male gender;
Chronic diseases of the spine.

Diagnostics

Signs of a lumbar disc herniation quickly begin to torment the patient, but only a specialist can confidently diagnose and find a deformed disc. For this, x-rays are used in two projections, which help to create an overall picture of the disease. A more detailed picture of the pathology can be obtained using MRI.

To understand how badly the nerves and areas of their innervation have been damaged, a neurologist checks the patient for tendon reflexes, sensitivity lower limbs and their mobility. Treatment for a hernia of the lumbar spine begins only after the doctor has carried out a complete diagnosis.

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Treatment

Treatment methods for intervertebral hernia may include conservative or surgical treatment of the lumbar spine. Only in the first stages of hernia development do conservative medicine methods prove effective. Traditional methods will not answer the question of how to cure the pathology.

The goal of conservative methods is to relieve pain and restore the patient’s quality of life.

To prevent surgery, a person must change their usual lifestyle. Stress less, move more. Observe special diet, stimulating the trophism of nervous and cartilage tissue.

Medicines

Treatment for lumbar spinal hernia medications eliminates symptoms rather than truly changes the patient's condition. , such as Diclofenac, Ibuprofen or Indomethacin must be taken. By relieving pain, they save from muscle atrophy in the future. They also eliminate inflammatory process, which in any case manifests itself if the nerve roots are pinched. Such drugs can be used both externally in the form of ointments and internally in the form of tablets.

In the situation of a herniated disc in the lumbar region, the body forces certain muscle groups to support the spine in the area of pathology. The patient experiences stiffness and muscle pain. Central muscle relaxants, such as Mydocalm or Sirdalud, help cope with muscle spasms. For intervertebral hernia of the lumbar region, novocaine is often used.

Exercise therapy

It is difficult to treat a herniated disc conservative methods. But it will help prevent the further development of pathology. Exercise therapy can be done when the main symptoms of a lumbar disc hernia, such as pinched nerves and pain, have already gone away.

The exercise program must be compiled individually by the instructor. Includes body tilts, careful turns and rotations. The goal is to strengthen the spinal muscles, thereby preventing disc displacement in the future.

Special exercises are performed in horizontal position face down, side or face up. The patient can also stand with his back against a wall. Having assumed this position, he performs bends, rotations, lifts, and abductions of the legs and arms. Therapeutic gymnastics movements, such as hanging on a bar or an underwater version of it, allow you to stretch the spine. As a result, the intervertebral discs feel freer and begin to return to their natural state.

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If the disease is at an early stage, then classes will help completely cure the hernia. If the lumbar hernia is advanced, gymnastics will ease the symptoms. Any exercises must be carried out under the supervision of an instructor and with the permission of the attending physician, otherwise there is a risk of aggravating the pathology.

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Physiotherapy

For a lumbar hernia, symptoms can be relieved using therapeutic methods of physiotherapy:

Electrophoresis with substances that relieve inflammation and pain;
Warming treatment of the spine;
Acupuncture;
Underwater massage techniques;
Acupressure reflexology.

Massage

It is permissible to massage an intervertebral hernia in the absence of exacerbation, but intervertebral hernia is a diagnosis in which any manipulation requires the permission of the attending physician. If such permission is received, the massage therapist will help improve blood circulation in the lumbar spine.

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Nervous and bone tissue will receive more nutrition, and harmful accumulations of lactic acid will leave the cells. Muscle spasms will subside, which will relieve pain and give the patient lost mobility. And the release of endorphins that occurs during the session will serve as a mild anesthetic and will also reduce tension in the back area.

Surgical removal

IN following situations Conservative treatment of lumbar hernia will not bring results:

Sequestration (rupture) of the intervertebral disc has occurred;
The patency of the spinal canal has worsened;
The sciatic nerve is inflamed;
The intervertebral disc has shifted very much;
The patient's condition does not improve for several months.

Lumbosacral disc herniation occupies a leading position among dysfunctions musculoskeletal system. This pathology requires timely diagnosis and the appointment of competent therapy. Advanced forms of the disease can have very dangerous consequences in the form of paresis or paralysis.

Causes of pain in the lumbosacral spine

Many people are familiar with discomfort in the lumbar region firsthand. A person may experience pain of different types. Is it transient (acute) or chronic. The first goes away faster than the cause that provoked it. The second continues even after the termination of action irritating factors. The causes of each of the above syndromes may be the following conditions:

The appearance of acute pain is provoked by:

Chronic pain occurs due to:

deforming spondylosis;
oncology;
osteomyelitis;
myositis (inflammation) of the spinal muscles.

Hernia of the lumbosacral spine

Intervertebral fibrocartilaginous formations consist of a core, surrounding rings with collagen fibers and hyaline connective tissue. Thanks to this structure, they provide strength and shock absorption to the spine. This significantly reduces the risk of damage due to injuries, heavy physical exertion, and sprains. It happens that under the influence of negative factors, disc space pathologies develop.

Lumbar intervertebral hernia sacral region The spine is formed when circular collagen fibers rupture. Protrusion of the nucleus pulposus occurs. The result is a hernia, which compresses the nerve roots and leads to inflammation of the adjacent tissues. In the absence of proper treatment, the patient consistently experiences the following stages of the formation of a lumbosacral hernia of the spine:

Protrusion. On at this stage There is a small size of the protrusion (3 mm).
Prolapse. The size of the lumbar hernia is about 1.5 cm.
Sequestration. The stage is characterized by pinched nerve roots and constant severe pain.

Symptoms

The first signs of the development of degenerative changes in the intervertebral space are often ignored by patients. Blunt, aching character periodically occurring syndromes are simply “experienced” by them day after day. As a result of such a careless attitude to the problem, over time, patients experience a progressive displacement of the pulp nucleus beyond the disc space. The following symptoms of a hernia of the lumbosacral spine are distinguished:

muscle atrophy;
pain when raising the leg (a specific sign of a herniated disc);
lumbago spreading throughout the lower extremities;
numbness;
lumbar pain;
decreased reflex activity;
development of radiculitis as a consequence of a hernia;
dry skin.

Risk factors

Degenerative changes in the intervertebral discs, manifested by lumbosacral hernia, can occur due to many reasons. Modern lifestyle often provokes the development of dysfunction of the musculoskeletal system. To avoid negative influence will help increase physical activity, balanced diet, reducing possible stressful situations. The main risk factors for the formation of intervertebral hernia in the lumbosacral spine include:

hard physical labor;
work that requires the body to remain in a static position for a long time;
neglect of the principles of physical activity;
bad addictions and habits;
excess weight, which additionally loads the lower spine.

Treatment of lumbar disc herniation

In the stage of protrusion of the fibrous ring therapeutic measures To eliminate protrusion in the lower spine, they are limited to bed rest, the prescription of anti-inflammatory and other drugs. Advanced forms of pathology require the use of measures to relieve swelling of adjacent tissues with medication, release intervertebral discs and eliminate compression of nerve roots. In addition to these, there are the following methods for treating lumbosacral hernia:

through conservative therapy involving the use of medications:
- synthetic hormonal drugs, injected into the epidural space of the spine (Methylprednisolone);
- opioid analgesics;
- NSAIDs (Indomethacin, Movalis), used at the beginning of the formation of a lumbosacral hernia;
- blockade injections of novocaine or lidocaine into the lower spine;
- drugs to improve blood circulation (Actovegin, Trental);
- injections with B vitamins to accelerate the recovery of tissue adjacent to the hernia area;
- external agents with non-steroidal components.
through surgery:
- Endoscopic discectomy – resection of damaged disc space. The “breakage” is removed along with the hernia through a small incision in the skin.
- Laminectomy – extraction of the vertebral arch.
- Ligamentectomy – disc curettage.
- Chemonnucleolysis - drying out the formed hernia.
- Spinal fusion is the transplantation of a new bone disc from the patient’s pelvic bone.
- Laser disc decompression – laser evaporation of an existing hernia.

Therapeutic exercises for the lumbar spine

Recovery period is of paramount importance in the entire process of treatment of intervertebral hernia. Medical Physical Culture(physical therapy) helps the body adapt to the changes that have occurred and gradually develop a new set of conditioned reflex motor reactions. The lower spine is at high risk for hernia recurrence. In view of this, it is important to follow the basic rules of physical activity.

Therapeutic exercises for hernia lower section The spine includes measures aimed at stretching the load-bearing part of the skeleton, for example, swimming. Regularly include the following activities:

To perform the exercise, get on all fours with support on your knees and elbows. Next, you need to simultaneously raise your right hand and left leg, fix the body for 5 s. Take the starting position and perform the approach from the other side.
Take a horizontal position with your arms straight and your knees bent. Raise your pelvis with emphasis on your back and fixate the position for 3 s.
Lie on your stomach and place your hands under your chin. Smoothly lift the body without lifting the lower part of the body from the floor surface. You need to hold this position for 5 seconds.

During the rehabilitation period, it is strongly recommended to adhere to moderate physical activity. After 2-3 months after extraction of the lumbosacral hernia, the patient can begin exercise therapy and take short walks. You can speed up the adaptation and healing processes with the help of sanatorium-resort treatment, including baths with radon, turpentine, and sulfides.

Risks can be significantly reduced reappearance intervertebral hernia, subject to the following recommendations:

conducting active image life without heavy loads on the spine;
the use of preventive means of protection against injuries to the load-bearing part of the skeleton;
visiting the swimming pool;
reduction of excess body weight;
conducting regular classes;
maintaining constant monitoring of correct posture;
preventing the body from being in a static, awkward position;
taking frequent walks in the fresh air.

Video: Exercises for the lumbosacral spine

A hernia of the lumbar spine is a protrusion of the central part of the intervertebral disc (nucleus pulposus) to the side and back beyond the space between two vertebrae. Most often, hernias are found in the lumbar spine, which experiences maximum stress when sitting, walking and lifting loads.

Causes and risk factors

The cause of the appearance of hernias in the lumbar spine is seen in degenerative-dystrophic changes in the intervertebral discs. Gradual dehydration and thinning of the fibrous ring - the peripheral areas of the intervertebral disc contribute to the protrusion of the nucleus pulposus in vulnerable areas. Clinical manifestations intervertebral hernias are usually associated with compression of the spinal nerve roots and blood vessels protruding edges of the intervertebral discs. In the most advanced cases, the spinal cord is also subject to compression.

Factors that have a negative impact on the trophism of the intervertebral discs in the lumbar spine include:

passive lifestyle;
excess body weight;
tall height (from 180 cm for men and from 170 cm for women);
unbalanced mode of physical activity (long periods of immobility are replaced by intense loads);
lumbar spine injuries;
congenital hip dysplasia;
poor posture and persistent spinal deformities;
heavy physical labor associated with heavy lifting and long stay in a bent position;
professional sports;
sudden lifting of heavy loads with insufficient preparation;
improper performance of exercises with weights;
endocrine disorders and metabolic pathologies;
hereditary predisposition.

Stages

The formation of a herniated intervertebral disc is preceded by a slight displacement of the nucleus pulposus to the periphery without damage to the fibrous ring. At this stage, the process of hernia formation can be stopped with the help of therapeutic exercises and other preventive measures, however, due to the absence of complaints, the initial stage of intervertebral disc degeneration is most often discovered by chance. Most patients consult a doctor if there is a formed extrusion.

Uncomplicated lumbar hernias disappear on their own in 80% of cases due to dehydration of damaged tissue within 6–12 months.

The progressive development of a hernia of the lumbar spine goes through four stages.

Protrusion. Partial loss of elasticity of the fibrous ring with displacement of the nucleus pulposus to the side by more than 2-3 mm. Clinical manifestations are usually absent.
Extrusion– partial protrusion of the edges of the intervertebral disc with rupture of the fibrous ring in the thinnest area. Sensory-motor symptoms are observed on the side of the protrusion.
Intervertebral disc prolapse. When a hernia protrudes into the spinal canal, the protruding edges of the nucleus pulposus compress the vertebral bodies, blood vessels and roots peripheral nerves.
Sequestration. The protruding part of the nucleus pulposus penetrates the spinal canal, preventing normal blood supply to the spinal cord and compressing the soft tissue. Damage to nerve structures can cause dysfunction pelvic organs and paralysis of the lower half of the body. Often found allergic conditions caused by immune cell response cerebrospinal fluid on foreign tissue of the intervertebral disc.

Symptoms of a hernia of the lumbar spine

The pronounced clinical picture of a hernia of the lumbar spine appears mainly at the extrusion stage. The most common complaint is severe pain in the right or left leg, covering inner side thighs and extending into the buttock. Depending on the size and location of the hernia, pain may extend from the hip to the heel and the back of the foot. The pain is sharp, burning in nature and intensifies when coughing, sneezing, sitting for long periods of time, sudden movements, driving on uneven terrain, trying to bend forward or roll over to the other side. Often, several weeks before the onset of pain, patients experience mild discomfort in the lower back.

If the hernia affects dorsal roots spinal nerves, to painful sensations unilateral sensory disturbances in the leg, lower back or perineum are added. Patients may complain of chills, burning, tingling, numbness, or goosebumps. Impaired nerve conduction due to weakening or compensatory muscle tension leads to limited mobility of the lumbar region. Patients have difficulty going up and down stairs, squatting, jumping and bending while keeping their legs straight; gait becomes unsteady and unbalanced. Patients often take forced postures, stoop and shift their body weight to one limb; when looking at the bare back, protruding lumbar muscles on one side are noticeable.

Indirect symptoms of a hernia of the lumbar spine indicate insufficient blood supply and atrophic phenomena. One leg may be thinner, cooler, or paler than the other; There is also less hair on the body on the side of the hernia.

When the spinal cord is pinched, the pain spreads to both legs and is accompanied by disruption of the nervous regulation of the pelvic organs. Patients appear frequent urge to urination, urinary and fecal incontinence, diarrhea or constipation; women may be concerned about gynecological disorders, and men may have problems with potency.

The most common complications of hernias of the lumbar spine are progressive atrophy of the nerve roots, etc. cauda equina syndrome, which occurs when the spinal canal is completely blocked and several nerves are simultaneously pinched.

Diagnostics

A preliminary diagnosis is made by a neurologist based on medical history, clinical picture and physical examination. To identify paresthesias and biomechanical disorders characteristic of spinal compression syndromes, standard diagnostic procedures have been developed:

study tendon reflexes lower extremities;
functional test with straight leg raise;
measuring muscle strength and tone;
determination of pain, temperature and vibration sensitivity of the legs, buttocks, perineum and lower abdomen.

External manifestations of compression of the nerve roots and spinal cord allow us to judge the size and localization of the pathology, but do not have sufficient specificity for diagnosing a hernia of the lumbar spine. Inflammation of the nerve roots or oncopathology can manifest themselves in a similar way, so the decisive word in the diagnosis of intervertebral hernias belongs to instrumental soft tissue imaging techniques - MRI and CT. If spinal cord injury is suspected, contrast myelography is prescribed.

Most often, hernias are found in the lumbar spine, which experiences maximum stress when sitting, walking and lifting loads.

Treatment of hernia of the lumbar spine

In the absence of complications, treatment of small intervertebral hernias is reduced to pain relief and activation of blood circulation in adjacent tissues. A short course of painkillers and/or non-steroidal anti-inflammatory drugs is usually sufficient to relieve acute pain. If the response to drug therapy is poor, X-ray controlled blockade of the damaged nerve roots may be performed. Muscle relaxants are used to eliminate muscle spasms. For the first 3-5 days after the onset of an exacerbation, the patient must observe bed rest with lumbar immobilization. It is recommended to lie on your back with a soft cushion under your lower back.

After cupping pain syndrome Exercise therapy, kinesiotherapy and post-isometric relaxation are indicated to help restore soft tissue trophism and form a muscle corset to support the spine. At first, all exercises for a hernia of the lumbar spine are performed in a lying position or standing on all fours. You should start by lifting, abducting and bringing your legs bent at the knees, and after 3-4 weeks of regular exercise you can exercise at the wall bars, with a ball or with gymnastic sticks. A visit to the swimming pool is also recommended.

With low performance conservative treatment and the appearance of complications, the issue of surgical intervention is considered. The least traumatic method of surgical treatment of intervertebral hernias is microdiscectomy - removal of the nucleus pulposus through a puncture using a thin endoscopic manipulator and replacement of destroyed tissue with a special substance. In some cases, the disc is completely removed and an endoprosthesis is installed in its place. Massage and manual therapy can be indicated only in the presence of subluxations of the vertebral joints. Therapeutic effect acupuncture, heat therapy and UHF therapy for herniated intervertebral discs has not been proven.

Possible complications of a herniated lumbar spine

The most common complications of hernias of the lumbar spine are progressive atrophy of the nerve roots, etc. cauda equina syndrome, which occurs when the spinal canal is completely blocked and several nerves are simultaneously pinched. In such cases, to prevent paralysis, it is indicated emergency surgery within 24 hours of the onset of signs of severe neurological deficits, such as weakness of the knees and feet, numbness of the legs and perineum, loss of urinary and bowel control.

Forecast

Uncomplicated lumbar hernias disappear on their own in 80% of cases due to dehydration of damaged tissue within 6–12 months. Adequate treatment treatment started at an early stage greatly increases the likelihood of a complete cure.

With prolonged compression of the roots of peripheral nerves and the spinal cord, irreversible damage to the nerve structures occurs with the potential for complete loss of mobility and the ability to self-care. For this reason, lumbar hernias even with asymptomatic require constant medical supervision and monitoring of the dynamics of the process.

Prevention

To prevent intervertebral hernias, it is important to maintain physical activity, monitor weight and posture, and refuse bad habits and promptly seek medical attention in the event of a spinal injury. It is recommended to eat enough protein and B vitamins. When working sedentarily, it is useful to take breaks for industrial exercises every 2-3 hours.

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Spinal hernia is a rather dangerous disease. Ignoring it can lead to complete paralysis. With timely diagnosis, the pathology responds well to conservative treatment. Patients should reconsider their physical activity and diet. After treatment, it is necessary to follow preventive measures to avoid relapse.

A spinal hernia often forms in the lumbar or cervical spine, less often - in the chest. Timely diagnosis and specialist assistance increase the effectiveness of treatment. IN severe cases doctors prescribe surgery. Often degenerative changes are irreversible. However, proper treatment can relieve pain and other symptoms that cause discomfort and stop disc displacement and destruction.

What is a herniated disc?

The pathology is associated with displacement of intervertebral discs. It causes numbness, pain and weakness. The anatomical task of the discs is to absorb the load on the spinal column during movement. Any deformation in it causes discomfort in a person.

The intervertebral disc consists of a fibrous ring, the outer side of which consists of collagen fibers, and the inner side of the nucleus pulposus. The ring limits the core, but if this function is disrupted, it is displaced and an intervertebral hernia is formed. The pathology develops gradually. Long-term disc degeneration occurs due to loss of fluid and increased fragility. A hernia is formed in several stages:

Protrusion– a protrusion appears, the internal fibers of the ring are damaged, but the rupture has not yet occurred. The corpus pulposum is kept within certain boundaries, which makes it possible to cure the disease using conservative methods.

Entrusion– the outer fibers of the ring are damaged, which allows the nucleus pulposus to extend beyond the boundaries of the disc.

Disease catalysts include:

Note!

Statistics show that pathology is diagnosed in men much more often than in women.

Doctors use the classification of spinal hernias according to their location:

cervical – 4% of all cases of the disease;
chest – 31%;
lumbar – 65%.

Symptoms of pathology

A herniated disc occurs when there is pressure inside the disc. Neurological disease manifests itself when the fibrous ring is stretched due to breaking load, which causes compression of nerve branches and blood vessels. Until this point, symptoms are often attributed to another disease. In the later stages, pain is constantly present and does not depend on physical activity.

Primary signs of a spinal hernia:

Acute pain in the spine area, which disappears with rest.
Unnatural swelling and muscle tension.
Kyphosis or scoliosis of the spine.
Burning, tingling, “goose bumps” - paresthesia, turning into paresis.

Many patients experience hormonal imbalance– impotence or cessation of menstruation.

Patients complain of sharp and severe pain. It is associated with compression nerve root a fallen disk that is responsible for the functioning of some organ. Pathology causes disruptions in the functioning of the organ. Symptoms depend on the location of the pathology:

Cervical region

Decreased performance, sleep disturbance, neurasthenia, headaches, increased fatigue, vision problems, hypertension, epilepsy, inflammation of the tonsils, nausea, numbness of the fingers, pain in the limbs, tinnitus, loss taste sensations, increased intracranial and blood pressure.

Thoracic region

Dysfunction thyroid gland, discomfort in the shoulders and shoulder blades, pain and burning in the chest, decreased sensitivity of the skin when nerve endings are damaged.

Lumbar

Diarrhea, hemorrhoids, cystitis, pelvic inflammation, numbness of the lower extremities, muscle atrophy, bladder stones, unnatural sweating or dry feet.

People with unfavorable heredity, whose family members have degenerative diseases spine, more attention should be paid to prevention.

If symptomatic neurology of a spinal hernia appears, you need to contact a surgeon or neurologist who will diagnose and determine treatment.

Diagnosis of the disease

Before starting treatment, it is necessary to determine the investigative causes of the pathology using laboratory diagnostics. Only a specialist can determine the presence of swelling using x-rays and MRI.

Upon visual examination of the patient, a distortion of posture will be noticeable, and the sensitivity of some areas will be lost.

The doctor must feel the spine to determine the degree of pain and localization of the pathology, and to identify unnatural tension muscle tone. During flexion and extension, the limitation of mobility and range of motion are determined.

MRI allows you to determine:

size
localization.

With a hernia, a protrusion appears in the interdiscal space of the nucleus:

protrusion – up to 3 mm;
prolapse – 3-5 mm;
developed hernia – 6 mm.

With hardware examination, the directions of protrusion can be identified.

Additional studies are prescribed depending on individual characteristics.

Treatment

Correct treatment can only be prescribed after full examination taking into account the stage of the disease and type of pathology. For example, in the absence of complications, action to relieve large disc damage is sufficient.

Conventionally, there are three stages of treatment:

pain relief with medications and complete rest;
massage and complex therapy;
rehabilitation, recovery.

Treatment begins with over-the-counter medications; if there is no result, they switch to strong analgesics (codeine). At the initial stage, it is recommended to ensure rest and maintain bed rest, take painkillers, engage in exercise therapy, and undergo physical therapy. If after 3 months the condition worsens (neurological deficit syndrome, decreased potency, numbness in the limbs, increased pain), then surgery is prescribed - the last resort of treatment due to the increased risk of complications.

Video

Professor I.M. Danilov will tell you in detail about proper treatment spinal hernia.

Non-surgical methods

After a complete examination, the initial stage of a hernia can be treated at home with the help of medications (painkillers, blockers), therapeutic exercises, and physiotherapy.

The following methods show good effectiveness:

Manual therapy – a specialist performs special manipulations to eliminate pathology. Course duration is 2-10 sessions.

Hirudotherapy

Treatment with leeches. The saliva of worms contains an enzyme that provokes the resorption of the fallen fragment and improves blood circulation.

Cryotherapy

Liquid nitrogen is applied to the problem area to increase blood circulation.

Osteopathy

With light movements and pressure, the doctor eliminates pathological changes.

Acupuncture

Impact on active points to irritate nerve endings. The effect is similar to a massage, when the massage therapist touches these points tactilely.

Physiotherapy allows you to relieve pain without taking medications, as well as speed up the recovery process. Patients are recommended:

Each method has its own indications and limitations. Only the attending physician will select the exact complex.

Drug treatment

First of all conservative therapy necessary to eliminate pain neurological reflexes. Patients are prescribed anti-inflammatory non-steroidal drugs:

diclofenac;
indomethacin;
ibuprofen.

Note!

In the presence of chronic gastrointestinal pathologies, the choice of anti-inflammatory therapy is approached more carefully.

At the first signs of improvement, they move on to complex therapeutic and preventive treatment. Subsequently, the patient must undergo a preventive examination every month by a neurologist or therapist.

Muscle relaxants, such as Mydocalm and Sirdalud, are prescribed to relieve spasms. It's worth remembering side effects:

absent-mindedness, decreased performance;
nausea;
decreased blood pressure;
loss of sensation;
urinary and intestinal disorders;
psychological problems.

To protect the gastric mucosa, drugs are used that cover the stomach with a protective film:

Almagel.

almag;
Almagel;
gastal;
phosphalugel.

When treating a hernia, chondroprotectors are used to restore cartilage tissue:

structum;
teraflex;
alflutop.

The course of treatment with chondroprotectors should be more than 3 months.

To improve blood circulation in the problem area, the following is prescribed:

trental
pentoxifylline.

Patients must take vitamins B, D, A, E to restore damaged tissues and reduce pain.

Use a deep penetration transdermal ointment. It is produced immediately before use, as it contains a lot of organic matter, which completely eliminates factory production. The ointment should be applied with light movements, kneading should be completely avoided, so as not to cause major damage.

Among pharmaceutical ointments we can highlight:

non-steroidal anti-inflammatory drugs (Fastum gel, Ketonal, Nurofen, Voltaren);
combined effects – pain relief and swelling relief (Dexpanthenol, Dolobene);
irritating effects (Nicoflex, Capsicam);
chondroprotectors (Chondroxide, Arthrocyte).

When prescribing an ointment, one should take into account the likelihood allergic reaction to components.

Blockade

If painkillers are ineffective, then an X-ray-controlled blockade is performed. A needle with a hormonal solution is inserted into the area of compression of the nerve roots. Local administration ensures maximum effectiveness. The injection can be given at the exit site of the nerve processes, between the vertebral processes, or into the intervertebral area. A contrast agent is often used to determine the route of penetration of the drug.

The procedure is performed under local anesthesia and X-ray control. Practice shows that in 50% of cases patients recover.

Manual therapy

Manual therapy is preferable to massage. By sliding and stretching, the pinched nerve is released. Manual therapy can be used as a pain reliever without taking various medications.

Manual therapy should be performed only in specialized clinics. It can only be used for hernias of a certain size and location.

Manual therapy does not treat pathology, but only relieves symptoms for a while. Patients should in the future exclude the convergence of the vertebrae and increased pressure on the disc.

Folk remedies

Folk remedies should be used with caution. You can reduce symptoms with the help of bee products, herbal infusions, and horse fat.

Note!

General rules of use folk remedies: Avoid heating the surface and avoid heating substances.

In the east they believe that daily use prunes, figs and dried apricots strengthens the spine and improves healing effect other conservative remedies.

A compress of honey and potatoes will help reduce pain. Raw potatoes rub and mix with honey. Apply to the area of pain, cover with film, and wrap. Leave for 2-3 hours.

You can also make a cake 1 cm thick from honey and flour, which is applied overnight and tied with plastic wrap.

A compress of Kalanchoe and burdock and fir leaves has a local effect. But all remedies should be used only after consultation with your doctor.

Fine shavings from horse fat are covered with plastic film, and the top is covered with natural fabric. The compress is tightly secured with a bandage and worn throughout the day. Instead of horse fat, you can use badger or dog fat. Patients note a decrease in pain within 2 hours after application. Horse fat accelerates the synthesis of ceramides, which increases protective functions body. Additionally, it has regenerating, moisturizing properties and contains the necessary Omega-3.

Surgery

severe pain for a long time;
severe neurological disorders;
impotence, urinary incontinence.

There are several types of surgical intervention, the exact type is determined by the attending physician.

Discectomy

The nucleus pulposus is removed through an open incision. In severe cases, it is necessary to remove the disc and replace it with a titanium implant. The long recovery period and the risk of infection with pathogenic microflora forces doctors to resort to this method in rare cases.

After surgery, it is important to follow preventive measures, as the disease can recur. Patients should regularly perform exercises to strengthen muscles, undergo physical therapy, and take vitamin and mineral supplements. In the presence of excess weight switch to special diet with restrictions on fats and “fast” carbohydrates, increasing the consumption of fiber, fruits and vegetables, and low-fat fermented milk products.

Endoscopic surgery

A camera and instrument are inserted through the puncture. The method is considered gentle, since the muscles are almost not damaged. The hernia is removed and the disc is corrected. Positive dynamics are observed in 80% of patients.

Microsurgical laser surgery

Laser treatment, like surgery, is considered last resort. But unlike the latter, it is considered more gentle. A puncture is made to the patient to insert a needle with a light guide. Next, a laser is used to relieve pressure in the disc. Soft tissues have a high permeability for targeted radiation, which makes it possible to treat pathology with a laser without damaging the tissue. At elevated temperatures, damaged areas are evaporated. The symptoms of a hernia immediately disappear as the pressure on the nerve endings is reduced.

Duration of the procedure– 10-40 minutes, local anesthesia is used. After a couple of days the person is transferred to hospital treatment. The technique is used in the absence of disc destruction, mainly in patients under 40 years of age. With age, the disc dries out, which makes the use of laser impractical.

Physical exercise

Patients are advised to adhere to a regime of rest and control of physical activity. It is necessary to avoid voltage increases in spinal column: perform jumps, lift weights. A person must control movements, excluding sudden movements, strong bends, and twisting.

Exercise therapy

A doctor and a trainer with a medical background should select exercises. During exercise, the load on the spinal column should be completely eliminated, which completely eliminates exercises in a vertical position.

Simple and effective exercises:

Walk around the room on all fours, keeping your back and arms straight.
In the same position, simultaneously extend your arm and leg from opposite sides. If possible, hold the position for a couple of seconds to strengthen the ligaments.
Hanging on the bar.
Lie on your back and pull your knees to your chest.

Yoga

At the initial stage of the disease, yoga is not prohibited. The only restriction is not to do the exercises in bed. If pain or discomfort occurs, it is recommended to stop exercising.

Allowed exercises:

To stretch the ligaments and muscles of the back, lie on your back, pull your knees to your chin and roll to the sides.
Lie on your back, bend your knees and clasp your shins with your hands. Try to straighten your spine as much as possible.
Get on all fours and bend over like a cat. You need to look at the ceiling, and then at the floor.
Lie on your back, bend one leg and try to reach your knee with your forehead. Change leg.

Exercise training

A properly selected simulator and the supervision of a qualified instructor will become effective means. Exercise is allowed only during the period of remission and according to an individually designed program.

It is important to control your breathing: when tension increases, inhale strongly, and then exhale slowly. This will avoid the negative effects of increased load. After each approach, take a short break. In total, the duration of the lesson is 3 hours, but active actions only 1 hour.

There are different exercise machines depending on the method of creating the load. Weighting is achieved using body weight or a system of blocks. For example, horizontal bars and parallel bars provide load using body weight and can only be used by people with good physical fitness.

Rules for using simulators:

if there is pain, use pain-relieving exercises;
eliminate axial loads;
avoid shock loads;
do not perform barbell presses;
Kettlebell lifting is prohibited.

Sport

A herniated disc is a limitation for some sports. All exercises in a sitting or standing position are completely excluded.

Prohibited species are:

race walking;
Weightlifting;
active species sports that involve running or standing for a long time (football, skiing, basketball);
body-building;
partial restriction on athletics with jumping.

Gymnastics

The gymnastic complex for treatment can be performed using several methods: Bubnovsky, Pilyuiko, Dikul. The purpose of the complex is to strengthen the muscle corset to prevent pinched nerves.

Gymnastics is necessary for patients due to reduced mobility. It is necessary to speed up metabolism and blood circulation, activate the muscles, which will allow the vertebrae to take a natural position and the hernia to resolve. The course must be selected according to individually taking into account the physiological characteristics of the patient and the location of the pathology.

Rehabilitation

After a full course of treatment or surgery, the patient must undergo rehabilitation period. Patients must follow all doctor's recommendations to avoid complications and relapse. In most cases, patients are recommended to wear a special corset, undergo a series of physical procedures, and control their body weight.

Corset

Orthopedic devices reduce the load on the spine. The corset should be flexible, but have a dense base. It is especially necessary for people who do not monitor their posture during the day. The corset allows you to fix the spine.

Some models have straps to secure the structure on the shoulders. The front part covers the area from the pelvis to the chest, the back part covers the area from the shoulders to the buttocks. High blood pressure transferred from the spine to the abdominal cavity.

When choosing a model, pay attention so that the corset does not compress the spine. You cannot wear it all the time, as this will cause degradation of the back muscles. The exact time is determined by the attending physician.

Spinal traction

Extraction can be dry or underwater. In the first case, special simulators or weighted loads are used. In this case, the patient can be in a vertical or horizontal position. Underwater spinal stretching is considered more gentle: in water, body weight is significantly reduced, which makes the procedure less painful.

During the procedure, there is a risk of pinching a large hernia. The method has contraindications:

sharp pain;
oncology;
kidney stone disease;
cardiovascular diseases;
osteoporosis.

After traction, it is mandatory to wear a corset and perform a series of exercise therapy exercises. This is necessary to prevent the vertebrae from returning to their original location.

Nutrition

Diet is important for patients with overweight. Obesity provokes pathology and aggravates the course of the disease. Normal weight will be a condition successful treatment. To lose weight, you need to introduce restrictions on the calorie content of foods and consume more fiber.

smoked meats,
alcohol,
spicy dishes,
pickled products.

Getting a disability

Many patients are interested in obtaining disability, since the disease affects their standard of living and ability to work. The group is given in the following cases:

the occurrence of complications after surgery;
long course of the disease;
late diagnosis.

Often people with a herniated disc do not even try to get disability, although they are entitled to it by law. It is mandatory to give a group in case of complete or partial loss of independent movement and ability to work.

1 First group issued if a person cannot do without outside help V Everyday life– cannot move on his own, diagnosed with paralysis.

2 Second group can be obtained in case of intense pain, impaired motor ability, or after surgery due to loss of ability to work.

3 Third group It is prescribed to patients with increased muscle tension and intense pain, with frequent exacerbations of the disease due to work activity.

Hernia during pregnancy

It was previously mentioned that pregnancy can cause a herniated disc. The fetus increases the load on the spine, and the normal distribution of the load is disrupted. If pathology appears during this period, it is necessary to begin treatment.

The main difficulty is the restriction on taking medications and exercise therapy, so as not to harm the child. Doctors recommend gentle treatment based on folk remedies.

During childbirth, the doctor must take into account the mother's illness and exercise maximum caution. After the baby is born running form The disease is recommended to be eliminated by surgical intervention.

Army for spinal hernia

Intervertebral hernia is considered a contraindication to military service. Pathology is often accompanied by complications that lead to complete disuse. The disease is especially dangerous in the later stages.

To defer, a doctor’s opinion is required after a man’s treatment for back pain. Be sure to include the results of the above examinations.

At mild form a hernia is delayed for 6-12 months, as it can be treated conservatively. The reasons for failure may be:

atrophy, muscle paresis;
hernia more than 8 mm;
decreased sensitivity in the absence of natural tendon reflexes;
congenital pathologies spinal column;
intensive development of the disease;
change in the dural sac;
indications for surgical intervention if the patient refuses surgery or has a number of contraindications to it.

An advanced form of spinal hernia leads to severe complications. Main danger– damage to nerve endings and the spinal cord, which can lead to paralysis, loss of skin sensitivity, and disruption of normal limb mobility. Treatment without preliminary diagnosis will aggravate the situation and lead to irreversible consequences.

Questions - Answers

The hernia is very bad in the sacral region, I had an MRI and a blockade, but I still miss my leg. What to do?

You did not describe the MRI results (what kind of hernia) and symptoms: do you have pain, movement disorders, loss of sensation in the leg, etc. This is important for deciding treatment tactics. If there are motor or sensory disturbances, it is necessary to discuss the issue of surgery with a neurosurgeon. If there are no absolute indications for surgery, you need to contact an osteopath who will help you cope with the pain and select the right exercises for your back muscles.

What effect does tebantine have on treating the spine?

Tebantin - anticonvulsant, but it is also used for back pain due to compression of nerves and roots. In this case, it acts as an anesthetic by altering signal transmission in nerve endings. It does not affect the cause of pain and inflammation. Therefore, if you want not only to relieve pain (remove symptoms), but to work with the cause of the disease, you need to use other methods (osteopathy and, if necessary, surgery).

(Total 10,367, today 63)

Tom 03/03/2018 at 10:37

I had a herniated spine. I already thought that I would remain semi-paralyzed forever. I tried everything: neurologists - ours and Russian ones, injections, acupuncture, chiropractors, massages, healers, I was in the hospital. For six months I relied on doctors and massages. It got worse. I could barely walk, the pain was excruciating - I saved myself with painkilling injections. Having exhausted all means and having lost hope in anyone, I began to study the nature of my sore. I came across a doctor's book on this topic - everything was explained well there. What causes a hernia, what happens to the vertebrae and discs. I realized that the root of the pain is the compression of the discs between the vertebrae, and I need to pull them out. It turns out that in this case a vacuum effect occurs in the discs, the squeezed hernia is retracted back and their restoration occurs. And I went (crawled) to the sports field of the nearest school. And she began to hang on the crossbar. At first it was possible only for a few seconds - my hands couldn’t stand it. I had to hang there slowly, slowly pulling my knees up. Already on the third day I felt relief, the pain began to go away. A few days later I started jogging carefully. In general, the crossbar turned out to be the most effective remedy. Since then I really respect this sports equipment. And plus yoga, later. My back didn't bother me anymore. P.S. Maybe my experience will be useful to you.

Azat 03/03/2018 at 10:46

People! Just don’t do the operation!.. There is a special home exercise machine for hanging upside down, which stretches the vertebrae. Order as soon as possible. My wife uses it all the time; she also had a very advanced and bad spinal hernia. And the vertebrae stuck out like a hump like a dinosaur’s (not anymore, pah-pah-pah). Kazakh folk chiropractors straighten very well with the help of horse fat (they lubricate it for several days, it smells terrible, but the bones soften, then a special massage, she also underwent all this), but the fat is also special from a certain place - Kazakh healers know... Then you must definitely do it a set of Chinese qigong exercises. This is also important.

Mukhtar 03/03/2018 at 11:38

Professor Bubnovsky's method helped me. 2014. An MRI showed I had a 5 mm hernia. In 2015 I bought inversion boots for the horizontal bar. I also ordered an inversion table. You hang upside down and do exercises. The effect is excellent. Now I'm lifting weights. Manual massage helps.

Alya 09/08/2018 at 21:22

I myself know first-hand what discomfort and pain intervertebral hernias cause. I have 2 in the lumbar region. I suffered for 5 years until I found ways to get rid of the pain. Acupuncture, manual therapy and massage helped me. all this was done at the Paramita clinic. Plus, yoga exercises have become mandatory for me, I do it almost every day, at first I worked with a trainer, and the girl also medical education in the field of rehabilitation. So don’t give up, everything is in your power, fight for your health and try to avoid surgery until the last minute, there are ways to deal with this disease without surgery. I wish everyone good health!

Lyubov M. 09.25.2018 at 20:18

My mother has been walking only with a cane for six months now - she was diagnosed with a hernia. Before that, there was just some minor pain, I thought it would go away on its own. In winter, the pain became wild, the pills didn’t help, maybe my body just got used to them. I had to call an ambulance again. The doctor who arrived injected me with an analgesic and advised me to drink Sustalife. We obeyed. Now my mother’s condition is much better - she only hurts due to the weather.

This is a rupture of a spinal disc (fibrous ring, cartilage), as a result of uneven load on the vertebrae.

Intervertebral hernia of the lumbar region is one of the most dangerous diseases spine, which causes pain in the lower back, can radiate to the leg, over time hampers movement, interferes with normal movement, and leads to disability of the patient.

Intervertebral

The lumbar spine consists of 5 vertebrae. Between the bodies of these vertebrae are cartilage pads, or intervertebral discs. These discs act as spacers between the vertebrae, act as shock absorbers during movement and protect the vertebrae from mechanical wear. Due to various negative factors, discs can become displaced. This displacement or dislocation is the basis of such a pathology as intervertebral hernia of the lumbar spine.

The main reason leading to the development of intervertebral hernia in the lower back is osteochondrosis. As a matter of fact, to a large extent, the symptoms of a hernia are symptoms of osteochondrosis. It should be recalled that the intervertebral disc in the lower back, as in other parts of the spine, consists of an internal liquid nucleus pulposus surrounded by a fibrous capsule and bounded above and below by endplates.

The lumbar region accounts for most of pressure from body weight, the intervertebral disc in the lower back experiences enormous stress when walking or lifting heavy objects. To replace tissues damaged due to these loads with new ones, processes of renewal, or regeneration, constantly occur in it. With age or due to certain diseases or metabolic disorders, these regenerative processes weaken. A worn-out disc can no longer withstand the same loads. After a provoking factor (trauma, sudden movement, heavy lifting), the lumbar disc is “squeezed out” to the side or posteriorly.

Source moyaspina.ru

How does the disease manifest itself?

With a problem such as a herniated sacral spine, symptoms may not appear immediately. The specificity of this department suggests that there is a certain “reserve” here, which is necessary to ensure the mobility of this part of the spine, therefore, in some cases, disc protrusion, and sometimes a full-fledged hernia, early stages practically does not show itself. However, there are some signs that you should pay attention to and consult a doctor without waiting for full-blown pain syndromes to develop.

arising from physical activity stiffness in the lower back, difficulty in independent movements;

change in skin temperature of one of the legs;

violations of muscle tone in one of the legs, with progressive atrophy or malnutrition often observed;

appearance neurological symptoms(burning, numbness, lumbago and sciatica that occur on the affected side);

compensating body postures that a person takes unconsciously.

Any of the symptoms described above is worthy of attention, even in cases where it has just begun to appear. Sciatica and lumbago, which are essentially pain syndromes, in the first stages of the disease have a paroxysmal nature and low intensity, but without the necessary treatment, the pain will intensify.

Source vashaspina.ru

Symptoms

It should be especially noted that with a hernia of the lumbar spine, symptoms may be completely absent, since they are caused not by the presence of a hernia, pinched disc and, especially, spinal nerves, but by spasm of the deep muscles of the spine and accompanying swelling and inflammation.

There are many known cases of severe pain in the lumbar region, in which hernias of the lumbosacral spine are not detected even on MRI. Conversely, it happens that the patient’s photographs show several herniated lumbar discs at once, but he does not complain of pain.

But if a lumbar intervertebral hernia does make itself known, the symptoms will be as follows:

Pain in the lumbar region, often spreading along the sciatic nerve, radiating to the leg

Sometimes numbness or burning of the lower extremities

Muscle weakness, decreased tendon reflexes

In some cases, a hernia of the lumbosacral spine is accompanied by “body distortion”

It is difficult for the patient to walk, stand, or sit for a long time. In advanced cases, lumbar disc herniation can lead to dysfunction Bladder and intestines, as well as paralysis of the lower extremities.

Source bubnovsky-vip.ru

Signs

Signs of a developing hernia:

vertebrogenic syndrome, manifested by lower back pain, deformation of the lumbar region (antalgic scoliosis), tension of the paravertebral muscles;

sensory disturbances (paresthesia, hypoesthesia) in the area of innervation of the corresponding nerve bundle;

hypokinesia (low mobility) of muscles innervated by the affected nerve;

weakening of reflexes until they disappear;

dysfunction of the pelvic organs (urinary and/or fecal incontinence, decreased potency in men and frigidity in women);

specific changes in the vertebrae and discs, detected by neuroimaging (CT, MRI) or radiography;

deviations in functional state nerves, determined by electro-neurophysiological techniques (transcranial magnetic stimulation, H-reflex, F-wave).

If the first five signs may be a manifestation of other diseases of the spine (osteochondrosis, spinal tumors), then the last two points make it possible to 100% confirm the diagnosis of lumbar intervertebral hernia.

Source spinazdorov.ru

Causes

In many cases, the disease is a consequence of natural aging of the spine. Young people and children have their own concentration of water in the spine. As the body ages, the discs begin to dry out. They become weaker, thinner, and the distance between the vertebrae also decreases. This process is considered normal. Has the name degenerative change disk with age. The main cause that leads to the occurrence of intervertebral hernia is osteochondrosis. The lumbar region bears most of the pressure from the entire body weight, and the intervertebral disc will experience enormous stress while walking or lifting heavy objects. In order to replace damaged tissues with new ones, renewal and regeneration processes constantly occur. Due to some diseases and with age, weakening occurs. metabolic processes. The disk, which has become worn out, cannot withstand the previous loads. Lumbar disc will be “squeezed out” posteriorly or to the sides after the provoking factor is carried out.

Intervertebral hernia In addition, in addition to osteochondrosis and injuries, an intervertebral hernia of the lumbar region can appear as a result of acquired and congenital structural disorders in the spinal column. We are talking about a variety of types of deformities in the spine, such as lordosis, scoliosis, and other pathologies. These are also congenital disorders in anatomical structure vertebrae Discs may become misaligned due to anomalous structure pelvic bones. The pelvis is beveled in any direction. A hernia of the lumbar spine can be caused by ailments of a specific nature that affect the spine, such as tumors, syphilis and tuberculosis.

Pressure may increase inside the intervertebral disc. This is facilitated by a variety of factors that lead to the formation of a hernia. The main reasons leading to an increase in pressure in the internal and intervertebral region come down to receiving strong blows to the back, falling on the back, lifting heavy objects from the ground, and sharp turns of the body to the sides.

Source doctorignatyev.com

Diagnostics

Diagnosis and differential diagnosis

Main diagnostic criteria intervertebral disc herniations are:

the presence of vertebrogenic syndrome, manifested by pain, limited mobility and deformities (antalgic scoliosis) in the affected part of the spine; tonic tension of the paravertebral muscles;

sensory disorders in the area of the neurometamere of the affected root;

motor disturbances in the muscles innervated by the affected root;

decreased or lost reflexes;

the presence of relatively deep biomechanical disturbances in motor compensation;

data from computed tomography (CT), magnetic resonance imaging (MRI) or radiographic examination, verifying the pathology of the intervertebral disc, spinal canal and intervertebral foramina;

data from electroneurophysiological studies (F-wave, H-reflex, somatosensory evoked potentials, transcranial magnetic stimulation), recording conduction disturbances along the root, as well as the results of needle electromyography with analysis of action potentials of motor units, allowing to establish the presence of denervation changes in the muscles of the affected myotome.

Source lvrach.ru

Sequestered

Causes of sequestered hernia

Due to the absence of its own blood vessels, the disc receives nutrients by diffusion (fusion of substances). The adjacent muscle structures play a major role in this. During muscle tension (excessive physical stress), the mechanism of degenerative changes in the injured area is triggered. The fibrous ring loses water and vitamins, its height decreases, and cracks appear.

Sequestration of a hernia occurs in the following cases:

osteochondrosis of the spine (hereditary predisposition, history of long-term disease, frequent exacerbations, ineffective treatment and so on);

anatomical developmental defects;

microelementosis (lack or excess of trace elements and minerals in the human body);

excess weight, physical inactivity, unhealthy diet;

static, dynamic loads on the spine.

The following can provoke deterioration of the patient’s condition with further development of sequestered hernia of L4-L5, L5-S1 and other vertebrae of the lumbar spine:

hypothermia;

lifting weights;

improper bending and squatting;

emotional overstrain.

Source spinazdorov.ru

Treatment of sequestered disc herniation

The choice of conservative or surgical therapy depends on several factors:

the size of the hernia (its anteroposterior or sagittal size is taken into account): it is determined by MRI or CT data;

diameter of the spinal canal: if there is stenosis, then, most likely, conservative treatment begun at the time of sequestration of the hernia will be ineffective;

location of the hernia relative to the spinal cord and roots;

quality of human life, mainly referring to the severity of pain, numbness of the limbs.

Modern medicine tries not to immediately resort to surgery, but only in the case of a combination of the following factors:

if, despite conservative treatment, numbness of the limbs, muscle weakness continues to progress, the function of the pelvic organs is impaired or pain increases;

almost always - in the case of sequestration of a hernia more than 18 mm (according to other sources - more than 10 mm) in the anteroposterior dimension;

in any case, if there is a narrowing of the spinal canal and an intervertebral hernia has formed;

if the treatment had an effect for a short period of time, then the condition worsened again, and it is clear that this happened in the same part of the spine.

Source gryzha.net

Treatment

Treatment of intervertebral disc herniation localized in the lumbar region.

In the acute phase of the disease, strict bed rest is prescribed. Drug therapy includes the prescription of drugs that relieve pain and signs of inflammation; means that improve blood circulation and vitamins. After acute symptoms subside, massage and exercises are prescribed physical therapy to strengthen the lumbar muscles.

There are certain indications for surgical treatment. These include:

1. Ineffectiveness of conservative treatment and presence of signs of root compression

2. Compression of the roots of the cauda equina.

The essence of the operation is to decompress and release the spinal roots from compression.

The prognosis for surgical treatment is favorable, complications occur very rarely. A timely operation leads to a complete recovery or significant improvement in health in more than 70% of cases.

Source spinet.ru