The first signs and manifestations of an intervertebral hernia of the lumbar spine are treatment and exercises. Symptoms of an intervertebral hernia of the lumbar spine

Pain in the back and limbs should not be left without proper attention. Because in about half of the patients, back pain is provoked by the intervertebral hernia. However, often the disease is discovered by chance during a computed tomography. The disease occurs with a frequency of 100 cases per 100,000 population. Intervertebral hernias are more often found at the age of 30-40 years.

Table of contents:

Causes

The spine is the main support of the body. The vertebral column is made up of vertebrae connected to each other by intervertebral discs. The function of the latter is to provide shock absorption when walking, running, as well as the flexibility of the entire spine. The intervertebral disc consists of an outer shell - the annulus fibrosus, as well as the nucleus pulposus, located in the center of the disc. Normally, the fibrous ring is quite dense and able to withstand physical exertion. But the properties of the connective tissue membrane can change.

With compression of the motor fibers of the spinal roots, weakness of the leg muscles is observed, as well as a decrease in reflexes. When the sensitive fibers of the spinal roots are compressed, there is a decrease in skin sensitivity, tingling, a feeling of crawling along the back of the leg, from the buttock to the heel. These symptoms are considered as manifestations of sciatica.

Vegetative disorders may be observed: the skin of the lower back and legs turns pale, red or white spots may appear on it, and increased sweating is recorded.

In addition, with compression of the roots innervated by the pelvic organs, the patient complains of urination and defecation disorders, as well as a violation of potency.

With compression or damage to the spinal cord, paresis or paralysis in the lower extremities may occur.

With this type of intervertebral hernia, a person is disturbed by constant aching pains in the neck, which is the earliest sign of the disease. With compression of the nerve roots and vertebral artery, headaches occur. Moreover, the pain can be diffuse or concentrated in the neck and temples. There are also symptoms such as dizziness, tinnitus. Due to inadequate oxygen supply to neurons, constant weakness and rapid fatigue develop. In addition, there may be an increase in blood pressure.

With compression of the sensitive fibers of the spinal roots in the neck, occiput, hands, there are sensations of numbness, tingling, crawling, and a decrease in skin sensitivity. With compression of the motor fibers of the spinal roots, weakness of the muscles of the hand is observed. Vegetative disorders are characteristic: the skin of the neck, hands turns pale, there is increased sweating.

With severe compression of the hernia of the spinal cord, paralysis may develop.

With this type of disease, a person is concerned about back pain, mainly between the shoulder blades. However, the pain can radiate to the chest, lumbar region, neck, upper limbs. Pain sensations noticeably increase when coughing, sneezing, laughing, turning the body. It is noteworthy that the pain is often shingles in nature.

Sometimes the pain spreads to the abdomen, which can mimic the pathology of the abdominal organs. When the spinal cord is compressed below the injury site, paresis and paralysis occur.

In the presence of characteristic symptoms and complaints of a person, a neuropathologist examines. The doctor determines muscle tone, skin sensitivity, as well as the state of reflexes. To confirm the diagnosis, the patient should undergo instrumental studies.

The most accessible method is radiography of the spinal column in frontal and lateral projections. On the pictures, the intervertebral discs are not visualized, and therefore the hernia cannot be determined. But with the help of radiography, it is possible to identify the cause of the development of the disease: vertebral injuries, signs of osteochondrosis, congenital anomalies.

The most effective research is magnetic resonance. This method allows you to assess the condition of soft tissues. With the help of the obtained images, you can study the condition of the intervertebral discs, as well as the presence of a hernia.

Not all herniated discs need active treatment. So patients with protrusion of the intervertebral disc up to three millimeters and no symptoms need only observation.

In the presence of severe pain, it will not be possible to avoid taking medications. For this purpose, drugs belonging to the group of NSAIDs (diclofenac, meloxicam, ketorol) are used. With intervertebral hernias with a pronounced inflammatory process, they resort to the use of ointments containing glucocorticosteroids (flucinar, triacort, esperon, dermovate).

A fairly common and effective procedure is a therapeutic blockade. This is the introduction of anesthetics (lidocaine, novocaine) into the epidural space. The purpose of the procedure is to eliminate pain and muscle spasm. The patient experiences relief after a couple of minutes. The effect of the blockade can last for several weeks.

Additionally, the doctor may prescribe B vitamins (neurovitan, milgamma), which provide regeneration of destroyed nerve fibers, as well as improve the conduction of a nerve impulse. Chondroprotectors (structum, alfutol) are prescribed for the repair of cartilaginous tissue of the discs.

If, despite conservative therapy, the pain does not leave the person and worries more and more every day, then it is necessary to consider the option of surgical treatment. Immediate surgical intervention requires compression of the cauda equina.

Operations are carried out in an open way, as well as endoscopically. During the operation, the doctor removes the hernia and restores the integrity of the fibrous ring. If the intervertebral disc is severely damaged, surgery is performed to replace it with an implant.

The spinal column is a connection of 34 vertebrae connected in pairs by intervertebral discs. It is not straight: from the head to the coccyx it makes several alternating bends: a forward bulge in the cervical region, a backward bulge in the thoracic region, then in the lumbar region the forward bend again occurs, and then the sacrum together with the coccyx lean back.

All this is necessary to provide cushioning associated with walking on two legs. But such a structure also determines the concentration of the center of gravity in the lumbosacral region.

Nature provided for this by making the lumbar vertebrae the thickest and most durable, and the sacral vertebrae completely soldered together.

All vertebrae, except sacrococcygeal, have a special structure. They consist of a cylindrical body, which bears the main load, and processes that provide us with the ability to bend in different directions, turn, and twist.

The two parts are connected by two semicircular arches on both sides so that there is a gap in the middle. This is the spinal canal, and it is intended for the spinal cord.

The latter is a kind of "checkpoint" of the second rank (after the brain), carrying impulses from the brain to the organs and vice versa.

The peripheral endings of the myelon (the so-called spinal cord) are the spinal nerves that emerge from it as part of the roots. The anterior roots are motor.

They carry commands to the muscles. The posterior roots are sensitive, they are sent, on the contrary, from the organs to the brain.

At first, the roots do not divide into anterior-posterior, but only into right-left ones, leaving sideways from the spinal cord through an opening between the processes of the upper and lower vertebrae.

Passing the bone ring, separation immediately occurs.

Squeezing by a hernia of the spinal cord itself leads to a violation of a large number of functions at once: the internal organs stop working, the sensitivity and movement of the limbs are disturbed (in the case of the lumbosacral region, only the lower ones).

If the disk began to protrude towards one of the roots, this will cause sensory-motor disturbances in only one limb.

Now about the hernia itself. This is a protrusion of the central part of the disc, which normally resembles a very dense and springy jelly in consistency.

This structure is called the nucleus pulposus and is the main shock-absorbing element and can move inside the disc and spread out depending on the direction and strength of the load on the nearby vertebrae.

At the same time, normally, the surrounding tissues do not change their structure and do not suffer, remaining the same in density as the tendon of any muscle. As soon as the thinning of the fibers occurs in the peripheral part of the disc (fibrous ring), the nucleus pulposus rushes to the weak spot under the action of the load.

As long as it has not yet gone beyond the disc, this is not a hernia, and the situation can still be corrected.

In fact, the fibrous ring is not so easy to destroy, because it consists of fibers that lie in several layers and intersect in three planes. But this is possible either due to a single action of high pressure on the nucleus pulposus, or when replacing the scar tissue familiar to the disc. The latter occurs when the drive fails. How does he eat?

Many patients complain of back pain during an orthopedic appointment. The most common cause of this is an intervertebral hernia.

The disease is a displacement of the spinal disc and a rupture of the fibrous ring, consisting of strong collagen fibers. The contents of the disc (nucleus pulposus) may begin to compress the spinal cord and nerve roots.

A herniated disc is the result of damage to the intervertebral disc. Part of the gelatinous tissue of the disc nucleus, when the disc itself is deformed, is compressed and protrudes into the spinal canal.

There, this tissue presses on the nerve endings located, in great numbers, in the region of the spinal column. Nerve roots are pinched by a protruding hernia and cause swelling of the tissues.

And edema, in turn, gives a strong pain syndrome.

It is impossible to ignore the pain in this case. And it is not necessary! On the contrary, urgent action is needed.

Symptoms of a hernia

This type of disease is the most common. This was the functional feature of the lower back, which differs from other departments in that it is most susceptible to the entire severity of the transferred physical exertion.

A herniated disc, which is also called a herniated disc or disc prolapse, by its nature is a falling out or complete prolapse of the nucleus pulposus, which is located inside the intervertebral structure.

A herniated disc develops a deformity that begins to bulge. In this case, the ring breaks, in which all the contents can get out.

There are several types of intervertebral hernia. All of them are divided depending on the location of the hernia:

education in the cervical region;
protrusion in the thoracic region;
the disease developed in the lumbar region.

Most often, a person is faced with a herniated disc in the lumbar region. It is this part of the human body that suffers more from excessive stress and stress. In addition, the features of the structure of the lumbosacral junction also affect.

In second place in terms of the number of formations is a herniated disc of the cervical spine. This part is the most mobile, so it can often be overloaded and tired.

Intervertebral discs are flexible "sleeves" between the vertebrae. Their main job site is space for the spinal nerves, which exit the spinal cord through bony windows (called foramina), and act as shock absorbers.

The discs are made from two separate parts.

fibrous ring. The annulus is the outer part of the disc. It consists of ligamentous rings (can be compared with rings on a tree). Part of the pulpous center contains a jelly core. Fluid cannot be compressed, so these jelly centers act as shock absorbers.

When you carry the weight, the pressure pushes the core towards the outside of the disc 360 degrees. As you lean forward, the core is pushed more toward the back of the disc. The annular fibers are generally stiff enough to support the disc during normal activities, including work.

But when there is too much disc pressure, these layers can become ligaments and begin to collapse from within. As the innermost layers begin to tear, the core jelly begins to be forced out by the outer (right or left or both) backs of the disc. The larger the gap, the greater the bulge.

Injuries that cause intervertebral discs to bulge out herniated. It can be caused either by an acute injury or by repetitive physical exertion. Mechanical stresses act on injured or weakened annular ligaments and allow the jelly to bulge outward.

If a bulge (often referred to as a disc herniation) protrudes over a small area (less than 25% of the circumference of the disc), then we refer to it as the focal point of the disc.

However, too often, the vertebral disc can protrude over large areas (up to 50% of the disc circumference). This pathology is called diffuse herniated disc.

The differences in the two cases are insignificant. Focal disc swellings are more localized, causing pain that is usually focused in one area.

This is because there are fewer nerves involved. It must be borne in mind that a herniated disc can often cause sciatica.

Because diffuse disc swellings take up more space, they tend to cause a wider range of symptoms. The pain is often on both sides. But due to the pressure on the cord, it can give other symptoms due to several spinal nerves.

Pain helps you know what kind of disc herniation you're dealing with. The recovery time may be longer for the diffuse type of hernia.

Causes

Most often, vertebral hernias of the lumbar spine appear with osteochondrosis, when, due to age-related changes, the trophism of the fibrous ring worsens, it becomes drier and more brittle. However, osteochondrosis and intervertebral hernia are different diseases.

To provoke the appearance of a hernia can also:

The main reasons for the formation of an intervertebral hernia are, oddly enough, absolutely polar:

inactive life, suggesting a low level of mobility;
permanent sedentary work;
excessive activity of athletes;
physical form of labor.

As described above, each intervertebral disc consists of a gel-like nucleus pulposus surrounded by a dense and durable membrane (annulus fibrosus).

If, as a result of tissue damage or deterioration that has appeared with age, the process of disc degeneration begins, part of the nucleus pulposus may be squeezed out through a gap in the outer shell.

This phenomenon is called intervertebral hernia.

The intervertebral disc has four concentric layers: the outer annulus fibrosus, consisting of dense collagenous fibrous plates; internal fibrous ring, consisting of fibrous cartilage tissue; transition area; and central nucleus pulposus.

So, the intervertebral disc consists of collagen fibers of the annulus fibrosus, which provide strength, and proteoglycans of the nucleus pulposus, which provide resistance to compression.

Several factors, including genetic and changes in hydration and collagen, play a role in the development of degenerative disc disease. It is generally accepted that the ability of the nucleus pulposus to bind water plays a significant role in the physical properties of the disc.

In a healthy disc, the nucleus pulposus distributes the load evenly over the entire annulus fibrosus. Decreased disc hydration can reduce the cushioning effect, which causes the load on the fibrous membrane to be distributed asymmetrically, which can lead to damage.

An increase in the content of collagen in the nucleus is also considered one of the factors responsible for disc degeneration.

1. Incorrect posture (scoliosis, kyphoscoliosis), undeveloped muscle corset, pathological motor and positional stereotypes.
2. Sedentary lifestyle, prolonged stay in a monotonous position, static loads.
3. Power and contact sports, improper weight lifting.
4. Injuries.
5. Congenital anomalies in the development of bone, cartilage, connective tissue, spinal column.
6. Age-related changes, osteoporosis.

The main reason for the formation of an intervertebral hernia of the department in question is osteochondrosis. However, there are other reasons predisposing to the development of this condition:

violation of metabolic processes in the body;
various types of injuries, to a greater extent - during an accident, namely after a sharp jerk of the head forward;
excessive physical activity, weight lifting (especially jerky), too sharp slopes;
pathology of the hip joint, curvature of the spinal column - in particular, scoliosis;
obesity;
in some cases - structural changes in the spinal column during tumor processes, syphilis, congenital anomalies, syphilis.

READ ALSO: Umbilical hernia in children operation

There are also many factors involved:

weakness of the back muscles;
infections;
hypodynamia;
bad habits;
age-related changes;
hereditary factors;
a profession that involves a long stay in a “sitting” position (secretary, crane operator, driver, programmer, etc.).

Important! These factors lead to accelerated aging and rapid wear of tissues - cartilage and bone - and this subsequently becomes the cause of the formation of intervertebral hernial protrusion.

As a rule, lumbar hernia is a consequence of the development of lumbar osteochondrosis.

There are factors that provoke the development of degeneration:

Among the causes of pathology should be noted viral and bacterial etiology. Some microorganisms have excellent adaptability to nervous tissue and can use these cells for introduction and subsequent reproduction.

Infection with the herpes virus is in the first place among the causes of intercostal neuralgia.

Kinds

Depending on the location, the hernia can be located in the cervical, thoracic, lumbar or sacral spine. According to the location of the hernia relative to the vertebrae, there are the following types of hernias:

Depending on which direction the center of the disc protrudes (nucleus pulposus), a herniated disc L5 S1 can be:

(if the table is not fully visible, scroll to the right)

The larger the L5 S1 hernia, the more intense the pain in the lower back, perineum or leg.

Severe advanced forms of the disease may require surgical treatment.

The last stage of the disease is a sequestered hernia, when the contents of the disc drain into the spinal canal. It manifests itself in four ways:

strong "lumbago" in the lower back;

the pain is aggravated by coughing, straining, laughing;

one leg becomes numb and becomes inactive, up to the development of paralysis;

the independent ability to defecate and urinate may be impaired.

If there is a suspicion of hernia sequestration, urgent treatment is mandatory.

Click on photo to enlarge

Disc herniation is a pathology in which parts of the damaged and altered nucleus pulposus are squeezed out through a defect in the annulus fibrosus, provoking its rupture or excessive protrusion beyond normal physiological boundaries, falling into the spinal canal cavity or “pressing” into the vertebral body.

If the fibrous ring is intact, its protrusion under the influence of sequesters of the altered nucleus pulposus is designated as a protrusion (protrusion) of the disc.

Often the term "protrusion" is used to refer to the size of the hernia, leading to a misinterpretation of the condition.

Due to the fact that in most cases a hernia is formed precisely in the lumbar region of the spinal column, it is worth paying more attention to this area, highlighting certain types of pathology, as well as localization features.

First of all, let's talk about the general classification of dorsal hernias, in total, 5 types are distinguished among them:

Intervertebral hernias are divided into three types:

1. By size:

Protrusion - protrusion of the disc by 1-3 mm.
Prolapse - prolapse of the disc by 3-6 mm.
The development of a hernia is a protrusion of the disc by 6 to 15.

2. By type of tissue, intervertebral hernias:

Bone (spondylosis osteophyte) - is diagnosed very rarely (in 1% of cases) in the elderly.
Cartilaginous (osteophytes) - develop in 15% of patients.
Pulpous (Schmorl's hernia) - are formed in 84% of cases.

3. In the direction of exit in accordance with the center of gravity of the spinal segment:

Foraminal - hernial protrusion is carried out through the hole from which the nerve endings emerge
Median disc herniation - characterized by a split of the round disc cartilage along the radius. The exit gate in this case is directed to the periphery from the circular platform of the vertebral body
left-sided
right hand
Front
rear

Lumbar hernia is usually divided into two types:

L4-L5 - when the nerve root is pinched between the lumbar vertebrae 4 and 5;
L5-S1 - infringement occurred between 1 sacral and 5 lumbar vertebrae.

Stages of development

The process of hernia formation occurs in stages:

The progression of the pathology varies from sudden to slow onset of symptoms. There are four stages:

disc protrusion
Dropped disc
Disc extrusion
Absorbed disc

Stages 1 and 2 are called incomplete herniated discs, while stages 3 and 4 are called complete hernias. Neurological deficits may include sensory changes (ie, tingling, numbness) and movement changes (weakness, impaired reflex function).

These changes are caused by compression of the nerve caused by pressure from the internal disc.

Hernia progression

Cervical - the pain spreads to the neck, shoulders and arms.
Thoracic - the pain spreads to the chest.
Lumbar - the pain spreads to the buttocks, thighs, legs.

Cauda equina syndrome stems from a central disc herniation and is a serious pathology requiring immediate surgical intervention. Symptoms include bilateral leg pain, loss of perianal sensation (anus), bladder paralysis, and weakness of the anal sphincter.

Signs of the disease

With a hernia of the considered localization, the following symptoms may be observed:

intense pain in the projection of the sacrum;
feeling of "heavy legs", general weakness;
pain syndrome, aggravated during walking and radiating to the thighs;
stiffness of movements;
in advanced cases - violations of the physiological functioning of the genitourinary organs;
local numbness in the lower extremities.

Pain syndrome as the disease develops "evolves" as follows:

At the initial stage of the development of the pathology, the pain is aching, dull in nature, localized only in the lesion, aggravated by exercise and may be completely absent at rest.
Pain increases, spreading to the muscles of the lower back.
The lower extremities are also involved in the process, the patient's legs hurt, the pain is sharp with “shoots”. It can affect different parts of the leg, perineum.

The pathological process proceeds in the form of the following stages:

Prolapse - minimal displacement. The disk in the absence of any deformation can return to its place. The manifestation of pain syndrome is insignificant.
Protrusion. The disc is still limited by the vertebral bodies, but has already undergone another, additional displacement after having already been displaced.
extrusion and sequestration. An outwardly displaced nucleus sags between the vertebrae. Subsequently, the capsule breaks and its contents flow out.

The most common signs are:

The first thing you need for a speedy recovery is to pay attention to alarming symptoms in time. This will make it possible to start treatment in the early stages of the disease, and this greatly increases the chances of success. So, you should be on the lookout for the following symptoms:

Photo: squeezed roots between discs

Symptoms

The first thing that the patient needs to pay attention to is pain passing into the thigh, knee and lower leg. Such sensations have characteristic signs:

Dull, aching pain.
With any tension of the spinal muscles, the pain increases.
After taking a horizontal position, pain decreases.
Soreness is felt in a certain place on the back.

Signs depend on in which part of the spinal column a hernia has formed. A common symptom is back pain.

Cervical calving is characterized by the appearance of frequent dizziness and headaches, numbness of the fingers, increased blood pressure, possible memory impairment and deterioration in concentration.

This pathology is not common, but it poses a particular danger to the patient, since the vessels leading to the brain can be infringed. Incorrect, sharp movement of the neck can lead to poor blood circulation.

All symptoms can be divided into 2 groups: irritations and lesions.

The symptomatology is strikingly different depending on the location of the hernia, but the stage of progression of the pathological process, the size of the formation, the factor of infringement of nerves, blood vessels, etc. also play a significant role here.

A common symptom for all types of hernias is pain. In the early stages, the pain in the back is quite insignificant, and many even periodically leave them unattended.

However, as the disease progresses and the formation grows, the pain intensifies and becomes permanent. The larger the hernia, the more unbearable the pain, in the end, it becomes impossible to endure them without painkillers.

Lumbar

Symptoms of the disease do not appear immediately, in some cases the first stages pass without manifestations. The symptoms of an intervertebral hernia will differ depending on the department in which the formation of the bulge began.

The main complaint from patients is a sharp, severe pain. It is provoked by a prolapsed disc that presses on the nerve root.

Each of them is responsible for the work of a specific organ, so the prolapse of a vertebra affects the spinal cord and the nearby nerve endings.

A dorsal herniated disc is usually asymptomatic, but the following symptoms are sometimes observed: discomfort, pain in the lower back that lasts for a long time.

Over time, the pain gets worse. She starts to be convulsive.

Discomfort is especially felt after physical exertion in one position. The patient may hear clicking or crunching in the back.

During the pain syndrome, the pain is intense, even during breathing and coughing. Over time, the pain begins to give in the leg. As a result of worsening back discomfort, it is difficult to straighten the leg, the knee jerk worsens, and other symptoms are observed.

Symptoms of the disease depend on the size of the hernia, its localization:

There are a lot of symptoms of arthritis: increased pain in the joints at night, stiffness in the body and joints, which disappears only within an hour or two. The most alarming sign of arthritis is the regular stiffness of the hands in the morning, the feeling of "imaginary gloves" on the hands immediately after waking up.

You should also beware if you have swelling of the wrist joints, that is, those that are located at the base of the fingers.

With dumping syndrome of the operated stomach, the main symptoms are the following:

Vascular and neurovegetative: attacks of weakness, palpitations, blanching or a feeling of heat with reddening of the face, trembling fingers and hands, dizziness, darkening of the eyes, cold sweat. These complaints are directly related to food intake and are observed only during an attack of dumping syndrome.
Dyspeptic and abdominal discomfort: lack of appetite, nausea, regurgitation, vomiting, rumbling in the abdomen, loose unstable stools, constipation. This category of complaints is associated with a violation of the motor-evacuation activity of the gastrointestinal tract and disorders of the exocrine function of the pancreas.
Complaints associated with insufficient digestion, with metabolic disorders: emaciation, anemia, general weakening of the body, decreased ability to work, physical impotence, impotence.
Various pain sensations, most often caused by the inflammatory process in the hepato-pancreatic-duodenal system, duodenostasis and adhesive process in the abdominal cavity.
Psychoneurological disorders and personality asthenia: irritability, tearfulness, insomnia, headaches, imbalance, fixation neurasthenia.

Diagnostics

To make a diagnosis, the doctor will conduct a survey, visual examination of the patient, probe problem areas. Additionally, an examination will be scheduled:

The medical examination should begin with a visit to the doctor. In this case, it is necessary to consult a neurologist. The specialist will conduct a survey and examination of the patient, after which additional diagnostics may be needed.

Currently, the most informative methods include computed and magnetic resonance imaging. Thanks to these methods, you can find out the exact location of the hernia, its size and effect on the spinal canal, nerve roots.

Your doctor will begin your assessment with a complete physical examination and a medical history that includes detailed information about your symptoms. He or she will perform a neurological exam to check muscle reflexes, sensation and muscle strength.

READ ALSO: Rehabilitation after removal of a hernia of the lumbar spine

The doctor may also recommend other diagnostic tests to confirm the diagnosis or to learn more about the location and size of a herniated disc.

These tests may include:

Not always pain in the lumbar or cervical region indicates the presence of intervertebral hernias. Only an experienced doctor can determine it during a comprehensive examination of the patient. A neurologist or neurosurgeon will make a final diagnosis after an additional examination using the following methods:

MRI (Magnetic Resonance Therapy), MRI is the most reliable diagnosis;
spondylography;
radiographic examination.

To establish the exact location of the hernia, the degree of progression of the pathology, the size of the formation and associated complications, a full-fledged diagnosis is needed, which involves:

To establish a diagnosis, doctors initially use the simplest methods: they use special tests to identify the symptoms of the disease, check tendon reflexes.

Such a check allows you to determine how affected the spinal column. However, without the use of hardware diagnostics, it is quite difficult to determine the presence of an intervertebral hernia in a patient.

It is difficult to suspect the formation of a lumbar hernia in the initial stages, since its clinical picture is similar to the symptoms of uncomplicated osteochondrosis and the onset of other pathological processes (lumbar spondylosis, lumbar spondylarthrosis, lumbarization, sacralization, etc.).

). Patients themselves often turn to a neurologist, orthopedist or vertebrologist only at the stage of radicular syndrome.

For accurate diagnosis of intervertebral hernia of the lumbar spine, it is necessary to conduct a number of examinations in a medical institution:

Despite the fact that the symptoms of such a disease are difficult to ignore, one familiarization with the symptoms is not enough to make a diagnosis. A number of additional studies are needed. Among them:

neurological test.
X-ray.
Magnetic resonance imaging. Allows you to take a kind of "photo" of soft tissues and track the protrusion of the intervertebral disc.
CT scan.
Electromyogram.

Treatment

Of great importance in the treatment of patients is the correct position of the spinal column. The mattress should be firm and even. A wooden shield should be placed under the mattress.

A few simple and effective exercises for intervertebral hernia

Physiotherapy exercises and physiotherapeutic methods are of great importance. They are aimed at strengthening the muscular corset of the back, relieving pain and inflammation.

Physiotherapy

The main drugs are non-steroidal anti-inflammatory drugs. They relieve pain and inflammation.

With severe muscle stiffness, muscle relaxants are used.

In case of pathology of the roots, vascular preparations are necessarily used, which improve the blood supply to the nerve endings.

Neurotrophic preparations are also used, which renew damaged roots.

Effective use after exacerbation of chondroprotectors, due to which cartilaginous discs are renewed.

The course of therapy is prescribed by a neuropathologist on an individual basis. When choosing the right direction, gender, age, diagnostic indicators, external examination will be taken into account.

At the disposal of the attending physician may be the main methods of treatment (conservative, surgical) and a number of additional procedures (massage, resonant wave therapy, acupuncture, hirudotherapy).

The duration of treatment for non-advanced stages of the disease is from three to six weeks.

Surgical treatment (surgical intervention) is rarely used, provided that the lumbar hernia could not be cured with medication.

The surgeon's manipulations are carried out under the influence of general anesthesia in order to remove the protrusion, reduce the risk of complications in the muscles, the bone of the inflamed area, modern techniques are used (laminectomy, microdiscectomy).

After removing the inflammation for a week, it is necessary to follow the instructions of specialists, and then follow the preventive measures.

Conservative (drug) treatment is considered the main one, while the use of one or another type of drug depends on the stage, signs and accompanying symptoms. For the treatment of a hernia of the lumbar are used:

non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac, Baralgin);
novocaine blockade with the addition of corticosteroids (done topically to quickly relieve pain);
chondroprotectors for the restoration of cartilage tissue (Chondroxide, Alflutop, Structum);
muscle relaxants of general action (Mydocalm, Sirdalud);
vitamin complexes with a high content of group B to restore nerve tissue (Neurovitan, Milgamma, Neurobeks).

Additional methods (physical and manual therapy, acupuncture, exercise therapy, hirudotherapy) are used in the subacute or recovery period, this helps to restore body mobility.

A prerequisite in order not to damage problem discs with your actions: it is necessary to carry out alternative methods of treatment under the supervision of a specialist.

Often, the treatment of disc herniation consists in the use of conservative methods, physiotherapy, manual therapy and physiotherapy exercises. First of all, you need drug therapy aimed at relieving pain, eliminating spasm of the muscle corset.

For this, painkillers and anti-inflammatory (non-steroidal) medicines are prescribed: Movalis, Diclofenac, Ibuprofen, Indomethacin, Meloxicam.

They produce painkillers in the form of tablets, gels and ointments for topical use, injections.

Vitamins of group B are an obligatory component of therapy. Under their action, nerve tissues are restored, and the passage of impulses improves.

To prevent the development of degenerative-dystrophic changes in bone tissue and cartilage, it is necessary to take chondroprotectors: Teraflex, Artrofon, Chondroitin, Rumalon.

It improves blood circulation in the problem area and reduces tension in muscle tissues by taking muscle relaxants: Mydocalm, Venoruton. They are usually combined with non-steroidal anti-inflammatory drugs.

There are two main methods of treatment: surgical and conservative.

There is only one method of surgical treatment - surgery.

In the conservative method, the range of effects on the lumbar hernia is more extensive:

The prolapse of the intervertebral disc is treated with the usual traditional method. Surgery is indicated only in extreme cases. This is the reason why it is very important to "catch" the disease of the intervertebral disc in time in order to avoid surgery.

For the vast majority of people suffering from intervertebral hernias, the so-called. "Conservative" treatments, which may include:

A herniated disc is treated with conservative or surgical methods. The main goal of treating a person with this disease is his desire to return to normal life without pain, restore activity in movements, and return to working capacity.

Traditional treatment

To get rid of herniated discs, conservative treatment is preferable, which consists in performing the following procedures:

Conservative therapy is the most preferred therapeutic tactic for a herniated disc. It is complex.

The drug component includes drugs for the relief of pain (ketoprofen, ibuprofen, diclofenac, naproxen, meloxicam, etc.), muscle relaxants for the removal of muscle-tonic syndrome (tolperisone hydrochloride), vitamin complexes necessary to maintain nervous tissue (B1, B6, B12), decongestants.

In order to stop the intense pain syndrome, local administration of corticosteroids and local anesthetics in the form of paravertebral blockades is used.

In the initial stages, chondroprotectors are effective (chondroitin sulfate, glucosamine, etc.)

L5 S1 disc herniation is treated conservatively and surgically.

Surgery is resorted to only if urination, defecation disorders have developed, or the legs have become paralyzed. In other cases, conservative treatment is used first.

Conservative therapy

Conservative treatment must be comprehensive:

Yulin's swing

Operation

Such treatment is carried out in extreme cases: with the ineffectiveness of conservative therapy, the development of paralysis or "horse tail syndrome". In modern operations, an area of the intervertebral disc that is pressing on the nerves or spinal cord is removed through an incision or puncture.

The disc is laser vaporized or sucked out using negative pressure. In very rare cases, a “major operation” is performed, when the damaged disc is removed with conventional neurosurgical instruments through a relatively large incision.

As mentioned earlier, the treatment of a sequestered hernia is based on the results obtained during the diagnosis. Treatment necessarily involves the involvement of a doctor. Only a specialist decides which means in the treatment of pathology will be used.

The fact is that for a full-fledged treatment, an integrated approach is important when it comes to conservative methods.

In cases where it is possible to do without surgical intervention, that is, there is no threat to the vital functions of the patient's body, an integrated approach involves the following methods of struggle:

Medical therapy.
Physiotherapy.
Acupuncture.
Physiotherapy.

Conservative treatment

Such therapy, which involves taking medications and using physiotherapy, is carried out only if the nucleus pulposus has not completely separated. This means that part of the sequester has protruded beyond the disc, but is still retained by the gelatinous substance.

The essence of conservative treatment is to prevent the final prolapse of the sequester until the final necrosis of its tissues. In this area, the process of ossification will occur, due to which the hole in the fibrous ring will close.

During treatment, it is important to ensure that new bone formations do not damage nerve tissue.

Conservative treatment includes:

The use of drugs with analgesic and anti-inflammatory effects.
Physiotherapy.
Massage course.
Muscular rest, etc.

Acupuncture

Acupuncture or acupuncture is one type of conservative treatment. Its essence lies in the impact on biologically active points to stimulate various processes in the body.

Thanks to acupuncture, you can get rid of back pain, restore nerve function to prevent problems with internal organs and disorders of the musculoskeletal functions. Acupuncture should be performed only by a highly qualified specialist.

With the initial manifestations of pain and neurological syndromes caused by disc herniation, pharmacotherapy is used. They use analgesics, steroidal and non-steroidal anti-inflammatory drugs, vitamin therapy, chondroprotectors, muscle relaxants, anticonvulsants, drugs that improve blood circulation.

It is good to combine drug therapy with physiotherapy. Positively proved such methods as the impact of diadynamic currents, magnetotherapy.

There are techniques for introducing certain drugs into the affected area using electrophoresis.

With a decrease in the severity of the pain syndrome, you can resort to the help of a manual therapist, a massage therapist. It is useful to use techniques such as post-isometric relaxation, underwater and dry traction, exercises on the Evminov board.

And, of course, physiotherapy exercises for the formation of the correct posture and muscle corset.

Do not forget about acupuncture, pharmacopuncture.

There are methods of surgical treatment of herniated intervertebral discs. Indications for such operations are very limited: increasing paresis, dysfunction of the pelvic organs, and disabling pain syndrome.

Some doctors believe that the presence of a sequestering hernia is also an indication for surgery. There are several methods of surgical treatment, choose the most appropriate method for each patient individually.

Any of the methods of treatment implies a change in lifestyle, the formation of the correct stereotypes of physical and static activity, work on oneself. Without this, treatment will be ineffective and the disease may return.

TV channel "Russia-1", program "About the most important" on the topic "Herniated disc":

ABOUT THE MOST IMPORTANT Intervertebral hernia

Channel One, the program “Live Healthy” with Elena Malysheva on the topic “Herniated disc”:

Intervertebral hernia: symptoms and signs

Dorsal herniated disc requires immediate treatment with the obligatory involvement of a doctor. All measures to combat pathology are based on the obtained diagnostic data.

Surgical oncologist, higher medical education in the specialty "General Medicine".

This article provides a detailed overview of the signs of a lumbar disc herniation. The most common symptoms of a herniated disc in the lumbar region are:

Pain in the lower back or buttocks.

Pain that radiates (radiates) to the leg.

Numbness, weakness, tingling or prickling sensation in the leg.

Pain in the lower back is sharp and burning in nature, rather than dull. They are caused by a bulging disc affecting nearby nerve roots.

The main symptoms of a hernia of the lower back

Symptoms in some patients with a hernia of the lumbar spine are constant, very pronounced, deliver tangible, and sometimes simply unbearable discomfort. Other patients report that symptoms occur intermittently and are relatively tolerable.

Most often, there is not one, but several symptoms in the complex. Here are the 6 most common combinations:

Pain in the lumbar region associated with pain in the leg (the latter is felt more strongly).

Pain in only one buttock and one leg on one side of the body (pain on both the right and left is rare).

Pain occurs in the lower back or buttock and travels along the sciatic nerve to the area below the waist, then to the thigh, lower leg and foot.

There may be tingling or tingling, numbness or weakness in the feet, as well as throughout the leg.

When moving the leg or rotating the foot, weakness and numbness are felt.

Shooting pain in the leg that may make it difficult to stand or walk.

In a lying position or when walking, pain in the lumbar region weakens, while standing and sitting - they increase.

Unpleasant sensations can go away or weaken on their own or with the help of therapy (medications, injections, exercises, etc.). Sometimes it is possible to stop the symptoms of a hernia in the lumbar spine only with the help of surgical intervention.

Attention! The most common localizations of a herniated disc are the lumbar segment L4–L5 (more than 50% of cases) and the lumbosacral segment L5–S1 (more than 80% of cases). Let's talk about the symptoms of the defeat of these segments in more detail.

Symptoms of a herniated disc L4–L5 (lumbar)

X-ray: lumbar disc herniation L4–L5

The lower back is the most complex of all sections of the spinal column. The L4–L5 vertebrae complete the lumbar region and, together with the intervertebral discs, joints, nerves, and soft tissues, perform a huge number of important functions, including support for the upper body and the implementation of body movements in various directions.

But due to the very high load, the L4–L5 segment is especially susceptible to various lesions and destruction (that is, degenerative changes - osteochondrosis). In most patients, a lumbar hernia develops in this segment.

In addition to the general symptoms, an L4–L5 herniated disc may present with the following symptoms:

inability to move or extend the big toe;
drooping (paralytic) foot caused by weakening of the calf muscles;
numbness or pain in the top of the foot.

On a note. Checking for the symptom of a drop foot is quite simple: it is enough to walk in high-heeled shoes. With a paralytic foot, this cannot be done.

Symptoms of an intervertebral hernia L5–S1 (lumbosacral dressing)

X-ray: L5–S1 lumbar herniation

The base of the spine is formed by a unique segment of the L5–S1 vertebrae, also known as the lumbosacral joint. If the outer part of the intervertebral disc located in this segment bulges out, a hernia is formed. Typical symptoms of the pathology of this department (in addition to the main ones):

absence of the Achilles reflex: when the hammer strikes the Achilles tendon, there is no contraction of the calf muscle and flexion of the sole;
inability to move, lift up the toes;
pain radiating to the foot, heel, or outer part of the foot.

Under what signs should an ambulance be called immediately?

For any symptoms of intervertebral hernia, the patient should consult a doctor: a neurosurgeon, orthopedist or vertebrologist.

In some cases, you should immediately call an ambulance:

The pain syndrome, numbness or tingling becomes so strong that it literally "drives you crazy" and is not eliminated with the help of medicines.
Have problems with urination or bowel movements.
The effect of "saddle blockade" begins to appear from time to time or constantly: the sensitivity of the inner thighs, perineum and lower buttocks is lost (the area "as in contact with the saddle").
Asymmetric paralysis of the feet, pain syndrome, numbness or loss of sensation in the legs, impaired activity of the pelvic organs and the absence of Achilles reflexes develop. Taken together, all these are signs of the development of a rather serious disease - cauda equina syndrome.

In no case should these phenomena be ignored, since this can lead to the development of irreversible paralysis of the lower extremities.

Owner and responsible for the site and content: Afinogenov Alexey.

A hernia of the lumbar part of the spine is the most common form of this disease, which manifests itself as a result of a ruptured disc of the spine. Diseases are more often exposed to men 30-50 years old.

Due to the occurrence of strong physical activity, the fibrous ring of the spinal disc is torn, due to which the semi-liquid core begins to penetrate the spinal canal. This causes compression in the spinal cord, which leads to disastrous results.

The main symptoms of the disease

With the occurrence and further development of a lumbar hernia, the following symptoms begin to appear:

pain in the lumbar region, as well as constricting sensations;
sharp pain when tilting the body and turning it;
feeling of backache (sharp pain) in the lower back, which spontaneously appear and can also abruptly disappear;
pain radiating to the lower limbs;
burning sensation, tingling in the legs, numbness of the extremities, "goosebumps";
in especially severe cases, there are malfunctions in the work of the intestines, sometimes in the bladder and other organs, atrophy of the muscles of the legs appears, and paralysis is possible.

Characteristics of pain syndrome in hernia

First of all, a lumbar hernia is characterized by pronounced pain. It can be described as dull, aching. The pains are so severe that because of them the patient cannot sit down normally, stand calmly and even cough. Relief occurs only in a horizontal position, when the limbs and spine do not bear any load. Therefore, during an exacerbation of a lumbar hernia, it is recommended to lie down as much as possible.

If pain has begun due to a lumbar hernia, you should not wait for it to pass. Even years later, it will torment a person, and the problem will only get worse. Therefore, it is better to consult a doctor immediately. This will cure the disease at the initial stage and avoid surgical intervention.

As soon as a patient with a hernia makes some movement to change position, or tries to make certain movements, there is a sharp shooting pain in the lower back. It's called sciatica.

According to the characteristics of the pain, it is possible to approximately determine where the spinal deformity occurred. If the 5th lumbar vertebra is damaged, the pain will be localized in the big toe. And if the place of the vertebral hernia is located between the 5th lumbar and 1st sacral vertebrae, the patient will complain of pain in the sacrum, in the little finger, in the back of the leg. Sick people usually prefer to endure even constant pain, and only in especially severe cases do they decide to consult a doctor.

Note!

A lumbosacral hernia is especially dangerous for women. It is in this area that the pelvic organs are located. If there are problems with the spine, interruptions in the blood circulation of these organs will begin, which will cause chronic gynecological pathologies. As a rule, patients with a hernia of the lower back have significant disturbances in the functioning of the excretory system, as well as disruptions in the menstrual cycle.

Due to the presence of pathology in the spine, the muscles in this area are unnecessarily tense. With this action, the body tries to keep the spine as motionless as possible so that the problem does not worsen. But in the long run, this can lead to scoliosis.

With an intervertebral hernia of the lower back, severe compression of the nerve roots can easily occur. It causes a condition of loss of sensitivity of the skin in some areas. As a result of this, dry skin develops, after a while it begins to peel off strongly.

Ultimately, the pain leads to the fact that the patient's mobility is drastically reduced. Sometimes the problem is so severe that the knee jerk disappears for a while, the sensitivity of the big toe, as well as the ankle, is lost. Ultimately, this can all lead to severe paralysis of the limbs.

Causes of the disease

The spine can endure even an increased load on the body. This is due to its special anatomical structure. Thus, the center of the disc is formed by the nucleus pulposus. But if a person develops osteochondrosis, over time it is erased and loses its functions, as it receives less nutrients along with the blood flow. This leads to the fact that the fibrous rings of the discs between the vertebrae begin to crack and collapse, which causes a change in the distance between the vertebrae. The facet joints are stretched, and the disc is partially advanced into the spinal canal, which causes extrusion of the nucleus pulposus. Thus, a hernia is formed. In this case, the spinal nerves experience strong pressure, swelling begins to develop in this area, which is accompanied by severe pain.

The following factors contribute to the appearance and further development of a hernia:

hypodynamic lifestyle, as a result of which some parts of the body begin to receive less nutrients that are responsible for the ability of the spine to be flexible and mobile;
overweight, due to which the spine is unnecessarily strained;
regular overload in the lumbar region;
frequent lifting of gravity in a standing position by those patients who do not have developed muscles of the lower back and lower extremities;
the presence of defects in the musculoskeletal system: flat feet, problems with posture, the presence of pathological curvature.

It is the lower back that takes on the main load when the body moves. This load increases when a person tries to lift something heavy from the floor. In order for the spine to endure the process of lifting weights from the floor as gently as possible, it is recommended to do this so that the main emphasis is on the muscles of the buttocks and legs. But at the same time, it is important that the muscular frame of the back is strong enough. This is achieved by doing the exercises prescribed by the doctor.

Treatment of vertebral hernia

Lumbar hernia should be treated by a doctor. In this case, it is necessary to pre-diagnose, which includes ultrasound, MRI, ECG and other procedures. This is due to the fact that a hernia of the spine in the lumbar region has symptoms that echo diseases of the organs located in the pelvic area, as well as Bechterew's disease. To distinguish between them, it is necessary to carry out diagnostic measures.

Treatment can be either surgical or conservative. It is important to start treating a hernia in the early stages, because then conservative treatment will not have an effect. It must be understood that the methods of alternative treatment do not have the desired effect.

In order to avoid surgery, it is recommended not just to take drugs or go for a massage. It is important to completely transform your lifestyle, making it more mobile. You also need to give up harmful (alcohol, drugs, tobacco) and even adhere to some dietary principles.

Surgery

Doctors resort to hernia resection only when traditional methods of treatment have no effect or give minimal results due to the severity of the condition:

rupture (or sequestration) of the intervertebral disc;
inflammation of the sciatic nerve;
decreased patency of the spinal canal;
significant displacement of the intervertebral disc;
lack of improvement in the patient's condition for a long time.

Today, medicine is able to offer various sparing interventions. Doctors may perform one of the following types of surgery:

Laser reconstruction. With the help of a laser, excess moisture can be quickly removed from the dermatized pulp. This relieves pressure on the nerve. This type of intervention is considered the mildest, but it has the most contraindications.
Surgical removal of part of the disc. The needle is inserted through the skin into the site of inflammation, and part of the nucleus pulposus is removed there.
Removal of the entire disc and replacing it with a prosthesis, if the pathological process is running.

Medical treatment

Taking medications for spinal hernia is aimed not so much at eliminating the problem, but at combating the symptoms. But it is also important, because a strong pain syndrome stops, and a person can return to a relatively normal life.

First of all, painkillers are taken. These are Diclofenac, Indomethacin or Ibuprofen. Their use is mandatory. They not only relieve pain, but are also able to prevent further muscle atrophy. After all, a person can now move more freely and not lose muscle strength. In addition, these drugs remove the inflammatory process caused by compression of the nerve roots. Non-steroidal analgesics are used both in tablets and as topical agents.

With a hernia of the spine, the body innervates the muscles in the region of the spine in such a way that they support and immobilize it as much as possible. This leads to severe stiffness in movement and sharp muscle pain. To relax the muscles and give the body a rest, it may be necessary to administer central muscle relaxants, for example, Sirdalud or Mydocalm. These drugs relieve muscle spasm. It is also possible to use novocaine blockades for pain relief of especially problematic areas.

Exercise as a treatment

One pill is not enough to eliminate the signs of a vertebral hernia by conservative methods. It is very important to supplement it with therapeutic exercises, the use of which will stop the development of the problem. But you need to remember that exercises can be practiced only if the pain is completely eliminated, as well as the symptoms of a pinched nerve.

The exercise program is compiled by the instructor specifically for each patient. Usually it contains exercises for tilting the body, its rotation and turns. All exercises are aimed at strengthening the muscular apparatus of the spine and preventing disc displacement in the future.

It is recommended to devote special time to exercises performed in various horizontal poses. In this case, the patient can perform rotations, abduction of arms or legs to the sides, lifts, and inclinations. You can also hang on the bar to stretch your spine a little. This will give the intervertebral discs more free space, which will increase the likelihood of them returning to a healthy state.

When contacting a doctor at the initial stage, a hernia can still be cured. But if the problem is running, doing the exercises will only reduce the number of negative symptoms. It is important to follow all the recommendations of the instructor and the attending physician.

Physiotherapy

For the treatment of a hernia of the lower back, it is also possible to use physiotherapeutic methods of treatment:

acupuncture;
point reflexology;
electrophoresis;
warming therapy of the spine;
underwater massage techniques.

Massage

The use of massage for the treatment of vertebral hernia is possible only during the period when there is no exacerbation. In this case, it is necessary to obtain the approval of the attending physician for such manipulations.

Thanks to the massage, you can increase blood circulation in the area of \u200b\u200binflammation. This will nourish the bone and nerve tissues with useful substances and will allow you to quickly remove decay products from them. As a result, the muscle spasm will go away, the pain syndrome will decrease. In addition, during the massage, you can get a portion of endorphins, which serve as a natural anesthetic.

Video

You can get acquainted with the methods of treatment of intervertebral hernia without surgery in the video below:

Prevention of lumbar hernia

To prevent hernia, do the following:

watch your posture;
walk, swim, do yoga, various sports as much as possible;
keep your back correctly when working at a computer;
if the work involves long sitting, you need to take frequent breaks and do small moving exercises;
try to carry the same weight in both hands;
before lifting weights, bend your knees and straighten your back;
choose an orthopedic mattress for sleeping;
give up bad habits and eating junk food.

Rehabilitation

After completion of treatment, it is important to go through the longest and most difficult process - rehabilitation. This is especially true of surgical intervention, the consequences of which remain for life. It is recommended to perform simple exercises daily to prevent the appearance of a new hernia. You also need to avoid being in drafts and at low temperatures. At this time, it is possible to visit sessions of physiotherapy and exercise therapy.

The entire recovery period can be divided into several stages. First, for about two weeks, you need to stop the pain, then you can try to move around the apartment, do slight back bends. Three months later, the stage of enhanced physical training begins, which lasts up to a year. Only a year after a serious exacerbation of the lumbar hernia, you can begin to lift light weights.

(Total 2,053, today 5)

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

An intervertebral hernia of the lumbar spine is one of the most dangerous diseases of the spine, which causes pain in the lower back, can radiate to the leg, over time hinders 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, play the role of shock absorbers during movement and protect the vertebrae from mechanical wear. Due to various negative factors, the disks can shift. This displacement or dislocation underlies such a pathology as an intervertebral hernia of the lumbar spine.

The main reason leading to the development of an intervertebral hernia in the lower back is osteochondrosis. In 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 the endplates.

The lumbar region accounts for most of the pressure of the body weight, the intervertebral disc in the lower back experiences a tremendous load when walking, lifting weights. In order to replace tissues damaged as a result of these loads with new ones, processes of renewal, or regeneration, are constantly taking place in it. With age or due to certain diseases, metabolic disorders, these regenerative processes weaken. A worn disk can no longer withstand the previous loads. After a provoking factor (trauma, sudden movement, lifting weights), the lumbar disc is “squeezed out” to the side or backwards.

Source moyaspina.ru

How does the disease manifest itself?

With a problem such as a hernia of the 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 department of the spine, therefore, in some cases, disc protrusion, and sometimes a full-fledged hernia, practically does not manifest itself in the early stages. However, there are some signs that you should pay attention to and consult a doctor without waiting for the development of full-fledged pain syndromes.

stiffness in the lower back that occurs during physical exertion, difficulty in independent movements;

change in skin temperature of one of the legs;

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

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

compensatory postures of the body that a person takes unconsciously.

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

Source: www.vashaspina.ru

Symptoms

It should be especially noted that with a hernia of the lumbar, there may be no symptoms at all, because they are caused not by the presence of a hernia, infringement of the disc and, especially, the spinal nerves, but by a spasm of the deep muscles of the spine and the accompanying swelling and inflammation.

There are many cases of severe pain in the lumbar region, in which hernias of the lumbosacral spine are not detected even on MRI. And vice versa, it happens that a patient has several herniated discs of the lumbar spine at once in the pictures, but he does not complain about pain.

But if, nevertheless, an intervertebral hernia of the lumbar spine makes itself felt, 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 a "skewed body"

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

Source bubnovsky-vip.ru

signs

Signs of a developing hernia:

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

sensory disturbances (paresthesia, hypesthesia), in the region of innervation of the corresponding nerve bundle;

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

weakening of reflexes up to their disappearance;

violation of the functions 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 methods (CT, MRI) or radiography;

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

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

Source spinazdorov.ru

Causes

The disease in many cases is a consequence of the 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. It is called degenerative disc change with age. The main cause that leads to the occurrence of an intervertebral hernia is osteochondrosis. The lumbar region accounts for most of the pressure of the entire body weight, and the intervertebral disc will experience a tremendous load while walking or lifting weights. In order to replace damaged tissues with new ones, processes of renewal and regeneration are constantly taking place. Through some diseases and with age, there is a weakening of metabolic processes. The previous load is not able to withstand the disk, which has become worn out. The lumbar disc will "squeeze out" backwards or to the sides after the provoking factor has been carried out.

Intervertebral hernia In addition, in addition to osteochondrosis and injuries, an intervertebral hernia of the lumbar spine may appear due to 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. Also, these are congenital disorders in the anatomical structure of the vertebrae. Displaced discs can be due to the abnormal structure of the pelvic bones. The pelvis tilts in any direction. Diseases of a specific nature that affect the spine, such as tumors, syphilis and tuberculosis, can lead to a hernia of the lumbar.

Pressure may build up 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 are reduced to received strong blows to the back, falling on the back, lifting weights from the ground, and sharp turns of the body to the sides.

Source doctorignatyev.com

Diagnostics

Diagnosis and differential diagnosis

The main diagnostic criteria for a herniated disc are:

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

sensory disorders in the neurometamer zone of the affected root;

motor disturbances in the muscles innervated by the affected root;

decrease or loss of reflexes;

the presence of relatively deep biomechanical disturbances in the compensation of a motor act;

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

data from an electroneurophysiological study (F-wave, H-reflex, somatosensory evoked potentials, transcranial magnetic stimulation), recording a violation of the conduction along the root, as well as the results of needle electromyography with an analysis of the action potentials of motor units, which make it possible to establish the presence of denervation changes in the muscles of the affected myotome.

Source lvrach.ru

Sequestered

Causes of a sequestered hernia

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

Sequestration of a hernia occurs in the following cases:

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

anatomical developmental defects;

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

excess weight, hypodynamia, malnutrition;

static, dynamic loads on the spine.

To provoke a deterioration in the patient's condition with the further development of a sequestered hernia of L4-L5, L5-S1 and other vertebrae of the lumbar spine can:

hypothermia;

weight lifting;

incorrect bending and squatting;

emotional stress.

Source spinazdorov.ru

Treatment of a sequestered disc herniation

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

the size of the hernia (anterior-posterior or sagittal size is taken into account): it is determined according to MRI or CT data;

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

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

the quality of human life, mainly refers 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 such factors:

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

almost always - in the case of a hernia sequester more than 18 mm (according to other sources - more than 10 mm) in the anterior-posterior size;

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, while it is clear that this happened in the same section of the spine.

Source gryzha.net

Treatment

Treatment of a herniated disc in the lumbar region.

In the acute phase of the disease, strict bed rest is prescribed. Drug therapy includes the appointment of drugs that relieve pain and signs of inflammation; circulatory aids and vitamins. After the acute manifestations subside, massage and physiotherapy exercises are prescribed to strengthen the lumbar muscles.

There are certain indications for surgical treatment. These include:

1. Ineffectiveness of conservative treatment and the 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 are very rare. A timely operation leads to a complete recovery or a significant improvement in the state of health in more than 70% of cases.

Source spinet.ru