A lumbar intervertebral hernia is one of the most severe complications of osteochondrosis. Most often it is diagnosed in men 30-50 years old. Pathology is manifested by pain in the lower back when tilting and turning the body, limiting mobility. Treatment of a hernia of the lumbar spine is predominantly conservative. Surgery is performed in extreme cases due to the high likelihood of recurrence.
The degenerative disc is a protrusion of the intervertebral disc between the vertebral bodies outside the spinal canal. In the absence of treatment, its size slowly but steadily increases. This causes the compression of blood vessels and nerve roots, as well as circulatory disorders in the spinal cord. Most often, the protrusion is detected at the level of the last 2 lumbar vertebrae or between the last lumbar vertebra and the first sacral vertebra.
What are the types of pathology
Herniated discs are classified according to their size. The bulging of the disc is considered small up to 4 mm, medium – up to 7 mm. A large hernia reaches 9 mm in size, and a huge one – 12 mm. In vertebrology and neurology, the following types of lumbar disc bulging are also distinguished:
- foraminal ones are formed at the sites of the exit of the nerve roots, provoking muscle weakness of the legs on the side of the lesion;
- the dorsal ones are displaced towards the spinal canal, predisposing to complete paralysis of both legs;
- ventral ones are formed in the upper segments of the lumbar spine and are asymptomatic.
Median disc swelling is the most uncommon pathology. The hernia is located on the back of the spine on the left or right. Over time, there is a rupture of the posterior longitudinal ligament, compression of the spinal cord and the development of cauda equina syndrome
The causes of hernia
Frequent causes of hernial protrusion are low physical activity and increased stress on the lumbar spine. It is predisposed to lordosis, scoliosis, prolonged stay in one position of the body, lifting weights. Also, factors provoking the formation of a hernia are:
- previous injuries – compression fractures, vertebral subluxations, severe bruises;
- misalignment of the pelvis, including as a result of dysplasia of the hip joints ;
- endocrine pathologies, for example, diabetes mellitus, hyper- and hypothyroidism;
- spondyloarthrosis , ankylosing spondylitis, and Calve’s disease.
The risk group includes smokers, people who abuse alcohol, or whose body does not have enough micronutrients and vitamins.
All symptoms of degenerative disc appear gradually. At first, there are mild dull, aching, pressing pains after prolonged standing or physical exertion. They become weaker or disappear completely when lying down. As the protrusion grows larger, the pains become constant – they are felt both when moving and at rest.
From the side of the lesion, muscle tone increases. A person tries to eliminate pain by tilting the body in the opposite direction. His posture and gait change. Soon the clinic is replenished with lumbago – acute, sudden, shooting pain in the lower back.
When is it recommended to see a doctor
A hernia is a consequence of untreated lumbar osteochondrosis. Therefore, it is advisable to consult a doctor at the first signs of this degenerative-dystrophic pathology. The leading symptoms are crunching, crackling when bending and turning, pain, limitation of mobility. Neurologists, vertebrologists, orthopedists are involved in the treatment of osteochondrosis and intervertebral hernia.
Other diseases of the spine (spondyloarthrosis, tumors, spondylitis ) can be masked under the symptoms of lumbar hernia. Therefore, based on the patient’s complaints, the results of an external examination, only a preliminary diagnosis can be made.
To confirm it, CT or MRI is performed. With their help, it is possible to establish the degree of compression of the spinal cord when the disc is bulging. This parameter is crucial in determining therapeutic tactics.
Radiography in the diagnosis of a hernia is not very informative, since soft tissue structures are poorly visualized on the images obtained. However, it is prescribed to patients to assess the condition of the lumbar vertebrae.
In the treatment of hernial protrusions, mainly conservative methods are used. Only an integrated approach is practiced with the simultaneous use of drugs, physiotherapy, massage sessions, exercise therapy. In the acute or subacute period, the wearing of semi-rigid elastic corsets that stabilize the lumbar structures is indicated. At the stage of remission, warming belts-bandages made of sheep and camel wool are used.
Medical treatment of a lumbar hernia is aimed at improving the patient’s well-being, reducing its size, and preventing relapse. Non -steroidal anti-inflammatory drugs in the form of injections, tablets, gels help to eliminate pain. These are Diclofenac, Meloxicam, Ibuprofen, Nimesulide, Ketorolac. If they are ineffective, blockades with glucocorticosteroids (Triamcinolone, Diprospan, Dexamethasone) and anesthetics (Lidocaine, Novocaine) are used.
Also, the treatment regimens include means to improve blood circulation – Pentoxifylline, Xanthinol nicotinate. The use of chondroprotective ( Teraflex, Struktum, Artra) prevents the enlargement of the hernial protrusion.
Daily physical therapy exercises help to reduce the size of the hernia by strengthening the muscular corset of the lower back, improving posture, and correctly redistributing loads to all parts of the spine. Patients are advised to shallow bends, side turns, lunges, imitation of cycling while lying and sitting. All movements should be smooth, with low amplitude.
Electrophoresis and ultraphonophoresis are most in demand in the treatment of hernial protrusions. During exacerbations, procedures are carried out with glucocorticosteroids, analgesics, anesthetics. During the period of remission, B vitamins, chondroprotectors, and solutions of calcium salts are used.
Applications with paraffin, ozokerite, therapeutic mud, laser therapy , UHF therapy, magnetotherapy , and ultraviolet irradiation are also used.
To improve tropism, eliminate muscle spasms, restore innervation, patients are recommended 15-20 massage sessions. During the procedure, kneading, rubbing, vibration are performed. The masseur treats only tense muscles without touching the damaged vertebral discs. In addition to classical massage, vacuum ( cupping ), point (acupuncture), segmental massage are used in the treatment of lumbar hernias.
Sessions of acupuncture can be carried out in the subacute period to relieve pain, eliminate stiffness. Thin, short steel or silver needles are inserted into biologically active points. They are located along the spinal column, on the arms, legs, shoulders. After installing the needles, impulses are sent to the central nervous system, and in response, the process of producing substances with anesthetic, anti-edematous action is started. The production of endorphins also increases, which improves the patient’s psycho-emotional state.
After placing 3-7 leeches on the lower back, these annelids bite through the skin, injecting saliva into the blood. It contains over 100 different biologically active substances with analgesic, blood thinning, anti-inflammatory effects. After saturation, the leeches fall off and are immediately disposed of. In total, about 10 sessions are prescribed with a break of 2-3 days.
In sanatoriums, mud, mineral waters, radon and hydrogen sulfide baths are used to treat lumbar hernias. Physiotherapy and massage procedures, physical education and gymnastics are required. Even a short stay in a sanatorium has a general health-improving effect due to walks on the seaside or in woodlands.
Patient nutritional features
Nutritionists recommend that patients with lumbar hernia completely exclude foods high in fat and simple carbohydrates from their diet . These are semi-finished products, smoked meats, mayonnaise, sausages and confectionery. Instead, you need to eat fresh vegetables and fruits, low-fat cheeses and cottage cheese. Every day you need to drink at least 2.5 liters of liquid – water, chamomile tea, rosehip infusion, sweet and sour compotes, jelly, juices, fruit drinks.
Folk unconventional methods
The use of compresses, oil and alcohol rubbing, homemade ointments can not reduce the size of the hernia, eliminate the compression of the nerve roots and blood vessels. Therefore, the use of folk remedies is advisable only after the main conservative or surgical treatment.
If a hernia is detected at the initial stages of its formation, the strength of the still slightly damaged disc is increased by intradiscal electrothermal therapy or puncture laser vaporization.
Small hernias up to 0.6 mm are removed using endoscopic microdiscectomy. Large protrusions are excised during discectomy or microdiscectomy. To stabilize the spine, a B-Twin implant is placed in the lumbar spine.
Possible complications of a hernia of the lumbar spine
The most common complication of an intervertebral hernia is a radicular syndrome. It is manifested by acute back pain, muscle weakness and hypotension, decreased sensitivity. Less commonly diagnosed discogenic myelopathy, which causes narrowing of the spinal canal and compression of the spinal substance.
The main prevention of lumbar hernia is to see a doctor when the first symptoms of osteochondrosis appear. To avoid its enlargement, painful relapses will allow regular exercise therapy, the exclusion of increased loads on the lower back, and hypothermia.