Spinal hernia is a rapidly progressing disease, the initial symptoms of which can easily be overlooked. And hernia of the lumbar spine occurs much more frequently than others. Therefore, the symptoms of the disease should know everything in order to start treatment promptly.
Intervertebral hernia is a pathological deformation of the structure of the intervertebral disc, manifested by the release of its central core beyond the thinned fibrous ring. The released disk squeezes blood vessels and spinal roots, the level of this compression determines the clinical symptoms of the disease.
Normally, the discs perform very important functions – depreciation during movement and mobility of the spine.
The main cause of hernia are spinal diseases – osteochondrosis, curvature. Injuries and microtraumas can also cause disc integrity problems. Hard work, improper exercise techniques have a negative effect on the spine. Other causes are obesity, pregnancy, hereditary predisposition, work in a sitting position.
Types and stages of intervertebral hernia
- prolapse – up to 3 mm (pushing the fibrous ring);
- protrusion – up to 15 mm (the ring is already deformed, but its outer part is still capable of holding the core);
- extrusion – the core outside the vertebral bodies (complete damage to the ring);
- sequestration – the prolapse of the nucleus into the spinal canal and the compression of the spinal cord.
Stage of spinal hernia
The most common variant is lumbar hernia.
There are a number of negative factors that trigger the pathological thinning of the fibrous ring.
The power ring may be defective if you:
- spend most of your work and free time sitting;
- doing physical exercises incorrectly, especially with weighting;
- have excess weight and / or your height is more than 180 cm;
- history of spinal injuries (accident, falling);
- have a violation of posture;
- drink alcohol, smoke;
- lift heavily;
- predisposed along the hereditary line, have endocrine diseases;
- have diseases – tuberculosis, oncology, syphilitic infection.
Clinical symptoms are directly proportional to the level of spinal lesions.
The main manifestation is pain, and most often in the legs along the inner side, it is possible to radiate to the foot, to the lower back. Patients call their pain shooting or aching, giving away to any point of the body. Characterized by increased pain during physical activity, sneezing and coughing, and the horizontal position brings relief. Pain can be permanent or periodic. Over time, the pain can be joined by a violation of sensitivity of varying degrees – numbness of the foot, groin.
The sciatic nerves are often compressed, and then the disease is manifested by pain on the outside of the legs.
If the disease has reached the sequestration stage, limitation of movement in the lumbar region may be added to the patient’s complaints. Possible dysfunction of the pelvic organs – instability of the chair without other digestive disorders, frequent urge and urinary incontinence, gynecological diseases and diseases of the prostate, erectile dysfunction.
When examining a neurologist on the basis of symptoms, studying the sensitivity of the extremities and determining tendon reflexes, an approximate level of finding a hernia in the spine is assumed. This is necessary for further diagnostics – radiography and MRI (CT):
What is the essence of the method, the pros and cons
- myelogram – staining of the cerebrospinal fluid to study the patency of the canal and inspect the contours of the spinal cord ;;
- electromyography – used to detect compression or damage to the nerves;
- laboratory blood test – exclusion of infectious diseases, oncology, arthritis;
- cerebrospinal fluid puncture – detection of bleeding in the spinal canal, infection, inflammation;
- discography – method based on X-ray, the essence of which is to stain the intervertebral disc.
Treatment of intervertebral hernia lumbar
Methods of treating spinal hernia can be divided into two main groups – conservative and surgical treatment. It is important to start treatment in time, at the stage when it is possible to achieve a result non-invasive. To determine the treatment tactics, the disease is conditionally divided into several periods:
one Acute period. Severe pain, limited mobility, decreased sensitivity. For this period, apply only conservative methods of treatment.
2 Subacute period. After a few days, the pain syndrome is reduced, and mobility and sensitivity are partially restored.
2 Recovery period. After a few weeks, the pain is completely relieved, there is still a slight violation of sensitivity.
Medical conservative treatment
Medicines for internal use
Involves intramuscular and intravenous administration, as well as taking pills. The duration of treatment is several months. Aimed at reducing pain and preventing recurrence of the disease. The following medications are used:
- Nonsteroidal anti-inflammatory drugs – used to alleviate pain and reduce the inflammatory response of damaged tissues. The most commonly used diclofenac, ibuprofen, indomethacin, nimesulide, meloxicam, naproxen. The effect is explained by a decrease in histamine, thereby reducing puffiness and the development of recovery processes is suspended. Excellent analgesic effect. Frequent side effects with prolonged use – NSAID-associated gastritis, gastric ulcer. The course is not more than two weeks.
- With the ineffectiveness of nonsteroidal means are used steroid (hormonal) – dexamethasone, hydrocortisone, diprospan. They have an anti-inflammatory effect by reducing the function of leukocytes and macrophages. Reception courses, with a gradual decrease in dose. Cautious intake is caused by a variety of possible side effects – endocrine system diseases, metabolic disorders, pathology of other systems and organs.
- Muscle relaxants – mydocalm, xeomin, baclofen. Anesthetic effect by reducing muscle excitability. Muscles relax and blood flow improves, adequate tissue nutrition is restored.
- Diuretics – rarely used and only in the acute phase, to reduce the swelling of tissues. Because of the risk of hypotension and water-salt imbalance are prescribed with caution, not a long course.
- Chondroprotectors. Such drugs as teraflex, chondroxide, struktum, arthra, aflutop are used. Aimed at restoring the structure and functionality of intervertebral discs due to the reconstruction of cartilage tissue.
- Vitamins of group B for the regeneration of damaged and constricted nerve fibers, the normalization of the conduction of nerves. An example is milgamma, neurobion, neurovitan, neuromultivitis.
- Drug Synthetic – morphine, codeine. It is used only in extremely difficult cases when other methods of anesthesia are ineffective.
- Tricyclic antidepressants – have the effect of relaxing the muscles, calming effect. The most commonly used drug in this group is amitriptyline.
- Vitamin D and Calcium. Increase bone tissue metabolism, improving its remodeling, optimizes neuromuscular conductivity and contractility. Calcium D3-teva, calcium D3Nikomed.
- Pentoxifylline, improves microcirculation and nutrition of damaged tissues, restoring blood flow. By reducing the swelling of the roots of the spinal cord, symptoms associated with nerve compression regress.
- Alpha lipoic acid (Berlithion, Thiogamma) restores the cell membranes of nerve cells, improves microcirculation and blood flow in general.
The treatment process also includes Actovegin, which has an antihypoxic effect by improving blood circulation.
Drugs for external use
In the acute period of the disease, some preparations in the form of gels, ointments and patches are used to relieve pain. In addition to pain relief, the manifestation of the inflammatory reaction and the severity of discomfort are reduced. The following groups of drugs are used:
Nonsteroidal anti-inflammatory ointment: block inflammatory mediators, thereby reducing inflammation (hyperthermia, edema, tenderness).
Chondroprotective ointments, which improve cartilage regeneration processes.
Homeopathic Ointment – It is an ointment of components of natural origin, used to improve the metabolism of cartilage and its speedy recovery.
Combined ointments and gels – anti-inflammatory, analgesic effect.
Plasters – contain drugs of the above groups, with a similar symptomatic effect. Plasters are easy to use, highly effective due to a fixed dose of the drug, the duration of action.
The peculiarity of this group of methods is to increase the regenerative capacity of the organism. Used in combination with medical methods, enhancing their action. The treatment is aimed at rehabilitation after illness and prevention of complications. May be used at any stage of the disease.
- Electrotherapy – electrodes are mounted on the body, action by applying a small current.
- Electrophoresis, electrostimulation. The method may include the administration of drugs.
- Laser therapy – red and infrared radiation.
- Magnetic therapy – apparatus, with adjustable frequency of the magnetic field.
- Shock wave therapy – acoustic low-frequency pulses.
- Ozokeritotherapy or paraffin therapy. The introduction of drugs using ultrasound a few centimeters deep into the body.
- Extremely high frequency currents – the formation of resonance, promotes self-healing.
- Acupuncture – action on biological active points, administration of drugs is possible.
- Diadynamic currents – treatment by current.
Exercise with hernia in the lumbar spine is the most important pathogenetic component of treatment. With this method, you can forget about the recurrence of the disease for many years. Physical exercise must be performed correctly, metered, according to the recommendations of the doctor exercise therapy. If acute pain or sensory impairment occurs, stop exercising.
It is necessary to be engaged daily, excepting the sharp movements. The duration of classes is gradually increasing.
Traditional methods of treatment
Traditional medicine offers the following methods – making lotions and compresses from plants, turpentine bath, rubbing honey and horse fat and others. There is no evidence base for these methods, with their use allergic and other undesirable reactions are possible. It is more advisable to consult with a specialist and use proven medicines and devices in treatment.
Blockade is the administration of drugs (lidocaine, novocaine, corticosteroids, diprospan) between the processes of the vertebrae or at the exit of the spinal cord roots. The advantage of this method is to quickly and effectively relieve pain, reduce the inflammatory response in the lesion. The procedure is carried out by courses – about 5 introductions.
What is the essence of the blockade of the spine, read here.
The operation is indicated for patients with intractable pain, dysfunction of the pelvic organs, impaired sensitivity. Types of surgery:
- Microdiscectomy – extraction under the microscope of the ectopic part of the intervertebral disk.
- Laminectomy – rarely used, it removes part of the vertebra.
- Implantation – The method of treatment, the essence of the replacement of the deformed disk with its artificial counterpart.
- Endoscopic laser reduction of damaged disc.
Spinal health is a daily, every minute work. Do not forget to straighten your back, treat diseases in a timely manner, and follow a technique when playing sports. By following these recommendations, you will not have to look for ways to treat an intervertebral hernia.
Brattseva Ekaterina Valerievna Doctor of the highest category. Assistant professor. Candidate of Medical Sciences. Medical practice experience: 13 years.