This rupture of the spinal disc (fibrous ring, cartilage), as a result of uneven load on the vertebrae.
Intervertebral hernia of the lumbar spine is one of the most dangerous diseases of the spine, which causes back pain, can give up in the leg, restricts movement over time, interferes with normal movement, and leads to disability of the patient.
The lumbar spine consists of 5 vertebrae. Between the bodies of these vertebrae are cartilaginous pads, or intervertebral discs. These discs serve 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 discs may shift. This displacement or dislocation forms the basis of such a pathology as 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 the symptoms of osteochondrosis. It should be recalled that the intervertebral disc in the lower back, as in the other part of the spine, consists of an internal liquid pulposal nucleus surrounded by a fibrous capsule, and bounded above and below by the endplates.
The lumbar region accounts for most of the pressure with the body mass, the intervertebral disc in the lower back experiences a tremendous load when walking, lifting weights. In order to replace the tissues damaged by these loads with new ones, the processes of renewal or regeneration are constantly taking place in it. With age or due to some diseases, metabolic disorders, these regenerative processes weaken. A worn disc can no longer withstand the same load. After the provoking factor (trauma, sudden movement, weight lifting), the lumbar disc is “squeezed out” to the side or backwards.
How does the disease manifest itself?
With a problem such as a hernia of the sacral spine, the symptoms may not immediately appear. The specificity of this department suggests that there is a certain “reserve” that is necessary to ensure the mobility of this section of the spine, therefore, in some cases, the disc protrusion, and sometimes a full hernia, practically does not manifest itself in the early stages. However, there are some signs that should be paid attention to and consult a doctor without waiting for the development of full-fledged pain syndromes.
stiffness arising during physical exertion in the lower back, difficulty in independent movements;
changing the temperature of the skin of one of the legs;
impaired muscle tone of one of the legs, often with progressive atrophy or malnutrition;
the appearance of neurological symptoms (burning, numbness, lumbago and sciatica that occur on the affected side);
compensating body poses that a person takes unconsciously.
Any of the symptoms described above is worthy of attention even in cases where it has just begun to manifest itself. Sciatica and lumbago, which are essentially pain syndromes, have paroxysmal character and low intensity in the early stages of the disease, but without the necessary treatment, the pain will increase.
Removal of spinal hernia by reference.
It should be especially noted that with hernia of the lumbar spine, the symptoms may be absent altogether, since they are not caused by the presence of a hernia, pinching of the disc and, especially, spinal nerves, but by spasms of the deep muscles of the spine and the accompanying edema and inflammation.
There are a lot of 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 hernias of the lumbar discs in the pictures, and he does not complain of pain.
But if you still know about the intervertebral hernia of the lumbar spine, the symptoms will be as follows:
Pain in the lumbar region, often extending along the sciatic nerve, extending to the leg
Sometimes numbness or burning of the lower limbs
Muscle weakness, decreased tendon reflexes
In some cases, herniation 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, a herniated disc of the lumbar spine can lead to dysfunction of the bladder and bowel, as well as paralysis of the lower extremities.
Signs of a developing hernia:
vertebral syndrome, manifested by lower back pain, deformity of the lumbar region (antalgic scoliosis), tension of paravertebral muscles;
sensitive disorders (paresthesia, hypesthesia), in the area of innervation of the corresponding nerve bundle;
hypokinesia (low mobility) of muscles innervated by the affected nerve;
weakening of reflexes until they disappear;
dysfunction of the pelvic organs (urinary incontinence and / or feces, reduced 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-neuro-physiological 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 intervertebral hernia of the lumbar spine.
The disease in many cases is the result of natural aging of the spine. Young people and children have their own water concentration in the spine. When the body gets old, the discs start to dry. They become weaker, thin, and the distance between the vertebrae also decreases. This process is considered normal. It carries the name of a degenerative disc change with age. The main reason that causes the appearance of an intervertebral hernia is osteochondrosis. The lumbar region accounts for most of the pressure of the entire body mass, and the intervertebral disk will experience tremendous stress while walking or lifting weights. In order to replace damaged tissue with new ones, renewal and regeneration processes are constantly taking place. Through some diseases and with age, the metabolic processes weaken. Previous loads are not able to withstand a disc that has become worn. The lumbar disc will be “squeezed out” posteriorly or sideways after the provoking factor.
Intervertebral herniaIn addition, in addition to osteochondrosis and injuries, intervertebral hernia of the lumbar spine may appear due to acquired and congenital structural disorders in the spinal column. We are talking about the most different types of deformities in the spine, like lordosis, scoliosis, and other pathologies. It is also a congenital disorder in the anatomical structure of the vertebrae. Discs may move due to the abnormal structure of the pelvic bones. The pelvis is cut in any direction. Ailments of a specific nature that affect the spine, such as tumors, syphilis and tuberculosis, can lead to hernia of the lumbar spine.
Inside the intervertebral disc may increase pressure. 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 inner and intervertebral area, are reduced to the received strong blows to the back, falling on the back, lifting weights from the ground, sharp body turns to the sides.
Diagnostics and differential diagnostics
The main diagnostic criteria for a herniated disc are:
the presence of vertebral syndrome, manifested by pain, restriction of mobility and deformities (antalgic scoliosis) in the affected spine; tonic tension of the paravertebral muscles;
sensitive disorders in the area of the neurometamer of the affected root;
movement disorders in the muscles innervated by the affected root;
decrease or loss of reflexes;
the presence of relatively profound biomechanical violations of motor act compensation;
data of computed tomography (CT), magnetic resonance imaging (MRI) or X-ray examination, verifying the pathology of the intervertebral disc, spinal canal and intervertebral holes;
electroneurophysiological data (F-wave, H-reflex, somatosensory evoked potentials, transcranial magnetic stimulation) recording the conduction disturbance along the spine, as well as the results of needle electromyography with an analysis of the action potentials of the motor units, allowing to establish the presence of denervation changes in the muscles of the affected myotome.
Causes of sequestered hernia
Due to the lack of its own blood vessels, the disk receives nutrients by diffusion (fusion of substances). The main role in this play adjacent muscle structure. During muscle tension (excessive physical stress), the mechanism of dystrophic changes of the injured part starts. The fibrous ring loses water and vitamins, its height decreases, cracks appear.
Hernia sequestration occurs in the following cases:
spinal osteochondrosis (hereditary predisposition, history of perennial disease, frequent exacerbations, ineffective treatment, and so on);
anatomical developmental defects;
microelementoses (lack or excess of the content of trace elements and minerals in the human body);
excess weight, lack of exercise, unhealthy diet;
static, dynamic loads on the spine.
To provoke a deterioration in the patient’s condition with the further development of the sequestered hernia L4-L5, L5-S1 and other vertebrae of the lumbar spine can:
wrong bends and squats;
Treatment of sequestered disc herniation
The choice of conservative or operative therapy depends on several factors:
the size of the hernia (anterior-posterior or sagittal size is taken into account): it is determined by MRI or CT data;
diameter of the spinal canal: if there is stenosis, then, most likely, conservative treatment, started already at the time of hernia sequestration, will be ineffective;
the location of the hernia relative to the spinal cord and roots;
quality of human life, mainly refers to the severity of pain, numbness of the limbs.
Modern medicine is trying 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 limbs continues to progress, muscle weakness, pelvic organ function is impaired, or pain increases;
almost always – in the case of a herniated sequestra more than 18 mm (according to other data – more than 10 mm) in the anteroposterior size;
in any case, if there is a narrowing of the spinal canal and the formation of an intervertebral hernia has occurred;
if the treatment had an effect on a short period of time, then the condition worsened again, while it is clear that this happened in the same section of the spine.
Treatment of herniated intervertebral disc localized in the lumbar spine.
In the acute phase of the disease, strict bed rest is prescribed. Drug therapy involves prescribing pain relievers and signs of inflammation; means of improving blood circulation and vitamins. After the subsidence of the acute manifestations, massage and physical therapy classes are prescribed to strengthen the lumbar muscles.
For surgical treatment there are certain indications. These include:
1. Inefficiency of conservative treatment and the presence of signs of root compression
2. Compression of horsetail roots.
The essence of the operation is to decompress and release the spinal roots from compression.
The prognosis for surgical treatment is favorable, complications occur very rarely. A timely performed operation leads to a complete recovery or a significant improvement in health in more than 70% of cases.