Lumbar spine hernia
The content of the article:
- Causes and risk factors
- Stages
- Symptoms of a hernia of the lumbar spine
- Diagnostics
- Lumbar spine hernia treatment
- Possible complications of a hernia of the lumbar spine
- Forecast
- Prevention
A hernia of the lumbar spine is a protrusion of the central part of the intervertebral disc (nucleus pulposus) to the side and back outside the interval between two vertebrae. Most often, hernias are found in the lumbar spine, which experiences maximum stress while sitting, walking and lifting weights.
Signs of a hernia of the lumbar spine
Causes and risk factors
The cause of the appearance of hernias in the lumbar spine is seen in degenerative-dystrophic changes in the intervertebral discs. Gradual dehydration and thinning of the annulus fibrosus - the peripheral areas of the intervertebral disc contribute to the protrusion of the nucleus pulposus in vulnerable areas. Clinical manifestations of intervertebral hernias are usually associated with compression of the roots of the spinal nerves and blood vessels by the protruding edges of the intervertebral discs. In the most advanced cases, the spinal cord is also compressed.
Among the factors that have a negative impact on the trophism of intervertebral discs in the lumbar spine include:
- passive lifestyle;
- overweight;
- high growth (from 180 cm for men and from 170 cm for women);
- unbalanced mode of physical activity (long periods of immobility are replaced by intense loads);
- lumbar spine injuries;
- congenital dysplasia of the hip joint;
- posture disorders and persistent deformities of the spine;
- heavy physical labor associated with lifting weights and being in a bent position for a long time;
- professional sports;
- a sharp rise in heavy loads with insufficient preparation;
- improper performance of exercises with weights;
- smoking and alcohol abuse;
- endocrine disorders and metabolic pathologies;
- hereditary predisposition.
Obesity, sedentary lifestyle - predisposing factors for a hernia of the lumbar spine
Stages
The formation of a herniated intervertebral disc is preceded by a slight displacement of the nucleus pulposus to the periphery without damaging the annulus fibrosus. At this stage, the process of hernia formation can be stopped with the help of therapeutic exercises and other preventive measures, however, due to the absence of complaints, the initial stage of intervertebral disc degeneration is most often discovered by chance. Most patients see a doctor if they have a formed extrusion.
The progressive development of a hernia of the lumbar spine goes through four stages.
- Protrusion. Partial loss of elasticity of the annulus fibrosus with displacement of the nucleus pulposus by more than 2-3 mm. Clinical manifestations are usually absent.
- Extrusion - partial protrusion of the edges of the intervertebral disc with rupture of the annulus fibrosus in the thinnest area. From the side of protrusion, sensory-motor symptoms are observed.
- Intervertebral disc prolapse. When the hernia protrudes into the spinal canal, the protruding edges of the nucleus pulposus squeeze the vertebral bodies, blood vessels and peripheral nerve roots.
- Sequestration. The protruding part of the nucleus pulposus penetrates into the spinal canal, interfering with the normal blood supply to the spinal cord and squeezing soft tissues. Damage to nerve structures can lead to dysfunction of the pelvic organs and paralysis of the lower half of the body. Allergic conditions are common, caused by the reaction of the immune cells of the cerebrospinal fluid to foreign tissue of the intervertebral disc.
Stages of development of a hernia of the lumbar spine
Symptoms of a hernia of the lumbar spine
A pronounced clinical picture of a hernia of the lumbar spine manifests itself mainly at the stage of extrusion. The most common complaint is severe pain in the right or left leg, covering the inner side of the thigh and radiating to the buttock. Depending on the size and location of the hernia, soreness may descend from the thigh to the heel and the back of the foot. The pain is sharp, burning in nature and increases with coughing, sneezing, sitting for a long time, sudden movements, driving on uneven terrain, trying to bend forward or roll over. Often, a few weeks before the onset of pain, patients are worried about moderate discomfort in the lower back.
If the hernia touches the posterior roots of the spinal nerves, unilateral sensory disturbances in the leg, lower back or perineum are added to the painful sensations. Patients may complain of chills, burning, tingling, numbness, or "goose bumps" on the skin. Nerve conduction disorders against the background of weakening or compensatory muscle tension leads to a limitation of the mobility of the lumbar spine. Patients find it difficult to climb and descend stairs, squat, bounce and bend, keeping their legs straight; gait becomes wobbly and out of balance. Patients often take forced postures, stoop and transfer body weight to one limb; when looking at the bare back, protruding lumbar muscles are noticeable on one side.
The most common symptom of a lumbar hernia is acute leg pain radiating to the inner thigh and buttock.
Indirect symptoms of a hernia of the lumbar spine indicate insufficient blood supply and atrophic phenomena. One leg may be thinner, colder, or paler than the other; there is also a more sparse hairline on the body from the side of the hernia.
When the spinal cord is pinched, the pain spreads to both legs and is accompanied by a violation of the nervous regulation of the pelvic organs. Patients have frequent urge to urinate, urinary and fecal incontinence, diarrhea or constipation; women may be worried about gynecological disorders, and men - problems with potency.
Diagnostics
A preliminary diagnosis is made by a neuropathologist based on the history, clinical presentation and physical examination. To identify paresthesias and biomechanical disorders characteristic of spinal compression syndromes, standard diagnostic procedures have been developed:
- study of tendon reflexes of the lower extremities;
- functional test with raising a straightened leg;
- measurement of muscle strength and tone;
- determination of pain, temperature and vibration sensitivity of the legs, buttocks, perineum and lower abdomen.
Hernia of the lumbar spine on MRI
External manifestations of compression of the nerve roots and spinal cord make it possible to judge the size and location of the pathology, but do not have sufficient specificity for diagnosing a hernia of the lumbar spine. In a similar way, inflammation of the nerve roots or oncopathology can manifest itself, therefore the decisive word in the diagnosis of intervertebral hernias belongs to instrumental techniques for visualizing soft tissues - MRI and CT. If spinal cord injury is suspected, contrast myelography is done.
Lumbar spine hernia treatment
In the absence of complications, the treatment of small intervertebral hernias is reduced to pain relief and activation of blood circulation in the adjacent tissues. A short course of pain relievers and / or nonsteroidal anti-inflammatory drugs (NSAIDs) are usually sufficient to relieve acute pain. If the response to drug therapy is poor, X-ray-controlled blockade of the damaged nerve roots can be performed. To eliminate muscle spasms, muscle relaxants are used. The first 3-5 days from the beginning of the exacerbation, the patient must comply with bed rest with immobilization of the lower back. It is recommended to lie on your back with a soft roller under your lower back.
After the relief of pain, exercise therapy, kinesiotherapy and post-isometric relaxation are shown, which contribute to the restoration of soft tissue trophism and the formation of a muscular corset to support the spine. At first, all exercises for a hernia of the lumbar spine are performed while lying down or standing on all fours. You should start with lifting, abducting and bringing the legs bent at the knees, and after 3-4 weeks of regular exercise, you can exercise at the wall bar, with a ball or with gymnastic sticks. It is also recommended to use the pool.
With a low efficiency of conservative treatment and the appearance of complications, the question of surgical intervention is considered. The least traumatic method of surgical treatment of intervertebral hernias is microdiscectomy - removal of the nucleus pulposus through a puncture using a thin endoscopic manipulator and replacement of the destroyed tissues with a special substance. In some cases, the disc is removed completely, and an endoprosthesis is placed in its place.
Endoscopic microdiscectomy is the least traumatic method of surgical treatment of lumbar hernia
Physiotherapy and non-traditional methods of treatment can be used only in the absence of acute pain and signs of neurological deficit. A good effect is provided by electrophoresis, hirudotherapy, diadynamic therapy; osteopathy, massage and manual therapy can be indicated only in the presence of subluxation of the vertebral joints. The therapeutic effect of acupuncture, heat therapy and UHF therapy for herniated intervertebral discs has not been proven.
Possible complications of a hernia of the lumbar spine
The most frequent complications of hernias of the lumbar spine are progressive atrophy of the nerve roots, etc. cauda equina syndrome, which occurs when the spinal canal is completely blocked and several nerves are pinched at the same time. In such cases, emergency surgery is indicated to prevent paralysis within 24 hours of the onset of signs of severe neurological deficits, such as weakness of knee and foot movements, numbness of the legs and perineum, loss of control of urination and defecation.
Forecast
Uncomplicated lumbar hernias in 80% of cases disappear on their own due to dehydration of damaged tissues within 6–12 months. Adequate treatment, started at an early stage, greatly increases the likelihood of a complete cure.
With prolonged compression of the roots of the peripheral nerves and the spinal cord, irreversible damage to the nerve structures occurs with a prospective complete loss of mobility and the ability to self-service. For this reason, hernia of the lumbar spine, even with an asymptomatic course, requires constant medical supervision and control of the dynamics of the process.
Prevention
For the prevention of intervertebral hernias, it is important to maintain physical activity, monitor weight and posture, give up bad habits and seek medical help in a timely manner in case of a spinal injury. It is recommended to eat a sufficient amount of protein and B vitamins. When sedentary work, it is useful to take breaks for industrial gymnastics every 2-3 hours.
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
