Herniated disc L5-S1
The content of the article:
- What is an intervertebral hernia?
- The reasons
- Classification
- Hernia L 5 -S 1 of the lumbar spine: symptoms
- Diagnostics
- Complications and consequences
-
Treatment of herniated disc L 5 -S 1 of the lumbar spine
- Conservative therapy
- Exercises for hernia L 5 -S 1
- Surgery
- Prevention
- Video
Herniated disc L 5 -S 1 is the most common type of disc herniation of the lumbosacral spine (L - designation of lumbar vertebrae, S - sacral). The disease is widespread: the incidence rate is 300 cases for every 100 thousand adults. More often men are sick at the age of 30-50 years.
This segment of the spine has the greatest load, so hernias occur here most often
What is an intervertebral hernia?
Between the vertebral bodies there are thin intervertebral discs formed by cartilaginous tissue. They are highly resilient and elastic. Under the influence of various negative factors, the disc gradually loses its physiological properties, becomes denser and sequestered. The gelatinous core dries out, and the annulus fibrosus begins to protrude into the spinal canal. This stage of the disease is called protrusion. As the pathological process progresses further, the protrusion breaks and fragments of the nucleus fall out. In this case, they speak of disc prolapse.
The reasons
The main reason for the formation of a herniated intervertebral disc (IVD) is osteochondrosis of the spine.
Factors that increase the risk of the disease are:
- lumbarization or sacralization;
- congenital narrowness of the spinal canal;
- asymmetrical arrangement of intervertebral joints;
- reflected myofascial (muscle) pain;
- reflected pain in diseases of a number of internal organs (spondylogenic somatic)
- physical stress;
- exposure to vibration;
- sedentary lifestyle;
- obesity;
- smoking.
Classification
Depending on the location of the protrusion of the hernia of the lumbosacral spine, they are divided into several types:
| View | Description |
| Dorsal (posterior) | The protrusion of the disc occurs towards the passage of the spinal nerve roots |
| Paramedial | The bulge is located to the left or right of the substance of the spinal cord ("medial" means located in the center, paramedial - off-center) |
| Median (central) | The hernial protrusion is directed into the spinal canal along its midline |
| Circular | The nucleus is located around the entire circumference of the spinal canal |
Hernia L 5 -S 1 of the lumbar spine: symptoms
The clinical picture of each type of hernia L 5 -S 1 has its own characteristics:
| Hernia type | Symptoms |
| Posterior median |
· Violation of the motor function of the lower extremities; • back pain, which radiates along the outer surface of the thigh and lower leg; Dysfunction of the pelvic organs (dysuria, decreased potency) |
| Dorsal |
· Pain in the lumbar region, radiating to the gluteal muscles and hip joint, and with the progression of the disease - to the toes; Gait disturbances; Increased pain (lumbago) when sneezing or coughing; · Discomfort while sitting; Shin muscle atrophy |
| Paramedial |
This form of the disease is the most dangerous, since with it the hernial protrusion directly squeezes the spinal cord, and not its nerve roots. It is characterized by: Burning pain and numbness in the groin area; Difficulty in defecating and urinating with strong urge |
| Circular |
• back pain, persisting even at rest; Weakness in the lower extremities; Involuntary urination and defecation, paralysis of the legs (in advanced cases of the disease) |
The severity of the pain syndrome is the stronger, the larger the size of the hernial formation.
Diagnostics
If a person is suspected of having a herniated disc L 5 -S 1, an instrumental examination is shown, which may include the following diagnostic methods:
- X-ray of the lumbosacral spine;
- myelography;
- magnetic resonance imaging;
- high resolution computed tomography (MRI preferred);
- electromyography.
Differential diagnosis is carried out with the following diseases:
- ankylosing spondylitis;
- tuberculous spondylitis;
- primary or metastatic tumors of the spinal cord, spine;
- Leriche syndrome;
- spondylolisthesis;
- diabetic neuropathy;
- metabolic spondylopathy;
- poor circulation in the additional spinal artery.
Complications and consequences
The prognosis with timely treatment is favorable. With a significant hernial protrusion, the patient may develop cauda equina syndrome - compression of the bundle of spinal nerves that innervate the pelvic organs and lower extremities. Clinically manifested as follows:
- severe pain in the lumbar region that extends to one or both legs;
- paresthesia of the skin of the inner surface of the thighs, perineum (a symptom of the rider's trousers);
- incontinence of urine and feces;
- severe weakness of the muscles of the lower extremities;
- a sharp decrease up to the complete absence of knee and Achilles reflexes, tone of the external anal sphincter;
- impotence.
After surgical treatment, recovery or significant improvement in health is observed in 70-80% of patients. However, later there may be a relapse of the pathology in other segments of the spine.
Treatment of herniated disc L 5 -S 1 of the lumbar spine
Conservative therapy
Treatment of IVD hernias begins with a complex conservative therapy, which includes the following areas:
| Treatment method | Justification |
| Medication |
Patients can be assigned: · Non-steroidal anti-inflammatory drugs - suppress the activity of inflammation, relieve pain; · Muscle relaxants - eliminate increased muscle spasm; B vitamins - improve the conduction of an electrical impulse along the nerve fiber; · Chondroprotectors - improve metabolic processes in IVD tissue; Novocaine-glucocorticoid blockade - has a quick analgesic effect |
| Massage | Normalizes back muscle tone |
| Physiotherapy | Aimed at strengthening the muscles of the back and abdominal muscles, the formation of a muscular corset that supports the spine in the correct physiological position, relieves it of unnecessary stress |
| Physiotherapeutic methods (dynamic currents, electrophoresis, magnetotherapy) | Improve nerve conduction, reduce the severity of pain, normalize muscle tone |
| Additional methods (hirudotherapy, apitherapy, exercise equipment) | Improves metabolism in the affected discs, relieve them of unnecessary stress |
Small hernias (1-2 mm) respond well to conservative treatment.
Exercises for hernia L 5 -S 1
There are many different types of exercises recommended for patients with disc herniation. However, it is not recommended to use any of them without consulting your healthcare professional.
It is necessary to understand that kinesiotherapy and exercise therapy are serious methods of therapeutic influence, which have not only their own indications, but also contraindications.
Surgery
The indications for surgical treatment are:
- ineffectiveness of conservative therapy;
- development of cauda equina syndrome.
In most cases, operations to remove IVD hernias are performed laparoscopically. Through a puncture or small incision, the doctor vaporizes the damaged disc with laser radiation or destroys it chemically and then sucks it out under negative pressure.
It is extremely rare to resort to traditional open surgery, during which the affected disc is removed using conventional surgical instruments.
Attention! Photo of shocking content.
Click on the link to view.
Prevention
Prevention of the formation of IVD hernias is based on the correct lifestyle and includes:
- quitting smoking and alcohol abuse;
- the fight against excess weight;
- rational nutrition, balanced in the content of essential nutrients, vitamins and minerals;
- a sufficient level of physical activity.
It should be borne in mind that not all sports have a beneficial effect on the health of the spine. The most optimal are swimming, gymnastics, yoga, Pilates. But weightlifting leads to an overload of the spinal column, worsens metabolic processes in the discs, and provokes the development of osteochondrosis.
Video
We offer for viewing a video on the topic of the article.
Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
Found a mistake in the text? Select it and press Ctrl + Enter.
