Hernia of the lumbar spine: signs and treatment. Intervertebral hernia of the lumbosacral region

The annular space is the outer layer of the disc and its strongest ligament, which connects each vertebrae together. The mushy core of the disc serves as the main shock absorber.

A disc herniation occurs when the outer fibers of the intervertebral disc (in the annulus) are damaged and the soft inner material from the nucleus pulposus leaks out of its normal space.
This often compresses one of the nerve roots, causing pain, numbness and weakness in the skin and muscles that are in the area of ​​the compressed nerve root.
It usually occurs on one side of the spinal canal.

Typically, hernia is most common among young and middle-aged people. In older adults, degenerative changes that occur in the spine during aging reduce the risk of this disease.
Discs can rupture suddenly due to too much high pressure on the disk - for example, falling from the stairs.

Symptoms of a spinal hernia

1. starts in the back of the back
2. gives to the buttocks,
3. from the buttocks radiates to the thigh and leg,
4. the pain is localized on one side.

• , the pain is aggravated by movement, coughing, sneezing.
• Back muscle spasm
• The pain starts in the lower back or buttock and radiates down the leg,
• Muscle weakness in the legs,
• Numbness in the leg
• Decreased reflexes in the knee or ankle,
• Feature changes Bladder or intestines.

• difficulties with gait,
• coordination problems,
• loss of bowel or bladder control.

Symptoms depending on the vertebra

1. L3-4 - pain in the front of the thigh or calf, when bending and straightening the knee,
2. L4-5 - pain in the back of the leg and when bending,
3. L5-S1 - pain on the side of the leg, sole of the leg when bending

Diagnosis of vertebral hernia

• An X-ray of the spine is usually done after an injury to rule out a fracture or other consequences.
• A CT scan of the spine is valuable in assessing bone trauma - for example, the occurrence of cracks. However, this type of examination cannot always reliably show a herniated disc.
  A CT scan does not show torn ligaments or minor disc fractures.
• MRI of the spine is the best method for visualizing the spinal cord and nerve roots, intervertebral discs, ligaments, etc.
• An electrodiagnostic test is useful in assessing weakness in the muscles of the arms or legs and can show whether weakness in the limbs is due to an abnormality or compression of a nerve root or whether there is another cause.

Conservative treatment of lumbar intervertebral disc herniation

1. duration of symptoms
2. pain in the back,
3. nature of symptoms (numbness or weakness in the limbs),
4. age of the patient.

Lumbar intervertebral disc herniation - drug treatment

1. physiotherapy,
2. epidural injection,
3. blocker medications.

• if there is severe pain, and the patient cannot lead a normal life,
• if the patient experiences progressive neurological symptoms- increasing weakness and/or numbness of the legs.

• Providing pain relief, especially leg pain.
• Return the patient to his usual way of life.

Medicines for the treatment of lumbar intervertebral disc herniation

List of medications:

• Anti-inflammatory drugs such as ibuprofen reduce swelling and pain.
• Muscle relaxants such as cyclobenzaprine relieve muscle spasms. Side effects are drowsiness.
• Drugs that affect nerve damage include Pregabalin, Gabapentin, and Duloxetine. Side effects - dizziness, fatigue, drowsiness.
• Narcotics for severe pain - Oxycodone and Hydrocodone. Side effects include lethargy, nausea, and constipation.
• Epidural injections steroid drugs(introduced into the cavity only outside the bag cerebrospinal fluid) reduce swelling, inflammation and pain.
• Injections of cortisone directly into the area of ​​the spinal nerves.

Physical therapy and strengthening exercises are more effective treatments than bed rest.

Physical therapists can help you choose exercises designed to minimize pain. Often the following are also combined with exercises:

1. Hot or cold compresses.
2. Stretching.
3. Ultrasound.
4. Electrical stimulation.

Lumbar intervertebral disc herniation - surgical treatment

1. numbness or weakness
2. problems with movement (pain in the legs),
3. loss of bladder or bowel control.

Spinal surgery is a last resort option. Even after you have tried all the methods and there is no improvement, do not rush. Even after enlisting the doctor’s support for its necessity, do not rush. Surgery is not always a 100% guarantee of effective treatment.

Intervertebral hernia is very often localized in the lumbar spine. Women over 30 years of age are most susceptible to this disease. The cause of the pathology is a rupture of the disc, which occurs under the influence of heavy load or due to a violation of its nutrition. If left untreated, the disease can cause disability.

The lumbar region is the most mobile part of the spine. It bears the greatest weight load, as it is responsible for the center of balance of the body. This makes him the most vulnerable and traumatized. Lack of physical activity also negatively affects his condition and leads to disruption of his nutrition.

The lumbar region includes five vertebrae connected by discs. Thanks to them, the distribution of weight on the spine occurs. The structure of the discs is a semi-fluid core surrounded by a fibrous ring.

Heavy loads lead to damage to the fibrous ring and its rupture. As a result, the semi-liquid core enters the spinal canal, which is accompanied by pinching of the nerve endings. Microcracks form, which increase under load.

Symptoms of the disease

The manifestation of symptoms depends on the stage of the disease. Initially, a hernia does not cause much discomfort, and people rarely seek treatment. medical care, considering it a manifestation of ordinary fatigue and pain from physical activity. When the disease progresses, it is no longer possible to ignore it, since the symptoms are quite pronounced:

1. Discomfort when turning and bending.
2. Prolonged nagging pain in the lower back.
3. Severe pain radiating to the buttock.
4. Feeling of tingling and goosebumps.
5. Temporary numbness and burning of the legs.
6. Problems with the bowels and bladder.
7. Paralysis.

These symptoms appear during the development of the disease and often depend on the individual characteristics of the body. Some people may suffer for years from the initial form of the disease, which does not progress and is expressed only by dull aching pain. Some, for example, after injuries in car accidents, cannot get out of bed after just a few months.

Most often, hernias occur in the lumbosacral segment L5–S1 and lumbar segment L4–L5. If there is a hernia in the L4–L5 region, the following can be added to the main symptoms of the disease:

1. Difficulty moving thumb legs.
2. Weakening of the calf muscles, which causes foot drop.
3. Pain and numbness in the upper part of the foot.

With a hernia in the L5–S1 region, there is no possibility of moving and lifting the fingers, pain radiates to the foot or heel, and there is no Achilles reflex.

Based on the nature of the pain, it is enough for a specialist to simply establish their cause, but an accurate diagnosis is possible only after full examination, which includes radiography and computed tomography. These methods allow you to visualize the damaged disk.

Development of pain syndrome

At the initial stage, a person feels a dull aching pain. When lying down, the pain disappears, but intensifies when walking. The pain can subside and suddenly appear, and is present throughout the disease.

This is the initial stage, which can last several years. Most people ignore pain and refuse to visit a specialist, which leads to further development of the disease.

The pain begins to intensify, radiating to the hip and causing numbness in the limbs. A person feels discomfort when bending over, lifting their legs and putting pressure on the lower back. Shooting pains begin to appear, which can radiate to the leg, foot or buttock. Discomfort increases with any movement. Relief can only be felt in a lying position. When sitting or standing upright, the pain intensifies.

Important! Low back disease is characterized by shooting pains that can last up to several weeks.

It is difficult for a person to move, sit and stand - in any position he feels severe pain. But it’s not just the lower back that hurts – the pain radiates to the buttock, foot and ankle. In the absence of treatment, internal organs begin to suffer, and especially the genitourinary system. This happens due to poor circulation in the pelvis.

Compression of the nerve roots leads to:

1. Weakness in the muscles of the legs and thighs. It is difficult for the patient to move, jump and squat.
2. A crawling sensation in the legs.
3. My feet are constantly cold.
4. Sweating at the site of compression of the root.

If the hernia protrudes backwards, it can compress the spinal cord, leading to severe paralysis. There is a decrease in body temperature, swelling and dryness of the skin occur.

Causes of pathology

There are many reasons for this pathology. It can be a consequence of osteochondrosis or scoliosis, and also develop after a serious injury. Hernias occur due to a lack of nutrition of the intervertebral discs, which is produced through the back muscles. If you refuse physical activity, the muscles atrophy, which leads to a lack of nutrition of the discs and an increased risk of injury.

Factors provoking the disease:

1. Lifting weights.
2. Great physical activity.
3. Falls.
4. Excess weight.
5. Passive lifestyle.
6. Incorrect posture.
7. Infections and viruses.
8. Natural aging.
9. Smoking.

Important! The disease most often affects women, and with a height above 170 cm, the risk of a hernia is much higher.

Hernias occur due to sudden lifting of weight. If more at a young age Men do not notice aching pain after hard physical work, but after a while it becomes difficult for them to straighten up when lifting loads. Women who carry heavy bags in one hand are also susceptible to this disease, and efforts should be made to distribute the weight evenly.

Very often, hernias occur after a fall or injury, but in most cases they do not appear immediately, but after a couple of years. A person begins to feel a sharp pain that radiates to one of the legs, and can rarely determine what caused this illness. The location of the pain depends on the location of the spinal injury.

Important! If several parts of the spine are damaged, both the right and left legs will hurt.

Excess weight puts a lot of stress on the spine. Obesity is often accompanied by diseases of the spine and vascular system, which increases the risk of hernia formation. Smoking also has a negative effect, which affects blood circulation. Some infectious and inflammatory diseases can also lead to the development of hernias due to destruction of the lining of the intervertebral discs.

Consequences

The disease is dangerous for both sexes. Women experience gynecological diseases due to poor circulation in the reproductive organs. Problems with urination and menstruation may occur. All pelvic organs suffer, but this does not appear immediately.

Important! In men, if left untreated, impotence and other diseases of the genitourinary system may develop.

Very often this disease is accompanied by intestinal disorders. Frequent constipation and pain radiating to anus, and bloating. Because of high pressure curvature of the spine develops in the affected area. It becomes impossible to bend your back - hunchback and stoop may appear. Due to compression of the nerve roots, there may be a decrease in sensitivity in the affected areas. A person's legs, fingers, or hips begin to go numb.

Sometimes the disease is accompanied by the appearance of lumbago, which causes severe pain. At this time, the person cannot get out of bed, and with any change of position, the pain increases. The most dangerous consequence is limited mobility and paralysis. Due to severe pain, a person can neither lie nor sit. The knee reflex may disappear and the mobility of the thumb may be impaired. If treatment is ignored, disability may occur.

Video - Lumbar intervertebral hernia symptoms, exercises

Effective treatments

At the moment, there are two ways to treat pathology - surgical and conservative methods. As practice shows, most patients do not require surgery, but conservative treatment methods are sufficient. They are aimed at eliminating pain in the lumbar region. In acute cases of the disease, you need to stay in bed and take painkillers.

Usually withdrawal pain syndrome happens within a month. After this, the disease is not yet completely cured and it is necessary to strengthen the damaged discs. For the next month, under no circumstances should you lift weights or engage in heavy physical work.

Most popular drugs

After pain relief, great importance is given to therapeutic exercises and special physical exercises. The patient is faced with the task of strengthening the ligamentous apparatus and muscles. A person needs to independently monitor the health of his back and stop lifting weights.

Performing an operation is a last resort method, which is resorted to if it fails. long time reduce pain or the hernia caused a malfunction of the internal organs. To remove a hernia, a minimally invasive operation is performed, which takes place under general anesthesia and lasts about half an hour. Thanks to the use of micro-instruments, the tissues surrounding the spine are practically not injured, and the body’s recovery occurs in the shortest possible time.

Carrying out surgery only in 10% of cases does not bring the desired result and after some time new hernias may appear. This happens due to a weakened muscle corset. In this case, it is necessary to pay great importance therapeutic exercises and strengthen your back. After this, it is recommended to repeat the operation again, which usually has a positive result.

Prevention

First of all, you need to give up a sedentary lifestyle. It is recommended to take walks and exercises for the spine every day. Swimming and yoga are beneficial. After prolonged work in a sitting position, it is necessary to do physical exercises.

Before lifting weights, you need to bend your knees and keep your back straight. Under no circumstances should you make too sharp turns or movements. Regular heavy physical activity, accompanied by lifting heavy loads, is a risk of developing spinal pathologies at an early age.

Important! Exercise should be moderate if a person wants to maintain his health.

Proper nutrition plays a huge role. You should avoid fried, smoked and fatty foods. They lead not only to excess weight, but also to problems of the vascular system. Eating foods rich in protein will be beneficial. You need to choose lean varieties of meat, and use stewing, steaming or boiling as heat treatment. The diet must include vegetables and fruits.

It is one of the most common dysfunctions of the musculoskeletal system.

This problem occurs when the core pulp of the spinal disc is actually squeezed out of the annulus fibrosus.

Such a violation leads to the fact that the tissues of the damaged intervertebral disc begin to put pressure on the nerve roots spinal column.

Because of this, the patient experiences severe pain. Because the this type The disease is very common, it is worth knowing the main symptoms and being ready to start treatment in a timely manner, because a herniated disc can lead to a limitation (or even complete deprivation) of the patient’s ability to work.

What is a lumbar disc herniation?

Intervertebral hernia lumbar spine - This is a disease in which the central part of the vertebral disc is squeezed out of the intervertebral space by two adjacent vertebrae.

If the problem is not diagnosed at this stage, then further deformation will lead to aggravation of the situation and the release of the core of the intervertebral disc to the outside(the integrity of the capsule is compromised). This process will mark the formation of a hernia.

Classification of the disease

The hernia has a fairly extensive number of “variations”; only a specialist can give a competent and complete description of your specific case after conducting research.

It is well known that a hernia of the lumbar spine is divided into into two main types:

1. L4-L5- V medical practice Each part of the spinal column is designated by a specific letter Latin alphabet(the letter L was highlighted for the spine). This type of disease means that compression of the nerve roots occurs in the space between the 4th and 5th vertebrae in the lumbar spine;
2. L5-S1- with this type of disease, pinching of nerve endings occurs between the 5th vertebra in the lumbar region and 1st vertebra in the sacral region of the spinal column.

In addition to this classification, we can give a division by the nature of the tissues that protrude beyond the spinal column. From this point of view, there are:

• Pulpous hernia- a hernia of this type consists of a nucleus pulposus, which is “squeezed out” due to a violation of the integrity of the fibrous ring. This type occurs in the vast majority of patients (approximately 86% of cases);
• Cartilaginous hernia- a hernia of this type consists of fragments of deformed intervertebral cartilage. This type occurs after many years of inflammation, which is often caused by various spinal injuries. This type occurs in approximately 13% of cases;
• Bone hernia- this type can be called a hernia only conditionally, since the main reason for its appearance is osteochondrosis (or other long-term degenerative-dystrophic process), which leads to the growth bone tissue and the appearance of osteophytes (bone “spikes”). Osteophytes compress the nerve endings of the spinal cord and narrow its canal, which leads to the formation of a hernia. Typically, this type of disease occurs in only 1% of patients, most of whom are elderly.

Prevalence and significance of the disease

Intervertebral hernia of the lumbar spine occupies one of the leading places in terms of prevalence among all diseases of the musculoskeletal system.

This means that this type of spinal dysfunction requires not only timely diagnosis and treatment, but also prevention, since otherwise (in advanced stages) the development of the disease can threaten to deprive the patient of his ability to work (from partial limitation to complete deprivation).

That's why Don't be careless about this problem, at the first symptoms you should contact a specialist and begin treatment.

Causes of the disease

The list of risk factors is quite extensive when it comes to the formation of a hernia in the lumbar region. A specialist will tell you the specific reason (or a combination of them) after conducting a series of examinations.

The most common causes of intervertebral herniation are:

All this is just a small part of the factors that can lead to changes in the tissues of the intervertebral discs and displacement of the nucleus.

Symptoms and methods of diagnosing the disease

Usually the first signs that signal us about the presence of disorders in the lumbar spine are ignored. Aching, Blunt pain in this area it is simply “experienced” by the patient. Therefore on early stages degenerative changes usually go unnoticed and develop into full-blown intervertebral hernia.

When a hernia has already formed, new symptoms appear, which are already difficult not to notice or endure. This is first of all:

• pain in the lumbar region when lifting the leg;
• amyotrophy;
• frequent “lumbago” (sharp pain in the lower back resulting from awkward movement, heavy lifting, hypothermia, etc.);
• numbness;
• the appearance of radiculitis;
• reduction or limitation of reflex activity;
• dryness skin in the damaged area.

Such symptoms quickly become entrenched in the patient’s life, without giving him the slightest rest. Therefore, at the first manifestations of the disease, it is worth getting diagnosed.

In order to find a disc that has undergone deformation, a specialist will carry out a number of measures, including:

• X-ray diagnostics(in two projections);
• MRI(will help clarify the details of the development of the disease);
• tendon reflex test(this simple method will allow you to find out how badly the nerve endings are damaged, as well as identify the level of sensitivity lower limbs and their mobility).

Only after the main diagnostic measures, the specialist will prescribe you a treatment course that will help you cope with the developed disease.

Video: "What is a vertebral hernia?"

Treatment of lumbar disc herniation

When the main list of diagnostic steps is left behind, it’s time to start treatment.

But you need to take into account that the course of the disease is divided into three main periods:

Dividing into periods allows specialists to apply the correct strategy for treating a hernia.

Treatment of the disease in the acute period

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Next fact

This period is the most painful and dangerous in terms of physical activity.. Here you need to be very careful not to harm yourself even more. The main thing at this stage is a minimum of movements and bed rest.

You should lie on a small pillow and place a small cushion under your back. Correct position on your back should be given to you by a doctor, since he is the one who knows which specific discs are damaged.

At this stage, the disease is usually used painkillers. It is preferable that they be introduced into the body by injection (at the initial stage).

Diclofenac, Movalis, Rofica are widely used. When the pain subsides a little, you can replace the injections with tablet forms of the same drugs or add others (Ibuprofen, Meloxicam, etc.);

At this stage of the disease, any manipulations of this kind are prohibited.

During the acute period of the disease, you can only move your toes. Other movements are prohibited.

Treatment of the disease in the subacute period

When the crisis has passed a little, you can move on to the next treatment course. Subacute period requires the patient to remain in semi-bed rest and carefully monitoring your well-being. Any movements that cause pain should be avoided.

Drug treatment

In the subacute period, the same types of medications are used as in the acute period. The only difference is that the dose of drugs is reduced or the form of administration is changed (for example, injections are replaced with tablets). All changes should be made only by your attending physician based on the symptoms you are experiencing at this stage.

The following procedures have a very good effect on the body::

• thermal procedures;
• acupressure;
• acupuncture (here you need to be careful and find a competent specialist);
• underwater massage.

Used as an additional means hirudotherapy(treatment with medicinal leeches). But here it is important to find a competent specialist and consult with your doctor.

This technique is insidious and can cause complications. The same applies to manual therapy and massage courses - both methods require a competent approach and professional execution.

Physiotherapy

Physical therapy in the subacute period should be performed with great caution. All exercises should not be painful. If you feel pain, immediately stop doing the exercises and go to rest.

Exercises to perform:

Important! Be sure to consult with your physician before starting exercise.

1. Lie on your back, straighten your arms and legs. Relax all your muscles. Slowly raise your arms up, stretch slightly, and then slowly lower your arms;
2. Lie on your back, relax your body. Bend left leg in the knee, then swing it slightly left and right, relax the muscles. Repeat with the opposite leg;
3. Lie on your stomach, place your hands under your chin. Bend your knees and alternately touch your heels to your buttocks. After this, relax all your muscles and rest a little;
4. Lie on your back. Start bending and unbending your leg at the knee and moving it in different directions;
5. Take the same starting position as in exercise 4. Bend your leg at the knee and pull it towards your chest with your hands. Repeat for each leg;

Treatment during the recovery period

At this stage, medication and physiotherapeutic treatment remain the same.. The difference is that the dose of medication is significantly reduced; some groups of drugs may even be excluded from the course by your attending physician. Physiotherapeutic procedures remain the same.

Physiotherapy

The recovery period is characterized by an expansion of the volume of physical activity. It is important to consult with your doctor when expanding your gymnastics complex.

Exercises to perform:

1. Starting position - lying on your stomach. The doctor bends and straightens the leg at the hip, fixing it for 6-8 seconds in an extended state;
2. Starting position - lying on your stomach. Alternately move the left one, then right leg from the body;
3. Starting position - lying on your stomach. Raise your straightened leg at a slight angle (over time, the lifting angle needs to be increased);
4. Starting position: lying on your side on the healthy side. Bend the affected leg at the knee and move it away from the body;

Surgical intervention

The decision to remove a hernia is made by your doctor based on certain symptoms that may seriously threaten your health.

Among these symptoms is a narrowing of the spinal canal (despite all medical complex), numbness of the limbs, severe weakness in the muscles, dysfunction of the pelvic organs, compression of the “cauda equina” (the end of the spinal cord, consisting of a bundle of nerve endings, pinching or irritation of which causes unbearable pain in the perineum and lower extremities).

Surgical intervention in in this case represents the release of the spinal cord from the hernia compressing it.

There are several ways to do this:

• Endoscopy;
• Endoprosthetics;
• Percutaneous discectomy;

Each of these methods is used under certain characteristic conditions of the disease.

Folk recipes

In order to make conservative treatment even more effective, you can use some traditional methods that can help relieve unwanted symptoms of the disease.

Disease prevention and recovery prognosis

In order to prevent the formation of a hernia, First of all, you need to monitor your own weight. In most cases, it is excess weight that causes the formation of a hernia, since our spine cannot withstand such a strong load.

Besides watch your diet and lifestyle, eliminate smoking, minimize alcohol consumption, eliminate strong physical activity, play sports (running, swimming, walking, cycling), choose a hard mattress for sleeping, establish a daily routine.

If you notice the first symptoms of the disease, consult a doctor immediately. He will prescribe you a treatment course that may avoid surgery or serious complications. Timely treatment will help defeat the disease in the early stages.

Conclusion

Since intervertebral hernia of the lumbar spine is one of the most common diseases of the musculoskeletal system these days, you should know as much as possible about it, to prevent the disease in time or choose the right treatment:

• The initial symptoms of the disease may be completely ignored by the patient, since they are not pronounced. More severe symptoms will become when the hernia is finally formed. At the first signs, we advise you to contact a specialist and undergo an examination;
• In medical practice, lumbar intervertebral hernia has three main periods of the disease: acute, subacute and recovery. For each of these periods there is a complex therapeutic measures, therefore, only your attending physician can prescribe certain procedures based on the symptoms that are bothering you at a particular moment;
• The acute period of the disease is characterized by severe pain and limitation of motor functions., so you need to stay in bed and give your body maximum rest until the crisis is over;
• Besides conservative methods some treatments can be used folk recipes . But it is worth consulting with your doctor, and also taking into account individual characteristics your body before using any unconventional methods;
• It is much easier to prevent any disease than to treat it later, so check out the preventive techniques that will help you avoid the appearance of a hernia.

Rheumatologist, Orthopedist

Engaged in the management of traumatological and orthopedic patients, reading radiographs and interpreting test results, as well as conducting conservative and operational methods treatment.

The spine constantly experiences increased loads and performs supporting and motor functions. With moderate and severe degenerative-dystrophic changes, intervertebral hernias develop.

A dangerous manifestation often affects the lumbar region, which bears the greatest load. Timely diagnosis and treatment of a hernia during periods of exacerbation and remission prevents complications and relieves excruciating pain in the lower back, buttocks, and lower extremities.

general information

A herniated disc occurs when there is irrational stress on the spine. Influenced negative factors There is a rupture of the cartilage and fibrous ring that form the spinal disc. The shock-absorbing function is disrupted, part of the disc protrudes, the nerve roots feel strong pressure, painful sensations appear.

Hernia in the lumbar region is one of the most dangerous diseases spine, accompanied by painful symptoms. Over time, a pronounced pain syndrome spreads to the buttocks, “radiates” to the legs, and hinders movement. The lack of timely, competent treatment sometimes causes disability in patients of different ages.

Causes

Damage to the intervertebral discs occurs with prolonged exposure to negative factors:

• heavy physical activity;
• prolonged standing or sitting position throughout the day;
• no load, low physical activity provokes the development of osteochondrosis, which often causes complications in the form of intervertebral hernias;
• spinal injuries, especially with DBT;
• classes certain types sports with high load on the spine and joints: weightlifting, gymnastics;
• congenital pathologies;
• , undertreated in childhood;
• scoliosis (severe stages are often accompanied by the appearance of a hernia);
• lifting (especially jerking), moving heavy loads.

Many patients do not realize how much many habits affect the condition of the intervertebral discs. Smoking, frequent consumption of strong coffee, poor, irregular nutrition disrupt the supply of oxygen and nutrients to the tissues of the intervertebral discs. The regular effect of negative factors enhances the aging of the vertebrae, accelerates degenerative-dystrophic changes, provokes protrusions and intervertebral hernias.

Signs and symptoms

Negative manifestations depend on the area of ​​localization of the hernia. Most often, ruptured intervertebral discs are observed in the lumbar region with characteristic symptoms.

You can suspect dangerous changes in the spine if the following signs appear:

• feeling of numbness in the toes when sitting for a long time;
• when the sacral vertebrae are affected, the pain descends to the knee area, spreads along the inner thigh to the ankle, and the legs become numb;
• the lower limbs often feel “wobbly” and heavy, moving at a fast pace provokes pain;
• unpleasant feeling in the legs (“goose bumps”);
• stiffness in the lumbar region, pain when bending over, walking for a long time or staying in one place;
• painful sensations in the buttocks, upper legs.

Important! With an exacerbation, the negative symptoms intensify, “shots” in the leg area occur more often, the pain syndrome is more pronounced, and it is difficult for the patient without painkillers. Often a person does not realize that sharp pain in the legs is directly related to the poor condition of the lumbar vertebrae.

Treatment with conservative methods

How to treat intervertebral hernia? Conservative therapy is recommended for mild and middle stage intervertebral hernia of the lumbar spine. It is important not to miss the moment when only a complex operation will help relieve suffering. A timely visit to a doctor will help stop the progression of negative changes in the vertebrae and prevent the development of a lumbar hernia.

Goals of conservative therapy:

• reduce painful symptoms;
• improve mobility of the lumbar region;
• eliminate vertebral subluxations that accelerate the formation of a hernia;
• strengthen the muscle corset;
• balance the articular surfaces.

Treatment options for intervertebral hernia without surgery:

• vertical or horizontal traction. When the spine is stretched, the load on the nerve roots weakens, blood vessels, spinal cord. After the procedures, muscle tension decreases, tissue swelling in the area around the spinal column decreases;
• manual therapy. Modern technique reduces pain, eliminates muscle spasms, normalizes the mobility of the damaged area. The success of treatment depends on qualifications chiropractor: incorrect actions often cause dangerous complications, including disability;
• acupuncture. Effective method effects on biologically active zones reduce pain, relieve tissue swelling, relax muscles, normalize the regeneration process;
• physiotherapy. Special exercises are indispensable for various stages spinal lesions. Physical exercise indispensable for the formation of the correct muscle corset. Elastic, strong muscles and ligaments support the spine and prevent excessive pressure on intervertebral discs. The doctor selects a complex of exercise therapy for the development of intervertebral hernia individually, taking into account the severity of the pathology, general condition patient;
• drug therapy. Drugs various groups provide high quality treatment for osteochondrosis, spondylosis, pinched nerve roots. During remission, the doctor prescribes chondroprotectors that stop the destruction cartilage tissue, muscle relaxants to relieve muscle spasms. B vitamins (injections) are useful for restoring neurohumoral regulation. Ascorbic acid and tocopherol strengthen blood vessels and soft tissues.

Additional measures during exacerbation

If pain increases, pronounced muscle spasms, or noticeable limitation of mobility, the doctor will definitely prescribe non-steroidal anti-inflammatory compounds. Often it is inflammatory process exacerbates negative symptoms.

For acute pain, you will have to give even more injections strong drugs– glucocorticosteroids. The pain syndrome is reduced, but hormonal compounds cannot be used for a long time: the risk of side effects is high.

Treatment of intervertebral hernia during an exacerbation is carried out with the use of muscle relaxants. Medicines in the form of an injection solution are also more effective. The drug Mydocalm has a pronounced positive effect, not as many side effects as other central muscle relaxants.

Important! Often, during an exacerbation, patients use traditional recipes. Popular remedies: compress of Kalanchoe leaves (cabbage, aloe), rubbing of vodka and garlic, massage of the affected area with tincture of propolis and comfrey root. Homemade compositions, when used correctly, reduce pain and facilitate movement in the affected area. It is important to get advice from your doctor to find out whether you can use a tincture or homemade ointment.

Surgery

Not always conservative therapy provides positive impact on a weakened spine. Often the reason for the low effectiveness of treatment is the patient’s delay in seeking medical help.

Sometimes the patient does not follow the recommendations, violates the treatment regimen, or skips procedures. In some cases the patient does not special exercises. Doctors confirm the effectiveness of various therapeutic and health-improving techniques and strongly advise not to give up movement if you have diseases of the spine. After consultation with a specialist, you can conduct classes using the Olga Yanchuk go method.

Surgical methods treatment:

• microdiscectomy. Hernia removal is performed using endoscopy. Minimal incision, low risk of complications, recovery period is reduced to three months. There are restrictions on the size of the hernia;
• laser vaporization. The laser action dries out the core of the intervertebral disc. After drying, the formation decreases, returns to its place, and the protrusion disappears;
• discectomy. After removal of the damaged disc, the vertebrae form a fixed joint. Doctors often replace a destroyed disc with an artificial formation that retains the properties of a natural element. Prosthetics show good results for restoring the functionality of the damaged part of the spinal column. Rehabilitation is long - up to six months. It is mandatory to take NSAIDs, therapeutic exercises, massage, and physiotherapy.

The development of intervertebral hernia is not the first stage various pathologies spine. Moderate and severe degrees of osteochondrosis, scoliosis, and spondyloarthrosis do not develop in one day. The main reason is an incorrect lifestyle, uneven loads on the spine. Getting rid of negative factors or reducing their influence means reducing the risk of dangerous complication– intervertebral hernia.

How to proceed:

• refuse to carry loads that are inappropriate for your age and build, do not lift heavy objects, especially jerkily;
• forget about sitting at the computer for a long time without a break. A five-minute warm-up every hour is a simple way to reduce the risk of developing osteochondrosis and complications due to pressure on the vertebrae and discs;
• strengthen the muscle frame in the back area. Regular physical activity, a set of exercises lasting 15–30 minutes, will provide a sufficient level of stress on the joints and muscle tissue. Classes take place 3–4 times a week;
• Healthy food. Vegetables must be on the menu vegetable oils, fermented milk products, dishes with gelatin, non-acidic fruits, salmon, cereals, rabbit, turkey, chicken. For cartilage and joint tissue there is little benefit from large quantity oily fish, meat, offal, strong coffee, alcohol. Bread, chocolate, sweets, excess salt and sugar, soda with synthetic fillers, and animal fats also worsen the condition of the musculoskeletal system.

There are a lot on the Internet useful videos instructions from detailed description exercise therapy complexes. The trainer explains the nuances of each exercise and shows an example. It is easy to choose gymnastics for any level of training. Pay attention to effective, simple complexes for strengthening the muscles of the musculoskeletal corset.

Complex No. 1:

Complex No. 2:

Treatment of lumbar intervertebral hernia during periods of exacerbation and remission requires strict adherence to the rules and recommendations specified by the doctor in the treatment regimen. Patient discipline, giving up bad habits, dosed exercise combined with medication, physical therapy will reduce negative manifestations in the lumbar spine.

A lumbar intervertebral hernia is a protrusion of the central part of the disc between two vertebrae beyond the space between them. Most often, such a diverticulum is directed towards the spinal canal and compresses the roots of the spinal nerves, but it can also impair blood circulation in the spinal cord itself. The disease causes symptoms in the perineum, legs and pelvic organs.

Treatment is most often conservative, consisting of a complex: medications, exercise therapy, physiotherapy, blockades also help well. Surgical removal of a damaged section of a disk or its entirety is rarely used, as it carries quite high risks. Basically, this happens due to the fault of the person himself: either when he comes in late, considering what is happening with his back and legs as “manifestations of age” or “trifle”, or in case of neglect of the rules of treatment, which differs in different periods diseases.

What is a hernia

The spinal column is a collection of 34 vertebrae connected in pairs by intervertebral discs. It is not straight: from the head to the coccyx it makes several alternating bends: a convex bend is forward - in the cervical region, a convex bend is backward - in the thoracic region, then in the lumbar region a forward bend occurs again, and then the sacrum and the coccyx bend back. All this is necessary to provide the shock absorption associated with walking on two legs. But this structure also causes the center of gravity to be concentrated in the lumbosacral region. Nature provided for this by making the lumbar vertebrae the thickest and strongest, and the sacral vertebrae completely soldered together.

All vertebrae, except the sacrococcygeal ones, have a special structure. They consist of a cylindrical body, which bears the main load, and processes that provide us with the ability to bend in different directions, turn, and twist. The two parts are connected by two semicircular arches on both sides so that there is a gap in the middle. This is the spinal canal, and it is intended for the spinal cord. The latter is a kind of “checkpoint” of the second rank (after the brain), carrying impulses from the brain to the organs and vice versa.

The peripheral endings of the myelon (the so-called spinal cord) are the spinal nerves that emerge from it as part of the roots. The anterior roots are motor. They carry commands to the muscles. The dorsal roots are sensitive and, on the contrary, are directed from the organs to the brain. At first, the roots are not divided into anterior-posterior, but only into right-left, emerging laterally from the spinal cord through the hole between the processes of the upper and lower vertebrae. Having passed the bone ring, separation immediately occurs.

Compression of the spinal cord itself by a hernia leads to disruption of a large number of functions at once: internal organs stop working, sensitivity and movement of the limbs are impaired (in the case of the lumbosacral region - only the lower ones). If the disc begins to protrude towards one of the roots, this will cause sensory-motor disturbances in only one limb.

Now about the hernia itself. This is a protrusion of the central part of the disc, which normally has the consistency of a very dense and springy jelly. This structure is called the nucleus pulposus and is the main shock-absorbing element and can move inside the disc and spread out depending on the direction and force of the load on nearby vertebrae. At the same time, normally the surrounding tissues do not change their structure and do not suffer, remaining in density the same as the tendon of any muscle. As soon as thinning of the fibers occurs in the peripheral part of the disc (fibrous ring), the nucleus pulposus, under the influence of load, rushes into weakness. While it has not yet gone beyond the disc, it is not yet a hernia, and the situation can still be corrected.

In fact, the annulus fibrosus is not easy to destroy, because it consists of fibers lying in several layers and intersecting in three planes. But this is possible either due to a single action of high pressure on the nucleus pulposus, or when replacing the usual disc tissue with scar tissue. The latter occurs when the disk power supply fails. How does he eat?

The disc is somewhat like a sponge: it receives oxygen and nutrients during the movement of the spine, when filling of the cartilage occurs. When it, again under the influence of movements, contracts, waste substances are forced out of it. At the same time, in order for the trophism of the intervertebral disc to be complete, the movements must be performed in full, including bending, flexion and extension. A sharp increase in the type and amplitude of motor activity after a period of prolonged low mobility of the spinal column, oddly enough, does not increase the nutrition of the cartilage, but significantly increases the risk of rupture of the fibrous ring.

A little about myths

The diagnosis of “intervertebral hernia of the lumbosacral spine” is made very often when magnetic resonance imaging reveals any protrusion of the disc in any direction. But with age, the nutrition of the disc deteriorates, and the appearance of an intervertebral “diverticulum” of 2-3 mm, without nagging pain in the leg, coldness of its skin can be considered a variant of the norm. Even multiple 2-3 mm protrusions in a person 40 years of age and older are not a diagnosis and do not require special treatment. But, being a borderline state (between normal and pathological), they signal to a person that it is time for him to pay attention to his spine, because so much depends on it. To do this, you do not need to take any pills, but increasing the range of movements of your back, as well as periodically, in courses, classic massage- exactly what is needed. Once again: no medications and, especially, no operations!

How does a hernia form?

The nucleus pulposus does not immediately appear outside the disc. Before this there are several stages:

1. Disc protrusion. The annulus fibrosus slightly loses its elasticity, as a result the nucleus pulposus shifts to one side. If at this stage the correct alternation of rest and therapeutic exercises is ensured, the process of intervertebral herniation can be stopped.
2. Incomplete prolapse of a section of the disc. The fibrous ring is destroyed in one area, and material from the nucleus pulposus rushes there.
3. Complete disc prolapse. The nucleus extends beyond the fibrous ring, compressing the vertebral bodies and structures of the nervous system.
4. Disc sequestration. This is the name of the condition when a section of the “freed” nucleus pulposus enters the spinal canal. It causes allergic reactions, since the substance is foreign to this location. Sequestration is also dangerous due to disruption of the blood supply to the spinal cord and its nerves. May cause paralysis of the lower extremities and pelvic organs.

Causes of hernia formation

More often vertebral hernia lumbar spine appear with osteochondrosis, when, due to age-related changes, the trophism of the fibrous ring worsens, it becomes drier and brittle. However, osteochondrosis and intervertebral hernia are different diseases.

A hernia can also be caused by:

• spinal injuries: road accidents, blows, falls on the back;
• lifting a heavy load with an incorrect back position: a person lifted a load from a standing position, bending at the waist, when it was necessary to sit down and, standing up, keep the lower back straight. You can “get” a hernia by lifting weights, bending over and turning to the side;
• scoliosis or lordosis of the thoracic or lumbar region, when the load on certain vertebrae of the lower back increases significantly;
• dysplasia hip joint on one or both sides. Degenerative changes in intervertebral discs the lower back develops due to increased and improperly distributed load on them;
• diseases of the spine: tuberculosis, tumors, ;
• due to illness endocrine organs, chronic processes accompanied by intoxication or due to genetic diseases.

Risk factors

The more items in the list below that fit “your” case, the greater the chance of developing lumbosacral hernias. This:

• Large weight, that is, a large load on the spine, the lumbar region of which suffers the most.
• Male gender: Men are more likely to suffer from intervertebral herniation.
• Ages 30-50: The years of “maximum strength” and confidence in one’s experience are where the heaviest weights are most likely to be lifted and people are most likely to have accidents or work-related injuries.
• Physical inactivity: sedentary work, “transfer” from the computer to the steering wheel and back. If the volume of movements performed by the spine is insufficient, the nutrition of its structures, especially the intervertebral discs, deteriorates. Moreover, both in the car and at the workplace, the back most often takes a bent position.
• Heavy physical labor. In this case, the intervertebral discs do not have time to receive the necessary substances, constantly receiving stress. Monotonous movements are especially dangerous.
• Smoking. In this case, the saturation of the blood, and then the intervertebral discs, with oxygen is disrupted.
• Frequent “minor” spinal injuries, each of which disrupts the nutrition of the disc. These injuries do not make themselves felt immediately, but after several years (up to 5).

How to recognize a lumbosacral hernia

It cannot be said that the symptoms of a hernia of the lumbosacral spine are very specific, and a diagnosis can be made from them: in exactly the same way, a tumor that has developed in this section and compresses the roots can manifest itself, or local inflammation spine. Although the latter diseases are quite rare, they cannot be discounted. Therefore, after reading the symptoms, do not rush to make this diagnosis.

The symptoms that manifest a hernia of the lumbar spine can be divided into several groups:

Diagnostics

Before deciding what treatment a lumbar hernia will receive in this particular case, you need to make a diagnosis. This is done using instrumental methods(about them below), but the neurologist will be able to indicate which area of ​​the spine needs to be examined by a radiologist or magnetic resonance imaging specialist only after:

• determination of reflexes from the tendons located on the legs;
• straight leg raise test;
• studies of temperature, pain and vibration sensitivity over the entire surface of the legs, in the buttocks, perineum, and lower abdomen.

With an intervertebral hernia of the lumbosacral region, sensory disorders will be noted in the area innervated by the affected root, the neurologist will determine the loss or decrease of tendon reflexes, and identify deep disturbances in the biomechanics of movements of the affected limbs.

In addition to the preliminary determination of the affected segment, such an examination helps to determine the degree of innervation disturbance, treatment tactics, and after it begins, to see the dynamics of the changes occurring.

The diagnosis itself is made on the basis of one of the tomographs - magnetic resonance or computer multislice - of the lumbosacral region (see). If spinal cord damage is indicated, the diagnosis can be supplemented with contrast myelography - a study in which an X-ray contrast agent will be injected into the spinal canal through a lumbar puncture. Next, an x-ray is performed, which shows how the contrast agent passes through the spinal canal and whether it accumulates at some level (the latter means that the spinal cord is compressed and, most likely, in order to prevent its death, an operation to remove the hernia is needed lumbar region).

Treatment of the disease

Therapy for a hernia of the lumbosacral region is aimed at eliminating pain, relieving spasm of the “squeezed” (to maintain relative balance) spinal muscles, and eliminating ischemia of the spinal cord and its roots. In addition, it is necessary to create a strong muscle corset, balance the joints between the processes of the vertebrae, and eliminate their subluxations, since these phenomena can provoke the growth of an intervertebral hernia.

How is a lumbar hernia treated? There are 2 main treatment methods used here: conservative (pills, injections, exercises) and surgical. The course of the disease is divided into three periods:

1. Spicy. Here you feel pain, stiffness of movement, and loss of sensation in your legs.
2. Subacute. Starts after 3-5 days. Characterized by a decrease in pain severity. Sensitivity is restored slightly.
3. Restorative. It begins at 3-4 weeks of treatment and is not always present. It is characterized by the absence of pain and minor sensory disturbances.

This separation is necessary in order to apply the correct treatment tactics. So, in the acute period, only conservative therapy is carried out; subacute and recovery may be the time when surgical treatment is involved.

Let's consider the conservative treatment plan by period.

Acute period

Here you need bed rest with minimal physical activity in the lumbar region. Lie on a small pillow, on your back, with a small cotton-gauze roll under your back. The doctor must adjust the position of the back, depending on which area of ​​the disc there is a rupture, so that it can heal. If there is neuralgia sciatic nerve, legs need to be bent at the knee and hip joints.

Medicines

• Painkillers are also anti-inflammatory. Usually - in the form of injections for the first 3-5 days: "", "Rofika", "Movalis". Then you should gradually replace the injections with similar tablets (“Meloxicam” and others).
• Blockade with novocaine with the addition of an anti-inflammatory hormone. This remedy can relieve pain immediately – and for 2-3 weeks. During a course, you can apply 3-4 such blockades, only in different places near the affected disc.
• Centrally acting muscle relaxants: "", "Sirdalud". They are needed in order to relieve painful muscle spasms on one side of the spinal column.
• Vitamins B1, B6, B12 in a complex (preparations "", "Neurovitan", "Neurobeks"). They have some relaxing effect, restore nerve tissue, and improve the conduction of impulses in the pinched fiber.

Manual therapy

Not applicable during this period.

Exercise therapy

You can only move your toes, nothing more.

Subacute period

Mode - semi-bed. In this case, you need to pay attention to how you feel and not perform movements that cause pain.

Drug therapy

Painkillers-anti-inflammatory drugs in tablets, muscle relaxants in tablets and vitamins are the basis of drug therapy.

Physiotherapy

The following methods are used:

• thermal procedures;
• acupressure;
• acupuncture;
• diadynamic therapy;
• underwater massage.

Additional Methods

The use of medicinal leeches – hirudotherapy – has proven itself well. These worms, injecting special substances into the tissue, help resolve fragments of the protruding disc. Leeches help 7 out of 10 patients. Course – 10-12 procedures, with an interval of 3-4 days.

Massage. This method should be used with extreme caution, only if there is no pain in the leg.

Manual therapy. The method is most effective when there is not only a hernia, but also displacement of the intervertebral joints. Optimally 2-7 sessions with a chiropractor in combination with following method– post-isometric relaxation.

Postisometric relaxation. These are classes with a specialist. They consist of a combination of 5-10 seconds of isometric work (tension and tension, but without pain) of the muscles and the same time of passive stretching of the muscle.

Exercise therapy

Exercises for lumbar hernia in the subacute period should be performed from the starting positions:

• lying on your back;
• On knees;
• on the stomach.

They should not be accompanied by pain. When it appears, stop the exercise and rest. It is optimal to use an unloading corset during exercise therapy.

1. Lying on your back, arms and legs straight. All muscles are relaxed. Raise your arms slowly up, stretch, lower your arms.
2. Lying on your back. The body is relaxed. Bend your right leg at the knee, swing it left and right, relax the muscles. Repeat the same with your left leg.
3. Starting position – on the stomach, hands under the chin. Bend your knees, touch your buttocks with your heels, relax your muscles, and rest.
4. Standing with your face or side to the gymnastic wall, raise your legs one by one, swing back and forth and to the sides.
5. Lying on your back. Bend and straighten your leg at the knee, move it to the sides.
6. I.p. - Same. Using your hands, alternately pull your right and left leg bent at the knee to your chest.
7. Standing, feet shoulder-width apart. Slowly turn your torso to the right and left, while simultaneously spreading your arms to the sides. When raising your arms, inhale; when lowering, exhale.
8. Standing, feet shoulder-width apart, knees bent, heels close to the buttocks, spread shoulder-width apart. Inhale. As you exhale, alternately tilt your knees inward without moving your pelvis.

This - approximate complex exercises. The doctor and exercise therapy instructor who deal specifically with your case should tell you more.

Recovery period

Volume drug treatment at this stage much less: painkillers are not used (can only be used novocaine blockades, if pain reappears while performing some exercise), the course of vitamins and muscle relaxants has already ended or is ending by this time.

Physiotherapy and methods alternative treatment(hirudotherapy, acupuncture) in the recovery period do not differ from what it was in the subacute period.

Exercise therapy

The scope of exercises for a lumbar hernia is expanding, because you need to strengthen the muscular corset of the back and lower extremities, as well as recreate the correct posture:

1. Lying on your stomach. The doctor bends and straightens the leg at the hip, holding it for 5-7 seconds in an extended position.
2. Lying on your stomach. Bring and abduct the right and left legs alternately from the body.
3. Lying on your stomach, lift your straight leg first by a small angle, then by a larger angle.
4. Lying on your side on the side of your healthy leg, move your affected leg away from your body, bent at the knee.
5. Standing with your back to the gymnastic wall, straighten your back and slightly move your pelvis back so that the shoulder blades of the buttocks calf muscles and the heels touched the wall. Raising yourself on your toes, stand there for 3-5 seconds, then return to the starting position.
6. Walking with a bag filled with clean sand weighing up to 500 grams on your head. Step over imaginary obstacles without bending your back. Also, without slouching, squat down, trying not to drop the bag.

Exercises with gymnastic apparatuses: balls, dumbbells, gymnastic sticks are also carried out under the supervision of an instructor. It is also necessary to perform half-hangs (on the horizontal bar, but without releasing your legs) and, gradually, hangs. It is also important to do exercises on stairs.

Surgical treatment

The decision that removal of a lumbar hernia is necessary is made based on the following indications:

• if there is a narrowing of the spinal canal;
• despite treatment, numbness of the limbs, muscle weakness increases, or dysfunction of the pelvic organs has also appeared;
• when conservative therapy was effective for a short time, then deterioration occurred in the same part of the spine;
• a portion of the hernia has fallen into the spinal canal;
• compression of the cauda equina occurred (the end of the spinal cord in the form of a bundle of nerves, irritation or pinching of which causes terrible pain in the perineum and legs).

The essence of the operation is to free the spinal cord or roots from the hernia compressing them. This can be done as follows:

1. Endoscopically. 3 micro-incisions are made in the spine area; a camera is inserted into one, which will transmit the image to the monitor; through the other 2, surgeons work with micro-instruments. The hernial protrusion and residual elements of the nucleus pulposus are removed.
2. Percutaneous discectomy. This intervention involves removing its destroyed core through a puncture in the intervertebral disc. Next, it is replaced with a special substance, which, to purchase required properties, should cool down.
3. Disc endoprosthetics. The damaged disc is removed and an implant is placed in its place.
4. . The nucleus pulposus is most saturated with water. This is what the laser is designed for, which has the property of evaporating moisture-containing structures.

Prevention

To prevent the development of hernias in the intervertebral discs in the lumbosacral regions, you need to:

• control your own weight, preventing it from increasing significantly;
• eat well;
• no smoking;
• limit physical activity;
• exclude physical inactivity;
• sleep on a hard mattress, in a supine position.

If you start treatment with a neurologist on time, you can return to your usual activities within 5 days after pain relief. By following the above rules and performing the recommended exercises, there is a very high probability that you will no longer remember the symptoms of an intervertebral hernia.