How to treat a lumbar spinal hernia

Spinal diseases

According to statistics, about 80% of people experience back pain at least once in their lives. Most of them are not associated with diseases of the spine, but are a consequence of muscle spasms and overexertion. In this case, no treatment is required and the pain subsides on its own. But this happens in 8-9 patients out of 10. What should the rest of us do if the spine hurts? And how to recognize that the problem is really serious and the body needs help? To answer these questions, you need to know the main symptoms of spinal diseases.

The lower back is a special risk area

A healthy spine has a curved shape: it should not be absolutely straight, as many people believe. Physiological curves in the neck and lower back are especially noticeable - these areas are especially vulnerable due to their mobility. The thoracic region is firmly fixed by the ribs, so it is much less likely to undergo dystrophic changes. Osteochondrosis, hernias and other pathologies most often develop in the lower back, since this section is the most loaded - it accounts for the weight of the entire upper body. The risk of various injuries increases with congenital and acquired deformities, injuries, and excess weight.

What is a lumbar disc herniation

The lumbar region includes 5 vertebrae, between which are intervertebral discs. Each of them is a fibrocartilaginous formation, which consists of a fibrous ring and a nucleus pulposus.

The spinal discs perform a shock-absorbing function, that is, they soften and absorb stress on the back when moving. Thanks to it, optimal flexibility of the spinal system is maintained.

If the discs are frequently exposed to negative influences, then gradually the annulus fibrosus may become less strong. Also, due to injuries, cracks appear and other problems arise. As a result, the pulp, located in the inner part, protrudes beyond the fiber. It is this condition that is commonly called lumbar hernia.

When this pathology appears, unpleasant symptoms are observed, mobility decreases and the quality of life deteriorates. It is recommended to understand how to treat a herniated disc and use the recommendations.

Ankylosing spondylitis (ankylosing spondylitis)

This is a systemic inflammatory disease that affects all spinal structures. Inflammation begins in the sacroiliac joints, then spreads higher, developing in an ascending line. Over time, calcium deposits appear in the ligaments, which leads to a decrease in mobility and flexibility. Without treatment, ankylosing spondylitis progresses, and gradually the vertebrae fuse together: ankylosis occurs. The first symptoms are dull pain and stiffness in the lower back, which intensifies in the morning and decreases after physical activity and a hot shower. During the day, the pain is stronger at rest; when a person moves, it subsides. In the later stages, posture noticeably deteriorates.

Spinal cord tumor - symptoms and treatment

Tumors are caused by changes in genes that control how cells function, especially their growth and division. Genetic disorders can be inherited from parents or occur during life due to errors in cell division or due to environmental damage to DNA [17].

Benign and malignant formations

Tumors are divided into benign and malignant. Most primary neoplasms that develop from the spinal cord, its membrane and/or roots are benign. Unlike malignant tumors, they are not characterized by invasion - the ability of tumor cells to separate from it and penetrate into surrounding tissues. As a rule, invasion is the first stage of a complex process leading to the appearance of metastases. A metastatic tumor contains cells similar to the cells of the primary tumor [1]. When cells break off from a cancerous tumor, they can travel to other areas of the body through the bloodstream or lymphatic system. From there they can enter any organ or tissue [15].

Tumors of the breast (21%), lung (19%), prostate (7.5%), kidney (5%), gastrointestinal tract (4.5%) and thyroid gland (2.5%) most often metastasize to the spinal cord. %) [16].

The rate of tumor growth depends on the type of tissue and location of the tumor [1]. Symptoms develop quickly if the tumor is malignant.

The tumor grows over time and puts pressure on the contents of the spinal canal. Severe pain occurs with tumors in the cervical region and cauda equina. The pain can be one-sided, when the tumor develops on the lateral surface of the spinal cord and compresses the root; bilateral pain at the onset of the disease serves as an indication of the posterior localization of the tumor.

Tumors of the posterior surface of the spinal cord cause loss of joint-muscular sensation and sensitivity to vibration. The posterolateral localization of the tumor is manifested by painful radicular (radicular) syndrome, decreased sensitivity in this area, followed by its complete loss.

As the tumor progresses, other symptoms occur that indicate spinal cord compression. Half spinal cord syndrome is manifested by muscle weakness with involuntary contractions, loss of deep sensitivity (sensation of body weight, vibration, pressure), impaired ability to understand through touch what is written or drawn on the skin (graphesthesia). In addition, pain, temperature, and less often tactile sensations in the opposite side of the body are dulled.

The stage of paraparesis (decreased muscle strength) is the longest, and neurological symptoms in this period depend on the location of the tumor. The average duration of this stage is 2-3 years, with neoplasms of the cauda equina – up to 10 or more years [8].

Herniated disc

Hernial protrusion is caused by the destruction of the fibrous ring of the disc, which, under the weight of the overlying vertebrae, is flattened and extends beyond its anatomical boundaries. Hernias are detected during examination for osteochondrosis and are its complication. Hernias, like protrusions, often develop asymptomatically and may not manifest themselves in any way. Otherwise, patients complain of dull pain at the location of the hernia. It increases with walking and standing, and goes away after resting in a lying position. If a nerve root near the disc is pinched, the pain is difficult to endure because it resembles an electric shock and is sharply shooting, piercing in nature. In the area of ​​innervation of the pinched nerve, numbness and muscle weakness are possible.

How to treat

The prognosis after identifying the symptoms of a spinal cord tumor will be most comforting if treated correctly. It implies:

• surgery to remove pathological tissue - if this cannot be done completely, the largest possible area of ​​the tumor is removed without affecting the spinal cord;
• radiotherapy and chemotherapy;
• drug treatment after surgery to restore blood supply.

The prognosis for getting rid of benign tumors noticed in the early stages will be most comforting. With malignant tumors the situation is somewhat worse.

Radiculopathy (radicular syndrome)

The compression of the nerve root described above can be caused not only by a hernia. Pinching is the direct cause of back pain caused by:

• spondylosis;
• ankylosing spondylitis;
• injury;
• neoplasm;
• syphilis, tuberculosis, meningitis, osteomyelitis (inflammatory nerve damage).

Nerve damage causes a burning, stabbing pain. The affected area gets very hot and shoots, as if it had been struck by lightning.

Types of Spinal Tumors

Benign Tumors

The term benign tumor is used to refer to tumors that have a low likelihood of spreading (metastasizing) to other organs and tissues. But, nevertheless, benign tumors can also cause big problems due to compression of tissues or blood vessels. Fortunately, most benign tumors can be successfully treated.

The following are examples of benign tumors that can occur in the spine or surrounding tissues:

Osteoid osteoma is a benign tumor that has the unique feature of occurring on the back of the vertebrae during puberty. It develops primarily in the legs and back, and not in the vertebral body. This type of tumor occurs in approximately 10% of all spinal bone tumors. Typically manifested by back pain, especially at night, and the use of aspirin or other NSAIDs (for example, ibuprofen) is quite effective. Often poorly visualized by radiography and therefore preferable to CT. Treatment options include long-term use of NSAIDs or surgery (especially radiofrequency ablation). With surgical treatment, pain quickly disappears and relapse is extremely rare.

Osteoblastoma is a variant of osteoid osteoma measuring more than 2 cm. It is also characterized by localization in the posterior part of the vertebrae. But the symptoms of osteoblastomas are more pronounced and surgical treatment is usually required. The recurrence rate is significantly higher than that of osteoid osteoma and is up to 10% (and in the same place).

Aneurysmal bone cyst. This is a benign tumor that often occurs in the cervical spine and can affect the posterior elements of the vertebrae or the vertebral body itself. These tumors are more common in older adolescents and present with pain and, in some cases, other neurological problems. Therapeutic measures for this type of tumor are excision of the tumor, curettage of the affected area and, if necessary, decompression of the spinal structures.

Giant cell tumors are poorly understood. They tend to be located in the vertebral body (the front side of the spinal column), and although technically "benign", they can be very aggressive and sometimes spread to other tissues. They may present with pain or symptoms of spinal cord compression. They most often occur between the ages of 20 and 40, but are also possible at other ages. Treatment of these tumors is surgical (resection or total removal of pathological tissue) and surgical treatment is the treatment of choice. In some cases, tumor embolization and preoperative irradiation are performed and this improves the results of surgical treatment. They can present local pain as well as symptoms of spinal cord compression. These tumors require a careful preoperative approach. Incomplete removal of a giant cell tumor can lead to possible malignant transformation.

Eosinophilic granuloma : a benign bone lesion characterized by pain and a characteristic radiographic appearance of “vertebra plana” - flat vertebrae, thinning of the vertebral bodies. It occurs in both children and adults. These tumors can occur either independently or as part of a syndrome with damage to other organs and tissues. Treatment of such tumors is selected individually, and different treatment methods are used, both surgical and radiation.

Enchondromas are benign tumors consisting of cartilage. Potentially, when enlarged, these tumors can affect spinal structures. The recommended treatment is surgery. Sometimes it is possible to transform these tumors into a poorly differentiated malignant cartilaginous tumor - chondrosarcoma. Fortunately, this happens quite rarely. But the rapid development of a tumor requires a mandatory biopsy, and this helps prevent the malignancy of a benign tumor from becoming malignant.

Malignant Tumors

Doctors use the term malignant to indicate the possible invasion of a tumor into other tissues and organs. Accordingly, the treatment of malignant tumors is much more difficult than the treatment of benign tumors (less prone to invasive growth)

The following are examples of malignant tumors that can occur in the spine and surrounding tissues:

Metastases. Any malignant tumor can metastasize to bone tissue, but most likely to spread from the following organs: breast, prostate, kidney, thyroid, and lungs. Hematogenous metastasis can occur in two ways: through the venous system or through the arterial system. The spine and its surrounding tissues have a good blood supply, with drainage of many structures of the pelvic area through the venous system called Bateson's plexus. Lymphatic channels can also be a route of metastasis, but only in a third of cases. Spread or metastasis of tumors from anywhere in the body to the spine is possible after a long period of tumor growth in the primary site. Metastatic tumors are usually accompanied by severe pain. If the metastatic tumor is large enough, then a compression effect on the spinal cord is possible, which can manifest itself as impaired conduction of the motor functions of the limbs, dysfunction of the intestines and bladder. As a rule, metastatic cancer is not curable, and the goal of treatment is aimed at reducing pain and decompressing neural structures (by surgical methods) and thus preserving the patient’s quality of life to the maximum extent possible. Surgery, chemotherapy, and dosed radiation therapy help reduce pain from spinal metastases.

Myeloma is the most common type of primary, malignant bone tumor. Typically, the disease occurs in adults over 40 years of age. Various bone tissues are involved in the process, including the spine. Pain syndrome is most characteristic of this disease. But sometimes lesions of the spine can occur without pain for a certain period of time. Treatment for this disease is palliative (implying only a reduction in symptoms, but not a cure). Chemotherapy is used to reduce pain and slow tumor progression. Surgical treatment is used in the presence of fractures or the need for decompression of spinal structures.

Osteogenic sarcoma is the second and most common primary malignant tumor of bone tissue. There are two age groups in which this type of tumor develops more often: adolescents, young adults and the elderly. Spinal involvement with this tumor is quite rare. Modern advances in neuroimaging, chemotherapy, and surgical treatment of osteosarcoma have significantly improved 5-year patient survival to 80 percent. This is a significant medical success, since 20 years ago this tumor was almost always fatal.

Leukemia . Various forms of leukemia may be accompanied by pain in the lower back or neck, which is caused by degeneration of the bone marrow of the vertebrae. But with leukemia, general symptoms such as anemia, fever, general weakness bother the patient much earlier than back pain.

Tips for maintaining a healthy spine

To avoid problems with the “axis of life,” therapists and neurologists advise strengthening it with the help of:

• regular and dosed physical activity. A strong muscle corset reduces the load on the spine - you can get the right “dose” even with daily walking;
• proper organization of the workplace. When working sedentarily, get up and do a warm-up every half hour or hour;
• weight control, which increases pressure on the vertebrae and discs, and they wear out faster.

Does your back still hurt? Take care of yourself and avoid heavy loads, get more rest. If you have back pain, you can contact our specialists. They know very well what spinal diseases are and are familiar with the latest treatment methods. With us you can improve your health under the guidance of an experienced doctor who will make all the necessary appointments. At the end of therapy, he will recommend how you should eat and what exercise will be beneficial for you. You can make an appointment by calling +375 29 628 85 82 or leaving your contacts in the feedback form.

Cervical spinal cord lesions

A tumor can occur in both the upper and lower cervical region. Insidious processes in this zone are especially difficult. With lesions of the cervical part of the spinal column, early radicular syndrome is observed, manifested by shooting pains in the back of the head. When the upper pole of the tumor is concentrated in the cranial cavity, and the lower pole is in the spinal canal, intracranial hypertension is observed. Cervical ASM provokes respiratory dysfunction (dyspnea) due to paralysis of the diaphragmatic zone of the thoracic region; tumors often cause damage to the glossopharyngeal, hypoglossal and vagus nerves with impaired swallowing, speech and respiratory functions. Moreover, common phenomena with a similar location of the disease are:

• flaccid paresis of the arms along with muscle wasting;
• radicular pain and numbness in the hands;
• motor failure of the upper limbs;
• weakness of the hands.

Cervical spine.

Pathologies located in the cervical region contribute to a decrease in visual and hearing acuity, problems with memory and concentration, and the occurrence of severe disorders of the vestibular system.