Disc herniation L5–S1, conservative treatment, surgery, symptoms

December 19, 2019

123831

4 out of 5

Over the years, intervertebral discs wear out as a result of severe physical activity or other factors, and gradually lose their elasticity and firmness. Since the center of gravity of the human body is located at the border of the transition of the lumbar spine to the lumbosacral spine, it is this area that is subject to maximum static-dynamic loads. Therefore, in approximately half of all patients in whom intervertebral hernias are detected, they are present at the level of the L5–S1 segment.

The L5–S1 disc is located between the last lumbar vertebra and the sacrum. The degenerative changes that occur in it due to osteochondrosis, obesity, scoliosis, trauma, metabolic and other disorders lead first to the formation of L5–S1 protrusion, and subsequently to a hernia. Intense physical activity, especially associated with heavy lifting, can also provoke the development of the disease. But a sedentary, sedentary lifestyle also provokes malnutrition of the disc tissue, a gradual decrease in its level of hydration and elasticity, and ultimately leads to protrusion and disc herniation.

Since the so-called cauda equina (a large nerve plexus) passes at the L5–S1 level, the formation of a hernia quickly leads to severe pain and neurological complications. If treatment is not started in a timely manner, cauda equina syndrome develops, which causes:

severe pain in the lower back, radiating to the legs;
paresthesia of the posterior surfaces of the thighs and perineum;
weakness of the leg muscles, decreased knee and Achilles reflexes;
fecal and urinary incontinence;
erectile dysfunction.

Types of hernias

There are anterior and posterior intervertebral hernias. But if the former are formed on the outside of the vertebrae and rarely lead to disturbances in well-being, then the posterior ones, protruding into the spinal canal, can put pressure on the nerve roots and provoke serious complications.

A hernia can protrude into different areas of the spinal canal, towards the surface of one of the vertebral bodies, etc. Therefore, the following types of intervertebral hernia are distinguished:.

Dorsal

A hernia forms in the area where the spinal roots pass. It causes pain in the lower back, radiating to the buttocks, hip joints, and lameness. With this type of hernial protrusion, it is difficult for patients to sit, there is numbness in the legs, a decrease in the volume of the muscles of the lower extremities and the rapid onset of fatigue when walking. When the abdominal muscles are tense, lumbago occurs.

Median

The hernia is located in the center of the spinal canal. It provokes pain in the lower back, radiating to the back of the thighs, legs, and sometimes feet. With large sizes, there is a violation of urinary control, deterioration of erection and decreased sensitivity of the legs, leading to paresis or paralysis.

Paramedian

The nucleus pulposus protrudes into the right or left side of the spinal canal, where many nerve endings pass. This causes burning pain in the perineum, difficulty urinating and defecating even with strong urge, and a feeling of numbness in the groin area.

Foraminal

The hernia is located in the narrowest place of the spine (foramen). Since nerve fibers pass through it, even a small formation can provoke very severe pain and cause severe neurological abnormalities.

Circular or diffuse

The protrusion occupies the entire space of the spinal canal, which is associated with a serious risk of compression of the spinal cord. The formation of a hernia is accompanied by the presence of pain even at rest, a tingling sensation in the legs and severe weakness up to the loss of motor ability and control over emptying the bladder and bowels.

Sequestered

It is a separated part of the nucleus pulposus, displaced from the affected intervertebral disc up or down the spinal canal. A sequestered hernia is a 100% indication for surgical intervention. Separation of part of the nucleus is accompanied by severe lumbago, increased pain when straining, and impaired leg mobility.

Regardless of the type of L5–S1 hernia, its formation almost instantly leads to a decrease in a person’s quality of life and causes severe pain in the back and legs.

Radicular syndrome

Compression of the spinal cord roots (and their subsequent death) impairs nutrition in the tissues and is characterized by several symptoms:

weakness of the muscles of the thigh, leg and foot, as well as a decrease in their tone;
noticeable muscle atrophy. Without performing its functions, the leg becomes thinner and weaker, asymmetry appears;
impaired skin sensitivity, tingling, numbness and chilliness of the fingers;
the appearance of dryness or increased sweating of the skin in the area of the damaged root;
possible paralysis - movement becomes difficult, which can lead to complete disability.

With complications, other symptoms are also possible - for example, lumbodynia (lumbago in the lumbar region), dysfunction of the hip and knee joints.

The choice of diagnostic method depends on the cause of the pathology and is carried out only by a qualified doctor.

Diagnostics

To diagnose an L5–S1 intervertebral hernia, an in-person examination by a neurologist or vertebrologist is required first. At the first consultation, the doctor collects anamnesis, finds out working conditions, the nature of the symptoms and examines the patient. This suggests the presence of a hernia and prescribe additional studies:

MRI;
x-ray of the lumbosacral spine;
CT;
myelography.

The most informative method for diagnosing the disease is MRI. The study allows you to accurately determine the presence of a protrusion or hernia of any spinal motion segment and even detect foraminal hernias, which are especially difficult to diagnose. Thanks to MRI, the doctor receives accurate data on the location of the protrusion, its size, and tendency to sequestration, which allows him to prescribe the most effective treatment in each specific case.

If your back hurts

If you experience attacks of acute pain in the spine before visiting a doctor, you can relieve it in the following ways:

take a non-steroidal anti-inflammatory drug or analgesic;
take a natural sedative (infusion of valerian or motherwort);
take a horizontal position on a flat, hard surface;
apply a tight bandage to the source of pain or wear a special corset;
use for external use an ointment or gel containing a non-steroidal anti-inflammatory drug;
Avoid sharp turns and climbs to avoid new attacks of pain.

Under no circumstances should you take any other medications without a doctor’s prescription.

In most cases, timely diagnosis of the pathology and conservative treatment allow you to completely get rid of it. The spine determines the health of many organs and systems of our body. In addition, the blood vessels passing through it nourish the brain. Therefore, you need to treat his condition very carefully and if you experience any pain, consult a doctor. Only a specialist will be able to select adequate treatment and relieve annoying pain.

Conservative methods of treating spinal hernia L5–S1

Treatment without surgery for L5–S1 disc herniation in the early stages of development is often successful and leads to normalization of the patient’s condition. But the duration of remission directly depends on how correct a person’s lifestyle is and what stress they are exposed to daily. But in order to achieve positive dynamics, therapy must be correctly selected and comprehensive.

Drug therapy

Necessary to eliminate pain, muscle spasms and improve the conduction of nerve impulses. For this purpose, NSAIDs, muscle relaxants, and B vitamins are prescribed. To accelerate the processes of cartilage tissue restoration, chondroprotectors can be used, but the effectiveness of drugs from this pharmacological group is not 100% confirmed.

Blockades

Injections of anesthetics (lidocaine, novocaine), sometimes in combination with corticosteroids, at certain points in the area of the affected spinal motion segment. They are used to quickly relieve acute pain, but can only be performed by qualified medical personnel under completely sterile conditions.

Manual therapy

A course of sessions conducted at a certain interval allows you to eliminate spasms of overstrained muscles and, conversely, tone overly relaxed ones. Restoring the correct anatomy of the spinal motion segment may even lead to a reduction in the size of the hernia.

Exercise therapy

A set of individually selected exercises allows you to strengthen the muscle corset and reduce the load on the affected area of the spine.

Physiotherapy

Aimed at reducing the intensity of pain, normalizing muscle tone and improving nerve conduction. For this purpose, a course of electrophoresis, magnetic therapy, and diadynamic current therapy is prescribed.

In certain cases, patients are recommended to undergo traction therapy, i.e., spinal traction. With its help, displaced vertebrae fall into place, and the distance between them increases slightly, which eliminates excess pressure on the affected intervertebral discs.

To increase the effectiveness of conservative treatment, patients can resort to additional methods:

reflexology;
kinesitherapy;
osteopathy;
hirudotherapy.

Treatment of intervertebral hernia in Moscow

In the well-known clinic of Dr. Dlin (Moscow), patients are offered effective and safe modern treatment for spinal diseases, of which a significant part are intervertebral hernias, using comprehensive programs combining traditional and innovative medical technologies. To identify the causes of pain in the spinal column, high-quality diagnostics are carried out using modern equipment of the latest generation. After an accurate diagnosis is established, professional recommendations for effective treatment of the disease are offered.

The clinic’s specialists, with a long history of successful work, undergo regular advanced training in the world’s leading centers - leaders in the treatment of painful symptoms of any origin. From the first sessions, patients experience pain relief and a full quality of life is restored.

Offers for patients:

effective treatment at an international level using innovative technologies;
use of modern diagnostic and treatment equipment and the latest safe medications;
services of experienced doctors;
elimination of negative manifestations from the first therapy sessions;
attentive staff and comfortable environment.

To make an appointment and clarify any questions you may have, call the contact numbers listed on the website!

Surgery for spinal hernia L5–S1

Surgery for a hernia of the lumbosacral spine is a last resort measure, which is resorted to in strictly defined situations:

in the absence of positive changes in the patient’s condition after 1–3 months of treatment with conservative methods;
severe cauda equina syndrome;
the occurrence of paralysis;
sequestered hernias.

All operations performed for hernia are minimally invasive and have a high level of safety. Modern neurosurgery offers such ways to solve the problem as:

nucleoplasty;
endoscopic surgery;
microdiscectomy.

The specific surgical tactics for L5–S1 disc herniation are selected based on its size, type, and general health of the patient. If at the stage of preoperative preparation it is assumed that a significant part of the intervertebral disc will be removed, the neurosurgeon will notify the patient of the need to install a special implant to close the resulting defect. Today, a special Barricaid mesh is used for these purposes. It is used to fill the missing part of the annulus fibrosus and prevent the nucleus pulposus from leaking out through the existing defect.

Sometimes the L5–S1 intervertebral hernia reaches such a size that complete removal of the disc is required. In such situations, neurosurgeons may decide to achieve spinal fusion, i.e. fusion of the L5 and S1 vertebrae with each other, but this will lead to limited mobility of the spine, which is not always acceptable for patients.

Another option to solve the problem is to install an M6 endoprosthesis. It is a copy of a natural intervertebral disc, as it has an artificial fibrous ring and nucleus pulposus. Installing an endoprosthesis requires a neurosurgeon to have a thorough knowledge of the technology, but if the doctor has undergone appropriate training, then installing the M6 does not cause any difficulties.

Puncture surgery

Methods of puncture surgery (nucleoplasty) have appeared in the arsenal of neurosurgeons recently, but have already managed to completely revolutionize the idea of operations for intervertebral hernias. They are practically devoid of intraoperative risks, allow you to leave the clinic on the day of surgery, completely free from pain, and avoid the formation of scars.

The essence of nucleoplasty is the introduction, under the control of an image intensifier, of a thin cannula into the nucleus pulposus of the disc through the soft tissue above the affected spinal motion segment. As soon as it reaches the center of the nucleus, an electrode is immersed in it, which creates:

laser energy (laser nucleoplasty);
cold plasma (cold plasma);
radio waves (radio wave).

In the first case, evaporation of part of the nucleus pulposus is carried out using the thermal energy of the laser, but this is associated with the risk of overheating of surrounding tissues, which may include blood vessels and nerves. Therefore, recently preference has been given to other methods of nucleoplasty, especially cold plasma and hydroplasty.

The essence of cold plasma nucleoplasty is the use of cold plasma, which destroys nuclear tissue without causing strong heating. As a result, negative pressure is created in the intervertebral disc, which leads to the retraction of the resulting protrusion back.

Hydroplasty is based on the destruction of the contents of the nucleus by the pressure of a saline solution. It is carried out using a SpineGet device specially created for this procedure. The tip inserted into the body has 2 branches: for injection of liquid supplied under pressure and for suction of waste material. Since the destruction of the nucleus and removal of the resulting particles along with saline solution occurs simultaneously, the neurosurgeon can very accurately control how much of the nucleus pulposus should still be removed.

But puncture therapy methods can only be used for hernias L5–S1, the size of which does not exceed 7 mm.

Endoscopic hernia surgery

Endoscopic operations are indicated for large hernias or their location in narrow areas of the spinal canal. The essence of the method is to create access with a shaver in its projection and insert the endoscope. It is a tube through which special instruments are inserted into the surgical field and the altered tissue is excised. The neurosurgeon controls his every step through a camera inserted into the treatment area using a similar technique.

Endoscopic surgery for intervertebral hernia has a low percentage of intraoperative complications and a short recovery period. But it also cannot be performed in all cases.

Microdiscectomy

One of the classic techniques for removing hernias is microdiscectomy. It involves removal of a protrusion or the entire disc in an open manner through an incision of up to 3 cm. The method is indicated for severe neurological complications, the impossibility of using other techniques, and this operation is also indicated for sequestered hernias L5–S1.

Spinal syndrome

The complication is caused by a constant spasmodic state of the muscles. Due to this, the motor functions of the lumbar region are limited, and full extension of the back becomes impossible. As a result, the patient develops a hunchback, stoop and a skew of the body in the healthy direction. Possible poor posture and loss of stability during movements.

In the vast majority of cases, lumbar hernia occurs in the lower sections. Damage and prolapse of the discs between L4 - L5 and L5 - S1 occurs, which leads to pain localized on the outer surface of the thighs, the anterior outer area of the lower leg, the back of the foot and in the big toe area.

Rehabilitation

After any operation, the rehabilitation period begins. But after nucleoplasty or hydroplasty, there are practically no restrictions and pain. After endoscopic surgery, you need to stay in the hospital for about 5 days, after microdiscectomy - 7-10 days and stay in bed for 24 hours without getting up. Naturally, after more traumatic surgical interventions, postoperative pain is present and a long period is required for complete recovery.

Thus, depending on the type of operation performed, patients may be prescribed for different periods of time:

drug treatment;
exercise therapy;
wearing a corset;
kinesitherapy;
massotherapy;
physiotherapy.

Even after successful completion of the operation for intervertebral hernia and the rehabilitation period, it is necessary to adhere to a gentle regimen and avoid strong physical exertion, but physical inactivity is also dangerous. Therefore, it is worth doing physical therapy every day, taking breaks to warm up during sedentary work, and swimming regularly.

Removal of lumbar hernia using microsurgical method

The hernia is removed through a small incision in the skin (2-3 cm). During the operation, the neurosurgeon uses special microsurgical instruments and magnifying optics. This method is indicated for patients with severe instability of the spinal segment, as well as osteophytes (growths on the bones). Only by microdiscectomy is it possible to gain access to the spinal hernia and install an interbody cage or implant.

Microsurgical removal of spinal hernia:

Hospitalization - 1-3 days.
The rehabilitation period is about 1 month.
It is distinguished by high clinical effectiveness, thanks to the precision approach of neurosurgeons at the Pirogov Clinic.
The pain goes away immediately after surgery.

View reviews about the removal of spinal hernias in our clinic