The height of the intervertebral discs is reduced: what does this mean, the reasons for the decrease in the lumbar and cervical region

Spinal problems worry many modern people who lead a passive lifestyle. A decrease in the height of intervertebral discs is observed in 80% of people on the globe who have reached the age of 50–60 years. Pathological changes occur gradually and cause vertebral instability, hernias and curvature of posture.

Intervertebral discs are connective cartilage tissue that fixes the vertebrae of the spine in one position. The mobility and flexibility of the spine and the ability to lead a normal active life depend on their normal condition. Due to the special structure of the fabric, they act as shock absorbers when running, jumping, bending and other movements. Constant exposure to a number of negative factors leads to wear and sagging of discs.

How does the lesion develop?

Intervertebral discs consist of a soft core and a dense shell - the fibrous ring, enclosed in hyaline plates. There are no blood vessels in this cartilage, which means that nutrition comes to them from neighboring soft tissues. Normal muscle development, adequate stress on the body and the absence of problems with the circulatory system help keep the discs between the vertebrae healthy.

The appearance of degenerative changes in the body (development of osteochondrosis), a passive lifestyle, sedentary work, lack of sports - all this leads to stiffness of movement, pain in the back when turning, as well as swelling and spasms.

They, in turn, seriously aggravate blood circulation, which worsens the condition of the pathological area. Over time, the discs lose water and cease to be flexible, microcracks appear. As a result, over time, the height of the intervertebral disc decreases.

Reduced height of intervertebral discs is the first stage of degenerative-dystrophic changes in the spine

Intervertebral disc - pathology and treatment

Back pain is directly related to the degenerative process in the intervertebral disc [K. Luoma et al., 2000], which leads to hernia formation. Pathological changes in the disc area can be clinically either asymptomatic or cause pain in both the lumbar region and the leg [SD Boden, DO Davis et al., 1990]. The degenerative process causes a decrease in the height of the intervertebral disc and, consequently, a change in the biomechanics of movements in the spine. This leads to the involvement of nearby structures (facet joints, muscles, ligaments) in the pathological process. These processes - pathology of the intervertebral disc, degenerative-dystrophic changes in the facet joints and ligaments (especially yellow ones) - cause stenosis of the spinal canal, which is the most common cause of back pain in older people. In intervertebral discs, degenerative changes occur much earlier than in bone and muscle structures. Thus, their initial manifestations are detected at the age of 11–16 years [N. Boos, S. Weissbach et al., 2002]. Intervertebral disc degeneration has been observed to increase with age, especially in men. In 20% of people at a young age, moderate signs of degeneration are observed, while by the age of 50 in 10%, and by the age of 70 in 60%, the degree of change reaches a pronounced degree [J. Miller, C. Schmatz, A. Schultz, 1988]. Anatomy Intervertebral discs (Fig. 1A) are located between the vertebral bodies. They are the main element connecting the spinal column into a single whole and make up 1/3 of its height (Fig. 1B). The main function of intervertebral discs is mechanical (support and shock-absorbing). They provide flexibility to the spinal column during various movements (bending, rotation). In the lumbar spine, the diameter of the discs is on average 4 cm, and the height is 7–10 mm [LT Twomey, JR Taylor, 1987]. The intervertebral disc has a complex structure. In its central part there is a nucleus pulposus, which is surrounded by a cartilaginous (fibrous) ring. Above and below the nucleus pulposus are the end plates (Fig. 1 A, B). The nucleus pulposus contains well-hydrated collagen (randomly arranged) and elastic (radially arranged) fibers [J. Yu et al., 2002] (Fig. 2). At the border between the nucleus pulposus and the fibrous ring (which is clearly defined up to 10 years of life), cells resembling chondrocytes are located with a fairly low density. The annulus fibrosus consists of 20–25 rings or plates [F. Marchand, A.M. Ahmed, 1990], between which there are collagen fibers, which are directed parallel to the plates and at an angle of 60° to the vertical axis (Fig. 1). Elastic fibers are located radially in relation to the rings, which restore the shape of the disc after the movement [J. Yu et al., 2002]. The cells of the annulus fibrosus, located closer to the center, have an oval shape, while at its periphery they elongate and are located parallel to the collagen fibers, resembling fibroblasts. Unlike articular cartilage, disc cells (both the nucleus pulposus and the annulus fibrosus) have long, thin cytoplasmic projections that reach 30 μm or more [SB Bruehlmann et al., 2002]. The function of these projections remains unknown, but it is assumed that they are capable of sensing mechanical stress in tissues [RJ Errington et al., 1998]. End plates are a thin (less than 1 mm) layer of hyaline cartilage located between the vertebral body and the intervertebral disc. The collagen fibers it contains are arranged horizontally [S. Roberts et al., 1989] (Fig. 3). The intervertebral disc of a healthy person contains blood vessels and nerves only in the outer plates of the fibrous ring [S. Roberts et al., 1995]. The endplate, like any hyaline cartilage, has no vessels or nerves. Basically, the nerves travel accompanied by vessels, but they can also travel independently of them (branches of the sinuvertebral nerve, anterior and gray communicating branches). The sinuvertebral nerve is the recurrent meningeal branch of the spinal nerve. This nerve leaves the spinal ganglion and enters the intervertebral foramen, where it divides into ascending and descending branches (Fig. 4). As has been shown in animals, the sensory fibers of the sinuvertebral nerve are formed by fibers from both the anterior and posterior roots (Fig. 5). It should be noted that the anterior longitudinal ligament is innervated by branches of the spinal ganglion. The posterior longitudinal ligament receives nociceptive innervation from the ascending branches of the sinuvertebral nerve, which also innervates the outer plates of the annulus fibrosus [WE Johnson et al., 2001]. With age, there is a gradual blurring of the boundary between the fibrous ring and the nucleus pulposus, which becomes more and more fibrotic [JA Buckwalter, 1995]. Over time, the disc becomes morphologically less structured - the annular plates of the annulus fibrosus change (merge, bifurcate), collagen and elastic fibers are located more and more chaotically. Cracks often form, especially in the nucleus pulposus. Degeneration processes are also observed in the blood vessels and nerves of the disc [S. Roberts et al., 1995]. Fragmented cell proliferation occurs (especially in the nucleus pulposus) [WEB Johnson et al., 2001]. Over time, intervertebral disc cells die. Thus, in an adult, the number of cellular elements decreases by almost 2 times [JJ Trout et al., 1982]. It should be noted that degenerative changes in the intervertebral disc (cell death, fragmented cell proliferation, fragmentation of the nucleus pulposus, changes in the annulus fibrosus), the severity of which is determined by a person’s age, is quite difficult to differentiate from those changes that would be interpreted as “pathological”. Physiology The mechanical properties (and therefore the function) of the intervertebral disc are provided by the intercellular matrix, the main components of which are collagen and aggrecan (proteoglycan). The collagen network is formed by type I and type II collagen fibers, which constitute approximately 70% and 20% of the dry weight of the entire disc, respectively. Collagen fibers provide strength to the disc and fix it to the vertebral bodies [DR Eyre, H. Muir, 1977]. Aggrecan (the main disc proteoglycan), composed of chondroitin and keratan sulfate, provides hydration to the disc. Thus, the weight of proteoglycans and water in the annulus fibrosus is 5 and 70%, and in the nucleus pulposus – 15 and 80%, respectively. Synthetic and lytic (proteinases) processes constantly occur in the intercellular matrix. However, it is a histologically constant structure, which ensures the mechanical strength of the intervertebral disc [C. Weiler et al., 2002]. Despite the morphological similarity with articular cartilage, the intervertebral disc has a number of differences. Thus, protein glycans (aggrecan) of the disc contain a higher content of keratan sulfate. In addition, in the same person, disc aggrecans are smaller and have more pronounced degenerative changes than articular cartilage aggrecans [B. Johnstone et al., 1995]. Pathophysiology The main element of intervertebral disc degeneration is a decrease in the number of protein glycans. Fragmentation of aggrecans and loss of glycosaminoglycans occur, which leads to a drop in osmotic pressure and, as a consequence, dehydration of the disc. However, even in degenerated discs, cells retain the ability to produce normal aggrecans [RI Inkinen et al., 1998]. Compared to protein glycans, the collagen composition of the disc changes to a lesser extent. Thus, the absolute amount of collagen in the disc, as a rule, does not change. However, redistribution of different types of collagen fibers is possible. In addition, the process of collagen denaturation occurs. However, by analogy with protein glycans, disc cell elements retain the ability to synthesize healthy collagen even in a degenerated intervertebral disc [VC Duance et al., 1998]. Loss of protein glycans and dehydration of the disc lead to a decrease in their shock-absorbing and supporting functions. The intervertebral discs decrease in height and gradually begin to prolapse into the spinal canal. Thus, improper redistribution of axial load on the endplates and annulus fibrosus can provoke discogenic pain [DS McNally et al., 1996]. Degenerative-dystrophic changes are not limited only to the intervertebral disc, since changes in its height lead to pathological processes in neighboring formations. Thus, a decrease in the supporting function of the disc leads to overload in the facet joints, which contributes to the development of osteoarthritis and a decrease in the tension of the yellow ligaments, which leads to a decrease in their elasticity and corrugation. Disc prolapse, facet joint arthrosis, and thickening (corrugation) of the ligamentum flavum lead to spinal canal stenosis [MA Adams et al., 1990]. It has now been proven that compression of the root by an intervertebral hernia is not the only cause of radicular pain, since about 70% of people do not experience pain when the roots are compressed by a hernial protrusion [N. Boos et al., 1995]. It is believed that in some cases, when a herniated disc comes into contact with a root, sensitization of the latter occurs due to aseptic (autoimmune) inflammation, the source of which is the cells of the affected disc [K. Olmarker, B. Rydevik, 2002]. One of the main causes of intervertebral disc degeneration is a violation of adequate nutrition of its cellular elements. In vitro, it was shown that intervertebral disc cells are quite sensitive to oxygen deficiency, glucose and pH changes. Impaired cell function leads to changes in the composition of the intercellular matrix, which triggers and/or accelerates degenerative processes in the disc. Nutrition of the cells of the intervertebral disc occurs indirectly, since blood vessels are located from them at a distance of up to 8 mm (capillaries of the vertebral bodies and outer plates of the fibrous ring (Fig. 6) [S. Holm et al., 1981]. Impaired nutrition of the disc may be associated with many reasons: various anemias, atherosclerosis [JP Jones, 1997]. In addition, metabolic disorders are observed with overload and insufficient load on the intervertebral disc. It is believed that in these cases there is a restructuring of the capillaries of the vertebral bodies and/or compaction of the endplates, which impedes diffusion nutrients [S. Roberts et al., 1996]. However, it should be noted that the degenerative process is associated only with incorrect execution of movements during physical activity, while their correct execution increases the intradiscal content of protein glycans. There are several stages of degenerative-dystrophic changes in the intervertebral disc [ BL Sachs et al., 1987]: • Stage 0. The disc is not changed. • Stage 1: Small tears in the inner 1/3 of the annular plates of the annulus fibrosus. • Stage 2: Significant destruction of the disc occurs, but the outer rings of the annulus fibrosus are preserved, which prevent herniation. There is no compression of the roots. At this stage, in addition to back pain, it may radiate to the legs to the level of the knee joint. • Stage 3. Cracks and tears are observed along the entire radius of the annulus fibrosus. The disc prolapses, causing tears in the posterior longitudinal ligament. Currently, this classification has been slightly modified, since it did not include compression syndromes. Attempts to create a real classification, based on computed tomography data, have been made since 1990 and ended in 1996 (Schellhas): • Stage 0. The contrast agent injected into the center of the disc does not leave the boundaries of the nucleus pulposus (Fig. 7). • Stage 1: At this stage, the contrast penetrates to the inner 1/3 of the annulus fibrosus. • Stage 2: Contrast extends to 2/3 of the annulus fibrosus. • Stage 3. Crack along the entire radius of the annulus fibrosus. The contrast penetrates to the outer plates of the annulus fibrosus. It is believed that pain occurs at this stage, since only the outer layers of the disc are innervated. • At the 4th stage, there is a spread of contrast around the circumference (reminiscent of an anchor), but not more than 30°. This is due to the fact that radial discontinuities merge with concentric ones. • At stage 5, contrast penetrates into the epidural space. Apparently, this provokes aseptic (autoimmune) inflammation in nearby soft tissues, which sometimes causes radiculopathy even without obvious signs of compression. The mechanism of discogenic pain In 1979, Brodsky and Binder tried to identify the mechanisms of discogenic pain using discography. They showed that pain occurs with the introduction of substances like glycosaminoglycans and lactic acid, with compression of the roots, with hyperflexion of the facet joints. In addition, they suggested that the endplates may be a source of pain. Ohnmeiss in 1997 showed that complete rupture of the annulus fibrosus or disc herniation is not necessary for the occurrence of leg pain. He proved that even at stage 2 (when the outer plates of the annulus fibrosus remain intact), pain in the lower back occurs, radiating to the leg. The pathogenesis of the development of discogenic pain remains not fully understood. It is traditionally believed that the source of pain is directly the root that is subjected to compression (Fig. 8 A). However, it has now been proven that pain from one level can also come from underlying segments (Fig. 8 B) [WS Oh, JC Shim, 2004]. As shown in the figure, L4–L5 disc pathology can cause pain in the L2 dermatome. Treatment of discogenic pain Most of the main methods of both surgical and conservative treatment of discogenic pain are aimed not at restoring the pathological disc, but at reducing the symptoms of the disease. In essence, this is palliative therapy aimed at quickly restoring the patient’s ability to work. It includes bed rest (with early activation), the use of non-steroidal anti-inflammatory drugs, muscle relaxants, local administration of local anesthetics and corticosteroids, manual therapy and various methods of surgical correction. Attitudes towards surgical intervention around the world are somewhat different and account for only a small percentage of the total number of patients suffering from back pain. Thus, in the UK, one in 2000 patients with back pain undergoes surgery, while in the United States of America this figure is 5 times higher [JN Gibson et al., 2000]. At the same time, the effectiveness of surgical treatment of discogenic pain in these countries is comparable. However, recent studies show that with appropriate patient selection, the effectiveness of surgical correction of discogenic pain increases significantly [P. Fritzell et al., 2001]. Surgical therapy includes discectomy with arthrodesis, intradiscal steroid injection, intradiscal decompression, annulus fibrosus repair, and various laser therapy options. Currently, minimally invasive techniques are becoming increasingly widespread: plastic surgery of the fibrous ring (electrothermal, high-frequency), percutaneous disc decompression (laser, high-frequency, mechanical), endoscopic percutaneous discectomy. Recently, new directions in intervertebral disc surgery have been developed - replacement of the nucleus pulposus [LM Boyd, AJ Carter, 2006], restoration of end plates [JC Lotz, AJ Kim, 2005], disc replacement [RC Huang et al., 2004]. Great efforts of researchers are aimed at the possibility of restoring the suffering disc. The main reason for actively studying the possibility of restoring the affected intervertebral disc is due to the fact that a violation of the biomechanics of movement (which is not corrected by symptomatic therapy) causes pathology of nearby formations (ligaments, muscles, facet joints), which leads to the development of spinal stenosis. Substances that promote the restoration of the intervertebral disc are glucosamine and chondroitin sulfate. Their effectiveness has been proven in both intervertebral disc pathology and peripheral joint cartilage pathology (osteoarthrosis) [TE McAlindon et al., 2000]. It is believed that glucosamine and chondroitin sulfate stimulate the work of chondrocytes (biosynthesis of proteoglycans) and inhibit the function of lytic enzymes (proteinases). This helps to improve the qualitative composition of the intercellular matrix and, accordingly, restore the physical properties of the intervertebral disc. There are various ways of administering glucosamine and chondroitin sulfate - oral, transdermal and intradiscal [R. Derby et al., 2004]. A published meta-analysis covering studies up to 1999 is devoted to the study of chondroitin sulfate [McAlindon TE et al., 2000]. The authors conclude that chondroitin sulfate has a moderate to significant effect on pain and functional joint mobility in osteoarthritis compared with placebo. This substance is safe and characterized by a minimum of side effects. In a randomized controlled comparative study of chondroitin sulfate and diclofenac conducted in 146 patients, a faster decrease in the severity of clinical symptoms was observed in patients who used non -steroidal anti -inflammatory drugs, however, the return of these symptoms was noted immediately after the cancellation of therapy; Khondroitin Sulfate, on the contrary, was characterized by a slower beginning of the therapeutic action, which remained up to 3 months after the end of the treatment. Another randomized controlled study demonstrated the advantages of sulfate chondroitin over placebo in 130 patients with osteoarthritis of the knee joints and once again confirmed the preservation of the therapeutic effect up to 1 month after the end of the treatment. Thus, the effectiveness of chondroitin sulfate was proved only in the treatment of osteoarthrosis of the knee and picnic joints and has the degree of evidence a (Eular, European Mooreris League). At the same time, in the treatment of pain syndromes in the back (osteochondrosis) of large -scale, double blind, placebo of controlled studies was not conducted. However, taking into account the anatomical and hystological similarity of the cartilage tissue of the disk and the peripheral joints, one can assume the similar effectiveness of sulfate chondroitin and osteochondrosis. Thus, some domestic studies showed the effectiveness of chondroitin sulfate in back pain [N.A. Shostak et al., 2004; S.P. Filonenko et al., 2005]. Researchers showed a significant decrease in pain and improvement of ability to work. One of the drugs containing chondroitin sulfate is chondroxide (Nizhfarm, Russia). One of its tablets contains as an active component of chondroitin sulfate - 0.25 g (dry and 100%substance) and excipients. With a single chondroxide of the average therapeutic dose, the maximum plasma concentration is reached after 3-4 hours. It accumulates mainly in cartilaginous tissue (maximum concentration in articular cartilage is achieved after 48 hours). Take chondroxide inside, 0.5 g (2 tablets) 2 times a day. Tables are taken, washed down with a small amount of water. The recommended duration of the initial course is 6 months. It should be borne in mind that the therapeutic effect of chondroxide remains for 3-5 months. After its cancellation, depending on the localization and the stage of the disease. The modern and actively studying direction in the therapy of degenerative -dystrophic changes in the intervertebral disc is cell therapy. The essence of this method is to stimulate (usually use growth factors) of the product of the intercellular matrix [R. Osada et al., 1996] and blocking some cytokines inhibiting matrix synthesis [K. Takegami et al., 2002]. However, the intra -disconed administration of growth factors and cytokine inhibitors did not lead to the restoration of the matrix, since their action was short enough. Currently, this type of therapy is trying to implement this type of engineering [K. Nishida et al., 1999].

Causes

The main reason for the appearance of pathology in people of any age is a slowdown in metabolism in the body, impaired blood flow and nutrient deficiency in cartilage tissue. But, in addition to this, the following factors can affect malnutrition in the intervertebral discs and reduce their height:

unbalanced diet;
obesity;
changes in tissues with age;
trauma or stress;
infectious processes;
pregnancy;
stress and metabolic disorders in tissues.

Determining the cause allows you to choose the most effective therapy for the intervertebral disc and achieve improvements in treatment in a short time. The first step to restoring normalcy is to eliminate the underlying factors that led to the problem.

Symptoms of the disease

Signs of pathological changes depend largely on the stage and location. Conventionally, the disease occurs in several stages:

What is a herniated disc?

Elementary. The damage to the disk is minor, so the problem goes unnoticed by many. Patients in this phase complain only of stiffness of movement in the first hours after waking up, as well as discomfort in the back during physical activity.
Second. Degenerative changes in the disc continue to progress. Characteristic subsidence and defects of the fibrous membrane are observed. At this stage, the appearance of curvatures of the thoracic spine, instability of individual vertebrae, as well as severe pain during prolonged stay in an uncomfortable position are noticeable.
Active. At this stage, cracks appear in the disc, or it begins to extend beyond the anatomical limits. Characteristic signs of this stage are swelling, inflammation, muscle spasms, and decreased sensitivity in certain areas or limbs.
Progressive. At this stage, there is a noticeable decrease in the height of the intervertebral discs, their extension beyond the vertebra and the formation of osteophytes. Signs of pathology are loss of segment mobility, limb paralysis and dysfunction of internal organs, often leading to complete disability.

Pain in the affected parts of the spine is the first and constant symptom

It is worth contacting a specialist when the first symptoms appear. The sooner treatment is started, the higher the likelihood of a favorable outcome.

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.

Diagnostic tests

Today, specialists use a variety of modern technology to carry out diagnostic procedures in order to identify intervertebral disc pathology at an early stage.

When the first signs appear, contact a neurologist, who, after a visual examination, interviewing the patient and studying the medical history, prescribes the following studies:

X-ray. It allows you to detect disorders in the cervical spine even at a stage when no symptoms are observed.
MRI. Prescribed where X-ray examination is not effective (for diagnosing intervertebral hernias at the initial stage). With the help of such a device, you can notice all the degenerative changes in the spinal trunk.
Electroneurography. Allows you to detect characteristic processes in nerve pathways or their damage.
Discography. Allows you to study damage in the disk structure.

The neurologist selects treatment based on information after the examination and the clinical picture.

Features of treatment

Reducing the height of intervertebral discs is treated conservatively, with medication or surgery, depending on the patient’s condition, the location of the problem, and the stage of the disease. In some cases, the progression of the disease and the proliferation of osteophytes are only slowed down or slightly stopped, which improves the condition of the cartilage in general. All actions are aimed at eliminating pain, improving blood circulation and metabolic reactions, as well as restoring disc mobility.

Treatment is necessarily comprehensive and includes several of the following measures:

physiotherapy and manual procedures;
working out the joint to improve the movement of lymph and blood;
physiotherapy;
swimming or yoga;
massotherapy;
cryotherapy;
spinal traction (natural, hardware or water);
procedures to strengthen the muscle, bone and ligament structures of the body.

All this is accompanied by taking painkillers to eliminate discomfort in the cervical discs or other area, as well as medications to relieve inflammation and nourish cartilage tissue. For some time, the patient is recommended to wear a support corset, completely give up bad habits and follow a diet.

Regular exercise therapy will help avoid complications of osteochondrosis

Symptoms

The main manifestation of pathological changes in the intervertebral discs is pain. Pain even at the early, so-called pre-hernia stage can be quite severe and protracted. They are often poorly controlled with painkillers. In this case, the biomechanics of the lumbar spine often deteriorates significantly.

The thing is that all people have different disc sizes, and the spinal roots pass at different distances from them. Therefore, in some patients, the pathology does not make itself felt for quite a long time, until the protrusion reaches enormous sizes, while in others, neurological symptoms and pain occur almost immediately and are acute.

Therefore, the size of the hernia or protrusion does not play a significant role in the need for surgery. Neurosurgeons are primarily guided by the patient’s condition, and therefore, in some cases, surgical intervention is indicated for protrusions and the presence of a congenitally narrow spinal canal.

In most cases, pain appears when the protrusion reaches stage 3 of development and its size exceeds 3 mm.

The occurrence of pain, especially acute pain, is a clear sign of compression of the spinal nerves. Often the pain is aching and dull, but it can also be burning or have the appearance of a lumbago. They can radiate to one or both legs, most often to the thigh and lower leg.

Lower back pain occurs when:

changing body position;
physical activity;
staying in one static position for a long time.

Also, protrusion of the lumbar spine can cause:

reduction in the possible range of motion in the lower back (most often it is difficult for patients to bend over and turn the body due to sudden or intensifying pain);
disturbances of sensitivity (parasthesia), which is manifested by the appearance of tingling, numbness or a feeling of crawling on the skin in the lumbar region, perineum or legs;
decreased muscle tone in the legs and reflex spasms of the back muscles in the projection of the affected area of the spine;
dysfunction of the pelvic organs occurs with a congenitally narrow spinal canal and compression of the nerves of the cauda equina, since they are responsible for control of urination, defecation, and the functioning of the genital organs;
rapid fatigue, decreased performance.

The severity of pain and neurological symptoms is determined by the location of the protrusion, its size, the degree of inflammation and the amount of nerve compression.

Such symptoms are often a reason for detailed consideration of the need for surgical intervention. Prolonged delay can provoke irreversible changes and lead to paralysis.

Preventive actions

A herniated disc l5 s1 takes a long time and is difficult to treat, so every person at risk should take care of high-quality prevention. It will prevent a decrease in the height of discs of other locations, which will protect against possible other complications. The main methods of prevention are:

regular proper nutrition;
control of body weight, eliminating the appearance of extra pounds;
constant maintenance of water balance;
exclusion of stressful situations;
performing special gymnastics;
quitting smoking and alcohol;
regular exercise.

Such simple actions will strengthen the muscle frame and establish metabolic processes between the discs of the lumbar region and neighboring tissues. This will ensure their normal height is maintained and the spine is healthy.

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.