Intervertebral hernia of the lumbar region, treatment at the EVVRO LPS clinic in Krasnodar

Lumbar intervertebral hernia is a disease that manifests itself in the form of disc protrusion and rupture of the fibrous ring. As a rule, it occurs as a result of uneven load on the vertebrae.

The symptoms of the disease increase as the size of the hernia increases and serves as the main diagnostic criterion for the stage of the disease. The signs are varied and conditionally grouped into 3 large groups:

Painful symptoms.
Spinal syndrome.
Radicular syndrome.

Each of them has its own dynamics, methods of determination and possible violations.

Pain

This is the first and main symptom. It can change location, intensity, character, manifests itself independently or in combination with other signs. In the early stages, when the size of the hernia is small, pain appears only at the site of projection of the damaged disc. They intensify with sudden movement, heavy lifting or prolonged sitting. This course of the disease (with exacerbations and remissions) can continue for several years. It is at this stage that the disease can be easily stopped by simply adjusting your lifestyle.

As the size of the hernia increases, compression of the membranes or roots of the spinal cord is observed. The pain intensifies when the head is raised or the legs are straightened, and their character may change from acute to aching or shooting.

Diagnostics

Diagnosis and treatment of dorsal hernia is carried out by doctors such as neurologists, vertebrologists, and neurosurgeons. First of all, you should contact a neurologist or vertebrologist. These specialists diagnose the condition of the spine, evaluate symptoms, and identify the location and depth of the lesion. It is impossible to establish a diagnosis without additional research methods. These include:

Magnetic resonance imaging.
This is the gold standard for diagnosing intervertebral hernias. Tomography allows you to see both bone structures and soft tissues. In this way, it is possible to diagnose pathology, determine its type and location, and assess damage to spinal cord structures.
CT scan.
This type of study is used when it is not possible to do an MRI. To a greater extent, it is aimed at assessing bone structures, and to a lesser extent – soft tissues.
X-ray of the spinal column.
This type of examination does not show soft tissue. The presence of a hernia is not visible on x-ray. But this type of study allows us to evaluate the bone structures, location and integrity of the vertebral bodies. Used with CT or MRI.
Lab tests.
A general blood test and clinical urine test are performed. In some cases, a number of additional tests are performed at the discretion of the doctor.

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.

Symptoms

The first symptoms of this disease appear after compression of the nerve endings begins. In the initial stage, pain of relatively low intensity occurs, occurring after certain loads with irradiation into the buttock and leg. As a rule, they are preceded by a crunching sensation in the damaged area of the spinal column. Then the pain syndrome becomes more and more pronounced, accompanied by sensory disturbances, weakness and cramps in the calf muscles, foot, big toe, and stiffness in the lumbar region.

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.

Treatment of L4–L5 disc herniation without surgery

If signs of a L4–L5 hernia occur, you should immediately contact a chiropractor, vertebrologist or neurologist. In this case, it is worth having on hand the results of all the studies performed, so that already at the first consultation the doctor can assess the current situation as fully as possible and immediately prescribe the optimal treatment.

Traditionally, conservative therapy can effectively combat most L4–L5 hernias up to 8 mm in size without surgery. For each patient, the nature of treatment is selected strictly individually, taking into account the concomitant diseases present.

Conservative treatment of L4–L5 disc herniation gives especially good results when its size is no more than 5-6 mm.

But this, unfortunately, is rare in medical practice. Patients have been self-medicating for a long time, relieving lower back pain with ointments or tablets and attributing their occurrence to age. Of course, they are partly right, but such measures only help to temporarily eliminate discomfort, which does a disservice to a person.

He continues to lead his usual lifestyle: lifting weights or sitting at the computer for long periods without breaks. This leads to continued negative effects on already suffering discs and an increase in herniation.

Treatment is always comprehensive, which makes it possible to effectively influence not only the problem itself, but also the causes of its occurrence. Therefore, patients are prescribed:

drug therapy;
osteopathy;
manual therapy;
massage;
physiotherapy (phonophoresis, carboxytherapy, ozone therapy);
individual sessions with a rehabilitation specialist;
diet.

When diagnosing an intervertebral hernia of L4–L5, it is recommended to optimize physical activity. That is, stop lifting heavy objects, and when working sedentarily, get up and move every hour. Slow walks in the fresh air are also considered beneficial.

If at the time of treatment the patient has acute pain syndrome, and MRI shows the presence of a formation larger than 12 mm, hospitalization and strict bed rest are recommended.

Drug therapy

Without exception, all patients treated for L4-L5 hernia without surgery are prescribed drug therapy. It is aimed at solving a whole range of problems in the presence of a L4–L5 hernia, ranging from eliminating the symptoms of the disease to activating the processes of natural restoration of intervertebral discs. The patient is prescribed a complex of medications from representatives of the following groups:

NSAIDs – have analgesic and anti-inflammatory properties;
corticosteroids – give a pronounced anti-inflammatory effect, injected into the epidural space;
muscle relaxants – eliminate muscle spasms, which often cause severe lower back pain;
psychotropic drugs – significantly increase the effectiveness of NSAIDs and muscle relaxants, and also help improve the psycho-emotional state of a patient exhausted by constant pain;
B vitamins – improve nerve conduction and help normalize the functioning of the pelvic organs, which suffer as a result of compression of the spinal roots;
Vitamin D is a remedy responsible for the condition of bone tissue, as well as for higher brain functions, such as memory, memory, attention, and speech.
chondroprotectors – saturate cartilage tissue with components important for its effective regeneration, in particular glucosamine and chondroitin. chondroprotectors - contain natural structural elements of cartilage tissue, but the effectiveness of their use for already formed protrusions has not yet been proven. We recommend Mermaids Marine Collagen to our patients. ;
biostimulants – help increase the intensity of metabolic processes.

All medications are taken in courses, the duration of which can vary within fairly wide limits. The doctor selects specific medications and doses individually, and also describes the specifics of using each of them. This allows you to achieve good results and reduce the likelihood of side effects.

In cases of severe pain, spinal blocks can be performed in a medical facility.

Manual therapy

Manual therapy is prescribed outside the period of exacerbation to each patient in the absence of compelling contraindications. This is an effective method of treating L4–L5 hernias without surgery, since the human spine and intervertebral discs in particular have a natural ability to recover when conditions favorable for this are created. It is this idea that underlies A. Gritsenko’s method. It just allows you to create a positive environment for the spine, in which regeneration processes would occur most pronouncedly.

Also, with the help of this unique proprietary technique, it becomes possible to eliminate the need for surgical intervention. A chiropractor who has fully mastered the method is able to use precise movements to eliminate compression of the nerve and restore the possibility of normal passage of bioelectric impulses through it.

Gritsenko method

Therefore, thanks to the use of Gritsenko’s technique, it is possible to eliminate neurological symptoms without surgery and completely normalize the functioning of the pelvic organs, which so often suffer from a hernia of L4–L5. Most patients note an improvement in their condition after the first session and its increase in the future. They observe:

reduction of pain in the lower back, knees, hips, ankles and feet;
normalization of urination processes;
elimination of swelling of the legs;
increasing potency without the use of specialized medications;
increasing the body's adaptive capabilities;
reducing the severity of inflammatory processes in the prostate gland, which is especially important for men with chronic prostatitis;
increasing immunity and, accordingly, reducing the frequency of colds.

The method has 95 patents and is recognized as a highly effective means of combating neurological disorders caused by spinal pathologies. At the same time, conducting sessions does not require significant changes in lifestyle. They can be combined with work, business trips and other everyday activities.

Manual therapy has a complex effect on the body and allows not only to effectively combat existing diseases and eliminate existing preconditions for the development of others. After all, the spine is in a very close connection with the work of every organ of the human body, so the slightest changes in it respond by disrupting the functioning of the corresponding systems.

But you can only trust manual therapy to highly qualified specialists who have not only a special medical education, but also a license to practice manual therapy. Otherwise, the patient risks not getting the expected result or even facing the problem of deterioration of the condition and the need for urgent surgery.

Physiotherapy

The main method of physical therapy used for L4-L5 hernia is traction therapy or spinal traction. It is designed to increase the space between the L4 and L5 vertebrae to eliminate increased pressure on the disc lying between them. Thanks to this, not only does the regeneration process improve, but also the pressure on the nerve roots decreases.

The procedure is performed in a medical facility. After it, the patient is usually recommended to lie down for a while and then put on an orthopedic corset. It will help maintain the effect achieved during spinal traction.

Also, for L4–L5 disc herniation, the following courses are indicated:

electrophoresis;
laser therapy;
ultrasound therapy;
UHF.

Exercise therapy

Physical therapy also plays an important role in the treatment of L4–L5 hernia in a conservative way (without surgery). A set of exercises individually developed by a rehabilitation doctor helps to strengthen the muscular corset that serves as support for the spine and, accordingly, reduce the load on it.

Initially, patients are offered light exercises, gradually the number of repetitions is increased to the optimal level, and then more effective exercises are replaced. Any changes to the exercise therapy complex can only be made by a specialist. If the patient notices the appearance of pain, a repeated consultation with a doctor and correction of the exercise therapy program is required.

Diet

The diet is aimed at normalizing weight and providing the body with the substances necessary to restore cartilage tissue. Therefore, patients are recommended to switch to fractional meals and eat at least 5-6 times a day, but in small portions, and also enrich the diet with fresh vegetables, fruits, and jellies.

Fatty foods, confectionery and bakery products, and alcohol are prohibited. In general, the diet should not undergo significant changes and the majority of products are allowed for consumption.

Causes of development of lumbar hernia

As a result of deformation of the L1–L5 intervertebral disc, accompanied by a displacement of the nucleus, rupture of the fibrous ring occurs. In this case, quite varied symptoms arise, which depend on which segment is affected.

The development of lumbar hernia is influenced by the following reasons:

spinal column injury (falls, blows);
osteochondrosis and hip dysplasia;
overweight and scoliosis;
incorrect back position when lifting weights;
smoking, which impairs the nutrition of intervertebral structures;
Frequently being in an uncomfortable position.

The appearance of a lumbar hernia is also influenced by a number of provoking factors, among which are the lack of physical activity and hereditary predisposition. Protrusion of the fibrous ring can occur in the presence of spinal pathologies such as spondylarthrosis and ankylosing spondylitis. According to statistics, men are more likely to suffer from lumbar hernia than women. The most susceptible to the development of this pathology are people whose professional activities involve sedentary work and monotonous movements. Infectious diseases can also trigger the development of a pathological process.

What is a dorsal hernia

A dorsal hernia is a protrusion of an intervertebral disc into the lumen of the spinal canal. Each vertebra consists of a body, an arch and several processes. The anterior wall of the vertebral foramen is the vertebral body, and the posterior and lateral walls are the vertebral arch. Located one on top of the other, the holes form the spinal canal. It contains the spinal cord and the initial parts of its roots, which then become the spinal nerves.

Intervertebral discs are located between the bodies of two adjacent vertebrae along the entire length of the spinal column from the cervical region to the coccygeal region. They consist of the nucleus pulposus and the fibrous ring around it. A dorsal hernia is formed when part of the disc breaks through the fibrous ring and rushes back towards the vertebral arch. Thus, the core ends up in the spinal canal, compressing its structures.

Classification of lumbar hernia

Symptoms of intervertebral disc deformation and rupture of the fibrous ring occur due to pinched nerve roots. The nature of the manifestation of a lumbar hernia depends on the area of localization of the pathology.

Typological symptoms of protrusion in the lower spine depending on the damage to the segments:

L1–L2 - accompanied by pain radiating to the intestinal area, which is often mistaken for signs of appendicitis;
L2–L3 - characterized by discomfort in the knee area and impaired functioning of the genitourinary organs;
L3–L4 - lumbar hernia causes disturbances in urination processes, accompanied by pain, limitation of motor activity of the feet and knees;
L4–L5 - accompanied by pain and loss of sensitivity in the area of the toes and feet. Often the pain radiates to the thigh or buttock, which interferes with normal motor activity.

Therapy is prescribed depending on the signs of the disease.

Approach to treating the disease in our clinic

The Paramita clinic has developed a unique approach to the treatment of dorsal hernias. This:

thorough preliminary examination of the patient using instrumental studies and oriental methods;
development of an individual treatment plan for each patient, taking into account the characteristics of the disease;
using a treatment complex that includes advanced European techniques and traditional Eastern methods, which allows you to get rid of a hernia and improve the health of the body as a whole.

We eliminate pain during the first visits to the doctor.

Kinds

In relation to the midline of the abdomen, there are right-sided and left-sided paramedian hernias. They are characterized by compression of the nerve endings extending from the spinal cord to the right and left sides, respectively. When a complex of compensatory reactions is activated, a complication of such types is lameness of the lower limb on the affected side.

According to the nature of the protrusion, it happens:

Posterior and anterior paramedian hernia
- a feature of these types is the prolapse of the hernial protrusion in front of the vertebral body and into the lumen of the spinal canal, respectively. The first case is rare and is characterized by minimal disturbances, while the second requires surgical intervention.
Median-paramedian
- the exit of the nucleus is observed to the side or in the center of the midline.
Paramedian-foraminal hernia
- protrusion occurs laterally towards the spinal root, squeezing it.
Lateral
- localized to the left or left of the spinal column, involving the fibrous ring in its posterior part in the pathological process.
Sequestered
- the core of the intervertebral disc protrudes sideways, partially or completely penetrating the spinal canal.
Bilateral
- damage to the spinal column occurs on both sides.
Dorsal
- the nucleus shifts into the space between the vertebrae.

Recovery prognosis

Conservative treatment brings relief in 70% of cases , but may last several years. The earlier the disease is diagnosed, the more successful it is. If you follow all the doctor’s recommendations, the disease goes into remission, but you must constantly protect the spine by all available means.

In some cases, after additional examination, surgical treatment is required . This is a way to get rid of the disease quickly and for a long time, although in rare cases relapse and even immobilization are possible.

Removal of paramedian hernia

If conservative treatment does not produce the desired result within 2-3 months, surgical intervention is performed. Indications for surgery are:

Pain syndrome that cannot be relieved even with strong painkillers.
Pelvic disorders leading to limited movement.
Disruption of internal organs.
Threat of developing paralysis.

Types of surgical interventions

Today, a paramedian hernia is removed in several ways:

Discectomy
. An open operation aimed at removing the intervertebral disc, its parts and vertebral processes affecting the arteries and spinal cord. For a long time it was a priority method of surgical treatment, but due to the need for general anesthesia and high morbidity, it is rarely used.
Endoscopic discectomy
. The essence of the operation is similar to discectomy, but for its implementation endoscopic equipment is used, which is inserted through a small incision.
Laser vaporization
. Using a laser, the doctor removes the pulpous tissue of the intervertebral disc.
Cold plasma nucleoplasty
. Cold plasma affects deformed vertebrae and pathological areas, as a result of which they decrease in size and cease to put pressure on the nerve endings.

Rehabilitation after surgery

During the rehabilitation period you need to go swimming and wear a corset

To consolidate the results obtained after the operation, the patient will need to undergo postoperative rehabilitation. It includes taking medications (aimed at relieving pain), wearing special corsets (supporting the spine in the correct position, reducing the load) and exercise therapy. Also, during the first month you can be in a vertical position for no more than 1.5 hours.