L5 S1 intervertebral disc herniation: types, symptoms and treatment

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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.

What it is?

Intervertebral discs are a dense capsule, inside of which there is a nucleus in the form of a jelly-like mass. Their names are associated with the location of the corresponding bone structures, i.e. disc is located between the fifth lumbar and first sacral vertebrae, and the L4-L5 disc is adjacent to it and slightly higher .

Most often, a hernia affects two discs located in the lumbar region

Interestingly, the marginal lumbar disc, unlike others, is shaped like a trapezoid rather than a rectangle. And he is most at risk of hernias.

A herniated disc is a rupture of the capsule and release of its contents between the vertebrae . In this case, the disc is deformed, which causes additional protrusion. This compresses the nerve roots that are located inside the spinal canal or adjacent to the vertebrae.

Clinical picture

The clinical picture is that the nerves and other nearby tissues compressed by bulging discs become inflamed, swell and lose functionality.

This is accompanied by such syndromes:

• Painful . The pain is constant, it does not subside when at rest, and intensifies with movement. More often it is localized on the right in the lower back.
• Muscle tension . The muscles near the inflamed spine are swollen and hardened.
• Neurological . It is observed with inflammation of the roots of the nerve trunks responsible for the lower extremities. In this case, there is pain in the sciatic nerve, burning and soreness in the outer part of the lower leg and ankle, both legs or one of them become numb and weak.

The degree of manifestation of each of these signs depends on the size of the pathological protrusion. If it is small, then pain predominates, and with significant pathology, neurological symptoms are pronounced.

Classification and degree

The clinic and treatment of the problem depends on the location and size of the hernia. In most cases, there is a rupture of the posterior and posterolateral part of the fibrous ring of the disc capsule.

In this regard, hernias are divided into:

Depending on the size of the protrusion of the nucleus, there are 4 degrees of severity of the disease:

1. If they do not exceed half a centimeter, then therapeutic exercises are used for treatment.
2. When the value is from 5 to 8 mm, massage and medications are used.
3. If they are in the range from 8 to 12 mm, then treatment procedures are carried out inpatiently with strict bed rest.
4. If the hernia is more than 12 mm, then this is its most severe degree and surgery cannot be avoided.

Prevalence and significance

Herniated discs L5-S1 and L4-L5 are quite common . Most often it occurs in men of average physically active age, but with already manifested age-related abnormalities in bone tissue.

However, even in young people who care little about the health of their back, chronically overloading it, not paying attention to short-term deformations and pinched nerves, advanced forms of hernial pathologies appear over time. This especially applies to long-term chronic osteochondrosis, which affects all age categories, regardless of gender.

Relentless medical statistics claim that 96% of all herniated formations of the spine are localized in the L5-S1 area. Therefore, ignoring their prevention and causes is very dangerous. .

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.

Risk factors, causes

The frequency phenomenon of lesions of this disc is determined:

• A large load falls on this part of the spine due to its connection with the legs, which bear the entire weight of the body.
• Anatomical features of the extreme vertebral disc.
• Increased physical work (carrying and lifting heavy objects), which leads to accelerated destruction of the intervertebral disc due to the high pressure on it.
• Congenital pathologies affecting the strength and endurance of connective tissues (muscles, ligaments, tendons).

The most common causes of these hernias are::

• Injuries due to road accidents, when sudden movements alternate with the head forward and backward. Their consequences often appear one and a half to three years after the accident.
• Dysplasia TSB (birth pathology). In this case, deformation of the joint leads to pelvic distortion and the formation of a hernia after many years.
• Chronic osteochondrosis, accompanied by loss of disc flexibility.
• Bad habits. Smoking – due to deterioration of blood oxygen saturation, the vertebral discs experience nutritional deficiency. Coffee has a negative effect on blood circulation in the tissues adjacent to the vertebrae, and a violation of the diet does not contribute to the health of the supporting apparatus.
• Physical inactivity and a sedentary lifestyle are a direct road to osteochondrosis, and from there it’s not far to intervertebral pathologies.

Provocateurs of disorders in the lumbar region are bending forward with a turn to the side, carrying heavy objects in front of oneself . For those suffering from a lumbar disc herniation, these movements cause sharp, difficult-to-control pain.

Video: “Intervertebral disc protrusion”

Prevention

Prevention of IVD hernia formation is based on a healthy lifestyle and includes:

• cessation of smoking and alcohol abuse;
• fight against excess weight;
• rational nutrition, balanced in the content of essential nutrients, vitamins and minerals;
• sufficient level of physical activity.

It should be borne in mind that not all sports have a beneficial effect on the health of the spine. The most optimal are swimming, gymnastics, yoga, Pilates. But weightlifting leads to overload of the spinal column, worsens metabolic processes in the discs, and provokes the development of osteochondrosis.

Consequences

A medial hernia is especially dangerous due to the risk of damage to the spinal canal . When it is diagnosed early, conservative treatment using traditional methods is possible.

A medial hernia is dangerous because there is a risk of damage to the spinal cord

With serious protrusions of the nucleus, the ligament or even the membrane of the spinal cord may be damaged. And this is fraught with paraparesis and pelvic pathologies of varying degrees. In the worst case, even surgery does not help, and paralysis of the legs is inevitable.

Types of surgical interventions

Typically, surgical intervention for uncomplicated sequestration is a three-stage procedure. First, measures are taken to remove the sequester itself - sequestrectomy, as a source of potential danger. Then the remains of the destroyed intervertebral disc at this level are eliminated, and the third stage is reconstructive plastic surgery. In ideal cases, for example, as in neurosurgical clinics in the Czech Republic and other developed countries of Western Europe, this is prosthetics, that is, replacing the disc with a new one. Modern materials have such good shock-absorbing properties that they can not only successfully compete with the cartilage tissue of healthy young people, but also surpass them in physical and biochemical characteristics.

In domestic clinics, sometimes it is necessary to perform a spinal fusion operation, that is, to fuse two adjacent vertebrae into a single monolith. Quite often, when sequestering a hernia, it is simply impossible to perform traditional surgical interventions, such as microdiscectomy, or laser removal of the hernia due to the significant removal of the sequestration into the cavity of the spinal canal, as well as the massive destruction of cartilage tissue in this segment.

Symptoms and diagnostic methods

With an intervertebral hernia of L4-L5, in addition to pain in the lower back and difficulty moving , there is weakness in the big toe, pain in the buttock and leg, a feeling of “pins and needles” in it and numbness in the fingers . And with a hernia of the lower lumbar region, the pain is localized in the knee, ankle and inside the thigh, and the legs go numb. This misleads the patient regarding the cause and source of pain.

Another disease brings:

• General weakness.
• Sensory disturbances in the limbs.
• Urinary disorder.
• Problems with male potency and libido in women.

These signs do not appear simultaneously, but increase gradually. The appearance of any of them is a signal to consult a doctor.

The most effective diagnostic method for this problem is MRI. Although its procedure is complex, it is the only way to safely and accurately determine the existence of a hernia, its location and size. CT cannot guarantee such an error-free research result, but is used to diagnose hernias along with MRI.

You can learn more about other types of herniated discs in the following articles:

• You can find out what types of intervertebral hernias there are here
• Symptoms and diagnosis of C5-C6 disc herniation in the cervical region
• Why a hernia in the thoracic region is dangerous and how to treat it can be read on the page pozvonochnik/drugie-zabolevaniya/mezhpozvonochnaya-gryzha/grudnoi-otdel.html

Treatment

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The choice of treatment methods is related to the severity of the disease and the location of the problem area . At the initial stage, its goal is to minimize the load on the lumbar area; in most cases, bed rest and selection of an immobilizing corset are prescribed. There are several conservative treatment methods and surgical ones.

Medicines

Basic treatment with drug therapy is aimed at the following effects:

Surgery

It is used only when the conservative method is ineffective:

• If, despite taking medications, the pain does not subside for more than a month.
• In case of pronounced neurological pathologies with impaired leg movement.
• With progressive compression of the nerve roots against the background of immobility of the legs.

Treatment is carried out traditionally or using endoscopic technology (with minimal trauma). In this case, the destroyed parts of the disc are removed, which compress the nerves and adjacent tissues.

Removal of the median hernia is performed endoscopically

Exercise therapy, massage

The set of exercises for vertebral hernia is divided into 3 types: flexion, extension and traction. Only a specialist can combine these movements.

But there are general rules for exercise therapy for these pathologies:

• The muscles are pre-warmed. To do this, the body is rubbed, lightly pinched and patted, ensuring blood flow to the superficial vessels.
• The movements are smooth and slow, not abrupt.
• Twisting and maximum bending should be avoided.
• Jumping, pushing and aerobics are prohibited.

Massage serves to stimulate blood circulation in the problem area , relieve swelling, and improve metabolism. It is not used in the acute period with severe pain.

Treatment at home

Home treatment is possible only for the first and second stages of the disease , which corresponds to a protrusion of the hernia of no more than 8 mm. At the same time, exercise therapy classes are regularly attended under the guidance of a specialist, qualified massage is used, and if necessary, a course of drug therapy prescribed by a doctor is included. Physical activity is excluded, but movement is not contraindicated. Therapeutic walking in the air is practiced, and time at the computer is strictly dosed.

Prevention

To prevent and treat the disease, laser, magnetic and ultrasound therapy, mud therapy, other physiotherapeutic procedures, massage and exercise therapy are used . These procedures are combined with vitamin therapy, a balanced diet, and sometimes with a fasting diet.

The main prevention of spinal hernias is physical exercise.

Giving up bad habits and unhealthy foods reduces the risk of depletion of intervertebral discs. To avoid physical inactivity, you should not forget about daily walks in the air. To keep your discs hydrated, it is important to drink plenty of still water regularly.

People with a predominance of physical labor need to pay special attention to the dosage of physical activity , and if this is not possible, then wear special belts and bandages that protect the spine from overstrain. When lifting weights, you need to keep your back straight and squat, bending your legs. And when driving in a car, you should not forget about seat belts.

Removal of dorsal hernia

Removal is not the primary treatment method. Surgical intervention is resorted to if there are indications.

Indications for surgical treatment:

• Large size hernia (more than 10mm).
• The presence of paresis or paralysis.
• Lack of sensitivity due to compression of the nerve roots.
• Disorder of the function of the pelvic organs.
• Failure of conservative treatment for three months.

We use non-surgical hernia treatment techniques
Read more about our unique technique

Types of surgical interventions

• Microdiscectomy
  is the removal of the disc along with the hernia through a paravertebral incision 2-3 cm long, used for relapse.
• Laminectomy –
  resection of part of the intervertebral disc along with the hernia through a small incision, used for relatively large protrusions.
• Endoscopic discectomy
  is the removal of a hernia or disc using special endoscopic instruments, performed through a puncture in the skin and minimal incisions.
• Nucleoplasty
  is also a minimally invasive technique that allows you to destroy hernias by introducing various substances into the disc, and is used for small sizes.

Rehabilitation after surgery

Therapeutic exercises and swimming help to recover faster after removal of a dorsal hernia

During the rehabilitation period, it is recommended to continue treatment. Preference should be given to the same physiotherapeutic interventions that were used before surgery. For example, in case of severe pain, electrophoresis with Novocaine is used.

Read more about electrophoresis here.

It is important to start physical therapy on time. Light gymnastic exercises under the supervision of an instructor are suitable for this. In the late rehabilitation period, when postoperative wounds have healed, it is recommended to go swimming in the pool.

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.