Paramedian hernia - causes, types and treatment methods

Paramedian disc herniation is a pathology in which part of the intervertebral discs is displaced into the spinal canal, which leads to compression of the spinal cord on one or both sides. The causes of the disease are injuries or chronic degenerative diseases of the spine:

scoliosis;
osteochondrosis;
dysplasia.

It is worth noting that this type of hernia is quite common and is considered the most dangerous for human health, as it can lead to disability.

Depending on the type of operation and category of complexity from 100,000 - 250,000 rubles.

Included in the price:

surgery, anesthesia, dressings, medications, food and hospital stay, observation by a surgeon in the postoperative period.

40-60 minutes

(duration of operation)

2-3 days in hospital

Indications

persistent and severe symptoms of compression of the spinal nerves by a herniated disc, not amenable to conservative therapy
the patient's desire to get rid of pain

Contraindications

chronic diseases in the stage of decompensation
acute inflammatory processes in the body

Features of paramedian hernia

A distinctive feature of this hernial defect is the protrusion of disc contents to the left or right of the dural sac, into the spinal canal. This leads to compression of the spinal cord on one or both sides, compression of the nerve roots and/or rupture of the fibrous ring, which prevents the destruction of the disc.

Because a paramedian hernia puts pressure on the spinal cord and can increase in size over time, there is a risk of damage to spinal structures. Most often, this pathology is a consequence of a natural degenerative process in the spinal column, which results in increased pressure on the intervertebral discs.

The physiological purpose of the intervertebral disc is to act as a shock absorber that prevents friction between the vertebrae. It also takes part in ensuring flexibility and mobility of the spine. Therefore, when it is exposed to strong pressure from a paramedian hernia, it becomes deformed and gradually goes beyond its anatomical boundaries. An inflammatory process may begin at the site of its formation. If left untreated, it spreads throughout the body.

This diagnosis is considered one of the most dangerous, because in the absence of timely medical intervention, the pathological process becomes irreversible, leading to disability of the patient.

The mechanism of formation of intervertebral disc herniation and symptoms of the disease

Degenerative processes in the spine, leading to the appearance of herniated intervertebral discs, develop mainly in people with a corresponding hereditary predisposition, detected in 48% of the population. From about 18-35 years of age, aging of the spine and reactive changes begin as a result of the degenerative process that occurs in the intervertebral disc. Since the disc has a poor blood supply, it is nourished by the diffusion of nutrients from the ligaments that surround the disc at the periphery and the blood-supplied bone covered with cartilage. With age, the level of diffusion to the nucleus pulposus decreases, which affects the synthesis of collagen and proteoglycans, and leads to drying of the disc. As the disc dries out, its resistance to mechanical stress decreases. Cracks form inside the annulus fibrosus and facet joints. This process develops under the influence of hormonal changes and pathological impulses from various tissues, and the main role in the formation of the disease is played by static and dynamic loads.

The nucleus pulposus first swells, then dries out, the disc flattens, and the annulus fibrosus begins to bulge, forming a protrusion of the intervertebral disc. Cracks and breaks appear in the dystrophically altered collagen fibers of the fibrous ring. herniation, disc outside the fibrous ring . If this formation loses connection with the disk, it becomes sequestered . In case of penetration of the disc substance into the vertebral body, the so-called “Schmorl’s node” is formed.

There are median, paramedian and lateral hernias. Medial hernias are those that are located anterior to the posterior longitudinal ligament. Paramedian hernias form partly behind the posterior longitudinal ligament, partly outside it. Lateral hernias are located outside the posterior longitudinal ligament. Through cracks in the fibrous ring, vessels begin to grow into the zone of the nucleus pulposus, and the process of fibrosis and calcification begins in the nucleus, which ultimately leads to laxity of the spinal motion segment.

The degenerative process in discs under the influence of static-dynamic overload of the spinal motion segment is facilitated by acquired and congenital features of the spine. A decrease in the number of discs also leads to their overload (sacralization of L5, congenital synostosis, injury to an adjacent disc, compression fractures of adjacent vertebrae, etc.). Endocrine disorders also lead to dystrophic processes in the disc, for example, in hypothyroidism, the synthesis of collagen, in which thyroxine is involved, is disrupted. In addition to the spine itself, the support, statics and biomechanics of the spinal segment are determined by the muscles surrounding it. Muscular-tonic tension arising as a result of pathological impulses from the affected spinal segment becomes persistent over time. Painful hardness, nodules and dense cords appear in the muscles. Dystrophic processes develop in poorly blood-supplied areas of attachment of tendons and other fibrous tissues to bone protrusions (the so-called neuroosteofibrosis, which is also the result of muscle-tonic tension). In persons with insufficiently symmetrical innervation, with reduced dexterity and imperfect prediction of motor situations, discoordination easily occurs in the work of the muscles of the spinal segment and the entire spine. This occurs during a sharp turn, lifting weights, pregnancy, in the postpartum period, etc. With an unexpected load in the spinal segment, a shift of its elements, protrusion and prolapse of the disc easily occur.

When a hernia affects the spinal root, so-called radicular symptoms: pain, numbness, tingling in the segment of the arm or leg corresponding to the innervated root. In advanced cases, weakness occurs during certain movements (paresis) or their complete absence (paralysis), as well as dysfunction of the pelvic organs (for example, urinary incontinence).

Reasons for development

The main etiology of the disease is an age-related degenerative process, leading to a decrease in the free space between the vertebrae and an increase in the likelihood of the formation of a hernial sac. Therefore, paramedian hernia is often diagnosed in elderly people.

There are a number of factors that increase the risk of its occurrence before age 50. This:

Injury to the cervical spine and/or back.
History of scoliosis, osteochondrosis or dysplasia.
Hereditary predisposition.
Excessive physical stress on the spinal column (heavy physical work, participation in strenuous sports, prolonged stay in a static position, etc.).
Incorrect body position when lifting or carrying heavy objects.
Large excess weight.
Underdeveloped back muscles (due to related problems, sedentary lifestyle).
Metabolic disorder caused by deficiency of Ca and P.
Congenital diseases of the spine.
The presence of systemic pathologies affecting small joints (ankylosing spondylitis, rheumatoid arthritis).
Incorrect foot placement (flat feet, club feet).

What it is

The intervertebral disc consists of two structures - an elastic fibrous ring on the outside, which acts as a shell, and the nucleus pulposus inside, which has a gelatinous structure. During degenerative processes and excessive physical activity, the vertebrae compress the disc, the fibrous ring gradually loses its elasticity, then ruptures and the pulp comes out through it, to the side of the spinal column - to the left or to the right. This is how a paramedian hernia is formed.

Such a hernial protrusion is dangerous because it pinches the nerve endings of the spinal cord and vertebral artery, which leads to dysfunction of the internal organs and neurological disorders.

The lumbosacral spine takes on the maximum load, so a paramedian hernia often develops there. Less commonly appears in the cervical and thoracic regions.

Degenerative-dystrophic diseases of the spine are diagnosed in 10–90% of the entire population of our country. Disability is assigned in 42% of patients with intervertebral hernia. Paramedian hernia is diagnosed more often in people of working age - from 35 to 60 years (source - scientific article “Experience in the treatment of patients with herniated intervertebral discs at the lumbar level”, authors - V. A. Sorokovnikov, Z. V. Koshkareva et al., Federal State Budgetary Institution "Scientific Center for Reconstructive and Restorative Surgery" of the Siberian Branch of the Russian Academy of Medical Sciences of Irkutsk).

What is the danger?

Paramedian disc herniation requires treatment, preferably in the early stages of development. This is due to the fact that in the absence of timely therapy, pathologies of the musculoskeletal system develop, the ability to carry out full movements is lost and, as a result, the inability to care for oneself independently (disability). Doctors at our clinic make every effort to prevent such an outcome, making life easier for patients.

Each type of intervertebral hernia has serious complications, so you should not delay treatment.
See how easy it is to get rid of a hernia in 10 sessions

One of the main consequences of this pathology is severe and debilitating pain in the back, which is difficult to respond to painkillers. This pathological change affects not only locally, so there is general weakness, fatigue, loss of mood and sleep problems. With further progression, paresis, muscle atrophy and paralysis of the limbs are possible. Paramedian disc herniation L5-S1 leads to the appearance of cervicogenic dizziness. They do not cause a major impact on health, but they do affect a person’s quality of life.

A serious and dangerous consequence of this disease is compression and mechanical damage to the spinal canal, since nerve endings responsible for the innervation of internal organs originate from it.

If they become pinched (especially in the lumbar spine), cauda equina syndrome may occur, which is characterized by:

intense pain in the lower back, spreading to one or two lower limbs;
impaired sensitivity of the perineum and inner thigh, leading to numbness or tingling of the skin;
weakness in the legs;
absence of tendon reflexes in the legs, deterioration of the tone of the anal sphincter.

Symptoms and diagnosis

In the initial stages, the patient does not always suspect that he has a serious disease, because the pain is not very strong until the disc protrusion is small.

The main symptoms of a dorsal lumbar hernia:

pain in the lower back, also often in the buttock and leg;
numbness of the leg;
decreased sensitivity of the legs and gluteal muscles;
with decreased sensitivity and numbness (radicular syndrome), there may also be dry skin or, conversely, increased sweating;
weakness of foot flexion;
decreased or absent knee and Achilles reflex on the affected side (Lasegue syndrome).

The severity of symptoms depends on the size of the hernia or its proximity to the spinal roots. If the pain is severe and there is a decrease in the sensitivity of the limbs, this indicates a serious stage and the need to urgently begin treatment.

The main and most accurate method for diagnosing a hernia is MRI . This method allows you to see:

direction of the hernia;
dimensions;
How compressed is the spinal canal?

An alternative diagnosis is CT, but it only shows the presence of a protrusion without detailed parameters.

Localization

Paramedian disc herniation is localized in the cervical, thoracic, lumbar and lumbosacral regions

Cervical spine (segment C5-C6)

The cervical vertebrae are the most vulnerable to injury. This is due to their small size, high mobility and underdeveloped muscle corset. A paramedian hernia in the cervical spine occurs due to injury (often during an accident), a sharp (whiplash) tilting of the head back, physiological abnormalities and inflammation in the soft tissues.

Symptoms include pain in the upper extremities, weakness, headaches, and inability to perform daily tasks.

Want to learn more about cervical hernia? Read our article.

Thoracic region (segment T7-T8)

Paramedian hernia in the thoracic region is rare. It is difficult to diagnose, as it can masquerade as angina, pneumonia, myocardial infarction and lung abscess. The patient feels pain and a feeling of pressure in the chest, especially when bending forward. Hypoxia and shortness of breath are possible.

Lumbar (segment L4-L5)

A paramedian hernia in the lumbar region is diagnosed in people who lead a sedentary lifestyle with sedentary work. Due to the fixed state of the spine, the pressure on the intervertebral discs in the L4-L5 segment increases, which leads to impaired blood circulation and the integrity of the surrounding anatomical structures. The patient suffers from pain in the lower back, spreading to the legs.

Lumbosacral region (segment L5-S1)

Median paramedian L5-S1 disc herniation is the most common. This is due to the large load on this area in any position of the body. It often leads to serious complications, including neurological disorders, dysfunction of internal organs, and inability to move. If cauda equina syndrome occurs, surgery cannot be avoided.

Read all about lumbar hernias in this article.

Surgical treatment of intervertebral disc herniation

In the Department of Spine Surgery of the Russian Scientific Center for Surgery named after. Academician B.V. Petrovsky, as a rule, microsurgical discectomy according to Caspar - the world “gold standard” for the surgical treatment of intervertebral disc herniations. The idea of this operation is to be minimally invasive while maintaining wide possibilities for its implementation.

First, an accurate marking of the level of the affected intervertebral disc is made using , which leads to minimization of intraoperative trauma to the muscles, ligaments and bony spinal structures. Surgical access is made through a skin incision, the size of which does not exceed 3-4 centimeters. The bone structures of the spine are not resected, which allows maintaining the support and stability of the operated segment. All manipulations in the spinal canal are performed under control

, which guarantees the safety of the operation. a dynamic implant DIAM is installed between the spinous processes of adjacent vertebrae , the main advantage of which is the preservation of the full range of movements in the operated segment. The surgical wound, in the absence of contraindications, is sutured with a cosmetic intradermal suture, which makes the postoperative scar virtually indistinguishable later.

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.

Dorsal hernia and stages of the disease

How do hernias form?

The mechanism of hernia formation is determined by the structure of the intervertebral disc. It consists of the nucleus pulposus (a jelly-like substance) and a tough multilayer fibrous membrane (annulus fibrosus). Protrusion of the contents (nucleus) through a weak point of the fibrous capsule leads to the formation of hernias.

Stages of kernel falling out:

Disc degeneration	The displacement has not yet occurred, but there is a weakening of the disc structure due to chemical processes, age, and stress.
Prolapse (3-6 mm)	A protrusion of the nucleus has already appeared, but the fibrous membrane is not damaged, the nucleus remains inside the disc.
Extrusion	The nucleus pierces one or more layers of the annulus fibrosus, but still remains inside.
Sequestration	All layers of the fibrous membrane are damaged, and the core extends beyond the disc.

Dorsal (posterior) hernia is a general name for that stage of disc protrusion when there is actual or threat of infringement of the nerves located in the intervertebral canal, as well as the membranes and substance of the spinal cord.

With a hernia in segments l5-s1 and l4-l5, only the spinal roots are damaged, but the spinal cord is not affected.

They also differ in the direction of fallout:

Circular. The disc falls out from all sides.
Median. The direction of the prolapse is to the center of the spinal canal.
Foramilnaya. Infringement of the 5th lumbar root, directed into the intervertebral canal.
Paramedian l5-s1. It is directed to the center of the spinal canal and infringes on the 1st sacral root. In this case, there is a curvature of the spine in the opposite direction from the hernia.
Diffuse. Uneven protrusion without rupture of the annulus fibrosus. Typically, this definition means up to 50% disc damage.

Clinical picture

Signs of paramedian disc herniation directly depend on the affected part of the spine. But all patients experience common symptoms, including sudden sharp pain (in the later stages it acquires a constant aching character), headaches and dizziness, loss of sensitivity, numbness, surges in blood pressure, increased body temperature (especially in the presence of an inflammatory process), vestibular dysfunction. apparatus, numbness of smoked meats, stiffness of movements.

What types of intervertebral hernias are most difficult to treat?

4 stages of treatment for intervertebral hernia

Symptoms of paramedian hernia in the cervical spine

Dizziness, headaches (against the background of increased blood pressure), hearing and vision impairment, constant pallor or redness, numbness of the facial skin, decreased memory, poor concentration are the main signs of this type of hernia.

With protrusion in the C5-C6 segment, the following also appears:

hypotension or hypertension;
pain in the hernia area;
loss of sensation in the upper extremities;
dizziness (up to loss of consciousness), tinnitus.

Symptoms of paramedian hernia in the thoracic region

Skin tingling and pain are the first symptoms of a paramedian hernia in the thoracic region

The main signs of a hernia that occurs in the T7-T8 segment include tingling of the skin, a feeling of pressure behind the sternum, pain in the stomach, loss of sensation in the legs and arms, and indigestion. The patient may experience shortness of breath, poor posture, chest pain that worsens when bending forward, and stiffness in movements in the torso.

Read more about the symptoms and treatment of thoracic hernias here.

Symptoms of paramedian hernia in the lumbosacral region

Such a hernia is manifested by the following symptoms: pain radiating to the lower extremities and tingling in the feet, gait disturbance (claudication), numbness, loss of sensation.

A hernia in the L4-L5 segment can be recognized by the following symptoms:

tremor;
swelling of the lower extremities;
weakness in the legs;
fecal and urinary incontinence;
erectile dysfunction in men;
disruption of the menstrual cycle in women.

Signs of a hernia in the L5-S1 segment:

burning, loss of sensitivity, swelling in the lower extremities;
scrotal numbness
atrophy and paralysis (in later stages).

Risk factors, causes

Frequent causes of hernia development are spinal injuries. The most common cause of disc damage is considered to be traumatic lesions of the spine. A strong dynamic impact on the posterior surface of the spinal column often causes displacement of the disc due to its weaker fixation compared to the vertebrae.

A direct blow directed to the area of the transverse processes of the spine and combined with forced rotational movements and muscle tension (when lifting weights, flexion movements, sudden straining, jumping from a height, falling) leads to traumatic deformations of the disc. The main risk group in this case are athletes involved in basketball, boxing, weightlifting, and powerlifting.

The second most common cause of disc damage is associated with significant pressure on the spinal column, in which the acting force is directed downward. This situation usually occurs when transporting heavy objects directly on the shoulder, without using devices that reduce the load on the spine. People whose occupation involves hard physical work (farmers, builders, riggers, loaders) are susceptible to pathologies of this kind.

Other possible causes of hernia formation are:

hereditary predisposition;
congenital anatomical features of any segment of the spine;
age-related changes occurring in the tissues of the spine;
metabolic disorders and obesity;
sedentary lifestyle;
the presence of inflammatory processes of the intervertebral disc or capsules of the intervertebral joints;
Bekhterev's disease;
neoplasms (chondromas) in the cartilaginous part of the discs.

The risk group also includes people who have suffered from dysplasia, scoliosis, and osteochondrosis for a long time: these diseases, as they progress, lead to protrusions and ruptures of the fibrous ring.

Video: “Lecture on the causes of L4-L5 disc herniation”

Pay attention to other types of intervertebral hernias:

You can read about the consequences and treatment of median disc herniation on the page pozvonochnik/drugie-zabolevaniya/mezhpozvonochnaya-gryzha/mediannaya-gryzha-diska-l5-s1-i-l4-l5.html
What is a foraminal disc herniation and how it is treated can be found here
What are the types of intervertebral hernias based on the size and direction of protrusion?

Diagnostics

To identify a paramedian disc herniation, consult a neurologist, vertebrologist or orthopedist. At the first visit of the patient, a detailed medical history is collected (genetic predisposition, lifestyle, occupation, physical activity, previous injuries, concomitant diseases, etc.). During the examination, muscle weakness, decreased sensitivity in some areas of the body, dullness or absence of tendon reflexes will be determined.

Using palpation, the doctor examines the spinal column, determining the location of pain. After this, the patient receives a referral for further examination, which will confirm the diagnosis and understand the degree of neglect of the pathological process.

For this, the following diagnostic methods are used:

X-ray
– reveals degenerative changes in the bone tissue of the spine and its destruction, but does not visualize cartilaginous structures.
Electromyography
is necessary to assess the conductivity of muscle tissue and nerve endings.
CT scan
makes it possible to obtain layer-by-layer images of the spinal column. Due to poor image quality, it is used only in the absence of MRI.
MRI
is the most popular and informative diagnostic method, allowing one to obtain detailed three-dimensional images of the vertebrae and their tissues. It is the main way to diagnose paramedian disc herniation.

Recovery prognosis

The prospects for cure depend both on the localization of the hernial formation and on its timely diagnosis . Treatment of a clinically recent neurologically uncomplicated paramedian hernia usually results in complete recovery.

This process takes from six months to a year if the correct motor regimen is observed, eliminating loads on the spinal axis and sudden rotational movements. Improving the prognosis largely depends on the patient himself.

Treatment without surgery

At the initial stages of the disease, for which there are no complications, conservative therapy is allowed. It is aimed at improving the patient’s quality of life and eliminating severe symptoms.

First aid for an attack of illness

When faced with an exacerbation of the disease or the first attack of pain, it is necessary, first of all, to stop and stop the current activity, take a position lying on your back on a flat surface, with your arms extended along your body. Already in a lying position, you need to slowly, without sudden movements, take a comfortable position that relieves pain: raise your lower back, twist a little to the right or left, pull your shoulders to your neck, etc. After this, you will need to take several deep and slow breaths to normalize your breathing. It is possible to take analgesics or NSAIDs.

Drug therapy

Preparations for drug therapy of paramedian hernia

The basis of drug therapy for paramedian hernia is 4 groups of drugs:

Analgesics
– for quick relief of pain (Ketanov, Ketoprofen);
Non-steroidal anti-inflammatory drugs
- eliminate the source of inflammation, local swelling and reduce pain (Diclofenac, Ibuprofen);
Muscle relaxants
– relieve muscle spasms, alleviating the patient’s condition (Mydocalm).
B vitamins
- play an important role in restoring metabolism, strengthening neural connections and blood circulation (Milgamma).

To relieve acute pain, a blockade of the affected part of the spine is performed using analgesics in combination with hormonal drugs (for example, Lidocaine with Dexamethasone).

Folk remedies

Among the methods of alternative medicine, rubbing from a mixture of mumiyo and honey in a ratio of 1:100 is effective. To prepare this mixture, you need to dissolve the mummy in a small glass of water and add honey. This paste should be rubbed on the hernia site before going to bed.

St. John's wort, birch and fir oil also show good results. It is recommended to rub them into the skin in the spine area with massage movements. To enhance effectiveness, it is recommended to use patting movements on the back. After completely absorbing the oil, the lower back should be wrapped in warmth.

Physiotherapy

Magnetotherapy – with the help of a constant or alternating low-frequency magnetic field, blood circulation, the condition of bone and cartilage tissues are improved, and the risk of relapses and complications of the disease is reduced.
Acupuncture - significantly reduces pain, eliminates muscle spasms, and normalizes intercellular metabolic processes.
Electrophoresis - helps eliminate spasms, relieves pain, strengthens the muscle corset, and helps restore posture.

Exercise therapy

Physical therapy for paramedian hernia is carried out exclusively in the remission stage. The set of exercises is chosen by the attending physician (it depends on the severity of the symptoms). Exercise therapy is performed at least 3-4 times a week for 1-2 months. Sudden movements, jumping and heavy loads are strictly prohibited. To relieve tension from the cervical spine when performing exercise therapy, a special fixing collar is used to immobilize the neck.

In case of paramedial hernia of the lumbar spine, lying on the stomach, it is recommended to flex and extend the leg at the hip, holding it for 5-7 seconds in an extended position. In a lying position, you can move your right and left legs away from your body in turn. These exercises strengthen the muscle frame, eliminate spasm and reduce pain.

Massage and manual therapy

Several massage techniques are used to treat paramedian hernia: classical, acupressure, vacuum, honey and Swedish. Hydromassage, which involves influencing the spine with an active water jet, shows good results. To improve the condition, you need to undergo a massage course of 10-12 sessions.

Manual therapy is a set of manual techniques that eliminate displacement of discs and vertebrae. It restores the physiological curves of the spine, increasing the distance between the vertebrae, which reduces compression of the nerve roots. This helps increase mobility, reduce soreness and muscle spasm.

Traction therapy

During the traction process, the paravertebral ligaments and muscles, articular elements and intervertebral discs are stretched. As a result, intradiscal pressure decreases, and the distance between individual vertebrae increases by 2-4 mm. This is enough to eliminate pain caused by compression of the nerve root.

Lumbar hernia

What is a lumbar hernia?

The intervertebral disc consists of a nucleus pulposus and a dense elastic membrane surrounding it - the fibrous ring. A rupture of the annulus fibrosus and protrusion of part of the nucleus pulposus through it is called a disc herniation.

Features of lumbar hernia

The lower back is the most overloaded part of the spine. But even against this background, the last two discs stand out especially. After all, in addition to the vertical load, they account for the bulk of bending, bending and rotation in the lower back. This feature predetermines the greatest risk of hernias in this place. More load means more wear. Therefore, as practice shows, lumbar hernias most often occur between the 4th and 5th vertebrae (L4–L5 disc herniation), as well as between the fifth lumbar vertebra and the sacrum (L5–S1 disc herniation).

The lumbar spine consists of five vertebrae, between which are intervertebral discs. The vertebrae and discs are counted from top to bottom. The lumbar vertebrae are designated by the Latin letter “L” - from the Latin word “Lumbus” - lower back and a serial number from 1 to 5 - L1, L2, L3, L4, L5. Discs are designated differently. The dash seems to indicate between which vertebrae the disc is located: L1–L2, L2–L3, L3–L4, L4–L5, L5–S1. "S" stands for "Sacrum" - sacrum. Depending on which disc is affected and in which direction the hernia protrudes - back or to the side, the symptoms of a lumbar hernia will depend.

Symptoms of a lumbar hernia

The presence of a hernia affects both the spine itself and the nerves and blood vessels. Therefore, the symptoms of a lumbar hernia are usually divided into groups - into vertebral and non-vertebral. Extravertebrates, in turn, are divided into reflex and radicular. Since the group of symptoms is called a “syndrome,” we can say that all the symptoms of a lumbar hernia are combined into three syndromes: vertebral, reflex and radicular.

Spinal syndrome manifests itself:

Violation of the configuration of the spine (curvature).
Tension of the lower back muscles;
Impaired lumbar mobility;
Local pain in the lower back;

These symptoms of a lumbar hernia are caused by increased tone of the paravertebral muscles. Which, in turn, leads to distortion of the torso and temporary scoliosis. At the same time, the range of movements decreases - it is difficult for the patient to walk, stand up and sit down.

Physical activity, prolonged uncomfortable position, hypothermia, stress are factors that aggravate the symptoms of a lumbar hernia.

Reflex syndrome. Its basis is considered to be pain in the lower back or leg. It may be constant or worsen after physical activity or awkward movement. Malfunctions in the functioning of the intestines, bladder and other internal organs occur. Sexual function suffers. Sleep is disrupted due to pain. Mood swings, irritability and fatigue are noted. Sometimes depression occurs. The sensitivity of the lower extremities is impaired - numbness, goosebumps, piercing or burning. Sweating increases. There are shootings. Gait and coordination changes.

Radicular syndrome - occurs due to the impact of a hernia on the nerves exiting the spine.

Spinal nerves

There are many nerves coming out of the spine. They are called spinal nerves. Each such nerve gradually branches and follows a specific area of the body with clearly defined boundaries. This area is called the zone of segmental innervation. Each vertebra, disc, nerve and zone are numbered, strictly corresponding to each other. If a nerve is exposed, the symptoms will appear in the zone of segmental innervation corresponding to that nerve, and not just anywhere - in an arbitrary place.

Remember! Radicular syndrome is a key sign of disc herniation. If an MRI reveals a disc herniation, but there is no radicular syndrome, then the detected hernia does not affect the nerve and is not the cause of pain.

Such hernias are called “silent”, in contrast to clinically significant hernias.

In such cases, the pain is not caused by a hernia at all, but by some other diseases that can occur in parallel with the detected hernia. And then there is no point in fighting a hernia. To eliminate pain, these “other” diseases must be identified and eliminated. But the paradox is that we only see what we know. Therefore, if the doctor does not know that there are diseases similar in symptoms to a hernia, then how can he eliminate them? But it often happens that a hernia causes pain, and it is also accompanied by “another” disease, which also makes its contribution. And then the pain becomes completely unbearable, and the symptoms become intertwined.

To eliminate pain, you need to have a good understanding of these intricacies. Now do you understand how important it is to find an experienced and knowledgeable doctor?! After all, the exact diagnosis and treatment results will depend on the doctor, and not on the MRI images!

When choosing a clinic, the main thing is to get to an experienced and knowledgeable doctor.

Radicular symptoms of lumbar osteochondrosis include:

Decreased or lost reflexes;
Muscle weakness;
Impaired sensitivity;
Radicular pain.

Localization of radicular symptoms of lumbar hernia

Innervation zones of the lumbar segments

Upper lumbar disc herniation L1–L2 and L2–L3

They are extremely rare, and they affect the nerve even less often.

L3–L4 disc herniation

affects the L4 spinal nerve. Main signs: weak knee reflex. Pain, numbness and decreased sensitivity occur along the front surface of the thigh.

L4–L5 disc herniation

affects the L5 spinal nerve. Main signs: weakness in the muscles that lift the big toe and foot. It is difficult for the patient to stand on his heel. Pain, numbness and decreased sensitivity occur from the lower back to the buttock and thigh “along the stripes”, then through the lower leg, gradually moving to its front part and ending in the first three toes.

L5–S1 disc herniation

affects the spinal nerve S1. Main signs: weakness in the calf muscles. It is difficult for the patient to stand on his toes. Pain, numbness and decreased sensitivity are detected from the buttock, further along the back of the thigh and lower leg, moving to the lateral surface of the foot and little toe.

Radicular syndrome is the main clinical sign of disc herniation. The absence of radicular syndrome in the presence of a hernia indicates that the detected hernia is “silent”.

How can you tell if pain is caused by a hernia?

The nerve exits the spine near the disc. Next, the nerve follows to a certain area of the body that it innervates. Each disc, nerve, and zone has labels that correspond to each other. To simplify a little, we can say that each hernia corresponds to a specific zone, where the symptoms of a lumbar hernia appear. That is, in order to understand whether the hernia detected on the MRI is the cause of the pain or whether this pain has other causes, you need to check the symptoms in the area that corresponds to the detected hernia. If everything matches, then yes - the pain is caused by a herniated disc. And if not, then the doctor should analyze the situation further and continue to look for the disease that caused this pain, and not adjust the diagnosis to the hernia detected on the MRI.

It is important to know!
Lumbar hernias are often combined with myofascial syndrome. This can significantly change the picture of the disease.

Causes of lumbar hernia

It is necessary to understand that the causes of a lumbar hernia do not stop at the moment of its appearance, but continue to exist along with the hernia. This can be thought of as parents and child. They conceived and gave birth to him, but their life is not over - they continue to live and are able to give birth again. So are the reasons - continuing to exist, they are capable of forming more than one new hernia, as well as increasing the size of the existing one. However, not everything is so hopeless. Medicine has the ability to eliminate or at least minimize the effect of some causes. And this is quite enough to cope with existing hernias and prevent the appearance of new ones.

The causes of lumbar hernia can be divided into two groups: main and additional.

The main ones are dystrophy, dysplasia and muscle imbalance.

Additional ones are scoliosis, overload, trauma and microtrauma.

Read more about the causes of lumbar disc herniation in the article “Causes of disc herniation.”

Statistics say: pain due to a hernia occurs more often in middle age. At a young or older age, even if there is a hernia on MRI, it is worth analyzing other possible causes of pain, for example, myofascial syndrome. Its manifestations are often confused with those of a hernia.

Treatment of lumbar hernia

The first thing to do if pain occurs is to reduce the load to a minimum and, of course, consult a doctor. The question is - which one?

The main type of non-surgical treatment for lumbar hernia is manual therapy. Other types of treatment - massage, medications, physiotherapy and exercise therapy - are auxiliary. It’s like choosing a medicine for pneumonia - you can’t do without an antibiotic. Likewise, with a lumbar hernia, the main thing is manual therapy.

At the Spina Zdorova clinic, we use all methods of treating lumbar hernia that are available in soft manual therapy:

Postisometric relaxation;
Facilitation;
Inhibition;
Recoil;
Articulation;
Deep tissue massage;
Myofascial release.

The qualifications of the doctors at the Spina Zdorova clinic allow us to freely use these and other methods to treat lumbar hernia. In addition, in each specific case, we combine them, taking into account the synergy effect.

What is synergy?

Synergy is not just a heap of different effects, it is the correct sequence in the combination of methods. Synergy leads to additional quality of treatment. An example from life is our hands. How long does it take to fasten a button? Seconds?! And if you do it with one hand, you may not be able to do it in a minute. That is, to act with two hands is not twice as fast as with one, but many times faster. Is there a difference between listening to the same music performed by individual instruments or by the whole orchestra together? This is the effect of synergy - it makes it possible to do everything much more powerfully, efficiently and quickly, but at the same time more carefully. This also applies to treatment at the Spina Zdorova clinic.

Auxiliary methods - medications, massage, physiotherapy and exercise therapy

Treatment with drugs. When treating lumbar hernia, medications of various spectrums of action are used. These are drugs that relieve deep tissue swelling, inflammation and pain. Drugs that improve blood circulation. In addition, they use drugs that help restore damaged cartilage tissue of the disc and pinched nerves - chondroprotectors and B vitamins. Taking medications, in combination with other treatment methods, if necessary, is prescribed by a chiropractor.

Massage. As you know, there is massage for pleasure and massage for treatment. Massage for pleasure is done in spas, and massage for treatment is done in medical clinics. At the Spina Zdravaya clinic, medical massage is performed during a gentle manual therapy session. Therapeutic massage can increase the effectiveness of manual treatment and normalize metabolic processes!

Physiotherapy. There are many physiotherapeutic methods that help manual therapy in the treatment of lumbar hernia, for example, treatment with ultrasound, electrophoresis, laser, etc. The attending physician will give a specific recommendation.

Physical therapy for the treatment of lumbar hernia involves regular exercises to strengthen the muscles. The main thing is to do the right exercises without sudden movements. During treatment at the Spina Zdorova clinic, the doctor will recommend the necessary exercises for you. The best option is Pilates classes.

Prevention of lumbar hernia

To avoid relapses, you must first get rid of the disease completely. And then reduce the risk factors. Create comfortable conditions for sleeping and working. Watch your weight and eat right. Keep up your physical activity. But, most importantly, do not neglect your health and do not skimp on it. Don't let things take their course. After recovery, try to do at least one maintenance session of gentle manual therapy once every three to six months - this will help to significantly reduce risk factors. Do not forget, an advanced lumbar hernia threatens surgery. Remember: your health comes first!

Advantages of treatment for lumbar hernia at the Spina Zdravaya clinic

Guarantee of complete and qualified treatment. The word “full” is key in our work.
We consider each case individually and comprehensively - no formalism.
Synergy effect.
Guaranteed fair treatment and fair price.
The location is a stone's throw from the metro in the very center of Moscow.

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.

Treatment

In most cases, paramedian disc herniations are cured with conservative methods. Therapy should be carried out comprehensively, using medications, physiotherapy and exercise therapy.

Drugs

The main goal of drug therapy for paramedian hernias is:

pain relief;
reducing the intensity of the inflammatory process;
reduction of muscle tension.

Paravertebral blockades using local analgesics (solutions of novocaine, lidocaine), as well as their combination with hydrocortisone and vitamin B12 .

Paravertebral blockades are the most effective in eliminating back pain.

The combined use of these medicinal substances has a local anesthetic, anti-edematous, anti-inflammatory, and absorbable effect.

Special groups of medications are also used:

analgesics;
antispasmodics;
NSAIDs;
muscle relaxants;
drugs that improve blood supply and tissue trophism in the affected area.

Video: “Formation and elimination of disc protrusions”

Exercise therapy, massage

After reducing the intensity of the pain syndrome, the goal of conservative therapy is to normalize mobility and strengthen the patient’s muscle corset. For this purpose, massage and therapeutic exercises are prescribed.

Massage procedures create the basis for spinal traction, which is subsequently carried out with the help of special exercise therapy aimed at performing flexion-extension, strengthening the muscles and ligaments of the spinal column. This way they solve the problem of fixing the spine in a certain position that eliminates compression of the nerve roots.

Important! Massive or long-standing hernias may not respond to conservative treatment methods. Prescribing massage for sequestered hernias also requires caution.

Surgery

In cases where there are no stable positive results from conservative therapy, the disease is advanced or its rapidly progressing form, surgical intervention is prescribed. Surgical treatment of paramedian hernia is a fairly common occurrence due to the fact that pathology often initiates rupture of the fibrous ring .

In this case, to reduce pressure on the nerve endings, the entire damaged disc or its fragments are removed. The prognosis for the outcome of the operation is usually favorable, and under certain conditions the patient experiences stable remission.

Surgical treatment of a hernia involves partial or complete removal of a vertebral disc

Treatment at home

The possibilities of self-treatment only provide some relief to the patient’s condition, relaxation of spasmed muscles and a decrease in compression of the nerve roots, and neutralize the manifestations of pain.

In the acute course of the disease, the patient should first of all limit the load on the spinal column and ensure rest: intense loads only aggravate the course of the disease. Alternating contrast compresses on the affected area helps reduce inflammation and pain.

Important! Self-massage is contraindicated in the acute phase of a diagnosed paramedian hernia. After two to three days of bed rest, the patient should begin to move, avoiding sudden, active movements.

Prevention

In preventing the formation of a paramedian hernia, the main role is played by healthy habits, a balanced diet, and a rational regime of work and rest . The correct approach to physical activity that arises in certain situations is also important.

If for some reason the dynamic effect on the spinal column cannot be limited, you should resort to orthopedic methods of protection against spinal injury - use special splints, bandages, corsets, belts.

Treatment at the Paramita Clinic

We have developed our own approach to the treatment of paramedian hernias. It includes:

examination of the patient using modern instrumental and laboratory tests, including MRI;
development of an individual treatment plan for each patient, including effective Western techniques and traditional Eastern methods.

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

This helps not only eliminate the hernia, recover faster after surgery, but also restore the health of the body as a whole.

Complications and consequences

Did you know that...

Next fact

If a dorsal hernia is not diagnosed and treated on time, dangerous consequences can occur at an advanced stage:

One of the most dangerous consequences of a dorsal hernia in the lumbar region is paralysis of the lower extremities. When the disc core exits the fibrous ring (sequestration), very severe pain is usually observed, during which the patient loses the ability to move and care for himself.
Partial or complete paralysis of the leg muscles. In case of paralysis, disability is assigned.
Foot paralysis (popularly called “slap-foot”).
Atrophy of leg tissue with loss of sensitivity.
Impaired functioning of the pelvic organs, the consequences of which are urinary and fecal incontinence.
Sexual disorders. Men may experience decreased erection and premature ejaculation, and women may experience uterine prolapse.

In this case, a dorsal hernia l4-l5 can lead to paralysis of the lower extremities and loss of sensitivity, and l5-s1 - to serious problems with the pelvic organs.

Prevention and prognosis

As practice shows, if you contact our specialists early, the prognosis is favorable for recovery. Correct use of medications and compliance with medical recommendations allows you to restore damaged tissue and prevent the development of severe complications (including disability). To prevent the development of a recurrence of a paramedian hernia, you will need regular exercise therapy, acupressure sessions, and sleeping on an orthopedic mattress and pillow.

After completion of treatment, physical activity should be dosed, including reducing the time of sedentary work, swimming, and paying special attention to proper nutrition, with a sufficient amount of vitamins and microelements

Consequences

Paramedian hernia is dangerous for the development of severe complications:

vertebral artery stenosis – appears when the artery is compressed by a hernial protrusion, can cause cerebral circulatory problems;
compression of the spinal nerve - causes muscle atrophy, paresis, extinction of tendon reflexes;
compression of the spinal cord - peripheral paresis occurs, loss of sensitivity in individual parts of the body.

Without emergency treatment, these changes may become irreversible. To prevent the development of complications, treatment of paramedian intervertebral disc herniation should be carried out in clinics in the Czech Republic. Modern techniques, European technical equipment, the best doctors - all this will help you avoid serious consequences and return to a healthy life.

FAQ

How to relieve pain?

It is recommended to lie on your back on a flat surface and take an anesthetic or NSAID. For acute pain, a blockade will help.

Is there a chance to be cured without surgery?

Yes, if you seek qualified help early, it is possible to use only conservative treatment.

How long does the rehabilitation period take?

Recovery after surgery ranges from 1 to 2 months.

Bibliography:

Kalantarov, T.K. General issues of propaedeutics of surgical diseases [Text]: educational manual / T.K. Kalantarov, E.M. Mokhov - Tver: Triada, 2012.
Bubnovsky, S.M. A herniated spine is not a death sentence! / CM. Bubnovsky. - M.: Publishing house "Eksmo" LLC, 2011
Handbook of Spine Surgery. Ali A Baaj, Praveen V. Mummaneni, Juan S. Uribe, Alexander R. Vaccaro, Mark S. Greenberg.–Thieme, New York—Stuttgart.–2011.
European Manual of Medicine. Neurosurgery. W. Arnold, U. Ganzer, Christianto B. Lumenta, Concezio Di Rocco, Jens Haase, Jan Jakob A. Mooij. 2009.
Amosov, V. N. Hernia. Early diagnosis, treatment, prevention / V.N. Amosov. — M.: Vector, 2013

Themes

Intervertebral hernia, Spine, Pain, Treatment without surgery Date of publication: 12/01/2020 Date of update: 03/16/2021

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Treatment of dorsal hernia l5-s1 and l4-l5 and prognosis for recovery

Despite the danger of the disease, in most cases the prognosis is favorable, provided that the patient begins treatment before irreversible complications such as paralysis or disruption of the functioning of internal organs appear.

Main factors influencing the forecast:

timely initiation of treatment, before serious complications occur;
conscientious adherence to all doctor’s recommendations, including daily therapeutic exercises to prevent relapses.

Treatment during an exacerbation

At the stage of severe symptoms, when a person experiences severe pain, drug treatment is mainly carried out, which is aimed at relieving inflammation and relieving pain.

During the period of exacerbation of a spinal hernia, it is necessary to take steroidal and non-steroidal anti-inflammatory drugs. Basic drugs:

diclofenac;
ibuprofen;
meloxicam;
ketorol

Taken as prescribed by a doctor in the form of tablets, injections or ointments.

Steroid (hormonal) anti-inflammatory drugs are used when others do not work.

For particularly severe pain, a blockade is used . This procedure involves injecting novocaine, lidocaine or other anesthetics directly into the spinal area.

Physiotherapy (medicinal electrophoresis) can also be used during exacerbation..

You can learn more about intervertebral hernias and methods of their treatment in the following articles:

Read more about herniation of the cervical vertebrae C4-C5, C6-C7 in the next article
Symptoms and treatment of spinal hernia in the thoracic region
What does Schmorl's hernia of the thoracic region mean, you can find out on the page

Therapeutic gymnastics (therapeutic exercises)

Despite the simplicity and accessibility of the method, exercise therapy is one of the main ones in conservative treatment during the period of remission (when inflammation subsides). This is due to the need to form a muscular corset around the affected discs to prevent further progression of hernias.

It is important that the complex and intensity of the load be prescribed by the attending physician or rehabilitation specialist. Improper exercise can make the condition worse.

For hernias in the lumbar region, the main exercises are performed lying on a flat surface.

Examples from the complex:

Lying on your back, strain and relax your abdominal muscles. You can control the strength of tension with your hand on your stomach.
From a supine position, lift your pelvis and body above the floor for 10 seconds, leaning on your straight arms.
Lying on your back, pull one leg bent at the knee towards you, while simultaneously placing the other leg on it.

During therapeutic exercises, in addition to strengthening the muscles, they also relieve their tone and stretch the spine.

For people diagnosed with intervertebral hernia, gymnastics is recommended every day at home.

Is it possible to massage a dorsal hernia?

As prescribed by a doctor, massage can be performed by a qualified specialist in the subacute period or rehabilitation period in the absence of severe pain.

A competent massage helps relieve muscle tone, improve blood circulation in the discs, and generally reduces the risk of the disease becoming chronic.

Basic principles of massage for intervertebral hernia:

Only relaxing techniques are used: kneading, tapping and other rough techniques are unacceptable;
there should be no pain during the procedure;
the duration and strength of the impact increases with each session and starts small;
To reduce lower back tension, you need to place a cushion under your shins.

Contraindications for massage:

period of exacerbation;
skin diseases at the site of exposure;
fever above 38 degrees and general weakness.

Surgery

With conservative treatment, the effect is achieved in 70-80% of cases, especially with timely diagnosis, so surgery is not often used. There is still a risk of relapse after surgery.

Standard indications for surgery:

paralysis;
disruption of the functioning of internal organs;
very severe pain;
no effect of therapy;
large size hernia;
development of other complications.

Video: “When is surgical treatment for a herniated disc necessary?”

Treatment at home

Along with therapeutic exercises, you can also use some folk remedies at home, but it is better not to neglect traditional treatment and consult a doctor.

From popular folk remedies:

Attach a Kalanchoe leaf to the affected area with a patch overnight.
Rubbing the back in the area of the hernia with a mixture of 5 g of mumiyo, diluted in water with the addition of four tablespoons of honey.
Compresses made from alcohol tincture of garlic (150 g of alcohol per 300 g of garlic, infused in a dark place for 10 days). The compress is covered with film and a warm cloth for 40 minutes.
Baths with the addition of a solution of salicylic alcohol (100 g), baby soap (10 g) per glass of boiling water. 3 tablespoons per bath. Bath temperature up to 37 degrees.
Rubbing with oils of comfrey, birch, St. John's wort.

Prevention of dorsal lumbar hernia

The most important principles of prevention that can get rid of an unpleasant and dangerous disease:

Normal level of physical activity, avoid physical inactivity.
To prevent intervertebral hernia, you need to lead an active lifestyle and strengthen your back muscles. Strengthen the muscles surrounding the spine. Physical education, banal exercises, yoga, Pilates are needed not only after the acquisition of problems, but also for healthy people in order to avoid them in the future.
Avoid being overweight if you can.
Excessive sports and physical activity, as well as heavy lifting, lead directly to hernias. It's better not to allow them.
To give up smoking. Nicotine has a very negative effect on the cartilage tissue of the discs, because the blood circulation of the whole body is disrupted.
The diet should include foods containing phosphorus, hyaluronic acid and mucopolysaccharides. These are seafood, fish (sea), dairy products, seaweed. Also needed in the diet are dishes containing broth from bones, cartilage, ligaments of fish and animals (jelly, fish soup, jellied meat).
Additional courses of vitamins also help strengthen vertebral structures.

Surgical treatment

Most doctors tend to provide predominantly conservative treatment for L5 and S1 hernias. However, in cases where traditional methods have not given positive dynamics, the patient is indicated for surgical treatment of the hernia. Among the advantages of this treatment method, it is worth noting the patient’s rapid recovery, as well as the complete elimination of all unpleasant symptoms accompanying this pathology.

If conservative methods do not produce results, surgery is the only option.

Sometimes conservative treatment is delayed for several years and does not give a lasting positive effect. In this case, doctors recommend resorting to surgery. One of the serious disadvantages of surgical treatment is the rather high probability of relapse. But to say that the majority of patients who have undergone such an operation are susceptible to relapse is categorically incorrect. It all depends on the individual characteristics of the body, compliance with the regimen prescribed by the doctor and the severity of the disease.

Intervertebral disc replacement

Prices for postoperative bandages

Postoperative period:

After surgery, the patient may experience pain and discomfort in the incision area. It must be borne in mind that the initial radicular pain may not completely regress immediately after surgery. To alleviate the condition in the postoperative period, painkillers and antibiotics are prescribed to prevent infectious complications. Under your doctor's supervision, you will be instructed to stand on your feet immediately after you have fully recovered from the epidural. During the first four weeks after surgery, you should adhere to some minimal restrictions at home, such as not lifting more than 2.5 kg, and not doing sudden bending or stretching. In addition, you should not drive a car until your doctor allows it.

Postoperative recommendations

Most people whose work does not involve heavy physical labor can begin work within 2-4 weeks after surgery or even earlier. Those whose jobs require heavy lifting or operating equipment that generates intense vibrations should wait a minimum of 2-4 months before returning to work. It should be noted that physical therapy can play a significant role in the body's recovery process.