How to treat a lumbar spinal hernia

15 April 2020

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2.6 out of 5

The lifestyle of modern people creates serious preconditions for the formation of intervertebral hernias. They are especially common in the lumbosacral spine, that is, in the disc located between the 5th lumbar vertebra and the sacrum, called L5–S1. This is due to the fact that it bears the greatest load when walking, sitting and doing physical work.

What is a lumbar disc herniation

The lumbar region includes 5 vertebrae, between which are intervertebral discs. Each of them is a fibrocartilaginous formation, which consists of a fibrous ring and a nucleus pulposus.

The spinal discs perform a shock-absorbing function, that is, they soften and absorb stress on the back when moving. Thanks to it, optimal flexibility of the spinal system is maintained.

If the discs are frequently exposed to negative influences, then gradually the annulus fibrosus may become less strong. Also, due to injuries, cracks appear and other problems arise. As a result, the pulp, located in the inner part, protrudes beyond the fiber. It is this condition that is commonly called lumbar hernia.

When this pathology appears, unpleasant symptoms are observed, mobility decreases and the quality of life deteriorates. It is recommended to understand how to treat a herniated disc and use the recommendations.

Surgery for hernia of the lumbosacral spine

Surgery is a last resort, which is resorted to when conservative treatment is ineffective or immediately when:

severe cauda equina syndrome (neurological deficit);
paralysis;
sequestered hernias.

The surgical techniques used today to remove intervertebral hernias of the lumbosacral spine are distinguished by a high level of safety and effectiveness. They allow you to remove hernias of almost any size and eliminate compression of the spinal roots. At the same time, modern minimally invasive operations ensure the best possible cosmetic result.

Today, for hernias of the lumbosacral region, the following are used:

puncture surgery (nucleoplasty);
endoscopic surgery;
microdiscectomy.

The surgical tactics are determined individually for each patient. In this case, not only the size of the hernia, its type, but also the general condition of the patient are taken into account. Therefore, immediately before surgery, each patient undergoes a comprehensive preoperative examination.

Sometimes the characteristics of the disease require neurosurgeons to remove not only the hernia itself, but also the entire disc. In such situations, even at the stage of planning the operation, the doctor will warn the patient about the need to install an endoprosthesis to replace the removed disc or use techniques to achieve spinal fusion, i.e. fusion of adjacent vertebral bodies. The first option is preferable because it allows you to maintain normal mobility and flexibility of the spine, especially if it is necessary to remove not just one hernia of the lumbosacral region, but also neoplasms in other parts of the spine.

If for financial reasons or other reasons the installation of endoprostheses is impossible, rigid stabilization techniques are used to close the defect, sometimes involving the installation of an autograft. As a result, the last lumbar vertebra, the sacrum, grows together, which somewhat limits the patient’s mobility. As a result, he will not be able to bend over as much as was possible before, or make body turns with the same amplitude.

Percutaneous or puncture surgery

Some modern neurosurgeons have unique methods for treating small intervertebral hernias through a pinpoint puncture with a thin puncture needle. Such operations are almost completely free of intraoperative risks and do not require long, complex rehabilitation. In most cases, patients after percutaneous removal of a lumbosacral intervertebral hernia (nucleoplasty) can leave the clinic on the same day and return to their normal lifestyle with minor restrictions.

The essence of the operation is to introduce, under X-ray control, a thin cannula into the center of the nucleus pulposus of the affected disc, through which the working electrode is then immersed. It creates heat or other energy. The surgeon makes several back-and-forth movements with the electrode in different directions without moving it beyond the disc. As a result, “brewed” passages are formed in the nucleus pulposus, and its total volume decreases. This creates negative pressure in it, which leads to retraction of the protrusion. The operation takes 30–40 minutes, after which the electrode along with the cannula are removed from the patient’s body, and the postoperative puncture is covered with a sterile bandage, without even stitches.

Today, there are several techniques for performing nuclecoplasty. This:

hydroplastics
cold plasma;
laser

They all have the same technology, but energy of different origins is used to destroy the nucleus pulposus.

A special technique of puncture surgery used for hernia of the lumbosacral region is hydroplasty. This operation has the same goals as other types of nucleoplasty, but liquid pressure is used to destroy part of the nucleus pulposus.

As in the first case, a thin conductor is inserted into the patient’s body in the projection of the L5–S1 disc into the center of the intervertebral disc. It has 2 branches: through the first, liquid is supplied into it under pressure, and through the second, waste material with particles of the nucleus pulposus is simultaneously aspirated and removed. The method allows you to very accurately control the degree of destruction and achieve ideal results.

Thus, nucleoplasty allows you to achieve excellent treatment results and avoid the formation of the slightest scars on the skin. But it may not always be carried out. Thus, they are not used to treat sequestered hernias or those larger than 7 mm.

Nucleoplasty can be performed under local anesthesia.

Endoscopic removal of lumbosacral intervertebral disc herniation

Endoscopic operations involve the use of special endoscopes equipped with LEDs and video cameras that transmit images in real time to a monitor. The neurosurgeon can precisely control every movement of the instruments immersed through the endoscope and accurately remove hernias of almost any size.

Endoscopic operations are indicated for large hernias, as well as their location in narrow areas of the spinal canal, for example, in the area of the foraminal openings. They are characterized by a high level of safety, effectiveness and a short rehabilitation period.

Microdiscectomy

Microdiscectomy is a classic method of surgical treatment of intervertebral hernias of the lumbosacral spine. It is also called the “gold standard” of surgery. The operation is performed exclusively under general anesthesia. To gain access to the affected disc, an incision of up to 3 cm is made in its projection.

After this, the surgeon carefully moves the soft tissues apart and fixes them in a comfortable position. Since the muscles are not injured, the recovery period is sharply reduced and is much easier than with previously used discectomy. In this case, the operation does not imply a violation of the integrity of the ligamentum flavum.

Microdiscectomy is performed using a special surgical microscope that provides 8x magnification. This allows you to eliminate both the hernia itself and the entire intervertebral disc, if necessary. In the first case, the hernia is carefully resected using special microsurgical instruments, and the disc itself is preserved. The resulting defect is closed with a special mesh, which is a synthetic substitute for the fibrous ring. Microdiscectomy can also be used to remove sequestered hernias.

If the L5–S1 intervertebral disc is severely damaged, it can be completely removed during microdiscectomy. After this, endoprostheses can be installed in the resulting space, or rigid stabilization techniques can be used to maintain the unity of the spine.

The final stage of the operation is treating the wound with antiseptics and applying postoperative sutures.

The operation gives especially good results when performed no later than 3 months after its appointment.

Reasons for appearance

There are many reasons for the appearance of a hernia; they can be divided into two groups: exogenous and endogenous. The first are external, and the second are internal.

Exogenous causes:

Tumors of different etiologies.
Syphilis, tuberculosis.
Back injuries.
Excessive stress, too active lifestyle.
Excess weight.
Lordosis, scoliosis, osteochondrosis.
Sedentary lifestyle. Because of this, the distribution of the load on the spine is disrupted, and the muscle corset is weakened.

Endogenous causes:

The intervertebral discs do not receive enough nutrients.
Dysfunction is associated with natural aging of the body.
With age, the concentration of water in the body decreases, which leads to drying of the discs.

You can also identify risk factors that increase the likelihood of a problem occurring in the body. For example, a hernia often appears in men between the ages of 30 and 50. It is also caused by smoking, sedentary work, hypothermia, and emotional stress. It is recommended to understand how to treat a lumbar disc herniation in order to take action and improve your health. The disease tends to progress, so it cannot be neglected.

general information

Intervertebral hernia most often forms in the lower part of the lumbar spine, as well as at the point of its transition to the sacral segment. It is this area that experiences the greatest load when the body is in an upright position. Intervertebral discs normally act as shock absorbers, dampening vibration when walking, running and jumping. Increased pressure or its uneven distribution, as well as narrowing of the joint space with osteochondrosis, leads to the formation of first protrusion and then disc herniation.

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Symptoms

The presence of a spinal hernia can be detected by characteristic signs. The pathology begins slowly, and at first there are almost no symptoms. The trigger can be a sudden movement or lifting of weight. This leads to severe pain.

The first signs are blurred, it is easy to not notice them and not ask the question of how to cure a herniated disc. A person may not pay attention to the symptoms, because they are not yet too disturbing.

The first symptoms are a feeling of fatigue in the lower back, numbness of the skin in the lower extremities, weakness in the legs and gait disturbance. Usually people attribute this to normal overwork. If nothing is done at this stage, then more obvious signs will appear. There will be pain in the lumbar region, rheas can be both weak and sharp. A person quickly gets tired when walking and suffers from muscle weakness. The skin becomes pale and vascular spots appear on it.

The most dangerous symptoms are paralysis and paresis. They appear due to compression of the spinal cord. The functioning of the pelvic organs may also be disrupted, which will lead to urine, feces and infertility. To prevent this, you need to figure out in time how to treat a hernia of the lumbar spine.

Types and stages

Depending on the direction of the protrusion, hernias are distinguished:

anterior: located anterior to the vertebral body; are rare and practically do not cause pathological symptoms;
posterior: bulge towards the spinal canal; one of the most common and dangerous options, since if it is large in size it can compress the spinal cord and its roots, causing pain and neurological disorders;
lateral: appear on the side of the spinal canal, often damaging the spinal roots passing in this place;
vertical (Schmorl's hernia): grow in a vertical direction, pressing into the vertebral body.

The stages of the disease are determined by the degree of disc displacement:

Stage 1 (protrusion): the disc moves relative to its normal position, but does not violate the integrity of the fibrous ring;
Stage 2 (extrusion): the fibrous ring breaks through, a slight protrusion of the disc is observed;
Stage 3 (prolapse): the disc hangs into the intervertebral space;
Stage 4 (sequestration): disc particles come off and fall into the spinal canal; the condition is associated with an extremely high risk of developing paralysis.

Diagnosis of the disease

To make a diagnosis, you will need to conduct neurological tests and instrumental studies. A neurologist will test your neurological status. This task can also be performed by a neurosurgeon or orthopedist. Diagnosis begins with an initial examination, during which a specialist evaluates muscle strength and tendon reflexes. He may suspect a hernia.

To confirm the diagnosis, the doctor will refer you for an MRI or MSCT. Based on the results of these studies, it is possible to accurately determine the disease.

Correct mode

During periods of exacerbation of the disease, it is necessary to observe bed rest, after which physical activity should be gradually increased. If there is no pain, it is recommended to walk and swim more often.

Quitting smoking and alcoholic beverages will help speed up recovery. They slow down the recovery of the disc, disrupting its blood supply.

People suffering from a hernia should not lift more than 2 kilograms. When lifting heavy objects, you should squat rather than bend, so that the main load falls on your legs.

Drug treatment

The doctor will most likely prescribe medication. The drugs can eliminate unpleasant symptoms, so taking anti-inflammatory or painkillers is required. For example, a doctor may prescribe Diclofenac or Ibuprofen. With the help of these drugs it will be possible to relieve pain and also prevent muscle tissue atrophy.

If the patient feels stiffness of movement or suffers from spasms, then the doctor will prescribe Mydocalm and Sirdalud. These are relaxing remedies that will quickly improve the patient’s well-being.

There are other answers to the question of how to cure a hernia of the lumbar spine. It is necessary not only to take medications, but also to undergo some other procedures.

Establishing diagnosis

The diagnosis is made after examination and examination of the patient. First of all, instrumental diagnostics are carried out to help determine whether the tendon reflexes are normal. The patient is asked to raise his straightened leg. Tests are also carried out for sensitivity to vibration, the ability to sense temperature and pain. If there is a hernia, there will be certain manifestations:

The doctor will determine the sensitivity disorder.
The patient's movement biomechanics will be changed.
Tendon reflexes will deviate from normal.

Also, to diagnose protrusion, CT or MRI diagnostics of the spine is performed. These studies will help not only visualize the hernia, but also determine the condition of the surrounding tissues and diagnose narrowing of the spinal canal, if any. If indicated, contrast myelography may be prescribed. After the examination, the degree of pathological changes can be determined and adequate treatment can be prescribed. If the nerves are not affected, the patient complains only of pain, conservative therapy is used.

Physiotherapy

In case of a hernia, doctors strongly recommend exercise therapy, since the gymnastic complex helps prevent the progression of the pathology. The exercise should be performed only after the discomfort disappears. The treatment program is prescribed by the instructor, focusing on the individual characteristics of the patient.

The main goal of the treatment program is to improve muscle condition and prevent further changes in the position of the disc. The patient will have to bend, lift, rotate the arms and body, as well as other exercises.

There are other physiotherapeutic methods of treatment, for example, influencing special points with needles, treatment with warm compresses. Spinal traction is also performed using the Ormed apparatus. All this allows you to quickly improve a person’s health.

Advantages of the clinic

“Health Energy” is a modern multidisciplinary clinic that diagnoses and treats various diseases in adults and children. We offer:

consultations with doctors of various profiles;
comprehensive diagnostic programs to assess the condition of the body;
targeted examinations to make a specific diagnosis or exclude it;
organizing remote consultations with foreign doctors to obtain an alternative opinion;
modern and time-tested treatment regimens, selected individually;
physiotherapy, massage, physical therapy and other auxiliary treatment methods;
all types of certificates and conclusions, registration of certificates of incapacity for work;
organization of rehabilitation after illnesses and injuries;
organization of sanatorium-resort treatment.

A hernia of the lumbar spine seems harmless only at first glance. It is this pathology that can most likely lead to complete or partial paralysis of the legs and a disorder of the pelvic functions. Do not bring the disease to its extreme stage; in the early stages it can be eliminated without surgery. Sign up for a consultation with the neurologists at Energy of Health.

Surgery

In advanced cases, the doctor may prescribe surgery. Surgical intervention cannot be avoided when the source of inflammation is in the area of the sciatic nerve, the disc has ruptured, or its position has changed significantly.

A procedure such as a discectomy may be performed. It involves removing part of the disc using a special needle. In addition, the problem area can be treated with a laser. This eliminates excess fluid and frees the nerve. In extreme cases, the doctor can remove the weight disc and then perform prosthetics.

Why is it better to be treated with us?

Please note that the Doctor Leader clinic is a multidisciplinary clinic. That is, doctors of different specialties are present there, all the necessary examinations and tests are carried out. Here you can undergo a full range of diagnostic measures, get advice from related specialists, and listen to the opinions of other doctors about your condition. You also need to take into account what was already mentioned above: we employ highly qualified doctors, the center is equipped with the latest technology. In addition, we truly see our main goal as helping people, not making money. Therefore, you can always count on a correct attitude, a comfortable stay in the clinic and competent medical care.

Prevention

It is easier to prevent a disease than to cure it, so you need to take care of prevention. Typically, a hernia appears against the background of sudden or regular stress. You should not overwork, lift heavy objects, or make sudden movements. For sleep, you should choose orthopedic massage. It is recommended to fall asleep on your back, as this is the most favorable position.

It is important to prevent the appearance of excess weight, as it leads to many health problems. You must not forget about correct posture and try to keep your back straight.

If the pathology is not treated, it will lead to intense pain, problems with the genitourinary system, and muscle weakness in the legs. To prevent this, you should consult a doctor in a timely manner and begin therapy. The result will appear quite quickly; symptoms should subside within the first week if the treatment is chosen correctly. The main thing is to follow the specialist’s recommendations and try to eliminate the causes that can lead to the progression of the pathology.

Complications

If a hernia is diagnosed at an early stage, following the doctor’s recommendations allows you to completely get rid of the protrusion. If the patient neglects treatment, the formation increases. Ultimately, this process can cause serious complications. Particles of the disc completely block the spinal canal, compressing the passing nerve roots. Cauda equina syndrome develops, manifested by:

severe pain;

loss of control over urination and bowel movements;
complete or partial paralysis of the lower limbs.

The condition requires immediate surgical attention as nerve function can be restored if the compression is relieved within 24 hours.

Who will treat you?

The Innovative Medical Center employs doctors of the highest category, doctors and candidates of medical sciences, who have accumulated extensive experience in the treatment of intervertebral hernias and have already helped many patients:

Bogdanov Vadim Yurievich chief physician, orthopedist - traumatologist. 15 years of experience.

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Ronami Valery Guseinovich professor, doctor of medicine. D., neurologist, reflexologist and chiropractor.

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Products for internal use

The following decoctions, tinctures and infusions have proven their effectiveness in the fight against hernia:

Tincture of cinquefoil. The root of the plant (300 grams), crushed in advance, is poured with vodka (half a liter) and placed in a dark, dry place for 3 weeks. The finished tincture, after shaking, is drunk 3 times a day, 20 milliliters. This remedy is considered the most effective. The tincture relieves pain, stops inflammatory processes, restores cartilage and bone tissue.
A decoction of lingonberries and cinquefoil. Crushed cinquefoil roots (40 grams) are brewed with boiling water (half a liter) and placed in a water bath for a quarter of an hour. The cinquefoil decoction is filtered and combined with lingonberry decoction. Use the remedy three times a day, 100 grams before meals.
Thyme infusion. The herb (20 g) is poured with boiling water (250 milliliters) and left until it cools. Drink a third of a glass three times a day.
Hop tincture. Plant cones (20 grams) are poured with boiling water (250 milliliters). Take 3 times a day, 20 milliliters.

Diet

One of the causes of a vertebral hernia is a malnutrition of the cartilage tissue that makes up the disc. Therefore, a proper diet will provide the damaged disc with the necessary substances.

If you have a hernia, you will have to exclude from your diet:

baked goods made from premium flour;
fatty foods;
meat products (bacon, sausages, frankfurters);
White rice;
chips;
salted nuts;
ketchup;
margarine;
ice cream;
spicy seasonings;
canned foods;
carbonated drinks.

Useful products include:

bread made from wholemeal flour;
vegetables (especially Jerusalem artichoke and pumpkin) and fruits;
legumes;
nuts;
bran;
porridge;
dietary meat (rabbit, chicken, turkey);
aspic;
jelly;
soy yogurt;
freshly milked milk.

Compresses

Compresses will help you quickly get rid of pain:

Potatoes and horseradish root are grated or passed through a meat grinder. Add honey (20 grams) to the mixture, spread it on a cloth and wrap it around the sore area for an hour. It is advisable to insulate the compress.
The top layer of a Kalanchoe leaf is removed and tied to the location of the hernia.
Kalanchoe leaves are crushed and ground with white or red clay in a ratio of 1:5, and fixed on the diseased area.
Indian onions are passed through a meat grinder and mixed in equal proportions with liquid honey. The mixture is rubbed into the sore spot. Then they wrap a woolen scarf around their back and fall asleep.
The affected area is rubbed with camphor oil. A compress of heated milk is placed on top and insulated. Leave for 2 hours, after which camphor oil is rubbed in again.
The garlic is crushed (300 grams) and poured with vodka (500 milliliters). Leave to infuse for 10 days. The resulting mixture is placed on a cloth and wrapped around the sore spot, insulated with cellophane and a woolen scarf.
Ointments
An ointment prepared based on animal ingredients can eliminate pain and relieve inflammation. For it, pork fat (200 grams) and beeswax (80 grams) are mixed, you can add marshmallow root (80 grams). The mixture is placed on low heat for 20 minutes. The ointment is rubbed into the affected part of the back.
Massage
“Golden mumiyo” tablets (5 pieces) are diluted in warm water (20 milliliters), liquid honey (100 grams) is added. Next you will need someone's help. The patient lies on his stomach, and the assistant smears his back with fir oil, applying the previously prepared mixture on top. Then he puts his palms to his back and tears them off with force. Repeat the action until the honey changes color. Then the back is wiped and covered with a blanket.