The spine, made up of segments, serves as a strong support for the body and ensures its flexibility. With age, the spine changes - intervertebral discs become deformed and undergo destruction. One of the unpleasant diseases that occurs under the influence of loads is protrusion. It is believed that in the age group “over 30”, 8 out of 10 people suffer from this disease.
The occurrence of protrusion is a signal of problems in the musculoskeletal system. As a rule, the disease develops as a consequence of osteochondrosis.
Why does protrusion develop?
Previously, it was believed that age was the main risk factor for the occurrence of protrusion, but it is now noted that the disease can also affect a young body.
The following main factors lead to the development of protrusion:
- Incorrect posture;
- Back injuries;
- Obesity;
- Heavy heredity;
- Underdevelopment of body muscles;
- Metabolism deficiencies;
- Severe infectious diseases;
- High loads on the back (sports can also have negative consequences);
- Physical inactivity.
Risk factors and causes
Disc protrusion develops under the influence of provoking factors, such as a sedentary lifestyle, sudden heavy lifting, and inadequate physical activity. Elderly patients are most susceptible to protrusions (with age, the likelihood of developing disc pathologies increases significantly).
This is all due to age-related changes in the nucleus pulposus of the intervertebral disc, causing a loss of shock-absorbing properties and a decrease in the elasticity of the fibrous capsule.
The main reasons for the development of L5-S1 protrusion are listed below. This :
- genetic predisposition, previous injuries and infections;
- metabolic disorders;
- underdeveloped muscular frame of the back and torso;
- excessive stress on the spine;
- incorrect posture;
- age-related changes;
- diseases of the spinal column;
- sudden movements, “wrong” lifting of weights, etc.
Consequences
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Bulging of the vertebrae located at the L5-S1 level is fraught with unpleasant consequences. As mentioned earlier, the most dangerous are the posterior and median protrusions, because they complicate the course of the disease due to rapid damage to the nerve roots.
In severe cases, entire bundles of nerve fibers are pinched (in medicine, this phenomenon is called pinched cauda equina). This leads to severe pain in the back and lower back, and in the absence of proper treatment, to disability of the patient.
Note what cauda equina syndrome means
What does bulging disc mean?
Protrusion is a condition when the intervertebral disc is squeezed into the spinal canal, but the fibrous ring remains intact. This is the initial stage of osteochondrosis, preceding the formation of a hernia.
Protrusion differs from hernia in the degree of damage to the fibrous ring:
- A whole ring with preservation of the structure is a sign of protrusion;
- A torn ring with prolapse of part of the disc indicates a hernia.
The condition of the spine is negatively affected by many factors, including:
- Sedentary work;
- Sitting at a computer for a long time in an uncomfortable position;
- Stress;
- Unbalanced diet;
- Scoliosis.
Over time, the fibrous ring loses its elasticity and cracks. As a result, the protrusion increases and the risk of complete rupture increases.
Causes of L5 S1 protrusion
The causes of L5 S1 disc protrusion are varied. Changes in the structure of the L5 and C1 intervertebral discs do not occur suddenly; the process of deformation formation is long-term.
There are a number of diseases that contribute to the appearance of disc changes:
- Osteochondrosis;
- Spondylosis;
- Scoliosis;
- Osteoporosis;
- Any spinal injury.
Deformation of the intervertebral discs occurs as a result of the destruction of cartilage tissue and a decrease in the elasticity of the disc. This is mainly due to a decrease in nutrients that enter the human body.
People at risk include:
- elderly,
- Leading a sedentary lifestyle;
- Having a profession related to office work.
An unbalanced diet and lack of water often affects it. Irrational physical activity contributes to the onset of the disease.
Types of protrusion
Several types of this disease are considered, depending on the direction of the protrusion.
- Circular protrusion
- a flattened disc protrudes evenly in a circle, horizontally, in all directions. Extruded areas reach up to 12 mm. There is a connection with neurological factors. - Diffuse
- characterized by a chronic course. It is dangerous because in the absence of therapeutic measures a person loses his ability to work completely, he is unable to perform any actions related to physical activity, and ultimately becomes disabled. - Central
(median) – when protrusion occurs towards the center. The risk of developing stenosis and compression increases. - Dorsal, or posterior protrusion
- when the disc protrudes towards the spinal canal. A ruptured ring degenerates into a hernia. The diagnosis of “dorsal protrusion” is used as a general one.
The protrusion takes a long time to form and passes through three successive stages.
Against the background of degenerative processes, the structure of the intervertebral disc changes - it becomes flat, cracks, and loses elasticity. There is slight soreness in the back. During the off-season, the patient's condition worsens. You need to see a doctor. If treatment is not carried out, paroxysmal pain appears - a sign of the development of a hernia.
At later stages of the disease, the symptoms described above are supplemented by pain in the legs, tension, and a feeling of numbness or tingling.
There may be pain in the buttocks. In addition, it is noted:
- Radiculitis;
- Skin sensitivity disorder;
- Muscle weakness;
- Difficulty urinating (if the stage is advanced).
Classification
There are several types of pathology characterized by a posterior orientation. It is worth considering the features of each of them in order to understand what the presence of the disease can lead to.
Posterior median protrusion
Posterior median disc protrusions are among the most dangerous. They are directed towards the middle of the spinal cord canal, so an increase in protrusion can lead to compression of the spinal cord. This, in turn, is fraught with serious consequences for the patient’s health.
Posterior diffuse protrusion
This name for the pathology means that the intervertebral disc protrudes backwards, but only a small part of it is affected. As a rule, the damage to the structural element is 25-50%. The doctor identifies such a disease using methods of visualizing the structures of the spinal column, after which he immediately prescribes treatment that can return the damaged disc to its place.
Anteroposterior protrusion
Anterior-posterior protrusion is characterized by the presence of protrusions in both directions. This can make the disease more difficult to treat.
Posterior median protrusion
This protrusion is located in the back of the disc and tends to the central part of the spinal cord or cauda equina. Can lead to significant pinching of nerve tissue and severe pain.
Symptoms of the disease
Protrusions can develop in children and adults. Most often this is a slight pain in the lumbar region. Problems make themselves felt in two ways:
- Mechanical effect on nerves;
- Inflammatory irritation.
In advanced cases, acute, paroxysmal pain appears. There may be pain in the legs, a feeling of numbness and tingling, and when lifting the leg, the back hurts in the lumbar region. Possible pain in the buttocks. The following symptoms may be observed:
- Weakness in the legs;
- Skin sensitivity disorders;
- Radiculitis - lumbar or sacral;
- In advanced cases, urination problems may occur.
Diagnostics
It is important to recognize the disease in a timely manner. People often ignore back pain, perceiving it as something inevitable, blaming it all on a hard day. Traditional methods are used for self-treatment. It is important to remember that with an unqualified approach to treatment, success will not be achieved. But if you consult a specialized doctor in a timely manner, the problem can be easily eliminated, avoiding many problems. The correct diagnosis can only be made by a qualified doctor, taking into account the results of a carefully conducted diagnosis.
Typically, diagnosis begins with examining the patient and using manual tests to determine the affected area. If protrusion is suspected, ultrasound, MRI, EMG, etc. are prescribed. X-rays will show the stages of development of the process. Using CT and MRI of the spine, compression of the nerve bundles is determined. An EMG will help determine the extent of the problem.
Which doctor treats disc protrusion?
Since back pain can come not only from intervertebral discs, it is necessary to be examined by several doctors:
- Neurologist - seen in peripheral clinics;
- Urologist – if spinal diseases are excluded, this specialist will help determine the origin of the pain;
- A vertebrologist is a narrow specialist who specializes in the condition of the spine; appointments are carried out only in specialized medical institutions;
- Orthopedist, cardiologist, rheumatologist, pulmonologist, gastroenterologist - when there is a suspicion that the pain is of a projection nature.
Treatment of protrusion
Protrusion is a dangerous disease; the treatment process should be carried out under the supervision of experienced specialists. It is necessary to carry out treatment to eliminate back pain, numbness of the limbs, headaches, to be able to actively work and rest.
Treatment is complex and consists of several procedures aimed at:
- Pain relief;
- Restoration of motor functions;
- Getting rid of edema;
- Normalization of sensitivity.
Typically, different drugs are used:
- Anti-inflammatory;
- Muscle relaxants;
- Analgesics.
Effective:
- Massages, if performed by an experienced specialist;
- Physiotherapy (exposure to currents, ultrasound, electrophoresis).
In the absence of positive dynamics, radical methods are used - surgical ones.
Surgery for hernia L4-L5
If there is no effect from conservative therapy carried out for more than 1–3 months, surgery is indicated for disc herniation. Also, it will not be possible to do without the help of neurosurgeons if the disease provokes the development of cauda equina syndrome. Moreover, if the protrusion is 12 mm or more, emergency surgery is performed.
Surgical intervention is designed to quickly relieve pressure on the nerve roots or spinal cord, which eliminates the risk of complications and pain. Its tactics are determined individually based on the type of L4–L5 hernia and its size.
Today, surgery for intervertebral hernia L4–L5 can be performed using one of the following methods:
- nucleoplasty;
- microdiscectomy;
- endoscopic hernia removal.
If necessary, the removed L4–L5 intervertebral disc is replaced with special implants or spinal fusion is achieved, i.e. fusion of the vertebral bodies.
Nucleoplasty
Nucleoplasty is a puncture method for removing L4–L5 hernias up to 7 mm in size. This is the least traumatic operation. It involves solving the problem by destroying part of the nucleus pulposus under the control of an electron-optical converter using:
- laser;
- cold plasma;
- radio waves;
- fluid pressure (hydroplastics).
Hydroplasty using the SpineGet device is recognized as the most effective and safe method. The technique involves destroying part of the nucleus pulposus with a saline solution, which is supplied inside the L4–L5 intervertebral disc through a special thin cannula. At the same time, the rarefied part of the nucleus is instantly aspirated through a special branch of the device and removed from the body. As a result, discomfort and pain are eliminated.
Hydrojet device.
Unlike laser nucleoplasty, hydroplasty does not involve the risk of excessive tissue heating and damage to blood vessels or nerves. The technique provides high precision control of the depth of exposure and the volume of removed tissue.
Microdiscectomy
Microdiscectomy is a minimally invasive operation that involves removing the L4–L5 intervertebral hernia through an incision not exceeding 3–4 cm and, if necessary, installing special implants. It has a wide range of indications, including this operation for sequestered hernias.
Microdiscectomy.
Endoscopic surgery
This tactic involves removing the L4–L5 hernia through pinpoint punctures of the soft tissue, through which special endoscopic equipment is inserted. Since there is a camera at the end of the endoscope, the operating surgeon can watch his every movement through a monitor.
Endoscopic removal of disc herniation.
Endoscopic surgery for a hernia is performed when it is located in the foraminal openings and other narrow areas of the spinal canal. It has a low number of intraoperative risks and minimizes the likelihood of damage to nerve endings. But, like nucleoplasty, it may not always be performed.
Intervertebral disc replacement methods
Prosthetics are used in cases of cauda equina syndrome or frequent recurrences of hernias, i.e. in cases where the intervertebral disc requires removal or after surgery there is a high risk of developing spinal instability. Modern implants and metal structures can completely replace the affected disc while maintaining the full scope of its functions or restore the integrity of the fibrous ring.
M6 disc prosthesis.
M6 endoprostheses, which are artificial discs, are characterized by absolute biocompatibility and high wear resistance. They allow you to replace a removed disk or several at the same time.
If, after surgery to remove a hernia, a large defect in the fibrous ring has formed, the Barricaid implant can be used. It is a mesh that fills the missing part of the disc shell and prevents the nucleus pulposus from leaking into the spinal canal after surgery.
A transpedicular fixation technique can also be used to stabilize the vertebrae in their normal position. With the help of metal structures and screws, the vertebrae in the area of the removed disc are securely fixed and combined into a single system.