Lumbar spinal hernia: signs and effective treatment methods

How does a lumbar intervertebral hernia occur?

The intervertebral disc looks like a small cylinder formed from connective tissue. On the outer side it is protected by a fibrous ring, in its inner part there is a substance that has increased elasticity and can impart springiness to the spine.

If the intervertebral disc is subjected to regular negative impact or injury, the fibrous ring may lose its strength and cracks may appear in its area. As a result, the pulp located in its inner part can protrude beyond the boundaries of the fiber. Most often, this process is called “lumbar hernia” and develops in the corresponding part of the spine.

The occurrence of any discomfort in this area is due to pinching of the nerve endings by excess pulp.

Stages of the disease

Lumbar spinal hernia is characterized by different signs at certain stages of disease progression. Currently, each patient has the opportunity to stop the development of the disease and prevent the risk of serious consequences, as well as to treat a hernia of the lumbar spine without surgery , for this it is necessary to visit a competent specialist in a timely manner. Below we will talk about the main stages characteristic of this pathology:

• Prolapse. In this case, there is a slight change in the position of the disk. There is a possibility of its return to its usual place, subject to the cessation of the negative impact;
• Protrusion. There is a strong displacement of the location of the disc, but it does not protrude beyond the boundaries of the vertebrae;
• Extrusion. The nucleus is displaced beyond the boundaries of the vertebrae;
• Sequestration. It is characterized by the appearance of cracks in the area of ​​the fibrous ring. In this case, there is a displacement of the pulp beyond the line marked by the vertebrae.

Why intervertebral disc damage occurs and pain occurs

Our spine is structured like a multi-storey building: from strong floors of the same type - vertebrae, connected to each other by elastic intervertebral discs. The intervertebral disc is a closed chamber consisting of an outer part - a very strong fibrous (fibrous) ring and a semi-liquid inner part - the pulpous nucleus. Each spinal disc is designed for a strictly defined volume and direction of movement.

If the volume or direction of the load on the disc is not adequate, overload and gradual destruction of the discs occurs - spinal osteochondrosis with protrusions and herniations of intervertebral discs. If a spinal hernia puts pressure on a nerve root, pain in the radicular syndrome develops. Overload of the intervertebral disc can last for years, and the “last straw” can be physical activity, awkward movement or even sneezing.

Common causes of disc overload and herniation:

1. Idle muscles and deviation of the center of gravity above or below the affected disc , curvature of the spine - scoliosis;

On the left – one of the muscles cannot maintain the correct position of the vertebrae. The load on the discs of the lumbar spine is distributed with a deviation from the normal axis and this over time can lead to a herniated disc in the lumbosacral region. On the right is the normal load distribution.

2. Stiffness of the vertebrae above and below transfers the load to a healthy area of ​​the spine, where a hernia can form due to overload.

Left. The window cleaner is healthy. On right. The washer has poor movement of his right shoulder and thoracic vertebrae. Therefore, he is forced to make movements with his lower back. Overload in the lumbar spine results in a herniated disc causing damage to the sciatic nerve.

Lumbar intervertebral hernia: symptoms

If a lumbar intervertebral hernia is considered, symptoms and treatment, first of all, we are talking about eliminating the consequences of radicular deformity. In this case, atrophy of the muscles of the buttocks and legs is observed. Many patients note numbness in the lower extremities, a slight tingling sensation and a feeling of coldness. In addition, they gradually lose the ability to climb stairs, bend over, jump and squat. In difficult situations, a person experiences significant asymmetry of the body and an increase in temperature in the affected area.

If the hernia moves to the inner part of the spine, the patient may lose the ability to move his legs. Excessive pressure on this area of ​​the spine poses a serious risk to human life. However, the greatest danger to the body is posed by a lumbar hernia, the symptoms of which are characterized by difficulty urinating, and treatment in this case must be selected more carefully, taking into account the need to restore the functioning of the genitourinary system. If the signs of the disease are ignored, men may develop sexual dysfunction, and for women this can lead to frigidity.

Conservative therapy

The basis of treatment is the elimination of the aseptic inflammatory process and the resulting swelling in the area of ​​the affected disc. As a result of reducing the volume of soft tissue surrounding the nerve roots, it is possible to reduce the pressure on it, which will lead to self-elimination of neurological disorders. Moreover, the sooner treatment is started, the higher the likelihood of full recovery.

Patients are prescribed a set of measures that are selected for each individual. Typically this is:

• drug treatment;
• physiotherapy;
• manual therapy;
• Exercise therapy.

In general, the nature of the therapy does not differ significantly from treatment aimed at eliminating pain. But if, despite all efforts, sensory disturbances persist, patients are recommended to undergo a more thorough examination, since their causes may lie not only in a hernia, but also in the presence of diabetic, alcoholic polyneuropathy, or even in the onset of multiple sclerosis.

Drug therapy

Almost all patients without exception are prescribed:

• NSAIDs – have analgesic and anti-inflammatory properties;
• muscle relaxants – have a relaxing effect on overly toned muscles, which leads to an improvement in the quality of transmission of bioelectric impulses and a reduction in the severity of sensitivity disorders;
• corticosteroids – have a pronounced anti-inflammatory effect, therefore they are used for severe inflammatory processes;
• vitamin and mineral complexes, especially those containing B vitamins, help normalize the quality of signal transmission along compressed nerves and spinal roots.

Additionally, other drugs may be prescribed that are necessary to eliminate the negative effects of basic medications. That is why drug therapy is developed individually for each patient. For example, patients with gastritis and similar diseases of the gastrointestinal tract are advised to use proton pump inhibitors simultaneously with the use of NSAIDs to protect the mucous membranes.

Physiotherapy

Physiotherapy methods are aimed at restoring normal blood circulation in the affected area, which can effectively combat soft tissue swelling. Most often, patients are prescribed a course of procedures:

• electrophoresis with vitamins and aminophylline;
• UHF;
• magnetic therapy;
• phonophoresis.

Traction therapy or spinal traction is recommended for most patients. The procedure involves the use of a special apparatus that creates a tensile load on the spine. The patient is placed on a special couch or in a bathtub (with underwater traction), and special belts are attached to his body.

By selecting the optimal load, it is possible to increase the distance between the vertebral bodies, which immediately leads to a decrease in pressure on the affected disc and decompression of the compressed nerve.

Exercise therapy

Therapeutic gymnastics plays one of the main roles in the conservative treatment of sensitivity disorders and numbness. Correctly selected exercises help restore normal mobility not only of the legs, but also of the back. With their help, it is possible to improve blood circulation and strengthen the muscle corset, which will create adequate support for the spine and minimize the risk of progression of intervertebral hernia.

But exercise therapy is allowed only after acute pain has been eliminated. For each patient, the complex is developed individually, taking into account the patient’s level of physical fitness, location, size and type of hernia.

Exercises are performed daily at a calm pace, without sudden movements. It is recommended to conduct the first classes under the supervision of a specialist in order to fully master the correct technique for performing each exercise.

Manual therapy

Skilled manual pressure on the back muscles and spine can eliminate excessive muscle tone, activate blood circulation and even normalize the position of the vertebrae. As a result, it is possible to significantly improve microcirculation and provide the affected intervertebral disc with the necessary nutrients, as well as eliminate the prerequisites for further aggravation of the situation and pinched nerves. Therefore, after a course of manual therapy, patients note a significant improvement in their condition.

Pain intensity

If the patient suspects that he has a herniated lumbar disc, then appropriate treatment is prescribed only after confirmation of the symptoms. As mentioned above, the main symptom of the disease is pain. Most often he is of a dull nature. Increased discomfort can be observed after a person remains in one position for a long time. Temporary relief comes from changing the position of the body.

It is a mistake to assume that a lumbar disc herniation is a passing phenomenon and to delay treatment. Over time, the disease can become more progressive, causing multiple pinching of nerve endings.

Over time, the pain syndrome can be localized in the gluteal area or accompanied by lumbago in the lower back. This process is called sciatica.

Why does pain occur with a vertebral hernia?

From the above, it is clear that pain in the presence of destruction of the intervertebral disc is formed not only from the fact that the destroyed cartilage itself directly compresses the nerve roots. This can be done by fascia and ligaments, and they are stretched from the hernia at a sufficient distance. The pain component is associated with various types of pain in color, the appearance of sensory and autonomic disorders, disruption of autonomic-vascular innervation, venous disorder and muscle swelling.

Finally, one cannot help but remember the component of secondary muscle spasm, which occurs as diffuse, low-intensity pain in the back and lower back, disturbing for weeks and months. In some cases, muscles, being subject to spasm, form a local persistent pain syndrome, for example, the piriformis muscle. The neurologist needs an accurate topical diagnosis related to the correct localization of the lesion.

Causes of the disease

If a patient is diagnosed with a Schmorl hernia of the lumbar region, then we can talk about the following causes of the pathology:

• Excessive body weight;
• Sudden careless movements;
• Increased physical activity;
• Traumatization of the spine as a result of an accident or fall from a height;
• Incorrect formation of the hip joint in children;
• Presence of osteochondrosis;
• Prolonged sitting, sedentary lifestyle;
• Uneven distribution of the load on the spine due to prolonged driving;
• Lack of oxygen due to a long period of smoking;
• Rachiocampsis;
• Age over 30 years;
• Hereditary factor;
• Chronic diseases of the spine.

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Causes of pain syndrome

With age, the articular processes of the vertebrae, both medial and lateral, become sources of osteophyte growth.

This leads to a decrease in the size of the intervertebral foramina. The adipose tissue that supports the root on all sides undergoes gradual atrophy, and the arachnoid membrane of the spinal cord, which envelops the root, also changes and gradually atrophies. The nerve roots themselves gradually conduct impulses worse and worse, both the fibers themselves and the ganglia. All this leads to insufficiency of the intervertebral foramen; the root does not become a source of serious pain only if it is at rest. As soon as any load occurs on the spinal column, these resting conditions are disrupted and severe pain occurs.

Osteophytes on x-ray

Numerous physiological studies have shown that a decrease in the height of the intervertebral disc leads to the bringing of adjacent vertebral bodies closer to each other. The corresponding openings between the vertebrae also decrease in size. If there is an extension movement in the lower back, then often the upper vertebra slips a little relative to the lower one. And if this slippage occurs with instability, a reduced size of the intervertebral foramina, then compression of the nerves often occurs, even the process of inflammatory aseptic epiduritis.

In the intervertebral foramina, the roots cease to lie normally, they move upward and become overstretched. When the patient's age approaches 50 years, these symptoms associated with distant pain in the leg appear quite clearly.

By the way, when the root is compressed in the intervertebral foramen, the root is affected at the level of the upper vertebra. So, if a patient has a hernia of L5-S1, then we are talking about damage to the L5 root, and if a hernia occurs at L4-L5, the symptoms correspond to damage to the L4 root.

The most characteristic course of pain is in the presence of foraminal hernias, which do not appear at all with aching pain in the lower back, but with persistent, shooting radicular pain. These pains are especially pronounced when the patient tilts to the painful side, with the slightest shock to the root. This is coughing, sneezing, laughing, straining in the toilet. In this case, a characteristic clinical picture develops with the appearance of pain in the corresponding limb; pain in the leg radiates along its entire length, right up to the big toe.

The most unfavorable situation occurs in the presence of a sequestered hernia, if the sequester moves downward and irritation of the nerves of the cauda equina occurs. The relevant symptoms are described below. In addition to a disc herniation, the root may be compressed by other structures that also need to be taken into account. This:

• compression of the root in the lateral recess of the vertebrae;
• frequent formation of adhesions, including after surgery;
• anatomical features of the structure of the articular processes of the vertebrae, which lead to lengthening of the root, bending it around the root of the vertebral arch;
• compression by the inflamed, thickened ligamentum flavum and osteophytes.

Let's consider how the leg can hurt depending on the location of the hernia.

Diagnostic features

If a patient suspects that he or she has a lumbar disc herniation, a thorough diagnosis is necessary before undergoing treatment. However, in order for the diagnosis to be made as accurately as possible and the damaged disc to be identified in the shortest possible time, it is better to contact a qualified specialist in a trusted clinic. In this case, a prerequisite is to take x-rays in frontal and lateral projections, which allows you to form a general idea of ​​​​the disease. More detailed information about the disease can be obtained using MRI. In addition, the doctor should determine how much mobility and sensitivity is maintained in the legs, and also check the patient for the presence of tendon reflexes. Once the nature of the damage to the nerve endings due to a lumbar hernia is established, the doctor can prescribe treatment.

Treatment of intervertebral disc herniation. How can we help you

Treatment of intervertebral hernia in our clinic will be structured as follows:

1. Quickly relieve pain and stop the pressure of the hernia on the nerve root. If the root is compressed for a long time, there is a risk of its atrophy, and this is fraught with a long and even incomplete restoration of the functions of the muscles of the affected limb. The volume of the disc herniation and pain can be reduced within 1-2 days by reducing its edema and swelling . The method of treating intervertebral hernia in the acute stage is medications, pain blockades, IVs, treatment with position and rest.
2. Unload the affected disk. This will allow you to move more freely and without risk, and the damaged disc will be able to gradually heal. Here, it is possible to fix the lower back with a belt/bandage, soft osteopathy or manual therapy on stiff areas of the spine (manipulation is not performed on the affected disc - this is dangerous), and gymnastics for unloading.
3. Restoration of the nerve root after compression. The sooner we begin treatment, the faster the transmission of nerve signals along the spine will be restored. This results in a gradual reduction in pain, restoration of strength and sensitivity in the affected limb. For this purpose, we will offer you various nerve regeneration stimulants and B vitamins.
4. Disc healing. A disc with a herniated spine heals in a unique way: the affected area grows with calcium compounds and becomes stronger. In this case, calcification of the herniated vertebral disc is the norm. Calcium deposition can be accelerated with the help of medications containing calcium, vitamin D and healing stimulants, chondroprotectors. To reduce the size of the hernia, if necessary, we will offer you Karipazim (Karipain) electrophoresis.
5. Spinal mobility and cartilage nutrition. At the end of the acute period, we will offer you to take chondroprotectors on your own for several months. This will improve the general condition of the spine and joints.
6. Return to active life and sports is usually possible after 4-12 months.

We will also teach you how to independently maintain your health and select an individual program for preventing the formation of intervertebral hernias, including a personal set of exercises that you can safely perform at home.

In what cases is surgical treatment required - removal of a herniated disc?

How to treat a herniated lumbar spine?

If a patient is diagnosed with a lumbar spinal hernia, treatment must begin as soon as possible. At the same time, at the initial stage of the pathology, treatment can be carried out using conservative methods; in complex cases, the only method of eliminating the pathology is surgical intervention.

To avoid radical measures and undergo treatment for a hernia of the lumbar spine without surgery, a person is advised to give up bad habits. Increasing physical activity and following a special diet that has a beneficial effect on cartilage and nerves will gradually restore the health of the spine.

Use of medications

If a person is diagnosed with a lumbar hernia, treatment with medications can only eliminate the signs of the disease, and not cope with them completely. In this case, it is mandatory to take painkillers and anti-inflammatory drugs such as Ibuprofen or Diclofenac. They help not only relieve acute pain, but also prevent muscle tissue atrophy in the future. Such medications can be used not only in the form of tablets, but also in the form of gels and ointments.

If the patient feels stiffness of movement and spasms in the muscle area, the doctor prescribes relaxants - Sirdalud and Mydocalm.

Exercise therapy for hernia of the lumbar spine

Treatment of a hernia of the lumbosacral region with conservative methods does not achieve the desired effect in all situations. However, such a gymnastic complex helps prevent subsequent progression of the disease. Exercises for a hernia of the lumbar spine are recommended to be performed only after the discomfort disappears.

The treatment program is compiled by the instructor on an individual basis. Its main goal is to improve the condition of the muscles and prevent further changes in the position of the disc. At the initial stages of development, such activities help to completely get rid of pathology. Exercises for acute lumbar hernia help alleviate the symptoms of the disease, but they are prescribed only after the doctor’s permission. In this case, gentle rotations of the torso and arms, lifting, bending and other activities that help stretch the spine are allowed.

Physiotherapeutic procedures

In order to eliminate the symptoms of a herniated lumbar spine and prescribe effective treatment, the following physiotherapeutic methods are used:

• Impact on acupuncture points using needles;
• Treatment using warm compresses;
• Electrophoresis with anti-inflammatory and anesthetic compounds;
• Underwater massage.

Make an appointment Online booking

• Clinic on Krasnopresnenskaya +7 (499) 252-41-35 Volkov lane, 21
• Clinic on Varshavskaya +7 (499) 610-02-09 Varshavskoe highway, 75, building 1
• Clinic in Annino +7 (495) 388-08-08 Varshavskoe highway, 154, building 1

Massage

If the lumbar intervertebral hernia has already passed the acute period, massage can be performed as a treatment. With its help, it is possible to normalize blood circulation, provide the necessary nutrition to tissues and nerves, eliminate spasms in the muscles, free cells from harmful lactic acid and restore lost mobility. In addition, during massage procedures, endorphins are produced in the body, which also gives an anesthetic effect.

The Importance of Shock Wave Therapy

Despite all the variety of modern methods of combating this disease, the shock wave therapy method remains the most effective and safe for the body. For intervertebral hernia of the lumbar region, the shock wave treatment method is as follows:

• Exposure of discs to low-frequency sound that is not perceptible to the human ear;
• High intensity of sound waves applied to the affected area.

This method of treatment is carried out only if the doctor has not identified any contraindications in the patient during the diagnosis. As a rule, such restrictions include pregnancy, the presence of cancer, acute infectious processes in the body, or the use of a pacemaker.

Experts note the following advantages of this procedure:

• The possibility of surgical intervention is excluded, since during the shock wave action the dead part of the hernia of the lumbar spine removed
• Shorter and easier rehabilitation period, in contrast to surgery;
• Possibility of restoring blood circulation in the affected area;
• Gentle impact on diseased areas;
• Absence of any discomfort during the treatment session and after it;
• Quick pain relief;
• Elimination of salt accumulations;
• Possibility of strengthening the vertebrae;
• Elimination of edema;
• Cell regeneration;
• Restoring limb mobility;
• Removing muscle tone.

Surgery to remove a hernia of the lumbar spine

There are cases when conservative methods of influence are ineffective. These include:

• The presence of a focus of inflammation in the area of ​​the sciatic nerve;
• Significant change in the position of the intervertebral disc;
• Disc rupture;
• Poor patency in the longitudinal canal of the spinal cord;
• Deterioration of the patient's condition over time.

In this case, only surgical treatment can eliminate the intervertebral hernia of the lumbar spine. However, today there are gentle, minimally invasive surgical techniques, which include:

• Laser exposure. Using a laser, it is possible to eliminate unnecessary fluid from the damaged pulp and relieve the nerve from pressure;
• Discectomy. This technique involves removing part of the disk. In this case, a needle is used to remove a section of the nucleus pulposus;
• In the most difficult cases, the disc is completely removed and then replaced with prosthetics.

Sensitivity of the legs due to spinal hernia

Normally, when exposed to receptors in the skin and soft tissues, a person feels irritation due to the transmission of bioelectric impulses along special nerves, called sensory nerves, to special parts of the central nervous system. In medicine, there are several types of sensitivity: touch, sensation of vibration, pressure, weight, position in space.

First of all, with intervertebral hernias, superficial or tactile sensitivity is disrupted, i.e., the quality of perception of the nature of touching the skin, its localization and intensity is distorted. Although pain is also a type of sensitivity, it is usually perceived as a separate symptom.

In case of spinal hernia, it is also important to evaluate the temperature sensitivity of the skin. To do this, alternately place cold and warm objects against the area of ​​the limb. Additionally, the minimum discriminatory distance is calculated, i.e., the one at which two simultaneous touches are felt as one.

Joint-muscular sensations, sensations of vibration, pressure, weight are among the deep types of sensitivity. However, many of them can also be disrupted due to the formation of intervertebral hernias.

In the case of a spinal hernia, which is a protruding defect of a disc located between two vertebral bodies, sensory disturbances are a consequence of compression of the spinal ganglia or other areas of sensory nerves. Many of them pass in the spinal canal and foraminal openings of the spine, so pathological protrusion, especially large ones, can put pressure on them, up to completely blocking the possibility of transmitting nerve impulses from peripheral nerves to the sensory (spinal) ganglia.

The nervous system of the human body is built in such a way that the sensory ganglia are located at the back of the spine. They are specific nodes in which the bodies of the first neurons responsible for the perception of signals from peripheral nerves, including the legs, are located.

So, in the lumbar region all the sensory nerves coming from the lower extremities gather. In the area between the first and third lumbar vertebrae, they merge into the posterior sensory roots, which are directly connected to the spinal cord. At this stage, the bodies of its neurons are already involved in the work of transmitting the signal about the action of the stimulus to the brain. Thus, bioelectric impulses are transmitted through sensitive fibers from bottom to top.

In addition to the posterior nerves responsible for sensitivity, there are also anterior spinal roots, which are responsible for a person’s motor capabilities (muscle tone, subordination of muscles to a person’s desires). But signals are transmitted through them from top to bottom. That is, first a bioelectric impulse is formed in the brain, transmitted to the corresponding neurons of the spinal cord and from them to the corresponding motor roots.

Hernias almost always compress both the anterior and posterior roots. That is why its formation often leads to various sensitivity disorders at different levels of exposure, limited mobility and muscle disorders.

Sometimes the changes that have arisen can only be detected by a doctor using special neurological tests or the use of special instrumental diagnostic methods. Moreover, the nature of the manifested deviations from the norm strictly depends on which specific intervertebral disc is affected. Thus, sensory disorders in the legs are associated with the presence of degenerative processes in the discs of the lumbar spine.

The presence of an inflammatory process in the intervertebral disc and pinched nerves can provoke a reflex muscle spasm. This in turn leads to pain of varying severity, as well as leg cramps.

Prevention rules

As is known, deformation of intervertebral discs occurs against the background of regular or sudden load. Therefore, the most important point is to reduce this load. When sleeping at night, it is recommended to use an orthopedic mattress. It is best to fall asleep lying on your back.

It is also necessary to take a close look at your weight, since its excess has a negative effect on the spine. When performing a set of therapeutic exercises, it is advisable to avoid sudden movements and prolonged stress. Even at home, remember about correct posture, and try to change your body position more often when sitting.

What to do for lower back pain radiating to the leg and buttock

First of all, if pain occurs in the lower back, buttock, or thigh, you should ensure complete rest. Gradually, the pain should subside due to muscle relaxation. You should also definitely make an appointment with a chiropractor - a neurologist, but before examining a specialist, it is important not to take any medications, since painkillers will blur the clinical picture and make it difficult to diagnose the disease.

It is important not to self-medicate when pain occurs and not to rely on ointments, creams or gels containing diclofenac sodium and other NSAIDs, since they have practically no therapeutic effect, but only dull the symptoms of the disease.

Possible complications

Among the most serious dangers posed by a lumbar hernia is a disruption in the supply of nerves to the pelvic region and lower extremities. In this case, the patient may experience the following symptoms:

• Significant deterioration of sensitivity in the legs and perineum;
• The pain becomes too intense;
• Muscle weakness in the lower extremities and a noticeable change in gait;
• Severe disturbances in the functioning of the urinary system;
• Development of impotence in men, lack of sexual activity in women.

If you have one or more of the above symptoms, you should seek help from a neurosurgery specialist as soon as possible. In this case, the effectiveness of conservative methods is considered zero. The possibility of restoring the health of the lumbar spine depends on how seriously you take this problem and how promptly you visit a medical clinic.

Intervertebral hernia in the lower back. Treatment during an exacerbation. What to do?

If there is a sequestered disc herniation that compresses the root, the patient experiences severe pain, there are signs of sensory impairment, weakness in the leg, and non-steroidal anti-inflammatory drugs are powerless, then the neurosurgeon is clearly inclined to surgical treatment. The effect of the operation is comparable to the effect of an extracted tooth - relief occurs immediately after surgery.

When the pain does not radiate to the leg, but only bothers the back, then most often we are dealing with spondyloarthrosis.

In this situation, it is possible to be conservative, i.e. without surgery. It includes taking NSAIDs, bed rest, wearing orthoses, physiotherapy, massage and even manual therapy (with a skillful approach), various types of therapeutic blockades. Methods of denervation of the causative facet joints are also used - radiofrequency denervation of the facets.

Outside of an exacerbation, the patient must develop a motor behavioral stereotype for himself, go to the pool, get a massage, do fitness, and normalize weight.