Lumbar intervertebral disc herniation. Treatment, Symptoms

Lumbar intervertebral disc herniation symptoms

Osteochondrosis is a degenerative disease of the intervertebral disc, which consists of several stages - 4 stages according to A.I. Osna. To talk about the stages of this disease, it is necessary to imagine the structure of the intervertebral disc. It consists of the fibrous ring and the nucleus pulposus - a jelly-like mass under some pressure.

Diagram of the structure of the intervertebral disc:

(scheme borrowed from the resource medklik.ru)

At the first stage, the fibrous ring becomes somewhat thinner and the nucleus pulposus rushes into this place, pain syndrome is local in the lower back and occurs due to irritation of the ring.

At the second stage, the ring bursts and prolapse of the nucleus pulposus into the ring defect occurs. The nucleus pulposus is infringed, which explains the pain.

At the third stage, the nucleus pulposus prolapses into the free spinal canal or under the anterior longitudinal ligament. The so-called extrusion or sequestration. In this situation, the pain syndrome changes its character and pain in the lumbar spine can completely disappear (decompression in the disc cavity and pinching of the nucleus pulposus in the hilum of the fibrous ring is eliminated). Pain appears in the limb (leg) of the striped type, shooting or pulling, radiating to the toes - this is radiculitis !!!

In addition to pain, sensory disorders occur in the form of anesthesia (as if through paper or cellophane), paresthesia - a crawling sensation, etc.

There may be weakness - the so-called. paresis, decreased or loss of reflexes. In addition to compression of the root, an important artery - Adamkiewicz or Deproge-Gotteron - can be compressed and lead to myeloradiculoischemia, which is manifested by disruption of the pelvic organs - urinary and fecal retention, impotence, etc.

Those. this stage has neurological manifestations or complications. Most often, it is at this stage that we, neurosurgeons, offer surgical intervention.

The fourth stage is the stage of secondary changes in other structures of the spine and complete “drying out” of the disc (it is black on MRI, there is no glow of the nucleus pulposus), the height of the disc sharply decreases, varicose veins develop in the spinal canal - venous congestion, cicatricial adhesive epiduritis, facets hypertrophy joints, secondary spinal stenosis develops.

This stage is characterized by pain in the back and legs, weakness, and often intermittent caudogenic claudication. At this stage, decompressive interventions with the installation of stabilizing systems are possible.

Thus, with a herniated disc there are:

• Pain syndrome: lumbodynia - back pain, lumboishalgia - pain in the back and hip;
• Muscular-tonic syndrome - tense back muscles;
• Orthopedic - manifested by poor posture (antalgic scoliosis);
• Radicular syndrome is all signs of a dysfunction of the root (see above + pain along the dermatome).

Intervertebral hernia - symptoms and treatment

Treatment is prescribed to the patient based on causal and symptomatic therapy. Symptomatic therapy is aimed at easing and relieving pain. For this purpose, means are used whose task is to change the impaired functions of the nerves, and means aimed at eliminating inflammatory foci.[2]

Drug treatment

For severe pain it is prescribed:[9]

• promedol;
• glucocorticoids (diprospan, dexamethasone);
• NSPS (Diclofenac, Voltaren, Xefocam, etc.);
• chondroprotectors (Hyaluronic acid, Chondroitin sulfate, Glucosamine sulfate);
• B vitamins (B1, B6, B12);
• vitamin C;
• vascular drugs (Actovegin, Trental, Lysine aescinate, etc.);
• muscle relaxants (Mydocalm, Sirdalud, Baklosan, etc.);
• antidepressants (Amitriptyline, etc.).

Manual therapy, exercise therapy and massage

Exercise therapy and massage can reduce pain, but do not eliminate the hernia. The effectiveness of manual therapy for the treatment of hernia does not have sufficient evidence. Since 2021 in Russia, the methodology has been removed from the nomenclature of medical and pharmacist specialties; certificates for this type of activity are no longer issued.

Physiotherapy methods:

• UHF;
• electric light baths;
• electrophoresis with novocaine;
• irradiation with ultraviolet rays;
• ultrasound;
• diadynamic currents;
• salt and pine baths;
• radon baths;
• mud therapy.

Spinal traction

In case of damage to the intervertebral discs with compression of the roots, traction is indicated. In modern clinics, traction is performed on special traction tables with a connected electric drive.

In the acute period - rest, the patient is placed on a hard mattress or wooden board.[9] Painkillers are prescribed.

Surgery

Surgery for intervertebral hernias should be performed after conservative treatment has been tried. Indications for surgery include a long course of the disease, frequent relapses, lack of effect from conservative treatment, and the appearance of caudal and spinal symptoms, at least to a mild degree.[2]

Discectomy has been shown to be an effective treatment for acute disc herniation regarding neurological symptoms, but does not eliminate the consequences of altered biomechanical properties of the segment. In this situation, the surgeon is faced with a dilemma about how to perform a major discectomy: if only the extruding material is resected, there is a risk of recurrent disc herniation; however, if all or most of the disc tissue is resected, there is also a significant likelihood that loss of biomechanical function will lead to instability or collapse of the segment. Because of slowly progressive disc degeneration, which is associated with cellular aging, increased catabolic activity, and decreased matrix synthesis, cell therapy is an attractive approach to intervertebral disc regeneration.[10]

Recovery after removal of intervertebral hernia

After surgery, you should not lift heavy objects and the load on the spine should be evenly distributed. Patients are often referred for post-operative rehabilitation, which may include exercise and physical therapy techniques. However, data on its effectiveness are insufficient, and results in the published literature are contradictory [11][12].

Myths and dangerous misconceptions about hernia treatment

The main myth is the benefits of manual therapy, especially trusts and crunches. These methods, as well as home remedies , such as various compresses, are not effective against hernia.

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.

The benefits of Nordic walking

Nordic walking appeared in the 30s of the last century thanks to skiing. It was originally used by skiers and biathletes in the summer to prevent loss of shape . Simple running did not cope with this task, and the trainers suggested using sticks. Soon the effectiveness of this kind of training was appreciated all over the world, and in 1997 special sticks were born.

Over time, Nordic walking, also called Finnish, Nordic or Nordic walking, began to be used not only by athletes, but also by ordinary people who want to keep the body in good shape, strengthen the spine and prevent joint problems.

It is considered safer and more effective than regular walking , since part of the weight falls on the poles, which relieves the stress on the body. The load on the lumbar region and leg joints is reduced to 35%, which is a significant advantage in case of intervertebral hernia.

Pay attention to the benefits of Nordic walking

Nordic walking may be indicated in the following cases:

• intervertebral hernia;
• other problems of the musculoskeletal system;
• overweight;
• sleep disorders;
• mild forms of respiratory system diseases;
• diseases of the heart and blood vessels;
• postoperative period (except for abdominal operations).

The benefits of this type of activity are as follows::

1. Restoring the functioning of joints . This happens due to the fact that movements during walking activate metabolism in the blood vessels.
2. Decreased blood glucose levels . Physical activity ensures rapid absorption of the latter, therefore Nordic walking reduces the risks of diabetes and can prevent its further development in the early stages.
3. Weight normalization . Physical activity helps burn excess fat and also produces a general strengthening effect.
4. Working out all muscle groups . This is especially important if a person leads a sedentary lifestyle.
5. Prevention of osteoporosis . The skeletal system receives smooth loads, which gradually strengthens its tissues.
6. Improving immunity . Regular walks in the fresh air are an excellent way to prevent illness.
7. Preventing stress . Classes allow you to get rid of emotional stress and reboot your nervous system.

All this has a beneficial effect on the condition of a patient with a spinal hernia. This type of activity helps to maintain shape safely, as it fully meets the requirements for loads allowed for this pathology. The activity is as gentle as possible, which does not provoke complications and allows you to keep yourself in good shape.

Video: “The benefits of Nordic walking”

Intervertebral hernia of the lumbar spine. Treatment

You need to remember that a neurosurgeon does not treat a hernia, but the manifestations that it causes - pain, dysfunction of the limbs. Degenerative changes are not reversible and discs cannot be restored to their former hydrophilicity and elasticity. The facet joints also change irrevocably, and the main thing is to remove inflammation in them or the compressive effect on the surrounding nerves.

As has already been mentioned several times, a disc herniation that has radicular (pain in the leg, dysfunction) or myeloradiculoischemic manifestations is often subject to surgical removal.

First aid for exacerbation of spinal hernia

A herniated disc should be treated immediately after the first symptoms of exacerbation appear. This makes it easier and easier to get rid of pain.

First aid for an exacerbation is as follows:

1. If it hurts to sit/stand, you need to lie on your back. This way you will remove the load from the spine, which will be evenly distributed throughout the body.
2. Take an analgesic - Analgin, Paracetamol, Aspirin. Diclofenac has a good effect, but it should be taken only after consulting a doctor.
3. Take muscle relaxants - they eliminate spasms by reducing muscle tone (Mydocalm, Sirdalud, Tizalud).
4. If you don’t have painkillers on hand, apply ice to the painful area for 10 minutes. To avoid getting an ice burn, first wrap the ice in a layer of cloth. If you have kidney problems, you should not apply ice to your lower back.
5. Immobilize the affected area. If you have a special half-corset or collar, wear it. These devices will relieve stress from the spine, reducing the intensity of pain.

Warming procedures, which will increase inflammation and pain, are strictly prohibited. Heat can be used during the remission stage and only after consultation with a doctor.

How to prevent a hernia from worsening

To avoid recurrence of hernia:

• Avoid a sedentary lifestyle. Walk, hike, swim, and other permitted sports.
• Watch your posture, avoid slouching. If you spend a lot of time sitting, buy a special chair.
• Don't lift heavy things.
• Monitor your weight and nutritional quality.
• Drink plenty of water.
• Avoid back injuries, especially in winter. To walk on snow and ice, buy good shoes with non-slip soles.
• When playing sports and physical activity, wear an orthopedic corset.
• Sleep on an orthopedic mattress, avoid feather beds.

What not to do during an exacerbation of a hernia

In case of exacerbation of a herniated disc, you should not:

1. Make sudden movements.
2. Perform exercises with weights to twist the spine.
3. Lift weights, including squats with a barbell and kettlebells.
4. Pull up on the horizontal bar.
5. Do push-ups.
6. Bend over with straight legs (for lower back pain).
7. Exercise. When the pain begins to go away, swimming, Pilates, and yoga are allowed.
8. Visit the sauna and take a very hot bath.

Risk factors

The treatment program directly depends on the cause of the disease:

• Excess weight.
• Advanced stage of osteochondrosis.
• Injuries.
• Excessive physical activity.
• Age-related changes.
• Sedentary lifestyle.
• Hip dysplasia.
• Posture defects.
• Hereditary predisposition.

These etiological factors are the basis of the pathological process. However, their timely elimination helps to significantly improve the patient’s condition.