Lumbar spine protrusions are one of the stages of degenerative-dystrophic changes of the intervertebral discs. Most often, this pathology affects the lumbar spine, as these areas have the maximum load. Disc protrusion is the precursor of a more complex condition - the intervertebral hernia. Therefore, it is very important to identify the violation in time and start a comprehensive treatment.
The main cause of development of protrusion of intervertebral discs is increased pressure on cartilaginous tissue and dystrophic changes in its structure. The precursor of protrusion is osteochondrosis, although some experts consider the protrusion of the disk as one of the stages of osteochondrosis of the spine.
Long stay in one work posture is a serious risk factor for the development of the
disc protrusion. The main causes of development of protrusion of intervertebral discs:
- genetic predisposition to the development of osteochondrosis;
- features of the structure of the spine;
- pathological posture types;
- post-traumatic and other types of deformities of the spinal column;
- endocrine and metabolic diseases;
- long stay in one position, for example, sedentary work;
- insufficient development of the back muscles;
- extreme physical exertion;
- professional sports;
- overweight;Age-dependent involuntary changes.
It's important to remember! These conditions are not necessarily accompanied by protrusions, they only increase the risk of developing the disease and are, most likely, risk factors. Therefore, if you try to eliminate the adverse effects of these circumstances, you can cure the protrusion or prevent its development.
What is the protrusion, its types
The protrusion of the intervertebral disc is its protrusion beyond the spinal column, but the integrity of the fibrous capsule that surrounds the disc is preserved( this distinguishes the protrusion from the hernia).
The protrusion of the spine of the lumbar region, depending on the size, is divided into:
- small( bulging up to 4 mm disk),
- average( 4-7 mm),
- large( 7-9 mm),
- giant( more than 9 mm).
Symptoms in this condition may be completely absent, manifest at a minimum or be accompanied by intolerable pain. This depends on the size of the protrusion and its localization along the circumference of the intervertebral disc.
In relation to the protrusion to the circumference of the disc, several pathology variants are distinguished.
- Circular - when protrusion uniform throughout the perimeter of the disc. It occurs most often( 85% of cases).It is accompanied by infringement of the nerve roots of the spinal cord, manifested by pronounced clinical signs. The course of the pathology is chronic and prolonged. Most often this is the result of degenerative and dystrophic changes in the vertebral disks.
- Diffuse - protrusion occurs in a circle, but not evenly. Symptoms occur when most of the disk presses on nerve endings, if not, the disease can be asymptomatic.
Types of protrusions of intervertebral discs
- Lateral - when the disc is protruded to the side( right or left).In this case there is a high probability of infringement of nerve endings and the corresponding symptomatology when reaching protrusion of large sizes, until this time the pathology proceeds asymptomatically.
- Medial - when the disc protrudes inside the spinal canal. As a rule, there are no symptoms, but it can reach large sizes, which is very dangerous, since it can squeeze the spinal cord and cause a disruption of its function.
- Ventral - when the disc protrudes anteriorly from the spine. Such a condition is never accompanied by pain and is not dangerous, therefore, it practically does not represent a clinical interest.
- Posteradic ( foraminal and paramedian) - when protrusion develops backwards and away from the spine, it is exactly where the intervertebral foramen is located and the nerve roots leave the spinal cord. Therefore, there is a high risk of nerve compression and related consequences.
As already mentioned, the protrusion of the lumbar spine is accompanied by pathological symptoms only when protrusion presses on the nerve roots or the spinal cord itself. In the remaining cases, there are no signs, and pathology is detected accidentally during a survey on another occasion.
The most common symptoms of low back protrusion:
- mobility limitation in the lumbar region;
- constant low back pain( low or medium intensity lumbalgia), which increases with sudden movements, in an uncomfortable position, during prolonged stay in one position;
- can cause acute pain syndrome, which is called lumbago, it is an acute pain that occurs suddenly and causes a person to freeze in a certain position, gives in the foot, passes after several minutes;
- for prolonged periods, patients begin to complain of decreased leg muscular strength, stiffness and tingling in the lower limbs;
- can sometimes suffer from the function of the pelvic organs( rectum, bladder, reproductive system).
Back pain - the main symptom of protruding
The last two groups of symptoms are neurological in nature and are associated with the compression of nerve fibers. This is a very dangerous sign that can even lead to disability.
It is not difficult to establish a diagnosis of protrusion of the intervertebral disc. At objective survey the doctor considers characteristic complaints, the given inspection which should include inspection by the doctor-neurologist. Unfortunately, there are several diseases that show similar symptoms, so additional methods are needed to clarify the diagnosis.
It is not possible to establish a protrusion on the X-ray examination of the spine, since the X-ray does not "see" the soft tissues to which the cartilage of the discs belongs. Visualization of the pathology can be done with MRI or CT.These types of examinations can accurately diagnose the disease, determine the size of the protrusion and its localization. The data obtained is used to formulate a treatment plan.
No specific laboratory signs of the disease exist.
Treatment of the lumbar spine
Immediately it is necessary to say that it is possible to cure the protrusion through conservative methods, while the hernia can only be removed surgically. In this process, patience, compliance with all doctor's recommendations and elimination of risk factors for pathology are very important.
The goal of conservative therapy is to eliminate acute or chronic pain syndrome, eliminate inflammatory changes, unload the spinal column, strengthen the back muscles, improve blood supply and metabolic processes in the tissues of the spine. All this allows to achieve stabilization of degenerative changes.
There are a lot of methods of therapeutic influence. As a rule, the complex consists of the following methods:
- Medication. To it resort only at exacerbations of a pathology and development of an acute painful syndrome. Applied analgesics, non-steroidal anti-inflammatory drugs, muscle relaxants, B vitamins, decongestants. In particularly difficult cases, blockades are resorted to by local anesthetics and glucocorticoid drugs. To strengthen and renew the cartilaginous tissue, the use of chondroprotectors with long courses is used. During the period of exacerbation, it is mandatory to have a bed rest for unloading the spine.
- Massage and therapeutic physical exercises. These are the most effective methods of treating protrusions. Therapeutic gymnastics allows to strengthen the muscular corset and provide additional and good stabilization for the damaged spine. It is important that all exercises are performed regularly and correctly. Excellent, if the complex will pick up for you an expert. Massage can be performed only outside the exacerbation of the pathology, when there is no pain. It allows you to remove pathological and painful muscle spasm, improve the nutrition of the spinal tissues, strengthen the muscle corset.
- Extension of the spine. It is also an important element of therapy. Allows to unload the affected segment of the vertebral column. The extension can be underwater or dry. In each case, the doctor determines the type of traction, load and duration of treatment.
- Physiotherapeutic procedures - laser therapy, shock wave therapy, UHF, magnetotherapy, paraffin applications, ultrasound, etc.
- Non-traditional methods of treatment - acupuncture, osteopathy, manual therapy, apitherapy, hirudotherapy, folk recipes.
Underwater spinal traction is an effective method for the treatment of
disc protrusion. Surgical treatment of
Surgical treatment of disc protrusions is practically not used, since after the operation the risk of developing a hernia and worsening of the patient's condition increases.
Indications for operation:
- no effect of conservative treatment for 6 months;
- rapid rates of disease and increased protrusion size;
- protrusions press on the spinal cord or nerve roots, which threatens the patient's health.
When making a conclusion, it must be emphasized that the protrusion of the intervertebral disc is a very deceptive condition, because today it does not make itself felt, but tomorrow it can make you suffer from intense pain. Therefore, in detecting the disease, every effort should be made to eliminate it and prevent it.
- Reasons for
- What is the protrusion, its types
- Treatment for protrusion of the lumbar spine