The lumbar spine consists of 5 vertebrae, between which there are intervertebral discs. The sacral section is represented by one bone, sacrum. The last lumbar vertebra also connects with the sacrum disc. Accordingly, hernias can occur at any of the listed levels, but most often the cartilage tissue between the 4th and 5th lumbar vertebrae, and between the 5th lumbar 1st sacrum suffers.
Herniation of the lumbosacral spine is most common, since it is this part of the spine that has the maximum load. Hernia is a protrusion of the inner part of the intervertebral disc( pulpous core), which arises from degenerative-dystrophic changes in the cartilaginous tissue and rupture of the fibrous capsule of the disc. This is a complication of such a disease as osteochondrosis, although traumatic hernia discs can rarely occur.
Lumbosacral artery is a dangerous disease, since protrusion can put pressure on the spinal cord if the hernia is formed at the level of the 1st-3rd lumbar vertebra, or on a bundle of nerve fibers inside and outside the spinal canal, if protrusion appears on thelevel of the 4th lumbar-1 st sacral vertebra( because at this level the spinal cord inside the canal is absent).
Hernia may appear in any of these intervertebral discs
The causes of the formation of intervertebral hernias are somewhat. As a rule, they appear due to such a degenerative-dystrophic process as osteochondrosis. For a long time this disease was considered normal age-related changes, but in the last few years the incidence of osteochondrosis has increased significantly among people of young age and even adolescents. This proves that it's not just about age. A large role is played by factors that contribute to the disruption of metabolic processes and nutrition of the cartilaginous tissue of the discs, as well as the constant overload of certain segments of the spine.
Risk factors for the development of the intervertebral hernia:
- working conditions, when the lumbar region has constant stresses that cause microtraumas inside the cartilaginous tissue and degeneration of the discs, for example, work as a loader, gardener, long stay in one posture( office workers);
- spine trauma;
- congenital and acquired diseases of the musculoskeletal system;
- curvature of the spine;
- poor development of the back muscles;
- metabolic and endocrinological diseases.
It's important to remember! The described risk factors do not mean that their owners necessarily form an intervertebral hernia, but the more such negative influences, the greater the chance to get sick. Therefore, people who are at risk should take preventive measures to prevent pathology.
Symptoms of intervertebral hernia depend, first of all on its size, level of appearance and type( depending on localization).
There are several varieties of protrusion of the disc relative to the spine circumference:
- Backward-mounted .These are the most dangerous and clinically significant types of formations, since protrusion is directed into the vertebral canal( medial), which can lead to compression of the spinal cord tissue. Also, the hernia can be turned towards the spinal roots( foraminal and paramedian) and cause their inflammation, irritation or compression with the corresponding consequences.
- Lateral , or lateral. In this case, the hernial sac prolapses away from the spinal column. Such a hernia is not dangerous, it can cause symptoms only if it reaches a large size.
- Ventral .Diagnosed when protrusion is in front of the spine. This type of hernia never causes pathological symptoms and does not represent a particular clinical interest, as a rule, it is diagnosed accidentally during examination on another occasion.
- Common .In this case, protrusion occurs around the entire perimeter of the disk. It can be circular, when the disk is squeezed out evenly, or diffuse when its uneven prolapse occurs. In both cases, the hernia is a serious problem and a health hazard, as it often causes compression of the nervous system structures.
Types of intervertebral hernias
Depending on the size, hernias of the lumbosacral can be classified as follows:
- small( 1-5 mm), which require mainly outpatient conservative treatment, exercise therapy, perhaps the use of spinal traction;
- averages( 6-8 mm), treats them out-patient, the operation is not indicated;
- large( 9-12 mm), which try to treat conservatively, but the operation can be prescribed with symptoms of compression of the spinal cord or the development of horse tail syndrome;
- giant( more than 12 mm), surgical treatment, conservative therapy can be used only if there are contraindications to surgical correction.
As a rule, the disease develops gradually over several years. Symptoms of the pathology appear if the protrusion causes irritation, inflammation or compression of the nerve roots that come out of the spinal canal, or the spinal cord tissue is squeezed.
The main symptom that points to the lumbosacral hernia is pain. Back pain may have several options:
- Lumbalgia is a chronic pain in the lower back of low or medium intensity. Appear or worsen in case of spinal congestion, clumsy movements.
- Lumbago is an acute pain that occurs suddenly in the lumbar region in the form of a lumbago, its intensity is very high. Pain causes a person to freeze in the movement in which it is, when the pain has overtaken it, and does not allow it to straighten. Lasts for several minutes, then replaced by lumbargia.
- Lumboeishalgia .This pain syndrome is characterized, in addition to the typical lumbargia, by the spread of pain along the sciatic nerve( the posterior surface of the buttocks and thighs).Can be as one-sided, and arise immediately in two legs.
In parallel with the pain syndrome, patients feel stiffness in the waist, limitation of the amplitude of movements, muscle tension in this zone, there may be a crunch or clicks when moving in the spine.
The following symptoms are indicative of a lesion of the spinal cord or nerve endings:
- decrease in muscular strength in the lower limbs;
- foot paresis;
- violation of the sensitivity of the skin of the legs;
- muscular atrophy of the lower limbs( you can see muscle slimming);
- various disorders of the pelvic organs( delay or incontinence of urine, feces);
- erectile dysfunction in men, loss of sensitivity of the genital organs in women;
- , when the spinal cord is compressed, leg paralysis may occur( lower paraparesis).
Localization of sensitivity disorders in hernias of various lumbar discs
If the hernia is at the level of the 3rd lumbar-1-st sacral vertebra, then a bundle of nerve fibers can be compressed, which leave the spinal cord, because at this level the spinal cord is already absent. In this case, the horse tail syndrome develops. These nerves provide sensory and motor innervation to the lower limbs and pelvic organs. This function suffers when compressing the horse's tail.
In each case, the hernia of the spine requires detailed diagnosis, because there are a few dozens of diseases that may show similar signs. And also the specification of localization, type of protrusion, its size plays an important role in the preparation of the treatment program.
Methods of diagnosis:
- neurological examination,
- standard set of laboratory tests,
- radiography of the spine,
- MRI or CT of the lumbosacral spine.
Magnetic resonance imaging - the "gold standard" for diagnosis of hernia of the spine
Treatment of lumbosacral hernia can be conservative and surgical. As a rule, at the early stage of the disease the success of conservative therapy is very high and reaches 90%, but only if all medical recommendations are observed. Applied methods:
- drug therapy( analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants, decongestants, chondroprotectors, B vitamins, drugs for normalizing microcirculation);
- special therapeutic exercise complexes( ASF)
- blockade of the spine with local anesthetics, corticosteroid hormones for relief of acute pain;
- spinal traction;
- physiotherapy procedures;
- sanatorium treatment.
In the case of ineffectiveness of conservative therapy for 6 months, the presence of constant severe pain, with the threat of compression of the spinal cord or the presence of such proceed to surgical treatment of the hernia.
There are a lot of techniques for surgical intervention on the spine for hernia, in particular, modern and minimally invasive. The choice of the necessary procedure is made by a specialist doctor, based on the individual situation of each patient.
It is important to note that, despite modern technologies and operating procedures, surgical treatment of a spinal hernia is always a big risk, in addition, in such cases, a long rehabilitation is necessary, on which half of the success depends. Therefore, it is better to try to get rid of the problem by conservative methods, which, in addition to the therapeutic effect, are also prophylactic.
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