Causes and treatment of herniated disc L5-S1

Herniated disc l5 s1 is a disease in which there is a partial or complete protrusion of the intervertebral disc. The terminology of the l5 s1 disc herniation suggests that the bulge is located between the fifth lumbar and the first sacral vertebra. The high frequency of formation of pathology in this department is explained by the fact that this area lends itself to the greatest pressure during life.

The lumbar spine can withstand not only the own weight of the human body, but also any load exerted on the body.

Features of disc herniation l5 s1

The human spine consists of a series of individual vertebrae that do not directly touch each other. Between them are intervertebral discs that perform a number of functions, namely: weight absorption, pressure balancing, partial nutrition of the vertebrae. The intervertebral disc itself is a dense and solid structure, consisting of fibrocartilaginous tissue, in the center of which is the nucleus pulposus.

The disk itself does not have its own blood supply, and it is fed only by diffusion, when nutrients are transported through the penetrating cell membranes according to the concentration gradient law. This is of particular importance, since in case of traumatic damage to the vertebra and its surrounding tissues, the intervertebral disc is susceptible to damage.

The concept of nutrition of the disk structure also occupies a special place when talking about the constant load that the vertebrae are subject to. Thus, due to the compensatory capabilities of the body, under constant pressure, the disk expands and increases, compensating for pressure and creating a stronger shock-absorbing field.

With an increase in the disc, the process of penetration of nutrients worsens. After some time, the disk in the reverse order becomes smaller, it dries up and atrophies without nutrition. As a result, the disc is no longer such an elastic structure, and some of its peripheral parts migrate into the spinal canal, where contact is created between the disc and the spinal cord, which gives rise to a number of clinical symptoms.

Reasons for education

The formation of a herniated disc requires a combination of several factors. If one factor acts, the body compensates for an adequate load. But if several factors act at the same time, the likelihood of developing an intervertebral hernia l5 s1 increases several times.

A herniated disc is formed due to the following reasons:

1. Diseases of the musculoskeletal system : osteoarthritis, osteochondrosis.
2. Congenital, genetically determined diseases of the spinal column , in which there is dissonance between the spines.
3. Defects of the spine : scoliosis - bending part of the column to the side, lordosis - pathological convex bend, kyphosis - curvature of the upper back.
4. Constant, intense and frequent physical activity on the body . Most often, such loads are associated with the lifting of unbearable weights.
5. Congenital diseases characterized by weakness of muscle fibers or connective ligaments.
6. Joint diseases: Bechterew's disease or rheumatoid arthritis.
7. Excess body weight , provoking an increase in the load on the lumbar region.
8. Unhealed injuries, past injuries and operations in the back.
9. Pathologies of the vascular system , especially the vessels running along the vertebra and spinal cord. Their lesions contribute to malnutrition of the intervertebral disc.
10. Unbalanced diet: a small amount of minerals (fluorine, phosphorus, calcium, magnesium) consumed during the day. Insufficient water intake.

Kinds

Lumbar hernia is characterized by a large variety of protrusions.

Among them are the following:

1. Dorsal disc herniation l5 s1 (posterior hernia). It is characterized by bulging of the hernia towards the location where the spinal nerve fibers are located. Dorsal disc herniation l5 s1 is one of the most common among all.
2. Median disc herniation l5 s1 (median hernia). Its distinguishing features: bulging is located centrally in relation to the spinal canal. In medicine they say: "medial location."
3. Circular disc herniation l5 s1. We are talking about it when a hernia covers the spinal cord from all sides.
4. Foraminal disc herniation l5 s1 (paraforaminal - covers the nerves from all sides) - the pathology is located in a place directly at the exit point of the nerve endings from the spinal cord.
5. Median paramedian disc herniation l5 s1. A dangerous disease, accompanied by compression of both the spinal cord and nerve roots.
6. Dorsal median hernia. Posterior median hernia is a combination of posterior and median hernia.
7. Dorsal diffuse hernia is a type of pathology that manifests itself in uneven displacement of the intervertebral disc. Diffuse disc herniation is not accompanied by a rupture of the fibrous ring.
8. Subligamentary hernia is a pathology manifested by necrosis of disc tissue under the vertebral ligaments.

There are also left-sided and right-sided hernias. Right-sided hernia is equal in frequency to its opponent.

Clinical picture

The leading and main symptom is pain. Most often, it manifests itself with any load on the human spinal column - during work, running, long walking and swimming. With the growth of the protrusion, compression of the nerve endings occurs, which causes the corresponding symptoms.

Namely:

• lumbago - sharp and sharp pain backache in the lumbar region;
• lumbalgia - the presence of constant pain in the same area;
• lumbar ischialgia - pain in the lower back, spreading to the lower limbs and parts of the pelvis.

Another syndrome is the defeat of nerve functions at the level of the location of the hernia:

• paresthesia - tingling, numbness, loss of sensation on the skin of the lower back, lower extremities and pelvis;
• weakening of the muscle strength of the legs;
• decreased functioning of tendon reflexes;
• excessive sweating, sudden changes in skin color;
• at the level of the hernia, a strong muscle spasm is recorded, patients can hardly bend down, unbend, run, everyday life is difficult.

There are also violations of the pelvic organs:

• difficulty urinating, defecation; sometimes these processes are activated arbitrarily, regardless of the will of the person himself;
• constipation;
• in men - a violation of potency, a decrease in libido, in women - a failure of reproductive function.

Diagnostics

Diagnostic measures begin with a general examination of the patient, his condition is assessed, signs of a hernia are studied. Then the doctor performs an objective examination: palpates the protrusion, assesses the stability of the course of the disease, predicts the likelihood of complications depending on the stage of development of the disease.

Of particular importance in the diagnosis are instrumental research methods. It is on the basis of the information that they provide that the final diagnosis is made.

These methods include:

1. Magnetic resonance imaging . The tomographic technique of the spine is based on the phenomenon of magnetic resonance. This study provides accurate information about the location, size and degree of nerve herniation. MRI is considered the "gold" standard in diagnosing hernia pathology.
2. CT scan. Its advantage is the detailing of the structure of bone tissue, but not as MRI provides information about soft tissues.
3. X-ray diagnostics . This method is less and less used in modern medicine, as it is gradually losing its relevance. In functional terms, it is inferior to computer diagnostic methods. X-ray provides information only about hard tissues, excluding soft ones.

Therapeutic measures

Any hernial pathology is treated with conservative therapy and surgical intervention. In the foreground, of course, is the second type of treatment. Surgery makes it possible to eliminate not only the symptoms, but also completely eradicate the cause of the development of the disease.

Conservative therapy comes to the fore and is an auxiliary tool.

There are a large number of information sites that say that surgery is used in extreme cases. Actually it is not. It is simply impossible to completely cure an organic pathology, which is characterized by a strong compression of the spinal cord and nerves with pills. Moreover, surgical interventions are carried out with the help of modern microscopes, lasers and endoscopic devices.

Endoscopic microdiscectomy . This operation is performed under local anesthesia. During the operation, a small incision is made, the dimensions of which do not exceed 0.5 centimeters. An endoscope with a small camera is inserted into the resulting hole, which feeds video to monitors. Further, under the supervision of a specialist, a hernia is sought out, it is studied and can be removed. This intervention carries a minimum degree of injury. After 2-3 days, the patient is already free to move and merges into his usual way of life.

Laser treatment is also a surgical operation, belongs to the class of minimally invasive manipulations. This is an expensive operation, but it is by far one of the most effective. A small needle is inserted at the location of the hernia, through which a laser cable and a camera are passed. Further, the damaged disk heats up and evaporates. The disc contracts and the nerve roots are released from the pressure. The procedure is well tolerated by people of all ages.

Treatment with conservative therapy involves the use of a number of drugs: painkillers, muscle relaxants, B vitamins, anti-inflammatory drugs.