Hernia in the lumbosacral spine

Intervertebral hernia of the lumbosacral spine is a common pathology of the musculoskeletal system, the precursor of which is osteochondrosis. The disease affects mainly the elderly and people over 35 years of age, which is associated with the processes of physiological aging of the body and the gradual wear of the bone and cartilage tissue.

A herniated disc is a surgical disease, but the operation is already prescribed as a last resort, when there is a risk of disability.

This is due to the high risk of surgical intervention, which has its consequences. Before choosing a treatment strategy, all risks are taken into account, both the consequences of the pathology without surgery, and the removal of the pathological focus.

It is impossible to get rid of the protrusion of the intervertebral disc without surgery, but the defect can be reduced in size by some minimally invasive techniques, which will reduce pressure on soft tissues.

A hernia in the lumbosacral region is dangerous with complications such as dysfunction of the pelvic organs and paralysis of the limbs. The most severe consequence is disability with the impossibility of self-care .

Causes of a herniated disc

Pathology of the lumbosacral region occurs as a result of degenerative-dystrophic changes, spinal injury, a sharp increase in load or impact. In the first case, the disease develops slowly, and for several years the disc herniation may not exceed 2-3 mm, but at any time there is a risk of complications and tissue sequestration.

Prolapse of the nucleus pulposus by more than 9 mm is already a serious condition requiring a surgical operation.

So what can provoke the occurrence of a hernia in the lumbosacral region:

1. High loads. Lifting weights, engaging in heavy sports and physical work without proper training can lead to malnutrition of the intervertebral disc and deformation of the vertebrae. A crack appears on the fibrous core, and at any moment the gelatinous body can pass through it.
2. Lack of activity and moderate exercise. This is the other extreme, where the lack of movement causes diffusion to fail. The nutrition of the intervertebral disc occurs due to the absorption of substances from the surrounding tissues. This happens for the most part during movement, when the muscles are actively working.
3. Osteochondrosis and various posture disorders . Such diseases have a bad effect on the whole body. From deformation and degenerative disorders, a decrease in the height of the intervertebral disc occurs, which is why the vertebrae begin to put pressure on it more. Constant compression provokes an even greater output of the nucleus pulposus. The curvature of the spine is accompanied by an uneven distribution of the load on the spine. Given that the lumbosacral takes on the largest share of it, it suffers most often.
4. Traumatic back injury . A blunt blow, a dislocation of a vertebra, and a compression fracture of the spine can be both the cause of the protrusion of the intervertebral disc and the consequence of this disease.

In addition to the main causes, there are a number of risk factors that affect the appearance of a hernia:

• bad habits (smoking, drugs, alcohol) - they affect the nutrition of the tissues of the spinal column, and a violation of this process will be the initial factor in the appearance of back problems;
• frequent sitting and occupational hazards associated with it - driving a car, working in an office will negatively affect the condition of the disk and vertebrae, but if this cannot be avoided, it is enough to take breaks for exercise regularly;
• gender - women are much more likely to face this problem;
• age after 35 years - this factor is associated with the natural physiological aging of the body, in particular the tissues of the musculoskeletal system;
• sudden movements, prolonged stay in one position;
• hypothermia of the body - this leads to an exacerbation of pathological processes in the spine and the whole body.

The impact on the spine of several factors at the same time aggravates the patient's condition, and the disease progresses faster. First there is protrusion. At this stage, the pathological process may stop, if only the patient, together with the doctor, selects the optimal prophylaxis regimen that can be followed for a long time.

Short courses of treatment during an exacerbation will not give such a result as daily prevention.

In the first case, therapy will be aimed at eliminating the symptoms of the disease. If prophylaxis is carried out, there is a general improvement of the body, which is extremely important in the pathology of the spinal column.

Clinical manifestations

The initial manifestations of a herniated disc will be the following symptoms:

• aching pain in the lumbar region, radiating to the leg;
• increased pain during movement;
• violation of the sensitivity of the skin of the legs, perineum, buttocks;
• pain during prolonged sitting, walking;
• general weakness, fatigue;
• some patients have irritability, apathy.

Progressing, the pathology in the lumbosacral region leads to compression of the nerve fibers, which provokes severe pain and a neurological complex of symptoms. Gradually, moderate soreness develops into acute pain of the type of lumbago, which is defined as sciatica.

The patient experiences unbearable sensations not only in the region of the pathology focus, but also on the inner side of the thigh, in the buttocks and other parts of the spine. It becomes difficult for the patient to move, when walking, he begins to focus on one leg. It is even more difficult to walk up and down stairs. Swelling of tissues and muscle spasm are noted in the lumbar and sacral region.

With a herniated disc, the patient tries to take a comfortable position of the body, which leads to a curvature of the spine, which deviates towards the absence of pain. So there is an accompanying hernia scoliosis.

Diagnosis of the disease is carried out by X-ray methods of research. The patient is also assigned to CT or MRI. Magnetic resonance imaging will be the most accurate method, because the doctor sees the slightest changes in the pictures, and can determine the pathology when it is just emerging. The patient will need to consult several specialists: a neurosurgeon, a vertebrologist, an orthopedist, a neurologist.

How is lumbar spine treated?

With a hernia of the lumbar and lumbosacral sections, treatment is aimed at eliminating pain and preventing problems with the pelvic organs, gastrointestinal tract and lower limbs. To this end, the attending physician selects a set of measures, the ineffectiveness of which for several months will be the reason for the appointment of surgical treatment.

When there are no signs of sequestration and complications, lumbosacral hernia therapy includes standard methods: medicines, manual therapy, massage, diet, exercise therapy, traditional medicine recipes, physiotherapy procedures.

What to do with a herniated disc in the lumbosacral spine:

1. Medical therapy . The patient is shown non-steroidal anti-inflammatory drugs, analgesics for oral administration, intramuscular administration and blockades. According to indications, chondroprotectors, muscle relaxants, vitamin complexes, local remedies will be prescribed. Treatment is prescribed by courses during the period of exacerbation and for its prevention.
2. Manual therapy . Alternative treatment option. The technique involves the rehabilitation of the spine by the influence of the hands of a doctor who performs various manipulations aimed at eliminating clamps, spasms and pain.
3. Massage . Unlike manual therapy, massage is relaxing and restorative. It is performed exclusively by a specialist, because the wrong movement, strong pressure and impact on the “risk zones” can result in an exacerbation of the pathological process.
4. Physiotherapy . Electrophoresis and drug phonophoresis are performed directly in the lumbar region. Methods involve the introduction of medicinal substances under the influence of current (electrophoresis) and ultrasound (phonophoresis).
5. Bandage . Before and after the operation, the patient is prescribed to wear a supporting corset, which will be an important measure to prevent soft tissue compression. The belt for the lumbosacral region reduces the load by taking over the function of the muscles of the lower back. Prolonged wearing is dangerous, and has the opposite effect.
6. Therapeutic exercise . Gymnastics is prescribed in a certain period of the disease, when there are no complications and pain syndrome. A special set of exercises has several positive effects at the same time: strengthening the muscles, stimulating blood flow, relieving swelling and muscle spasm, general health improvement, normalization of the psycho-emotional state.

Indications for surgery

It is necessary to operate a hernia according to strict indications. When drug therapy with concomitant treatment with various methods fails, and the clinical complex only grows, the option of radical surgery (discectomy, laminectomy) or minimally invasive hernia removal techniques (endoscopy, vaporization, microdiscectomy) is considered.

The operation will be prescribed in case of disc sequestration, when the nucleus pulposus breaks off and begins to wander freely along the spinal canal.

After the operation, rehabilitation begins, which will last from 2 to 8 months. It includes the implementation of all the recommendations of the attending physician and surgeon. The basic rules for recovery after hernia removal are rest for the spine and elimination of pain.

After the operation, there is a risk of consequences in the form of nerve damage, up to paresis and paralysis, therefore, the risks of intervention and inaction are always compared. Prevention of recurrence and complications is a lifelong measure, because any risk factor can trigger the reappearance of the disease.