Symptoms of a hernia of the lumbar spine
Intervertebral discs act as shock absorbers, softening the load on the vertebrae. Their nutrition is carried out due to diffusion, substances come from the surrounding tissues, which occurs during the movement of the spine. The disc consists of the nucleus pulposus and the annulus fibrosus, located next to the nerve roots and spinal canal.
Frequent diseases of the intervertebral disc are osteochondrosis and hernia.
Hernia refers to surgical ailments, it poses the greatest danger to the spine, can lead to severe consequences, up to the cessation of motor function, paresis and paralysis of the lower extremities.
Intervertebral hernia of the lumbar spine occurs more often than all other forms of protrusion of the disc of different localization. The lower back has the greatest load, its increase against the background of a sedentary lifestyle can become a factor in the development of a serious illness.
The main causes of a hernia of the spine
A sharp increase in load can provoke a hernia, but the main reason is physical inactivity, lack of movement. The discs gradually wear out, the power is disturbed in them, the ring breaks, and part of the pulp comes out. What is important, not every protrusion of the intervertebral disc requires surgical treatment, when the nerve root is not compressed by the contents of the pulp, there are practically no signs of a hernia of the lumbar spine, as well as a threat to health and life.
But still, squeezing can occur at any time, and the first symptom will be severe pain, backache. When the signs of a hernia in the lumbar region are not disturbing, then it is important to constantly observe preventive measures.
What does a lumbar hernia look like?
- First, degenerative disorders occur.
- Then the nucleus pulposus tries to come out.
- The annulus fibrosus ruptures, the pulp extends beyond the nucleus.
Diagnosis of intervertebral hernia of the lumbar spine is rarely performed at the stage of degeneration. More often, the first signs are ignored, and the disk at the stage of protrusion or directly hernia needs to be examined.
Why do signs of an intervertebral hernia of the lumbar spine appear:
- disk malnutrition , which occurs in the absence of adequate load and movement;
- hard physical work , lifting weights, playing sports without training;
- a sharp change in activity , "dacha" syndrome, when, after a sedentary winter, active work begins in the garden or in the garden;
- overweight , which is often combined with physical inactivity, increases the load on the back, the lower back suffers most from it;
- pregnancy period , which is also associated with an increase in the load on the spinal column;
- genetic weakness of the spine in women and men - a hernia can occur without any previous disorders or due to a tendency to pathologies of the intervertebral discs and cartilage.
How does a lumbar hernia manifest?
A herniated disc causes pain. It can be of different intensity and nature, which will depend on the stage of the pathology, the general condition of the spine and the therapeutic measures already taken.
Vertebral hernias have a typical set of symptoms in all patients:
- pain in the lumbar region radiating to the right or left leg, but only one;
- numbness of the extremities, a feeling of crawling, tingling of the skin;
- constant discomfort, aggravated during physical activity;
- pain with a long stay in one position of the body;
- constant attempts to take a forced position to relieve symptoms;
- general manifestations in the form of fatigue, sleep disturbances, weakness, apathy;
- periodic shooting pains, which often occurs during movement.
Unpleasant symptoms are always aggravated while walking, in a standing and sitting position, weaken at rest, when the patient lies or takes a comfortable reclining position.
The most commonly affected discs are L4-L5 (lumbar) and L5-S1 (lumbosacral).
With a pathology of the lumbar spine, the following symptoms will be:
- numbness and pain in the foot;
- violation of the movement of the big toe;
- "Dangling foot", which is associated with muscle weakness.
How to determine the intervertebral hernia of the vertebrae L4-L5? You can put on high heels and try to walk. With such a symptom of a hernia as a paralytic or hanging foot, this will not work, doubts about the presence of a problem will disappear, and it will be possible to immediately send a neurologist to a doctor. This advice is not only for girls, men can also check it, and when there are no heels, you can walk on toes and heels, which will also be problematic if the motor function is impaired.
Damage to the nerve roots is manifested by a number of signs and conditions:
- weakness of the muscles of the thigh and foot of one leg;
- inability to stand in one position for a long time;
- pain and heaviness while climbing stairs and jumping;
- muscle atrophy, reduction of the limb in volume;
- decreased skin sensitivity;
- numbness, tingling;
- increased sweating or, conversely, dryness of the face;
- problematic movement, in severe cases - disability.
When the nucleus pulposus exits posteriorly, the spinal canal is compressed. This condition is dangerous, and with a sharp movement, complete compression of the spinal cord can occur.
A posterior hernia has a number of other manifestations in both women and men:
- violation of the functioning of the pelvic organs - problems with the intestines, impaired urination, incontinence of urine and feces or their retention;
- violation of the sensitivity of the skin in the pelvic area;
- in men - a decrease in potency, in women - frigidity;
- variable lameness, the need to rest often when walking.
Weakness of the muscles of the spine and chronic pain are accompanied by spasm in the lumbar region of the back. Symptoms are constantly only growing, soreness intensifies, which affects the quality of life and the ability to do the usual things. When squeezing the spinal roots, the function of the organs for which they are responsible may be impaired. So, there are problems with urination, bowel movements and other processes.
Typical signs of pathology appear below the level of the affected vertebra, that is, with a hernia of the lumbar region, the organs of the small pelvis, the entire lumbosacral segment of the back and legs suffer.
By indirect signs, it is already possible to make a preliminary diagnosis:
- protrusion of the disc in the lumbar region - pain and dysfunction of the foot, thigh, lower leg, thumb;
- protrusion of the disc in the lumbosacral region - pain and dysfunction of the sacrum, heel, little finger, back of the thigh.
If the disc is damaged at the level of the L5-S1 vertebrae, the absence of the Achilles reflex can be observed. The patient cannot move the little toe, there are difficulties while lifting the leg up, the pain radiates from the sacrum to the outside of the foot.
With complete prolapse of the nucleus pulposus into the spinal canal, a sequestered hernia is diagnosed. This is the most severe form of the disease with the greatest risk of complications. The nucleus pulposus separates from the disc and may enter the epidural space. If, in other forms of pathology, radical treatment is extremely rare, then a sequestered hernia will be an indication for surgery.
How disk sequestration manifests itself:
- cauda equina syndrome;
- anemia, pale legs;
- indigestion, constipation is replaced by diarrhea;
- severe pain in the lower back;
- anemia can lead to loss of reflexes and paralysis of the limbs.
Often a sequestered hernia is preceded by osteochondrosis or other inflammatory and degenerative processes of the spine. The risk group includes people involved in sports and heavy physical work. In women, a complicated hernia can be provoked by constant stress, postponed childbirth, hypothermia, and many other factors.
A protrusion of the nucleus pulposus into the intervertebral disc without affecting the spinal cord is defined as Schmorl's hernia. This is the least dangerous form of the disease, it can be treated conservatively, but in order for it not to progress, you must constantly follow preventive measures. This form of the disease of the lumbar spine is detected during X-ray, CT or MRI of the spine.
For most patients, Schmorl's hernia is not dangerous, it will manifest itself with mild symptoms that can be easily eliminated with painkillers and antispasmodics.
When the x-ray showed the presence of pathology, treatment should begin immediately. Schmorl's hernia increases the risk of a compression fracture, and there is always a chance that the nucleus pulposus will enter the vertebral space.
More often this form of pathology is detected during examination of the spine in a child or adolescent. This is due to active growth, when bone and cartilage tissue does not have time to form, and any injury, poor posture, high loads can provoke a protrusion of the intervertebral disc.
This hernia is characterized by mild symptoms in the form of aching pain, stiffness of movements, muscle weakness. But without treatment, the condition gradually worsens.
What can a bulging lumbar disc lead to without treatment:
- pinching the “horse tail” is a life-threatening condition, the patient becomes immobilized, suffers unbearable pain that even strong painkillers cannot cope with;
- lumbodynia - dull or aching pain that often appears in the morning in a sitting or standing position, this disorder can accompany a hernia for several years, the pain intensity only increases with time;
- lumbago - backache, which is accompanied by muscle tension, difficulty in performing almost any movement, this condition often occurs after lumbodynia;
- lumboischialgia - pain radiating to one or less often two legs, a symptom appears after lumbago, this manifestation is typical only for a hernia in the lumbar and lumbosacral region, it is with this symptom that they often come to the doctor for examination;
- dysfunction of the internal organs is a common complication that occurs with the pathology of any part of the back and depends on the severity of the hernia, mainly the intestines and the genitourinary system suffer.
To confirm the diagnosis, the doctor collects an anamnesis of life and past diseases. After an external examination, the patient takes blood and urine tests. Then instrumental diagnostics is carried out.
The following methods can accurately determine the location of the hernia and its severity:
- MRI - tomography will allow you to see the damaged disc, the degree of pulp output and the exact localization of the pathological process, the method has no contraindications, except for the presence of metal implants in the body, in addition, MRI tomography will show the state of the vessels, reveal ischemia, and also show the roots;
- vertical tomography is an MRI, when the patient is standing, is performed before surgical treatment to assess the degree of compression of the vertebrae, it is important for choosing the operation technique;
- CT is an alternative to x-ray with contrast, like MRI shows the location and degree of protrusion of the intervertebral disc;
- X-ray - loses its relevance, preference is given to CT and MRI, X-ray shows the pathology of hard tissues, determines the damage to the vertebra, but does not allow a detailed description of the disease, the method serves as a method of preliminary diagnosis.
Given the variety of forms of the disease and a different approach to the treatment of each, it is important not to self-medicate and not to try to endure the pain, but to undergo an examination. This will make it clear what kind of hernia is developing, and what needs to be done in order to prevent its complications.
When you need to urgently go to the doctor or call an ambulance:
- any symptom becomes unbearable, is not removed by any means;
- the sensitivity of the thigh, buttocks and groin is disturbed;
- paralysis of the feet appears, it is impossible to stand on toes;
- pain is not relieved by strong painkillers;
- the movement of the spine is disturbed, it is impossible to sit down, turn or bend over.
Prevention of complications
Your doctor may suggest supportive treatments:
- manual therapy - not suitable for everyone and not always, has many contraindications, is prescribed exclusively by a specialist, can only be useful for relieving pain at the initial stage of pathology;
- acupuncture - acupuncture with the use of various drugs helps to relieve pain, relieve spasm, involves the introduction of the drug at certain trigger points;
- traction - it is recommended to carry out in water, this method is safer, but special simulators can also be used, this will anesthetize for a short period, but will not affect the underlying disease in any way;
- a corset is an important element during the period of severe symptoms of a hernia, but wearing it all the time will only hurt, because the natural muscle corset weakens;
- physiotherapy - cold treatment, electrophoresis, magnetotherapy can be used as an additional treatment measure, relieving unpleasant symptoms.
For prevention, the doctor will also recommend changing your habits a little, reconsidering your lifestyle, nutrition, and the quality of physical activity.
In order not to provoke complications, you should maintain your posture. When the back is in the correct position, the load on different departments is distributed evenly, which already eliminates an important risk factor. You also need to watch your weight. With obesity, the lower back has an extra load, which can lead to compression of the nerve roots and the addition of other symptoms.
Physical education with a hernia is contraindicated, but certain exercises to relax and stretch the muscles are acceptable and even useful. The disease must be approached comprehensively, and when there is no indication for an urgent operation, a neurologist, traumatologist, physiotherapist and other specialists should be consulted in order to draw up the correct prevention plan.