What is dangerous sequestered hernia of the lumbar

A sequestered hernia of the lumbar spine is more often diagnosed between the L5 S1 vertebrae, and this disease manifests itself by rupture of the fibrous ring of the disc and the exit of the nucleus into the lumen of the spinal canal. This pathology is a threat not only to the possibility of normal function of the spinal column and movement, but also to life. A sequestered L5 S1 disc herniation will be an indication for surgical treatment unless the risks of surgery outweigh the potential benefits.

The second place in the frequency of occurrence of this pathology will be the cervical region, and the pathological process in it requires special attention. Indeed, without treatment, there is a risk of paralysis of the limbs and an early stroke.

Sequestered hernia of the spine is the cause of disability in more than 10% of patients who initially encountered osteochondrosis, but ignored the need for conservative therapy. This disease significantly affects the quality of life, worsening the physical and psycho-emotional state.

Causes and risk factors

Sequestered disc herniation L4 L5 and L5 S1 of the lumbar spine can be anterior, median, lateral and combined, depending on the location. Its main cause will be the usual uncomplicated hernia, which was preceded by osteochondrosis. That is, initially there is a malnutrition of the intervertebral disc, then it becomes brittle, a crack occurs, deformation, and everything ends with the exit of the pulp into the spinal canal.

The appearance of a sequester of the intervertebral disc in the lower back may be the result of :

• dynamic, static load on the back;
• congenital and acquired defects of the spinal column;
• osteochondrosis;
• hereditary predisposition to degenerative processes;
• lack of physical activity;
• heavy sports;
• excess weight;
• trauma, difficult childbirth.

Predisposing factors will be endocrine diseases and bad habits such as smoking, alcohol and drugs.

A special risk group is represented by athletes and workers who, due to their employment, constantly perform the same type of movement, while experiencing a high load on the lumbar spine.

How the disease manifests itself

An equestered herniated disc has the following symptoms:

Pain syndrome.

A sequestered hernia of L5 S1 provokes the so-called "lumbago", and its intensity is so strong that the patient may lose consciousness. Usually this condition occurs after lifting weights, with a sharp tilt and turn, falling on the back and impact. The pain necessarily radiates to the leg, spreading along the posterolateral surface of the thigh. This symptom is aggravated by changing the position of the body and during movement.

Restriction of mobility.

With a hernia in the lumbar region, the movement in the legs is disturbed, the gait changes, it becomes difficult to move the fingers or even the entire leg. Without treatment, a sequestered hernia can lead to complete paralysis of the limbs, and if the hernia is localized in the cervical region, complete paralysis can occur.

Violation of thermoregulation.

Feet and hands become cold, regardless of the ambient temperature. This is the result of compression of the nerves and blood vessels. For the same reason, tissue atrophy, increased sweating, and numbness of the fingers can be observed.

body intoxication.

The immune system begins to attack the sequester as a foreign body, which causes intoxication of the body, muscle weakness develops, nausea, dizziness appear, appetite disappears.

Methods of treatment

Methods of treatment are selected based on the localization of the pathological process:

• hernia L4  L5 - requires surgical treatment, followed by a long period of rehabilitation under the supervision of the attending physician, the patient is usually examined once a month, then an MRI, CT or X-ray is prescribed to prevent postoperative complications;
• hernia L5  S1 - often leads to compression of the "ponytail" and then an operation is necessarily prescribed, otherwise irreversible processes occur leading to impaired reproductive function, problems with the intestines and bladder;
• other localization - both conservative and surgical treatment options are considered, depending on the radiological and clinical picture.

Conservative therapy

Drug treatment of a sequestered hernia includes taking painkillers, hormonal drugs, muscle relaxants, B vitamins. These drugs are needed to reduce pain, eliminate the inflammatory process, and improve the body's resistance.

Muscle relaxants are especially important in disc pathology, because they relax the muscles. B vitamins are necessary to improve the conductivity of the nerve damaged by the sequester.

 

Physiotherapy procedures are prescribed to eliminate tissue swelling, to reduce the inflammatory process and pain relief. Non-traditional methods of physical impact will also be useful in sequestration. It can be acupuncture, manual therapy, hirudotherapy. But these procedures also have a number of contraindications, especially during sequestration, because there is always a risk of moving part of the disk and damaging surrounding structures.

What drugs are prescribed for a hernia of the lumbar:

• Hypothiazide , Furosemide - diuretics, taken once to eliminate tissue swelling;
• Actovegin , Pentoxifylline - nootropics and vascular agents, are needed to normalize blood circulation in the brain and improve trophic processes;
• Finlepsin , Carbamazepine - eliminate neuropathic pain;
• Chondroitin and analogues - chondroprotectors, are prescribed to improve the nutrition of cartilage tissue and stimulate its growth;
• Diclofenac , Naiz - non-steroidal anti-inflammatory drugs, with a herniated disc, they are always prescribed to relieve pain and inflammation.

Operation

Sequestered hernia L4 L5 requires surgery most often, because this is the most mobile part of the spine, and at any time there may be damage to the spinal cord with the risk of disability.

to remove sequesters:

1. Microsurgical microdiscectomy a minimally invasive surgical option that reduces pressure on the spinal roots.
2. Prosthetics a donor or artificial bone is installed, the disc is removed first.
3. Endoscopic surgery - a small incision is made up to 7 mm, a spinal microscope is used, after the intervention there are no scars, a plus will also be the possibility of performing under local anesthesia.
4. L aminotomy  - removal of part of the vertebra to reduce tissue compression.
5. Percutaneous nucleoplasty is a minimally invasive operation performed under local anesthesia and X-ray control . Cold plasma is injected into the pathological focus through a needle. This has a sclerosing effect, because the disc and sequester are reduced.

Rehabilitation

The rehabilitation period is determined by the method of hernia removal. The operation can be open and endoscopic. In the first case, the risk of complications is higher, and therefore there are more restrictions in the early period.

For the first two months, dietary nutrition is required to restore the balance of vitamins and trace elements, as well as to maintain good health.

After the operation, every year you need to visit a doctor for a preventive examination. It is recommended to do an MRI every year, because this diagnostic method is not only absolutely safe, but also shows pathological changes in the spinal column at the initial stage of their development, when other studies are ineffective.

 

From the second month and throughout the year, rehabilitation includes physiotherapy and drug therapy.

Of the drugs prescribed analgesics, anti-inflammatory, decongestants. Physiotherapy includes procedures such as massage, electrophoresis, magnetotherapy, UHF. Additionally, it is recommended to undergo spa treatment, where specialized centers offer a number of procedures aimed at restoring the whole body, and improving the condition of the spine, in particular.

Prevention

A sequestered hernia in the lumbar spine is the result of an untreated disc protrusion when there is already a defect, but it is still possible to prevent the occurrence of sequesters.

What is important for the prevention of sequestration in the lumbar spine:

• wear a postoperative bandage or a special supporting corset;
• give up hard physical work, but do therapeutic exercises;
• follow a diet to normalize metabolism;
• often change the position of the body, avoid the same type of movements;
• maintain weight within the normal range;
• refuse a course of therapy with an osteopath (only “soft” techniques for influencing the spine are allowed).

After the removal of the sequesters, the rehabilitation specialist may offer a course of kinesitherapy.

This is a recovery technique that involves stretching the spine using special medical simulators. Kinesitherapy is prescribed individually, it has contraindications and risks. Exercises train the muscles well and help to strengthen them, which will already be a good prevention of the recurrence of the pathology. At home, you will also need to do therapeutic exercises, but the complex is selected by a specialist and approved by the attending physician.