The structure of this zone has some peculiarities. The discs are relatively tall. The center of gravity of the body is projected onto the lower back.
The lumbar region is the most mobile part of the spine. It consists of five vertebrae and shock absorbers between them.
The muscle corset in this part is not strong enough. The maximum number of spinal hernias occurs in this area.
What is an intervertebral hernia in the lumbar spine
The flexibility and full functioning of the spinal column depends on the healthy state of the intervertebral discs. Negative factors lead to aging of the cartilage tissue. The most detrimental effect on the disc is the loss of moisture.
Partial destruction of the shock absorber is called a spinal hernia. The direction in which the loss of the cartilaginous tissue that has lost its structure has occurred determines what type of problems this phenomenon will indicate.
A right-sided or left-sided hernia can create conditions for oppression of the radicular nerve. The prolapse of a hernia with the destroyed part back is dangerous by oppression of the spinal cord.
Causes of occurrence
it
- Prolonged sitting in a sitting position. This can be, for example, among students and office workers. This factor is especially bad if the back is hunched over. For sedentary work, it is necessary to have a comfortable chair and sit with the backrest supported.
- In order for the disc to have a sufficient supply of nutrients, it is necessary to make a moderate amount of movement of the spine. During motor manipulations, a pressure drop is created around the disc and diffusional delivery of nutrition improves. A sedentary lifestyle leads to degenerative phenomena in the shock absorbers of the spine. And this is a prerequisite for creating a hernia.
- The disease osteochondrosis potentially carries the possibility of a hernia.
- Spinal injuries create the environment for a hernia to appear. Lumbar hernias are common after an accident. With sudden braking, a quick movement of the head in the form of a nod forward – backward can cause “whiplash” and provoke a hernia of the lower back.
- The misalignment of the pelvis creates the prerequisites for the occurrence of a hernia. This happens if, with hip dysplasia, the treatment was unsuccessful.
- Smoking contributes to nutritional depletion because it reduces the amount of oxygen in the blood. Taking coffee also impairs the movement of blood in the tissues, and therefore reduces the flow of nutrients.
Symptoms and Signs
When conducting an MRI, hernias are sometimes revealed that the person did not even know about. This suggests that they do not give any signal, asymptomatic. However, these phenomena often cause many problems.
Intervertebral hernia of the lumbosacral zone may have symptoms:
Painful sensations
- In the lower back: dislocation of painful sensations from the buttocks and further down the sides of the surface of the legs or the back of the legs below the knee.
- In the leg – it happens, it appears a few days after the manifestation of low back pain, or it occurs on its own.
The nature of the pain
- It occurs when a person turns over on the other side during sleep.
- Sometimes the pain is expressed by tingling or numbness, “chills”, burning.
- The pain intensifies if a person sits and coughs at the same time, leans forward.
Signs that radicular nerves are being oppressed:
- sensitivity in the legs is impaired,
- difficulty urinating (urinary incontinence or retention)
- feeling of numbness in the perineum,
- loss of bowel control
- feeling of weakness in the leg
- gait disorder
- paralysis.
What is dangerous
- Pain can lead to restriction of movement and the most extreme point is paralysis.
- When the nerve root is squeezed in the area of the skin associated with the oppressed nerve, sensitivity is disturbed. The skin in this place dries up.
- A lumbar hernia provokes muscle tension in the affected area. This is a defensive reaction of the body in order to fix the spine in the place of the problem in a normal position. Tension in one place can cause curvature in another area of the spine, and provoke scoliosis.
- A situation may arise when, with the slightest movement, there is a sharp pain in the lumbar region. This phenomenon is called lumbago in the lower back.
- Circulatory disorders caused by a hernia in the lower back can provoke gynecological problems in women.
Diagnostics
The specialists are equipped with a modern diagnostic method – using MRI.
The method allows you to clearly see the state of hard tissues and soft layers. The advantages include the ability to view the section in the desired plane, layer-by-layer scanning and the safety of the method.
The photo shows MRI images with a hernia of the lumbar spine
Diagnosed hernias are classified by size:
| Name | Large prolapse | Large hernia | Medium hernia | Small hernia |
| Size, mm | <12 | 9 ÷ 12 | 6 ÷ 8 | 1 ÷ 5 |
| Recommendations | A treatment course is underway. It is also possible in an outpatient clinic. It is being considered whether an urgent operation is needed depending on whether there is an oppression of the spinal cord, causing danger of consequences. | An urgent need to undergo treatment. It can be done on an outpatient basis. Specialists are considering surgery if the hernia causes dangerous compression of the spinal cord. | An outpatient course of treatment is prescribed. | You can carry out the doctor’s prescription at home, if necessary, visit the clinic. |
Pregnancy with a hernia
Combining spinal problems and carrying a baby requires special attention. This situation should not be allowed to take its course.
Pregnancy puts an increasing strain on the spine. It is necessary to undergo an examination to establish the size of the hernia, the direction of spread and how dangerous it creates.
Treatment cannot be postponed. Medications used in conservative treatment, almost all are not recommended for use during childbearing.
Specialists select for the patient those methods that are permissible and will not harm the fetus, alternative methods are also considered.
Contraindications
What not to do with a hernia in the lumbar region:
- Pain relievers should not be used unless urgently needed.
- To prevent muscle spasm, hypothermia should be avoided.
- The hernia should not be overheated. Stimulated circulation can further increase tissue edema.
- Massage can lead to the same result, so it is not recommended either.
- The hernia area does not need to be exposed to strong mechanical stress, for example, rubbing, bruises.
- Traction of the spine by vertical sagging on the bar is contraindicated. The muscles are quite overloaded, and this exercise will add more stress.
- You should not eat fatty foods, alcohol, sweet, spicy, starchy foods.
Treatment recommendations
There are three options for the development of events:
- A small hernia within three millimeters can heal by itself if certain conditions are met. Relieve the spine from any load for several days. Pain relievers can be taken if needed. The body has enormous resources to restore health. If in the future you follow the rules that help the normal state of the ridge:
- lift weights correctly – so that your back is straight,
- monitor your posture,
- give payloads to the spine,
- follow a diet,
then it is possible that the situation will return to normal and the hernia will no longer remind of itself.
- If there is no compression of the spinal cord or nerve roots, in which surgery is necessary, specialists prescribe only conservative treatment. It consists of two stages.
- Removal of an acute condition with medication. If the drugs fail to improve the condition, then an epidural block is used. The procedure involves the introduction of anesthetic and hormones into the focus of the problem. Usually, this exercise relieves acute pain and helps the body to tune in to improve the situation.
- Restoration by methods chosen by the doctor:
- hirudotherapy,
- manual therapy,
- therapeutic exercises,
- acupuncture,
- physiotherapy,
- folk methods,
- kinesitherapy,
- cryotherapy.
- If the hernia presses the spinal cord in such a way that it has serious consequences, then an operation is performed.
- The most progressive method is microsurgical intervention. Performed under the supervision of a microscope with microinstruments. A short recovery period, since the operation makes minimal trauma to the surrounding tissues.
- Classic operation – performed with partial removal of the vertebral arch. The method is used less often. Has a long recovery period.
- Prosthetics – replacement of a disc with an artificial analogue.
- Endoscopic intervention is performed through a puncture. The exercise allows the patient to get out of bed on the same day after surgery.