Protrusion of the intervertebral disc beyond the vertebral bodies in the lumbar spine. Clinically manifests as lumbodynia and vertebral syndrome. Complicated by discogenic radiculopathy and myelopathy. Diagnosed primarily by MRI of the spine. Treatment can be conservative (anti-inflammatory drugs, muscle relaxants, traction, manual therapy, physiotherapy, exercise therapy, massage) and surgical (laser vaporization, electrothermal therapy, microdiscectomy, discectomy, installation of a B-Twin implant).

Among the causes of disruption of the trophism of the intervertebral disc, the most common are insufficient motor activity and improper distribution of the load on the spinal column. The latter may be caused by abnormalities in the development of the spine, acquired curvature of the spine (excessive lumbar lordosis, scoliosis), static or dynamic load in an uncomfortable position, heavy lifting, pelvic distortion (for example, due to hip dysplasia), obesity. To the main etiofactors lumbar hernia also include previous spinal injuries (lumbar spine fracture, spinal contusion, vertebral subluxation), dysmetabolic processes in the body, various diseases spine (Bechterew's disease and other spondyloarthritis, spondyloarthrosis, Calve's disease, spinal tuberculosis, etc.).

Symptoms of a hernia of the lumbar spine

In its clinical development, intervertebral hernia lumbar region usually goes through several stages. However, a number of patients experience a long latent course, and the manifestation of the hernia occurs only at the stage of complications. Main clinical syndromes pain and vertebral ones appear.

Pain syndrome At the onset of the disease it is unstable. Occurs mainly during physical activity on the lower back (bending over, lifting weights, working in a tilted position, prolonged sitting or standing, sudden movement). The pain is localized in the lower back (lumbodynia), is dull in nature, and gradually disappears in a comfortable horizontal position. Over time intensity pain syndrome increases, lumbodynia becomes constant and aching, unloading the spine in a horizontal position brings patients only partial relief. Joins spinal syndrome, there is a limitation of motor activity.

Spinal syndrome caused by reflex muscle-tonic changes that occur in response to chronic pain impulses. The paravertebral muscles enter a state of constant tonic contraction, which further aggravates the pain syndrome. Muscle hypertonicity, as a rule, is expressed unevenly, resulting in a distortion of the torso, which creates conditions for the development of scoliosis. The range of motion in the lumbar spine decreases. Patients are unable to fully straighten their back, bend over, or raise their legs. There is difficulty walking and, if necessary, getting up from a sitting position or sitting down.

Complications

Diagnosis of lumbar disc herniation

It is difficult to suspect the formation of a lumbar hernia in the initial stages, since its clinical picture is similar to the symptoms of uncomplicated osteochondrosis and the onset of other pathological processes(lumbar spondylosis, lumbar spondyloarthrosis, lumbarization, sacralization, etc.). Patients themselves often turn to a neurologist, orthopedist or vertebrologist only at the stage of radicular syndrome.

Hernia of the intervertebral region of the lumbar region is considered one of serious illnesses, which is characterized by a violation of the integrity and structure of the intervertebral disc. The causes of this disease may be various factors. These include various injuries, back bruises received from a fall or strong impact, sudden lifting of objects with heavy weight or bending of the entire body.

Hernia of the intervertebral region of the lumbar region

Often a lumbar hernia is formed as a result of a sedentary and passive lifestyle, especially if a person has a large number of extra pounds. And when such a disease begins, it causes a lot of discomfort and has a negative impact on the usual way of a person’s entire life. He has to not only put up with the pain, but also adapt to the peculiarities happening to his body, when every movement is given with great difficulty. And in order to start the right and complex treatment, which guarantees positive result, it is necessary to recognize in the early stages the moment when the disease manifests itself. And for this you need to know all the symptoms of a hernia of the lumbar spine.

General signs of the disease

A lumbar hernia, which has extensive symptoms, may initially manifest itself with the following symptoms:

The appearance of such symptoms when we're talking about about a hernia in the lower back will depend on the severity of the disease itself. If the disease reaches an advanced stage, then all the symptoms become more pronounced. In this case, pain cannot be tolerated. Every movement is given with hellish effort, and the person is saved only by painkillers.

To prevent and treat HERNIA, our regular reader uses the increasingly popular NON-SURGICAL treatment method, recommended by leading German and Israeli orthopedists. After carefully reviewing it, we decided to offer it to your attention.

The main symptoms of lumbar intervertebral hernia

Intervertebral hernia of the lumbar region is characterized by its specific symptoms. The main and most noticeable of them is pain. These unpleasant sensations initially grow slowly and bother the person from time to time. But then such pain begins to progress and increase that it becomes impossible to endure it.

At first the pain is dull and aching. It is localized in the affected area of ​​the vertebra. Then, if a person encounters physical stress and strain, makes sudden movements or lifts objects that are too heavy, the feeling of pain intensifies. When a person is at rest, the discomfort disappears. But the next time, under certain factors, the pain spreads to everything psoas muscles, and then to the lower limbs. But here you are painful sensations shooting and sharp. And depending on which area is damaged, discomfort can affect the legs, buttocks, feet and heels, and pelvic area.

The entire process of pain usually takes two stages. When it is small and localized in the lumbar region, dystrophic changes occur within the body with the intervertebral discs. As a result, small cracks form there and the strength of the joint tissue itself decreases. But during the second stage, significant compression of the root occurs. And when the resulting hernia comes into direct contact with him, this provokes very severe pain, from which a person is ready to climb the wall, because it is unbearable.

Subsequently, the hernia of the spine constantly reminds itself of itself with increasing pain when standing for a long time, during long walking, during any bending and amplitude turns of the body. And that's not all. Unpleasant sensations may appear when coughing, when doing lower back exercises, when lifting one of the lower limbs up, when sitting awkwardly, and even when driving a car on uneven roads.

On initial stages You can reduce the pain arising from a herniated disc by taking a lying position. Sometimes tucking one leg under you helps.

Other symptoms

Symptoms of a lumbar disc herniation are manifested not only by pain. Due to weakening muscles, one or both legs may be less mobile than they were before. It becomes difficult to lift your lower limb and it may be impossible to bend your leg knee joint. There is also a feeling of tightness in the lumbar region. Any bending over with straight legs causes pain and spasms in the lumbar region, making it difficult to perform normal bendings. Other symptoms of a herniated lumbar spine are manifested by the following physical disorders:

. It becomes difficult to sit on the surface of a chair or sofa, it is impossible to jump and it is difficult to climb up the stairs. And such violations are additionally accompanied by the fact that the legs get tired faster, and ordinary walking tires a person so much that after a while he needs to sit down and rest in order to restore strength in the lower extremities. If the spinal cord is compressed and the hernia in the lumbar region is not treated at all, then the resulting weakness in both legs gradually turns into paralysis of the lower body.

Some sensory disturbance. This symptom manifests itself in adults in the form of numbness, burning and tingling sensations, as well as freezing of certain parts of the body. At the same time, the perception of pain itself, hot and cold temperatures is reduced. Typically, impaired sensitivity is localized in the area of ​​the lumbar hernia with a smooth transition to the outer side of the thighs. But if such a phenomenon occurs on the site sacral region spine, then the spasm moves to the perineum, then descending to the lower leg and to the outer side of the thigh.

State change skin lower limbs. If one leg is affected during a hernia of the lumbar spine, the skin on it turns pale, the muscles begin to atrophy, hair stops growing, and the lower limb becomes cold to the touch. At the same time, the process of sweating may increase or decrease, and the pulse begins to be felt both on the thigh and under the knee, even between the fingers.

Internal symptoms

Symptoms of a lumbar hernia can also indicate such internal disorders as disruption of the normal functioning of the intestines, manifested in the form of diarrhea and constipation. This disorder occurs regardless of what food a person takes at that moment. When it comes to constipation, a special diet, the main part of which is liquid food, can change the situation. Despite the fact that such disorders occur, the stomach does not hurt and gas formation does not occur.

In some cases the function is impaired bladder. There is a urge to urinate, which is regular and very frequent. Urine is released in small volumes. At the same time, it is clean, without any impurities or blood. And during this process there is no discomfort or pain. The only thing is that this disorder may be accompanied by temporary urinary incontinence.

Some genital organs deteriorate in functionality. And such symptoms in men are manifested by a decrease in libido. At the same time, representatives of the stronger sex experience erectile dysfunction and chronic prostatitis begins to develop. But in women, such disorders manifest themselves in the form of gynecological diseases.
Signs that are noticeable to others

Often, the symptoms that a person experiences during an intervertebral hernia can become noticeable to others. You can understand that a relative or loved one is suffering from a vertebral hernia of the sacrolumbar region by the following signs:

• the patient begins to hunch and stoop;
• one leg may appear shorter than the other;
• posture changes, which affects a person’s gait;
• movements become shaky and unstable.

If you look at the patient’s bare back in the lumbar region, you will be able to notice with the naked eye the tense state of the muscles on one side of the spine. The muscles may protrude and feel tight and hard to the touch. The gluteal fold is smoothed. And if you palpate the areas of the back where the bones of the spine are located, the person may feel severe pain.

The first symptoms by which the onset of the disease is recognized

In order for a hernia of the lumbar spine, manifested by unpleasant symptoms, to be effective in treatment, you need to know what signs precede it and how it all begins. First there is a dull and aching pain. Often it is such minor spasms that a person ignores, even if they flow from day to day. Because of this, the symptoms progress. As a result, a hernia can be recognized by the following signs:

And if treatment is not started at this moment, then the lumbar region has a negative impact on the general condition of the body and the person’s well-being. A lumbago occurs in the lumbar area when any movement is accompanied by extreme acute pain. It is impossible to walk, sit, or even perform physical exercises normally. And this condition can continue for several weeks.

When not treated on time, symptoms manifest as disorders in the area of ​​the affected root. There, sensitivity decreases, movement is constrained, and tendon reflexes decrease.

Vertebral signs

A lumbar disc hernia can manifest itself with vertebral signs. They arise due to local changes that have occurred in the spine or sacral region. In the place where the disc prolapse occurred, a stretch of the ligamentous-muscular apparatus may be observed, and soft fabrics are compressed by the prolapsed formation.

To understand that we are talking about the presence of a vertebral sign, you can carry out local palpation of all areas of the back. And in those places where there is damage, a noticeable pain syndrome will appear. This is due to irritation of the main receptors in diseased ligaments.

The course of the disease and features of its treatment

Regarding the course of the hernia disease in the lumbar spine, which causes unpleasant symptoms, then it takes place in several stages:

1. Spicy. Pain sensations appear, significant stiffness of movements develops, and sensitivity in the lower extremities is impaired.
2. Subacute. Usually begins on the third or fifth day from the moment the hernia appears. Painful sensations begin to gradually decrease, and they are no longer so pronounced. Sensitivity is restored, but not completely.
3. Restorative. This stage begins already during treatment (fourth week). The pain goes away, but sensitivity is still slightly impaired.

At acute period fully recommended bed rest when physical activity is reduced to a minimum. You can place a pillow under the lower back, where the sacrum is located. It is also recommended to make a cushion under your back that will lift this area. In this case, it is important to create the correct position, which will depend on where in the disc there is a rupture. When it comes to neurology sciatic nerve, then the legs bend at the knees and at the hip joints. During this period, they are appointed medications, manual therapy is performed, physical therapy exercises are prescribed.

When the subacute period begins, semi-bed rest is already prescribed. Here you need to carefully monitor the general well-being of a person. The main thing is to avoid movements that provoke pain if you have a vertebral hernia. And at this stage physiotherapy is already involved. But it is carried out if there is no high temperature.

During the recovery period, specialists begin to reduce drug treatment. Painkillers are no longer used, but it is recommended to take a course of vitamin complexes. Thanks to this, weakened joints receive those minerals and trace elements that they were deficient in. Then, under the supervision of an instructor, special gymnastics are performed, aimed at strengthening and healing the damaged area. But doing physical exercises on your own is not recommended.

And in conclusion

When a person is faced with such an unpleasant and painful problem as an intervertebral hernia in the lumbar region, he experiences all the unpleasant and uncomfortable symptoms of this disease. His whole life begins to change for the worse. It becomes difficult for him to carry out normal movements, he is no longer able to exercise normally, and all activity gradually decreases. And if a hernia is ignored and a person does not begin to treat it, but continues to lead a normal lifestyle, then he later faces serious complications and disorders of his bone and nervous system.

Each symptom that appears at a certain stage of the disease significantly worsens health and general well-being. And in advanced situations, a person may experience complete paralysis of the lower extremities. This is a serious violation that you should try to avoid. This is why you should know all the symptoms indicating the formation of a lumbar intervertebral hernia in order to begin comprehensive and correct treatment on time.

Hernias of the lumbar spine are the most common diseases of this type. Their characteristics and symptoms are discussed in detail in this article. Patients faced with a similar diagnosis will probably be interested in how to treat a hernia of the lumbar spine.

Medicines

Conservative treatment of intervertebral hernia has several directions, depending on the point of application:

• etiotropic therapy;
• symptomatic;
• pathogenetic.

Medicines that eliminate causes

Etiotropic treatment is aimed at eliminating the cause of the disease. It includes the following groups of drugs:

• chondroprotectors;
• traditional and homeopathic remedies that improve the nutrition of cartilage tissue.

Chondroprotective drugs contain mainly various combinations of chondroitin sulfate, glucosamine, collagen and some amino acids. The positive effect of the use of this group of drugs is to restore the fibrin ring of the intervertebral discs, maintaining their elasticity and ability to resist abrasion and rupture.

In addition, chondroitin and glucosamine have an anti-inflammatory effect, affecting the basic mechanisms of inflammation. Preparations based on them reduce cellular infiltration, the release of inflammatory mediators and the germination of pathological vessels.

Drugs with chondroprotective effects have several dosage forms: external creams, ointments, gels, tablets, capsules and powders, as well as injection solutions. Regardless of the form, the drugs must be taken for a long time, because they act at the cellular level.

Chondroitin sulfate contains the following solutions: Artradol, Mucosat, Chondrolone, Chondroxide tablets, Structum capsules.

Glucosamine is the active ingredient in Don preparations, Elbon solution, and Glucosamine Maximum tablets.

The combined composition of the following drugs: Artra, Condronova, Teraflex, Teraflex Advance (supplemented with ibuprofen).

Drugs that affect the metabolism of intervertebral disc tissue can be of natural or synthetic origin.

The drug Alflutop, which is available in the form of an injection solution or gel, is made from an extract of small sea fish with the addition of various excipients.

Its effect is anti-inflammatory, analgesic, regenerative, chondroprotective. Treatment of lumbar disc herniation is based on preventing destruction molecular structure intervertebral disc, especially between the 4th and 5th vertebrae.

Among homeopathic medicines For the treatment of lumbar intervertebral hernia, Cel-T and Traumeel ointments are most effective. Active substances are included in the composition in microscopic doses, but due to the small fraction they are able to penetrate into the vertebral hernia and stop the destruction of tissues and slow down their aging. Ointments are rubbed in 3-4 times a day, and also used during massage.

It is also customary to treat lumbar disc hernia using drugs that improve nutrition and blood supply to the intervertebral discs and nerve roots. For this purpose, the drugs Pentoxifylline and Trental, vitamin complexes from group B, calcium and magnesium ions are prescribed.

Medicines that relieve symptoms

Symptomatic therapy for lumbosacral hernia consists of controlling pain, eliminating muscle spasm and parasthesias, which arise from pinched nerves between the fourth and fifth lumbar vertebrae or between the end of the lumbar spine and the sacrum.

The main group of drugs is analgesics, represented by non-steroidal anti-inflammatory drugs.

There are quite a lot of trade names, but among active ingredients It should be noted diclofenac, ibuprofen, nimesulide, naproxen. They are produced in the form of tablets, ointments, injection solutions, as well as transdermal patches, which provide a uniform and constant release of the active substance.

Elimination of pain from intervertebral hernia in the lower back occurs due to the inhibition of COX inflammatory mediators. In fact, the drugs block the pain impulse in the nerve, but do not affect the formation of a hernia in the lumbar spine.

For very severe pain when the nerve roots are pinched by the protrusion of a lumbar hernia, in addition to taking NSAIDs orally and using anesthetic ointments, the so-called blockade is also used. This is a medicinal switch off of one of the components of the pain arc. It should be understood that a spinal hernia cannot be treated in this way, but it improves the patient’s quality of life by reliably eliminating pain. The blockade can be performed with a solution of Novocaine or another medicinal mixture, since the drugs are administered near the spine, the procedure is called paravertebral blockade.

Drugs can be administered epidurally along the midline between the vertebral processes or at the exit site of the spinal nerve roots. The latter method allows you to provide targeted pain relief to the pinched nerve and relieve the feeling of numbness from the innervated muscle, eliminating the sensation of goosebumps (parasthesia).

Medicines acting on pain mechanisms

A pathogenetic approach to help get rid of pain from herniated intervertebral discs involves the use of muscle relaxants.

Medicines from this group at the level of the central nervous system inhibit the excitability of muscle fibers and eliminate the spasmodic syndrome that occurs in response to severe pain. But at the same time they leave it normal nerve conduction. This selectivity allows you to relieve pain and maintain muscle strength.

Most often, therapy is carried out with Baclofen (tablets), Sirdalud (tablet), Mydocalm (tablets and injection solution).

Muscle relaxants combine well with NSAIDs. This combination allows you to eliminate inflammation and effectively relieve pain, but they should only be prescribed by a doctor, since the drugs have some side effects.

Pinching of the nerve roots occurs not only due to muscle spasm, but also due to inflammatory edema at the site of hernia formation. Drugs from the corticosteroid group – Dexamethasone, Prednisolone, Methylprednisolone – have a powerful anti-edematous and anti-inflammatory effect.

Physical treatments

Conservative methods of treating lumbar intervertebral hernia also include various physical procedures:

• electrophoresis with drugs,
• impact on spasmodic muscles with low frequency current (amplipulse),
• irritation active points acupuncture;
• manual therapy according to indications.

These methods increase blood circulation in the area of ​​the lumbar hernia, relax the paravertebral muscles, help increase the space between the vertebrae of the sacral spine and retract the hernia.

Physiotherapeutic procedures also include mechanical traction of the spinal column. It can be performed “dry” or in water, which gives additional relaxation to the back muscles and facilitates the traction procedure. Despite certain benefits, traction therapy also has contraindications, so you should first consult with your doctor about the possibility of its use.

Self help

There are treatment methods that can be practiced at home.

First of all, this is special gymnastics, a set of exercises of which is selected to effectively stretch the spine and develop its flexibility. Read more about the treatment of a hernia of the lumbar spine with Bubnovsky exercises.

Therapeutic effect give traditional medicine recipes:

• cinquefoil tincture three times a day, 20 milliliters;
• a mixture of lingonberry and cinquefoil decoction, which is drunk 0.1 liter before meals;
• infusion of thyme or hops before meals, 20 ml;
• compress of grated potatoes and horseradish with honey;
• rubbing with camphor oil or mummy solution.

Surgery

If conservative treatment for lumbar intervertebral disc herniation is ineffective, surgical treatment methods are used.

Interventions for hernia can be endoscopic and microsurgical. Endoscopic removal is carried out with visualization through a neurosurgical endoscope, microsurgical is controlled through a neurosurgical microscope. Endoscopic intervention, for example, treatment of l5 s1 disc herniation, is less invasive than microsurgical intervention. Rehabilitation is easier and faster, the operation itself lasts about an hour, access to the vertebrae is predominantly posterior.

But microsurgical removal (microdiscectomy) allows you to remove hernias of any size and from any location.

For minor disc protrusion, the following may also be used:

• puncture laser vaporization of the disc nucleus. Excess tissue is evaporated by a laser, which is guided through a special light guide to the targeted point on the disc through a puncture needle.
• electrothermal therapy. Coagulation of disc tissue with a heated catheter, which is inserted through a puncture needle. Coagulation helps strengthen the intervertebral disc and destroy the nerve fiber that causes pain.

Usually surgery remains as a means of reserve, and many doctors resort to it in extreme cases. A decision about the need for surgery can only be made based on the results. thorough examination, in particular MRI and the symptoms that the patient demonstrates.

Intervertebral hernia is very often localized in the lumbar spine. Women over 30 years of age are most susceptible to this disease. The cause of the pathology is a rupture of the disc, which occurs under the influence of heavy load or due to a violation of its nutrition. If left untreated, the disease can cause disability.

The lumbar region is the most mobile part of the spine. It bears the greatest weight load, as it is responsible for the center of balance of the body. This makes him the most vulnerable and traumatized. Lack of physical activity also negatively affects his condition and leads to disruption of his nutrition.

The lumbar region includes five vertebrae connected by discs. Thanks to them, the distribution of weight on the spine occurs. The structure of the discs is a semi-fluid core surrounded by a fibrous ring.

Heavy loads lead to damage to the fibrous ring and its rupture. As a result, the semi-liquid core enters the spinal canal, which is accompanied by pinching of the nerve endings. Microcracks form, which increase under load.

Symptoms of the disease

The manifestation of symptoms depends on the stage of the disease. Initially, a hernia does not cause much discomfort, and people rarely seek treatment. medical care, considering it a manifestation of ordinary fatigue and pain from physical activity. When the disease progresses, it is no longer possible to ignore it, since the symptoms are quite pronounced:

1. Discomfort when turning and bending.
2. Prolonged nagging pain in the lower back.
3. Severe pain radiating to the buttock.
4. Feeling of tingling and goosebumps.
5. Temporary numbness and burning of the legs.
6. Problems with the bowels and bladder.
7. Paralysis.

These symptoms appear as the disease progresses and often depend on individual characteristics body. Some people may suffer for years from the initial form of the disease, which does not progress and is expressed only by dull aching pain. Some, for example, after injuries in car accidents, cannot get out of bed after just a few months.

Most often, hernias occur in the lumbosacral segment L5–S1 and lumbar segment L4–L5. If there is a hernia in the L4–L5 region, the following can be added to the main symptoms of the disease:

1. Difficulty moving thumb legs.
2. Weakening of the calf muscles, which causes foot drop.
3. Pain and numbness in the upper part of the foot.

With a hernia in the L5–S1 region, there is no possibility of moving and lifting the fingers, pain radiates to the foot or heel, and there is no Achilles reflex.

Based on the nature of the pain, it is enough for a specialist to simply establish their cause, but an accurate diagnosis is possible only after full examination which includes radiography and computed tomography. These methods allow you to visualize the damaged disk.

Development of pain syndrome

At the initial stage, a person feels a dull aching pain. When lying down, the pain disappears, but intensifies when walking. The pain can subside and suddenly appear, and is present throughout the disease.

This is the initial stage, which can last several years. Most people ignore pain and refuse to visit a specialist, which leads to further development of the disease.

The pain begins to intensify, radiating to the thigh and causing numbness in the limbs. A person feels discomfort when bending over, lifting their legs and putting pressure on the lower back. Shooting pains begin to appear, which can radiate to the leg, foot or buttock. Discomfort increases with any movement. Relief can only be felt in a lying position. When sitting or upright position the pain intensifies.

Important! Low back disease is characterized by shooting pains that can last up to several weeks.

It is difficult for a person to move, sit and stand - in any position he feels severe pain. But it’s not just the lower back that hurts – the pain radiates to the buttock, foot and ankle. If left untreated, they begin to suffer internal organs, and especially genitourinary system. This happens due to poor circulation in the pelvis.

Compression of the nerve roots leads to:

1. Weakness in the muscles of the legs and thighs. It is difficult for the patient to move, jump and squat.
2. A crawling sensation in the legs.
3. My feet are constantly cold.
4. Sweating at the site of compression of the root.

If the hernia protrudes backwards, it can compress the spinal cord, leading to severe paralysis. There is a decrease in body temperature, swelling and dryness of the skin occur.

Causes of pathology

There are many reasons for this pathology. It can be a consequence of osteochondrosis or scoliosis, and also develop after a serious injury. Hernias occur due to lack of nutrition of the intervertebral discs, which is produced through the back muscles. If you refuse physical activity, the muscles atrophy, which leads to a lack of nutrition of the discs and an increased risk of injury.

Factors provoking the disease:

1. Lifting weights.
2. Large physical activity.
3. Falls.
4. Excess weight.
5. Sedentary lifestyle.
6. Incorrect posture.
7. Infections and viruses.
8. Natural aging.
9. Smoking.

Important! The disease most often affects women, and with a height above 170 cm, the risk of a hernia is much higher.

Hernias occur due to sudden lifting of weight. If at a younger age men do not notice aching pain after hard physical work, then after a while it becomes difficult for them to straighten up when lifting loads. Women who carry heavy bags in one hand are also susceptible to this disease, and efforts should be made to distribute the weight evenly.

Very often, hernias occur after a fall or injury, but in most cases they do not appear immediately, but after a couple of years. A person begins to feel a sharp pain that radiates to one of the legs, and can rarely determine what caused this illness. The location of the pain depends on the location of the spinal injury.

Important! If several parts of the spine are damaged, both the right and left legs will hurt.

Excess weight puts a lot of stress on the spine. Obesity is often accompanied by diseases of the spine and vascular system, which increases the risk of hernia formation. Smoking also has a negative effect, which affects blood circulation. Some infectious and inflammatory diseases can also lead to the development of hernias due to destruction of the lining of the intervertebral discs.

Consequences

The disease is dangerous for both sexes. Women experience gynecological diseases due to poor circulation in the reproductive organs. Problems with urination and menstruation may occur. All pelvic organs suffer, but this does not appear immediately.

Important! In men, if left untreated, impotence and other diseases of the genitourinary system may develop.

Very often this disease is accompanied intestinal disorders. They torture frequent constipation, pain radiating to anus, and bloating. For the reason high pressure curvature of the spine develops in the affected area. It becomes impossible to bend your back - you may become hunchbacked and stooped. Due to compression of the nerve roots, there may be a decrease in sensitivity in the affected areas. A person's legs, fingers, or hips begin to go numb.

Sometimes the disease is accompanied by the appearance of lumbago, which causes severe pain. At this time, the person cannot get out of bed, and with any change of position, the pain increases. The most dangerous consequence is limited mobility and paralysis. Due to severe pain, a person can neither lie nor sit. The knee reflex may disappear and mobility may be impaired. thumb. If treatment is ignored, disability may occur.

Video - Lumbar intervertebral hernia symptoms, exercises

Effective treatments

On at the moment There are two ways to treat pathology - surgical and conservative methods. As practice shows, most patients do not require surgery, but rather conservative methods treatment. They are aimed at eliminating pain in the lumbar region. At acute course illness, you need to stay in bed and take painkillers.

Typically, pain relief occurs within a month. After this, the disease is not yet completely cured and it is necessary to strengthen the damaged discs. For the next month, under no circumstances should you lift weights or engage in heavy physical work.

Most popular drugs

Spectrum of action	Name of drugs
Non-steroidal anti-inflammatory drugs. Relieving pain, swelling and inflammation	Ibuprofen, Naproxen, Diclofenac
Muscle relaxants. Drugs for relieving muscle spasms	tubocurarine, Atracurium, Vecuronium, Doxacurium
Corticosteroids. Relieve swelling	Diprospan, Dexamethasone, Prednisone
Antidepressants. Block pain and promote the production of endorphins, which are painkillers	Amitriptyline, Doxepin, Desipramine

After pain relief great importance is given therapeutic exercises and special physical exercises. The patient is faced with the task of strengthening ligamentous apparatus and muscles. A person needs to independently monitor the health of his back and stop lifting weights.

Carrying out an operation is extreme method, which is resorted to if it is not possible to reduce the pain for a long time or the hernia has caused a malfunction of the internal organs. To remove a hernia, a minimally invasive operation is performed, which takes place under general anesthesia and lasts about half an hour. Thanks to the use of micro-instruments, the tissues surrounding the spine are practically not injured, and the body’s recovery occurs in the shortest possible time.

Carrying out surgery only in 10% of cases does not bring the desired result and after some time new hernias may appear. This happens due to a weakened muscle corset. In this case, it is necessary to pay great attention to therapeutic exercises and strengthen the back. After this, it is recommended to repeat the operation again, which usually has a positive result.

Prevention

First of all, you need to give up sedentary image life. It is recommended to do it every day hiking and exercises for the spine. Swimming and yoga are beneficial. After long work V sitting position you need to do physical exercise.

Before lifting weights, you need to bend your knees and keep your back straight. Under no circumstances should you make too sharp turns or movements. Regular heavy physical activity, accompanied by lifting heavy loads, is a risk of developing spinal pathologies at an early age.

Important! Exercise should be moderate if a person wants to maintain his health.

Proper nutrition plays a huge role. You should avoid fried, smoked and fatty foods. They lead not only to excess weight, but also problems of the vascular system. Eating foods rich in protein will be beneficial. You need to choose low-fat varieties meat, and use stewing, steaming or boiling as heat treatment. The diet must include vegetables and fruits.

A lumbar intervertebral hernia is a protrusion of the central part of the disc between two vertebrae beyond the space between them. Most often, such a diverticulum is directed towards the spinal canal and compresses the roots of the spinal nerves, but it can also impair blood circulation in the spinal cord itself. The disease causes symptoms in the perineum, legs and pelvic organs.

Treatment is most often conservative, consisting of a complex: medications, exercise therapy, physiotherapy, blockades also help well. Surgical removal repair of a damaged section of the disk or its entirety is rarely used, as it carries quite large risks. Basically, this happens through the fault of the person himself: either when he comes in late, considering what is happening to his back and legs as “manifestations of age” or “trifle”, or in case of neglect of the rules of treatment, which differs in different periods of the disease.

What is a hernia

The spinal column is a collection of 34 vertebrae connected in pairs by intervertebral discs. It is not straight: from the head to the coccyx it makes several alternating bends: a bend with a convexity forward - in cervical spine, convex back - in the chest, then in the lumbar region a forward bend occurs again, and then the sacrum along with the coccyx bends back. All this is necessary to provide the shock absorption associated with walking on two legs. But this structure also causes the center of gravity to be concentrated in the lumbosacral region. Nature provided for this by making the lumbar vertebrae the thickest and strongest, and the sacral vertebrae completely soldered together.

All vertebrae, except the sacrococcygeal ones, have a special structure. They consist of a cylindrical body, which bears the main load, and processes that provide us with the ability to bend in different directions, turn, and twist. The two parts are connected by two semicircular arches on both sides so that there is a gap in the middle. This is the spinal canal, and it is intended for the spinal cord. The latter is a kind of “checkpoint” of the second rank (after the brain), carrying impulses from the brain to the organs and vice versa.

The peripheral endings of the myelon (the so-called spinal cord) are the spinal nerves that emerge from it as part of the roots. The anterior roots are motor. They carry commands to the muscles. The dorsal roots are sensitive and, on the contrary, are directed from the organs to the brain. At first, the roots are not divided into anterior-posterior, but only into right-left, emerging laterally from the spinal cord through the hole between the processes of the upper and lower vertebrae. Having passed the bone ring, separation immediately occurs.

Compression of the spinal cord itself by a hernia leads to disruption of a large number of functions at once: internal organs stop working, sensitivity and movement of the limbs are impaired (in the case of the lumbosacral region - only the lower ones). If the disc begins to protrude towards one of the roots, this will cause sensory-motor disturbances in only one limb.

Now about the hernia itself. This is a protrusion of the central part of the disc, which normally has the consistency of a very dense and springy jelly. This structure is called the nucleus pulposus and is the main shock-absorbing element and can move inside the disc and spread out depending on the direction and force of the load on nearby vertebrae. At the same time, normally the surrounding tissues do not change their structure and do not suffer, remaining in density the same as the tendon of any muscle. As soon as thinning of the fibers occurs in the peripheral part of the disc (fibrous ring), the nucleus pulposus, under the influence of load, rushes into weak point. While it has not yet gone beyond the disc, it is not yet a hernia, and the situation can still be corrected.

In fact, the annulus fibrosus is not easy to destroy, because it consists of fibers lying in several layers and intersecting in three planes. But this is possible either due to a single action of high pressure on the nucleus pulposus, or when replacing the usual disc tissue with scar tissue. The latter occurs when the disk power supply fails. How does he eat?

The disc is somewhat like a sponge: it receives oxygen and nutrients during the movement of the spine, when filling of the cartilage occurs. When it, again under the influence of movements, contracts, waste substances are forced out of it. At the same time, in order for the trophism of the intervertebral disc to be complete, the movements must be performed in full, including bending, flexion and extension. Sharp increase the type and amplitude of motor activity after a period of prolonged low mobility of the spinal column, oddly enough, does not increase the nutrition of the cartilage, but significantly increases the risk of rupture of the fibrous ring.

A little about myths

The diagnosis of “intervertebral hernia of the lumbosacral spine” is made very often when magnetic resonance imaging reveals any protrusion of the disc in any direction. But with age, the nutrition of the disc deteriorates, and the appearance of an intervertebral “diverticulum” of 2-3 mm, without nagging pain in the leg or coldness of its skin, can be considered a variant of the norm. Even multiple 2-3 mm protrusions in a person 40 years of age and older are not a diagnosis and do not require special treatment. But, being a borderline state (between normal and pathological), they signal to a person that it is time for him to pay attention to his spine, because so much depends on it. To do this, you don’t need to take any pills, but increasing the range of movements of your back, as well as periodic courses of classical massage, is what you need. Once again: no medications and, especially, no operations!

How does a hernia form?

The nucleus pulposus does not immediately appear outside the disc. Before this there are several stages:

1. Disc protrusion. The annulus fibrosus slightly loses its elasticity, as a result the nucleus pulposus shifts to one side. If at this stage the correct alternation of rest and therapeutic exercises is ensured, the process of intervertebral herniation can be stopped.
2. Incomplete prolapse of a section of the disc. The fibrous ring is destroyed in one area, and material from the nucleus pulposus rushes there.
3. Complete disc prolapse. The nucleus extends beyond the fibrous ring, compressing the vertebral bodies and structures of the nervous system.
4. Disc sequestration. This is the name of the condition when a section of the “freed” nucleus pulposus enters the spinal canal. This causes allergic reactions, since the substance is foreign to this location. Sequestration is also dangerous due to disruption of the blood supply to the spinal cord and its nerves. May cause paralysis of the lower extremities and pelvic organs.

Causes of hernia formation

More often vertebral hernia lumbar spine appear with osteochondrosis, when, due to age-related changes, the trophism of the fibrous ring worsens, it becomes drier and brittle. However, osteochondrosis and intervertebral hernia are different diseases.

A hernia can also be caused by:

• spinal injuries: road accidents, blows, falls on the back;
• lifting heavy weights incorrect position back: a person lifted a load from a standing position, bending at the waist, when it was necessary to sit down and, standing up, keep the lower back straight. You can “get” a hernia by lifting weights, bending over and turning to the side;
• scoliosis or lordosis of the thoracic or lumbar region, when the load on certain vertebrae of the lower back increases significantly;
• dysplasia hip joint on one or both sides. Degenerative changes V intervertebral discs the lower back develops due to increased and improperly distributed load on them;
• diseases of the spine: tuberculosis, tumors, ;
• due to illness endocrine organs, chronic processes accompanied by intoxication or due to genetic diseases.

Risk factors

The more items in the list below that fit “your” case, the greater the chance of developing lumbosacral hernias. This:

• Great weight, that is heavy load on the spine, the lumbar region of which suffers the most.
• Male gender: Men are more likely to suffer from intervertebral herniation.
• Ages 30-50: The years of “maximum strength” and confidence in one’s experience are where the heaviest weights are most likely to be lifted and people are most likely to have accidents or work-related injuries.
• Physical inactivity: sedentary work, “transfer” from the computer to the steering wheel and back. If the volume of movements performed by the spine is insufficient, the nutrition of its structures, especially the intervertebral discs, deteriorates. Moreover, both in the car and at the workplace, the back most often takes a bent position.
• Heavy physical work. In this case intervertebral discs don't have time to get necessary substances, constantly receiving load. Monotonous movements are especially dangerous.
• Smoking. In this case, the saturation of the blood, and then the intervertebral discs, with oxygen is disrupted.
• Frequent “minor” spinal injuries, each of which disrupts the nutrition of the disc. These injuries do not make themselves felt immediately, but after several years (up to 5).

How to recognize a lumbosacral hernia

It cannot be said that the symptoms of a hernia of the lumbosacral spine are very specific, and a diagnosis can be made from them: in exactly the same way, a tumor that has developed in this section and compresses the roots, or local inflammation of the root can manifest itself. Although the latter diseases are quite rare, they cannot be discounted. Therefore, after reading the symptoms, do not rush to make this diagnosis.

The symptoms that manifest a hernia of the lumbar spine can be divided into several groups:

Symptom	Characteristic
Pain	Localization: depends on where the injured person is located nerve root. Most often it goes along inside thighs, reaching the knee, shin, inner ankle. It can radiate into the buttock and leg, reaching the foot, and can be felt on the sides of the legs. May be localized at one point in the lumbar region Gradually the pain changes its localization, going down to the heel, back of the foot, especially in the area of ​​the big toe Intensity: in the initial stages - from a “lumbago” to a heavy, aching sensation. When it intensifies: when standing, walking for a long time, turning or tilting the body, coughing, lifting heavy objects, performing sudden movements, exercising with tension in the lower back muscles, raising the straight leg on this side up, sitting for a long time, driving on uneven roads. How it is weakened: in the initial stages upon adoption supine position the pain goes away, later it helps to remove the pain by lying on the healthy side with the affected leg bent in all joints
Limitation of movements	Due to muscle weakness and deterioration in the receipt of “commands” to them, one or both legs make a smaller range of movements than before. It is more difficult to lift the leg; it may not bend completely at the knee. A smaller range of motion is also observed in the lower back: now it is not so easy to bend completely with straight legs, lean to the side, and so on
Weakness of the leg muscles (if the hernia is compressing the spinal cord - symptoms apply to both legs)	It becomes difficult to squat, climb stairs, and jump. The leg gets tired quickly. If we are talking about compression of the spinal cord, then weakness of the leg muscles without treatment can result in paralysis of both lower extremities
Sensory impairment	It may manifest itself as numbness, tingling, burning or freezing. The sensation of hot-cold and pain worsens. Sensitivity disturbance is localized either in the lumbar region with transition to the outer side of the thigh, or in the sacrum and outside thighs, or from the perineum and, by inner surface thighs to shins and below. It depends on which disc the hernial protrusion is located in:
Skin changes on the affected leg (if the spinal cord is compressed, both legs are affected)	Compared to the “healthy” leg, the diseased leg is paler, thinner (due to muscle atrophy), and less hair grows on it. Its greasiness and sweating also differ, both more and less. The affected leg is usually colder. Important: the pulse in this leg can be felt on the thigh, and under the knee, and between the big and index fingers feet
Dysfunction of the pelvic organs. This symptom characteristic of compression of the spinal cord herniation	From the intestines: mainly constipation, less often - diarrhea. This almost does not depend on the nature of the food taken (but the situation with constipation improves somewhat when eating liquid food), and is not accompanied by abdominal pain or bloating. If the nervous regulation of the bladder is disturbed, frequent urge to urination, while urine is released in small portions, clean, without blood, and urination itself is painless. Urinary incontinence may occur. The regulation of the genital organs is disrupted. This is manifested by a decrease in sexual desire, in men - erectile dysfunction, in women – gynecological diseases
Symptoms noticeable to relatives and friends of a sick person	A person close to the patient may notice that he is hunched over, stooping, one leg seems shorter than the other, his posture has changed, and his movements have become unstable. If you look at the bare back in the lumbar region, you can see tense muscles on one side of the spine (they protrude and feel like a dense cord to the touch). The smoothness of the gluteal fold is visible. Pressure on the spinous processes of the vertebrae (these bones that form the contour of the spine) in the lumbar region causes pain

Diagnostics

Before deciding what treatment a lumbar hernia will receive in this particular case, you need to make a diagnosis. This is done using instrumental methods(about them below), but the neurologist will be able to indicate which area of ​​the spine needs to be examined by a radiologist or magnetic resonance imaging specialist only after:

• determination of reflexes from the tendons located on the legs;
• straight leg raise test;
• studies of temperature, pain and vibration sensitivity over the entire surface of the legs, in the buttocks, perineum, and lower abdomen.

At intervertebral hernia in the lumbosacral region, sensory disorders will be noted in the area innervated by the affected root, the neurologist will determine the loss or decrease of tendon reflexes, and identify deep disturbances in the biomechanics of movements of the affected limbs.

In addition to the preliminary determination of the affected segment, such an examination helps to determine the degree of innervation disturbance, treatment tactics, and after it begins, to see the dynamics of the changes occurring.

The diagnosis itself is made on the basis of one of the tomographs - magnetic resonance or computer multislice - of the lumbosacral region (see). If spinal cord damage is indicated, the diagnosis can be supplemented with contrast myelography - a study in which lumbar puncture An X-ray contrast agent will be injected into the spinal canal. Next, an x-ray is performed, which shows how contrast agent passes in the spinal canal, does it accumulate at some level (the latter means that the spinal cord is compressed and, most likely, in order to prevent its death, an operation to remove a lumbar hernia is needed).

Treatment of the disease

Therapy for a hernia of the lumbosacral region is aimed at eliminating pain, relieving spasm of the “squeezed” (to maintain relative balance) spinal muscles, and eliminating ischemia of the spinal cord and its roots. In addition, it is necessary to create a strong muscle corset, balance the joints between the processes of the vertebrae, and eliminate their subluxations, since these phenomena can provoke the growth of an intervertebral hernia.

How is a lumbar hernia treated? There are 2 main treatment methods used here: conservative (pills, injections, exercises) and surgical. The course of the disease is divided into three periods:

1. Spicy. Here you feel pain, stiffness of movement, and loss of sensation in your legs.
2. Subacute. Starts after 3-5 days. Characterized by a decrease in pain severity. Sensitivity is restored slightly.
3. Restorative. It begins at 3-4 weeks of treatment and is not always present. It is characterized by the absence of pain and minor sensory disturbances.

This division is necessary in order to apply the right tactics treatment. So, in the acute period, only conservative therapy is carried out; subacute and recovery may be the time when surgical treatment is involved.

Let's consider the plan conservative treatment by periods.

Acute period

Here you need bed rest with minimal motor activity in the lumbar region. Lie on a small pillow, on your back, with a small cotton-gauze roll under your back. The doctor must adjust the position of the back, depending on which area of ​​the disc there is a rupture, so that it can heal. If there is neuralgia of the sciatic nerve, the legs should be bent at the knee and hip joints.

Medicines

• Painkillers are also anti-inflammatory. Usually - in the form of injections for the first 3-5 days: "", "Rofika", "Movalis". Then you should gradually replace the injections with similar tablets (“Meloxicam” and others).
• Blockade with novocaine with the addition of an anti-inflammatory hormone. This remedy can relieve pain immediately – and for 2-3 weeks. During the course you can apply 3-4 such blockades, only in different places near the affected disc.
• Muscle relaxants central action: " ", "Sirdalud". They are needed in order to relieve painful muscle spasms on one side of the spinal column.
• Vitamins B1, B6, B12 in a complex (preparations "", "Neurovitan", "Neurobeks"). They have some relaxing effect, restore nerve tissue, and improve the conduction of impulses in the pinched fiber.

Manual therapy

Not applicable during this period.

Exercise therapy

You can only move your toes, nothing more.

Subacute period

Mode - semi-bed. In this case, you need to pay attention to how you feel and not perform movements that cause pain.

Drug therapy

Painkillers and anti-inflammatory drugs in tablets, muscle relaxants in tablets and vitamins are the basis of drug therapy.

Physiotherapy

The following methods are used:

• thermal procedures;
• acupressure;
• acupuncture;
• diadynamic therapy;
• underwater massage.

Additional Methods

Well proven application medical leeches– hirudotherapy. These worms, injecting special substances into the tissue, help resolve fragments of the protruding disc. Leeches help 7 out of 10 patients. Course – 10-12 procedures, with an interval of 3-4 days.

Massage. This method should be used with extreme caution, only if there is no pain in the leg.

Manual therapy. The method is most effective when there is not only a hernia, but also displacement of the intervertebral joints. Optimally 2-7 sessions with a chiropractor in combination with following method– post-isometric relaxation.

Postisometric relaxation. These are classes with a specialist. They consist of a combination of 5-10 seconds of isometric work (tension and tension, but without pain) of the muscles and the same time of passive stretching of the muscle.

Exercise therapy

Exercises for lumbar hernia in the subacute period should be performed from the starting positions:

• lying on your back;
• on all fours;
• on the stomach.

They should not be accompanied by pain. When it appears, stop the exercise and rest. It is optimal to use an unloading corset during exercise therapy.

1. Lying on your back, arms and legs straight. All muscles are relaxed. Raise your arms slowly up, stretch, lower your arms.
2. Lying on your back. The body is relaxed. Bend right leg in the knee, swing it left and right, relax the muscles. Repeat the same with your left leg.
3. Starting position – on the stomach, hands under the chin. Bend your knees, touch your buttocks with your heels, relax your muscles, and rest.
4. Standing with your face or side to the gymnastic wall, lift your legs one by one, swing back and forth and to the sides.
5. Lying on your back. Bend and straighten your leg at the knee, move it to the sides.
6. I.p. - Same. Using your hands, alternately pull your right and left leg bent at the knee to your chest.
7. Standing, feet shoulder-width apart. Slowly turn your torso to the right and left, while simultaneously spreading your arms to the sides. When raising your arms, inhale; when lowering, exhale.
8. Standing, feet shoulder-width apart, knees bent, heels close to the buttocks, spread shoulder-width apart. Inhale. As you exhale, alternately tilt your knees inward without moving your pelvis.

This is an approximate set of exercises. The doctor and exercise therapy instructor who deal specifically with your case should tell you more.

Recovery period

Volume drug treatment at this stage it is much less: painkillers are not used (novocaine blockades can only be used if pain arises again while performing some exercise), the course of vitamins and muscle relaxants has already ended or is ending by this time.

Physiotherapy and methods alternative treatment(hirudotherapy, acupuncture) in recovery period do not differ from what was in the subacute.

Exercise therapy

The scope of exercises for a lumbar hernia is expanding, because you need to strengthen the muscular corset of the back and lower extremities, as well as recreate the correct posture:

1. Lying on your stomach. The doctor bends and straightens the leg at the hip, holding it for 5-7 seconds in an extended position.
2. Lying on your stomach. Bring and abduct the right and left legs alternately from the body.
3. Lying on your stomach, lift your straight leg first by a small angle, then by a larger angle.
4. Lying on your side on the side of your healthy leg, move your affected leg away from your body, bent at the knee.
5. Standing with your back to the gymnastic wall, straighten your back and slightly move your pelvis back so that the shoulder blades of the buttocks calf muscles and the heels touched the wall. Raising yourself on your toes, stand there for 3-5 seconds, then return to the starting position.
6. Walking with a bag filled with clean sand weighing up to 500 grams on your head. Step over imaginary obstacles without bending your back. Also, without slouching, squat down, trying not to drop the bag.

Exercises with gymnastic apparatuses: balls, dumbbells, gymnastic sticks are also carried out under the supervision of an instructor. It is also necessary to perform half-hangs (on the horizontal bar, but without releasing your legs) and, gradually, hangs. It is also important to do exercises on stairs.

Surgical treatment

The decision that removal of a lumbar hernia is necessary is made based on the following indications:

• if there is a narrowing of the spinal canal;
• despite treatment, numbness of the limbs, muscle weakness increases, or dysfunction of the pelvic organs has also appeared;
• when conservative therapy was effective for a short time, then deterioration occurred in the same part of the spine;
• a portion of the hernia has fallen into the spinal canal;
• compression of the cauda equina occurred (the end of the spinal cord in the form of a bundle of nerves, irritation or pinching of which causes terrible pain in the perineum and legs).

The essence of the operation is to free the spinal cord or roots from the hernia compressing them. This can be done as follows:

1. Endoscopically. 3 micro-incisions are made in the spine area; a camera is inserted into one, which will transmit the image to the monitor; through the other 2, surgeons work with micro-instruments. The hernial protrusion and residual elements of the nucleus pulposus are removed.
2. Percutaneous discectomy. This intervention involves removing its destroyed core through a puncture in the intervertebral disc. Next, it is replaced with a special substance, which must cool to acquire the desired properties.
3. Disc endoprosthetics. The damaged disc is removed and an implant is placed in its place.
4. . The nucleus pulposus is most saturated with water. This is what the laser is designed for, which has the property of evaporating moisture-containing structures.

Prevention

To prevent the development of hernias in the intervertebral discs in the lumbosacral regions, you need to:

• control your own weight, preventing it from increasing significantly;
• eat well;
• no smoking;
• limit physical activity;
• exclude physical inactivity;
• sleep on a hard mattress, in a supine position.

If you start treatment with a neurologist on time, you can return to your usual activities within 5 days after pain relief. By following the above rules and performing the recommended exercises, there is a very high probability that you will no longer remember the symptoms of an intervertebral hernia.