Intervertebral hernia- damage to the intervertebral disc due to inflammatory process. The development of the disease is accompanied by a change in the shape and position of the discs, as well as a rupture of the fibrous ring.
In most cases, the disease affects the lumbar region and much less often the cervical and thoracic. There are two methods of treatment: therapy and surgery. Doctors rarely resort to surgical treatment. But it depends solely on the cause of the disease and its stage.
stages
A herniated disc can develop in four stages.
- Protrusion.
- Partial prolapse.
- Complete prolapse.
- Sequestration.
The development of each form can occur in any of the three departments that the disease affects.
Protrusion
The very first stage of pathology is called protrusion. Most often it occurs due to progressive osteochondrosis. Protrusion has a definite clinical picture. The contents of the disc, in the first stage, bulge outward. The protrusion can go beyond the lumbar vertebrae by 5 mm. A protrusion cervical able to move out of the disc by 2 mm. Thoracic protrusion goes 3 mm - 4 mm.
Protrusion is characterized by the preservation of the integrity of the fibrous ring. Protrusion is a hernia of the intervertebral sections, while its dimensions are much smaller than those that the pathology reaches during the development of subsequent stages.
Prolapse
After the patient has developed protrusion, the second and third stages begin. With partial prolapse, the symptoms of the disease increase. Pathology can be up to 10 mm in size. When the protrusion has already begun to increase in size, then the third stage of complete prolapse approaches. In this case, the kernel comes out of the disk. The hernia can reach 13 mm or even 15 mm.
Sequestration
The most recent phase of progressive disease. With it, the nucleus completely falls out of the disk and the parts of the vertebra are displaced. The pain syndrome becomes very strong and if medical assistance is not provided, then the patient becomes disabled, there is a high risk of paralysis.
Causes
There are several factors that influence the development of an intervertebral disc herniation. The causes of the disease are impaired metabolism and as a result of injuries. Scientists have also proven that the causes of spinal hernia are heredity and infection.
Before the doctor takes up the treatment of the patient, he must identify the causes of the pathology and, first of all, deal with their elimination. Together with how the causes are eliminated, conservative treatment can be started. 
Symptoms
Intervertebral hernia has the ICD code 10 according to the international classification of diseases. This indicates that the pathology is very dangerous and ranks 10th among the most serious diseases.
ICD - 10 is an indicator that when the first signs of violations are found, it is necessary to contact the doctors. ICD - 10 suggests an increase in symptoms with progressive stages of the disease.
It is not difficult to detect a disease that has the ICD code - 10, it is evidenced by such signs as pain, muscle numbness or stiffness of movements.
However, the symptoms strongly depend on whether the pathology progresses in the cervical, lumbar or thoracic region.
Features of symptoms
Pain naturally accompanies all forms of disturbance. But if the cervical region is damaged, the patient experiences severe discomfort and increased pain when moving the necks and arms. Migraines and pressure surges may also appear. If a hernia of the intervertebral disc L5-S1 appears at the first stage, then it will not be difficult to diagnose the pathology. 
Intervertebral hernia lumbar, unlike the cervical, has more obvious signs. A person who has such a disease looks like a hunchback. His spine does not look like a healthy person. Very often, the deformation is noticeable even to the naked eye. This happens due to damage to the L4-L5 vertebrae. Symptoms are relieved when the hernia reaches 10 mm. The patient begins to suffer from convulsions and numbness of the lower extremities.
Intervertebral hernia of the thoracic region, most often marked by symptoms of inflammation of the cervical subdivision. Symptoms occur already in the second stage, when strong pain appears in the area of the shoulder blades and shoulder joints. And all movements cause severe pain. The patient is not able to make movements with a large amplitude.
Dangerous form of hernia
The development of a hernia in the L4-L5 segments can progress to unique sizes (up to 18 mm). Damage to these vertebrae has a name - a circular form. 
Circular hernia occurs in the cervical region (L5-S1) or lumbar (L4-L5). With this form, the vertebral nucleus completely falls out. Circular pathology is very dangerous, especially if it concerns the L4-L5 segments. As a result of its development, all vertebrae are gradually damaged.
It is noticed that a circular hernia, even 5 mm, can cause serious deviations. Postponing treatment is dangerous, as the result may be complete paralysis of the patient's body.
Diagnostics
The diagnosis of intervertebral hernia of the lumbar (L4-L5), as well as cervical and thoracic, is established by diagnosing. The following methods are most often used:
- radiography;
- myelography;
- CT scan;
- Magnetic resonance imaging.
A hernia of the cervical region is diagnosed much less frequently than a circular pathology of the L4-L5 segments. It is L4-L5 that suffer most from stress on the spine, this is the reason for the frequency of the form of the disease. 
Treatment
The intervertebral form of a hernia involves complex treatment. It begins with the elimination of the causes of the disease. Then the doctor deals with the blockade of symptoms. And only after that the methods by which the patient will be treated are determined.
The main ways to treat the disease include:
- medication;
- therapy;
- massage;
- gymnastics;
- operation.
For each stage of the disease, there is a specific method of treatment. It also plays a role and then there was an injury to the cervical, lumbar or thoracic region.
medical
This method of treatment consists in taking a sick number of drugs that affect inflammatory areas and eliminate the causes of the disease. Very often, patients are prescribed topical ointments. They not only reduce inflammation, but also eliminate symptoms. Features of their use depend on the state of the body, the stage of pathology and the presence of contraindications. 
Therapy
Treated with the help of therapeutic methods is quite possible. The patient may be recommended manual or laser therapy.
But there is a more effective way - electrophoresis treatment with caripazim. This drug has been used for over ten years. Karipazim is a modern product with enzymes, created on the basis of special dietary supplements.
You can use caripazim at home. However, this process should take place only under the supervision of a physician. Therefore, electrophoresis with caripazim is also carried out in medical institutions. Thus, a hernia of the cervical and lumbar sections is treated.
Massage
With a hernia of the vertebrae, massage can also be performed at home. Massage is used to restore the position of the vertebrae. You can use massage to stretch the muscles at the level of the cervical and lumbar segments.
Massage can reduce pain, relieve nervous excitability and prevent muscle atrophy. But only a doctor can prescribe a massage. Despite the fact that massage seems to be an absolutely harmless procedure, it can have certain contraindications. The effect of massage depends on the stage of the disease. In the initial stages, massage can have an effect. But in the third stage, massage helps very rarely. 
Procedures such as massage should only be carried out by an experienced specialist. Turning to chiropractors or performing the procedure yourself at home is extremely dangerous. There is a risk of harm to the body and deterioration of the patient's condition.
Gymnastics
With an exacerbation of a hernia of the spinal column, gymnastics or any physical exercises are contraindicated. However, for preventive purposes or during the rehabilitation period, many patients are advised to perform the exercises developed by the Bubnovsky center.
Bubnovsky's gymnastics is a way of influencing certain parts of the spine that are prone to inflammatory processes. Such exercises are very often used to treat diseases of the musculoskeletal system.
The Bubnovsky Center has been studying the features of herniated discs for a long time. According to the results of their work, therapeutic gymnastics was created. The exercises that the Bubnovsky center offers can be performed with a hernia of any part of the spinal column.
Gymnastics is especially needed for those patients whose lumbar regions are affected. When performed correctly, exercises restore lymph flow and impaired blood flow. Gymnastics activates biochemical processes that play a leading role in the normal functioning of the body.
vociferous. These exercises are most effective in deforming the vertebrae of the L4-l5 segment. 
With the advice of a good specialist, you can do exercises at home. However, gymnastics should not be carried out without the recommendation of a doctor. If the exercises are performed during a dangerous period for the patient, then the result of self-treatment may be muscle atrophy or paralysis.
Bubnovsky developed exercises in order for gymnastics to increase the flexibility of the vertebrae, restore all the necessary processes, and also reduce the development of inflammatory processes. Exercises must be performed daily and following all recommendations.
Operation
Another way that a herniated intervertebral hernia is eliminated is surgery. Surgery is needed only in the last stage of the disease, or in the event of complications. Surgical intervention can be done in several ways.
- Microdiscectomy.
- Laser technique.
These methods of operation are the most common. But, despite the fact that modern medicine has a wide knowledge, surgical intervention in the region of the spinal column is a big risk. 
A feature of such a method as microdiscectomy is the use of microscopic instruments during the operation. Microdiscectomy allows surgeons to perform the operation with maximum precision, thereby reducing the risk.
Endoscopic microdiscectomy differs from the previous method using an endoscope. This uses local anesthesia. The risks for the patient in this case are minimal.
Surgical intervention is also carried out using a laser technique. Depending on the method by which the laser operates, the hernia can be vaporized or burned out. Restoration of the vertebrae when using the laser technique is very fast.
ethnoscience
Carry out medical procedures folk remedies at home is very risky. It is advisable to follow the recommendations given by the attending physician. However, many patients combine medical methods with folk remedies.
Before using folk remedies, it is worth checking with a specialist whether their use is permissible for this form of hernia. 
Effective Methods
People who performed medical procedures at home and used folk remedies consider the following methods to be the most effective:
- honey massages;
- drinking tincture of oil and comfrey roots;
- compresses of lilac and vodka.
Eliminating a hernia with folk remedies cannot lead to complete healing. However, folk remedies can reduce pain and reduce inflammation.
Therapeutic procedures with folk remedies are carried out preferably at bedtime. If, together with folk remedies, a light massage is performed, then the procedure has a warming effect, which helps to relax the muscles.
Do not forget that it is possible to be treated with folk remedies for a hernia progressing between the vertebrae only at the first stage of the disease. In addition, it is impossible to fight the disease only with folk remedies. The patient must go to a medical institution. 
A herniated disc is a very serious condition that can lead to Negative consequences. It is better to seek medical help after the first signs of a deviation in health status have been discovered. Self-medication is prohibited, since the spine is one of the main human organs.
In the absence of an impact on the pathology, it will grow and damage the entire spinal column, which can lead to paralysis, partial muscle atrophy and, as a result, the patient becomes disabled.
You often hear from patients: they say that doctors treated osteochondrosis and sciatica, then they did an MRI / CT scan of the spine, but it turned out that there was a herniated disc (IVD), and now only surgery is supposed to save. Is this really the only way out?
There are many opinions on this subject, since doctors of different specialties deal with the problem. Neurologists dissuade from surgery, chiropractors guarantee a complete cure, and neurosurgeons say that only they will relieve suffering, otherwise irreversible damage may occur.
What method of treatment herniated disc it is better which hernia to operate with open access, and in what cases - minimally invasive? Particularly impressive are the films showing minimally invasive expensive interventions, for example, laser vaporization, after which the patient is completely cured - send him into space at least now.
For a correct understanding of the problem, it is necessary to recall the main points of the pathogenesis of the disease.
How does a herniated disc grow?
A healthy intervertebral disc consists of end plates, a fibrous ring, in the center of which is the nucleus pulposus - this is a very strong elastic formation that can withstand significant loads. Therefore, in case of spinal injury, its fractures are more often observed than IVD injuries. Over the years, dystrophic processes (malnutrition) develop, they begin with the intervertebral disc, move to other elements of the spinal motion segment and are defined as osteochondrosis of the spine. This is a chronic multifactorial relapsing disease, a genetic predisposition to it is observed in 80% of people. It is important to note that the degeneration (degeneration) of the disc and its natural aging is one process, but at different speeds, complicated by herniation. Early age-related deterioration of the spine is an expression of the insufficiency of the biological perfection of a person - as a tribute to nature for the transition to a vertical position.
Initially, intradiscal changes (protrusion) of the IVD are observed, then the fibrous ring cannot withstand the load, and the nucleus pulposus ruptures it, forming a true hernia of the IVD (prolapse). The prolapse of the core can have different directions: upward or downward, the so-called Schmorl's hernia (clinically insignificant); anterior; and the most unpleasant - posteriorly, when fragments of the nucleus fall into the epidural space of the spinal canal and often lead to a disco-radicular conflict. At the same time, the degenerative process spreads both up and down to other IVDs (most often to L4-L5, L5-S1, C5-C6, C6-C7) and even the spine - more often the lumbar, then the cervical (up to 30%) and less often - chest (less than 1%).
Best known in clinical practice diagram of the stages of posterior herniation proposed by Armstrong J. (1952):
- Stage 1: initial dystrophic changes in the nucleus pulposus and the posterior part of the annulus fibrosus (Fig. 1),
- Stage 2: displacement (protrusion) of the nucleus pulposus posteriorly (Fig. 2),
- Stage 3: prolapse of sequesters of the nucleus pulposus into the spinal canal, where its resorption or fibrosis begins (Fig. 3).
In the “pre-computer era”, many researchers noted that disc sequestration resolves, and this process is faster in the vascularized epidural space. New high-resolution neuroimaging methods made it possible to observe this process in dynamics. The first portion of the prolapsed nucleus pulposus may be significantly reduced in size on CT during the period of remission, but an unsuccessful movement or overload leads to a repeated prolapse of another portion of the nucleus, causing an exacerbation.
At first, neurosurgeons who removed IVD hernias considered them to be benign chondroma tumors and did not associate the pathology with IVD.
The studies of the Dresden school of pathologists led by G. Schmorl (1926) helped to understand. Post-mortem analysis of 5,000 human spines different ages cartilage nodules were found in 38% of cases (usually in persons over 50 years of age). These results are consistent with current data obtained on volunteers: in 50% of CT scans of the spine and in 37% of myelographs performed in the population of all ages, pronounced pathological changes in the IVD were determined. And the patients had no complaints. The older the patient, the more often CT/MRI showed osteochondrosis of the spine, and in old age (>60 years) it is observed in 100% of cases.
What to do with a hernia of 10 mm, if conservative treatment is ineffective
The question is posed specifically, but it is impossible to answer unambiguously. It is clear that surgical assistance is already needed.
In Belarus, several methods of surgical treatment of herniated discs are used.
Percutaneous minimally invasive hernia removal. This is an attempt to eliminate the disco-radicular conflict with minimal trauma to the spine, without violating its stability. During percutaneous operations, when the nucleus pulposus is reduced (evaporated) or mechanically removed (without opening the spinal canal) to reduce intradiscal pressure. It is impossible to influence the sequesters of IVD hernia that have fallen out. Therefore, the indications for these interventions are hernias less than 6 mm (see "Medical Bulletin" dated February 12, 2009 No. 7, ")"). It is believed that with this size, the fibrous ring has not completely ruptured and the process of hernia formation is at stages 1–2.
For hernias larger than 10 mm, other surgical techniques are suitable. Now there are already more than a hundred of them, and new ones are appearing.
Standard microdiscectomy. It is called the gold standard of neurosurgical treatment of IVD hernias. The dropped out part and the remnants of the nucleus pulposus in the IVD are removed. With an acute development of the disease (patients note that something “crunched”, “shot” in the back), in middle-aged and young people, the results of treatment are good. Although the operation with minimal tissue trauma (skin incision in experienced neurosurgeons is 2–3 cm), it still exacerbates the degenerative-dystrophic process in the operated IVD and reduces its height, as a result, the predicted result is not always achieved. To preserve IVD functionality after hernia removal, it was proposed to suture the annulus wound. Specially designed new operation- annuloplasty (J. Cauthen, 2002). However, it turned out to be ineffective due to heavy loads and low regenerative potential of the annulus fibrosus; hernia recurrences were again observed.
The results of standard microdiscectomy worsen due to the age of patients, the long duration of the disease, repeated microdiscectomy at the same level; improve - manifestations of osteochondrosis only at one level, removal of large IVD hernias (> 6 mm according to CT).
Indications for standard microdiscectomy have been developed for a long time and are based on the neurological manifestations of hernias. They are divided into relative and absolute. With regard to absolute indications for standard microdiscectomy, all authors are unanimous: compression of the cauda equina, intractable severe pain attack, or myeloradiculoischemia with paralysis of certain muscle groups (like an acute abdomen) require urgent intervention. But the justification of microdiscectomy with relative indications is not recognized by everyone (Ya. Yu. Popelyansky, 2003; E. L. Tolpekin, F. V. Oleshkevich, 2006).
Epidurochemonucleolysis. Targeted prolonged treatment with a complex of drugs (bupivacaine, lidase, vit. B12) through a catheter placed through the lower sacral opening into the epidural space, under Rtg control. The technique makes it possible to deliver drugs directly to the zone of disco-radicular conflict without violating the integrity of anatomical structures. The criterion of effectiveness is the reduction in the size of the hernia during control CT examinations. When analyzing the results of treatment using this technology, it was revealed that the best results were obtained with hernias of more than 6 mm, when there is a rupture of the fibrous ring and the posterior longitudinal ligament, and lidase directly affects the sequesters of IVD hernias.
Based on the facts of the pathogenesis of the disease, the above results of treatment, it cannot be argued that the size of IVD hernias is a fundamental factor for indications for surgical treatment. There is no clear correlation between the size of the hernia and the severity of neurological manifestations, and, conversely, with acutely developed intractable pain in the lower back with severe clinical picture radiculopathy, in most cases we find large IVD hernias.
Who will judge the neurosurgeon and orthopedist
Posterior hernias intervertebral disc is a pathology of the musculoskeletal system and peripheral nervous system Therefore, there are two positions in the principles of providing surgical care - neurosurgeons and orthopedists.
Most neurosurgeons believe that the main cause of suffering is in compression of nerve structures caused by IVD herniation, and its surgical removal is the key to recovery.
Other positions are held orthopedists, focusing on the degenerative-dystrophic process in the IVD, therefore, they direct their efforts to restore the correct anatomical relationships in the spinal motion segment.
The ideal solution to the problem would be not only elimination of the disco-radicular conflict, but also restoration of IVD function and height. While this is not an achievable goal. Surgical treatment for multilevel lesions also remains unresolved.
In recent decades, at the junction of these disciplines, a new science has been formed - vertebroneurology. Conferences and symposiums on this topic are convened almost every year. In 1992 at the Soviet-American symposium about the treatment of osteochondrosis of the spine the American vertebroneurologist A. White noted that the effectiveness of treatment of such patients depends on the quality of the joint work of multidisciplinary "spinal" teams, which should include a therapist, surgeon, psychiatrist, radiologist, physiotherapist. The leading doctor of the team should not be a surgeon, but a specialist who knows the patient better, his psychosocial status, working conditions, material circumstances, and rehabilitation resource. Such a doctor would take responsibility for deciding on surgical treatment, pre- and post-operative management. In our country, the solution to this problem lies in the creation of vertebroneurology centers, where patients could receive emergency and planned assistance from all specialists working in this field. Patients with back pain would not have to visit a neurologist (therapist) several times at the clinic, then wait for a CT / MRI examination, which significantly increases the preoperative period.
The Clinic of Neurology and Neurosurgery of the Belarusian State Medical University has developed and implemented a method for the phased treatment of patients with neurological manifestations of osteochondrosis of the spine according to the principle of increasing radicalism:
1. therapeutic paravertebral blockade with hormonal and enzyme preparations, or transsacral epidemiological urochemonucleolysis;
2. standard microdiscectomy with endoscopic assistance;
3. standard microdiscectomy + epidurochemonucleolysis (with multilevel pathology);
4. standard microdiscectomy + dynamic stabilization of the spine with a U-implant (in case of severe dynamic instability and repeated operations).
Evgeny TOLPEKIN, neurosurgeon, candidate of medical sciences Sciences, Minsk
Over the past decade, the number of cases of vertebral hernia has almost tripled. As statistics show, timely access to a specialist is the key to successful treatment.
What is an intervertebral hernia? A spinal hernia (intervertebral hernia) is a prolapse of the nucleus pulposus outside the intervertebral disc. A hernia of the spine often occurs at the last stage of osteochondrosis, as well as against the background of curvature of the spine.
Most often, intervertebral hernias occur in the region of the lumbar spine (65% per 100 patients), due to the greater load on this area, as well as anatomical features. A little less often, intervertebral hernias occur in the cervical (31%) spine and much less often in the thoracic (4%).
Symptoms of an intervertebral hernia
The first harbingers of the formation of intervertebral hernias may appear as early as 20 years old and manifest as pain in the lower back or in other departments, backaches occur. Most often, intervertebral hernia occurs at the age of 30-50, more often in men, and in overweight people.
Symptoms may vary depending on the location of the herniated disc. This disease is characterized by pain, numbness, tingling, weight loss of one arm or leg, muscle weakness and other phenomena.
In almost all vertebral hernias, the first pain appears in adolescence and progresses with age. After the age of 20, the spine begins to age, and the risk of a herniated disc increases exponentially.
Diagnostics
When diagnosing a hernia of the spine, it is important to correctly collect complaints from the patient, determine the nature of the pain, the position in which it occurs, and exclude other diseases. After collecting complaints, tests are carried out, specialists check muscle strength, reflexes, which are disturbed and reduced in vertebral hernias. After determining the site of the approximate location of the intervertebral hernia, additional studies are often prescribed: magnetic resonance imaging (MRI), computed tomography(CT) and x-ray diagnostics.
Treatment
The main problem for doctors is that in 9% of cases, herniated discs are not cured by acupuncture, manual therapy, or other conservative methods of treatment known to medicine. Then the only hope is surgical treatment. According to different authors, unsatisfactory results of surgical treatment for disc herniation are observed in 10-20% of cases, and relapses after surgery - in 10-28% of patients. The percentage of complications is no more than 3-5%.
In most cases, if the patient consults a doctor in a timely manner, it is possible to do without surgical treatment of an intervertebral hernia. And if a person consciously wants to get away from a neurosurgical operation, he must be ready to make considerable efforts to work on his health, as well as prepare himself for the daily performance of special exercises.
Conservative methods include manual therapy, as well as a whole branch of medicine that studies the spine - vertebroneurology. In some cases, high-quality manual therapy is able to remove pain syndromes in a few steps, stop the progression of the disease.
The spine is the most important and complex organ of the musculoskeletal system and the nervous system. Injuries of the spinal column are the most formidable injuries, accompanied by various complications.
Intervertebral disc injuries are the most common. One type of injury is a herniated disc.
What is an intervertebral hernia?
Intervertebral hernia of the lumbosacral region is a disease that occurs when the intervertebral discs are deformed. As a result of the disease, part of the disc is deformed and protrudes, prolapse can occur in the cavity of the spinal canal, pinching the nerve roots.
A hernia is accompanied by pronounced pain and leads to dangerous complications. Without proper treatment, it can cause disability of the patient.
The formation of an intervertebral hernia
Types of hernias of the lumbosacral region
The displacement of the intervertebral disc occurs in different directions, so there are several types of hernias:
- Posterolateral- part of the intervertebral disc prolapses into the area of the spinal canal. The most dangerous type of hernia.
- Lateral hernias- the disk is shifted to the left or right relative to the spinal column.
- Anterior hernias- the intervertebral disc protrudes forward.
- Classic hernias- the intervertebral disc protrudes evenly around the entire circumference of the vertebra.
Hernias are also classified by size:
- small- the size of which does not exceed 5 mm;
- medium- the size is from 5 to 8 mm;
- large- range in size from 8 to 12 mm;
- gigantic– whose size exceeds 12 mm.
Hernia classification
According to the nature of the prolapsed tissues, hernias are divided into:
- pulpous- occur when the fibrous ring is destroyed or when the integrity of the vertebral body is violated;
- cartilaginous- occur if, due to chronic inflammation or physical activity, the cartilage loses its elasticity;
- bone- are mainly observed in the elderly and senile age, when bone growths compress the nerve roots or part of the spinal cord.
Hernias are also divided into primary and secondary. Primary hernia occurs due to trauma in the absence of diseases of the spine. Secondary hernia occurs, under the influence of spinal deformity or due to other diseases. There is a special type of vertebral hernia - Schmorl's hernia.
What are dangerous hernial protrusions?
A hernia in the lumbosacral region is dangerous: without treatment, the hernia progresses, the intervertebral disc compresses the roots of the spinal nerves. Depending on which nerve has ceased to function properly, urination and defecation disorders may occur.
With compression of the motor nerves, the mobility of the part is lost skeletal muscles lower extremities, gait is disturbed. In severe hernia, paralysis of one or both legs can develop, which will lead to disability.
Causes of a hernia
The direct causes of the development of pathology include:
- physical stress;
- osteochondrosis;
- subluxations of the vertebrae due to falls, bruises, sudden movements;
- scoliosis and other diseases of the spinal column;
- diseases of the hip statute;
- diseases associated with metabolic disorders;
- lack of calcium in the body and psychosomatics.
Causes of a hernia
The risk group includes the elderly, leading sedentary image lives suffering overweight as well as patients suffering from chronic diseases.
smoking and malnutrition also contribute to a decrease in muscle tone and improper functioning of the musculoskeletal system.
Stories from our readers!
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Symptoms of a hernia of the spine
Symptoms of a hernia will depend on where it occurs. When the nerve is compressed, radicular syndrome occurs - a sign that helps to localize the hernia.
| Localization in the spine | signs |
| L1 | Lower back pain, loss of sensation in the upper buttocks |
| L2 | Violation of sensitivity from the inside of the thigh, in the perineum and scrotum, in women - in the labia |
| L3 | Loss of sensation on the front of the thigh, weakness and involuntary twitching of the muscles in this area |
| L4 | Decreased knee jerk, numbness, difficulty bending the knee |
| L5 | Numbness, pain along the "lamp" on the outside of the leg, inability to raise the foot, loss of balance when resting on the heel |
| S1 | Pain in the back of the thigh, numbness of the calf muscles, inability to stand on toes |
| S2-S4 | Numbness on the posterolateral surface of the leg from the inside, difficulty in defecation, urination, in men - a decrease in erectile function. |
Common symptoms are a sharp "shooting" pain, a feeling of coldness and tingling in the legs, a decrease in skin sensitivity in certain areas, and muscle weakness.
Treatment
For an accurate diagnosis, you need to contact a qualified specialist. Treatment is carried out both conservatively and surgically. The treatment method chosen depends on the size and location of the bulge.
Therapy is aimed at relieving pain, normalizing the patient's well-being and strengthening muscles and ligaments. The main task facing the doctor is to prevent further degenerative changes and enlargement of the hernia.
Physiotherapy
complexes physiotherapy exercises- the most important element of the treatment is aimed at stretching the spine and strengthening the muscular corset.
A set of exercise therapy exercises is performed on the floor without shoes:
- The exercise is performed on the floor, lying on your back. The legs are bent at the knees. The abdominal muscles must be tightened, then slowly relaxed, while breathing is not delayed. Run 10 times.
- The exercise is performed in the supine position, hands are pressed to the body, legs are straightened. The upper part of the body rises above the floor for 10 seconds, then slowly returns to starting position. There is a pause of 10 seconds between lifts. Repeat the exercise 5-10 times.
- The exercise is performed lying on the floor on your back, legs slightly bent at the knees. The right hand is on the left knee. It is necessary to bend the leg, while resisting right hand. The exercise is performed 5-10 times, after which it is necessary to change position and do the same with the right leg, resting on the knee with the left hand.
- Starting position - lying on your back, you can put a flat pillow under your lower back. The legs are freely extended, the arms lie along the body. The shoulder blades and buttocks are pressed to the floor, the head cannot be torn off the floor. Fix the position for 5-7 seconds, you do not need to hold your breath. Relax your muscles, rest for 10 seconds. Repeat 10 times.
Exercises
Yoga and swimming
To strengthen the muscles, you can also use yoga asanas. Yoga is one of the traditional oriental sports in which sets of exercises are combined with relaxation and breathing techniques. Allows you to strengthen muscles and make ligaments more elastic.
Yoga courses are conducted by qualified instructors, however, before starting classes, you should consult with your doctor. In the presence of a vertebral hernia, deep bends, deflections and sharp twists should not be performed so as not to aggravate the situation.
Swimming is just as good as a method - the water supports the body, helping to distribute the load on the spine, while expending enough muscle effort to strengthen the muscles of the back and limbs. In diseases of the spine, it is recommended to swim breaststroke, or on the back.
simulators
In the treatment of hernias, specially designed simulators and gymnastics are used on them.
The following devices are used:
- simulator Bubnovsky;
- spinal trainer KC-500;
- elliptical trainer;
- exercise bike.
The work of the devices is aimed at strengthening the muscles of the back and improving blood supply.
Wearing a corset
With a hernia of the lumbosacral region, a special corset-belt is used, 30-40 centimeters wide, with special inserts. The product provides complete immobility of the lower spine and removes some of the load from the spinal column.
It is necessary to wear a corset during sedentary or physical work as prescribed by a doctor. Corsets are selected individually and adjusted to the figure for better fixation. For the treatment of a hernia, a corset must be worn for at least six hours a day, it is better to put on the product in a prone position.
Corset Corset Chest-Belt Corset for the spine
Spinal traction
Traction of the spine with a hernia is performed in order to return the vertebrae to their normal position and prevent further development of the disease. Treatment is carried out in a horizontal position in two versions: dry and water.
Indications for traction treatment are:
- severe back pain;
- pronounced radicular syndrome;
- violation
- difficulty moving limbs and muscle weakness.
Traction of the spine with a hardware method
The traction method is not used for the following pathologies:
- with high blood pressure, with severe diseases of the heart and blood vessels;
- in the presence of an acute infection or inflammatory process;
- pronounced obesity;
- cancerous diseases;
- an operation performed on the spine of any age.
Massage
Before stretching, the muscles are warmed up with the help of massage, then the traction itself is performed - during stretching, some points of the body are fixed, acting on the desired areas and stretching the spine.
Several types of massage are used to treat a hernia:
- hand massage;
- can;
- hardware.
Cupping massage scheme
One massage session takes from 10 minutes to half an hour, while the rule is observed: the spine itself is not affected, so as not to displace the intervertebral disc even more. The course consists of 10-15 procedures lasting about 30-40 minutes.
The duration of the massage course varies from ten days to a month - the effect is achieved only with course treatment, single irregular procedures not only will not give an effect, but can worsen the patient's condition.
The method of acupuncture is used as part of complex therapy for vertebral hernias, pursuing the following goals:
- release of nerve roots in case of their infringement;
- removal of edema;
- elimination of muscle spasm;
- reduction of pain syndrome;
- improved blood supply.
The procedure is prescribed together with massage sessions and physiotherapy procedures. The number of procedures is at least ten during the course. During the procedure, long sterile needles are inserted into the skin at various angles. The injections are quite painful, but relief comes by the middle of the course.
The main advantage of acupuncture is the ability to restore nerve function without resorting to surgery, that is, treatment with needles becomes an alternative to surgery.
Manual therapy
Another effective method of eliminating a herniated disc is manual therapy. The method allows to alleviate the patient's condition at almost any stage of hernia formation. The method of exposure is selected individually for each patient, depending on the location and size of the hernia.
The use of manual therapy along with massage and acupuncture allows not only to correct subluxations of the intervertebral discs, but also to saturate the cartilage tissue with oxygen, improve blood circulation and restore the lost elasticity of the cartilage.
Physiotherapy procedures
The composition of complex therapy includes such physiotherapy as:
- EHF - the impact of extremely high frequencies on the area prone to the disease, improves blood circulation.
- Electromyostimulation - improves muscle tone and relieves spasm.
Physiotherapy for hernia
The use of physiotherapy helps restore muscle activity and prevents tissue atrophy. All manipulations are performed under the supervision of a specialist in courses of 10 or more procedures.
The use of physiotherapy is contraindicated: 
- with acute pain;
- with untreated inflammatory processes;
- at elevated temperature;
- with decompensated heart failure;
- after myocardial infarction;
- with a pacemaker installed.
IMPORTANT! To clarify individual contraindications, it is recommended to undergo a complete examination before starting treatment.
Medical treatment
With infringement of the vertebral discs, drug treatment is aimed at suppressing inflammatory processes and improving the general condition of the patient.
Non-steroidal anti-inflammatory drugs in the form of ointments and creams:
- Diclofenac, Ibuprofen, or Indovazin- these drugs have analgesic and anti-inflammatory effects, reduce swelling, suppressing inflammatory mediators.
- Ointments are applied 1-2 times a day with a thin layer rub in circular motions until completely absorbed. The duration of treatment is from 1-2 weeks.
Diclofenac gel Ibuprofen ointment Indovasin
Chondroprotectors:
- Teraflex, Chondrogard or Mukosat. The composition of chondroprotectors includes collagen obtained from animal bones. This substance is close in structure to the collagen of the cartilage of the human body. It restores the tissue of the intervertebral discs, preventing degenerative tissue changes.
- Teraflex used in the form of an ointment or tablets with the addition of peppermint essential oil.
- Mukosat is prescribed in the form of tablets for ease of use.
- Chondrogard available as a solution for injection. The drug, the duration of the course, and the dosage of injections are selected by the doctor individually for each patient, depending on the severity of the disease.
Teraflex Advance Chondrogard Mukosat tablets
Performed to relieve pain novocaine blockade. Injections with novocaine are possible if the fibrous ring is preserved, and the size of the hernia does not exceed 8 mm. The blockade is performed only in a medical hospital and is valid for 3-4 hours after the administration of an anesthetic.
Surgery
Surgical treatment for a herniated disc consists in removing the herniated body and can cure many pathologies associated with a herniated disc.
An operation is scheduled in the following cases:
- with multiple compression of the nerves of the "horse tail";
- if the size of the hernia is more than 10 mm;
- with a sequestered hernia;
- if conservative treatment measures fail and the disease progresses rapidly.
Endoscopic surgery
The success rate of the operation is 90-95%, in about 6% of cases, a repeated hernia develops in the operated area. The latest method of surgical intervention is laser microsurgery - the laser not only destroys the body of the hernia, but also solders the surrounding tissues, preventing the re-formation of the protrusion.
Alternative methods of hernia treatment
Traditional folk treatment used to relieve pain and swelling. Herbal products are used.
Compresses
Compresses are applied directly to the area of hernia: 
- Compress with ointment based on calendula tincture. In order to perform a compress, alcohol tincture of calendula is mixed with petroleum jelly or any fat cream in a ratio of 1: 3, clean gauze is impregnated with ointment and fixed on the lower back. The compress is left overnight. This composition will help relieve inflammation and reduce swelling.
- Aloe honey compress. To prepare a compress, you will need three parts of alcohol or vodka, two parts of fresh aloe juice and one part of honey. The gauze is impregnated with a compress, which is fixed on the leg for 40 minutes in the morning or evening. The procedure is applied for 1-2 weeks, then you should take a break.
Tinctures
Tinctures are made both for lotions and for oral use.
The most popular is the cinquefoil tincture: 
- To prepare the tincture you will need 100 grams root per liter of alcohol.
- Should be insisted for three days in a dark cool place, then strain.
- The tincture is taken three times a day after meals. a tablespoon in a glass of water or rub into the area of the damaged disc.
Dried fruit remedy
To relieve inflammation and strengthen joint tissue, professional athletes recommend using a mixture of dried fruits in the diet - dried apricots, prunes and figs in a ratio of 5:2:1.
The mixture should be consumed in small amounts after each meal. A mixture of champions acts not only as a medicine, but is also an effective prevention of herniated discs.
Possible complications and consequences
The most important consequences of an untreated lumbar hernia are paralysis and atrophy of the leg muscles, gait disturbance and dysfunction of the pelvic organs. With prolonged infringement of the nerves of the cauda equina, the reproductive function of the body may be impaired.
The most formidable complication is complete paralysis of the lower extremities - this pathology develops with multiple hernias in the absence of treatment.
Disability with a hernia
Depending on the severity of the course of the disease, the patient may be assigned a disability group: 
- The first group of disability assigned in the event of paralysis of the limbs, as well as in the case of uncontrolled emptying of the bladder or intestines.
- The second group of disability assigned to patients with severe pain that is not stopped by drugs.
- For small hernias assigned the third group of disability- a person leads an almost full life, but long-term sedentary loads and physical overstrain are contraindicated for him.
With the current level of hernia treatment, disability of the first and second groups is rarely assigned.
Precautionary measures
Patients with a lumbar hernia should lead a gentle lifestyle that does not complicate their existence: 
- you can not sit in one position for a long time;
- it is contraindicated to lift heavy objects;
- The spine was injured. The person was hit or fell on his back.
- When the patient lifted heavy objects, the back was in the wrong position. The object may have been lifted by a person in a standing position (the loin was bent). And it was necessary, first, to sit down, and then, slowly, to get up. The loin should have been level at this point. You can become the "owner" of this disease if you lift heavy things, while bending over and turning to the side. The appearance of lordosis of the lumbar (or thoracic), or scoliosis, may be associated with an increase in the load on certain lumbar vertebrae.
- when hip dysplasia on 1 side (or 2). Pathologies of the lumbar region may develop due to the fact that the load on them is incorrectly calculated, or is too increased.
- spine diseases. We are talking about tuberculosis, tumors, syphilis; metabolic disorders as a result of endocrine diseases, inflammation, which are accompanied by intoxication or due to genetic diseases.
- The person has excess weight, and from this, the load on the musculoskeletal system increases. The lower back "gets" the most.
- Physical inactivity. This is usually typical for office workers, when people, for hours, are forced to sit near computers. When the spine moves little, its structures are less nourished. The intervertebral discs are especially affected.
- Pulpous - the nucleus pulposus protrudes into the spinal canal or into the anterior lateral region of the zone near the spine. The nucleus penetrates outward through the fissures of the annulus fibrosus. The nucleus may seep higher into the tissue of the body or into the vertebra below.
- Cartilaginous - certain particles of intervertebral cartilage that have lost elasticity due to chronic inflammation. Often the culprit is a viral etiology. As soon as there are increased loads on the musculoskeletal system, the damaged cartilage will be squeezed out. It compresses all the tissues around.
- Bone - appears in representatives of the older generation, as spondylosis develops, the bones of the vertebrae grow, forming osteophytes. They begin to put pressure on the roots of the spinal cord. When osteophytes become large, they tend to have a negative effect on the spinal cord.
- In the area of the buttocks, or in the lower back, severe pain occurs.
- Severe pain "ricochets" pain in the lower limb.
- In the leg, it is felt like something “pricks”, “pinches”. The leg is numb.
- the inability to move the big toe, but it is impossible to stretch the finger;
- such a state of a person when the foot hangs down due to weakness of the calf muscles;
- pain or numbness at the top of the foot.
- The occurrence of a feeling of pain in the lower back, simultaneously with pain in the leg (these pain feelings cause severe discomfort).
- Unpleasant feelings of pain on 1 side of the body of one leg, and one buttock (so that the feeling of pain bothers both the left and the right at one moment - this is rare).
- Discomfort may appear in the lower back or buttocks. Further, the pain goes along the sciatic nerve, down the waist. After that, the pain moves to the thigh, lower leg and finally to the foot.
- muscle tone changes.
- The thigh, foot and lower leg are weakened. It is difficult for a person to move normally.
- The fold of the buttocks begins to smooth out. As a result, the body loses symmetry. The person begins to limp.
- Sensitivity worsens in the limbs, lumbar region, lower leg. Opportunity is lost
- move fully.
- drug therapy;
- non-drug.
- relieve pain, and prevent inflammation from developing further;
- remove swelling of nerve endings in the area of compression;
- restore the nerve;
- restore tissue of the intervertebral disc.
- Juice from comfrey with the addition of honey;
- A compress of aloe leaves or badger fat.
- radiculitis;
- muscle weakness and even paralysis.
A herniated disc is considered a pathology when the nucleus pulposus protrudes (the middle of the intervertebral disc, in the form of jelly). This disease occurs due to the fact that the surrounding nucleus, the fibrous ring, is torn. The patient is diagnosed with vertebral syndrome. It includes a complex of complaints about pathological deformation of the spinal column and violation of its integrity.
Treatment of a hernia of the lumbar spine is usually conservative. It includes a complex consisting of medicines, exercise therapy, physiotherapy. Blockades are also an effective tool. It is very rare to remove, with the help of surgical intervention, the damaged area of the disk, or all of it.
Causes
A hernia of the lumbar spine can occur for the following reasons:
A herniated disc in the sacro-lumbar region is usually formed for the following reasons:
Performing hard work, where maximum physical effort is required, can also be the cause of an intervertebral hernia.
Types of intervertebral hernias
From the type of tissues that protrude beyond the boundaries of the distance between the vertebrae, there are:So, scientifically, Schmorl's lumbar hernia is called.
More varieties of intervertebral hernias may differ in localization and manifestations of a clinical nature. Disc herniation l5 s1 is formed between 1 sacral and 5 lumbar vertebrae. It is characterized as a rupture of the spinal disc due to pressure on the lower back or due to injuries.
This lumbar hernia is interpreted as follows: “L” - “lumbar”, means lumbar, and “S” - “sacrum”, means sacral.
The numbers are the number of the vertebra in order. Hernia l5 s1 is often determined by the doctor, because the greatest load is placed directly on the lumbar zone. These are the center of gravity, the weight of the person, and the activity of the disks.
Median vertebral disc herniation l5 s1 is as dangerous to human health as any other species. If this is the initial stage, then the treatment will pass without severe pain. But, often, the patient does not know that pathological changes begin in his back, before the diagnosis of the disease, or before the appearance of acute pain. They, when a person moves or performs physical activity, increase.
Medial hernia - what is this disease? This is a posterolateral or dorsal protrusion. It is considered a dangerous pathology, as the spinal canal, which runs along the spine, is damaged.
The disc herniation of the fifth 4th, 5th lumbar vertebra, according to statistics, is approximately 50% of the total number of recorded cases. When minor malnutrition of the intervertebral discs is damaged, the tissue structure is damaged, then with strong pressure, the disease will form more quickly.
L4 L5 disc herniation is considered the most dangerous of all types. Because of it, the pelvic organs cease to function normally, movement is limited. This leads to a paralytic state. A person can completely stop moving, or maybe partially.
Intervertebral hernia of the sacrum is a serious and severe disease. It is accompanied by strong feelings of pain, and the person cannot move completely. At the moment, this disease of the spine is widespread. People of different age categories can get sick with it.
Symptoms
Common symptoms of low back disease include:The appearance of pain is due to the fact that the nerve endings of the spine are affected. They are called "nerve roots". The sensation of pain appears when the damaged disc has pinched the nerve ending.
But it threatens health not only with pain. Not all people know that only at first, when squeezed, there is a feeling of pain. After a while, atrophy and death of the clamped root occurs.
As a result, irreversible processes occur:
Signs of a vertebral nature may appear due to damage to the spinal column in certain places. And also due to the fact that the nerve endings of the spinal cord are compressed.
These manifestations, without difficulty, can be diagnosed by probing or during a physical examination. When pressure occurs, the person becomes hurt. As a result internal organs stop working properly. It is possible that paralysis may begin.
In men, the disease of the lumbar spine is manifested in the difficulties associated with potency.
A hernia of the lumbar spine in women gives a signal of its existence in the form of gynecological problems and reproductive disorders.
But, they note that the symptoms and treatment of this disease in men and women practically do not differ.
Symptoms of an illness of the lumbar spine should be observed systemically. This means that the treatment should be comprehensive.
Video
Video - treatment according to Bubnovsky for spinal hernia
Diagnostics
It is very difficult to detect the formation of a l4 l5 lumbar hernia in the initial stage of the disease. This is because her clinical manifestations similar to uncomplicated osteochondrosis.
In the case of spinal disease in the lower back, radiography of the musculoskeletal system will be of secondary importance. This is due to the fact that it does not make it possible to diagnose soft tissue formations.
The diagnosis is established mainly by the results of MRI of the spine. Another one of the very effective methods consider CT.
Treatment Methods
How to treat a hernia of the lumbar spine? Treatment of intervertebral hernia of the lumbosacral spine depends on what stage of the disease.
If this is the initial stage, then the doctor will recommend conservative treatment, which will include:
Medications for this disease should:
To get rid of pain during treatment, non-steroidal drugs are used, which have already been discussed. Corticosteroids are also used. Muscle relaxants are used to relieve spasms. Use injections intravenously and intramuscularly, tablets, ointments, gels. If the case is severe, an intravertebral blockade is performed.
The described methods of treatment of intervertebral hernia of the lumbar without surgery does not end. The use of massage, therapeutic nutrition, physiotherapy and exercise therapy is also effective.
Is it possible to cure a hernia of the lumbar spine without surgery? Doctors answer: "Yes!" The main thing is to consult a doctor in a timely manner.
Treatment of disc herniation l5 s1 effectively takes place with the use of physiotherapeutic methods. Diadynamic currents, electrophoresis and magnetotherapy are able to relieve pain together with an increase in nerve conduction and relaxation of the paravertebral muscles. Comprehensive treatment of the disease includes special simulators and hirudotherapy sessions.
Physiotherapy
Thanks to the course of therapeutic gymnastics effective treatment a disease such as a hernia of the lumbosacral intervertebral disc l5 s1 lends itself. Under the influence of physical activity aimed at the work of the muscles of the press and the spine, the muscle tissue becomes stronger over time and experiences less stress.
The lumbar region takes on the maximum amount of load falling on the back area. This is where the pain occurs. Using a series of exercises, the complex of which is designed specifically for the treatment of this ailment of the lumbosacral region, you can maintain a painless condition of the lumbar region. This does not require special simulators and visits. medical institution. The patient independently plans the time for classes.
Manual therapy
In the treatment of lumbar intervertebral hernia, specialists often prescribe relaxing methods that create a relaxation effect, as well as the use of force methods in which the vertebrae return to their physiological places due to manual reduction.
As a result of the application of such methods of treatment, the sequence of strength and relaxation methods alternates or is performed in a certain sequence.
Acupuncture
When an intervertebral hernia of the lumbosacral spine appears, complex treatment is applied, including sessions of acupuncture and physiotherapy exercises in combination with massage.
This medical complex sometimes helps to treat a hernia of the lumbar spine without surgical intervention, but mostly it fails to become an alternative solution for medical and surgical treatment, and in combination with them only complements the complex treatment of the disease.
Surgical intervention
How to cure a hernia of the lumbar spine through surgery? The surgical way of solving the problem is always a last resort. Experts try to resort to such a solution as a last resort. This option is inevitable only when the pain syndrome cannot be stopped for a long period and the performance of other organs is disrupted.
How to get rid of a hernia in the lumbar region by resorting to surgery? Classic variant surgical operation is a cavity incision, which requires a sufficiently long postoperative recovery period in the future. Currently, endoscopic methods are widely used, which make it easier for the patient to undergo surgery and recover sooner. How to treat an intervertebral hernia of the lumbar, resorting to one or another method of the operation, the attending physician decides.
Folk methods of treatment
Treatment of intervertebral hernia of the lumbar spine can only be prescribed by a specialist. It must be understood that this disease cannot be completely cured by folk remedies. With this disease, only partial removal of the inflammatory process and pain syndrome is possible. Treatment with folk remedies increases efficiency when combined with pharmacological treatment.
Among the folk methods, the following methods of treating an intervertebral hernia of the lumbar at home are distinguished:
To find out how to treat a hernia of the lumbar spine at home, you can get advice from an orthopedist. Such therapy at home should always be combined with drug treatment.
Dosages of taking any folk or medication should be prescribed by your doctor.
Complications
An intervertebral hernia of the lumbar can provoke some complications:
A disease that occurs in the lower back can disrupt the functioning of the internal systems of the body. Sexual organs may be at risk bladder and intestines.
