The spinal column (spine) consists of 24 vertebrae and contains the central nervous system structure called the spinal cord. The muscles around the spine support the back and waist and enable it to perform the function of movement. Nerves that spread throughout the body from the spinal cord are responsible for communication between the other parts of the body and the brain.
The spine is examined in 4 separate sections. The neck is called the cervical, the body is thoracic, the lumbar region is the lumbar, and the coccyx is called the sacral spine. Vertebrae in the lumbar region are 5 from top to bottom and their nomenclature starts from L1 and ends at L5. Intervertebral discs, located between the vertebrae bones that make up the spine, fill between these bones.
Intervertebral discs consist of cartilage structures between the nucleus pulposus, annulus fibrosus and bone. The nucleus pulposus is a gel-like material and approximately 80% of its content consists of water. The rest of this structure is composed of type 2 collagen and proteoglycans. Annulus fibrosus is a ring-shaped structure that surrounds the nucleus pulposus. Damage to this structure, which consists of connective tissue elements brought together in a highly organized manner, may result in herniation of the nucleus pulposus material.
Ingredients
What is a herniated disc?
What are the symptoms of lumbar hernia?
What are the risk factors for herniated disc?
How is a hernia diagnosed?
How is lumbar hernia treated?
Is lumbar hernia surgery risky?
Does herniated disc recur?
What should be considered in order to be protected from herniated disc?
What is a herniated disc?
Lumbar hernia can be expressed as the rupture of the disc between the vertebrae in the lumbar region and compression of the nerves. This condition often causes severe back pain and pain that radiates to the leg. Herniation can occur at any level of the spine.
The basic pathology underlying the herniation of the disc is the rupture of the ring-shaped ligament structure in the posterior part and the movement of the structure inside the canal through this opening. This is a condition that occurs with aging. Some sudden movements and strains can also cause herniated disc. Especially heavy lifting can put a lot of pressure on the lumbar vertebrae and care should be taken as a result of this situation, herniation may occur.
What are the symptoms of lumbar hernia?
Among the symptoms of herniated disc, there are mainly complaints of low back, leg pain, numbness in the feet, difficulty in walking, and patients usually apply to a specialist with these symptoms. Symptoms may vary depending on the mechanism of the disease. Often, the connective tissue behind the spine and in front of the cartilage structure is torn as a result of a forceful movement at the waist. In the first stage, the patient only feels low back pain. After a while, the cartilage tissue from the torn ligament overflows into the canal where the nerves are located, and the pain may spread to the legs as a result of compression of the nerves.
This is the reason for the question "Why doesn't herniated disc cause pain in the back?" that our patients wonder. It makes you feel the pain at the pinched nerve end point, that is, where it goes. Likewise, it causes numbness and burning complaints in the legs and feet. In advanced stages, weakness may occur in the feet. In more advanced cases, the patient may also encounter urinary and stool incontinence and loss of sexual functions, following the development of a problem called cauda equina syndrome.
Cauda equina means horse tail in Latin and refers to the part of the spinal cord that descends from the hip level. In rare cases, if the herniated disc puts pressure on the entire spinal canal, the nerve fibers forming the cauda equina may also be affected. In this case, it may be necessary to prevent conditions such as paralysis or weakness that may occur in the future with emergency surgical intervention.
All of these may occur gradually, or they may reach the final stage in a few hours.
Severe low back pain may also occur as a result of the rupture of the disc. Other conditions that can cause this low back pain include strain on connective tissue elements such as muscles, tendons, and ligaments in this area. In distinguishing between muscle problems and pain in herniated disc, other nerve-related symptoms such as pain spreading to the leg or loss of strength are taken into account.
The symptoms that may occur after the development of hernia in the spine can be summarized as follows:
Pain and numbness, usually felt in one area of the body
Pain radiating to the legs
Worsening of pain at night
Pain worsening with movement
Pain even with short walks
Unexplained muscle weakness
Sensation problems such as itching, tingling and burning on the affected area
These symptoms may vary according to the various characteristics of the patients. If you have these symptoms, it is recommended that you apply to health institutions and seek help from specialist physicians.
How is lumbar hernia treated?
Emergency surgical treatment is applied in cases where severe loss of strength in the legs, urinary and stool incontinence and loss of sexual functions are encountered.
Surgery can be performed in patients who do not respond to even strong painkillers. Re-evaluation for surgical treatment may be required in those who do not respond to medication, rest, and physical therapy for three weeks.
According to the preferences of the patients who apply to health institutions with the symptoms of herniated disc and the characteristics of their diseases, drug therapy or surgical treatment may be preferred in the treatment planning. In drug therapy, it is aimed to control the pain of the patients. For this purpose, in the treatment that is started with non-steroidal anti-inflammatory drugs first, stronger painkillers such as opioids can be used when necessary.
Physicians may resort to surgical intervention in the treatment of lumbar hernia, if mechanical problems are detected that do not benefit from drug therapy or the underlying cause of the lumbar hernia needs to be corrected with an operation related to the spine.
Before surgical treatment, x-ray, CT, MRI and EMG studies can be repeated by orthopedic or neurosurgery specialists. Thanks to these examinations, physicians can perform the most appropriate surgical planning for the patient. The patient's age, the region of the hernia and the general health of the patient are among the other factors that affect the planning of the surgery.
There are various surgical interventions applied within the scope of the treatment of lumbar hernia:
laminectomy
In this operation, operators aim to remove the pressure on the nerves coming out of the region where the vertebrae arc (lamina). Physicians can also apply to the use of a microscope in this surgery, which can be performed through a small incision. When necessary, the removal of the lamina is called laminectomy.
Artificial Disc Surgery
Artificial disc surgery is performed while the patient is under general anesthesia. This procedure is generally preferred when there is a single vertebral problem in the lumbar region. If the patient has diseases such as arthritis (joint inflammation) or osteoporosis (bone loss), this type of surgery may not be preferred because there is a high probability that more than one disc may be affected.
This operation is started from an incision in the abdomen and the problematic disc of the patient is removed and an artificial disc with plastic or metal content is placed in its place. It may be necessary to keep people under observation in the hospital for a few days after the operation.
Spinal fusion applications
In spinal fusion applications, another hernia surgery performed under general anesthesia, 2 or more vertebrae are permanently fixed to each other. In this fixation process, bone grafts taken from another part of the patient are used. In this technique, support can be taken from plate and screw applications to support the fusion area. After spinal fusion surgery, that spine area of the patient is completely fixed. After the operation, patients should stay in the hospital for observation for a few days.
Is lumbar hernia surgery risky?
All surgeries are interventions that have some risks in themselves. Complications such as infection, bleeding and nerve damage are among the problems that may be encountered after herniated disc surgery.
Today, thanks to the developing microsurgical techniques, herniated disc surgeries are frequently performed. Herniated disc surgeries do not carry any more risk than other surgeries. With the help of microsurgery techniques, the operating field can be seen down to the smallest detail with the help of a microscope. This provides great comfort in herniated disc surgeries.
At the same time, in the treatment of herniated disc, laser, shrinkage of the disc with heat and various applications can be made into the disc, but the number of patients who can be treated with these treatments is very low.
After the operation, some post-discharge instructions can be given to the patients by the physicians. These include responses to return to normal activities and when to start physical exercises, which may vary from patient to patient. In some cases, physical therapy and rehabilitation may be necessary after the operation.
Chronic back pain is the most common complication in patients with lumbar hernia who do not receive appropriate treatment. Apart from back pain, problems such as irreversible nerve damage and severe nerve root compression may occur in patients who are deprived of treatment.
Does herniated disc recur?
The recurrence rate of lumbar hernia is very low. The rate of recurrence from the same place after hernia surgery is around 2-3. But that doesn't necessarily mean it will recur. This rate is much lower when postoperative recommendations are
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