Between the vertebrae are pads called intervertebral discs. Each disc has a soft, gel-like center surrounded by a hard, fibrous outer layer called the core.
Lumbar hernia occurs as a result of slipping or tearing of the discs that act as shock absorbers between the spine (as a result of forcing, falling, heavy lifting or forcing).
Slipped - herniated disc, also called ruptured disc, creates a pressure on the nerves coming out of the spinal cord by forcing the weakened or torn disc; this can cause severe pain. Although nerve compression is in the lumbar region, pain can also be seen in the waist, hip or leg areas, which are the target organs of these nerves.
What is Lumbal Disc Herniation?
The waist part of the spine consists of five vertebrae and discs. This area is known as the place that carries the body weight the most.
The vertebrae, on the other hand, protect the spinal cord from being damaged. Lumbar hernia occurs when the cartilage between the vertebrae is displaced and ruptured as a result of severe strain (heavy lifting, staying in the same position for a long time, exposure to strain, falling, overweight and too much birth) and compresses the nerves coming out of the spinal cord.
What Causes Lumbar Hernia?
Herniation occurs when the ring on the outer part of the disc weakens or tears. Various factors can cause disc weakening, including the following. These;
- Aging and degeneration
- Excess weight
- A sudden stress from heavy lifting
What are the Symptoms of Lumbar Hernia?
Lumbar hernia usually manifests itself with pain spreading to the hips, legs and feet, but the following symptoms may also be due to herniated disc;
- Tingling or numbness in the legs or feet
- Muscle weakness
- Strain when moving
- Leg pains
- Quick fatigue
- Loss of balance
- Difficulty sitting and walking
Diagnosis Methods of Lumbar Hernia
Before the diagnosis of herniated disc is made, a history is taken by the doctor and a physical examination is performed. He or she may perform a neurological exam to test the patient's muscle reflexes and muscle strength.
After physical examination, spinal cord or nerve compression caused by hernia is detected with high-resolution diagnostic devices such as x-ray, MRI, CT or CT scan. In addition, the EMG (electromyogram) device determines which nerve root or roots of the patient are affected by the hernia.
Lumbar Hernia Treatment Methods
What are Non-Surgical Treatment Methods in Lumbar Hernia?
For a patient diagnosed with a herniated disc, the doctor may recommend treatment methods such as short rest, anti-inflammatory drugs to reduce irritation causing pain, pain relievers for pain control, physical therapy, exercise, or epidural steroid injections.
If rest is recommended, you should ask your doctor how long you should have bed rest. Because bed rest that takes longer than necessary can cause joint stiffness and muscle weakness, and it will make it difficult for you to do movements that can reduce your pain.
Therefore, it is not recommended to rest longer than 2 days for low back pain and 1 week for lumbar hernia. In addition, lying on a hard bed or on the floor has no proven effectiveness in the treatment of hernia and pain. On the other hand, you should ask your doctor if you can continue to work during the lumbar hernia treatment.
If your lumbar hernia disease has not reached an advanced level and your continuing work is delayed, you should get information about how to do your daily activities without overloading your waist with the help of a nurse or physiotherapist.
The aim of non-surgical lumbar hernia treatment is to reduce nerve irritation caused by herniated disc and to increase the general functionality of the spine by protecting the general condition of the patient.
Among the first treatments that can be recommended by the doctor for herniated disc are; There are treatments such as ultrasonic heating therapy, electrical stimulation, heat application, cold application and manual massage. These applications can reduce lumbar hernia pain, inflammation, and muscle spasm and make it easier to start an exercise program.
Pulling and Stretching Method in Lumbar Hernia Treatment
The method of traction (pulling, stretching) in lumbar hernia may provide some pain relief in some patients; However, this treatment must be applied by a physical therapist or physiotherapist. Otherwise, this application may cause irreversible damages.
Is Corset Treatment Effective for Lumbar Hernia?
In some cases, your doctor may recommend that you use a lumbar hernia corset (a soft and flexible back support) to reduce your pain at the beginning of hernia treatment. However, herniated disc corsets do not allow the herniated disc to heal.
Although manual treatments provide short-term relief in low back pain of uncertain cause, such applications should be avoided in most disc hernias.
A physical therapy or exercise program usually begins with gentle stretching and posture change movements aimed at reducing back pain and leg complaints. When your pain decreases, intense exercises can be started to increase flexibility, strength, stamina and to return to a normal lifestyle.
Exercises should be started as soon as possible and as your lumbar hernia treatment progresses, the exercise program should be planned accordingly. Learning and applying an exercise and stretching program that can be applied at home is also an important part of the treatment.
Drug Treatment Method in Lumbar Hernia
Medications that help control pain are called pain relievers (analgesics). In most cases, back and leg pain responds to commonly used (over the counter) pain relievers such as aspirin or acetaminophen.
In patients whose pain cannot be controlled with these drugs, some analgesic-anti-inflammatory drugs called non-steroidal anti-inflammatory drugs (NSAIDs) can be added to control irritation and inflammation, which is the main source of pain caused by herniated disc.
If you have severe and persistent pain, your doctor may also prescribe narcotic analgesics for a short time. In some cases, muscle relaxants can be added to the treatment. Taking high doses of muscle relaxants will not speed up your recovery, as these drugs can cause side effects such as nausea, constipation, dizziness, instability and addiction.
All medicines should only be taken as described and in the amount. Tell your doctor about any medications you use (including those bought without a prescription) and if you have tried any of the recommended pain relievers before, tell them if they worked for you.
You should be followed up by your doctor for problems (stomach upset or bleeding) that may arise from long-term use of prescription or over-the-counter pain relievers and NSAIDs.
There are other drugs available that have anti-inflammatory effects. Cortisone medications (corticosteroids) are sometimes prescribed for very severe back and leg pain because of their strong anti-inflammatory effects. Corticosteroids, like NSAIDs, can have side effects. You should discuss the benefits and risks of these medications with your doctor.
Epidural injections or "blocks" can be used to relieve severe leg pain. These are corticosteroid injections into the epidural space (the space around the spinal nerves) by the doctor.
The first injection can be supplemented with one or two injections at a later date. These are usually done within a participatory rehabilitation and treatment program. Injections made to the points that trigger pain are local anesthetic injections made directly into soft tissues and muscles.
In some cases, although they are beneficial for pain control, injections at the trigger points do not provide the recovery of the herniated disc.
Lumbar Hernia Surgery
Lumbar hernia surgery The purpose of lumbar hernia surgery is to prevent the irritation of the herniated disc by pressing the nerves and thus causing complaints such as pain and loss of strength. The most common method in lumbar hernia surgery is called discectomy or partial discectomy. This method is to remove some of the herniated disc.
In order for the disc to be fully visible, a small part of the bone formation called the lamina behind the disc may need to be removed. (figure-2) If the bone removal is kept as low as possible, it is called hemilaminotomy, if it is done more commonly, it is called hemilominectomy.
Then, herniated disc tissue is removed with the help of special holders. (Figure-3) After the part of the disc compressing the nerve is removed, the irritation in the nerve disappears in a short time and full recovery can be achieved. (Figure-4) Today, this procedure can be commonly performed with small surgical incisions using an endoscope or microscope.
Diskectomy can be done under local, spinal or general anesthesia. The patient is placed face down on the operating table and the patient is given a position similar to a squatting position. A small incision is made in the skin over the herniated disc. Then the muscles on the spine are separated from the bone and pulled aside. A small amount of bone can be removed so that the surgeon can see the trapped nerve.
Herniated disc and other ruptured parts are removed without any pressure on the nerve. Any bony protrusions (osteophytes) that may be present are also removed to ensure that the nerve will not be subjected to any pressure. In this procedure, a very small amount of bleeding is usually encountered.
When Is Emergency Surgical Intervention Required In Lumbar Hernia?
Very rarely, a large herniated disc may cause a loss of bladder and bowel control by putting pressure on the nerves that control the bladder and bowels. This is usually accompanied by numbness and tingling in the groin and genital area. This is one of the rare situations that requires emergency disc herniation surgery, and if you encounter such a situation, call your doctor immediately.