The lumbar spine consists of a total of 5 lumbar spines. Between each vertebra, there is a special disc-shaped connective tissue layer, which can be defined as a shock absorber that acts as an absorber against impacts, ensuring the spine's durability.
What is Lumbar Hernia?
The lumbar disc consists of two different structures, inner and outer layer. Discs, which we can think of as the shock absorbing cushions of the spine, begin to deteriorate with age and lose their water content. When the structure of the outer layer, which is a tighter structure, deteriorates, the soft gel-like layer inside protrudes outward. This herniated part separates from the spinal cord in the spinal canal and presses on the nerves going towards the legs and compresses it in the narrow area where it is located.
Pain is felt both due to this compression and chemical substances spreading from the herniated area. The disease that develops in this way is called lumbar disc herniation, that is, herniated disc. This herniation may occur after forceful and sudden movements on the waist, or it may develop gradually as the disc structure deteriorates as you get older.
Disks deteriorate and lose their water content as age progresses. The disc that loses water turns black and puts more strain on the spine and facet joints that make up the back of the spinal cord. Disc collapse causes more load on the joints connecting the two vertebrae, and therefore degeneration and thickening of the joints are observed. Herniation is usually seen towards the spinal cord and the side where the nerves exit from the spinal cord, causing pressure on the nerve root that comes out from that distance. The herniated part breaks off from where it is attached and the free disc part, which is popularly called a ruptured hernia, can move up or down. If the hernia moves away from the nerve, the pain can go away without the need for any treatment, and this ruptured hernia disappears on its own. If a hernia develops between which two of the five vertebrae, that is, at what distance the hernia occurred, the complaints of the patients develop accordingly. The area where the pain spreads in the leg varies from patient to patient. herniated disc e It is seen most frequently in the L5-S1 and L4-L5 distances.
Canal stenosis occurs when the canal narrows both anteriorly and posteriorly, creating an hourglass appearance due to deterioration, thickening, and calcification of the ligaments, joints, and bone structures that form the spinal canal over the years. In this case, in addition to low back and leg pain, complaints such as getting tired quickly, numbness in the legs when walking, the need to stop and rest come to the fore.
What are the Symptoms of Lumbar Hernia?
The most common complaint is pain starting from the waist and spreading to the feet from the back of the leg. Patients often report severe hip pain, such as a knife inserted into the hip. In some cases, there may be numbness and loss of strength in the legs, as well as pain in the lower back and legs. Loss of strength is seen in the thigh, knee and most often in the ankle depending on the distance of the hernia. Due to the contraction of the muscles on both sides of the spine, the patient started to walk leaning towards the side without pain.
Most of the patients have a history of falling or lifting heavy loads before the onset of symptoms. Nerve root discomfort or compression causes pain in the distribution area of the affected root and this pain extends to the lower half of the leg. Situations that increase intra-abdominal pressure such as coughing, sneezing and straining increase pain. Usually, leg pain is more severe than the accompanying low back pain, and even after the low back pain goes away, the leg pain continues.
If the pressure continues for a long time without treatment, the pain disappears due to damage to the nerve. Complete loss of sensation develops and neurological signs such as weakness in the leg-foot muscles, urinary incontinence or inability to pass urine, and sexual dysfunction begin to develop. In a syndrome called cauda equina syndrome that requires urgent surgical intervention, loss of movement from the ankle upwards, and urinary and stool incontinence problems occur, called drop foot, depending on the severity of the pressure of the hernia.
How Does Herniated Back Occur in Children?
Although it is generally seen as a disease of adults and advanced age, it can also be seen in children and young people, although it is rare. Back pain is common in growing up and these pains are growing pains. is defined as. Doing heavy sports, lifting heavy for bodybuilding and carrying heavy bags are the factors that can lead to the development of herniated disc in today's children and youth.
If there is leg pain along with low back pain, necessary tests should be done without wasting time and herniated disc should be ruled out. If a herniated disc is detected, the solution should not be immediate surgery. However, if the pain does not go away despite all conservative treatment methods, surgery is considered.
How to Treat Herniated Back?
The main purpose of the treatment of herniated disc is to relieve the pain so that the patient can continue his/her daily life easily. Initially, painkillers, muscle relaxants and bed rest are given in the treatment. Informing the patient is also extremely important. It is essential for the physician to explain the causes of the disease and what needs to be done to prevent the recurrence of herniated disc. In particular, excessive weight gain should be avoided, and if the patient is overweight, rapid weight loss should be recommended. Lifting heavy is definitely inconvenient.
In patients who do not benefit from rest and drug therapy, physical therapy applications strengthen the muscles around the spine, thus providing a more balanced distribution of body weight and reducing the load on the disc. In this way, tiny hernias are prevented and disorders in the disc structure are prevented. Epidural steroid injection In case of nerve compression due to herniated disc, the inflammation causing pain by reaching the epidural region is relieved by injection of steroid and local anesthetic substance. In selective nerve blocks, injection of steroids and long-acting painkillers to the exit point of the nerves leaving the spinal cord reduces nerve root edema and inflammation, and helps relieve low back or leg pain, if any.
If there is a loss of strength and feeling in the leg or foot, or if the complaints of the patients cannot be relieved by preventive treatment methods or physical therapy, the herniated disc material should be surgically evacuated. There are 2 types of surgical methods in lumbar disc surgery, endoscopic and microscopic. In the studies performed, no significant difference was found between the results of both surgical methods. Recurrence of hernia in both surgical methods There is no difference in terms of preventing Microdiscectomy, a world-renowned Turkish physician, Prof. Dr. After it was defined by Gazi Yaşargil, it has been safely applied by all neurosurgeons for about 40 years. Thus, the herniated disc is removed with minimal damage to the surrounding tissues. During the surgery, the muscles around the spine must be stripped and a small section of bone must be removed to reach the hernia. But with the microscope, these tissues are removed with minimum precision and with little damage. The operation is a short operation that can be performed both under general anesthesia and under spinal anesthesia by anesthetizing the waist down. After the operation, patients are mobilized shortly after the operation, discharged on the same day or the next day, and can return to their normal lives.
In endoscopic surgery, an instrument called an endoscope with a camera on the end is inserted through an incision of 1 cm. The advantage of this method is that it requires a smaller skin incision, and that the muscles do not need to be stripped during the operation. It is also called closed surgery among the people. There is no significant difference with microdiscectomy in terms of results.
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