HERNIA
There are 31 vertebrae on our back that start from the neck region and extend below our hips and form the spinal canal. When five of these vertebrae herniate, problems are found in the lumbar region. Between these vertebral bones, there is a special connective tissue in the form of a disc, which facilitates movement, ensures the durability of the spine, and acts as a protector against impacts.
This disc consists of two parts, an inner and an outer layer. When the structure of the outer layer deteriorates, the soft layer inside protrudes outward. This protruding (herniated) part presses on the nerves in the spinal canal and compresses these nerves. Sometimes, chemicals are secreted from this herniated area and pain is felt. The disease that occurs in this way is called herniated disc.
WHO HAS A HERNIA? WHO ARE AT RISK?
More than 80 percent of the population suffers from low back pain at least once in their lifetime. For this reason, the number of applicants to the doctor is quite high. It is most common in middle age, but can occur at any age. People who work sitting down and do this on the wrong chair are more likely to have a herniated disc. Those who have to lift heavy loads, those who act carelessly while doing sports, those who start the exercise without warming up, and those with posture and sitting disorders are at risk.
Smoking and alcohol use, which are considered risk factors for almost every disease, can also trigger herniated disc. Those who have a stressful and restless life are also likely to suffer from a herniated disc. The more you are exposed to these risks, the more likely you are to have a herniated disc.
In addition to these factors, hereditary (family) factors should not be forgotten. Those with a hernia in the family are at risk.
CAUSES OF WAIST HERIED
Unconscious and irregular movements and lifting heavy loads play an important role in the formation of lumbar hernia. Even when a very light load is lifted, a herniated disc can occur. For example; When we bend and lift something, this load is not evenly distributed to every part of our back. Irregularly distributed load also causes herniated disc.
Another reason is the deterioration of the feeding of these discs. As we age, the vessels feeding these discs and the amount of water in the disc decrease. The disc, whose amount of water decreases and cannot get enough nutrients, becomes smaller. Therefore, the distance between the two vertebrae is reduced. Along with these negativities, there is also deterioration caused by physical movements in the disc, whose nutrition is reduced and therefore the amount of oxygen decreases. The number of cells in the disc also decreases.
Due to these effects, after a wrong move by the person, the inner part protrudes out and a herniated disc occurs.
HOW DOES HERNIA INDICATE ITSELF?
The biggest symptom of herniated disc is pain in the lower back and legs. When the patient goes to the doctor, he says that my back hurts my leg. But there may also be only back pain or only leg pain. Numbness and loss of strength may occur in the leg. In addition, difficulty in performing the movements that he has done before, restriction of his mobility and limping while walking can be seen.
In more advanced and severe forms of lumbar hernia, sexual disorders, difficulty in urinating and defecation or incontinence can be seen. Paralysis of the legs may occur or the feeling of the leg may decrease.
HOW DIAGNOSED?
Not every low back pain is a herniated disc. Many problems such as cancer, rheumatism, slipped back, hurting the waist while doing sports give symptoms such as herniated disc. Therefore, it is necessary to be careful when making a diagnosis. MRI has an important place in the diagnosis of herniated disc. With this method, it can be easily determined where and in which tissue the problem is. In addition, computed tomography may be preferred because it reveals the condition of the bone better. These images should be supported by the results of the examinations and clinical tests. Because making mistakes while interpreting the image also affects the treatment.
WAIST HERNIA TREATMENT
a) Initial Stage: The treatment of lumbar hernia depends on the degree of herniation, that is, the pressure exerted by the elastic substance we call the disc on the nerves going to the leg. If there is only low back and leg pain, if there is no numbness, loss of strength or limitation of movement, it means that herniated disc is in the initial stage. In this case, it is recommended to give the patient muscle relaxants, to rest in bed and to avoid movements that will force the back.
b) If Hernia Progresses: If the patient’s complaints persist despite the above recommendations, rest and muscle relaxants, physical therapy can be applied. Physical therapy must be under the supervision of a specialist. There may be an increase in pain for the first few days during physical therapy, but the patient should continue the treatment as long as the physical therapist recommends. If the patient’s pain does not go away despite all the treatments, the nucleoplasty method can be applied. Nucleoplasty is based on the principle of entering the herniated disc with a needle under X-ray, heating the disc with radiofrequency waves, destroying the nerves in the disc, and the collapse of the hernia by opening spaces in the disc. Nucleoplasty is performed as a single session, under local anesthesia, under operating room conditions without the patient sleeping, and is a method applied without the need for hospitalization. There is no risk, but there is no guarantee that it will completely destroy the hernia and the success rate is not very high. Laser discectomy is a similar method to nucleoplasty.
c) Conditions Requiring Surgery: If the patient’s pain persists despite physical therapy, or if there is a loss of strength that cannot be regressed, thinning of the leg, urinary incontinence, excruciating pain, or if a part of the disc is found to have ruptured in MR films, the solution is surgical intervention. mechanical pressure on the nerves coming from the spinal cord must be removed surgically. If surgical intervention is not performed and pressure on the nerve continues, the patient may develop problems such as urinary incontinence, loss of sexual power, and weakness in the feet. Unfortunately, there are beliefs among the public that if I have an operation, I will be disabled, I will not be able to get out of bed for a long time, I will have to wear a corset, or my hernia will recur, I will have surgery again. But thanks to microsurgery, such fears are no longer necessary.
SURGERY METHODS IN WAIST hernia
The purpose of lumbar hernia surgery is to clean the herniated disc and to relieve the pressure on the nerve.
Open discectomy: It is usually performed under general anesthesia. It is performed with the patient in the prone position. The application is made through an incision of approximately 3-5 cm in the skin above the hernia area. The muscle tissue is stripped from the bones on the affected disc, and the muscle and skin are removed from the surgical area with a surgical instrument called a retractor, so that the surgeon can see the spine and disc. In order to have a better perspective, bone and ligaments can be removed, thus providing access to the distorted disc without damaging the nerve root. The surgeon removes the disc and other surrounding structures, disc parts protruding from the disc wall. It is not a preferred method nowadays.
Microdiscectomy: This procedure is often performed under epidural anesthesia, which is a form of regional anesthesia below the waist, or under general anesthesia with an operating microscope under 20 to 40 magnification of the surgical field. A smaller incision is made (about 1-1.5 cm), the muscle tissue is less stripped and better vision is provided. This causes the post-operative period of the patient to be more comfortable and painless. Performing surgery by excluding less muscle tissue ensures less post-operative muscle spasm and pain. The microscope used in surgery, on the other hand, provides a larger, 3-dimensional and very detailed recognition of the tissues, reducing the possibility of complications. Veins, nerves and disc are seen much more clearly. The possibility of damaging tissues such as vessels and nerves is very low. It is safer to clean the disc with pressure effect under the microscope. The incision site is then closed with internal sutures and a small dressing is applied on it. Microdiscectomy is the safest and It is considered an effective method.
Full endoscopic lumbar hernia surgery: It is performed in the lumbar region by entering from the midline or from the side. In endoscopic intervention, a smaller skin incision is used than other methods. Endoscopic herniated disc surgery is performed by viewing the surgical site on the screen with the help of a 4 mm endoscope inserted through a 1 cm incision into the herniated disc area. The operations can be performed under local and epidural anesthesia. However, it is not possible to operate every hernia with this method.
WHAT SHOULD WE CONSIDER TO PROTECT FROM HERNIA?
We appreciate our health only after we lose it. However, the important thing is to take the necessary precautions before catching the disease and to minimize the risk of catching a herniated disc. For this, it is necessary to take care not to lift heavy loads at any time. We should avoid movements that contradict the structure of the body. Instead of bending down using the waist, it is necessary to squat, that is, bend our knees and bend. When buying something from a place, it is necessary to get as close to the object as possible. It is wrong to try this by lying down.
We need to avoid a sedentary lifestyle. Exercises that strengthen the waist muscles (done while healthy) are very beneficial. However, doing these does not mean that we will not have a herniated disc. Genetic factors and personal conditions also play a role in the formation of this disease.
Recommendations to the patient are as follows:
· The patient should never lift weights exceeding one or two kilograms.
· Leaning forward and sideways, bending the waist is prohibited. If something is to be taken from the ground, the patient is told to take it by crouching.
· It is recommended that patients put a pillow behind their waist to eliminate the lumbar cavity while sitting and not sit for more than twenty minutes. If the patient has to sit for a long time due to his profession, it is recommended to walk every twenty minutes.
· The patient is prohibited from reaching upwards. If he is going to buy something from above, he is told to get up on a chair or ladder.
· The patient is reminded to always keep his back warm and not to stand in front of an open window or ventilation.
· Patients with low back and leg pain should definitely avoid stress. In addition to increasing the pain, stress can also lead to the progression of herniated disc.
· It is recommended that the patient take bed rest during his stay at home. Contrary to popular belief, very hard floors are more harmful. It is more suitable for the patient to lie in a quality spring mattress and in the position that is most comfortable for the patient.
