Herniated disc disease occurs as a result of the tearing of the sheath of the structure called the disc, which is located between the spinal bones and which acts as a shock absorber, and the rubbery cartilage structure inside it overflows this tear and compresses the nerves going to the legs.
WHAT ARE THE SYMPTOMS?
Lumbar hernia patients are mainly; They apply with complaints of low back and/or leg pain, numbness in the feet, felting, difficulty in walking, loss of strength in the legs or feet.
Often, the connective tissue of the sheath surrounding the disc 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 rubbery tissue inside the disc from the ruptured area overflows into the canal where the nerves are located, and the pain spreads to the legs as a result of compression of the nerves. Our patients often wonder ‘If I have a herniated disc, there is no pain in my back, why does my leg hurt?’ This is the answer to the question. The pinched nerve feels pain along the line it extends. Likewise, leg and foot numbness causes complaints of felting, burning and tingling. In advanced stages, weakness may occur in the feet. In more advanced cases, cauda equina syndrome may be encountered, which is a very serious picture and is very rare. All of these may occur gradually, or they may reach the final stage within hours.
HOW IS THE DISEASE DIAGNOSED?
In the diagnosis of the disease; The most important criteria are the patient’s statements and neurological examination. In addition to the examination findings, direct x-ray, MRI (Magnetic Resonance Imaging), CT (Computed Tomography) are often used. Electrophysiological examination of the nerves, which we call EMG, may be required. The picture that emerges as a result of all examinations and findings helps to reveal whether the person has a herniated disc.
WHAT ARE THE RISK FACTORS FOR THE FORMATION OF HERNIA?
Among the diseases that cause loss of workforce in working life, herniated disc is seen at a rate of 25%. The loss of work force of these patients sometimes extends up to 6 months. In some occupational groups
, the rate of getting the disease is higher: Occupations that carry heavy loads and put a load on the body
, those who drive for a long time, occupations that require sitting or standing still at the desk
, being overweight….
At a certain time in their life, 85% of the society has low back pain. Whether these people are treated
or not, 85-90% of them get over this pain spontaneously
with rest. For this reason, it is useful to know that 85% of those who go to non-medical places and have an uneducated person
undergo manipulation on their waist will go away on their own with rest
! Do not forget that there is a medical solution to your back and leg
pain. Therefore, when you have these complaints
, first consult a doctor.
There is no difference in the rate of catching the disease between men and women. However, during pregnancy
, especially as a result of excessive weight gain, the pressure on the lumbar spine
increases and the risk increases. The disease is seen at a higher rate in obese and it is more difficult to treat
. Smoking has a negative effect on back health.
Herniated disc disease is less common in people who exercise regularly, especially in people with developed waist and abdominal muscles
.
Removing these risks should be with education from childhood and should start in the family. How to lift a load, how to pick something up from the ground, how to get out of bed, habit of doing regular waist exercise program, not gaining weight, the importance of walking… It is possible to significantly reduce today’s surgery and treatment costs by giving this education starting from kindergarten. It should not be forgotten that these trainings and gaining these habits are completely free, but the treatment of diseases is very costly.
TREATMENT
Treatment is conservative, except for primarily emergency surgical indications. Patients who do not respond to conservative treatment (ie, medication, rest, physical therapy, etc.) for three weeks should be re-evaluated.
The most important criterion in surgical practice is progressive loss of strength.
Surgery is also applied for severe pain that does not even respond to narcotic drugs.
Conditions requiring emergency surgery are rapid progressive loss of strength and cauda syndrome.
Radiological examinations are methods that support the diagnosis. It is completely wrong to operate the patient just because there is a hernia in MRI. For example, if we randomly select 100 people over the age of 40 passing by and have a low back MRI, at least 40% of them are reported by the radiologist as hernia or disc wear (blackening). Are we going to operate on these people now? Of course no! Do not forget that there are many people in the society who have a significant hernia or black disc in MRI and live without any high-level problems.
The goal is to treat the patient, never the MRI.
It is very, very wrong to say to a patient with a herniated disc that you will lose your sexual power, you will become paralyzed, you cannot hold your urine and your large toilet, and to operate for this!!!
