What is lumbar hernia? What kind of findings does lumbar hernia occur? How is the diagnosis of lumbar hernia made? What should those with lumbar hernia pay attention to? We learned the answers to all questions from Physiotherapy and Rehabilitation Specialist Associate Professor Ahmet INANIR.
What is a herniated disc, and with what findings does it occur?
Lumbar hernia is the condition in which the jelly-like soft part in the middle of the vertebrae, which acts as a medical suspension, protrudes beyond the hard outer capsule and causes pain, numbness, tingling or loss of strength by applying pressure or pressure to the borders. The pain increases with coughing, straining and laughing. Standing, sitting, and leaning forward increase the pain. Herniation occurs when there is weakening or tearing of the outer ring of the disc due to factors such as sudden tension, aging and degeneration caused by lifting a lot of weight, heavy loads. In particular, sudden-onset hernias are caused by heavy lifting, trauma, or sudden movement. In some patients, on the other hand, attacks of painful lumbar stiffness, which disappear spontaneously in a short time, are seen in the middle. Patients do not care about this because they recover many times, but in the end, severe low back pain and pain may begin in these patients, and even significant hernias may develop. These complaints become life-threatening to the patients. In middle border hernia, the patient usually feels the pain in the waist. On the other hand, in hernias that go to the side, the pain usually manifests itself by spreading to one leg. Along with pain, numbness in the leg, loss of strength, loss of reflexes and stability may occur. The patient may also have difficulty sitting and walking. lumbar disc herniation may not cause any symptoms.
It is necessary to explain the word ruptured hernia here. In a second degree hernia (protrusion), it is the true herniation of the disc back through a partial defect in the annulus fibrosus. 3rd degree (Extruded disc) It is true herniation of the disc back through a complete defect in the annulus fibrosus. If the solid is passing, the term bursting into this situation is used incorrectly.
How is the diagnosis made?
Diagnosis of hernia, especially its treatment, requires the skill of a specialist in hernia. After excluding other causes of lower back or leg pain, the diagnosis of hernia is definitely made by a specialist examination who has a good knowledge of the hernia, and with high-resolution diagnostic devices such as X-ray, MRI, CT or CT scan to help the diagnosis, the spinal cord or border relevance caused by the hernia is detected. is done. In addition, with the EMG device, it can be determined which border root or roots of the patient are affected by the hernia.
We would like to point out that it is extremely wrong to diagnose hernia with MRI alone. Although studies say that hernia is 4-5% of the causes of low back pain, pain in the waist region cannot be localized well by both the doctor and the patient, since it can originate from all anatomical structures. It should be evaluated in detail by a very experienced Physiotherapy and Rehabilitation specialist. Clinical studies show that the source of low back pain is related to intervertebral disc pathologies up to 39%. Considering the subsets of intervertebral disc pathologies, lumbar disc herniation and degenerative disc disease are the leading ones. In individuals with no complaints, 22-40% of the hernia is seen as a photograph in Magnetic Resonance Imaging and does not give any symptoms. For this reason, when a hernia is seen in the MRI of a patient with low back pain, it is an important defect to connect it directly to the hernia.
Which non-surgical treatments are applied in lumbar hernia? When is Surgery Necessary in Lumbar Hernia?
Rest can help relieve hernia or other low back pain by reducing intra-disc pressure and loading on the soft tissues around the vertebrae. The mattress should be neither hard nor soft enough to collapse. The patient can lie on his back, right or left side position. You should rest as much as your doctor recommends. The most valuable thing is to find a qualified doctor who can distinguish the factors that cause hernia and low back pain, and to continue our lives under his supervision. I’ve had a way to be applied and treated, now the opinion that everything will go well is wrong. It is very important to apply multiple procedures. Neither manual therapy, nor Prolotherapy, nor Neural Therapy, nor dry needling, nor stem cell applications are assay productive on their own. It is not possible to produce a definitive test for lumbar hernia by means such as cortisone, laser, ozone, hydrotherapy and radiofrequency.
Leech, cupping (can be used as an auxiliary) and creams applied from the surface do not have an analytic effect.
Surgery, however, is required in 1-2% of the cases and is considered in cases of stool and urinary incontinence, deterioration in sexual functions, and progressive loss of strength despite all kinds of (never the only system) medical treatment and precautions.
Since surgeries and procedures such as intra-disc nucleoplasty or annuloplasty damage the disc, they may invite new problems in the coming months and years, limit flexibility to a certain extent and make the patient mildly or significantly disabled. Whether the surgery is endoscopic or microsurgery is attractive, but it does not prevent damage to the disc as it causes volume reduction like open surgery.
What Should Those With Back Hernia Pay Attention To
Sudden movements should be avoided
Heavy lifting should not be done, attention should be paid to the weight of the lifted objects
Light sports should be done, avoid forcing the waist
In the same position for a long time
Care should be taken to bend the waist straight by bending the knees
No movements that will force or damage the spine
Should not gain weight, those who are overweight should definitely return to normal
A light backpack should be preferred instead of a handbag.
Do not stand too much
Prefer to lie on your back or side
Sit upright and support your waist
