Lumbar disc herniation is another name for lumbar hernia. Parallel to the advancement of technology, the decrease in people’s movement activities is one of the most important reasons for the increase in the number of patients with low back pain. Lumbar disc herniation is one of the diseases that most frequently cause loss of work force. The region called the waist consists of 5 vertebrae called the lumbar, and each of them is numbered from L1 to L5. Studies show that 80% of people complain of low back pain at any stage of their life. The most common cause of low back pain is herniated disc.
The lumbar spine carries most of the body weight. Therefore, hernia is more common in the lumbar region. In the lumbar region, this rate is in the regions between L4-5 and L5-S1 in 95% of the patients. Many patients do not consult a physician, as 90% of the patients do not have pain relief or decrease within a month without any treatment. Patients with low back pain have a 5% risk of having a herniated disc throughout their lifetime.
Risk factors for the formation of herniated disc include young-middle age, male gender, familial predisposition, environmental factors, previous trauma and smoking. With the increase in the frequency of low back pain with age, there is a decrease in the incidence of herniated disc. The reason is the loss of fluid in the structure of the disc and its hardening. Environmental factors; It can be summarized as excessive mechanical stress, sedentary life, exposure to repetitive vibrational effects.
The most common complaint in herniated disc is pain. Patients complain of low back pain that occurs suddenly or gradually after a reverse movement or trauma. This pain, which restricts the waist movements of the person, regresses spontaneously or within 2-3 weeks with bed rest and medical treatment. Rarely, there may be a history of direct low back and leg pain. Leg pain is added to non-healing back pain. Many patients describe their leg pain in the sensory distribution area of the nerve root under pressure. Pain increases with movement, coughing, sneezing, straining, and decreases with bed rest.
The second symptom accompanying pain is numbness, which is often in the legs. The numbness is where the nerve under pressure works. Loss of strength is a less common complaint. In the advanced stages of lumbar hernia, reflex loss also occurs.
Among the diagnostic methods, magnetic resonance (MR) imaging is the most preferred method. Lumbar CT may be preferred in patients who have a fear of being in a closed place and are thought to have pathology of bone structures. Direct radiography is used in cases of lumbar slippage and fractures.
Treatment methods in lumbar hernia can be divided into two parts:
1- Conservative treatment
2- Surgical treatment
In the natural course of pain due to lumbar disc herniation, patients have a great In most cases, the pain disappears within a few months. This demonstrates the need for conservative first-line treatment. Conservative treatment should be at least 6 weeks and maximum 6 months. During this treatment, short bed rest, painkillers and muscle relaxants should be applied, followed by passive movements and then gradually exercise programs.
Another method frequently used by patients with low back pain is to use a corset. However, its use is not recommended today because it causes muscle weakness.
Surgical treatment should be considered if the patient has progressive loss of strength, conservative treatment does not help, recurrent pain, recurrent neurological deficit, hernia on the floor of the narrow canal or the patient’s social life is severely affected. If the patient has a finding such as urinary or stool incontinence, drop foot (inability to pull the ankle), surgical treatment should be performed within 24 hours.
Surgical methods
– Standard lumbar discectomy
– Lumbar microdiscectomy
– Arthroscopic microdiscectomy.
Source
Turkish Neurosurgery Society Publications, Basic Neurosurgery Book
