WHAT IS A HERNIA?
The spine is made up of a series of interconnected bone structures called vertebrae. The structure called disk; It is a solid connective tissue that connects the vertebrae and acts as an intervertebral cushion. The discs consist of a solid outer layer called the annulus fibrosus and a gel-like nucleus pulposus in the middle. We can compare the function of this structure to shock absorbers in cars. As the person ages, this gel structure in the middle loses its water content and deteriorates, and it starts to fulfill its pillow function less. This causes the disc center to be displaced through a crack in the outer layer, creating a condition called disc herniation (lumbar hernia). Most of the hernias occur in the lumbar region of the lumbar vertebrae and in the distance of the last 3 discs just below the waist.
A herniated disc can cause low back pain as well as pressure on the nerves exiting the spine and cause pain, numbness and weakness in the legs, called sciatica. There are many other causes of low back and leg pain (such as muscle-bone-nerve tissue disorders, some infections, congenital structural disorders, etc.) besides herniated disc. Therefore, the differential diagnosis should be made carefully.
WHAT ARE THE TREATMENT METHODS?
Approximately 80-90% of patients with a herniated disc can recover without surgical intervention. Your doctor will usually start treatment with non-surgical methods. If you are still unable to perform your daily life activities due to your pain, if you have problems such as severe loss of strength or urinary incontinence, your doctor may recommend surgical treatment for you. Although surgical treatment may not fully restore the strength of your leg in some delayed cases, it prevents further weakness and helps to pass your leg pain. Surgery is usually recommended to relieve you of leg pain and has a success rate of over 90%, but post-operative advice should be followed by taking cicciye.
Sometimes, the hernia may compress the nerve root leading to the leg and cause significant loss of strength in the leg and even complete weakness of the foot, and therefore emergency surgery may be required. If this happens, you should contact your doctor immediately. Very rarely, a large hernia can cause the loss of this control by pressing on the nerves that control the bladder and bowel. The patient begins to involuntarily leak urine. This condition is often accompanied by numbness in the groin or genital area. This is one of the few conditions that requires emergency surgery due to a herniated disc. If this happens, you should contact your doctor immediately.
NON-SURGERY METHODS OF TREATMENT IN WARM Hernia
Your doctor will advise you as non-surgical treatments such as short-term rest, anti-inflammatory therapy to reduce edema, pain relievers to control pain, physical therapy, exercises, or epidural injections of medication. may recommend treatment. If rest is recommended for you, take care to rest for the recommended time. Bed rest for too long can cause stiffness in the joints and weakness in your muscles, preventing you from doing movements that will reduce pain. During your treatment, ask your doctor when you can start working again. After your doctor starts treatment, he or she can give you training on how to do your daily living activities without straining your back. The purpose of non-surgical treatment; to reduce nerve and disc injury, improve physical condition to protect the spine, and increase overall body functionality. This can only be achieved with a regular treatment program in which more than one treatment method is applied together in most patients with lumbar hernia.
In order to prepare you for an exercise program, your doctor may sometimes recommend ultrasound, electrical stimulation, hot and cold applications and superficial methods to reduce your pain and resolve muscle spasm.
Traction (stretching) may also provide limited pain control in some patients. Sometimes, your doctor may recommend not using steel rods or flexible waist corsets to reduce your pain, although they won’t actually heal your hernia. Although manipulation (low back pull) can provide a short-term improvement in non-specific low back pain, provided that it is done seriously and scientifically, it is not recommended in cases of herniated disc.
In order to reduce your back or leg pain, first of all, mild stretching exercises and posture changes should be recommended. After your pain subsides, more effective exercises can be done that will improve your flexibility, strength and endurance and help you return to your normal daily life. After starting the exercises, the type of exercise should be shaped according to the recovery status. Learning and maintaining home exercises and stretching programs are important parts of treatment.
MEDICINE THERAPY AND PAIN CONTROL
Medicines used to control pain are called analgesic drugs (painkillers). Although not very often, muscle relaxants may be recommended sometimes. If you have severe pain, your doctor may recommend using narcotic pain relievers for a short time. Use these drugs only when you need them. Otherwise, using it for a long time and in high doses will not cause you to recover faster, and it may cause unwanted side effects such as constipation and sleepiness, and you may become dependent on these drugs. All medications should be used only as recommended. Inform your doctor exactly about the drugs you are using and indicate whether you have benefited from the treatment given.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are also pain relievers and are also used to reduce edema and inflammation that occur as a result of lumbar hernia. If your doctor has prescribed you painkillers or anti-inflammatory drugs, you should be careful in terms of side effects such as stomach pain.
You should be under the control of your doctor in terms of problems that may arise with long-term use of painkillers or anti-inflammatory drugs. If you have severe leg pain, epidural injections or ‘blocks’ may be recommended. These are injections of drugs with a mixture of corticosteroids into the epidural space (the space around the spinal nerves) by a doctor specially trained in this technique. After the first injection, the same procedure can be repeated several more times at intervals. These treatments are often administered as part of a comprehensive medical treatment program. The purpose of these injections is to reduce the inflammation of the nerve and disc.
Trigger point injections are injections of local anesthetics, sometimes with corticosteroids, directly into the aching soft tissue or muscle in the lower back or buttocks. Although often useful in controlling pain, trigger point injections do not have a direct curative effect on herniated disc.
SURGICAL TREATMENT IN WAIST HERNIA
Purpose of surgery; It is to eliminate the pressure of the herniated disc, which causes lower back leg pain and leg weakness, on the nerve. The most commonly used method is discectomy provided that the microscope is always used, or partial (partial) discectomy, in which only the herniated disc part is removed. Sometimes it may be necessary to remove part of the bone called the lamina on the back of the disc in order to see the disc clearly. The bone removed can be a very small piece (hemilaminatomy) or a larger portion (hemilaminectomy). In some appropriate cases, the endoscopic system is used. This surgery is mostly performed under general anesthesia, but depending on the patient’s conditions, it can sometimes be performed without sleeping with a method called spinal anesthesia. The patient lies face down on the operating table, usually in a lap position. A small incision is made in the skin over the herniated disc and the muscles on the spine are stripped of the bone. Nerve congestion is relieved by removing the herniated disc and its ruptured parts. Bone protrusions called osteophytes are also cleaned so that nothing is left that can put pressure on the nerve. With the microsurgical method, there is usually very little bleeding and no blood is used.
