What is a herniated disc?
Lumbar hernia occurs when the discs between the 5 vertebrae that make up the lumbar spine
put pressure on the spinal cord and the nerves that separate from the spinal
cord due to wear, tear or slip due to various reasons.
What are the Causes of Lumbar
Hernia?
The fluid content inside the discs located between
the vertebrae decreases over time and depending on age. This reduces the
drive's durability against loads. Difficulties such as heavy lifting, making
uncontrolled sudden lumbar movements, standing still for a long time or being
exposed to traumas such as sitting, falling, bumping can cause ruptures in the
disc and cause a herniated disc.
Although lumbar hernia is more common in the middle-advanced age group, it can be seen in young
people and even in children. Although it occurs at the same rates in men and
women, the risk of it increases due to excessive weight gain in a short time
during pregnancy. Being overweight is an important risk factor for herniated
disc. In addition, smoking disrupts the nutrition of the discs, causing fluid
loss and increasing the risk of herniated discs. It also prolongs the healing
process. Working at a desk for a long time, driving for long periods, leading a
sedentary life, making movements and activities that force the spine and doing
inappropriate sports activities are other risk factors for herniated disc.
The fact that the muscles around the spine and the
trunk-abdominal muscles are powerless increases the load on the discs and
prepares the ground for herniation. For this reason, in order to prevent
herniated disc, in addition to staying away from the above risk factors, it is
very important to do exercises and sports that strengthen the waist, abdominal
and back muscles.
What are the Symptoms of Lumbar
Hernia?
The most important symptom in lumbar hernia disease
is the pain spreading from the waist to the leg. Patients often apply to the
physician with this complaint. However, these symptoms may not be seen in every
herniated disc patient. Sometimes it can be completely painless, but only pain
in the lumbar region can be seen at the beginning. The pain can usually radiate
along the back of the leg to the hip, knee or even heel. In cases that increase
spinal cord pressure, such as coughing, sneezing and straining, the pain may be
exacerbated and even stiffness may occur.
Pain in one or both legs may also be accompanied by
symptoms such as numbness, burning, tingling. The cause of these symptoms is
the pressure of the hernia on the leg nerves. In cases of severe nerve
pressure, further neurological problems such as weakness in the muscles of the
legs, ankles and feet, difficulty walking, urinary incontinence, loss of sexual
functions may occur.
The patient begins to experience difficulties in activities
of daily living, such as sitting and getting up and walking, due to pain,
stiffness and functional insufficiency.
How is Lumbar Hernia Diagnosed?
The diagnosis of lumbar hernia is made by imaging
methods such as x-ray, MRI (magnetic resonance) or CT (computed tomography) as
well as a careful patient history, physical and neurological examination. In
some cases, nerve examinations called EMGs (electromyography) may be needed.
What are the Treatment Methods in
Lumbar Hernia?
Lumbar hernia treatment is applied individually. It is not a condition that requires urgent surgical
treatment except for serious neurological symptoms such as progressive loss of
strength, urinary and stool incontinence. Generally, a very large proportion of
patients can be treated without the need for surgical intervention.
The first step in the treatment of lumbar hernia is
rest. However, since it has been understood in recent years that long-term rest
may have negative effects in the treatment of herniated disc, it is
important to keep rest and movement restriction as short as possible for the
success of the treatment. Although short-term bed rest can be given in very
serious painful situations, rest is more in the form of restricting movements
that put a burden on the spine. The patient's absence from work is evaluated by
the doctor depending on the work he does.
In this period, painkillers and muscle relaxant
drug treatments are usually applied. In some cases, steroid therapy can be done
in a controlled manner. It can be used for a short time when corset is
required.
Physical therapy methods have an important place in
the treatment of lumbar hernia. For this purpose, hot applications, ultrasound,
laser, pain relief flow treatments, massage, mobilization, manual therapy, dry needling, taping, traction
(classical and vertical traction-vertetrac) are the most commonly used treatment methods.
In some cases, epidural injections and nerve blocks
may be given to the lumbar region to relieve pain.
Exercise practices should be started early in the
treatment of herniated disc and should be an integral part of the treatment. At
the beginning, the patient is trained to organize the activities of daily
living and a program including stretching, stretching and posture exercises is
started so as not to increase the pain. With the reduction of pain in the later
stages of the process, endurance and strength increasing exercises are started.
The intensity of the exercises is adjusted according to the clinical condition
of the patient and it is aimed to return to daily living and working activities
as soon as possible.
Spinal decompression therapy is a treatment method
that is successfully applied in the treatment of
herniated disc. It is a technology that applies
controlled traction to create negative pressure on the problematic disc. It
provides a safer and more effective traction method than other traction methods
and can also be used in advanced hernia cases.
Surgery for lumbar hernia is the last treatment option used in cases with serious and progressive
neurological losses and despite all the treatments performed, no results are
obtained. In the postoperative period, physical therapy and rehabilitation can
be performed if necessary.