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SPINAL DISORDERS LUMBAR DISC HERNIA

Aging Spine

Lumbar Disc Hernia

What is lumbar disc hernia?

Bel fıtığı (Lumbal Disk Hernisi) nedir? The lower back of the spine is composed of five vertebrae and discs. This area is known as the part the greatest part of body weight. The vertebrae surround the spinal cord and prevent its injury.

Lumbar disc hernia results from sliding and tear of the intervertebral discs from excessive forcing (lifting heavy objects, falling, excessive body weight, numerous gestations), which subsequently compresses the nerves exiting the spinal cord. (figure 1).

What are the symptoms of lumbar disc hernia?

What are the nonsurgical treatment methods in lumbar disc hernia?

In a patient diagnosed with lumber disc hernia the doctor may recommend a brief period of rest, antiinflammatory drugs to decrease the inflammation, painkillers for pain control, physical therapy, exercise and epidural steroid injections.

If bed rest is recommended, then you should ask your doctor for how long this should be, because bed rest longer than necessary may result in joint stiffness and muscle weakness, and eventually make it difficult for you to do the movements which will decrease your pain. Therefore, bed rest longer than 2 days for low back pain, and longer than 1 week for lumbar hernia are not recommended. Also, lying on a hard mattress or on the floor has no proven efficacy on the treatment of hernia and pain. You should also ask your doctor if you can go to work during lumbar disc hernia treatment.

If your lumbar disc hernia has not reached the advanced stage and you need to go to work, in addition to beginning your treatment you should obtain information on how you can perform your daily activities with the help of a nurse of physiotherapist without excessive loading of your lower back.

The aim of nonsurgical lumbar disc hernia is to decrease the inflammation caused by herniated disc, to protect the spine by improvement of the patient’s general condition and to increase the general functionality.

Initial treatment that can be recommended by the doctor includes ultrasonic heating treatment, electric impulses, heat or cold application, and manual massage. These applications may decrease the pain of lumbar disc hernia, inflammation and muscle spasm, and facilitate the start of an exercise program.

Traction and tension method in the treatment of lumbar disc hernia

Traction (pulling, stretching) method may provide slight pain relief in some patients, however this treatment must be applied by a physical therapy specialist or physiotherapist. Otherwise this application may cause irreversible damage!

Is brace treatment effective for lumbar disc hernia?

In some conditions, in the beginning of treatment your doctor may recommend you to use a lumbar disc hernia brace (soft and flexible back support). However, lumbar disc hernia braces do not heal the herniated disc. Manually applied treatments provide a short term relief in back pain of unknown origin, however such types of applications should be avoided in most disc hernias.

A physical therapy and exercise program generally begins with light stretching and postural change exercises aimed at decreasing the back pain and leg complaints. When your pain decreases, intensive exercises directed toward increasing flexibility, strength, endurance and returning back to a normal lifestyle may be started. Exercises must begin as soon as possible, and the exercise program planned appropriately to suit the progression in your lumber disc hernia treatment. Learning an exercise program that can be applied at home and its application is an important part of the treatment.

Drug treatment method in lumbar disc hernia

Drugs used to control pain are called painkillers (analgesics). In most conditions the lower back and leg pain respond to frequently used (nonprescription over the counter) painkillers such as aspirin or acetaminophen. In patients whose pain cannot be controlled with these drugs, some analgesic-antiinflammatory drugs called non-steroidal antiinflammatory drugs (NSAIDs) may be added to control the inflammation and damage which are caused by disc herniation and are the true cause of pain. Included in this group of drugs are ibuprofen, naproxen, diclofenac and other drugs sold with prescription. If you have severe and persistent pain, your doctor may also prescribe narcotic analgesics for a brief period of time. In some conditions muscle relaxants are added to the treatment. Taking high doses of muscle relaxants will not accelerate your healing, besides these drugs have side effects such as nausea, constipation, lightheadedness, dizziness, and addiction. All drugs should be taken the way and amount they are described. Report to your doctor all the drugs you are using (including nonprescription drugs you used) and tell your doctor if you tried any of them before, tell if you had gotten any beneft or not.

You should be under the follow up of your doctor with respect to the problems (stomach problems or bleeding) that may arise from the long term use of prescribed or nonprescribed painkillers and NSAIDs.

There are other drugs with antiinflammatory effects. Drugs with cortisone (corticosteroids) are sometimes prescribed for severe lower back and leg pain due to their potent anti-inflammatory effects. Corticosteroids have side effects like NSAIDs. You should discuss with your doctor the benefits and risks of these drugs with your doctor.

Epidural injections or “blocks” may be used to relieve very intense leg pain. These are corticosteroid injections made into the epidural space (space around the spinal nerves) and by an educated physician. The first injection may be supplemented with one or two more injections later. These are generally performed as a part of a rehabilitation and treatment program.

Injections made on the points which trigger the pain are local anesthetic injections made directly on the soft tissues and muscles.

Although injections made to the trigger points are useful in some conditions for pain control, they do not restore the herniated disc.

Lumber disc hernia operation

Bel fıtığı ameliyatı The aim of lumbar disc hernia operation is to prevent the pressure of the herniated disc on the nerves and the resulting injury, thereby prevent it from causing pain and weakness. The most common method used in the lumbar disc hernia operations is named partial discectomy. This method involves removal of a part of the herniated disc.

Complete visualization of the disc requires removal of a small piece of the bone located at the back of the disc, named lamina (figure 2). If bone removal is kept at a minimum this is called hemi-laminotomy, if it is more extensive it is called hemilaminectomy. Then, the herniated disc tissue is removed with special forceps (figure 3). After the part of the disc that is pressing on the nerve is removed, the injury on the nerve will quickly disappear and complete recovery can be achieved (figure 4). Today this procedure is commonly performed with small cuts using an endoscope or microscope.

Discectomy can be performed under local, spinal or general anesthesia. The patient is placed on the operating table in prone position and a position similar to squatting is given. A small cut on the skin over the herniated disc is made, then the bones over the spine are retracted to the sides. The surgeon may remove a small piece of bone to see the compressed nerve.

The herniated disc and other torn pieces are removed in a manner that there is no pressure left on the nerve. The bone projections (osteophytes) are removed to be sure that the nerve will not be exposed to any pressure. There is often minimal bleeding during this procedure.

When is emergency surgical intervention necessary in lumbar disc hernia?

A large disc hernia may very rarely compress the nerves that control the bladder and the bowels, and result in loss of bladder and bowel control. This is often together with numbness in the groin and the genital area. This is one of the rare conditions requiring emergency disc hernia operation, and when you experience such a condition call your doctor immediately.

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