Herniated discs of the lumbar : causes, diagnosis , treatment , complications
Diseases Of The Spine / / April 28, 2016
problems with the loin can start for various reasons.Rupture disc and disc herniation are discussed more extensively in the past few decades.People often think that if they are concerned about the back, or rather in the lumbar spine, it is, nerepremenno, vertebral hernia.Nevertheless, the true hernia gelatinous nucleus pulposus (semi-solid structure of the connective tissue fibers and gelatinous substance chondrin) are not very common.Most of the problems that cause back pain, not related to the herniated disc.
Statistics show that about 25% of people under the age of 40 years complained of a herniated disc or disc degeneration.And almost 60% of people over the age of 40 years suffer from these same problems.
Brief spine anatomy
To better understand how emerging herniated disc, it is helpful to know some details of the anatomy and function of the spine.
Intervertebral discs - it cushions that act as shock absorbers between each of the vertebrae in the spine.The soft core of the disc ser
herniated disc in the lumbar spine occurs when the outer fibers of the intervertebral disc (ring) is damaged, and soft inner material of the nucleus pulposus breaks its normal space.If the ring is broken near the spinal canal, the nucleus pulposus material flowing down through the cracks of the drive limits can click on the spinal canal.
lumbar vertebra.There are five lumbar vertebrae, they are located in the lower back.These vertebrae receive the most stress and are the carrier part of the back.The lumbar vertebrae allow movements such as flexion and extension, and the exact same some lateral bending and twisting.
reasons herniated discs of the lumbar
Herniated lumbar disc may occur in children, although this is rare.The most common among middle-aged is a herniated nucleus pulposus and young adults.In the elderly degenerative changes that occur with aging in the spine, in fact, make it less likely for them to develop herniated disc.
discs can rupture suddenly due to too much pressure on them from different angles.For example, a fall from a ladder and landing in a bent position can cause a lot of pressure on the spine.If the force is powerful enough - or vertebrae may break or the disc can rupture.In between each vertebra bends much pressure on the discs.If you bend and try to lift something too heavy, it can lead to the rupture disc.
discs can also rupture and pressure from a small - usually due to weakening of the fibrous ring of repeated injuries that build up over time.When the ring is weakened at some point people may lift something or bend so that it will lead to too much pressure on the disc.Weakened disc ruptures, although five years ago this same thing would not cause problems.This is the aging spine.
disc hernia causes problems in two ways.Firstly, the material has a gap in the nucleus pulposus of the spinal canal, which can cause pressure on nerves in the spinal canal.There is also some evidence that the material the nucleus pulposus causing chemical irritation of the nerve roots.And the pressure on the nerve roots, and chemical irritation can lead to problems with the nervous system.And combination of both can cause pain, weakness and / or numbness in the body.
herniated intervertebral disc is usually related to the weakening of the outer layer of the disc and the result - a change in its plain (his outpouring, the protrusion), which may lead to a reduction in the space between two adjacent vertebrae and thus lead to pain due to pressurespinal cord extending from this part of the spine.
Some of the main causes of violations of the sliding disk in the lower back:
- Obesity. This condition leads to the fact that the enhanced and sharp, sudden exercise provoke a strong pressure on the spine, which weakens any of the drives and thus provokes the beginning of its degeneration;
- Lifting heavy objects. This may be another reason for the protrusions (loss fragments) of the disc;
- The aging of the organism. With increasing age of the person intervertebral discs begin to weaken, which may also lead to protrusion;
- Smoking. Some practitioners believe that smoking is a major cause of disc protrusion, because the reduced oxygen delivery to the body leads to disc degeneration;
- Frequent and prolonged sitting in one place. the seat in place for a long time - a major factor behind the problems with diseases;
- Paul. believed that men under the age of 50 years compared with women more likely to develop a herniated disc.
Symptoms herniated discs of the lumbar
Symptoms present herniated lumbar disc does not necessarily include pain in the back.The symptoms of herniated disc appear on the pressure on the nerves and irritation.However, many people have pain in the back and because of other problems, including - the disc ruptures.The symptoms of herniated disc usually include:
- Pain in the back.Bulging disc begins with back pain that progresses slowly, and decreases when the patient lies on a flat surface.
- Pain in the legs, which is transferred in one or both legs ;.Bulging disc also cause pain in the buttocks and thighs because of the pressure on the sciatic nerve, located in the lower part of the body, from the buttocks to the foot.
- Other affected nerves.If the bulging disc affect any other nerves, then (in extreme cases), this can lead to numbness and paralysis of muscles with consequent loss of bladder control.
- cauda equina syndrome (sensation in the groin and inner thighs, resembling a feeling of rider galloping on horseback).This syndrome causes suppression of nerve, located in the lower part of the spinal cord.This in turn causes numbness and paralysis of legs, hip pain and loss of control of the bladder.
- Numbness or tingling in one or both legs;
- Muscle weakness in certain muscles of one or both legs;
- Loss of reflexes in one or both legs.
All these symptoms depend on which nerves are affected in the lumbar spine.Thus, the arrangement helps to determine the diagnosis of symptoms.Knowledge, where the pain is localized, gives the doctor a better idea of what the drive is probably broken.
Diagnostics herniated discs of the lumbar
Diagnosis hernia nucleus pulposus begins with a complete history and physical examination question.The main issues will be the doctor to the patient are:
- Were you injured?
- Where does it hurt?
- Do you have numbness?Where?
- Do you have any weaknesses?Where?
- Have you had these problems or something like that before?
- Have you had any weight loss, fever, or other diseases in recent years?
Finally, the doctor will be interested to know whether the patient has problems with urination or defecation.It is important to make sure that there is no pressure of the intervertebral disc herniation on the nerves that go to the intestines and bladder.If the pressure is, it requires immediate surgical intervention.
doctor may suggest x-rays of the lower back.Regular X-rays will not show herniated disc, but will give the doctor information about how much wear is present in the spine, and can reveal other causes of the problem.
most common test today to diagnose herniated disc - magnetic resonance imaging (MRI).This test is painless and very accurate.As far as we know, it has no side effects and is almost entirely replaced by such tests as myelogram and computed tomography (CT), and the best test is done after X-ray, if the suspected disc herniation.
Sometimes MRI does not reveal the whole story.Then, other tests can be offered.Myelogram, usually in combination with CT can be necessary to provide the patient with as much information as possible.However, when it was not confirmed that the pain comes from the herniated disc, additional and more specialized tests may be conducted.Electrical testing (eg, EMG and MSP) can confirm that the pain in his leg, in fact, involved coming from damaged nerves.These tests may be required before a decision to proceed to surgery.
- Medical examination. After taking history doctor will prescribe the patient a physical examination.This will allow the doctor to rule out possible causes of pain and try to determine the source of the problem.in the neck, lower back, arms, legs, etc. - are the patient's body areas where he feels the pain will be considered
Below are some points that are tested in a typical survey:
- The movement of the spine and neck.Is there any pain when the patient turns, curves or moves forward?If so, where?He lost some flexibility?
- Weakness.The muscles will be tested for strength.The patient may be asked, so he tried to push or lift an arm or leg.
- Pain.Your doctor may try to determine whether a patient has weakness and pain in certain areas.
- Sensory changes.The patient will be asked if he could feel certain sensations in specific areas of the feet or hands.
- Reflex changes in tendon reflexes may be tested, for example, under the patella and below the Achilles tendon in the ankle.
- Motor skills.The patient may be asked to resemble the toes or heels.
- neurological tests. Bulging disc is connected with the spinal nerves, so the doctor will evaluate the sensory response of different parts of the body, which can suffer from bulging disc.
Direct test on his feet.This test is conducted by doctors to patients under the age of 35 years.In this test, the patient lies directly on a flat surface, and the doctor raises his injured leg with the knee straight.If the patient reports the pain, the doctor may diagnose that he suffers from a bulging disc in his lower back.
patient may be offered a number of diagnostic tests.Tests must be chosen taking into account that the physician is suspected cause of pain.Below are the most common diagnostic tests:
- X-rays. X-rays - a painless procedure that uses radioactive materials to take pictures of bone.If the doctor suspects vertebral degeneration, X-rays can be used to verify the reduction of the height of the space between the discs, bone spurs, nerve bundle sclerosis, faces hypertrophy (increase) and instability during flexion or extension of the limbs.X-rays show bone but not soft tissue.Thus, they will be used, if suspected fractures, infections or tumors.During X-ray to the patient will be asked to lie still on the table and hold certain position of the body while taking pictures of his spine.
- MRI - a fairly new test that does not use radiation.When using magnetic and radio waves, MRI creates computer graphics.Rays MRI can "cut" several layers of the spine and the possibility of soft tissue abnormalities - such as nerves and ligaments.MRI may also be advisable to check the water loss in the disc, facet joint hypertrophy (increase), stenosis (narrowing of the spinal canal) or herniated disc (intervertebral disc protrusion or rupture).During MRI the patient should lie on a table.computer scanner will make a lot of photos, which will then be observed and monitored by specialists.Some newer MRI machines called "open magnetic resonance imaging" are likely to be more comfortable for patients who feel claustrophobic.The procedure takes 30-60 minutes.
- CT . This is a test that is similar to an MRI and X-rays, because it can show the bones and soft tissues.Computed tomography is also able to produce X-ray "slices" of the spine, which allows each department to be considered separately.Scanning generates a set of cross-sectional images that can show problems such disc and bone degeneration, or as a cylindrical face osteogenesis hypertrophy.Tomography is not so clearly visible, like X-ray or MRI.To better see the soft tissue, it is necessary to do in conjunction with CT Myelogram.
like MRI, CT scan when the patient has to lie on a table that is inserted into the scanner.Scanner substantially x-ray tube that rotates around and makes a plurality of images.The procedure takes 30-60 minutes.
- myelogram. Myelogram - research that is used to examine the spinal canal and spinal cord.In the course of this test in the back of the bag a special X-ray dye is injected.This will require a lumbar puncture performed by a physician.This procedure is performed by introducing a fine needle into the lower part of the back and spinal canal.After the needle is injected dye which is blended with cerebrospinal fluid.The dye appears on the X-rays.Therefore, upon development of X-ray images can be seen the outlines of the spinal cord and nerve roots, i.e., drive problems and bone spurs.
myelogram For the patient lies on a rotating table.X-rays from the dye flow through the dorsal region help doctors determine if any unusual or abnormal depressions form.These recesses can be from a hernia or convex disc lesion, tumor, trauma or spinal nerves.Myelogram often combined with CT - in order to obtain a better view of the spine in cross-section.
In many cases, MRI and myelogram replaces, and CT.Sometimes a myelogram shows the problem is better than MRI, but it is used less than MRI.
- bone scan. bone scan can be used to detect problems in the spine.For this radioactive chemicals introduced into the blood through the IV.These substances are attached to any area of the bone, which is currently changing rapidly.A special camera takes pictures of the area of the skeleton in which there is a problem.
Problem areas are shown as dark areas on the film.This is because the chemical indicator is sent directly to the place where there is a problem.Within hours, a lot of indicators accumulated in the problem area.Radioactive chemical substances send radiation that can be detected by the camera.The camera determines the "hot spots" or specific problem areas.
bone scan is very useful when it is unclear where exactly the problem is localized in human bones.The ability to take a picture, on which light up an area where there is a problem, it seems, allows the physician to determine exactly where to look next.After identifying problem areas other tests can be made to show more aspects of these specific areas.Bone scan can help identify problem areas - such as bone tumors and compression fractures.Bone scan can also be used to determine bone density and thinning of bone in osteoporosis condition.
- electromyogram (EMG).