Low Back Pain and Lumbar Hernia
The most common cause of low back and leg pain is hernia. The disc is the cartilaginous tissue that serves as a cushion between the vertebrae. With force, this tissue loses its normal structure; tears and explosions happen. The exploding part immediately presses the nerve to the leg in the neighborhood and the findings occur. Symptoms of a herniated disc include blunt or sharp pain in the waist and leg, muscle spasm or cramps, weakness in the legs and / or drowsiness. Sneezing, coughing or bending from the waist to the front and bending usually increase the pain. Rarely defecation or urine control is lost and urine and fecal incontinence occurs. In this case, seek immediate medical attention.
Pain spreading to the leg is known as iyat sciatica.. Sciatica is usually a symptom of lumbar hernia. Sciatica can cause pressure on one or more nerves of the same name, pain from the hip to the leg and sometimes to the foot, burning, tingling and drowsiness. These signs and symptoms are usually on one side (left or right).
Anatomy: Between the five lumbar vertebrae, which we call the disc, there are relatively hard tissue on the outside and hard inside. The task of the discs is to provide waist flexibility and absorb shock shocks. Each disc has a gel-like inner material (core) and a rubber-like outer ring. Disc herniation is the condition of the core escaping from the ring as a result of weakening or tearing of the outer ring (thick arrow). The herniated part causes pressure on the nerve (small arrow) that leaves the neighboring leg immediately adjacent to the leaf; in more advanced cases, it prevents the nerve from conducting, and loss of strength and numbness in the affected side leg occurs.
Risk factors for hernia: Many factors increase the risk of disc herniation.
Lifestyle choices such as smoking, lack of regular exercise, overweight and malnutrition contribute greatly to poor disk health.
As the body ages, natural biochemical changes lead to a gradual decrease in the water content of the discs, which affects the strength and flexibility of the disc. With aging, discs can become less absorbing from shocks from our movements.
Wrong body posture habit, improper exercise, hard work forces the backbone
These factors, combined with daily wear, accidents, improper heavy lifting or bending, increase the likelihood of a hernia. For example, removing something wrong can cause intra-disk pressure to rise above 100 kg / cm2.
How is hernia diagnosed?
If you have severe back and leg pain, numbness in the leg and loss of strength, you should consult a doctor.
Physical and neurological examination
MRI, sometimes spine CT and flat spine film
EMG
Your doctor will diagnose you using these methods.
Non-Surgical Treatment of Lumbar Hernia
Applications we can do ourselves:
Medium 3-5 days rest on a hard bed
Cold Application: Cold treatment during the first 24-48 hours helps reduce swelling, muscle spasm and pain by reducing blood flow. Never apply cold or ice to your skin; instead, wrap the ice pack or cold battery with a towel and apply it to your waist for up to 15 minutes.
Hot treatment: Usually, after the first 48 hours, heat treatment can be applied. Warming and relaxing soft tissues increases blood flow. Increased blood flow, muscle spasm and disc injury as a result of the tissue to accumulate helps to remove irritating toxins. Do not apply heat directly to your skin (just like cold); Instead, wrap the heat source with a thick towel and apply for no longer than 20 minutes.
Drug Treatment: Always consult with your doctor before taking any of these drugs.
Painkillers: May contain painkillers to alleviate pain. Mild to moderate pain can be treated with non-steroidal anti-inflammatory drugs (NSAIDs). They reduce both swelling of the tissue and pain.
Anti-inflammatory: These drugs are used to reduce swelling in damaged tissues.
Muscle relaxants: Muscle relaxant is taken to relieve spasm.
Spinal Injection
Epidural steroid injections can be used if leg pain is very severe. It also gives anti-inflammatory drugs near the affected nerves in the lumbar spine. Discuss this option with your doctor and find out about the side effects before starting this treatment.
Physiotheraphy
Your doctor may recommend physical therapy. Physical therapy includes a combination of treatments to reduce pain and increase flexibility. Ice and heat therapy, gentle massage, stretching and pelvic pull are some examples, but your physiotherapist will work with you to develop the best treatment plan for pain and other symptoms.
Surgical Treatment of Lumbar Hernia:
Lumbar hernia;
Pain not responding to medication
Very severe back and / or leg pain
Leg muscular weakness, low foot
If there is surgery.
Some lumbar hernias rarely cause bowel / bladder control disorder. In this case, emergency medical surgery should be performed.
If surgery is recommended, ask for the purpose and possible outcomes of the surgery. You should understand all the details of what is recommended and do not hesitate to get a second opinion from another spine surgeon. Spine surgery is a big decision, so don't decide to rush.
Surgery is performed to relieve nerve pressure and leg pain. Surgery removes all or part of the disc that compresses the nerve. This is done under a microscope.
Today, the most successful treatment method is “microdisketomy yapılan under the microscope. The surgeon accesses the herniated disc by removing a portion of the bone covering the nerve. This process is called laminotomy. Then a portion of the disc between the vertebral bones and the herniated disc is removed and the pressure on the nerve is removed. The received material is sent to pathology.
Surgery can be performed using minimally invasive techniques. Minimally invasive spine surgery does not require a large skin incision, but uses small incisions and tiny special tools and devices such as microscopes during the operation.
Since 2016 in our hospital Op. Dr. Cevdet Gökçek performed nearly 50 microdisketomies under the microscope and achieved successful results in all patients. None of the patients had any serious complications, all had pain and returned to work and normal life.
Can we prevent the formation of a hernia?
A common cause of lumbar hernia is aging. It is not possible to stop aging. However, there are several factors that you control; especially to get support while lifting something, to avoid movements that force the waist, to correct your posture, not to smoke, to choose healthy food, not to lose weight, exercise reduces the risk of hernia occurs.
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