Herniated disc
What is a herniated disc?
The lumbar region is the most weight-bearing part of the body. Spinal movements are mostly made from this region. In the lumbar region, there are 5 vertebrae and below the tailbone. Between these bones, there are pads called discs. The wall of these pads (disks) consists of hard fibrous tissues. They have a gel-like texture in their middle part.
Lumbar hernia is a condition that occurs as a result of the damage of the fibrous tissue forming the disc wall, and the leakage of the gel part in the middle to the weakened area. This disc damage can occur in many different forms and degrees, from weakening of the disc wall to complete rupture. As a result of the displacement of the disc gel or its discharge from the torn area into the spinal canal, the root parts of the nerves going to the spinal cord or legs are under pressure. Although lumbar hernia is more common in advanced ages, it can be seen at any age.
Why does it happen?
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lifting heavy loads
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staying in a bent position for a long time
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overweight
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pregnancy and birth
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Disruption of disc structure due to aging
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Inherited lack of adequate formation and durability of the disc structure
What are the symptoms?
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Pain in the lower back and legs or in one leg
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Tingling and numbness in legs and feet
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Don't get tired easily
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In advanced cases, muscle weakness, urinary incontinence and loss of balance
How is it diagnosed?
Physical examination is important. The shape of the pain gives information about the nerves under pressure. Muscle strength and reflexes are evaluated. The EMG test shows which nerve root or roots are affected by the hernia. MRI is the most valuable diagnostic method in this regard. The site of the hernia clearly shows its localization and size.
How is it treated?
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Non-surgical methods
If the disc wall is not torn, only weakened and the disc material has ballooned in this area; If the disc wall is torn in the posterior midline, the disc material is protruding in the midline direction, and if they are in small volume so as not to cause pressure on the nerve roots, surgical treatment is not required. In this case, we can list a few of the treatment methods that can be applied as follows.
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The use of corsets that support this region to reduce the movements of the waist region
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2-7 days of bed rest. However, there is no scientific data that sleeping on a hard bed or hard floor is effective in the treatment of pain and hernia.
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Exercise; An exercise and stretching program that can be applied at home may be recommended by a specialist.
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Warming up and massaging the lumbar region is beneficial in pain control as it will reduce muscle spasm.
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Pulling and stretching methods can reduce pain. However, these operations should be done by an experienced specialist. Otherwise, it may cause irreversible damage.
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Pain reliever and muscle spasm reliever drug therapy
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Surgical methods
The pain is severe and long-lasting, even significantly affecting the person's daily activities; loss of sensation and strength; Surgical methods are applied in cases where there is loss of urine and stool control.
discectomy; removal of herniated disc material. Thus, the pressure on the nerve root or roots is eliminated. This procedure can be performed openly, microscopically and endoscopically.
The recurrence rate is high after partial discectomy operations performed in the form of removal of only disc material.
Instrumentation and total discectomy; It is open surgery. Screws are placed on the upper and lower vertebrae of the deteriorated disc. These are connected to each other with rods. Along with the herniated part of the disc, the residual part between the vertebrae is also cleaned.
The recurrence rate is very low with this method. It also prevents joint arthrosis and pain that will occur in the patient's lumbar region in the future.