Modern Approaches to the Treatment of Lumbar Spinal Disc Herniation

Presence of herniated intervertebral discs in the lumbar spine is the most typical cause of lower back pain and sciatica pain. This condition is diagnosed in 2-3% of the population, being the main cause of the spinal surgery in adults. Usually it is connected with aging and degenerative processes in the spine structures.

During the last decades surgical treatment of lumbar spinal disc herniation has evolved from the direct transdural resection to the microsurgical and endoscopic procedures. Despite the fact that surgery remains second-line therapy, prescribed in the failure of conservative treatment, it is performed widely nowadays, especially in young and physically active patients.

Causes of problems with intervertebral discs

Intervertebral discs consist of two parts “ an inner jelly-like nucleus pulposus and an outer flexible annulus fibrosus. Such structure allows dissipating physical loading during the flexion and extension, lateral bending and axial rotation. Vertebrae stay safe and do not rub against each other. Once the normal structure of the intervertebral discs is affected, a number of the spine pathologies arise.

The most significant causes of the spinal disc herniation include:

• Aging. With age, annulus fibrosus becomes weak, so that soft nucleus pulposus comes out under the pressure. This is how the herniation arises.
• Certain movements. The lumbar intervertebral disc may slip out of place during twisting movements, incorrect lifting of the heavy objects.
• Physically demanding professional occupation. If your job requires permanent pushing or pulling, twisting, then risk of the lumbar spinal disc pathology rises.
• Being overweight. Excessive body mass puts the additional physical load on the lumbar spine.
• Lack of physical activity. The sedentary lifestyle contributes to weakening of the spine muscles and displacement of spine structures.

Prevention of lumbar spinal disc herniation

Some of risk factors cannot be excluded (e.g. aging or gender), while others are perfectly modifiable. A system of lifestyle modifications can significantly reduce risk of the lumbar spinal disc herniation even in people with the burdened somatic anamnesis.

If you want to keep your spine healthy, you should:

• Take care about your posture “ keep fits on the floor while sitting, stand up with your shoulders back, sleep on an orthopedic mattress, avoid high heels.
• Practice correct and safe lifting techniques “ use leg muscles, not back muscles, to support the load.
• Maintain the normal body mass.
• Be active physically “ regular exercises strengthen you back muscles that support the spine. In addition, if you need to sit for the long period of time, it is better to stretch regularly.
• Stop smoking and using tobacco products “ it has been proved that nicotine contributes to the development of degenerative processes in the connective tissues (i.e. spine ligaments).

Symptoms of the spinal disc pathology

Displacement of the lumbar intervertebral disc causes two main problems:

1. Constant trauma of the neighboring vertebrae that are not protected by the intervertebral disc any more.
2. Compression of the nearby spinal nerve roots.

Due to these pathological mechanisms a number of symptoms arise. Pain syndrome is the most widespread of them. It includes backache, discomfort in the buttock and down the leg. Pain typically develops quickly and worsens with movement or from bending forward. At the early stages it may be alleviated by rest, applying cold or heat, sitting or lying in the specific position.

Pain may be accompanied by the sensitivity disorders, like numbness or tingling. This is explained by the affection of the sensitive nerve fibers. These symptoms are usually temporary, getting milder or more severe over time.

Another important and serious sign is loss of the bladder and bowel control. Muscles weakness in the legs can be also present. In presence of such complaints it is better to visit a doctor as soon as possible in order to exclude the rare but serious pathology “ cauda equina syndrome.

Diagnosis of lumbar spinal disc herniation

Doctor's consultation starts from the anamnesis taking. He will carefully ask you about the lifestyle and concomitant disorders. After that, a doctor will estimate your height and weight and proceed to neurological examination “ checking reflexes, sensitivity, and muscles strength.

The final diagnosis of the lumbar spinal disc herniation can be made only after the instrumental confirmation. Typically, you will need to undergo:

• MRI or CT scan provides a doctor with the detailed information on spinal column and spinal cord state.
• X-ray examination is helpful in excluding other possible causes of the back pain, like fractures, tumors, etc.
• Functional nerve tests, including the electromyography and nerve conduction studies, allow assessing the nerve roots viability and the degree of their damage.

Based on the clinical picture and instrumental examinations results, the treatment plan is elaborated.

Types of treatment and choosing the most appropriate technique

Treatment of the lumbar spinal disc herniation always starts from the conservative measures, including the physical therapy, painkillers (e.g. ibuprofen, naproxen), muscle relaxers (e.g. methocarbamol, cyclobenzaprine), and paravertebral cortisone injections. At the early disease stage these are sufficient for the symptoms alleviation. Combined with lifestyle modification, such tactics may lead to the total cure.

In case conservative measures have failed to bring relief, a doctor will recommend you surgical treatment. At this stage choosing a qualified surgeon and well-equipped hospital is crucial, as the principally diverse interventions are may be performed:

• Discectomy or microdiscectomy “ the damaged disc is removed via the conventional or endoscopic approach. This intervention may be followed by the artificial disc placement.
• Lumbar laminotomy “ a small part of the vertebra is removed in order to relieve pressure on the spinal cord and eliminate symptoms.
• Spinal fusion “ two neighboring vertebrae are firmly connected (fused). Motionless vertebrae cannot irritate nerve roots, so pain stops.

Undergoing treatment of lumbar spinal disc herniation in the well-equipped hospital with world reputation will significantly improve your chances to achieve the excellent result and reduce surgical risks. Fortunately, nowadays a patient can undergo treatment in the world leading clinics regardless of his origin country. Planning surgery abroad, it will be more convenient and safe to use services of Booking Health.

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