Dorsal hernia l5-s1 and l4-l5
Dorsal hernia l5-s1 and l4-l5 is a protrusion of the contents of the intervertebral disc directed into the space of the canal of the lumbosacral spine. So, l5-s1 is the fifth lumbar and first sacral vertebrae, and l4-l5 is the fifth and fourth lumbar vertebrae, that is, we are talking about a dorsal hernia that appeared in the intervals between them. It is from the direction in which the disc displacement is directed that the types of hernias are distinguished. A dorsal hernia, also called a posterior hernia, is directed towards the spinal canal. In this regard, there is a risk of pinching the spinal cord passing through it and the spinal nerves.
The direction of the protrusion of the dorsal hernia is associated with its particular soreness. In case of damage to the posterior longitudinal ligament, the formation of diffusion of a dorsal hernia occurs, which leads to severe neurological disorders with subsequent paresis and paralysis of the pelvic organs.
According to statistics, it is in the lumbar region that dorsal hernias appear most often.
- Causes of dorsal hernia l5-s1 and l4-l5
- Dorsal hernia symptoms l5-s1 and l4-l5
- Complications of dorsal hernia l5-s1 and l4-l5
- Diagnosis of dorsal hernia l5-s1 and l4-l5
- Dorsal hernia repair l5-s1 and l4-l5
Causes of dorsal hernia l5-s1 and l4-l5
There may be several reasons leading to the formation of a dorsal hernia of the lumbar spine:
- Dysplasia of the lumbosacral spine. This condition is a congenital malformation in the structure of the lumbar spine. At the same time, the structure and shape of the vertebrae changes, the ligaments are disrupted, cartilage tissue, blood vessels and nerves are destroyed. As a result, a dorsal protrusion is formed.
- Osteochondrosis of the spine, leading to the destruction of the intervertebral discs and the appearance of protrusion.
- Diseases of the spinal column associated with poor posture - kyphosis, scoliosis and lordosis.
- Lumbar spine injuries. This can also include the transferred surgical interventions, falls, sharp turns.
- Infections, such as tuberculosis of the bones.
- Excessive physical activity with weight lifting. Often, dorsal hernias occur in athletes. In addition, people who experience constant vibration, such as drivers, are at risk.
- Disruption of metabolic processes in the body, leading to malnutrition of cartilage tissue. In addition, a failure in metabolic processes leads to an increase in body weight. Fat deposits in the abdomen are considered especially dangerous in terms of the development of a dorsal hernia. They have a significant impact on the lower spine.
- Regular intake of nicotine into the body significantly increases the risk of hernia formation.
- Physical inactivity. In terms of the formation of a dorsal hernia, it is a sedentary lifestyle that is dangerous. Salespersons, accountants, drivers, people of those professions who have to spend most of their working time sitting are in the high-risk zone.
- The fact of a hereditary predisposition to the formation of a hernia cannot be ruled out.
Age-related changes that cause natural wear of the discs.
- Dietary disturbances that lead to insufficient intake of nutrients into the body. In this case, all organ systems suffer, including the spine. Since it is the lumbar region that experiences maximum stress, its vertebrae are destroyed before the rest.
Dorsal hernia symptoms l5-s1 and l4-l5
- Pain syndrome Until the hernia has reached an average size, the pain syndrome will be weak. As it grows, the pressure on the spinal nerves increases. As a result, any movement: raising a leg, changing the position of the body - all this will be accompanied by excruciating acute pain. In advanced cases, patients are not even able to cough without experiencing pain. It usually radiates to the buttocks and thighs.
Sensory impairment. In patients, the sensitivity of the legs and toes decreases, which is also associated with damage to the spinal nerves. Numbness of the tailbone, gluteal muscles may appear. In addition, the lower extremities are more likely to swell.
- Vertebral Syndrome. This is a complex of symptoms, the appearance of which is associated with pain. Intuitively, a person tries to unload the lumbar and sacral regions, begins to slouch, lean forward. As a result, incorrect posture is developed. In addition, the sense of balance suffers and the gait changes. Curvature of the spine leads to the development of problems in the work of internal organs.
Radicular syndrome. As muscle tissue atrophies, there is a violation of the sensitivity of the limbs, their weakness appears. The skin becomes dry, or, on the contrary, sweating may increase, which is associated with a violation of the sebaceous glands. As the hernia grows, the risk of paralysis of the lower body increases.
The more the spinal cord is damaged, the higher the risk of developing life-threatening conditions for the patient:
- Malfunctions of the reproductive system.
- Dysfunction of the pelvic organs, which is expressed in constipation or diarrhea, urinary incontinence, etc.
- Intermittent claudication.
- Sciatica in the lumbar region and pelvis, with lumbago pain in the whole back of the lower limbs. (Read also: Causes and Symptoms of Sciatica)
- Lasegue syndrome. The presence of this syndrome is determined by a neuropathologist. In a patient with a dorsal hernia, physiological reflexes, in particular, the knee and Achilles, disappear completely or partially. But at the same time, new pathological reflexes are formed.
Complications of dorsal hernia l5-s1 and l4-l5
Sequestration of a hernia with a violation of the integrity of the disc and the exit of the nucleus pulposus into the lumen of the spinal canal. The person suffers from severe pain, which is explained by the compression of the spinal nerves and spinal cord. As a result, the patient loses the ability to self-care, as he becomes unable to move.
- As the hernia grows, complete or partial paralysis of the patient can form with the assignment of a disability group.
- Formation of an autoimmune inflammatory process. The cause of its manifestation is the protein content of cartilage and fibrin fibers, which trigger an autoimmune reaction.
- Compression of the bundle of spinal nerve roots. In medicine, this complication is called a symptom of a cauda equina.
- Violations of the act of urination and the process of defecation due to malfunction of the pelvic organs.
- Atrophy of the tissues of the lower extremities associated with loss of sensitivity.
So, a dorsal hernia, located at the level of l4-l5, can lead to paralysis of the legs and a complete loss of sensation of the feet with all the consequences that follow from this condition.
A dorsal hernia, located at the l5-s1 level, can provoke serious disturbances in the functioning of the internal organs of the pelvis. Therefore, if the first symptoms of the disease appear, you should immediately seek medical help.
Diagnosis of dorsal hernia l5-s1 and l4-l5
If there is a suspicion of a dorsal hernia in the lumbar spine, instrumental diagnostic methods are necessary. The most informative method in this case will be MRI. The picture will show the direction of the protrusion, its size, the degree of compression of the spinal canal.
If it is not possible to conduct an MRI, then the patient can be sent for a CT scan. However, according to its results, it will be possible to establish only the very fact of the presence of a hernial protrusion. X-ray examination in this case is not very informative, it will only allow us to conclude that there are no other sources of pain - curvature of the spine, its injuries or tumors.
Dorsal hernia repair l5-s1 and l4-l5
If the hernia has already formed, then you can get rid of it only by surgical intervention. However, doctors are in no hurry to send the patient to the operating table, as there are clear indications for this.
Conservative treatment of dorsal hernia l5-s1 and l4-l5
Conservative treatment is reduced to relieve the patient of pain and prevent the progression of the hernia:
- In order to relieve the patient of pain, he is prescribed pain relievers and anti-inflammatory drugs, among them: Diclofenac sodium, Ibuprofen.
- To relieve muscle spasm, muscle relaxants are shown, for example, Baclofen, Sirdalud, Midocalm.
- Non-narcotic analgesics - Ketanol, Baralgin, Ketanov.
- Antidepressants and sedatives are aimed at eliminating the neurological disorders that often suffer from patients with a hernia of the spine. Among the most popular drugs are Desipramine, Doxepin, Amitriptyline.
- The use of hormonal drugs helps to relieve inflammation, however, they are prescribed only in the absence of an effect from other drugs.
- Vitamin therapy. It is advisable to take an increased dose of vitamin B, namely B1 and B12. Not only their intramuscular administration is possible, but also oral administration of drugs, for example, Neuromultivitis or Neurovitan.
The methods of conservative treatment also include:
- Physiotherapy. It is possible to start performing exercise therapy complexes only at the stage of remission of the disease, after it is possible to get rid of the pain syndrome. The patient is recommended to perform the exercises every day, without gaps. Abrupt movements should be avoided, the load at the initial stages should be minimal.
- Spinal traction. Modern medicine offers patients with a hernia to undergo traction using computerized devices that carry out the procedure according to the program laid down in them. The principle of this method is that the distance between the vertebrae is increased by a maximum of 2 mm. It is in this gap that the hernia, which can be partially retracted. You can undergo the procedure only in specialized medical institutions so as not to harm your health (for more details, see the article: spinal traction: indications and contraindications).
- Physiotherapy treatment. Among the most popular methods for relieving a patient from pain syndrome are drug electrophoresis (with the introduction of anesthetics, anti-inflammatory or hormonal drugs) and the use of diadynamic currents (promotes pain relief, relaxation and increased blood circulation).
Surgical treatment of dorsal hernia l5-s1 and l4-l5
As a rule, the operation is prescribed in no more than 20% of cases. The indication for the operation is the development of complications, the lack of effect from conservative therapy, a significant size of the hernia, severe pain syndrome. In addition, surgical intervention can be carried out with paralysis of the patient, as well as with violations of the work of internal organs.
Modern ways to get rid of bulging are as follows:
- Microdiscectomy, in which part of the hernia is removed and, if necessary, part of the vertebra. The procedure is performed under a microscope. Already after 5 days the patient can perform non-physical work, and after 3 weeks his working capacity is fully restored.
- Endoscopy is performed using a special device - an endoscope. Thanks to him, the puncture on the skin, which will be made to remove the hernia, will not exceed 20 mm. The duration of the procedure does not exceed 45 minutes; it will require the introduction of local anesthesia. The hernia itself can be removed with a laser or cold plasma.
- Laminectomy is rarely used by modern surgeons. It is performed in the event that the hernia is large. During the operation, the patient is removed part of the vertebra, as well as a fragment of the disc.
Nevertheless, no matter what method of removing the hernia would be chosen, there is always a risk of recurrence of the disease.
The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist
Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.