Lumbar Spinal Disc Protrusion: Causes And Treatment

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Lumbar Spinal Disc Protrusion: Causes And Treatment
Lumbar Spinal Disc Protrusion: Causes And Treatment
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Lumbar spine disc protrusion

Spinal disc protrusion - what is it?

Spinal disc protrusion
Spinal disc protrusion

Spinal disc protrusion is a pathological bulging of the intervertebral disc into the spinal canal, which is not accompanied by a violation of the integrity of the annulus fibrosus. Disc protrusion should not be regarded as an independent disease. Protrusion is one of the stages of osteochondrosis, which further leads to the formation of a hernia.

It is in the lumbar spine that disc protrusion is most often formed, somewhat less often it is observed in the cervical spine. The protrusion in the lumbar spine in the vast majority of cases is localized between the vertebrae L4 and L5, or between the first sacral vertebra S1 and the last lumbar vertebra L5. Discs located between the 3rd and 4th lumbar vertebrae are less likely to protrude, and the upper discs of the lumbar spine are very rare.

The age at which protrusion is most often found varies in the range from 30 to 50 years. Most often men are affected. Since the protrusion of the disc further leads to the formation of a hernia and to the possible disability of patients of working age, it is necessary to timely detect this condition and treat it. In addition, protrusion can cause severe back pain, which worsens a person's quality of life and affects his well-being. Spinal disc protrusion is the cause of approximately 30% of spinal pain in orthopedic patients.

Content:

  • Spinal disc protrusion symptoms
  • Causes of protrusion of the spinal discs
  • Stages of intervertebral disc protrusion formation
  • Spinal disc protrusion treatment

Spinal disc protrusion symptoms

Disc protrusion symptoms
Disc protrusion symptoms

Symptoms of spinal disc protrusion primarily depend on the degree of its protrusion beyond the vertebrae, as well as on the location of the pathological focus.

The following clinical picture is characteristic of protrusion of the lumbar disc:

  • Back pain, which is localized in the lumbosacral region. The pains are chronic and present almost constantly, with varying degrees of severity. They increase with increasing physical activity on the lumbar girdle. For example, when lifting weights, when bending down, when staying in one position for a long time (sitting or standing), when performing sudden movements.

  • When a person takes a comfortable position, the pressure of the disc on the nerve roots weakens, the pain goes away, or decreases
  • Numbness in groin and lower limbs.
  • Weakness of the muscles of the lower extremities.
  • Feeling of "goose bumps" and tingling in the legs.
  • The development of lumbosacral radiculitis.
  • Feeling of stiffness in the lumbar region.
  • Decreased range of motion in the lumbar spine. The patient is often unable to sleep on his stomach, fully straighten his lower back, and raise his leg high.

All of the above symptoms can be of varying severity. This is especially true for pain symptoms. Often, pain is absent until the protrusion of the spinal disc passes into an intervertebral hernia.

Causes of protrusion of the spinal discs

Causes of protrusion of the spinal discs
Causes of protrusion of the spinal discs

The causes of protrusion of the spinal discs are most often hidden in a disease such as osteochondrosis. The intervertebral disc suffers from degenerative-dystrophic changes that arise as a result of dysmetabolic disorders. The worse the process of feeding the disk, the faster it loses moisture and becomes inelastic. Under such conditions, even a minor injury or load on the spinal column can lead to the formation of protrusion. The disc extends beyond the vertebrae and remains in this state until a certain time. After a rupture of the annulus fibrosus, it makes sense to talk about a hernia of the spine.

The reasons that can affect the formation of protrusion of the intervertebral disc are as follows:

  1. Physical inactivity. Insufficient physical activity always negatively affects the structural elements of the spinal column.
  2. Uneven loads on the spine can provoke the formation of protrusion, which are the result of factors such as:

    • Anomalies in the development of the spinal column (splitting of the vertebrae, syndrome of additional cervical ribs, sacralization, etc.);
    • Curvature of the spinal column (lumbar lordosis, scoliosis);
    • Long-term static and dynamic loads;
    • Lifting weights;
    • Disorders of the position of the pelvic bones (dysplasia of the hip joints).
    • Overweight.
  3. Spinal injuries can become the cause of disc protrusion. These include bruises, subluxations and vertebral fractures.
  4. Protrusion of the disc is possible against the background of existing diseases of the spine, for example, with ankylosing spondylitis, Calvet disease, with tuberculosis of the spinal column, etc.

  5. Various dismetabolic processes occurring in the body lead to a deterioration in disk nutrition. These include hypothyroidism and diabetes mellitus.
  6. The formation of disc protrusion is possible against the background of collagenoses and systemic diseases of the connective tissue.

Indirect factors that can affect the formation of disc protrusion are age-related changes in the body and a hereditary predisposition to diseases of the spinal column.

Stages of intervertebral disc protrusion formation

Formation stages
Formation stages

The stages in the formation of protrusion of the intervertebral disc can be distinguished as follows:

  • Fracture of 70% of the disc itself, loss of elasticity, formation of cracks in the fibrous membrane.
  • Protrusion of the disc with displacement of the nucleus pulposus and stretching of the annulus fibrosus.
  • Increase in disc protrusion by more than 4 mm, followed by rupture of the annulus fibrosus.
  • Formation of a hernia of the spinal column.

Spinal disc protrusion treatment

Spinal disc protrusion treatment
Spinal disc protrusion treatment

Treatment of protrusion of the spinal discs should be timely and comprehensive, which will allow you to control the pathological process and prevent the formation of a hernia.

All patients should observe the following recommendations:

  • For a period of about 4 days, you should adhere to bed rest. Longer rest can negatively affect the effectiveness of therapy. Therefore, if a person's pain is not too pronounced, then physical activity should, if possible, be maintained.
  • For a while, the patient needs to completely abandon heavy lifting, from working in conditions of increased vibration. Excessive static loads, being in asymmetric positions, including prolonged sitting, are no less dangerous. It is necessary to minimize work at the table, at the computer, etc.
  • Implementation of complexes of physiotherapy exercises. During the first 14 days, the patient should walk, ride a bicycle or exercise on an exercise bike every day. In the future, you can move on to aerobics. The set of exercises should be aimed at strengthening the muscles of the spine and muscles of the anterior peritoneal wall.
  • It is good if physiotherapy exercises are complemented by water aerobics and massage. This will prevent the recurrence of protrusion and exclude its formation in other parts of the spine.
  • Be sure to properly organize a place for a night's rest. A semi-rigid mattress should be chosen, best of all if it is an orthopedic mattress. Complete rejection of the pillow is possible.

With regard to fixation devices, such as lumbar braces, they can be used for no more than four hours a day. Doctors recommend using such devices before the upcoming dynamic or static load.

Drug treatment of protrusion

Drug treatment of protrusion
Drug treatment of protrusion

As for the drug correction of disc protrusion, the patient is prescribed the following drugs:

Analgesic drugs. To reduce pain during protrusion of the intervertebral disc, nonsteroidal anti-inflammatory drugs are prescribed. As a rule, doctors recommend taking Diclofenac sodium, Nimesulide or Ketoprofen. NSAIDs are administered rectally if the patient has gastrointestinal diseases. However, oral administration is prioritized. Local application of ointments containing a non-steroidal anti-inflammatory component to the skin is not excluded. In this case, it is important to take into account the maximum daily dose of such drugs and take into account the dose of the active substance in creams and ointments.

Muscle relaxant drugs. It is possible to take Tizanidine, Baclofen, Mydocalm, etc. The course of treatment should not exceed 3 weeks. It is possible to notice an improvement in prima from muscle relaxants only at the initial stages of protrusion formation.

Chondroprotective drugs. These drugs do not affect the symptoms of the disease, but its course. Reception of chondroprotectors helps to stop the process of disc destruction. However, it will take a long time to take them. The maximum therapeutic effect can be achieved using third-generation drugs in which Glucosamine is combined with Chondroitin sulfate. These are tools such as: Artra, Teraflex, Artrozan.

A good effect is given by warming up the affected area: dry heat, electrophoresis with drugs, paraffin applications, exposure to ultrahigh and ultrafrequencies. Treatments based on hyperthermic action can relieve pain and muscle spasm. Any physiotherapy techniques (magnetotherapy, acupuncture, UHF, etc.) can only be prescribed by a doctor, since they all have certain contraindications.

With protrusion of the disc, it is possible to visit a chiropractor. It is important that this is a highly qualified doctor, otherwise there is a risk of complications and deterioration in well-being.

Epidural block with the introduction of steroid drugs helps to relieve acute pain. A combination of steroidal anti-inflammatory drugs and Cyancobolamine is possible. However, the use of blockages is limited, since they have only a temporary effect and will need to be administered continuously.

Drug treatment of protrusion
Drug treatment of protrusion

A good effect is obtained by stretching the spine, due to which the distance between the vertebrae increases. As a result, the load is removed from the disc, which allows to stop the progression of the disease, and the hernia does not form.

If conservative therapy does not give the desired effect for 8-16 weeks, then the question arises of the need for surgical intervention.

For disc protrusion without rupture of the annulus fibrosus, percutaneous discectomy or nucleoplasty is used. This is a minimally invasive technique that is performed on an outpatient basis. During the operation, a cannula is inserted into the intervertebral disc, through which a laser is inserted, or an electrode that supplies cold plasma. With their help, the nucleus pulposus is destroyed, as a result of which the pressure inside the disc drops. The annulus fibrosus and the posterior longitudinal ligament pull the protrusion inward and the protrusion is removed. The entire procedure is performed under X-ray control.

In 85-90% of cases, it is possible to refuse nucleoplasty, since conservative treatment in combination with the methods of physiotherapy exercises produces a sufficient effect. However, the patient must understand that it will be necessary to maintain physical activity to ensure the normal functioning of the spinal column throughout life. Otherwise, the pathological process will continue to progress, and the patient will have an intervertebral hernia. Therefore, it is so important to engage in physical education, gymnastics and swimming. You should also avoid finding the spine in the wrong position, refuse to lift weights, monitor body weight.

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Author of the article: Sokov Andrey Vladimirovich | Neurologist

Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".

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