How is spinal disc protrusion treated?
Lumbar disc protrusion is the exit of the disc beyond the vertebrae, but with the preservation of the integrity of the annulus fibrosus. Although protrusion is not an independent disease, but only a condition preceding the occurrence of a hernia, it must be disposed of.
How to treat protrusion of the spinal discs and what methods can be used to achieve the fastest possible result, the orthopedic surgeon decides in each case. However, there are general guidelines for the treatment of protrusion discs.
Content:
- How to treat protrusion during an exacerbation?
- How to treat protrusion after relieving an exacerbation?
- Surgical treatment of spinal disc protrusion
How to treat protrusion during an exacerbation?
The main symptom of exacerbation of the protrusion of the spinal disc is pain. They can be localized in the lumbar region, or they can be given to the buttocks and lower extremities. In addition, pain syndrome always contributes to the occurrence of muscle tension and muscle spasms. Therefore, the primary task facing the doctor and patient in the question of how to treat disc protrusion is to eliminate pain.
To reduce pain, you will need to take painkillers. As an analgesic for compression of nerve roots, non-steroidal anti-inflammatory drugs are used. A good effect can be achieved by taking Diclofenac, Ketoprofen, Ibuprofen. Preference should be given to oral administration of drugs, parenteral or rectal administration is practiced in the presence of gastrointestinal pathologies.
You can complement the treatment aimed at eliminating pain with the help of various creams and ointments containing an anti-inflammatory component. These can be such agents as: Bystrumgel, Voltaren, Diclogen gel, Nimesulide, etc.
Muscle relaxants of central action can eliminate muscle spasm during disc protrusion. They are used in the early stages of protrusion formation to relieve pain and to increase the effectiveness of physiotherapy, therapeutic exercises, and manual therapy. These can be drugs such as: Mydocalm, Sirdalud, Tolperil, Baclofen, Baklosan, etc.
In the acute period, the patient's motor activity should be limited. For up to 4 days, you must adhere to bed rest. At the same time, it is possible to wear corsets and orthopedic belts, which should be used only before dynamic or static load on the inflamed area. Do not use restraints for more than 4 hours in a row.
During the acute period, one should refuse to lift weights, from work in conditions of increased vibration, from prolonged stay in static positions. If this is not possible, then such activities should be kept to a minimum.
When the patient and the doctor consider it possible to start using physiotherapy exercises for pain relief, this is only welcome. During the first two weeks, you should go hiking, exercise on a stationary bike, visit the pool. You should switch to more active exercises after the acute period of the disease has passed.
How to treat protrusion after relieving an exacerbation?
After the end of the acute period, treatment of the protrusion of the lumbar disc should be continued, since the relief of pain does not mean the patient's recovery. Basic therapy consists of the following points:
Medication correction. To treat protrusion of the intervertebral disc, chondroprotective drugs are used. The main active ingredients in them are Glucosamine and Chondroitin sulfate. It is possible to use drugs both in the form of external ointments and creams, and their internal intake in the form of tablets. Sometimes the doctor prescribes intramuscular injection of chondroprotectors. Combined preparations containing two main active ingredients are: Artra, Teraflex and Artrozan. They are the last, third generation chondroprotectors. It should be noted that the maximum effectiveness of treatment with chondroprotectors can be obtained only at the initial stages of the development of the disease.
To restore nutrition and to improve metabolic processes in the damaged disc, as well as to normalize its blood supply, it is possible to use biogenic stimulants. It is vitreous and aloe extract.
It is possible to take vitamin and mineral complexes with an emphasis on B vitamins.
To reduce the intensity of the pain syndrome, which is not relieved by taking NSAIDs, local administration of corticosteroids and local anesthetics in the form of paravertebral blockades is prescribed. This allows you to relieve pain, and therefore, remove tonic muscle tension. Novocaine, Lidocaine, Trimecaine can be used as local anesthetics. As glucocorticoids: Dexamethasone, Hydrocortisone, Kenalog, etc.
Manual therapy, osteopathic treatment and spinal traction, massage. Manual therapy can become a full-fledged replacement for spinal traction only if the patient visits an experienced chiropractor. If the specialist does not have the proper qualifications, then his services should be abandoned, since there is a high risk of complications.
Osteopathic treatment of spinal disc protrusion is reduced to the use of such techniques as: vibration, kneading, stretching, inhibition, effluent. Osteopathy is on a par with manual therapy, so the choice of a specialist should be approached no less responsibly.
Spinal traction or traction therapy allows you to increase the distance between the vertebrae, eliminate compression of the spinal roots, reduce the load on the damaged disc, and relieve its pressure on adjacent tissues. The intervertebral gap increases by only a few millimeters, however, this is enough to eliminate protrusion and eliminate its symptoms. Dry and underwater traction of the spine is possible. The second method is preferable for disc protrusion. Before deciding on the procedure, you must familiarize yourself with its contraindications, including: congenital anomalies of the spine, fractures, osteoporosis, pregnancy, etc.
Massage is an auxiliary method of treating disc protrusion and well complements the complex of physiotherapy exercises. It is important to get an appointment with a masseur who knows how to treat protrusion and has the appropriate documents confirming his qualifications.
Reflexology, physiotherapy. Reflexology and physiotherapy are prescribed by the attending physician, who will select a set of optimal procedures for a particular patient. These can be techniques such as: phonophoresis using hydrocortisone, UHF, electrophoresis, electrical stimulation, mud therapy.
Implementation of exercise therapy complexes. Physical therapy is of the utmost importance in the treatment of intervertebral hernia. Thanks to a well-chosen complex, it is possible to achieve traction of the spinal column, strengthen the muscles surrounding it, and increase the blood supply to the damaged disc.
Exercise is important to do on a regular basis. Only in this way will it be possible to make the muscles that hold the spine strong, exclude the recurrence of protrusion and prevent it from appearing in other parts.
Return to an active lifestyle. From a doctor, a person should learn not only how to treat protrusion of the spine, but also learn how to live with this pathology. For this, the patient, first of all, needs to correctly organize a sleeping place. The mattress should be semi-rigid and orthopedic. You can refuse to use a pillow.
It is important to avoid stress on the spine, especially with the spine bent (or tilted) forward. For example, if a person has to lift a weight, you need to sit down, pick it up and rise with a straight back. You need to get out of bed with an emphasis on your hands, first lowering your feet to the floor. These and other techniques will prevent recurrence and progression of protrusion of the spinal disc.
A person should give up hard work, prevent hypothermia of the body. It is important to avoid overwork and stressful situations.
Meals should be high in calories with a sufficient daily intake of proteins and polyunsaturated fatty acids. It is important to monitor your own weight and prevent the development of obesity. It is also necessary to observe an adequate drinking regime.
A person should exclude hypodynamia from his life. Sports should be regular, but not injuring the spinal column.
Surgical treatment of spinal disc protrusion
The decision on the need for surgery is made by the doctor and the patient together. As a rule, in 90% of cases, even minimally invasive techniques can be abandoned. The operation is recommended only if conservative treatment is inconsistent for 8-16 weeks, as well as if it is impossible to stop the pain syndrome using other methods.
The least invasive surgical technique is nucleoplasty or percutaneous discectomy. This technique is used provided that the integrity of the annulus fibrosus and the posterior longitudinal ligament is preserved.
Under the control of X-ray equipment, a cannula is inserted into the disc, through which a cold plasma electrode or a laser is passed to it. With their help, a small part of the nucleus pulposus is destroyed. The pressure inside the disc drops, and due to the tension of the annulus fibrosus and the posterior longitudinal ligament, the protrusion is retracted.
The operation is not complicated and if the necessary equipment is available, it can be performed on an outpatient basis. After the intervention on the spine, the patient will need to gradually, but systematically increase physical activity, and during the recovery period, start performing exercise therapy.
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".
