Treatment of intervertebral hernia (lumbosacral spine). Surgery to remove the intervertebral hernia

Problems with the spine bother many people. Some people, because of hard work, develop a condition such as the intervertebral hernia of the lumbosacral spine.

What is it?

Intervertebral hernia is usually called a serious condition, in which the intervertebral disc moves from the plane of the spine. Most often, this condition develops as a result of the excessive burden on the spinal column.

Suffer from this disease mainly men between the ages of 20 to 50 years.

The incidence of this disease is about 100 cases per 100,000 population per year.

Most of these hernias appear due to physical overload of the spine as a result of labor. Possible manifestation of traumatic hernia after surgery on the spinal column or as a result of the lesion. Rarely, but there are congenital hernia of the spine.

In elderly people there are cases of development of hernias on the background of physiological weakness of the ligaments of the spine.

The most common is the intervertebral hernia of the lumbosacral spine, since the lower back is the most vulnerable place for the development of this disease.

Pathogenesis of hernia development

Under the influence of a high load on the spinal column, the intervertebral disc is gradually compressed. Because of this, the rim of the outer rim (outer fibrous ring) most often ruptures, after which the contents of the intervertebral disk exit outward.

The released pulpous nucleus can be displaced both inside the spinal canal, and in the sides from it. In the first case, infringement of the spinal cord develops, which can lead to irreversible consequences. In the second case, the radicular syndrome may develop due to compression of nerves emerging from the spinal cord. In the area of compression, aseptic inflammation develops, there is swelling of surrounding tissues, which further worsens the situation.

As a result, the intervertebral hernia is characterized by the symptoms of radicular syndrome (pain, sensitivity disorders and limb function). Over time, mobility in the spinal column is impaired.

Apparently, the place where the intervertebral hernia most often arises is the lumbosacral department. Treatment should be assigned as soon as the disk offset is diagnosed.

Treatment

In any case, immediately begin treatment of the intervertebral hernia. The lumbosacral spine performs an extremely important function of the body - maintaining the balance and overlying organs in an upright position. With the development of a hernia in the lumbar region, this function becomes much more difficult due to the intense pain syndrome that develops when the nerves are compressed. The condition is aggravated by the inopportune treatment to doctors.

When the first symptoms appear, immediately begin treatment of the intervertebral hernia. The lumbosacral spine responds well to such non-medicamentous methods as the use of orthopedic mattresses, massage, the use of cold compresses. These methods have a purely symptomatic orientation (to ease the patient's condition) and can only be used for some time to avoid complications of the hernia. With aggravation of the condition, it is desirable to immediately make an appointment with a neurologist.

Drug therapy

If nevertheless the intervertebral hernia has developed, how to treat it so as not to harm its organism? To do this, use anti-inflammatory drugs from the group of non-steroid agents. Most common were ointments, gels and creams. They usually contain "Diclofenac" ("Rumakar", "Diclobert"), "Indomethacin" ("Metindol", "Rumacid"). Concentration of drugs in these drugs allows you to remove intense pain syndrome and inflammation (however, taking the same dose of drugs inside may not have the proper effect, and also contribute to the development of a stomach ulcer or 12 duodenal ulcer).

It is possible to combine non-steroidal anti-inflammatory drugs with glucocorticoids.

Glucocorticoids are administered either intravenously or intravenously for the quickest possible effect. Used drugs such as Prednisolone and Dexamethasone. Treatment with glucocorticoids should be prescribed only if the NSAID is ineffective, as long-term admission corticosteroids bring the body more harm than good.

Physiotherapy in the treatment of herniated vertebral column

In second place in terms of frequency of use is physiotherapeutic treatment of the intervertebral hernia. The lumbosacral spine is one of the most accessible departments of the musculoskeletal system for the use of various apparatuses.

According to many experts, physiotherapy can contribute to a faster recovery, than with the use of medications.

Currently, the most effective method of treating intervertebral hernias is the use of multifunctional electrodes. The essence of this technique is the interruption of incoming pain impulses by means of radio-frequency waves.

Of the more well-known methods, electrophoresis with analgesics, therapeutic baths, and laser therapy are often used. Electrophoresis and phonophoresis allow the delivery of drugs directly to the spine. The effect is often noticeable after several procedures.

Relaxing hot baths in some cases can contribute to the spontaneous retention of the hernia in place.

If there is a worsening of the condition, despite the measures taken, the intervertebral hernia disease has become more complicated. How to treat it in this situation?

Surgical treatment of intervertebral hernia

If the conservative treatment used is ineffective or if severe neurologic symptoms (paralysis of the limb, urination and defecation, paresis, paresthesia, intense pain syndrome, pain on the posterior surface of the lower extremities) appear, surgical treatment should be started immediately.

Indications for emergency treatment are infringement of a spinal cord, compression of vessels passing or taking place nearby.

Treatment is carried out mainly in specialized surgical departments (most often in neurosurgery).

Among the methods of treatment used are two main groups - endoscopic surgery and traditional microsurgery.

Depending on how the disease proceeds, determine the tactics of operational access.

Treatment is mandatory under general anesthesia and with the support of basic vital functions.

Microsurgical removal

Prior to the introduction of microscopes into medical practice, if surgical treatment of the intervertebral hernia was shown, the lumbosacral spine section was often subjected to various complications in the postoperative period (suppuration, relapse). The real revolution was the use of optical instruments in the treatment of hernias. This allowed to reduce the vastness of operational access, which significantly reduced the incidence of developing complications.

Most often, the intervertebral hernia of the sacral region is removed through a microscopic incision (a laminectomy is performed). Under a large increase, it is possible to gently remove the hernial protrusion without damaging a number of underlying tissues.

Activation of the patient is already on the following day. The patient is allowed daily to work in 10 days, and a month later he can already engage in manual work without the risk of complications.

Endoscopic operations

These operations to remove the intervertebral hernia are a relatively new direction in neurosurgery. Most often they are carried out through posterolateral endoscopic approaches. The advantages of these methods is even greater safety in creating an operating wound (sometimes a normal skin puncture is done). However, this is also the main disadvantage - in this case, the possibilities of complete excision of the hernia and its removal from the puncture zone are limited. Hard-to-access hernias, or hernias, accompanied by compression of the spinal cord, with the help of such operations are not removed.

The patient can already on the day when the operation was performed, go up, walk. Work is allowed about a week after discharge from the hospital.

Complications of hernias

Over time, if the hernia begins to squeeze nearby lying tissue, it is possible the development of complications.

If the usual hernia (intervertebral) has developed, the lumbosacral section does not completely lose its function, and the spinal cord is not affected. All worsens when the hernia is shifted towards the spinal canal.

The most dangerous of them is infringement of a spinal cord. In this case, the functions of urination and defecation are violated, which creates a threat to life (severe intoxication, rupture of the bladder, intestines and urethra). In addition, if the inflammation passes to the spinal cord, it is possible to damage the overlying areas with a violation of the functions of internal organs, up to a lethal outcome.

Another common complication of a hernia is the radicular syndrome. With prolonged existence significantly worsens the condition.

More favorable complications are reduced sensitivity and paresthesia.

Rehabilitation and prevention

For the development of a hernia takes some time (ie, conditionally it can be called a chronic disease). If the main recommendations are observed, its development can be prevented.

To prevent recurrence, after removal of the intervertebral hernia, the load should be adequately distributed during physical work. It is not worth overworking, because it can end badly.

Also for the prevention of hernias, physical exercises and exercises are recommended that strengthen the muscular back skeleton (for example, deadlift with reasonable loads).

With prolonged and severe work for prevention, it is recommended to take relaxing hot baths - they contribute to a small divergence of the vertebrae, which prevents the disc from infringing.

Rehabilitation after a previous hernia includes avoidance of exercise, physical therapy, massage and manual therapy or acupuncture sessions.