What is a Herniated Disc? Diagnosis and Treatment

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What is a Herniated Disc?

Lumbar hernia, briefly, refers to a problem with the elastic structures (disks) between the vertebrae and forming our spine.

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Ingredients

A normal disk has a soft jelly-like centre, a core enclosed in a harder and more rubbery outer ring. In what has been termed a slipped disc or ruptured disc, a portion of the nucleus protrudes through a tear, resulting in a herniated disc.

A herniated disc, which can occur anywhere in the spine, can press and irritate a nearby nerve. Depending on where in our spine, a herniated disc can cause pain, numbness, or weakness in an arm or leg.

Many people have no symptoms from a herniated disc. Surgery is not usually necessary to correct the problem.

Lumbar Hernia Complaints

Most of the hernias can occur in the neck as well as in the waist. Complaints and findings depend on where the hernia develops and whether the disc is pressing on any nerve. And they usually affect one side of the body.

Arm or leg pain: If the herniated disc is in the lower back, the most pain is usually in the hips, thighs, and calves. There may also be pain in one part of the foot. If the herniated disc is in the neck, the most pain is usually felt in the shoulder and arm. This pain can radiate into the arm or leg when coughing, sneezing, or moving in certain positions. The pain is often described as sharp, burning, or stabbing.

Numbness or tingling: In people with a herniated disc, it can cause numbness or tingling in whichever part of our body the nerves under pressure control.

Weakness: the muscles directed by the nerves under pressure tend to weaken. This can cause you to stumble while walking or affect your ability to lift or hold objects. In rare cases, you may have a herniated disc without any symptoms. You may not know you have it unless it appears on radiological imaging.

Causes of Lumbar Hernia

Disc herniation is predominantly the result of gradual, aging wear and tear called disc degeneration.

As you get older or due to constant strain, your discs become less flexible.

Most people cannot pinpoint the cause of their herniated discs.

In some cases, instead of getting support from the leg and thigh muscles to lift heavy things, getting support from the lower back muscles, bending and turning while lifting can cause disc herniation.

Rarely, a traumatic event such as a fall or a blow to the back can also be the cause.

Risk Factors of Lumbar Hernia

Weight: Excess body weight puts extra strain on the discs in your lower back.
Profession: People who do physically heavy work have a higher risk of back problems. Repetitive lifting, pulling, pushing, and bending over can also increase your risk of herniated disc.
Genetics: In some people, the formation of herniated disc may be caused by defects in the genes.
Smoking: Smoking is thought to reduce the oxygen supply to the disc, causing the disc to break down more quickly.

Serious Consequences of Lumbar Hernia

Just above our waist, our spinal cord ends. Nerve community resembling a horse's tail, which we call the cauda equina, continues along the spinal canal after the spinal cord. And as the burdened nerves go to our legs, they also carry the nerves that control our urine and bowel movements.

Disc herniation rarely causes compression of the entire spinal canal, including all nerves of the cauda equina. In rare cases, emergency surgery may be required to avoid permanent weakness or paralysis.

In the following cases, immediate medical attention and emergency surgery are required.

Worsening complaints: Pain, numbness or weakness in the legs, increasing enough to interfere with your daily activities.
Urinary and stool problems: Cauda equina syndrome can cause urinary incontinence or difficulty urinating or incontinence even with a full bladder.
Severe numbness: This progressive loss of sensation in the inner thighs, back of the legs, and the area around the rectum.

When Should I Apply for a Doctorate?

If your back has been hurting for a long time and is spreading to your leg and you have the complaints I have explained above, you are likely to have a herniated disc.

You can apply to the nearest neurosurgeon. A good history, physical examination and X-ray, computerized tomography or MRI as determined by your doctor are essential. A definitive diagnosis can be made after the necessary imaging radiographs.

For the diagnosis of herniated disc, the first thing to be said is; Not every back pain is a herniated disc. There are 4 structures that can cause low back pain.

Muscles,
Facet joint,
Disk structure
Nerves.

Sudden low back pain is usually related to muscle spasm and joint. If the pain lasts for more than 6 weeks and occurs only in the lumbar region, it is usually caused by the disc or joint. If these pains are accompanied by leg pain, they are of nerve origin, then you may suspect a hernia. This can only be considered if the leg pain is persistent.

The way to be followed after the diagnosis of lumbar hernia.

1- Medical Treatment

First of all, drugs such as painkillers and muscle relaxants can be used orally or in the form of injections from the hip, depending on the patient's complaints. In most patients, significant improvement can be observed 3-10 days after this medical treatment.

2- Physiotherapy

Most lumbar hernias can be treated with physical therapy. More than 90% of herniated discs can be treated with properly planned physical therapy.

3- Pain Treatment

In some patients, the pain may be persistent. It is a form of treatment accompanied by an imaging device when medical and physical therapy is insufficient, alone or in combination with other treatments, provided that it directly targets the source of the pain. Its effectiveness is very high and certain drugs are made.

4- Surgery

If your back and leg pain does not go away despite all the treatments.
There is a loss of strength in the muscle group connected to the nerve that the disc presses on and if it is progressive
Sudden unilateral or bilateral foot drop (drop foot)
Sudden incontinence or inability to pass urine and feces
In such cases, surgery is required.

How Is Back Hernia Surgery Performed?

Surgery in lumbar hernia When the surgery is decided for the treatment of lumbar hernia, the operation is planned according to the patient's condition, the physician's knowledge and the location of the hernia.

Lumbar hernia surgery is performed with microdiscectomy, a method accepted as the gold standard by the whole world, unless the patient's condition is very different. In the operation performed by opening a small incision and entering the region of the hernia at the back of the body, the part of the disc pressing on the nerves or spinal cord is cut and removed.

With this surgery, which is much easier and more comfortable than the old methods, the leg pain caused by the patient's lumbar hernia is instantly relieved. The patient starts eating and drinking activities after the 3rd hour of the surgery. The patient is carried out three hours after surgery.

After the surgery, some pain and numbness in the leg may occur in the area where the surgery was performed. These pass over time. There will be no trace of your old pains. You can start walking within a week.

If you work at a desk, you can return to work within 10 days. What we want from patients is to rest themselves. Illnesses are usually caused by work stress and not being able to spare enough time for themselves. At the end of the 20th day, patients can start exercises to strengthen the waist and abdomen.

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What is a Herniated Disc? Diagnosis and Treatment