Experts from the Department of Neurosurgery of Memorial Hospital gave information about ları Causes and treatment methods of lumbar hernia Memorial.
1.Who is a hernia?
80% of adults complain of low back pain at least once in their lives . Lumbar hernia, usually 30 to 60 years of age in the adult group, although it can occur at almost any age can occur. The risk factors that may cause lumbar hernia rather than a group of lumbar hernia should be mentioned.
2. What are the risk factors?
Obesity: Overweight is the most common cause of lumbar hernia. Our body’s weight is our backbone. Excessive pressure of the discs that provide the flexibility of the spine and serve as a kind of support cushion leads to deformation and distortion. The herniated disc, which has lost its normal shape and is outwardly, causes different signs and symptoms by affecting the functions of the nerve. In pregnancy, the displacement of the body’s center of gravity causes additional burden on the spine.
Inactivity: It is not only our spine that carries the burden of our bodies. The function of the neck, back and waist muscles and abdominal muscles extending along the spine is very important. Because the muscles are not strong enough, the body weight that the muscles need to carry is an additional burden on the spine. This load causes the discs to herniate on the discs.
Smoking: Smoking is reported to increase disc degeneration and slow down healing.
Not to act in accordance with the physiology of the spine in everyday life:In our daily life, we should be aware of the physiology of the spine in a series of movements, such as lifting loads, pushing objects and pulling. When lifting a load from the ground, the knees must be crouched and the load must be removed. Care should be taken when lifting the load on the shoulder (such as laundry, hanging, etc.). During daily operation, it should be seated at a desk, in a fully upright position and the chair should be selected to support the waist recess. In cases where the chair is not suitable, an additional cushion to support the waist indentation will do the same. When you get out of bed suddenly by placing the load should be avoided. First side turn,
Occupational factors: Heavy physical activity and heavy lifting occupations. (Ex: Workers in construction), Continuous bending, tilting professions, Professions that constantly vibrate the body, such as cars, buses, trucks, occupations, Professions requiring long standing or sitting, People in football, weightlifting, rowing and wrestling. The incidence of low back painand lumbar hernia is increasing.
3. How to protect from lumbar hernia? What are the risky positions and movements?
Removing objects on the ground without leaning on the knees, pushing and pulling heavy objects without breaking the knees, lifting the load on the shoulder and reaching upwards, working without lumbar support for a long time at the table, carrying heavy loads over long distances, are the events that invite the hernia. Regular exercise in the same way is also very useful in the prevention of lumbar hernia. In spite of all precautions, it can develop herniated disc. In this case, refer to the recommendations of a brain and nerve surgeon.
4. Is each low back pain herniated disc? Every herniated disc requires surgery?
Only 3% of low back pain is due to the herniated hernias. Therefore, the first recommended bed rest and the use of pain relievers and muscle relaxants according to the examination of the physician and the results of the investigations. In spite of these measures, pain and pain in the legs and muscle weakness in the solution does not pass the surgery.
5. Is the rest of bed comfortable? Which position is suitable to sleep?
A suggestion that comes to the taboo at rest is the hard bed recommendation. Hard bed refers to the use of mattresses that cannot take shape and take shape. Today, many bed brands produced in the commercial market meet this need. Therefore, it is not necessary to create a particularly stiff ground for resting purposes. The patient’s comfortable position is the best lying position, especially when the knees are broken and a pillow is placed together, reducing the pain.
6. What are the symptoms of hernia?
Pain in one or both legs, numbness in the feet, movement limitation, difficulty in walking and sitting are signs of lumbar hernia. Symptoms such as impotence, fatigue, incontinence, and inability to walk may also be added if the herniated disc progresses.
7. How to diagnose the diagnosis of hernia?
Magnetic resonance (MR) is one of the modern diagnostic methods of today. EMG (Nerve measurement test) is also required in some cases. However, the gold standard for the diagnosis of lumbar hernia; clinical examination and observation of the physician.
8. How to treat hernia?
a) Inception Phase: The treatment of lumbar disc hernia depends on the degree of herniation, ie the pressure of the elastic material called the disc on the nerves leading to the leg. If only waist and leg pain is present, there is no lethargy, no power loss, no limitation of movement. In this case, the patient should be given muscle relaxant medications, bed rest and waist movements to avoid the waist is recommended. Recommendations to be made to the patient are:
- The patient should never remove the weights exceeding two kilograms.
- Bending forward and sideways, bending of the waist is prohibited. If something is to be taken from the floor, the patient is told to take a squat.
- Patients are advised to place a cushion on the back of the back of the waist to destroy the waist cavity and not sit more than twenty minutes. If the patient has to sit for a long time due to his or her occupation, it is recommended to walk every 20 minutes.
- The patient is forbidden to reach upwards. If he is going to get something from above, he is told to step on a chair or a ladder.
- The patient is reminded to keep the waist always warm, not to stand in front of the open window or ventilation.
- Patients with lower back and leg pain should avoid stress. Stress may cause pain to increase, as well as to increase the pain of the lumbar disc herniation.
- Bed rest is recommended for the patient during his stay in the house. Contrary to what is believed, very hard floors are more damaging. It is better to sleep in a quality spring bed and in the most comfortable position of the patient.
b) If the lumbar hernia advances:If the patient’s symptoms persist despite the above recommendations, rest and muscle relaxant medications, physical therapy may be used. Physical therapy must be under the supervision of a specialist. During the first few days of physical therapy, the pain may be increased, but the patient should continue the treatment as long as the physical therapist recommends. If, despite all treatment, the patient’s pain does not exceed the nucleoplasty method.
Nucleoplasty has not reached the advanced level of hernia herniated disc with a needle under the x-ray entering the radiofrequency waves of the disc heating, disc inside the disc and the disc inside the disc open the spaces of hernia collapse is based on. Nucleoplasty is performed as a single session, under local anesthesia, in the operating room conditions without sleep and is a method applied without hospitalization. There is no risk, but there is no guarantee that the hernia is completely destroyed, and the percentage of success is not very high. Laser discectomy is a method similar to nucleoplasty.
c) Surgical Conditions: If the patient’s pain persists despite physical therapy or if there is unreserved power loss, leg thinning, urinary incontinence, irresistible pain or if a piece of disc is detected in MR films, the solution is surgical intervention. mechanical pressure on the nerves coming from the spinal cord must be removed surgically. If surgery is not performed and the nerve continues to press, the patient may develop problems such as incontinence, loss of sexual power, and weakness in the feet. Unfortunately, if I operate in the public, I become crippled, I cannot get out of bed for a long time, I have to wear a corset, or there are beliefs such as hernia and hernia. But thanks to microsurgery, there is no need for such fears.
9. How is surgical treatment?
The purpose of lumbar hernia surgery is cleaning the herniated disc and removing the pressure on the nerve.
Open discectomy: It is usually performed under general anesthesia. The patient is performed in the prone position. Application is made on an approximately 3-5 cm incision opened in the skin above the hernia site. Muscle tissue is stripped from the bones on the affected disc, with the surgical instrument called the retractor, it removes the muscle and the skin from the surgical site and can see the surgeon, spine and disc. Bones and ligaments can be eliminated in order to have a better view so that access to the disrupted disc is blown up without damaging the nerve root. The surgeon disc and other surrounding structures are removed from the disc parts protruding from the disc wall. This is not a very preferred method.
Mikrodiscectomy:This procedure is usually performed under an area of regional anesthesia with Epidural Anesthesia or general anesthesia with an operation microscope and the surgical area is under 20 to 40 magnification. A smaller incision is made (about 1-1.5 cm), the muscle tissue is less peeled and provides better vision. This causes the patient’s postoperative period to be more comfortable and painless. Less muscle tissue to do surgery by performing surgery, muscle spasm and less pain to take after. Microscope used in the surgery, allowing the diagnosis of large, 3D and very detailed recognition reduces the likelihood of complications. Vessels, nerves and disc are seen much more clearly, The possibility of damaging tissues such as veins and nerves is very low, The disc with pressure effect under the microscope is safer to clean.
Endoscopic lumbar hernia surgery: The waist area is done by entering from the middle line or from the side. A smaller skin incision is used in other endoscopic procedures. Endoscopic lumbar disc herniation is performed with the help of a 4 mm endoscope inserted into the herniated disc space from a 1 cm incision. Surgery can be performed under local and epidural anesthesia. However, it is not possible to operate every hernia with this method.
Correct Misconceptions About Lumbar Herniated Disability
Every day, thousands of patients are referred to physicians with complaints of lumbar or leg pain, which may be a harbinger of lumbar hernia. As the world such complaints are also common in Turkey in a way that affects people’s family and social life, sometimes weeks can connect the patient to the bed. Successful results can be obtained when correct discontinuance and correct treatment are applied to the right patients in the treatment of recurrent disc herniation of the disc between the vertebrates and relapse of the nerves and spinal cord in this region. However, common hernia cases frequently come from headache information and may cause misleading instructions. Incorrect information obtained without consulting the physician may cause permanent damage to the body.
”Surgery is the last resort in herniated disc or spine.“
No. Contrary to popular belief, surgery may be the first choice in some cases. Especially if the patient is complaining about severe pain, loss of strength in the feet and urinary incontinence, surgery can be preferred.
”Lumbar hernia and calcification operations are very risky operations.“
No. The risk rate is reduced to a minimum with the new methods applied today. Microdiscectomy and microsurgical methods, ie, operations performed using a microscope, the chance of success is around 95%.
Alı The risk of relapse after surgery is high. “
No. If the patients are rested after the surgery, the weight adjustment is made, and the regular exercises and correct training are given, the relapse rate of the disease falls below 5%. Lumbar hernia is a degenerative disease of the spine. Therefore, no matter what method of treatment, risk factors should be reduced and life should be adjusted accordingly.
Yaş After a hernia surgery, the patient can continue his work life. “
No. If a person adopts the lifestyle that must be followed during the treatment, he or she may return to the beginning of his / her work and continue this activity as much as he wishes.
”Lumbar hernia surgery negatively affects sexual functions.“
No. These surgeries have no negative effects on sexual functions. However, in patients who have delayed and developed paralysis in their feet, the pre-operative problems may not be corrected.
”Physical therapy and exercise can completely destroy the hernia.“
No. Physical therapy and other methods cannot restore the original tissue. The purpose of such treatments is to strengthen the muscles and joints and distribute the body load.
”It is possible to heal with lumbar massage and waist pull.“
No. These methods can be used in physical therapy, but according to each patient, it should be performed according to different applications and under physician supervision. These types of treatment attempts by unqualified persons carry a high risk. Such misapplications can result in disability.
”Spine problems are related to being weak or overweight.“