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Herniated Disc (Lumbar Disc Hernia)

The spine consists of bones called ‘vertebrae‘, which are arranged on top of each other. In the middle of each vertebral body is the spinal cord, which is the continuation of the brain. The senses that return to the brain from various parts of the body or the orders that are dispersed from the brain to the body run in the spinal cord. The nerves that emerge from each vertebral body in the lumbar region also spread to the hip and leg, providing the sensation and movement of these regions. These bones, called vertebrae, are connected to each other by flexible structures called ‘discs’, which have elastic properties.

Over time, these flexible structures, that is, discs, fray out and lose their elasticity. As such, this disc is protruding backwards with traumas or loads. In other words, this disease occurs as a result of the internal part of the discs in the consistency of gelatin tearing the outer part consisting of a stronger connective tissue and pressing on the spinal cord and nerves.

Herniated disc is a pathological process that occurs as a result of herniation of the intervertebral disc(s) in the lumbar region. Depending on the movement and loading of the vertebra, 95% of hernias are seen at the L4-L5 level of the spine, while the second most common is the L3-L4 level, and the incidence continues to decrease towards the proximal. The most obvious symptom of herniated disc is low back and leg pain. The pain that occurs in the form of sciatica may be severe enough to prevent movements such as walking, standing, and sitting.

Herniated disc may also develop into paravertebral muscle spasm, a picture of severe symptoms such as lower extremity hypoesthesia and force defects. The incidence of herniated disc between the ages of 30-50 is increasing; the incidence rate after the age of 60 is decreasing, and it is rarely seen in childhood. The fact that herniated disc is characterized by frequent and severe symptoms, especially in the middle age, working population brings along social and economic problems.

What Are The Symptoms of Herniated Disc?

The most obvious symptom of herniated disc is low back and leg pain. Patients express a localized blunt pain, especially in the lumbar region. This pain is often not very uncomfortable and increases with prolonged standing and movement, decreasing with rest.

Pain spreading to the leg may develop in accordance with the anatomical distribution of the affected nerve root and the excess of the pressure, and this pain is sometimes severe enough to prevent movement. The sudden deterioration of the table can be due to a trauma, sudden movement or heavy lifting, or it can start suddenly without any reason. It may cause compression and stiffness in the waist and leg.

What Are The Risk Factors of Herniated Disc?

The main factors causing herniated disc can be listed as age, gender, obesity, smoking, sedentary lifestyle, heavy physical activity, traumatic accidents, work and occupational factors.
The incidence of herniated disc is generally high between the ages of 30 and 50, which is considered productive age.

Although there is literature information indicating that male gender is considered as a risk factor and the frequency of surgery due to herniated disc is two times higher in men than in women, so gender is not generally considered as a risk factor.

In the literature, it is stated that obesity is an important risk factor in the formation of herniated disc due to its load-increasing effect on the spine. Smoking negatively affects the oxygen carrying capacity of hemoglobin and the associated oxygenation problem in the discs are among the factors causing herniated disc.

Sedentary life, exposure to repetitive vibrational effects, working in jobs that require standing or sitting for a long time, weekly working days, daily working hours, physically intensive working are reported as factors associated with herniated disc.

What Are The Treatment Methods In Herniated Disc?

Physiotherapy, along with medical treatment, constitutes the first step of conservative treatment. In extremely painful cases, bed rest for 3-4 days may be recommended. Exercises for walking, abdominal muscles, gluteal region and leg muscles can be planned to be strengthening and stretching.
Patients need to be trained and especially taught to avoid movements that will increase intervertebral disc pressure. Since medical treatment will increase physiotherapy tolerance and patient comfort, it is recommended to use the treatment simultaneously.

First of all, nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation and edema. Opoid analgesics can provide symptomatic relief in myorelaxants.
Surgical treatment

Surgical treatment progressive motor deficit and cauda equina syndrome are considered as indications for emergency surgery. In addition, the presence of persistent pain that does not improve despite 4-6 weeks of conservative treatment and the detection of progressive neurological deficit during follow-up constitute indications for surgery.

The necessity of surgery is inevitable, especially if the neurological deficit includes motor losses. Different methods such as laminectomy, discectomy, foraminotomy and spinal fusion are preferred according to the pathological condition of the disc.

Open standard surgery can be performed in herniated disc surgery, as well as techniques requiring less invasive intervention such as microdiscectomy and endoscopic microdiscectomy in parallel with technological developments.

In procedures performed with invasive methods, the duration of surgery is short, tissue trauma and blood loss are less, and recovery and discharge take place earlier. Due to such advantages, invasive methods are accepted as the gold standard in the surgical treatment of herniated disc.

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