Foraminal herniation of intervertebral discs is fraught with rapid progression of the disease and pronounced pain that affects a person’s quality of life. In 4-10 cases out of a hundred in people diagnosed with intervertebral hernia, a violation of the integrity of the fibrous ring occurs in the area of ​​the foraminal opening. The spinal cord is located along the spine and is securely covered by the dura mater, from which two spinal nerves with a sensitive flexible root arise.

The bone bed is the foraminal opening in which the roots of the spinal nerves lie. It is formed in the lateral parts of the spine and is located between the articular processes of the vertebrae. The channel itself is 1.5 centimeters long. When the fibrous ring protrudes, creating pressure on it, compression of the endings occurs, as a result of which the brain receives an acute signal about the formation of pathology.

Foraminal hernias can occur in several places, and therefore four types of such protrusions are distinguished:

• Interforaminal or dorsal location - inside the hole;
• Foraminal medial - at the entrance between the vertebrae;
• Lateral – directly at the exit;
• Estraforaminal lateral - the protrusion is located outside the intervertebral foramen, or at the root of the vertebral arches.

Hernia pathologies are usually classified as left-sided or right-sided. They are also divided into cervical, thoracic and lumbar, depending on the location.

The complex structure of the musculoskeletal system sometimes malfunctions. Certain segments of the spine experience increased loads, as a result of which they begin to wear out. This can cause a crack to appear, which begins to irritate and pinch the roots.

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Among the main prerequisites for the formation of a hernia in the area of ​​the foraminal opening, leading to deformation of the fibrous ring, the following should be highlighted:

• Uneven distribution of load on the back skeleton during physical work or sports;
• Spinal injuries;
• Regularly staying in one position with a sedentary lifestyle;
• Poor nutrition, bad habits (smoking, alcohol abuse) and insufficient water consumption;
• Genetic predisposition due to mutation of collagen fibers that form the fibrous ring, which helps to reduce its strength;
• Age-related changes with worsening blood circulation and the appearance of protrusions;
• Excess weight, which creates additional stress on the vertebrae;
• Wearing uncomfortable shoes or flat feet.

Characteristic symptoms

Foraminal disc herniation differs from other similar pathologies in that during the development of the disease a person experiences sharp and very acute pain, since the nerve endings directly connected to the spinal cord are affected

Damage to the nerve roots in the neck

Cervical foraminal hernias are the least common. They are formed in discs c5, c6 and c7. They are manifested by headaches of varying intensity, dizziness, decreased hearing and vision (floaters before the eyes), muscle weakness, numbness of the fingers, as well as a feeling of discomfort in the affected area. Speech disturbances and changes in gait are rarely observed. Injuries to the neck that can lead to such pathologies may be the result of a direct blow (for example, injury from car accidents or during sudden immersion in water upside down).

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For pinched nerves in the lumbosacral region

The most common are protrusions in the lumbar and sacrolumbar spine, since it is in this area that the maximum load is created. Experts designate the areas of the back skeleton under consideration with the abbreviations l5-s1. Depending on which vertebrae there is a violation of the integrity of the area of ​​the fibrous ring, such a disease is accompanied by a digital designation. For example, a hernia l3-l4 is characterized by the presence of pathology in the lumbar region between the third and fourth vertebrae.

Among the symptoms, patients note:

• Sudden intense pain in the affected area, which can only be relieved, in some cases even with a narcotic drug. Changing body position does not bring relief;
• A sharp decrease in sensation in the legs. With protrusion, the patient cannot stand on his toes or heels. When the ring extends beyond the disc, complete immobilization of the lower extremities is possible;
• Decreased activity as a result of loss or weakening of tendon reflexes.

It should be noted that foraminal disc herniation has an acute onset and is poorly responsive to analgesic therapy. The pain does not stop for a long period. Conservative treatment methods are ineffective. Hernias l5-s1, l3-l4 and l4-l5 are eliminated exclusively by surgery.

Diagnostic methods

Only a highly qualified specialist can visually determine the presence of the disease after a thorough examination and interview of the patient. To confirm the diagnosis, the following diagnostic methods may be prescribed:

• Ultrasound and X-ray. These techniques make it possible to exclude the presence of concomitant spinal diseases. It is impossible to determine the size of the protrusion;
• MRI and CT. Computed tomography and magnetic resonance imaging allow you to see the damage in 3D format with an accurate assessment of the location, size of the hernial sac and the condition of the nerve endings.

MRI is considered to be the gold standard for diagnosis, since the patient is not exposed to X-rays, but the specialist can obtain complete information about the destruction of cartilage tissue, the localization of the site of swelling, the condition of the nerve roots, as a result of which further treatment is prescribed and a prognosis is made about the possible development and course of the disease.

Treatment

With such a diagnosis, there are two options for the development of events. For minor injuries, the patient may benefit from treatment with conservative methods. If such methods do not bring the expected effect, surgical intervention will be prescribed.

Conservative therapy

In the first stages, the patient will be offered conservative therapy, including analgesics and non-steroidal anti-inflammatory drugs. All medications will reduce muscle tension, relieve pain and swelling, and improve tissue nutrition in the damaged area. As an auxiliary therapy, the specialist will prescribe massages, consultation with a chiropractor and physical therapy.

All activities will be aimed at stretching the spine to release nerve endings and reduce the pain threshold. Wearing a special bandage helps. It is advisable to sleep on a hard surface. If possible, it is better to purchase an orthopedic mattress.

To reduce the size of the tumor, electrophoresis with injections of medications is used.

Surgery

Surgical intervention is indicated if one hundred days of traditional procedures have not brought significant relief, and the pain has become chronic. Surgery is also prescribed if the tumor is more than 10 mm in size and paralysis of the limbs is present.

The procedure is performed by neurosurgeons in a clinical setting. There are four intervention methods:

• Microdiscectomy. The intervertebral disc is removed, eliminating pressure on the nerve endings;
• Laminectomy. Sections of the intervertebral disc and part of the bone in the area of ​​the damaged area are eliminated;
• Interspinous spacers. The technique involves installing implants that help reduce pressure on the pinched roots;
• Transforminal endoscopy. It is carried out by puncture with the introduction of a needle and subsequent removal of a small part of the disc and sequestration. This allows you to restore the shock-absorbing functions of the vertebra with the elimination of pain.

Rehabilitation

After the procedures or surgery, the patient will need to undergo a course of rehabilitation aimed at restoring physical activity, strengthening the muscle corset and minimizing the risk of relapse. It is recommended to engage in physical therapy, visit the pool under the supervision of a trainer, reduce the time spent working at the computer, eliminate physical activity and driving for the first two months. You should not delay going to the doctor, since untimely treatment can lead to negative consequences, including paralysis of the limbs.

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Herniation is a serious disease of the spine. This pathology is dangerous with serious consequences. When a spinal disc is damaged, it becomes displaced and goes beyond its physiological boundaries. The spinal canal narrows, and the nerve roots and lining of the spinal cord are compressed. When surrounding tissues become inflamed, a person begins to experience discomfort. As the pathology develops, it causes severe pain in the area where the intervertebral hernia appears.

You can prevent complications and rid yourself of unpleasant symptoms. It will not be possible to identify the source and cause of pain on your own. Intervertebral hernias come in different types and sizes, and the indications for treatment of each case are individual. Only a doctor can prescribe the correct treatment.

Types of spinal hernias

All types of intervertebral hernias have been well studied by medicine, and effective methods of treatment and prevention have been found. By assessing the condition, a specialist can diagnose a herniation of several discs at once. The state of pathology is most often assessed by size. According to this criterion, hernias are classified into three types:

• Prolapse (protrusion of the hernia by 2-3 mm);
• Protrusion (protrusion from 5 to 15 mm);
• Extrusion (prolapse of the disc nucleus).

Of these types, disc protrusion is considered the most common pathology. The most dangerous is dorsal protrusion. It is characteristic of the lumbar region and is accompanied by compression of the spinal cord. At the slightest movement the pathology causes very severe pain. Such hernias can be treated, but only if you consult a doctor in a timely manner.
The variant of circular protrusion is dangerous due to dystrophic and degenerative processes in the spinal column. Sometimes the size of circular protrusions reaches a limit of 12 mm. If left untreated, neurological symptoms worsen and can lead to disability.
Median protrusion is rare. It is asymptomatic and provokes complications. By putting pressure on the spinal cord, the pathology can cause damage to the abdominal organs.
Protrusions of cervical discs provoke pain in the neck and shoulder area. With foraminal protrusion, the lumbosacral region may be affected, and the appearance of degenerative protrusion is associated with the formation of microcracks in the fibrous ring.
Types of spinal hernias are also classified by location. Hernias can occur in the cervical and thoracic regions, but the most vulnerable area of ​​the spine is the lumbar region.

Disc herniation l3, l4, l5, s1

The center of gravity is concentrated in the lumbar region, so it is in this area that the maximum load falls. In addition, the lumbar region is the most mobile area of ​​the spine. He is not characterized by a state of rest; he is constantly in action and almost “does not rest,” even when a person is sleeping. Such performance is rarely without consequences. The most serious and dangerous of them are intervertebral hernias. Such pathologies in the lumbar region used to be characteristic mainly of older people. Recently, more and more young people are among the patients of neurosurgeons.
Let us consider in detail the localization of lesions l3-l4, l4-l5, l4-s1, l5-s1. Why do pathologies appear, what symptoms are characteristic of them and how are diseases treated?

Localization of pathologies and typical symptoms of lumbar hernias

The intensity of symptoms may be associated with the primary disease that caused the hernia in the lumbar region. Education can be triggered by:

• • Hereditary predisposition;
  • Congenital anomalies;
  • Microelement imbalance that disrupts the nutrition of the intervertebral space;
  • Improper drinking regime (dehydration);

Each part of the spine is responsible for a specific muscle

• Obesity;
• Problems with blood vessels;
• Great physical activity;
• Spinal injuries.

When problems associated with protrusion of the intervertebral disc occur, symptoms manifest themselves in the form of lumbar pain, radiculitis, general weakness of the body, and numbness of the lower extremities. Severe forms of the disease may be accompanied by a disorder of the urinary system.
In case of pathological processes associated with the development of intervertebral disc herniation l3-l4, l4-l5, l4-s1, l5-s1, the patient is observed by a neurosurgeon. The disease requires constant monitoring of the condition and timely treatment. The disease manifests itself in different ways, the severity of symptoms is associated with the localization of the pathology, that is, the location of the damage.

Disc herniation l3-l4

This is a rare type of disc herniation. Damage to nerve fibers l3, l4 is characterized by pain in the lower abdomen, in the groin area, and inside the thigh. The sensitivity of the outer surface of the thigh is impaired, numbness, a slight burning sensation, and the appearance of “goosebumps” on the skin are possible.

Intervertebral hernia l4-l5

The most common type of hernia. Disks l4, l5 bear the maximum load. When the nerve is compressed, the patient feels pain in the first toe and foot. The sensitivity of these organs decreases and movement is limited.

Hernial formations l5-s1

This type of hernia is diagnosed frequently. The s1 nerve is compressed, causing weakness of the fingers, muscle pain, and numbness on the outer surface of the foot. A typical sign is the inability to stand on your toes.
Damage to the l4, l5, s1 nerve roots, which are part of the sciatic nerve, is usually characterized by pain in the thigh, foot and lower leg. It is difficult for the patient to bend his leg and move his fingers. The foot becomes cold, sometimes due to muscle atrophy it is difficult for the patient to control its movement.

Features of treatment of disc herniation l3, l4, l5, s1

The main symptom of intervertebral pathologies is pain. Its strength determines the treatment tactics. Sometimes the pain appears sporadically, during bending, sudden movements, prolonged sitting or standing. In any case, it is always discomfort and a violation of the usual way of life. Much has to be corrected, especially in advanced stages, when lack of treatment has caused complications. In these cases, surgery is prescribed. Surgeries to treat lumbar disc herniations are used in rare cases. Conservative methods are considered more effective. More than 70% of patients begin to feel improvement within two weeks. Full recovery occurs after six months, but only if the patient followed all the doctor’s recommendations.
At the first stage, as a rule, bed rest and medications are prescribed. Blockades of intervertebral hernia have proven their effectiveness. After the pain syndrome has been eliminated, massage, physiotherapy, therapeutic exercises, electrophoresis, phototherapy, etc. appear in terms of therapeutic measures. There are many new and effective treatment methods - laser therapy, acupuncture, shock wave therapy, etc.

Each person has a different reaction to pain. It depends on age and psychological state. In any case, pain always signals a health problem. Looking for the causes of the disease on your own is unwise and dangerous. It happens that diagnosis even for specialists causes difficulties. To understand the cause and identify the source of problems in the lumbar region, a whole range of studies is required. For final recovery, the patient's participation and responsibility are required. It is necessary to provide your doctor with the most complete description of your symptoms and follow all recommendations.

Article publication date: 06/03/2015

Article updated date: 11/08/2018

More than 50% of all cases of intervertebral hernia formation occur in the lumbar spine, and most often in its last segment, formed by the L4, L5 vertebrae and the disc between them. L4 L5 disc herniation accounts for 46% of the total number of occurrences of this pathology in the lumbosacral spine.

The color in the diagram highlights the area of ​​pain distribution when various intervertebral discs of the lumbar spine are affected

When a protrusion forms in this segment, there is a danger of compression (pinching) of the l5 nerve exiting at this level, and, as a consequence, disruption of the innervation of the limb on the affected side, a decrease in sensitivity and range of motion, and the development of muscle atrophy.

Disc herniation of the L4 L5 segment is the most dangerous of all types of intervertebral hernias. It can provoke disruption of the pelvic organs, limitation of motor function, and lead to partial or complete paralysis.

Symptoms of the pathology appear almost from the very beginning of the formation of a hernia: a person is tormented by aching and shooting pains in the lower back and leg, he constantly feels numbness in the lower leg and foot, the leg bends poorly at the knee, and the foot does not fully perform its functions when walking.

Some good news: the development of modern medicine makes it possible to get rid of the unpleasant symptoms of a L4 L5 disc herniation without resorting to surgery. And further adherence to the regime of physical activity and nutrition allows for 80% restoration of damaged tissue.

Causes of L4 L5 disc herniation

The lumbar vertebrae are much larger than other segments of the spine and wider in diameter than in height. This feature is explained by the heavy load that the lumbar region experiences continuously throughout the day. Having no supporting structures other than the muscular frame, the vertebrae of group L (Lumbar - lower back) take on the weight of the entire body, since the center of gravity falls on them. And at the same time, they allow the body to turn in different directions with a large amplitude.

Most of the severity is experienced by the last vertebral segment, consisting of the L4 L5 vertebrae and the disc between them. With a slight disturbance in the nutrition of the disc or a change in the structure of its tissues, strong pressure quickly completes the process of formation of an intervertebral hernia. Therefore, this part of the spine and specifically the L4 L5 disc is the most vulnerable place for the formation of pathology.

Forms and symptoms of the disease

L4 L5 disc herniation has several forms of manifestation, and each has its own symptoms.

There are also symptoms characteristic of any type of this hernia:

• increased pain when moving, defecating, eating;
• pain subsides when standing;
• autonomic disorders (increased sweating, increased dry skin, swelling of the ankles);
• severe pain in the lower back when trying to lift a straight leg while lying on your back, and immediate subsidence of pain when bending the knee of the raised leg.

Title and description	Symptoms
Foraminal hernia - the rupture of the fibrous ring is directed to the anterior part of the spine.	Pain only at the location of the hernia. Slight tingling when contracting the abdominal muscles (coughing, sneezing, laughing).
Paramedian hernia - a hernial protrusion protrudes from the left or right side, compressing the roots of the spinal cord.	Severe pain in the affected area, radiating to the buttock on the affected side. The pain quickly spreads to the lower leg and back of the thigh. Feeling of numbness in the leg.
Dorsal hernia - rupture of the fibrous ring occurs on the back side. The hernial protrusion is directed back towards the spinal cord. This is the most dangerous type of L4 L5 disc herniation due to its close proximity to the spinal cord. It not only compresses and injures the body of the spinal cord, but also causes many difficulties in treatment	Loss of sensation in the legs. Muscle weakness. Inability to control bowel movements and urination. Sexual dysfunction.
Medial hernia (Schmorl's hernia) - the development of a hernia occurs inside the vertebrae.	It is asymptomatic.

Treatment methods for hernia L4 L5

The choice of the correct treatment method for a L4 L5 disc herniation depends not only on the direction of the protrusion, but also on its size. That's why it is important to accurately establish all the parameters of the disease, which can be done with CT or MRI(conventional radiography provides insufficient information).

• A hernia up to 5 mm in size does not require hospitalization. The main method of treatment is special gymnastics and spinal traction therapy.
• Hernial protrusion up to 8 mm can easily be treated with conservative treatment, including drug therapy, gymnastics, massage and physiotherapy.
• A hernia up to 12 mm requires hospitalization in the acute period and strict bed rest until the pain syndrome is completely relieved. Further treatment is carried out on an outpatient basis.
  The operation is performed only if obvious symptoms of compression of the spinal cord or signs of a cauda equina appear (this is a complex of very severe symptoms in advanced pathology, including impaired urination, motor functions of the legs, etc.).
• If the hernia is larger than 12 mm, urgent surgery is indicated.

Conservative therapy

Of primary importance in the treatment of L4 L5 disc herniation is reducing the load on this area. Therefore, in the first days of treatment, strict bed rest is required to ensure rest for the spine in a horizontal position.

The next stage of conservative treatment includes drug therapy:

• analgesics,
• non-steroidal anti-inflammatory drugs,
• muscle relaxants,
• chondroprotectors,
• vitamins,
• glucocorticoids.

After pain relief, the following treatment methods are added:

• physiotherapy (treatment with short and long electric waves, electrophoresis, ultraviolet irradiation);
• classes in the pool;
• massage;
• therapeutic exercises.

A mandatory component of therapy is wearing a rigid support corset. During the first months, the corset is worn constantly, and later it is worn while performing work related to lifting weights.

Features of therapeutic exercises

Gymnastics takes a leading place in the treatment of L4 L5 disc herniation. Special exercises relieve pathological tension in the back muscles, strengthen them, helping to support a weakened spine.

The insidiousness of a L4 L5 disc herniation is the imbalance it causes in different muscle groups: one of them is tight and tense, while the other is relaxed. Only a physical therapy doctor can take into account all the nuances and correctly prescribe the necessary exercises. All classes must be carried out under his direct supervision. Self-training without the supervision of a specialist can only aggravate the situation and lead to nerve pinching.

The main rule for performing exercises when treating a hernia of this department is to exclude axial load on the spine: these are all types of exercises in which the main pressure is placed directly on the spine, that is, on the axis of the body (squats, bends, swings and lunges). All classes are carried out in a lying position or on special inclined simulators.

(if the table is not completely visible, scroll to the right)

An approximate set of physical exercises for disc herniation L4 L5. Consult your doctor before doing this.
Click on photo to enlarge

Surgical intervention

The main goal of the operation is to release the nerve roots or part of the spinal cord from pressure. Today, four methods of surgical intervention are practiced:

Microdiscectomy is the removal of the disc herniation itself with minimal intervention in the human body. The most effective method.

Endoscopic hernia removal. The operation is performed without incisions through small punctures using special instruments. The surgeon monitors his actions using a monitor.

Implantation. During the operation, the surgeon completely removes the damaged disc tissue and installs an artificial implant in its place.

Nucleoplasty is a direct impact on the core of a damaged disc with cold plasma pulses. Through a small puncture, an image intensifier (electron-optical converter) electrode is inserted into the core of the L4-L5 disc, through which pulses are supplied. As a result, the nuclear tissue is evaporated, the hernial protrusion is reduced and the compressed nerve root is released.

Surgical treatment allows you to quickly relieve pain and restore the conduction of nerve impulses, but there is a high risk of relapse of the disease, since the very cause of the hernia remains unresolved.

Alternative Methods

Completely getting rid of the symptoms of the disease, as well as eliminating the main cause of disc herniation, is possible only with an integrated approach to treatment, which includes the following treatment methods:

• Hirudotherapy (treatment with leeches);
• Ozone therapy (injections of ozone preparations into the affected areas);
• Homeosiniatry (injections of homeopathic medicines into biologically active points responsible for the condition of the affected tissue).

Forget about the disease

The modern approach to the treatment of L4 L5 disc herniation is time-tested techniques combined with innovative methods of therapy. In 90% of cases, surgery can be avoided, damaged tissues are restored, and if simple preventive measures are followed, the disease never appears again.

Owner and responsible for the site and content: Afinogenov Alexey.

Disc herniation l4 l5 is a disease that represents the protrusion of part of the intervertebral disc into the spinal column. 50% or more of all hernias occur in the lumbar spine, which is explained by the heavy load on this section. The medical nomenclature is as follows: the letter “l” means lumbar, lumbar. 4 and 5 are the serial numbers of the vertebrae.

A herniated disc l4 l5 means that the bulge is located between the fourth and fifth lumbar vertebrae.

The l5 hernia itself is not as dangerous as its consequences. The main threat is compression of part of the spinal cord and exiting nerve roots, which causes a certain clinical picture. It is believed that this hernia is the most dangerous among all spinal protrusions.

In a narrow sense, an intervertebral hernia is a pathology of the musculoskeletal system associated with partial migration of the central core of the intervertebral disc with subsequent rupture of the peripheral tissue of the ring.

Brief Anatomy of the Vertebrae and Disc

The lumbar spinal column contains 5 vertebrae connected to each other by an intervertebral disc. The 4th and 5th vertebrae are the last in the section, followed by the sacral section. The structures located between the vertebrae are called discs. They perform the function of pressure absorption, preventing the vertebrae from touching each other closely, protecting them from destruction.

The disk itself consists of an outer peripheral part and an inner central part. The periphery consists of the fibrous ring, and the inner part consists of the nucleus pulposus, which is filled with a gel-like liquid.

The spinal column itself consists of 34 vertebrae, in which in their center there is a long canal where the spinal cord lies. The peripheral part of the nervous system is extremely sensitive to all types of damage.

The actual hernia is formed when the peripheral part of the disc is destroyed, and the gel-like part of it passes through the crack. During the process of forming a bulge, the disc simply becomes wedged into the spinal cord, causing symptoms of damage.

At the physiological level, physical irritation of the nervous tissue occurs; nerve impulses are artificially created and sent in excessive quantities to a certain area of ​​the body.

Stages of formation

During its development, protrusion goes through four stages:

1. Protrusion stage. A small crack forms in the area of ​​the annulus fibrosus, through which part of the nucleus can pass. If at this time the influence of provoking factors is stopped, the “wound” will heal. At this time, the bulging diameter is up to 3 mm.
2. The second stage is disc protrusion. The nucleus pulposus begins to partially shift into the area of ​​the intervertebral canal. At this stage, the hernia is already beginning to compress the nerve roots and slightly the spinal cord. The muscles go into a state of spasm. Dimensions reach 5 mm.
3. Extrusion – increased protrusion of the disc. The outer shell of the disc ruptures. During this stage, the patient experiences severe pain in the lumbar region.
4. Loss of the central part of the disc - the nucleus. A full-fledged hernia is formed. Severe compression of the spinal cord and nerve fibers occurs. There is a possibility of developing inflammatory processes that can spread to the entire part of the peripheral nervous system. Gradually, the disc undergoes calcification - it hardens, completely losing its function.

Reasons for development

There are a number of factors influencing the formation of a hernia:

• a sedentary lifestyle, when a person’s back muscles weaken, atrophy and do not support the skeleton;
• inadequate loads on the back. This mainly applies to people whose lives are connected with hard work and professional sports;
• spinal diseases: scoliosis, kyphosis or lordosis. They are manifested by irregular bends to the side, back and forward, respectively;
• injury to the spine or individual vertebra: fracture, bruise, dislocation;
• excess body weight, when the load on the intervertebral disc increases significantly;
• people whose age ranges from 30 to 50 years. With age, the body's compensatory capabilities weaken, ligaments and muscles become depleted;
• genetic predisposition to weakness not only of the ligamentous system, but also of the musculoskeletal system and muscles.

Varieties

Hernia of the lumbar spine is famous for its great variability.

So, the following types are distinguished:

1. Median disc herniation l4 l5 . It is characterized by the median location of the protrusion relative to the central axis of the spinal cord.
2. Diffuse disc herniation l4 l5 . Its distinctive features: uneven distribution of the central part of the disc along the lumen of the spinal canal.
3. Foraminal disc herniation. This subtype is characterized by a specific location. The hernia grows at the site where the nerve roots exit the spinal cord. In clinical practice, symptoms of damage not so much to the spinal cord as to the branching roots predominate. Type: paraforaminal hernia - bilateral protrusion.
4. Paramedian disc herniation. It is characterized by a uniform distribution of hernial tissue relative to the center of the peripheral nervous system. Paramedian pathology can be left- or right-sided. One of the subtypes is median paramedian hernia.
5. Circular disc herniation is a herniated intervertebral disc, parts of which surround the spinal cord at the lumbar level.
6. Dorsal hernia . It is characterized by the direction of the protrusion towards the canal of the spinal column. The dorsal hernia is in close contact with the spinal cord.Dorsal disc herniation has a number of subtypes, including:

• dorsal diffuse disc herniation – uneven distribution of gel-like fluid behind the spinal cord; posterior diffuse disc herniation most often occurs against the background of degenerative bone diseases;
• dorsal median hernia located exactly behind the spinal cord along the central axis; posterior median hernia has a favorable course.

Clinical picture

Symptoms of hernia pathology appear already in the first stages of development. So, a person begins to feel pain in the lower back. The pain syndrome intensifies when the patient engages in physical labor and exercise.

There is a direct proportion: the larger the hernia, the more pronounced the pain.

In addition, the following signs are present:

• swelling in the lower back, shooting and aching pain;
• pain syndrome tends to spread to the pelvis and lower limbs, buttocks;
• all types of sensitivity are impaired: temperature, tactile; the patient complains that he perceives sensations worse;
• paresthesia in the form of numbness, tingling, and a sensation of goose bumps appearing on the skin;
• autonomic disorders: sudden cold or warming of the skin, excessive sweating;
• functional disorders of the pelvic organs: impaired urination, difficulty defecating; in men, libido decreases, erectile function is weakened, in women – birth defects;
• weakness when extending the foot.

Diagnostics

Instrumental diagnostic methods are of great importance in making a diagnosis.

Such as:

1. Magnetic resonance imaging.
2. CT scan.
3. X-ray diagnostics.
4. Myelography.

Based on the data after the procedures, a final diagnosis is made and treatment begins.

Treatment

Treatment of the disease is based on conservative treatment and surgery. The first type of treatment includes drug therapy and physical therapy.

Medicines include:

• painkillers;
• anti-inflammatory drugs;
• muscle relaxants;
• vitamin complexes;
• chondroprotectors.

All these substances are aimed at relieving pain, relaxing muscles, eliminating and preventing inflammatory processes. Also, drug therapy is intended to regenerate connective tissue and increase the nutrition of bone and cartilage tissue.

After doctors have relieved the pain, the stage of adding secondary treatment methods begins.

This includes:

• physiotherapy: treatment with long-wave radiation, the use of ultraviolet rays;
• activity in the pool;
• massage sessions, medical staff teaches the patient self-massage;
• physical therapy and gymnastics.

Gymnastics is designed to restore the patient’s muscle balance, which is achieved through a series of exercises prescribed by the attending physician. It is not recommended to do the exercises on your own. Therapeutic exercise involves stress on the abdominal muscles, push-ups.

Surgical treatment consists of eradicating the cause of the pathology.

Today, the following types of surgical intervention are relevant:

1. Microdiscectomy – removal of the protruding part of the disc. This is considered to be the most effective healing method.
2. Endoscopic intervention options . They are carried out through small punctures through which small tubes are inserted, with the help of which the surgeon removes the hernia.

Surgery has a number of advantages over conservative therapy:

• the operation is painless, the therapeutic effect occurs almost immediately, and the patient gets back on his feet within a few days;
• the patient quickly gets rid of suffering;
• the probability of relapse drops to 5%.

The disadvantages of the operation include the insignificant risk of infectious complications during the surgical intervention itself.

More than half of those diagnosed. Very often they occur in the space between the L4 and L5 vertebrae. More than 40% of all cases of disc herniation of the lumbar spine account for disc herniation of these vertebrae. In the case when a bulging of the tissues of the intervertebral disc is formed in this area, compression of the l5 nerve, which exits in this part, often occurs, dysfunction of the pelvic organs and lower extremities is provoked, their muscles atrophy, which leads to limited mobility or complete immobility and loss of performance, disability .

The symptoms of the disease are very pronounced, clearly noticeable already in the initial stages of the formation of a hernia: people complain that their lower limbs feel lumbago in this part of the body, it is difficult to bend the leg at the knee joint, pain spreads over the entire surface of the leg from the hip to the foot. The disease is more often diagnosed in adults. If you start treating the pathology in time, then there is a high probability that you will be able to limit yourself to conservative correction methods and do without surgery. Compliance with the doctor's recommendations regarding physical activity and diet makes it possible to almost completely restore the damaged area.

As a rule, it appears as a consequence of disc protrusion. With this pathology, the nucleus pulposus, the cartilage that is located between the vertebrae themselves, is displaced. The fibrous ring located around the nucleus is not damaged and delays the displacement of the intervertebral disc relative to the normal anatomical location. Diagnosing pathology at the stage of protrusion is difficult, because It most often does not manifest itself in any way and has unexpressed symptoms.

Elena Malysheva and the doctors of the “Live Healthy!” program will tell you more about the formation of the disease in the video:

Doctors believe that the main condition for the occurrence of protrusion is that the disc is dehydrated, its anatomically correct structure is disrupted due to a lack of oxygen and nutrients. This is due to the fact that the cartilage tissue located between the vertebrae is nourished by diffusion through the surrounding tissues, because it lacks a network of blood vessels. To ensure the necessary level of metabolism and support the normal structure of the cartilage tissue of the disc, it is extremely important to regularly maintain a comfortable level of physical activity and eat a balanced diet. If there are unfavorable factors that affect the intervertebral disc, its elasticity decreases, resulting in a decrease in shock absorption functions, and the subsequent progression of destructive processes in its tissues. First, a protrusion is formed, its progression leads to the formation of disc herniation l4 l5.

The following unfavorable conditions can be identified that lead to the development of pathology.

• Osteochondrosis of the spinal column.
• Poor posture. (read more)
• Hip dysplasia.
• Insufficient physical activity.

Poor posture

• Excessive regular static and dynamic physical activity associated with professional conditions.
• Unbalanced approach to nutrition.
• Traumatic injuries of the spinal column.
• Hypothermia, infection.

The occurrence of a hernia in the lumbar region is also due to increased axial overstrain of this part of the spinal column during physical activity and during rest. If a person sharply turns his body, bends deeply, lifts heavy objects, and he already has the prerequisites for the development of degenerative-dystrophic changes in the spine, then any of these actions can provoke a violation of the membrane of the fibrous ring, a change in the position of the nucleus pulposus.

Signs of pathology

The manifestation of pathology is detected in the process of progression of protrusion, if a person periodically experiences aching pain in the lumbar spine, which significantly intensifies during physical activity. But full symptoms appear when a hernia forms, which puts pressure on the nerve endings of the spinal cord. Pathological disorders are characterized by pain, increased tone of the back muscles, impaired sensitivity and limited mobility.

Signs of intervertebral hernia:

• Shots, .
• Swelling of the tissue on the affected part of the back.
• Radiation of pain from the back to the buttock and the entire surface of the lower extremities.
• The formation of a compacted area of ​​muscles in the area of ​​the l4 l5 hernia due to the need for their increased tone in order to maintain the spinal column in a normal anatomical position.

• Changes in the sensitivity of the legs to external stimuli.
• Dryness, local decrease in temperature of the skin of the lower extremities, excessive sweating of the feet.
• Feeling of burning, numbness, tingling over the entire surface of the leg: from the buttock to the foot.
• Lasègue's symptom. If a person lies on his back and tries to lift his leg without bending the knee, then he experiences pain in the lumbar spine. The pain subsides when the patient bends the leg.
• Diffuse paramedian and median disc herniation l4 l5 is determined by pain radiating to the legs, their numbness, and the inability to straighten or bend the foot.

When palpating the lumbar region of the back, a person experiences discomfort. If you have such symptoms, you should go to the hospital to diagnose a herniated disc. For this purpose, studies such as x-rays, MRI, and myelography are prescribed.

Types of hernias

There are several types of intervertebral hernias. There are foraminal (paraforaminal), dorsal, sequestered and other types of disc hernias l4 l5.

1. In foraminal disc herniation, damage to the fibrous ring is caused by stenosis of the intervertebral space due to swelling, directed towards the anterior surface of the spinal column. Lumbodynia syndrome is observed at the site of the hernia. It is also called an anterior hernia.
2. characterized by prolapse of the nucleus into the spinal canal, which puts pressure on the nerve roots of the spinal cord. It is the most common and most dangerous due to its very close location to the spinal cord. Causes muscle weakness, tenderness of the lower extremities, sexual dysfunction, and disturbances in the waste of urine and feces. With paramedian disc herniation l4 l5, the prolapse is localized on the right or left side of the spine. Intense lumbodynia occurs at the site of the lesion, which radiates to the leg.
3. develops directly inside the vertebrae, symptoms are not expressed.

Formation of intervertebral hernia

1. With a subligamentous hernia, a segment of the disc falls out between the lower back and the sacrum.
2. Based on the location of occurrence, the hernia is determined to be posterior, posterolateral, median, left-sided or right-sided.
3. With a free hernia, part of the nucleus falls out through the surface of the fibrous ring, maintaining connection with the disc.
4. If protrusion of the nucleus pulposus occurs due to high physical stress, and stops at rest, then such a hernia is called moving.

Treatment

Treatment of the pathology is selected in accordance with where the prolapsed part is directed, the type of hernia, and its size. Computer or magnetic resonance imaging helps in their precise determination.

Hernia size	Basic recommendations and treatment methods	Hospitalization
Less than 5 mm	A specially selected complex of physical therapy. Spinal column traction.	Not required
From 5 to 8 mm	Drug therapy. Massage courses. Physiotherapeutic procedures. Physiotherapy.	Not shown
From 8 to 12 mm	In the non-acute period: drug correction, massage, physiotherapy, gymnastics.	Required during periods of exacerbation. It is necessary to ensure complete rest until the acute pain stops. Surgical intervention in situations where there are clear signs of compression of the spinal cord, the functions of the genitourinary system are impaired, and motor dysfunction occurs.
Over 12 mm	Immediate surgical intervention to remove the hernia.	Necessary.

Therapeutic correction

In the treatment of l4 l5 disc herniation during an exacerbation, it is extremely important to reduce the load on the sore area. For this purpose, the patient is recommended to undergo strict bed rest for several days. Then, to relieve pain, drug therapy is prescribed, which includes the use of the following groups of drugs of varying costs:

• Painkillers – “Analgin”, “Baralgin”, etc.
• – “Ibuprofen”, “Diclofenac”, etc.
• Muscle relaxants - Baclofen, Diazapam, etc.
• Chondroprotectors - “Rumalon”, “Structrum”, etc. (the list of chondroprotectors can be found by clicking on the link)
• In more severe cases, glucocorticoids are prescribed to reduce pain.

Exercises for the treatment of hernias and protrusions of the lumbar disc. Watch the video below:

After the pain reaction is stopped, the following treatment methods are added.

• Constant use of a special restraining corset. In the first few weeks it must always be worn, then, if necessary, lift heavy objects and engage in physical labor.
• Physiotherapeutic treatment: UV irradiation, electrophoresis, magnetic therapy.
• Massage courses.
• Physiotherapy.
• Swimming.
• Traction of the spinal column without applying a load, which partially makes it possible to restore nutrition to the intervertebral discs and reduce compression on the nerve endings as a result of increasing the intervertebral space.

Treatment with leeches for diseases of the lumbar spine

Unconventional correction methods help to cope with the disease.

• Hirudotherapy is treatment using leeches.
• Injections of ozone preparations into areas of the body susceptible to pathology - ozone therapy.
• Homeosiniatry is the effect of homeopathy on biologically active points through injections.

Treatment of intervertebral hernia with folk remedies is not recommended in order to avoid undesirable consequences.

Physiotherapy

Much attention is given to physical therapy in the treatment of intervertebral hernia L4 L5. Specially selected exercises help relieve muscle tension in the back and strengthen the muscle corset. However, it is not recommended to perform the exercises on your own, so as not to aggravate the problem. It is necessary that the correct execution of the complex be monitored by a doctor-instructor. The main condition is to eliminate vertical load on the spinal column. Exercises should be performed lying on a horizontal straight surface or on specialized exercise machines with an inclined base. Exercises that strengthen the abdominal and back muscles are recommended: bending over, push-ups, abdominal exercises.

Operation

In the most difficult situations, surgery is necessary to treat a herniated L4 L5 disc. There is now a trend towards the practice of minimally invasive surgical procedures.

• The most effective methods are considered to be microdiscotomy and microlaminectomy: in these cases, the surrounding tissues are minimally damaged.
• Endoscopy - the intervention is carried out using specialized equipment, without using large incisions on the human body.

Microsurgical removal of intervertebral disc pathology in the lumbar region:

• Replacement of a damaged area of ​​an intervertebral disc with an implant – implantation.
• Nucleoplasty is a method in which impulses are applied to the nucleus pulposus of the disc, evaporating it, which leads to a reduction in the hernia and the release of the compressed nerve ending.

The surgical option for treating a herniated disc can quickly relieve pain and relieve nerve roots from compression; however, there remains a high level of probability of recurrence of the pathology, because the root cause of the protrusion is not eliminated.

A herniated disc l4 l5 requires early diagnosis, as well as comprehensive, timely treatment. In this case, it is possible to restore the damage without allowing the development of undesirable consequences.