What is a disc prolapse? It is the displacement of the disc nucleus, which is accompanied by fibrous ring breaking. A lumbar disc prolapse is the most common among spine diseases, it occurs in 90% of medical cases.
A cervical spine disc prolapse is slightly rare and a dorsal spine disc prolapse is the rarest. Treatment of a lumbar disc prolapse as treatment of a disc prolapse of the other parts of the spine usually is held by conservative methods, without surgery. Under such method of treatment more than half of patients get rid of disc prolapse symptoms almost completely already in a month and in a year up to 95 % of patients recover completely.
Previously people of middle age and people of hoary age suffered from such kind of diseases. Nowadays it turns out that disc prolapse becomes an “ageless”, even young people can suffer from this disease, although it is the most common for people older than 30 years.
What is it, a disc prolapse of lumbar spine?
As we have mentioned before, this type of a disc prolapse is the most common. The main ground for this disease is a specific functionality of this part of spine– it is the very part which bears the biggest load directed on intervertebral discs.
Discs in this part of spine are relatively higher (in comparison with discs in other parts of a spine). And very often this specialty is a reason for such phenomenon as a prolapsed intervertebral disc. There is one more factor – narrowness and weakness of a longitudinal ligament, which cannot prevent a vertebral disc prolapse formation only because of its anatomic features.
Such unpleasant diagnosis as a lumbar disc prolapse is suspected if the following symptoms appear: intense pain in the lumbar part of spine, which can spread to the gluteal region; pains which spread to side or back surfaces of legs and radiate to toes; reduction or disappearance of Achilles and knee reflexes. In severe cases, there may start disorder in pelvic organs functioning; in this case it is almost always necessary to carry out surgery.
Manifestations and causes of the disease
The following factors can provoke a lumbar spine prolapse: not only too passive (sedentary way of life, low quantity of physical exercises), but also active lifestyle of a person (professional sportsmen, people, whose job involves heavy physical activity.
The point is that an intervertebral disc takes nutrient materials not from its own net of blood vessels (simply, there are not any blood vessels in a disc), but by means of diffusion process. That is the reason why physical activity should be proportioned – if there is lack of physical activity, supply of nutrition materials to the disc will be disturbed, in the result of this the disc will start to lose its strength, and this in its turn will lead to different pathological processes, to degenerative and dystrophic disc diseases, among them a slipped disc is the most widely spread.
A developed slipped disc will inform about itself by the following symptoms:
- local pains, which become stronger, when in motion;
- pains, which can spread to gluteal region, and also to side or back surfaces of a hip;
- innervation occurs very often in the «area of engagement» of compressed root;
- there may happen disturbance of sensibility (decrease or increase) of legs;
- Disorder may happen in pelvic organs functioning.
Conservative treatment – could it be efficient?
Treatment of a lumbar disc prolapse usually is held by means of conservative methods; in the majority of cases it is quite sufficient. The research has shown that more than 70 % of patients during 12 weeks of treatment have significant improvement of their state and they can do without surgery. If to take into consideration more prolonged period of time, then more than 90% of patients overcome their disease.
Conservative treatment set the priority for pain syndrome removal in acute period of disease, and when it is removed – to prevent a disease recurrence.
Almost always in acute period of disease a bed regime is prescribed for a patient for several first days together with anodyne and nonsteroid anti – inflammatory medicines. In some cases neuromuscular relaxant can be prescribed only by a doctor. It is not a rare practice when medical blockings are used, but such practice is not approved by all doctors; it is deemed that injection made, adds additional irritation, and as a result they prevent fast recovery. In any case treatment and certain medicines are prescribed by a doctor on the ground of run diagnostics and analysed symptoms.
When the pain syndrome is removed, quantity of applied medicines decrease, and the main attention is paid for movement therapy, massages, and physiotherapeutic procedures. The main task is to improve the state of muscles corset and ligamentous apparatus. Conservative treatment itself presumes, that in the future a person will take care of his/her spine individually, that is to avoid dangerous movements; will change to some extend his/her movement stereotype; will regularly do exercises of movement therapy on his/her own.
Surgery is as a last resort treatable.
Surgical measure is considered to be a last resort treatable. It is applied only in those cases, when during a long period of time it is not possible to cope with pain syndrome removal, and the disease has a bad influence on internal organs functioning (and it happens very often with patients ill on a lumbar spine prolapse).
Earlier for treatment of such diseases a classical surgery was applied, which assume creation of quite big trepanation hole. Prolapse was removed successfully, but damage of muscles led to their disability to restore, and in its turn it led to regular disease recurrences. That is exactly why surgical methods with assume a maximum possible reduce of surgical injury.
Nowadays a „gold standard” of surgery is microdiscectomy for lumbar spine prolapse treatment. Essentially, that is a neurosurgery operation, which is held under very strong optical zoom with the help of eye loupe or operational microscope. By means of it, necessary section reduces considerably (up to 3-4 cm), accordingly a risk of recurrences and after operational complications become minimum.
Also endoscopic removal of a slipped disc gains a big popularity, thus this is quite new trend and that is the reason why it is seriously criticised compared with other methods. This method has its own advantages and disadvantages. On the one hand the size of section is this case is minimum (up to 2,5 cm), and as a result risk of recurrences and complications is minimal; a patient can walk on the next day after operation, and leave hospital for home in 3-4 days. On the other hand, this method has certain restrictions which depend on location and size of a slipped disc.