A prolapsed disc – it is a disease when the vertebral pulp is dislocated through the formed in the fibrous ring breaking. It is worth mentioning that this disease does not appear during one day, a disc herniation forms prior to it (bulging without the fibrous ring breaking). But it is not a rare case when the disc herniation is forming without any symptoms manifestation; that is why the onset of a prolapsed disc is unexpected for a person.
More often this disease appears in the pelvic part of a spine, rarer it appears in the cervical part of the spine, and the rarest case it is when it appears in the thoracic part of the spine.
The pelvic part of the spine is the weak point of the spine
Why the pelvic part of the spine is the most common place for appearance of a prolapsed disc? The reasons are very simple. This particular part of the spine takes the maximum load; the body center of gravity is located in this particular part of the spine. At the same time, the spine in this part has quite large movement amplitude, and it is the most mobile.
Cases of disease, when l5 s1 prolapsed disc occurs, are more often, a little bit rare is l4 l5 prolapsed disc. These particular intervertebral discs take the maximum load; they do have any rest almost never. Even if a person lies down, they do not lose their load.
Very often we do not even think how large the load which the lumbar spine bears is. And often, without understanding it, we do our best, in order to make our disc to «capitulate». One lifting of load by “our back” is worth much. And we lift loads correctly very seldom.
Causes of the disease appearance
Causes of a prolapsed disc formation can be different, but in most cases it appears as a result of the degenerative disc disease. In the result of the current degenerative processes the nucleus pulposus starts to lose water, accordingly it loses its absorbing abilities. The fibrous ring also has no sufficient quantity of the nutrient materials, and as a result its structure starts to ruin. As far as the load on the spine does not decrease, and the nucleus pulposus has lost its absorbing abilities, it starts to press the walls of the ring, and in the result of this process a disc herniation is formed. If the disease has not been detected on this stage, then in some period of time the fibrous ring will break and a prolapsed disc will be formed.
Metabolic disorder contributes to the contraction of this disease, also it can be excessively active lifestyle (for example professional sportsmen), or too sedentary behavior (people with sedentary lifestyle and low level of movement activity). The problem is that an intervertebral disc does not have its own net of blood vessels and it takes all nutrients from the neighboring tissues with the help of diffusion. Under condition of absence of necessary load diffusion simply does not flow adequately; and the intervertebral disc is kept on «starvation diet».
As we have already mentioned, because of it the pelvic spine suffers above all things, and as a result we have prolapsed l4 l5 or l5 s1 discs.
Pain as the main symptom of a prolapsed disc
In common case the disease reveals itself by local pains in the affected region, which can become stronger when in motion. This pain can spread also to the gluteal region, it can “shoot up the leg”, spreading to the internal and external surfaces of the hip. Sensibility can be also disturbed in that part for which the pressed nervous root is “responsible”. So, very often there is numbness of the foot, reflexes of the leg can disappear (knee reflex and Achilles reflex), sensibility can increase or decrease. Such symptoms will appear almost always, for example, under dorsal l5 s1prolapsed disc.
Much worse the situation is, if you have to deal with diagnosis – l5 s1 «median back prolapsed disc”. The problem is that the prolapsed disc starts to press peculiarly on the spinal cord or to compress «horse tail», and in the result of this the pelvic organs functioning is disturbed seriously. Such cases of the disease can be treated only surgically.
The most unpleasant and dangerous form of this disease is a sequestrating prolapsed disc. In this case a part of the prolapsed disc is detached, and the symptoms of the disease often increase, pains become unbearable. Besides this, it is not rare, when a sequestrating prolapsed disc l4 l5 leads to the same results, as the above mentioned form, “horse tail” compression or compression of the spinal cord itself. Many doctors consider that this type of the prolapsed disc can be treated only surgically.
What kind of treatment should be applied?
At the beginning of treatment of this disease always conservative methods are applied. It should be mentioned that they are effective and sufficient in the overwhelming majority of cases. In particular more than 70% of patients experience serious improvement already in 12 weeks of treatment, and in half a year from the moment the treatment started more than 90% of patients recover. And only in rare cases it is necessary to apply surgical interference.
Conservative treatment starts at the moment when the precise diagnosis is established. First of all the patient is ordered to bed rest for several days, analgesics and anti-inflammatory nonsteroidal medicines are prescribed. Also neuromuscular relaxants can be prescribed, if the pain syndrome appears in the result of muscles spasms.
On this stage the conservative treatment is aimed at the pain syndrome arresting and inflammatory process removal. In the result of the inflammatory process removal, compression the nervous roots, is removed totally or decreases, and as a result the pain syndrome disappear.
After the pain syndrome is arrested, the main stress in treatment is made at physiotherapeutic procedure, massages and movement therapy. It is worth mentioning, that nowadays a lot of new methods of the prolapsed disc treatment appear; there are the following new methods: acupuncture, Shockwave therapy, laser therapy, etc. Unfortunately, not all offered methods make the declared influence, it happens very often when they are of no use at all, so, it is better to defer to your doctor’s opinion and to follow procedures prescribed by him/her.
And movement therapy is the key to your total recovery and restoration of your movement activity. Complex of physical exercises is performed with the aim to restore the ligamentous apparatus and the muscles corset, it gives an opportunity to stop the development of the disease and prevent recurrences or formation of this disease in some other intervertebral disc.
This type of treatment is the last-resort treatment; in the most cases doctors try to avoid it. Surgical interference is recommended only in that case, when during a long period of time it is not possible to arrest the pain syndrome, or the disease starts to affect seriously the internals functioning. It usually happens when the diagnosis «the prolapsed disc l5 s1» or “sequestrating prolapsed disc” is established.
Now development of the surgical methods of treatment is aimed at decreasing of the surgical trauma. The reason is that the injured during the surgical interference muscles do not have enough time to restore, metabolic process is disturbed, the muscles corset cannot perform its task to the full extend, and this leads to the formation of a new disease or recurrences of the old one.
That is why the microdiscectomy is widely used now, which is micro neurosurgical interference. It is performed using optical enlargement (by a binocular eye loupe or by a special microscope). In the result the trauma is very small, and the risk of recurrences is minimal.
The other method, which is widely popularized nowadays, is the endoscopy. When using an endoscope the trauma the least, but this method has its drawbacks. Particularly, there are serious limitations because of size and location of the prolapsed disc, if it is possible to remove with the help of this method.