The human spine acts as a shock absorber. The anatomical structure of the spinal column allows you to soften the axial load on it. In some situations, pressure on the spine may increase. There are a number of professions in which the vertebrae experience stress all the time (driver, accountant, writer, athlete). The intervertebral layers can extend beyond the vertebrae, and this is called protrusion. Pathology is more common in the lumbar region. Disk protrusion L4 L5 - what is it?
What is the most important thing in the spine?
Between the vertebrae are discs that are cartilage in nature. The disk repeats the rounded shape of the articular surfaces of adjacent vertebrae. The periphery of the disc is a multilayer fibrous capsule, and the center isgelatinous nucleus. The central component of the disc is a gel-like substance. It smoothes the pressure on the vertebrae during the load. In this case, the nucleus is flattened, and the fibrous ring of the intervertebral disc holds it. When the pressure stops, the gelatinous substance collects again in the center. The thickness of the intervertebral "pillows" increases from top to bottom. The greatest height of the disc is in the lumbar region, then it decreases towards the coccyx.
Changes
L4 L5 disc protrusion - what is it? How is it determined?
Represents a protrusion of the disc beyond the intervertebral space. Most often occurs in the lumbar region, because it bears the greatest load. The disk between L4 and L5 is most commonly affected. Under the influence of damaging factors, the fibrous ring becomes thinner, microscopic ruptures of the fibers occur. At the same time, its integrity is preserved. When the degree of protrusion increases, the fibrous capsule ruptures and the gelatinous substance enters the space between the vertebrae. This pathology is called intervertebral hernia.
Causes of protrusion
- Osteochondrosis of the spine. The discs receive nutrition diffusely, from the above and below the vertebrae. With osteochondrosis, metabolic processes and blood circulation in the spine are disturbed. Intervertebral "layers" lack nutrients, water, and lose their elasticity. Protrusion is the end resultosteochondrosis.
- Injuries to the spine that can disrupt the structure of the discs.
- Excessive load on the spinal column. May occur when lifting weights suddenly.
- Background diseases of the spine - Bechterew's disease, tuberculous spondylitis, osteomyelitis.
- Overweight.
- Hereditary diseases of the connective tissue.
- Weakness of the muscular corset of the back.
- Bad posture and curvature of the spine.
- Age changes.
Main types of intervertebral disc protrusion L4 L5
Different in the nature and direction of the protrusion.
- Circular - there is a uniform protrusion of the nucleus pulposus around the entire circumference of the disc. The most common type of protrusion.
- Posterior (dorsal) - protrusion occurs towards the spinal canal. Often leads to serious neurological disorders.
- Diffuse - is a posterior type of protrusion, but degenerative changes affect a small area of the disc.
- Median (Schmorl's hernia) - characterized by protrusion of the central part of the disc towards the superior or underlying vertebra.
Clinical manifestations of disc protrusion L4 L5
According to the successive degenerative processes in the intervertebral disc, there are several stages of the disease.
- 1 stage (initial) - is the result of neglected and untreated osteochondrosis of the spine. Pain syndrome in the form of short-term outbreaks that occurs inthe process of a long sitting position, during intense physical exertion, when lifting weights. The process is limited to the level of the lumbar.
- 2 stage - pain becomes longer and spreads to other parts of the spine, lower limbs, inguinal region. This is due to a more significant protrusion of the disc and compression of the roots of the spinal cord. Neurological disorders are manifested in the form of a feeling of numbness of the limb, weakness of the muscles of the thigh and lower leg.
- 3 stage. The degree of stretching of the fibrous ring is maximum, the disk swells even more and causes serious disturbances in nerve nutrition. It is a condition bordering on a herniated disc. In general, everything is very serious.
What is disc protrusion L4 L5? This is a borderline condition between the last stage of osteochondrosis and a hernia of the spine.
Diagnosis
The disease may not manifest itself for a long time. First you need to understand the condition of the disk - protrusion or hernia. It is necessary to analyze the patient's complaints, find out the data of the anamnesis of life (focus on occupational hazards), the history of the disease (whether there is osteochondrosis). An examination by a neurologist is needed to identify neurological symptoms.
Instrumental types of diagnostics:
Plane radiograph of the spine
What helps you find out?
- Curvature that can cause protrusion.
- The condition of the vertebrae and their degreedamage.
- Estimate the distance between the vertebrae where the discs are.
The method carries little information, because it is aimed only at the bone structures of the column spine.
MRI (Magnetic Resonance Imaging)
Carry out such a procedure. For an MRI of the lumbosacral spine, prices range from 2500-3000 thousand rubles. Pretty affordable. You can examine in detail the vertebrae L4 L5, where the protrusion of the nucleus pulposus is located, and assess the integrity of the fibrous membrane. It is carried out in two projections and is the gold standard for diagnosing protrusions. Exhausts all questions when making a final diagnosis.
Where to get an MRI of the spine?
So. Where to get an MRI of the spine? Tomographs are located in almost every city. There are specialized diagnostic centers. If a person is from a district, he can go to the central district hospital or regional clinic. Prices for MRI of the lumbosacral spine are different in each region. Some cities have quotas. There you can get an MRI of the spine for free. Minus - there is a record, you need to wait in line.
Computed tomography
Used rarely, because it has a low degree of information content.
The results obtained help to choose the most optimal therapy. How to treat protrusion is decided by a neurologist or vertebrologist. Each of them has their own methods.
Treatment of disc protrusion L4 L5
Towards the treatment of lumbosacral diseasespine doctors approach comprehensively. Protrusion responds well to treatment in the initial stages of the process. The last stage in the development of pathology often has to be treated surgically.
Conservative methods
- Elimination of the causes and factors of the disease.
- Physical rest, exclusion of increased axial load on the spine.
- Wearing an orthopedic corset for the lower back.
- Elimination of pain syndrome. They use a group of non-steroidal anti-inflammatory drugs ("Nise", "Ibuprofen") and non-narcotic analgesics ("Tempalgin", "Pentalgin").
- Chondroprotective therapy (restoration of cartilage tissue). Apply injections of chondroitin sulfate. The course of treatment is 25 injections, which are carried out every other day.
- Prescribing drugs that improve cerebral circulation ("Cavinton").
- Reception of vitamin-mineral complexes.
- Massage. Allows you to passively strengthen the muscular corset of the back, relax tense areas of the muscles, improve local blood supply to tissues. Performed by a specialized he althcare professional.
- Therapeutic exercise. Allowed when the pain syndrome is eliminated. Should be a daily routine. It is developed individually for each patient by a rehabilitation doctor.
- Physiotherapy and manual therapy. They allow to improve local metabolic processes, relieve tissue swelling, activate blood circulation and reduce pain. Courses are held after the mainmedical treatment and include methods: acupuncture, magnetic and laser exposure.
- Hardware traction of the spine, the need for which is determined by the doctor.
How to treat protrusion when the effect of conservative treatment is not achieved for a long time. What to do?
Surgical treatment of protrusions is rarely used (10% of cases). Minimally invasive techniques are used:
- Bone blockade. A non-narcotic analgesic is injected into the spine, which relieves signs of inflammation (swelling and pain). A lasting improvement in well-being is achieved.
- Hydroplasty. It is the most effective and physiological method. Under the control of an x-ray machine, a liquid is injected, which washes out the destroyed part of the nucleus and fills the rest with water. Negative symptoms disappear almost immediately.
- Laser treatment. Effective in the early stages of protrusion, when the gel-like substance is not ossified. Based on the burning of the protruding part of the nucleus pulposus.
- Cold plasma nucleoplasty. Cold plasma is introduced into the nucleus pulposus, and part of the disk is evaporated. The pressure inside it drops, and this reduces the stretching of the fibrous membrane. Clinical manifestations disappear.
Prevention of disc protrusion L4 L5
Worrying about the he alth of the spine should be from early childhood. You can not self-medicate, which in most cases leads to an aggravation of the pathological process. If you have pain in the spine, you should see a doctor and be examined. In the early stages of the disease, they successfullyare being treated. Main:
- Timely detect and treat postural disorders, fixed curvature of the spine, osteochondrosis and other degenerative diseases of the osteoarticular apparatus.
- Eat foods with sufficient calcium content (cottage cheese, milk, cheese). To restore the structure of cartilage, products based on gelatin and agar are recommended: marmalade, jelly, fruit jelly, bone broth.
- Quit alcohol and smoking. These bad habits disrupt the body's calcium metabolism and lead to osteoporosis.
- Regular exercise. Trained muscles are a physiological corset for the lower back.
- Swimming, yoga, skiing, cycling.
- When lifting weights, evenly distribute the load on both hands.
- When sedentary work, arrange small physical exercises. Make sure you are properly seated at the table. Don't slouch your back.
- Keep your weight normal, because every extra kilogram additionally loads the spinal column.
- Use an orthopedic mattress and pillow. The bed should be hard.
- Courses of preventive massage.
What is disc protrusion L4 L5? This is a serious disease that requires immediate treatment and an adequate rehabilitation program. The prognosis is favorable with timely treatment to the clinic and the implementation of the recommendations of the attending physician. Without specialized therapy, the disease will inevitably lead to intervertebral hernia, increased pain. The pressure of the hernia on the spinal cord and its roots can lead todevelopment of paresis and paralysis.
