Herniated lumbar disc is one of the most common causes of low back pain in clinic. Symptoms may be in the form of pain radiating to the leg, muscle spasm or cramps, sensory loss and muscle weakness in the leg. Sneezing, coughing and bending down usually aggravate the pain. According to the level of nerve compression, symptoms such as pain, burning, tingling, numbness may be felt in various regions, from the hip to the sole. Mostly, only one side is affected. The discs in the lumbar vertebrae are shock-absorbing pads made of durable fibers. Each disk consists of nucleus in the centre, known as the water-filled pouch, and a surrounding hard cartilage, in other words annulus, that functions as a protector. The nerve roots come out of their own narrow passages between the spine and the discs after they originate from the spinal cord. Thus, the pain and other symptoms develop with the compression of damaged (herniated) disc on the spinal cord or the mentioned nerve roots.
Herniated lumbar disc occurs as a result of annular tear or fissure (crack) by protrusion of gelformed substance that we call nucleus.
A lot of factors increase the risk of getting herniated lumbar disc. These major factors include:
⦁ Having wrong lifestyles that weaken the discs such as smoking, not doing regular exercise, improper diet (obesity) and staying up at night
⦁ Gradual depletion of disc’s fluid content with the natural biochemical changes occurring as a result of ageing and thus decrease in strength and flexibility
⦁ Actions that endamage the mechanism of low back such as wrong posture, wrong and over lifting weights.
Herniated lumbar disc develops as a result of wear and tear occurring when one or a few of these factors exist together. Although the herniation may occur suddenly, it may also arise gradually within weeks or months.
NON-SURGICAL TREATMENT FOR HERNIATED LUMBAR DISC
It is often possible to treat herniated lumbar disc without the need for surgery. Medical treatment and bed rest are the first things to do. It is possible to eliminate the compression on the nerves by bed rest. Cold application to the area within the first 24-48 hours of the complaints may be beneficial in terms of reducing oedema, muscle spasm and pain. However, ice should never be in direct contact with the skin, for example it should be applied by wrapping in a towel for 15 minutes maximum.
Various pain relievers and muscle relaxants can be used for medical treatment. However, they should never be taken without consulting to a physician. It should not be forgotten that the uncontrolled interruption of acute pain without diagnosis may lead to undesirable consequences as it prevents the patient from protecting himself/herself. Another treatment to be administered is physical therapy methods. Physiotherapy is intended to reduce pain, eliminate muscle spasm, increase flexibility. Cold and hot application treatments, massage techniques and stretching exercises are the examples for physical therapy methods.
Epidural injection may be of great benefit in patients who cannot be treated with the above mentioned treatment methods. This procedure is the injection of various medications to alleviate pain, oedema and inflammation by entering the needle into the area where the nerves are under compression. In this way, both complaints are relieved and the nerve compression in the area, where the herniation is located, is eliminated. In clinical practice, recovery can be obtained in 80% of patients treated with epidural injection.
A treatment method called Intradiscal Laser Therapy can be performed in patients who cannot be treated successfully with epidural injection or in patients with herniated disc in the form of broad-based protrusions detected at the first examination. In this way, it is aimed to apply high heat to the disk contents with the help of laser and to pull the herniation back by shrinking the disc from all sides to the centre and to block the nerves transmitting pain. Another method is to halt the enzymatic activities that cause degeneration in the disk and to administer Intradiscal Ozone Injections to remove these enzymes from the environment. They are administered in the same session with epidural injections in clinical practice.
Another treatment we have been practising for the treatment of low back pain in clinic in the recent year is stem cell therapy. It can be administered to prevent recurrence of herniation and to increase the durability of the disc contents and the protective annulus in patients whose leg
pain is cured by the methods described above. After the procedure, the effect begins to show up within 6-8 weeks. The procedure has no side effect.
All of the above-mentioned herniated lumbar disc treatments are the procedures that can be performed by hospitalization for a few hours and the patient is discharged on the same day.
An important point is that your doctor who carries out this procedure should absolutely have the Algology Diploma (Ministry of Health approved) and the Certificate of Competency Examination (Turkish Algology Association approved). You should absolutely ask your doctor about these.