What Is Lumbar Hernia?
There are cartilaginous structures that counterpoise the load on the spine and enable the movement of spine between the vertebrae. These cartilaginous discs are surrounded by hard capsules that involve a dense nuclear structure similar to a paste. This structure is also preserved by the ligaments adhering to the vertebrae (connective tissue and muscles). Said structure can be imagined as a hydraulic pump.
If one of the capsules weakens and bulges towards the canal where there are nerves forming the posterior wall or if the capsule ruptures resulting in bulging of the nuclear material into the canal, the nerve roots preparing to exit from the spinal canal are compressed. The resultant severe pain that radiates from low-back to leg or knee is called lumbar hernia. The capsule or the nuclear material do not always compress the nerves due to bulging or rupture. In these cases, the patients suffer a severe low-back pain. This stage is defined as a pain that begins in the disc. Pain that develops in disc does not radiate to legs.
What are The Causes of Lumbar Hernia?
The most common causes include failure to do sports that involve abdomen and low-back exercises, excessive weight gain and carrying heavy objects.
What are The Symptoms of Lumbar Hernia?
The most common symptom is the pain that begins in low-back and radiates to hips, posterior parts of thigh and knee, lower leg and feet. In case of herniation in upper segment of the lumbar vertebra, the pain radiates from the posterior part of the thigh to the knee. Numbness develops in feet or lateral side of the leg. Numbness is also felt in inner part of the leg if the herniation is located in upper segment of the lumbar spine. Retraction in feet or weakness while bearing load on feet may be faced depending on the severity of compression on nerve root. In advanced stage lumbar hernia, gait pattern is affected as the patient cannot lockdown the knee or stabilize the pelvis.
What are The Lumbar Hernia Exercises?
It is important to do exercises that strengthen abdominal and back muscles, as they stabilize the lumbar vertebrae. One should avoid lumbar exercises throughout the painful period. A person with lumbar hernia attack may start passive lumbar exercises 45 days after the pain disappears, while active lumbar exercises can be started 3 months later. Starting the exercises before the disc capsule heals will cause relapse of the lumbar hernia.
When Should Lumbar Hernia be Suspected?
If the patient complains of a pain that radiates from the low back to leg or knee, lumbar hernia should be suspected.
How is Lumbar Hernia Diagnosed?
First diagnostic clue derives from medical history of the patient. Next, hernia can be easily made in the light of a physical examination. Most important diagnostic tool is MRI of the lumbar spine.
How is Lumbar Hernia Treated?
Physical examination is an important tool to guide the treatment. If the patient has strength loss, experiences difficulty in pulling the leg or cannot bear weight on the joint, an urgent surgery may be required. Conservative treatment applies to all patients, excluding severe pain. Bed rest, hot pack and medication treatment are prescribed. Medications include combinations of muscle relaxants, anti-inflammatory agents and analgesics. For patients without strength loss, nerve blocks can be performed by algology department. Exercise is avoided in acute phase and lumbar hot pack and similar treatment modalities alleviate the pain.
Surgical treatment is appropriate for patients who do not respond to the treatment within three weeks. The disc fragments that compress the nerve root are removed with microsurgical technique. Dynamic stabilization can be considered for patients who are suspected for recurrence.