Back pain: How and why disc herniation occurs

Up to 80% of people have back pain at least once in their life, while in 14% of people the pain lasted more than 2 weeks. These pains are a very frequent cause of medical treatment and absence from work.

Dr. Haxhi Avdyli,
Neurosurgeon
"Spinal Center"
Tel: 045856111, 044157129

Pain is reported in the young, but in the elderly, the pain is more intense. The most frequent causes are lifting weights and inappropriate positions in the workplace.

Since this disease affects many people, there are many different preparations and healing methods in the medical and pharmaceutical market, each case requires special treatment. Some use rest and bed rest, some traction, others heat or massage therapy, but also various gels and creams are used.

It should be known that in 90% of cases, back pain goes away by itself after 4 weeks, and only 5% of cases have pain for more than 3 months.

causes

Back pain can have causes that belong to two categories: Diseases of the musculoskeletal system and diseases of the spinal axis.

The first category includes pains caused by injuries to muscles, ligaments or back joints. The pains from this category are also increased by poor posture, poorly developed musculature, poor supply of this part with oxygen as a result of smoking and stress.

Musculoskeletal pains do not have a clear localization and are expressed by numbness and limitation of movements. Often these pains can increase during sitting and strenuous activities.

Leg pains and numbness are commonly known as "sciatica". These symptoms are reported due to muscle stiffness, inflammation of the joint coverings (bursitis). So, often, the pain caused by musculoskeletal diseases and disc herniations have similar symptoms.

Diseases of the spine - we have several spinal disorders that can cause back and leg pain, such as: disc herniation, spondylolisthesis, spinal stenosis, we also have rarer conditions, such as infections, tumors, spina bifida or fractures. These diseases are rarer than musculoskeletal ones.

Spondylolisthesis (spondylolisthesis) occurs when a ring slips forward from its place. This happens as a result of multiple minor injuries from injuries. This condition is diagnosed with a simple X-ray.

One of the frequent causes of back pain is disc herniation. But what is a herniated disc? Lumbar disc herniations most often occur at the L4/L5 and L5/S1 levels because these two levels are where the disc is subjected to pressure due to the mobility of the spine.

The most common symptoms of lumbar disc herniation can be pain along the leg as well as loss of sensation along the leg; depending on the level where the hernia has occurred, there is a sensitive change in the area from the compressed nerve. Likewise, the compression of the nerve root can cause a decrease in muscle strength, causing a weakening of the muscle strength of the sole and the whole leg.

How and why does a herniated disc occur?

Each ring is connected to each other with the interannular disk. The intervertebral disc is a cartilaginous plate that has ligaments on the side that hold the disc between the rings. The role of the disc is to enable the human spine to move in all directions. As a result of the various movements that a person makes during his work and life activities, the disc degeneration occurs, passing from a soft mass to a stronger mass.

Also, as a result of these degenerations, but also of any weight gain or any injury, it leads to the slipping of the disc, which in medical language is called disc herniation. The herniated disc moves towards the surrounding nerve structures where it can cause direct or indirect damage to the nerve elements or even the spinal cord.

The degree of damage caused by the disc depends on the level of the annulus, but also on the direction of the disc exit. This disc sometimes goes laterally where the nerve roots are located, causing severe pain in the lower back and legs. When the disc protrudes in the medial direction towards the spinal cord, then in addition to pain, it can also cause sensitivity and sphincter disorders. In this case, the patient has obstructions in urination and this is called cauda equina syndrome. In these cases, the indication for surgical intervention is urgent.

Lumbar spinal stenosis appears when we are dealing with narrowing of the spinal canal between the rings. This narrowing is due to inflammation of the inter-annular discs and appears more often in the elderly. These pains appear in the legs and are accompanied by numbness and weakening of muscle strength. These pains are more intense when walking and sitting. This condition is often referred to as neurogenic claudication.

Diagnosis

It is often difficult to find the real cause. Since many pains go away on their own, no medical treatment is required. When these pains are prolonged and do not go away even with the use of drugs, then further evaluation is recommended.

Prolonged pain can also be a consequence of inadequate treatment, depression, somatization - the transition of spiritual suffering to physical symptoms. Often patients also complain to benefit materially or for medical leave or disability insurance. When nerve root compression causes decreased muscle strength and weakening of muscle strength of the sole and the whole leg, then more careful evaluation is required.

When the disc affects the structures of the spinal cord, it can damage the sympathetic innervation causing disorder of urination and defecation. Erection and ejaculation disorders may also occur. This condition is known as cauda equina syndrome and requires urgent surgical intervention.

Healing

Medical treatment is required only when we are dealing with a serious injury because many symptoms go away on their own. It is good to find a suitable position that relieves the pain. Some people prefer standing on their backs, others on their sides.

If at the workplace there is no possibility for the back to find peace due to inappropriate positions, then it is recommended to rest at home until the pain subsides, weight lifting, sudden movements and inappropriate positions should be avoided.

If necessary, painkillers can also be used, which are numerous on the market. Non-steroidal anti-inflammatory analgesics are usually recommended, which in addition to the anti-pain effect also have the effect of soothing the inflammation. Muscle relaxants are preferred for one week only and go along with analgesics.

In the first days, it is recommended to keep cold cloths or ice for a duration of 15 minutes every 1-2 hours. Staying in bed for more than three days is not beneficial unless we are dealing with a severe herniated disc. The movement is difficult at first, but it is more than necessary. Movement helps to stretch the muscles and strengthen the muscles.

Even if you have been recommended to lie down, you can gradually increase the activity, provided that if the pain increases, you rest even more. You have to get away from sitting. While, after a week, a 20 min walk is preferred. every 3 hours lying down.

Exercises are recommended for patients who do not have acute pain and these exercises should be done in consultation with the physiatry specialist. For mild pain, all activities such as walking, swimming, low-intensity aerobics are preferred.

For low-intensity but prolonged pains, different massages are recommended, in many places acupuncture is also applied - Chinese therapy with small needles. There are patients who speak of benefit from it, but its action does not have a well-proven scientific basis. Even if it doesn't bring any great benefit, at least acupuncture doesn't hurt anywhere but the patient's pocket.

If the pain does not go away?

If the pain does not subside even with the use of analgesics, then a specialist should be consulted for this. When it is proven that we are dealing with disc herniation, then the recovery and rehabilitation of the patient is a complicated process. The goals of treatment are to reduce pain and prevent neurological sequelae.

After the onset of pain, bed rest and the start of drug therapy against pain are recommended. Physical therapy in the acute phase does not bring benefits. While in the stages of acute pain relief, physical rehabilitation has its beneficial importance.

The frequency of back pain has also increased the interest in the application of alternative medicine, where chiropractic is often mentioned. The potential benefits of manual manipulations are more due to pressure on the muscles.

Studies have shown that these manipulations bring only temporary benefit to the patient and have a high cost. These improvements are also a consequence of the longer stay and care for the patient, i.e. a placebo effect. Also, it is known that these manipulations are harmful for cases with sciatica symptoms, because they can cause further damage to the disc and nerves. There have been cases when they have caused injury to blood vessels and fractures, but also severe neck and brain damage. When this is added to the application of this compression practice by non-professional people, then the risk is even greater.

In addition to medical and physical treatment, in most cases when we have tumors or disc herniations proven by CT or magnetic resonance which matches the patient's condition, then the safest way of treatment is surgery.

When we are dealing with disc herniation which has migrated medially, causing sphincteric disorders, the so-called cauda equine syndrome, then the indication for surgical intervention is even more urgent, because any delay can leave an irreversible disorder in urination or defecation. The goal of the intervention is to remove the prolapsed disc and release the nerve root or the cord from compressive damage. 5-10%, in worldwide studies, may lead to recurrence of the hernia at the same or other vertebral levels

How to prevent the recurrence of back pain

It is important to maintain good muscle condition with regular physical activities and exercises. Avoid positions that are unpleasant for the back, such as bending over or lifting weights.

The exercise program should be started before the severe pains begin, which are often the result of work, and work stress and depression also play a role here. Walking upright and sitting in more suitable workplace seating can bring improvements.

Maintaining a normal body weight coupled with daily walking and light sports activities are the best prevention. /Telegraph/