Disc protrusion of the lumbar spine

Introduction / anatomy

To understand what a (also Intervertebral disc bulge mentioned) Disc protrusion of the Lumbar spine (Lumbar spine) is and why it causes which symptoms, one should briefly consider how that Spine is constructed. Our spine forms the basic structure of the skeleton in our body and consists of neck-, chest- and Lumbar spine (Lumbar spine). It also protects what is inside of it Spinal cord. It has essential functions for a stable stance and has to withstand and distribute a large amount of strength every day.

Therefore, it does not consist only of bony ones Whirl but has elastic between the vertebrae Band washers. The total 23 Intervertebral discs take care of that Mobility and elasticity of the spine, including the lumbar spine, and consist of an inner, gelatinous core (Nucleus pulposus), supported by a stable fiber ring (Annulus fibrosus) is surrounded.
Immediately behind the intervertebral discs and vertebral bodies Spinal canal the spinal cord. Shortly after the beginning of the lumbar spine at the level of the lumbar vertebrae L1 / L2, the spinal cord itself stops, but there are still many large ones annoy out of it and continue downward in the spinal canal (Cauda equina).
The intervertebral disc protrusion of the lumbar spine describes the state in which one of the Cores an intervertebral disc backwards bulging and presses on parts of the spinal cord or central nerves. In contrast to the herniated disc, in which the outer fiber ring of the intervertebral disc is at least partially torn and the core has slipped relatively far back, the fiber ring is in the intervertebral disc protrusion intact.

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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

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Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Causes of a protruding disc

The reasons that lead to an intervertebral disc protrusion of the lumbar spine are similar in many ways to those of a person Herniated disc of the lumbar spine Triggers are. Most intervertebral disc protrusions happen in the lumbar spine, and there is a reason.
On the one hand, work especially with the wrong ones burden, for example when carrying heavy loads, the leverage and distribution of the load on worst on the lumbar spine. On the other hand, they are Vertebral bodies In comparison to other areas of the spine, structurally more at risk of permitting intervertebral disc protrusion in the lumbar spine area.
Especially when the intervertebral discs are structurally weakened, the risk is greater. The normal ability to bind water and thus to keep the intervertebral disc elastic takes with it increasing age from. In addition, the surrounding fibers become weaker and have to yield to the pressure of the core. The intervertebral disc protrusion of the lumbar spine is almost always one Improper loading in the context of incorrect movements or excessive stress. Carrying a box of water from your back is a classic. It is also possible after a jump with awkward landing to provoke a lumbar disc protrusion.
Unfamiliar, new stress, for example in the context of a new sport, can also trigger this. Besides the Stresses of the back must also be Training condition of the Back muscles be seen. If this is weakened or not adequately trained, as is particularly the case with tall people, everyday movements such as getting up in the morning or leaving the shower can lead to intervertebral disc protrusion in the lumbar spine.
There are also a few other, but quite rare, causes of intervertebral disc protrusion. These include innate Muscle weakness or structural defects of the spine. Individual cases of disc protrusion are caused by a inflammation of the intervertebral discs.

Which segments are affected?

Intervertebral disc bulges rarely occur at the Cervical spine on (see also: Disc protrusion of the cervical spine).
In the most common cases, however, the intervertebral discs of the lumbar spine are affected.

In the Disc protrusion of the lumbar spine are particularly often the intervertebral discs between the fourth and fifth vertebral bodies (L4 / L5), but also between the fifth lumbar vertebra and the first vertebra of the sacrum (L5 / S1)affected.
The lower lumbar region is also exposed to special stresses in everyday life, for example during sport, physical work and when bending over. Even before the intervertebral disc bulges and prolapses, these areas of the vertebra are particularly prone to pain.

Symptoms of a protruding disc in the lumbar spine

First of all, it must be said that there are a significant number of cases that no or just a lot moderate Trigger symptoms.
Here the extent of the protrusion is too small or it was preceded by a slow process in which the participants took part annoy could adapt. However, there are a number of typical symptoms of various kinds that suggest a disc protrusion in the lumbar spine area. Which of these are noticeable in each individual case depends heavily on the exact extent and height of the intervertebral disc protrusion.
The first thing the patient often notices is relatively severe pain in the area of ​​the affected spinal segment occur. This pain comes from the direct compression of nerve fibers conditions. A characteristic of the intervertebral disc protrusion at the level of the lumbar spine is that the pain continues to the areas that are supplied by the nerves, radiate. This includes the buttocks, legs, and even feet or toes. An occurrence especially in front and lateral thigh as well as lower leg and on the Back of the foot speak for the involvement of the lumbar spine.
In addition to the pain, you can also Paresthesia, so-called paresthesias, occur. The focus is not on the pain, but on it uncomfortable tingling sensation or the feeling of one asleep leg. However, this can also go so far that, because of the intervertebral disc protrusion of the lumbar spine in the affected segments no feeling has more. It is often described that these symptoms worsen with certain movements, especially when bending over or coughing and sneezing.
In addition to the sensitive complaints, there are usually more motor Disturbances added. Since the nerve fibers that supply the muscles are also affected, it can become too Feelings of weakness and faster exhaustion come in the legs and buttocks. This is often noticeable when climbing stairs.
However, one cannot directly equate the extent of the symptoms with the extent of the bulging disc. Finally, a typical symptom of a lumbar disc protrusion is this Weakening muscle reflexes like the well-known one Patellar tendon reflex, in which one briefly touches the tendon below the Kneecap beats. The assessment of the reflexes is especially important in diagnostics.

Basically, on the basis of the symptoms shown, it is not possible to differentiate between a bulging disc and a herniated disc, since the degree of compression on the nerves is decisive for the loss of function. Therefore, a bulging disc with high compression can cause significantly more symptoms than a herniated disc that does not touch any neurological structures.

• Symptoms of a herniated disc of the lumbar spine
  and
• Symptoms in the leg of a herniated disc in the lumbar spine

Diagnosis of disc protrusion of the lumbar spine

The diagnosis of disc protrusion is primarily based on the medical history and clinical examination. Imaging methods such as MRI of the lumbar spine are only added if there is a need for further clarification or if there is uncertainty.
At the beginning there is a targeted questioning of the patient. It is important to know when the pain first occurred and whether it was sudden, for example during a certain activity, or over time. The question of whether the pain worsens or weakens with certain movements is also standard.
Paresthesia or numbness can also be queried and tested. The extent of the symptoms plays a major role in assessing the location of the disc protrusion more precisely. For example, pain or tingling in the foot indicate a disorder of the lower lumbar spine, the groin is affected in the upper lumbar spine.
Some clinical-neurological tests follow. Muscle strength and reflexes are checked. In addition, various gait and standing attempts, if they turn out to be pathological, indicate an intervertebral disc protrusion of the lumbar spine. There is also the option of tapping the spine. With these simple measures, you can find out a lot that is worth knowing that helps in making the correct diagnosis.

Imaging methods are used to make a definitive diagnosis of intervertebral disc protrusion in the lumbar spine. The gold standard in this question is magnetic resonance imaging (MRI of the lumbar spine). This also makes it possible to differentiate between a disc protrusion and a herniated disc, which causes similar symptoms.
The MRI of the lumbar spine has established itself as the most valuable imaging method in recent years.
Computed tomography (CT) and x-rays can also help assess the bony parts of the spine and rule out other causes such as tumors and bone degeneration. It should be noted that an intervertebral disc protrusion often does not cause any discomfort and so other causes can be considered for any back pain, even if the MRI shows a disc protrusion.

Read more about this under our special topics:

• MRI of the lumbar spine
  and
• MRI for a herniated disc

therapy

The treatment of intervertebral disc protrusion in the lumbar spine area is very similar to that of a herniated disc and is in conservative measures and operational intervention to subdivide. In most cases, conservative measures should definitely be started, which can be adjusted according to the severity of the symptoms and the duration of the symptoms. At the beginning there is of course bed rest and the Avoiding stress like carrying and lifting heavy things. Also should be immediately Pain medication how Paracetamol, Novalgin or Diclofenac be taken to prevent or relieve tension in the lumbar spine caused by the pain.
If this is not enough, additional can Cortisone can be used, which can also be injected directly into the affected area over the intervertebral disc protrusion together with local anesthetics. This suppresses inflammation.
Find out more about the topic here: Cortisone therapy for a herniated disc

The freedom from pain or pain relief is so important because it is followed by strengthening exercises and physical therapy can be started. Strong back muscles in the lumbar spine and the correction of poor posture, e.g. in a so-called Back school, are the keys to healing a lumbar disc protrusion. Additionally can Massages make a major contribution to the regression of symptoms through a trained physiotherapist.
Whatever part of the treatment of disc protrusion is heat treatments. Alternatively, acupuncture can be used. In particularly severe cases it becomes a supportive corset prescribed to be worn 23 hours a day. Overall, it can be said that over 90% of patients With intervertebral disc protrusion, the lumbar spine can be healed by conservative measures or made painless.
With the rest 10% comes one surgery in question, which resets the bulging disc to its original position. Even if the operation is often successful, the symptoms can also worsen after the operation. In addition, there are the general risks of surgical intervention or anesthesia, as well as the special complications of interventions on the spine. Therefore, conservative therapy should almost always be fully exhausted first.
All in all, the prognosis for disc protrusion of the lumbar spine is good. Most patients become symptom-free again. It is important to preventively strengthen your back and optimize your posture.

Exercises for a protruding disc in the lumbar spine

To prevent Disc protrusions and Herniated discs is a Strengthening the back muscles absolutely necessary.Certain sports, targeted physiotherapy with special exercises and so-called "Back schools“Are part of the therapy for disc problems. Sports to build the Back muscles are especially jogging, swim, To go biking, gymnastics and To dance. One should rather avoid punch sports like golf and tennis or jumping and throwing disciplines in athletics.

For the Lumbar spine Exercises that stabilize and build up the core muscles are helpful. For example, you can lie on your stomach, stretch out all fours, and try to keep your arms and legs off the floor for as long as possible. Do this exercise several times in a row with short breaks.
You can also lie on your back with your arms flat next to you. To do this, they lift their legs and try from there to lift the pelvis off the floor and hold it for as long as possible.

All exercises can be designed individually according to personal preferences. Even after a short time, you should feel which exercises are particularly stressing and exercising the core muscles. If the exercises are painful, do not do them or talk to your doctor or physiotherapist beforehand.

Transition to the herniated disc

If the fiber ring tears and the gelatinous core of the intervertebral disc emerges, this is called a disc prolapse. It is a dreaded complication of disc protrusion.
The components of the intervertebral disc press in the spinal canal on the nerves running there, mostly in the area of ​​the Lumbar spine. Clinically, the herniated disc has persistent sharp pain that is aggravated by movement.

The so-called is characteristic Sciatic painthat extends from the buttocks to the leg. If you have good mobility and moderate pain, the following applies: No bed rest, but rather an early start of everyday movements. Here, too, the aforementioned regular exercises to strengthen the back muscles in the case of intervertebral disc protrusion are ideal. In the short term, pain reliever medications such as ibuprofen can be used to relieve symptoms. If there are additional symptoms such as numbness, loss of movement, paralysis or disturbances in the area of ​​elimination, you should urgently consult a doctor! This is a serious complication of a herniated disc with loss of nerve fibers that must be resolved by an operation as soon as possible

Please also read our topics:

• Herniated disc of the lumbar spine
  and
• Operation of a herniated disc in the lumbar spine