Disc protrusion of the lumbar spine

introduction

The intervertebral disc bulge (Disc protrusion) is a degenerative, so wear-related, Disease of the spine. As the name suggests, an intervertebral disc protrudes into the spinal canal. This can result in compression of Nerve fibers or even Portions of the spinal cord lead what mostly strong pain or even neurological symptoms has the consequence.

The disc protrusion is also often called incomplete herniated disc designated. In contrast to a complete herniated disc (Prolapse), however, the fiber ring of the intervertebral disc does not tear. There is therapy for this disease tedious, but in most cases leads to Freedom from complaints. A surgical procedure will only be Rare performed.

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

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.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

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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• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

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Further information about myself can be found at Dr. Nicolas Gumpert

Symptoms

In many ways, a protruding disc can be considered a Prepress or one mild form of a herniated disc (Prolapse) to be viewed as. Their symptoms are similar to those of a mild disc prolapse. However, it should also be noted that there are many cases of intervertebral disc protrusion completely symptom-free are or just with slight discomfort accompanied. You will then (if any) often discovered only as an incidental finding during the investigation of another disease.

If a bulging disc becomes noticeable, it usually happens with it quite severe pain. Depending on the height of the spine at which the protrusion occurs, different nerve fibers can be damaged, so that the pain is shown in characteristic body regions. As with other parts of the spine, this can be done on the one hand Back pain be. Especially for the lumbar spine (Lumbar spine) are however Pain in the buttocks, the Legs and Feet, but especially in front and side thighs, as well as on Back of the foot, typical.

Besides that you can neurological symptoms occur in the named body regions. This is what counts above all non-painful discomfort (Paresthesia) and Numbness to the classic symptoms of a bulging disc. These discomforts can present themselves in very different ways. Often a tingle, „Ant running“Or itch described.
If the disease is more severe, it can ultimately also motor disorders with a Feeling weak and faster exhaustion of the leg muscles come.

All of these symptoms can increase or decrease in intensity depending on the current posture. Often described, for example, is an aggravation of the symptoms when the patient is bent over.

Pain

A bulging disc in the lumbar spine is often completely painless. Even if pain suddenly occurs, there has often been a painless intervertebral disc bulge for many years. If the bulge forms very quickly, however, it can be accompanied by severe pain. In particular, if the intervertebral disc bulges in the direction of the spinal canal and presses on the nerve fibers, this can lead to severe discomfort.

The pain itself is called dull pain in the hollow of the lower back described. It is deeply seated and can flare up and sting even with slight movement. Unfortunately, there are often symptoms along the exiting nerves of the lumbar spine. This can result in pain from the spine, over the buttocks, down to the legs, feet and toes.

It is of enormous importance for therapy Reduce dull lumbar pain with pain relievers. Only through movement and targeted muscle strengthening can the protruding discs of the lumbar spine be controlled in the long term. Until this point is reached, pain-free movement of the spine must be enabled with the help of pain relievers.

causes

Although intervertebral disc bulges can occur at any level of the spine, the lumbar spine is by far the most frequently affected. Most of the time the protrusion is at the level of the intervertebral disc between lumbar vertebrae 4 and 5, so just below the iliac crests. The simple reason for this is that the largest body weight rests on this section of the spine and the strongest leverage, for example when lifting heavy loads, is at work. Another factor that promotes the development of a prolapse is normal age-related wear and tear added.

However, other factors are believed to be the primary cause of disc protrusion. Which includes genetic weaknesses of the intervertebral disc structures, unilateral burdens The spine or one poorly developed back muscles. This view is confirmed by the rapidly increasing number of intervertebral disc protrusions and incidents in our time characterized by a lack of exercise and office work.
At the same time, studies have shown that Obesity From a BMI of 27.5 or higher, the risk of suffering from intervertebral disc disease doubles. In addition, there is often a Accident or injury-related cause Disc disease discussed. However, this has not yet been confirmed.

diagnosis

An initial suspected diagnosis is usually based on the clinical symptoms in combination with positive clinical tests, such as weakened reflexes of the lower extremities. The final diagnosis of a protruding disc in the lumbar spine is then made using a Magnetic resonance imaging of the spine (MRI) posed. Also in one CT a herniated disc is usually clearly visible.

What to do?

If the diagnosis of intervertebral disc protrusion has been made, appropriate therapy should be started as soon as possible to prevent the disease from progressing. This should be done with the attending physician Therapy plan worked out and the next treatment steps discussed.

Contrary to the need for bed rest and physical rest, it is still important to have a certain physical activity to be maintained provided there are no neurological symptoms (Paresthesia, muscle weakness) occur. Otherwise there is a risk of getting into a vicious circle inactivity, Muscle breakdown and Intensification of symptoms to guess.
To enable pain-free movement, you should not stop taking Painkiller be waived. Painkillers from the so-called group are particularly suitable for long-term use NSAIDsto which example Ibuprofen, Diclofenac and Naproxen (Dolormin®) counting.

Even if exercise is beneficial for the therapy of a protruding disc of the lumbar spine, it should heavy physical exertion yet avoided become. It is equally important to have a healthy posture in everyday life to pay attention.

Conservative therapy of the lumbar disc protrusion

The treatment of an intervertebral disc bulge is conservative in almost all cases non-operational. If this is applied consistently, it is a in almost all patients symptom-free life possible without serious restrictions in everyday life. In addition to the basic behavioral strategy described above as a result of the diagnosis of an intervertebral disc bulge, the main thing is to play physical therapy and Back school plays an important role, as the spine can be relieved significantly by strong back muscles.
In some cases, you can also use further pain and relaxation therapy Massages, Heat treatments or Acupuncture be helpful.

If the protrusion is severe, wearing a supportive corsets be necessary. Likewise, if other pain therapies are not sufficient, the Injections of local anesthetics or cortisol bring an improvement in the symptoms.

Exercises for the protruding discs of the lumbar spine

While pain relievers can alleviate the symptoms of disc protrusion, they still do not address the cause. An important component in the therapy of protruding discs is therefore that Training the core muscles, but especially the so-called autochthonous back muscles, which are particularly important for the stability of the spine. A whole range of exercises and sports are suitable for this.
A very classic example of training the back muscles of the lumbar spine is the so-called "bridge". In this, the buttocks are repeatedly raised in the supine position, but the back maintains a straight posture.

When training the core muscles, it is important not to neglect any muscle group. In the course of exercises for the back muscles, the Abdominal muscles be trained with. It is best to discuss the exact execution and selection of certain exercises with your doctor or physiotherapist.

Please also read our page Spine training

When is an operation necessary?

Surgery is one for the bulging disc very rare and often unpopular therapy alternative. The protruding intervertebral discs of the lumbar spine can be treated successfully in most cases with conservative therapy that is targeted and disciplined to strengthen the back. However, even for the approximately 10% of those affected who do not benefit from conservative therapy, operations are often not useful.

Since the intervertebral disc protrusion is not a crack in the intervertebral disc, unlike a herniated disc, they are Possibilities in an operation are severely limited. Modern surgical procedures allow the intervertebral disc tissue to be pushed back and removed with just a small cannula. However, it turns out that the The ratio between the risk of the operation and the benefit for the intervertebral disc is very low. An operation is almost never necessary for the protruding intervertebral discs of the lumbar spine.

Surgery of the protruding disc of the lumbar spine

Disc protrusions will only be Rare treated surgically. In a good 9 out of 10 patients, the conservative treatment described above leads to an improvement in the symptoms, often even to freedom from symptoms. Surgery is usually only considered when it should neurological failuressuch as signs of paralysis, so there is a risk of serious nerve damage.
The Benefit-risk factor an OP can be assessed well. Above all, it should be borne in mind that a surgical procedure always entails various risks. For example, it can be too Complications come during anesthesia or wound healing. In some cases, even a Worsening of symptoms occur after an operation.

Exercise with a bulging disc in the lumbar spine

After the diagnosis of a bulging disc, the question arises for many patients whether and to what extent they can or should continue to exercise. It can be clearly stated that exercise is actually one important part of the treatment of intervertebral disc protrusions. Sport is therefore urgently recommended for the treatment of the protruding intervertebral discs, as the disease often arises as a result of inactivity, overweight and muscle weakness. The primary goal of sporting exercises should be that Strengthen your back muscles without overloading your back. It is also important that there is no pain when exercising, as this in turn can lead to incorrect loads. If the pain is initially severe, you should slowly start building up your sport.

This can be done on the one hand targeted strength and movement exerciseshappened around in a gym.

Also the Sports play a role in the protruding discs of the lumbar spine. In order to strengthen the back and avoid unnecessary strain, some sports should be preferred to others.

Sports that train the core muscles, improve posture and coordination and are gentle on the joints are highly recommended. Above all, this includes endurance sports such as swim (but here especially backstroke and crawl), hike and also Play table tennis. Strength training is another gentle and strength-enhancing activity. Sports that involve jumping must first be handled with caution. These include above all Skiing or basketball. Since the limitations of the intervertebral disc bulge, however very individual can also represent sports such as To dance, To go biking or Ball sports be perceived as pleasant and helpful.

Also read our page Exercise after and after a herniated disc

Forecast and duration

The The duration depends strongly on the extent of the protruding intervertebral disc, of the Conducting disciplined therapy, the personal risk factors and the accompanying pain. With immediate control of the risk factors, targeted muscle building and a slightly straight intervertebral disc bulge, the disease can be quickly brought under control. Just few weeks can relieve the symptoms here. The Disease control and prevention other disc disease however, last for life.

The duration is different in more severe cases of intervertebral disc protrusion. If there is already great pressure on the nerves, the fibrous ring of the intervertebral disc is already damaged and inactivity and obesity also occur, the duration can be delayed. In such cases, the symptoms can be chronic for a few months. A subsequent herniated disc is also not uncommon.

Duration of treatment of a protruding disc in the lumbar spine

Treating a bulging disc is one lengthy affair and is influenced by a number of factors. Depending on the severity and exact location of the disease, the symptoms can be of very different duration. In addition to the degree of protrusion, the main influence is how disciplined the treatment and training plan is followed by the patient.
Despite appropriate treatment, a bulging disc of the lumbar spine can develop into one Herniated disc of the lumbar spine develop. However, this is rarely the case.