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Herniated Intervertebral Disc L5 S1

Protrusion of the l5 s1 disc brings a lot of trouble to the sick. It is characterized by an asymptomatic initial stage and the development of dangerous complications. For the disease there is no specific age. She is subject to both the elderly and the young. Timely diagnosis will eliminate the cause and prescribe treatment of the pathological process.

Protrusion of the l5 s1 disc is a disease that concerns the lumbar spine. One (fourth) lumbar and one (first) sacral vertebrae are affected. The pathological process develops due to the displacement of the fibrous ring due to the degenerative changes that have occurred. Due to the fact that the disease affects not only people in the age, but also young people, prevention is of particular relevance.

Causes of disease

The protrusion of the intervertebral disk l5 s1 becomes a consequence of various pathologies. This condition does not occur suddenly, developing over a long time. The s1 segment of the protrusion of the disc which occurs quite often is affected in the case of the development of the following diseases:

  • Osteochondrosis,
  • Osteoporosis,
  • Kyphosis,
  • Scoliosis,
  • Injuries
  • Pathologies leading to the destruction of cartilage tissue

In addition to the main reasons, there are risk factors, which include:

  • Elderly age,
  • Severe hypothermia
  • The presence of bad habits
  • Lack of necessary activity,
  • Power failure for a long time,
  • Frequent stressful situations.

Protrusion stages

The protrusion of the l5 s1 disc, like any pathological process, goes through several stages in its development. Among them are:

  • The initial period when small cracks appear on the fibrous ring. They cause a qualitative change in the structure of the disk. The patient feels soreness in the lumbar region,
  • The second stage - the intervertebral disc begins to move strongly to the side. The distance may be about 3 mm. A protrusion appears - protrusion of the disk core of the disk in the region of the spinal canal. The pain radiates, the discomfort in the lumbar region increases. In the second stage, it is possible to get rid of the disease without surgery, since a more conservative treatment is effective,
  • The third period is characterized by a rupture of the fibrous ring due to an increase in displacement. The result of this is the development of an intervertebral hernia. The soreness increases, sometimes getting intolerable.

At the beginning of the development of the disease does not manifest itself characteristic signs. Ill perceives the erased symptoms for fatigue or other diseases.

This process manifests itself after the transition to the second stage, when the manifestations become more extensive:

  • Soreness increases, which may radiate to the back of the head, arms, intercostal space,
  • There is constraint in movement,
  • There is a periodic lack of sensitivity of the fingers,
  • There is a headache, which becomes more intense when a person moves,
  • Blood pressure drops occur, even if it was previously normal.

What will help identify pathology?

The disease, such as the protrusion of the l5 s1 disc due to the worn out symptoms at the beginning of its occurrence, is often confused with other pathologies of the spinal column. Methods that will help to make a correct diagnosis are:

  • Palpation, during which reveal a protrusion of the disk,
  • Radiography,
  • Ultrasound procedure,
  • Magnetic resonance imaging.

In some cases, the disease is detected too late. The result is a surgical intervention, and in some cases the development of complications.

What is dangerous disease?

The danger of the disease is manifested in the consequences that it can cause. The most common among them are:

  • The rapid involvement in the process of nerve roots, often occurs during median protrusion,
  • Infringement of nerve fibers on the sides of the fifth lumbar and first sacral vertebra (because of this, manifestations increase, significantly worsening human health),
  • Jamming of the nerve fiber complex, often resulting in disability.

Treatment methods

Protrusion of the l5 s1 disc must be treated. This will avoid the development of complications, among which the most serious is disability. In addition, timely treatment will significantly improve the quality of life, eliminating the constant pain and other manifestations of pathology. The process of therapeutic treatment includes several areas:

  • Taking medication,
  • Massage courses,
  • Acupuncture,
  • Manual therapy
  • Physical therapy exercises,
  • Reflexology.

In addition to the main methods of exposure, there are general recommendations, the observance of which is also mandatory. These include:

  • The exception of a strong load on the back,
  • Limiting stress factors
  • Quality food.

The list of medicines includes the use of:

  • Nonsteroidal anti-inflammatory drugs,
  • Analgesics,
  • Muscle relaxants
  • Vitamin and mineral complexes,
  • Immunostimulants.

At the stage of recovery after the main treatment, physiotherapy is performed. Among them, the most effective is to conduct:

  • Magnetic therapy,
  • Electrophoresis
  • Myostimulation.

These procedures improve blood circulation, metabolism and rapid recovery of the affected area. In particularly advanced cases, surgery is indicated.

An indication of this will be not only severe pain, but also the involvement of internal organs in the pathological process. Among effective methods of surgical intervention, hydroplastic, laser vaporization, microdiscectomy are distinguished.

  • Be sure to read: exercises with protrusion in the lower back

The protrusion of the l5 s1 disc creates many problems for its owner. Constant pain, including headaches, violate the usual way of life. The deterioration of health adversely affects the performance of professional duties, even if they are not associated with physical activity. Timely diagnosis and treatment will restore lost or impaired functions and significantly improve life in general.

Treatment of spinal osteochondrosis

Why crunches the spine?

Treatment of chondrosis of the cervical spine

Possible complications of the disease

By itself, the disease is easily treatable if the patient has come to the hospital on time. Another thing is when the hernial fallout has already gone through several stages and complications began to appear against the background of a rather simple illness. It is the complications that can get away with the indication for operating the patient.

For example, very often the patient has protrusion. This is the initial stage of a herniated disc, when the pulpal nucleus has shifted, but not the fibrous ring that holds it. At the same time the disk can be displaced on 6 mm.

Protrusion of the L5 S1 segment can have several varieties:

  1. Circular protrusion. In this case, the intervertebral disc is evenly expanding and expanding. This type is most common
  2. Median protrusion. Sometimes it is still confused with Schmorl's hernia. At the same time dumping is directed to the center of the spinal canal,
  3. Dorzalnaya. This word means the general name for such a stage of falling out, when it can pinch elements of the nervous system in the spine,
  4. Diffuse protrusion of the L5 S1 - when the disc is affected by more than 40%,
  5. Foraminal. The hernia falls out into the intervertebral canal and the fifth root in the lower back is injured
  6. Paramedian protrusion of the L5 S1 zone. Paramedian infringes the first nerve root of the sacrum and goes to the center of the spinal canal,
  7. Joint protrusion of L5 S1 and L4 L5. At the same time, two segments of the human spine are affected.

Protrusion of the L5 S1 segment requires an integrated approach to treatment. Operating, as a rule, has not yet become an urgent factor. But already at the next stage - extrusion - without surgery it can be difficult to return the normal functioning of the spine to a person. Although at this stage, the usual treatment is also shown. The most dangerous form of herniation - sequestered disc herniation L5 S1 - occurs when improper or late treatment of extrusion.

With sequestered formation, the nerve roots of the lumbar and sacral regions are impaired. It also affects the nerve fibers in the spinal canal, which is popularly called horsetail syndrome.

With regard to symptoms, at the first signs of the disease, the patient will feel local pain in the affected area, which over time will begin to give in the buttock. Pain will increase when moving or increasing the load.

With more infringement of the nerve roots, the pain will begin to spread to the leg and to the part of the thigh. The patient will feel a decrease in sensitivity where the squeezed root “responded”. Therefore, there may be numb moans or disappear corresponding reflexes. This is especially characteristic of dorsal disc herniation.

The median dorsal disc herniation is considered to be quite complex, because it squeezes particularly important nerve roots. The work of the pelvic organs may be disrupted, then paralysis of the lower extremities occurs. To avoid such risks, doctors prescribe an operation. The same happens when the formation is sequestered.

Ways to cure ailment

Treatment of a herniated disk L5 S1 occurs in two ways. Either lumbar disease is amenable to traditional treatment, or the patient is placed on an operating table. The median hernia of the L5 S1 disc, which is considered to be more complex, has the same treatment as the dorsal, paramedian, and any other variation of the hernial formation.

Traditional treatment involves starting as soon as a diagnosis has been made. As a rule, it helps with almost 70% of cases. Otherwise, if the treatment did not give good results, you will have to undergo additional examinations and get rid of the illness with the help of surgery.

The advantage of surgical treatment is the speed of recovery and removal of the hernia with all its attendant symptoms. In addition, it will allow to get rid of the disease instantly and for a long time, because conservative treatment implies treatment for several years. The disadvantages of the operation include the possibility of relapse, although this percentage is small and is associated with the individual characteristics of each person.

What is pathology

L5 s1 protrusion - is the output of the specified disk beyond the spine. At the same time the fibrous ring remains intact. If it ruptures, an intervertebral hernia appears. The protrusion may be different in size - from 1 to 5 mm. If it is not trapped, then the symptoms do not appear. For a long time, a person may not even be aware of the problem of the presence of the l5 s1 protrusion.

Most often, this pathology is a complication of osteochondrosis, in which the destruction of cartilage tissue, and then the vertebrae. The lumbar region suffers most often as it is under maximum load.


The protrusion of the l5 s1 disk does not arise by itself. Often the pathology is a consequence of poor lifestyle or delayed treatment of osteochondrosis. There are other reasons for the development of pathology:

  • Spinal deformity (congenital or acquired).
  • Back injury.
  • Changes in the vertebrae l4-l5 due to age-related degenerative processes.
  • Congenital pathology of the skeleton.
  • Osteoporosis.

  • Weak activity, constant sitting position.
  • Excessive physical exertion (loaders, athletes).
  • Too much weight.
  • Chronic diseases of the bones or muscle structures.
  • Circulatory disorders in the lumbar spine, as a result of which the vertebral discs do not receive adequate nutrition.

How is the bulge formed

The protrusion of the l4-l5 discs develops gradually. In this way, the disease goes through several stages:

  1. Microscopic cracks appear on the fibrous ring, however, it continues to remain intact. Protrusion is not observed yet. At this stage, the symptoms may not appear, although sometimes there are outbreaks of pain that pass by themselves in a short time.

The neuropathologist Ignatiev Radion Gennadievich will tell you more about the protrusions:

  1. A slight protrusion (1-2 mm) appears. At the same time the fibrous ring continues to collapse. The pain syndrome becomes long and for its relief, medications are already required. Physical activity of the patient is limited. Discomfort is felt not only in the l5-s1 disk area, but also spreads to other parts of the body.
  2. The third stage of protrusion is characterized by a rupture of the fibrous ring. The disc bulges even more. Pain syndrome becomes very intense, while it is not always possible to remove it with standard analgesics. If nothing is done at this stage, then the patient will have a hernia. If it is pinched, partial or complete paralysis of the lower limbs may occur.

It is not necessary to postpone the treatment of the disease indefinitely. It is better to reinsure yourself and get tested as soon as possible, especially if there is a genetic predisposition to diseases of the supporting system.

The question of surgery for osteochondrosis is decided on the basis of:

  • clinical picture
  • the presence (or absence) of the effect of the treatment,
  • existing complications.

The decision on surgical intervention takes a neurologist during a consultation (do you want to get a neurologist consultation for free?). If necessary, the neurologist directs you to consult a neurosurgeon.

Manifestations of your disease may be associated with various changes in the spine:

  • spondylolisthesis (displacement of the vertebrae),
  • marginal growths (spondylosis),
  • arthrosis intervertebral joints,
  • muscle protective tension
  • scoliosisdue to this protection

In addition, functional blockades and overloads of the motor segments of the spine are not visible in the photographs. Simply MRI data insufficient.
To the question "is it operable," can be answered - yes, operable. However, it is necessary to understand whether you need this operation and whether the manifestations of your disease (lumbar osteochondrosis) are associated with intervertebral hernia, or with other changes in the spine.

The changes that are visible in the pictures did not appear yesterday, they are many years old. All this time until lumbar osteochondrosis has been forming, your the spine has adapted to these loads.
It is important to understand what are functional reserves of the spine at this moment. If the pain is not associated with intervertebral hernia (and you may have several reasons for the pain in the pictures) - the operation will not have the expected effect.

The operation itself requires further rehabilitation. Therefore, the issues of individual treatment are solved only on internal consultation.

Lumbar osteochondrosis on MRI images
* Lumbar osteochondrosis on MRI images *

The question of the need for surgery for osteochondrosis is raised in the case of:

  • prolonged pain syndrome (more than 3 months)
  • inefficiency all treatments
  • availability of appropriate neurological symptoms.

Contact about surgery for osteochondrosis is necessary for a neurosurgeon.
You should understand that a neurosurgeon is operating specialist and is not engaged in conservative treatment of the spine and rehabilitation. By virtue of his activities, his thinking may be limited to surgery.

Begin by consulting a neurologist.. Look for a specialist - rehabilitologist specializing in conservative methods of treatment.

What is most important in the spine?

Between the vertebrae there are discs, which are cartilage in nature. The disc repeats the rounded shape of the articular surfaces of the adjacent vertebrae. The periphery of the disc is a multi-layered fibrous capsule, and the center is a gelatinous core. The central component of the disk is a gel-like substance. It smoothes the pressure on the vertebrae during exercise. In this case, the nucleus is flattened, and the fibrous ring of the intervertebral disc holds it. At the termination of pressure the gelatinous substance again gathers in the center. The thickness of the intervertebral "pillows" increases from top to bottom. The greatest height of the disk in the lumbar spine, then it decreases in the direction of the coccyx.

Disc protrusion L4 L5 - what is it? How is it determined?

It is a bulging disc beyond the intervertebral space. Most often occurs in the lumbar spine, because it carries the greatest burden. The most commonly affected disc is between L4 and L5. When exposed to damaging factors, the fibrous ring becomes thinner, microscopic fiber breaks occur. At the same time its integrity is preserved. When the degree of protrusion increases, the fibrous capsule breaks and the gelatinous substance escapes into the space between the vertebrae. This pathology is called intervertebral hernia.

Causes of protrusion

  1. Osteocondritis of the spine. Discs receive food diffusely from the upper and lower vertebrae. With osteochondrosis, metabolic processes and blood circulation in the spine are disturbed. Intervertebral "interlayers" lack nutrients, water, and lose their elasticity. Protrusion is the end result of osteochondrosis.
  2. Spinal injuries that can disrupt the structure of the discs.
  3. Excessive load on the spine. May occur during heavy lifting.
  4. Background diseases of the spine - ankylosing spondylitis, tuberculous spondylitis, osteomyelitis.
  5. Overweight.
  6. Hereditary diseases of the connective tissue.
  7. The weakness of the muscular system of the back.
  8. Violation of posture and curvature of the spine.
  9. Age changes.

The main types of intervertebral disc protrusion L4 L5

They differ in the nature and direction of protrusion.

  • Circular - there is a uniform protrusion of the gelatinous core around the entire circumference of the disk. The most frequent type of protrusion.
  • Posterior (dorsal) - protrusion occurs in the direction of the spinal canal. Often leads to serious neurological disorders.
  • Diffuse - is a posterior protrusion, but degenerative changes affect a small portion of the disc.
  • Median (Schmorl's hernia) - characterized by protrusion of the central part of the disc in the direction of the upstream or underlying vertebra.

Clinical manifestations of protrusion of the disk L4 L5

According to successive degenerative processes in the intervertebral disc, several stages of the disease are distinguished.

  • Stage 1 (initial) - is the result of spinal cord osteochondrosis running and not treated. Pain syndrome in the form of short-term flashes arising in the process of prolonged sitting position, during intense physical exertion, while lifting weights. The process is organic lumbar level.
  • Stage 2 - painful sensations become longer and spread to other parts of the spine, lower limbs, and groin area. This is due to more significant protrusion of the disc and compression of the roots of the spinal cord. Neurological disorders are manifested in the sense of numbness in the limb, weakness of the muscles of the thigh and lower leg.
  • Stage 3 The degree of stretching of the fibrous ring is maximal, the disc protrudes even more and causes serious disturbances in the nervous system. It is a condition bordering a herniated intervertebral disc. In general, everything is very serious.

What is the protrusion of the disk L4 L5? This is the borderline between the last stage of osteochondrosis and spinal hernia.


The disease can not manifest itself for a long time. First you need to understand the condition of the disc - protrusion or hernia. It is necessary to analyze the patient's complaints, find out the history of life (to focus on occupational hazards), the history of the disease (whether there is an osteochondrosis). Neurological examination is necessary to identify neurological symptoms.

Instrumental types of diagnostics:

Review spine radiograph

What helps to find out?

  • Curvature, which can cause protrusions.
  • The condition of the vertebrae and the degree of their damage.
  • Estimation of the distance between the vertebrae where the discs are located.

The method carries little information, because it is directed only to the bone structures of the spinal column.

MRI (magnetic resonance imaging)

Conduct and such a procedure. On MRI of the lumbosacral spine prices range from 2500-3000 thousand rubles. Pretty affordable. You can examine in detail the vertebrae L4 L5, where the protrusion of the gelatinous nucleus is located, and assess the integrity of the fibrous membrane. It is carried out in two projections and is the gold standard for protrusion diagnostics. Exhausts all questions when making a final diagnosis.

Where to do an MRI of the spine?

So. Where to do an MRI of the spine? Tomographs are found in almost every city. There are specialized diagnostic centers. If a person is from the district, he may contact the central district hospital or the regional clinic. MRI of the lumbosacral spine prices in each region are different. In some cities there are quotas. There, an MRI of the spine can be done for free. Minus - there is a record, you need to wait for your turn.

Disc protrusion treatment L4 L5

Doctors approach the treatment of the lumbosacral spine disease complex. Protrusion is well treatable at the initial stages of the process. The last stage of the development of pathology often has to be treated surgically.

Conservative methods

  1. Elimination of the causes and factors of the disease.
  2. Physical rest, with the exception of increased axial load on the spine.
  3. Wearing an orthopedic corset for the lower back.
  4. Elimination of pain. A group of nonsteroidal anti-inflammatory drugs (Nise, Ibuprofen) and non-narcotic analgesics (Tempalgin, Pentalgin) are used.
  5. Chondroprotective therapy (restoration of cartilage tissue). Apply an injection of chondroitin sulfate. The course of treatment is 25 injections, which are carried out every other day.
  6. The appointment of drugs that improve cerebral circulation ("Kavinton").
  7. Reception of vitamin and mineral complexes.
  8. Massage. Allows you to passively strengthen the muscular corset of the back, relax tense muscle areas, improve the local blood supply to the tissues. Performed by a specialized medical professional.
  9. Physiotherapy. Allowed when pain is eliminated. Must be a daily procedure. Developed individually for each patient by a rehabilitation doctor.
  10. Physiotherapy and manual therapy. Allow to improve local metabolic processes, remove tissue swelling, increase blood circulation and reduce pain. Courses are conducted after the main drug treatment and include methods: acupuncture, magnetic and laser effects.
  11. Hardware spinal traction, the need of which is determined by the doctor.

How to treat protrusion when the effect of conservative treatment is not long-term. What to do?

Surgical treatment of protrusions is rarely used (10% of cases). Apply minimally invasive techniques:

  1. Bone blockade. A non-narcotic analgesic is inserted into the spinal column to relieve signs of inflammation (swelling and pain). Achieved a steady improvement in well-being.
  2. Hydroplasty. It is the most effective and physiological method. Under the control of the X-ray apparatus, a liquid is injected, which washes away the destroyed part of the nucleus and fills the remaining water. Negative symptoms disappear almost immediately.
  3. Laser treatment. Effective in the early stages of protrusion, when the gel-like substance is not ossified. Based on the burning of the protruding part of the pulpal nucleus.
  4. Cold plasma nucleoplasty. Cold plasma is introduced into the gelatinous nucleus, part of the disk is evaporated. The pressure inside it drops, and this reduces the stretching of the fibrous membrane. Clinical manifestations disappear.

Prevention of disk protrusion L4 L5

Worry about the health of the spine should be from early childhood. You can not engage in self-treatment, which in most cases leads to a worsening of the pathological process. When pain in the spine should see a doctor and examined. In the early stages of the disease, they are successfully treated. The main thing:

  1. In time to detect and treat a violation of posture, fixed spinal curvature, osteochondrosis and other degenerative diseases of the osteo-articular apparatus.
  2. Eat food with sufficient calcium (cottage cheese, milk, cheese). To restore the structure of cartilage, products based on gelatin and agar are recommended: marmalade, jelly, fruit jelly, bone broth.
  3. Waiver of alcohol and smoking. These bad habits disrupt calcium metabolism in the body and lead to osteoporosis.
  4. Regular exercise. The trained muscles are a physiological corset for a waist.
  5. Engage in swimming, yoga, skiing, cycling.
  6. When lifting, evenly distribute the load on both hands.
  7. When sedentary work to arrange a small physical mini. Ensure yourself are properly seated at the table. Do not slouch back.
  8. Keep your weight is normal, because every extra kilogram additionally loads the spinal column.
  9. Use orthopedic mattress and pillow. The bed should be hard.
  10. Courses preventive massage.

What is the protrusion of the disk L4 L5? This is a serious disease that requires immediate treatment and an adequate rehabilitation program. The prognosis is favorable with timely treatment at the clinic and following the recommendations of the attending physician. Without specialized therapy, the disease will inevitably lead to intervertebral hernia, increased pain syndrome. Hernia pressure on the spinal cord and its roots can lead to the development of paresis and paralysis.

Some clinics of St. Petersburg

  • City Hospital №26,
  • Road Clinical Hospital of Russian Railways,
  • Alexander Hospital,
  • Leningrad Regional Clinical Hospital,
  • Medical Center "Admiralty Shipyards".

In Kaliningrad, for example, you can contact the Naval Clinical Hospital of the Baltic Fleet, although this is not the only medical institution where you can get such help.

Protrusion of the loin and sacrum

Bulging can occur in any sector of the spine, but the lower back and the sacrum are particularly susceptible to this pathology, since the design of the spine and the structure of the human body determine the presence of increased stress on this particular area. And although all the zones into which the spine is divided are interconnected, each of them has certain configuration features and a structure of segments.

By the way. The lumbar zone has the largest amount of stress that the human spine experiences during life. It is distinguished by larger vertebrae than the other zones. Here injuries occur most often and pathological processes occur, almost always affecting the neighboring sacral area.

Description and structure of the lumbar and sacral area

This area of ​​the spine is often called lumbosacral. Diseases that occur in the lower back are not localized only there, but spread to the sacrum. The most vulnerable is the junction of zones, namely - the transition of the vertebrae L5 and S1.

In the lumbar region, the spine includes five segments, labeled L1 - L5. They are larger than all the others, both in width and in height. At the junction with the sacral area there is a smooth bending of the vertebral arch.

By the way. The lumbar vertebrae are responsible for the depreciation capabilities of the vertebral arch, its ability to balance the pressure of the upper part on the lower part. Also, no movement associated with movement in space — from standing and walking slowly, to running and jumping — is complete without the participation of this sector.

The sacrum is considered to be made up of vertebrae conditionally. It also has five vertebral segments, labeled S1 - S5, but they are fused together and form a solid bone that connects the spine to the pelvis. The sacral area controls the condition of the entire skeletal system of the lower part of the human body.

Pathology features

What is this pathology, which is one of the most common? It is worth starting with the fact that its formation does not occur autonomously, but is a consequence of other pathological changes.

Important! With this condition, the intervertebral disc bulges, violating the external border of the vertebra, up to ½ centimeter. At the same time, fibrous ring tissues do not break, remaining intact within the given pathology dimensions.

All protrusions formed in different disks have different manifestations. The protrusion of L5 - S1 is most pronounced in terms of the strength of the pain. The pains are extremely strong, which are almost impossible to endure, they radiate to one or both lower limbs and the gluteal region. They can be considered the first sign of the disease.

Important! Patients tend to believe that this is not a dangerous disease, and it is enough just to stop the pain in order to remove the problem. But the occurrence of this pathology is only a step towards complications that can lead to the complete destruction of the disk or its irreversible deformation at the next stages.

It is possible to completely cure the protrusion not surgically, but only if the disease is captured at an early stage, is the therapy prescribed in a timely manner and performed without question.

Reasons for education

The primary cause of protrusions is considered to be degenerative-dystrophic changes that occur, as a rule, as a result of physiological aging. But apart from that, there are a number of equally popular reasons that contribute to the emergence of this state or aggravate it.

  1. Pathological changes in posture.
  2. Muscle weakness in the abdominal and back areas.
  3. Occurrence and development in the body of the infectious focus.
  4. Any developmental abnormalities that affect the spine.
  5. The “human factor” is unbearable loads that the patient systematically exposes himself to, for example, lifting weights.
  6. Genetic factor, due to which the articular cartilage is not sufficiently developed.

Stages of development

Like any disease, protrusions do not develop simultaneously. There are pathological stages that pass in stages.

Table. Stages of development of protrusions

Sometimes there is asymptomatic leakage, but usually the patient is already at this stage experiencing pains of paroxysmal properties, which go away on their own, without any medical intervention.

During this stage, the fibrous ring loses its elasticity. It is not subject to destruction, only microcracks occur on the surface.

Detection of violations in most cases occurs during a preventive medical examination or at the stage of diagnosing other diseases.

The main events of this period are the beginning of the displacement of the fibrous ring. It protrudes (due to which a disk protrusion occurs) while still insignificant, literally one or two millimeters.

If the initial stage of pain is localized, the second is characterized by migrating pain.

The complexity of the second stage is higher than the initial one, but in diagnosing the pathology at this stage, the disease is not considered dangerous and can be cured even without the use of drugs.

The exception is the protrusion of the vertebrae L4 -L5, during which the fibrous ring is displaced more quickly, can reach three millimeters and spreads in several directions at once.

Marked maximum protrusion, reaching five millimeters. An increase in pain to the intolerable, numbness of the lower parts of the body, the occurrence of an inflammatory process, which begins due to an increase in the pressure of the fibrous ring on nearby nerve endings, is added to the previous symptoms.

At this stage, complex therapy is needed, including medication, physiotherapy and corrective methods.

Pathology classification and symptoms by type

Yes, physiological processes associated with aging are a significant factor in the formation of vertebral protrusions. But in many cases, the process does not depend on the patient’s age or gender. The cause is a variety of pathologies.

By the way. In order to determine the exact therapy after identifying the disease, the doctor must find out the type of the disease and determine the cause that provoked its occurrence.

There are several types of pathology in the classification of protrusions that are considered the most common and dangerous. The most serious of these are dorsal protrusions.

With these types of disc nuclei, bulging, presses on the spinal canal, pinching its cavity and nearby nerve fibers. The offset is in the rear direction.

Dorsal protrusion

When dorsal protrusion is formed in the vertebrae L4 - L5, the disease has the following symptoms:

  • pain occurs in the lumbar belt, radiating to the hip joints, buttocks, throughout the entire leg or both,
  • there is stiffness of movement
  • lower parts of the body located below the loins,
  • ankles become numb, sometimes tingling of toes,
  • blood circulation is disturbed,
  • organs are destabilized, the activity of which is affected by pinching of nerve endings.

If the protrusion originated in the vertebrae L5 - S1, the signs will be as follows:

  • pain directly at the site of injury,
  • pain radiating to the intercostal space,
  • pain arising in the occipital region, in the whole head, especially when moving,
  • numbness of the shoulder girdle, hands, fingers,
  • sudden fluctuations in blood pressure.

By the way. Most of these signs are not specific and may be inherent in many other diseases that are not related to the spine. Some are caused by fatigue or viral illnesses. Therefore, the diagnosis of protrusions is often untimely, difficult, and the treatment of the wrong disease is observed.

Dorsal protrusion can be of several varieties.

  1. Foraminal view.
  2. Median view.
  3. Diffuse view.

The latter is different in that the disc bulges unevenly and in many places.

By the way. There is another kind of circular protrusion, in which any part of the spine is subject to expansion, and the entire spinal disc undergoes degenerative changes.

Since the main symptom that allows the patient to pay attention to an altered state and consult a doctor is a pain syndrome, pain relief is the primary need for treatment.

The pain is accompanied by cramps and muscle tension, which also needs to be removed.

If you want to know in more detail what a spinal protrusion is, as well as consider alternative methods of treatment, you can read an article about it on our portal.

Oral medications

Preparations are prescribed orally from the following list:

The list may be extended by prescription. And if the patient has problems with the gastrointestinal area or other contraindications to oral administration, medications can be prescribed rectally or parenterally.

Ointments and gels

Additional therapeutic agents that enhance the effect of taking nonsteroids are the following:

These are gel- and creamy substances that have an auxiliary external effect.

Muscle relaxants

To avoid the occurrence of muscle spasms, muscle relaxants are prescribed, which can be applied at any stage of protrusion development. They not only help relieve pain, but also make other auxiliary therapeutic methods, such as physiotherapy, manual therapy, and gymnastics, much more effective.

These include the following drugs:

Council When the disease is diagnosed in the acute period, it is necessary to limit the motor activity and bed rest for at least four days, and maybe a week or more.

When taking painkillers in parallel, you can wear, according to medical indications, an orthopedic belt. It is also necessary to comply with the conditions of sleep and lying down, which are expressed in the use of orthopedic mattresses, pillows and so on.

Corrective and fixing belts and other devices are worn only with a load (of any kind, both static and dynamic) and not more than four hours a day.

Council If the patient is experiencing an acute period of the disease, in no case should one lift weights, engage in any activity that takes place under conditions of vibration and tremor of the spinal column. It is also forbidden to be in a static pose for a long time.

At a certain stage of the removal of an acute condition, physiotherapy exercises can be started, but this is done only according to the testimony of a physician, in compliance with all the prescriptions and the correct execution of the prescribed exercises.

After the aggravation begins to decline, the pain will decrease, and the mobility will increase, you can go swimming, go to the exercise bike, walk, and perform more active physical exercises.

Treatment after removal of exacerbation

When the exacerbation period passes, the treatment does not end there. The destruction of pain, even if it has passed completely, does not mean the destruction of protrusions. They can get out again at any time, leading to a serious disc fallout. Therefore, after an exacerbation, basic therapy is always continued until a complete cure is determined.

Basic therapy

Post-aggravation therapy consists of several components of the complex:

  1. Medication correction.
  2. Power recovery.
  3. Removal of residual pain.
  4. Manual therapy
  5. Traction.
  6. Osteopathy.
  7. Massage.
  8. Reflexology.
  9. Gymnastics.


For the final elimination of the protrusions of the lumbosacral region, chondroprotectors are used. They act, thanks to glucosamine and chondroitin sulfate, as a regenerating agent for the tissues of the intervertebral disk. Preparations are most often combined, are available in tablet form, and in the form of ointments, that is, for external use.

The hondoprotectors group is as follows:

By the way. Internal and external preparations are not equivalent in impact, therefore the latter are used as auxiliary, in addition to tablets. Drugs can also be administered intramuscularly.

The nutrition of tissues is restored by a group of biogenic stimulants, which include aloe in the form of an extract and the vitreous body.

It also helps to restore the reception of vitamins, the main of which is vitamin B.

By the way. If the pain syndrome cannot be stopped by nonsteroidal drugs, corticosteroids or local anesthetics are prescribed, which are administered by the blockade method paravertebral.

As for manual therapy, osteopathic therapeutic methods, massage and other additional therapeutic measures, they can rightly be a complete substitute for drug therapy at the initial stage of protrusion, and are a mandatory addition to the treatment of the second and third stages.

Often, traction of the spine (traction), stretching of the vertebrae, which, by increasing the intervertebral distance, relieves the load on the disc, and thus reduces the pressure of the bulging disc on adjacent tissues, is used.

Massage is used special and as a supplement to physical therapy, a set of exercises that must be appointed.

Important! Complex exercise therapy, perhaps, is of paramount importance among all auxiliary therapeutic techniques. If the doctor accurately diagnoses the stage and correctly selects the exercises, correction of the pathology can be achieved without the use of medications and even more so without surgery.


If there is a need for surgical intervention, which according to statistics occurs at 10% of patients' visits and diagnosing lumbosacral protrusions of varying degrees, minimally invasive techniques are used.

Important! By surgical measures resorted, if the pain syndrome can not be removed for more than 16 weeks. Or if the protrusion stage threatens to move to the last stage, fraught with aggravation and irreversible degeneration of the disc.

The most commonly used percutaneous discectomy. Since the fibrous ring remains intact during protrusion, a cannula is inserted under the X-ray apparatus into the disk, which is a conductor for a laser or a cold plasma. Thus, a fragment of the pulpal nucleus is destroyed. This reduces the pressure inside the disk and prevents its further protrusion.

Protrusion of the discs of the loins and sacrum is a disease that can be dealt with at the first stage even without drugs. The main time to diagnose pathology. This requires periodic preventive examinations. A healthy lifestyle in general and moderate physical activity will keep the vertebral discs healthy for as long as possible.

Symptoms of pathology in the lower back

Spinal osteochondrosis L3, L4, L5 and S1 is a lumbosacral osteochondrosis. He has a lot of inherent symptoms.

When one or more of them appear, you should immediately consult a doctor:

  • When moving in the lumbar region, there is discomfort and stiffness.
  • Turning or leaning becomes difficult.
  • Excessive fatigue.
  • Trouble sleeping
  • Unstable emotional state, irritability.
  • Urination disorders
  • Heavy sweating.
  • Tingling in the lower limbs.
  • Men may have problems with erection.
  • For women characterized by failures in the menstrual cycle.
  • Phlebeurysm.

These symptoms may appear one at a time or several. In any case, the help of a doctor is necessary. If you do not start treatment in time, serious complications can develop:

  • malfunction of the urinary and reproductive systems,
  • kidney pain,
  • irritation of the sciatic nerve
  • disc protrusion,
  • intervertebral hernia ,
  • radiculitis,
  • lumbodynia - different in strength pain, affecting the lower back. May be acute, subacute and chronic.

How is the survey

Osteochondrosis of the L3, L4, L5, S1 segments can be identified in several ways:

  1. X-ray examination. It shows the state of not only the spine as a whole, but also of each individual vertebra. Gives indirect information about the condition of the disks and channels.
  2. Tomography. A more accurate diagnosis, which allows to reveal the compression of the nerve roots, rupture of the disk or rupture of the membranes.
  3. MRI Such an examination is shown in difficult situations.

According to the results of the examination, the doctor will prescribe treatment.

Causes of destruction of disc tissue

Spinal osteochondrosis L4, L5 and other segments of the lumbosacral spine occurs for many reasons. Most often it is excessive exercise.

At risk are people doing heavy labor, overweight and problems with posture.

Also here are those who lead a sedentary lifestyle. In addition to loads, there are other factors leading to the development of osteochondrosis L4-S1:

  • all kinds of back injuries
  • unbalanced diet, stress, improper metabolism, lack of daily regimen and good rest,
  • genetic predisposition.

Sometimes this disease is a complication of flatfoot, beriberi and other disorders.

Effective treatment

Treatment is prescribed only after the examination. What methods to treat, the doctor chooses. Treatment is of two types:

  • conservative
  • using surgery.

The operation is indicated only in difficult cases when complications have developed. Most often it is carried out by diskectomy, or removal of a damaged intervertebral disc.

Surgical intervention in the treatment of L4, L5, S1 and other segments is prescribed when conservative treatment does not produce results within six months.

Conservative treatment is of several types:

  1. Need to change your lifestyle. This includes the control of physical activity. You may have to reduce them, or, conversely, add physiotherapy exercises to the daily routine. All exercises should be discussed with the doctor beforehand. It is recommended to purchase an orthopedic mattress that will help to distribute the load.
  2. Sometimes it becomes necessary to treat osteochondrosis of L4-5, L5-S1 disks with drugs. They relieve pain and eliminate the inflammatory process. In most cases, these are analgesics, muscle relaxants, biogenic stimulants, etc. In some cases, hormone therapy is prescribed. Such treatment should be carried out strictly under the supervision of a physician. Self-medication is unacceptable.
  3. To relieve pain and relieve inflammation, you can use traditional medicine. Broths and tinctures of herbs and other medicinal plants are used for ingestion and for compresses and lotions.

In the treatment of osteochondrosis of intervertebral cartilage in the area of ​​L4-5, L5-S1 and others, you can use a special fixing corset. This is a product that helps keep the spine in the right position.

However, as many experts say, there is a danger in its use - over time, muscles can atrophy. Therefore, wearing a corset is necessary only in case of severe pain.

In addition to the above methods of treatment, spinal traction, acupuncture, hirudotherapy, massage and physiotherapy are used.

What is osteochondrosis of the lumbosacral spine? This is a gradual destruction of the disks.

The patient has weakness, stiffness of movement, pain, disturbances in the work of some organs and systems. In order not to develop complications, it is necessary to consult a doctor as soon as possible and begin treatment.

A selection of my useful materials on the health of the spine and joints, which I recommend you to look at:

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Denial of responsibility

The information in the articles is intended solely for general information and should not be used for self-diagnosis of health problems or for medical purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know exactly the cause of your health problem.

Watch the video: Back Pain: Lumbar Disc Injury (April 2020).