Of the 33 vertebrae that make up our spine, five of them form the backbone. Some discs distribute the load between the bones and provide movement. The intervertebral discs consist of a jelly-like core and hard elastic fibers around them. Over time, the discs wear out and their walls become unstable due to aging, excess weight, smoking, long periods of inactivity, and strain. A herniated disc occurs when the wall of the worn disc is torn and the pulp-like core enters these tears. Hernia in the lower back occurs mostly in the lower levels where movement and loading are more, namely in the L4-L5 and L5-S1 discs.
If the protrusion formed by the degenerated disc compresses the nerve root going to the leg, low back and leg pain occurs. In addition to pain, the patient may complain of numbness, tingling, weakness, and thinning in the legs.
Most patients with herniated disc (lumbar disc herniation) are between the ages of 30-50. The main complaint is pain in the back and legs. Patients often state that their pre-existing mild low back pain increases with a strain and descends to their legs. Pain increases with coughing, sneezing, straining, and lower back movements. While many patients have difficulty in standing upright, some of them state that the pain increases more when they sit.
MRI is used for diagnosis. According to MR images, a herniated disc is classified from mild to severe bulging, protrusion, extrusion, and sequestered disc. There may not always be a complete agreement between the herniated disc symptoms and examination findings and the MR images. In one patient, a small hernia may cause unbearable pain, while in another patient, although the hernia is large, little pain may be felt.
Treatment of lumbar disc hernias can be grouped under two headings: conservative (non-surgical) and surgical.
Most of the cases respond positively to conservative treatment. Recovery has been reported in 75-90% or even more of patients. It is the most rational way to start conservative treatment first, to monitor the patient closely, and to decide according to the course of the disease and the result of the treatment, not rushing for surgical treatment. Bed rest should be kept very short (2-4 days). To increase muscle strength, exercises for the back and abdominal muscles should be started. The patient is asked not to lift heavy loads, to sit upright, and to keep his body upright by crouching while taking something from the ground. Pain relievers and muscle relaxants can be added to the treatment. A waist corset may be recommended while standing. During this period, the patient is taken to the physical therapy program. Stunning results can be obtained with epidural ozone injection made from the coccyx in both acute and chronic periods. In addition, dry needling, prolotherapy, and ozonated PRP and CGF can be applied in the treatment of herniated discs.
If there is no response to conservative treatment, surgical treatment is recommended.