Summary: Protrusion of the L4-L5 disc takes on particular clinical significance in the narrow vertebral canal, but can cause severe pain even with a large balance of the dural sac. In diagnostics, MRI is used on a high-field apparatus.
disc protrusion L4-L5
What is the protrusion of the disk L4-L5?
The bulging of the disc between the 4th and 5th lumbar vertebra is called the L4-L5 protrusion.
The lumbar spine is an unusually complex structure. The vertebrae L4-L5 are the lower vertebrae of the lumbar spine and, together with the adjacent discs, joints, nerves and soft tissue, they perform many functions, including maintaining body weight and performing a wide range of movements.
However, due to the high load and flexibility range, the L4-L5 segment is also prone to traumatization and the development of degenerative changes, such as:
- L4 vertebrae can “slip off” and lie on top of L5 vertebra, squeezing the nerve root and causing pain in the lower back and / or leg (sciatica),
- The intervertebral disk L4-L5 wears out quickly and can “bulge out” outward, which in turn can cause pain in the leg (sciatica) and / or in the lumbar spine,
- two arcuate glands that attach to the vertebrae L4 and L5 on the back of the spine are also prone to overexertion and / or the development of spondylarthrosis,
- on the back of the L4-L5 segment, there is a nerve that comes from the spinal canal along the back of each leg. If the proteins of the inflammation of the disc come into contact with this nerve or something squeeze it, then the pain will spread along the course of the nerve (radiculopathy or sciatica).
The most common causes of pain due to lesions of the L4-L5 segment are:
- intervertebral protrusions or disc herniation L4-L5. Most often, protrusions and hernias occur in the L4-L5 and L5-S1 discs, since these discs are the most heavily loaded. Bulging can pinch the nerve roots and cause pain in the lower back and / or leg,
- osteochondrosis of the intervertebral disk L4-L5. Degenerative changes in the L4-L5 disc can also cause pain in the lumbar spine and / or sciatica.
- spondylolisthesis L4-L5. The weakness of the bones, joints, and ligaments of the spine can lead to the L4 vertebra “slipping” onto the L5 vertebra, which leads to compression of the nerve root and, as a result, pain in the leg and other symptoms.
In addition, some diseases of the lumbar spine can cover many vertebral segments, including L4-L5. Spinal stenosis, spondylosis and spondyloarthrosis are common causes of back pain in people over 60 years of age.
Symptoms of disk protrusion L4-L5
Pain may be the first manifestation of L4-L5 protrusion. You may feel pain in the lumbar region of the pelvis. It can increase if you press on the muscle near the spine at the site of nerve compression. It can also suddenly become more intense when sneezing and coughing. Daily activities that require a long sitting or lifting weights usually increase the pain symptoms. You may have trouble sleeping. The pain may radiate to the left or right leg, depending on the pinched nerve, to give to the thigh. If you pinch the L5 nerve, you may feel pain along the back of the thigh or along the front of the lower leg. You may also suffer from pain in both legs if the protrusion pinches the nerve roots on both sides of the spine.
Tingling and numbness
Nerves transmit signals from the skin to the brain. The compression of the disk can prevent it or cause the transmission of false signals. Protrusion of the L4-L5 disc may cause tingling or even numbness of the skin area innervated by the L5 nerve. Most often, these symptoms are observed in the upper part of the foot or between the big and second toes. Tingling or numbness may occur with a change of posture or be permanent. These symptoms tend to worsen with increasing pressure on the L5 nerve.
The brain sends impulses to the muscles of our body, causing them to contract. Compression of the L5 nerve as a result of protrusion can cause weakness in the muscles innervated by this nerve. You may notice that it has become harder for you to take your foot off the ground or lift your thumb. This weakness increases the risk of falling. Usually intervertebral protrusions do not give such symptoms, it is more characteristic of hernias, but there are cases when the protrusion is located in the anatomically narrow vertebral canal, and its behavior is comparable to that for large hernias. Deep tendon reflexes also indicate nerve compression. In a healthy person, when knocking the tendon with a hammer, the muscle contracts. By compressing the L5 nerve, the muscle response to a given stimulus can be reduced. This reflex is tested on the hamstring.
Some symptoms may indicate the presence of a more severe nerve compression - cauda equina syndrome. Usually horsetail syndrome is observed for large hernias, but can also be detected during protrusions in the narrow vertebral canal. This condition causes a sudden or progressive loss of control of urination and / or defecation, impotence, weakness of the legs and numbness in the perineal area. If you have similar symptoms - seek medical attention immediately.
Disc protrusion treatment L4-L5
Usually, conservative methods (spinal stretching, massages, reflexology, etc.) are suitable for the treatment of protrusion of L4-L5, and only in rare cases spinal surgery is necessary.
Article added to Yandex Webmaster 2016-03-22, 10:32.
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Stages of formation of intervertebral disc protrusion
It is customary to distinguish three stages of the formation of intervertebral disc protrusion:
At the initial stage, changes in the disc structure itself occur due to the formation of small cracks on the fibrous ring. At the same time it can collapse into 2/3 parts. At this time, the person begins to experience bouts of pain that is acute. They are localized in the lumbar region.
The second stage is characterized by the appearance of a protrusion of the disk, which reaches a size of 3 mm. Symptoms of the ongoing pathological process make themselves felt stronger. At the same time the place of localization of pain varies somewhat. She begins to give away in areas that are located next to the damaged disk. Despite the progression of the disease, a person has every chance to get rid of the existing problem and cure protrusion without surgery. To the aid of the patient will come medical correction and physical therapy complexes.
If there is no treatment, the disc continues to bulge more and more. Fibrous ring may occur at any time, leading to the formation of an intervertebral hernia. At this time, a person has severe pain, possibly the appearance of some neurological disorders. Until the formation of a hernia, they will be weakly expressed, for example, a person will experience a feeling of numbness of the limb on the side where the protrusion is located.
In some cases, pain may be absent altogether. Sometimes pains occur only after a person has a hernia, or even after the first complications.
Causes of disk protrusion formation
Disc protrusion l5 s1, l4 l5, as well as protrusion of other intervertebral discs develops due to a disease such as osteochondrosis. This pathology of the chronic course, which has a significant impact on the human spine. Disks gradually lose moisture, suffer from malnutrition, they are washed out of amino acids and essential trace elements. As a result, the disc becomes less elastic, flattens, and a certain part of it begins to bulge. In the future, it threatens to break the fibrous ring, the formation of a hernia and the development of serious health problems.
Back pains are the result of pinching nerve endings that are clamped by the protruding disc. In addition, protrusion contributes to the formation of edema and inflammation in the affected area. This, in turn, leads to the fact that pain radiates to the leg and buttock.
In addition to osteochondrosis, the cause of disc protrusion can be osteoporosis, as well as lordosis, kyphosis, scoliosis and various injuries of the spine.
Thus, we can distinguish the following set of factors that influence the formation of disk protrusion:
Malfunctions in metabolic processes.
Trauma and infectious diseases.
Excessive load on the spine.
Weak back and body muscles.
Diseases of the spinal column.
Sharp body bends, weight lifting, etc.
How is protrusion different from a herniated disc?
During protrusion of the intervertebral disc, the fibrous ring retains its integrity, and the pulpal core does not go beyond its limits. The hernia is characterized by the rupture of the fibrous ring with the exit of the pulposus nucleus.
Degenerative-dystrophic changes in the spine lead to the formation of protrusion of the l5 s1 and l4 l5 disk, as well as the formation of protrusions of other localizations. The disk is unable to normal depreciation, loses its former flexibility. Its tissues dry up, and cracks form on the fibrous ring. The distance between the vertebrae gradually decreases, the pressure on the disk increases, and it begins to bulge. The harder it comes out of the vertebrae, the more pressure on the nerve roots. Their compression is observed in the last stages of the development of the disease. As for the hernia, the compression of the nerve roots is present initially, and the painful sensations will be much stronger than during protrusion.
Quite often, people from such professions as drivers, writers, accountants, and salespeople suffer from disk protrusion. Although it is possible the development of the disease due to spinal injuries, which are often received by athletes.
Symptoms of disk protrusion of l5 s1 and l4 l5
Since, due to the formed protrusion, the nerve roots of the spine are squeezed, this leads to pain. Therefore, for this pathology is characterized by pain.
The pain will radiate to the leg or arm, to the back of the head or to the intercostal spaces - it all depends on where the protrusion formed. In addition, the muscles of the limbs suffer, their normal sensitivity is lost. Often, the sciatic nerves are involved in the pathological process, since they are located next to the damaged disks l5 s1 and l4 l5.
Common symptoms of protrusion are:
Numbness of the fingers, pain in the arm, pain in the shoulder,
Blood pressure jumps,
Since these symptoms are characteristic of many other diseases, most people simply do not pay attention to them. Moreover, they do not even correlate them with such a spinal pathology as protrusion. As a result, a person for many years can be treated for a variety of diseases, and the true cause of these symptoms is not clear. In the meantime, the protrusion will progress and develop into an intervertebral hernia with all its attendant complications.
Very often, a person begins to experience the first pains in the spine at a young age, after he has spent a long time in an uncomfortable position, or has experienced strong exertion. A disease can manifest when an incline is incorrectly performed, especially when this inclination was accompanied by weight lifting. After 24 hours, weakness, pain and numbness will appear in the lower extremities.
As for the protrusion of the l5 s1 and l4 l5 disc, it is characterized by pain in the lumbar region radiating to the leg and the gluteus maximus. Although disc protrusion is a widespread disease, it is completely treatable.
Treatment of disk protrusion l5 s1 and l4 l5
If the protrusion of the disc is not treated, the disease will progress rapidly and will turn into an intervertebral hernia. Protrusion often does not require surgery, but it is not always possible to get rid of a hernia without the help of a surgeon. Therefore, it is so important that when the first symptoms of pathology appear, seek the help of a specialist, and not engage in self-treatment. Moreover, such methods often cause irreparable harm to health.
Treatment of disc protrusion should be directed not only at eliminating the symptoms, but also at eliminating the causes that provoked its occurrence. That is, it is important to stop the degenerative-dystrophic changes occurring in the intervertebral disc. They, in turn, can manifest due to a disruption in the blood supply of the disc, due to a failure of metabolic processes in the body, due to frequent lifting of weights, etc. There may be a malfunction in the drive of the disc due to large body mass, due to muscle spasm and t dd
Conservative therapy is aimed at eliminating pain, and for this it is necessary to remove muscle spasms. It is possible to undergo physiotherapeutic procedures, visit a chiropractor and a massage therapist. Sometimes shown medical correction. However, to get rid of pain - it does not mean to get rid of the disease itself.
Disc protrusion treatment is based on physical therapy and physiotherapy. These methods allow you to strengthen the muscular frame of the back and "straighten" the existing protrusion into place. In this way, it will be possible not only to stop the progression of the disease, but also to recover from it. Only a doctor can prescribe adequate treatment. Independent attempts to get rid of protrusion can cause irreparable harm to health.
Education: In 2005, he completed an internship at the First Moscow State Medical University named after I. M. Sechenov and received a diploma in the specialty “Neurology”. In 2009, graduate school in the specialty "Nervous Diseases".
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How is protrusion of the l5 disc formed?
First, let's talk about how protrusion of the l5 disc is formed and what negative factors are the beginning of the destruction of the intervertebral disc. First of all, you should pay attention to a sedentary lifestyle.Intervertebral discs consist of structural cartilage tissue that does not have its own capillary circulatory network. They can receive the fluid and nutrients they need solely through diffuse exchange with the surrounding muscle fibers.
If the muscles do not work and do not fill up regularly with blood, the diffuse metabolism slows down. The cartilage fibers begin to lose fluid and become brittle and unable to withstand the cushioning load they are exposed to. This is the factor of the primary destruction of the cartilage disc in any form of osteochondrosis.
L5 disc protrusion can form in individuals with the following risk factors:
- overweight increases the load on the vertebral column and large joints of the lower extremities,
- passive lifestyle,
- violation of the regime and diet,
- insufficient use of clean drinking water during the day,
- heavy exercise on the lumbar spine,
- injuries and falls on your back,
- organic cartilage diseases.
With a long process of destruction of the intervertebral disc, sooner or later the fibrous ring breaks. An intervertebral hernia is formed. Often, it requires emergency surgical intervention. Therefore, it is important to notice the signs of protrusion of the L5 disc in order to seek medical help.
What is the protrusion of the l5 disc?
There are typical symptoms of the disease. Let us try to understand how protrusion of the l5 disc is manifested and which primary features should be paid close attention.
The classic symptoms are similar to the manifestation of osteochondrosis of the lumbar spine and include:
- pain, usually associated with physical exertion,
- pain may be dull and prolonged, acute, burning, radiating to the groin and anterior abdominal wall,
- skin sensitivity is disturbed in the zone for which the damaged radicular nerve is responsible,
- numbness of the lower limb may lead to the formation of a temporary gait disturbance,
- the curvature of the functional posture due to the muscle tension syndrome in the area of pathological changes,
- signs of an inflammatory reaction in the area of a damaged disc.
To diagnose it is enough to take a radiographic image. They will see the modified form of the disc and protrusion of its edges beyond the vertebral bodies. In controversial diagnostic cases, it is recommended to make an MRI or CT scan, which usually gives more effective images.
How to treat protrusion of the l5 disc using manual therapy?
Modern official medicine does not have the capacity for effective conservative treatment of such a disease as protrusion of the l5 disc. This is primarily due to the fact that there is no affordable way to transport the medicines used, since for this it is necessary to restore the disturbed diffuse feeding of cartilage tissue. And to do this without removing the deformation of the disk is impossible. Therefore, only symptomatic remedies are assigned, which remove the pain syndrome, and the patient is ready to return to performing his professional duties.
Meanwhile, osteochondrosis progresses and rather quickly the disease reaches the state of hernial protrusion. Do not bring up to this. It is necessary to begin effective treatment in a timely manner. Moreover, the patient has all the possibilities for this.
Based on our many years of experience working with thousands of patients suffering from protrusion in the lumbar spine, it can responsibly state that therapy is possible even at the stage of hernia formation. Naturally, it will be longer. But a positive result in the implementation of all recommendations is guaranteed.
Manual therapy allows stopping pain syndrome without using pharmacological agents in literally 2-3 sessions. For this, traction extension of the spine is used. As a result of the procedure, the height of the intervertebral disk increases, the compression pressure on the radicular nerves is eliminated, the recovery process is accelerated. Then osteopathy, reflexology, massage and therapeutic exercises are used.
After the course of treatment with manual therapy, patients under examination do not detect protrusion of the l5 disc and do not experience pain.
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The main stages of the formation of protrusion
There are three main stages of the formation of intervertebral disc protrusion.
At the first stage, small cracks appear in the fibrous ring, as a result of which the design of the disc itself changes. At this stage, approximately two-thirds of the area may be destroyed. At this stage, the disease may manifest itself in acute outbreaks of pain, which is local in nature.
Disc protrusion may manifest back pain
In the second stage, the actual protrusion of the disk begins, which can reach 2-3 mm. The pain changes its character, it becomes irradiating, while there is serious discomfort in the area of the damaged disk. This stage is quite early, so there is still an opportunity to cure protrusion in a non-invasive manner, and even without the use of medications. For this it will be enough to do physical therapy, change lifestyle, etc.
The third stage is accompanied by increased disc bulging. It precedes the immediate rupture of the fibrous ring, as a result of which the intervertebral hernia appears. This stage is accompanied by acute radiating pain and minor neuralgic disorders, such as numbness of the limbs.
It should be borne in mind that the protrusion of the disks does not always manifest itself as pain. The pain appears only when the protruding disc begins to put pressure on the nerve roots of the spine, this compression is the cause of the pain.
Causes of disc protrusion
The protrusion of intervertebral discs in general, and the protrusion of the intervertebral disk l5 s1 in particular, appears as a result of the development of osteochondrosis. Osteochondrosis, in turn, is a chronic disease that develops over a long period of time. As a result of this disease, the amount of fluid in the cavities of the discs decreases, a deficiency of amino acids and trace elements occurs. As a result, the elasticity of the disks decreases, they take a flat shape and begin to bulge. Over time, the fibrous ring breaks and a hernia of the intervertebral disc begins, resulting in a decrease in the distance between the vertebrae, and the disc dries out.
Intervertebral disc protrusion appears as a result of osteochondrosis
The occurrence of pain leads to pinching of the nerves, which occurs almost always with spinal hernia. The protruding hernia squeezes the nerve fibers, swelling and inflammation occurs. As a result, muscle spasm can occur, and pain can "give up" to the gluteal region or leg.
In addition to osteochondrosis itself, osteoporosis, spinal injuries, scoliosis, kyphosis and lordosis can lead to the occurrence of protrusion.
In general, we can distinguish the following causes of spinal protrusion:
- heredity, infections and injuries,
- bad posture
- metabolic disorders
- excessive load on the spine,
- insufficient development of the muscular frame of the back and trunk as a whole,
- spinal disorders
- age changes
- "Wrong" lifting weights, sharp bends with a turn, etc.
Differences of protrusion from herniated disc
The main difference is the fact that during protrusion the fibrous ring is not yet destroyed, and the pulpal nucleus remains within it. With a hernia, the fibrous ring is ruptured, and the pulpal nucleus simply flows beyond it.
Over time, the protrusion can go into vertebral hernia
The main reason for the occurrence of any possible protrusion (for example, the dorsal protrusion of the l5 s1 disk, which is one of the most common), are dystrophic processes occurring in the spine. As a result of these processes, the disk gradually loses its depreciation qualities, the disk fabrics dry up, as a result of which they lose flexibility. Due to the loss of flexibility in the fibrous ring, cracks begin to appear, the intervertebral gap gradually narrows, the pressure on the damaged disk grows, as a result of which it begins to bulge. The bulging of the disc leads to the pinching of the nerve endings, as a result of which the pain syndrome appears. It is worth noting that such a serious protrusion that can cause compression of the spinal nerve roots is possible only in the later stages of the development of the disease. And with a hernia of an intervertebral disk, the compression of the roots is initially, and the pain syndrome is much stronger.
Very often, the cause of the above processes in the spine are also occupational diseases. Also, sports injuries to the back can be the cause of pinching nerve endings.
Symptoms of the disease
Bulging of the disc, which results in a herniated disc, often results in compression of the nerve roots of the spines. Such compression of nerve endings leads to pain along the entire irritated nerve. Accordingly, the most noticeable symptom of these two diseases (protrusion and hernia) is pain.
The nature of pain in the case of protrusion depends on the place of its appearance.
The nature of the pain in the case of protrusion depends on the place of its appearance, so the pain can "give up" in the leg, arm, intercostal spaces, the back of the head. Often is the weakening of the muscles in the affected areas, which may be accompanied by impaired sensitivity. Such compression often affects the sciatic nerves by virtue of its anatomical location.
The most characteristic symptoms of protrusion of the intervertebral disc of the spine are:
The symptoms, as you can see, are not particularly unique, so people often blame them on other diseases or on ordinary fatigue, but they almost never think about possible problems with the spine. The result is that a person can be treated for years with completely different diagnoses, and the treatment will be useless, or the results will be unsatisfactory. And the real cause of pain - protrusion, will gradually progress, as a result, everything will come to a logical outcome - the formation of a herniated disc with all the ensuing consequences.
In this case, pain quite often occurs even in adolescence after relatively moderate physical exertion or prolonged stay in an uncomfortable position. Often the disease occurs with improper tilting, especially if it is performed while turning in combination with the lifting of a heavy load. After about a day, there is pain and weakness in one of the legs, a violation of the sensitivity of the limbs may occur.
Protrusion of the l5 s1 and l4 l5 discs is most characteristic of pain in the lumbar region, which can radiate to the leg or buttock. It is worth considering that the protrusion of the lumbar discs is one of the most common diseases of the spine in our time. Fortunately, it is completely curable, but only under the condition of timely diagnosis and treatment.
How to treat protrusion of the l4-l5 and l5-s1 disc?
Without proper treatment, protrusion of the disc quickly turns into an intervertebral hernia, which can no longer be ignored or ignored. In this case, the protrusion of the surgical intervention does not require, but in some scenarios of the development of an intervertebral hernia, it is necessary to contact the surgeon. So it is extremely important that when the first symptoms appear, immediately contact a competent specialist, and not try to get rid of the pain with “folk remedies”, which often do not cure, but do harm.
It should be borne in mind that the treatment of protrusion is a whole range of therapeutic measures that are designed not only to eliminate pain, but also to eliminate the causes of its occurrence. And the reasons are the very degenerative-dystrophic processes in the disks, which can be caused by impaired blood supply and metabolic processes in combination with unreasonably large loads. Such loads may be caused by muscle spasms, overweight, etc.
Conservative treatment of protrusion of the discs involves, first of all, the elimination of pain by eliminating muscle spasm. Massage, manual therapy, physiotherapeutic methods, and in some cases, medical methods can be used. But it should be noted that simply eliminating pain is not yet a complete treatment.
The basis for the treatment of such diseases are physiotherapy and therapeutic exercises. It is these methods that are called upon to “correct” the arisen protrusion by improving the state of the muscular backbone and ligamentous apparatus. This is how it is possible not only to stop the development of the disease, but also to completely cure a person. But it should be borne in mind that treatment should be prescribed by a qualified doctor, otherwise you risk only hastening the progression of the disease.
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